[Pages H4528-H4535]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

PROTECTING SENIORS' ACCESS TO MEDICARE ACT OF 2015

Mr. RYAN of Wisconsin. Mr. Speaker, pursuant to House Resolution 319,
I call up the bill (H.R. 1190) to repeal the provisions of the Patient
Protection and Affordable Care Act providing for the Independent
Payment Advisory Board, and ask for its immediate consideration in the
House.
The Clerk read the title of the bill.
The SPEAKER pro tempore. Pursuant to House Resolution 319, the
amendment printed in part B of House Report 114-157 is adopted, and the
bill, as amended, is considered read.
The text of the bill, as amended, is as follows:

H.R. 1190

Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Protecting Seniors' Access
to Medicare Act of 2015''.

SEC. 2. REPEAL OF THE INDEPENDENT PAYMENT ADVISORY BOARD.

Effective as of the enactment of the Patient Protection and
Affordable Care Act (Public Law 111-148), sections 3403 and
10320 of such Act (including the amendments made by such
sections) are repealed, and any provision of law amended by
such sections is hereby restored as if such sections had not
been enacted into law.

SEC. 3. RESCINDING FUNDING AMOUNTS FOR PREVENTION AND PUBLIC
HEALTH FUND.

Section 4002(b) of the Patient Protection and Affordable
Care Act (42 U.S.C. 300u-11(b)) is amended--
(1) in paragraph (2), by striking ``2017'' and inserting
``2016'';
(2) in paragraph (5)--
(A) by striking ``2022'' and inserting ``2026''; and
(B) by redesignating such paragraph as paragraph (7); and
(3) by striking paragraphs (3) and (4) and inserting the
following:
``(3) for fiscal year 2017, $390,000,000;
``(4) for each of fiscal years 2018 and 2019, $487,000,000;
``(5) for each of fiscal years 2020 and 2021, $585,000,000;
``(6) for each of fiscal years 2022 through 2025,
$780,000,000; and''.

The SPEAKER pro tempore. The bill shall be debatable for 1 hour
equally divided and controlled by the chairs and ranking minority
members of the Committee on Ways and Means and the Committee on Energy
and Commerce.
The gentleman from Wisconsin (Mr. Ryan), the gentleman from Michigan
(Mr. Levin), the gentleman from Pennsylvania (Mr. Pitts), and the
gentleman from New Jersey (Mr. Pallone) each will control 15 minutes.
The Chair recognizes the gentleman from Wisconsin.

General Leave

Mr. RYAN of Wisconsin. Mr. Speaker, I ask unanimous consent that all
Members may have 5 legislative days within which to revise and extend
their remarks and include extraneous material on H.R. 1190, Protecting
Seniors' Access to Medicare Act of 2015, currently under consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Wisconsin?
There was no objection.
Mr. RYAN of Wisconsin. Mr. Speaker, I yield myself such time as I may
consume.
What we are bringing to the floor today is Dr. Roe's bill to repeal
the Independent Payment Advisory Board. This is a bill that came out of
the Committee on Ways and Means with a bipartisan vote. This is an
agency that Members on both sides of the aisle believe does not have
the right to exist, should not exist, and does not follow our
democratic process.
Let me explain why we are doing this. There is no greater example of
the conflict of visions than this. ObamaCare created something called
IPAB, the Independent Payment Advisory Board. It is a board of 15
people who are not elected or appointed.
They have the power to cut Medicare's payments for treatment. They
have a quota which they have to hit in order to find the same number to
actually cut. Every year, a formula kicks in, and the 15 unelected
bureaucrats

[[Page H4529]]

find where they are going to cut Medicare payments to providers to hit
that quota.
They can do all of this without Congress' approval. The idea, of
course, is that unelected bureaucrats know best, unelected bureaucrats
know better than patients, their doctors, or their representatives in
Congress; they will know which treatment works the best because they
are detached, they are distant, they are above the fray, they are not
involved in the emotions or the personal relationships that such
personal decisions like your health care ultimately involve.
That is the big problem. They are totally unaccountable. They are
divorced from reality. Health care is not a statistic. It is not a
formula. It is not uniform. It is not cookie cutter. It is personal. It
is individual. It is distinct.
Every patient is different. This is why patients, along with their
doctors, need to be put in charge of their health care. What IPAB would
essentially do is ration health care. It would take control away from
patients.
Now, the other side says, Hey, no, not so fast; Congress can override
them--but that is only with a supermajority vote.
Mr. Speaker, we have seen this movie before. It never ends well.
Seniors will suffer the consequences. Medicare is more than a program;
Medicare is a promise. Seniors have worked hard; they have paid their
taxes; they have planned on Medicare throughout all their working
lives, and now that they are retired, it is something that they
deserve, a secure retirement. It needs to be there, just like it has
been for our parents.
Think about what a Member of Congress will do. This Board of
unelected bureaucrats will say, We are cutting Medicare X, Y, and Z
ways to these providers for Medicare, which will deny services to
seniors; and they will do it according to this formula that is in law.
If Congress doesn't like it, then the law says Congress has to go cut
Medicare somewhere else and overturn this ruling with a three-fifths
supermajority vote in the House and the Senate--as if that would ever
happen.
All this thing has done, it is designed to basically go around
Congress, go around the laws, and have unelected and unaccountable
bureaucrats ration care for our seniors.
This is wrong; it is undemocratic; it does not fit with our
Constitution, and we think it ought to be repealed. That is why we are
bringing this bill to the House.
I reserve the balance of my time.

House of Representatives,

Committee on Energy and Commerce,

Washington, DC, June 12, 2015.
Hon. Paul Ryan,
Chairman, Committee on Ways and Means, Washington, DC.
Dear Chairman Ryan: I write in regard to H.R. 1190,
Protecting Seniors' Access to Medicare Act of 2015, which was
ordered reported by the Committee on Ways and Means on June
2, 2015. As you are aware, the bill also was referred to the
Committee on Energy and Commerce. I wanted to notify you that
the Committee on Energy and Commerce will forgo action on
H.R. 1190 so that it may proceed expeditiously to the House
floor for consideration.
This is done with the understanding that the Committee on
Energy and Commerce's jurisdictional interests over this and
similar legislation are in no way diminished or altered. In
addition, the Committee reserves the right to seek conferees
on H.R. 1190 and requests your support when such a request is
made.
I would appreciate your response confirming this
understanding with respect to H.R. 1190 and ask that a copy
of our exchange of letters on this matter be included in the
Congressional Record during consideration of the bill on the
House floor.
Sincerely,
Fred Upton,
Chairman.
____

House of Representatives,

Committee on Ways and Means,

Washington, DC, June 9, 2015.
Hon. Fred Upton,
Chairman, Committee on Energy and Commerce, Washington, DC.
Dear Mr. Chairman: Thank you for your letter regarding the
Committee's jurisdictional interest in H.R. 1190, the
Protecting Seniors' Access to Medicare Act of 2015, and your
willingness to forego consideration by your committee.
I agree that the Committee on Energy and Commerce has a
valid jurisdictional interest in certain provisions of the
bill and that the Committee's jurisdiction will not be
adversely affected by your decision to forego consideration.
As you have requested, I will support your request for an
appropriate appointment of outside conferees from your
committee in the event of a House-Senate conference on this
or similar legislation should such a conference be convened.
Finally, I will include a copy of your letter and this
response in the Congressional Record during the floor
consideration of H.R. 1190. Thank you again for your
cooperation.
Sincerely,
Paul Ryan,
Chairman.

Mr. LEVIN. I yield myself such time as I may consume.
The real purpose of this bill at this time, indeed, is to take a
further effort to repeal ACA. That is really what this is about at this
particular moment. The Republican leadership is, yet again, taking aim
at ACA. H.R. 1190 would repeal the Independent Payment Advisory Board,
IPAB. This would really be the 59th vote to repeal or undermine ACA.
Since it passed, we have seen the slowest growth in healthcare prices
over any period of that length in nearly 50 years. Growth in per
enrollee healthcare spending across both the public and private sectors
has been controlled.
The three slowest years of growth in real per capita national health
expenditures on record were 2011, 2012, and 2013. The ACA, in essence,
has changed the healthcare cost landscape, keeping cost increases down
and keeping or helping, at least, to keep families out of debt.
While we know the Medicare delivery system reforms have been working
to deliver value and lower costs, the IPAB was created as a backstop--a
backstop--only to come into effect if other efforts weren't successful.
This should be clear. IPAB only comes into being if delivery system
reforms aren't doing their job to manage Medicare.
According to the CBO, Medicare growth rates are projected to remain
beneath IPAB targets throughout the entire budget window, thereby not
triggering the Board's provisions until 2024. I think, when you
subtract 2015 from 2024, you get 9 years; so here we are, on this date,
at this time, 9 years, according to CBO, before the provisions would
come into effect, asking this Congress to repeal the IPAB provision.
If the ACA's delivery system efforts continue to be successful, IPAB
may never even need to be constituted. It is specifically prohibited
from cutting benefits or raising costs on seniors.
What IPAB can do, however, is to make recommendations to go after
overpayments, go after fraud and abuse, and try to improve, if needed,
the way there is reform of the delivery system. IPAB will not take away
Medicare benefits; it will not shift costs to seniors.
If we in Congress are doing our job as stewards of Medicare, we can
manage cost growth while protecting beneficiaries on the front end. In
the event IPAB makes recommendations, Congress always has the ability
to disapprove or modify them. If we do our job, we won't need IPAB. If
we fail to do our job, IPAB will prod us to action 9 years from now or
perhaps even later.
Let me talk a few words about the offset. It is a significant
reduction of funding for the prevention and public health fund. While
the Republicans so far have come forth with their proposals that are
never paid for, this time, they have decided to have a pay-for, but it
would cut by half or more than that the current funding for the
prevention and public health fund.
That fund was established in the ACA to provide expanded and
sustained national investments in prevention and public health and will
provide $900 million this year alone for interventions that will reduce
smoking, tackle heart disease, and help improve prenatal outcomes.
I have a listing of what it has meant for Michigan, just as one
example: $3.5 million for State health department efforts to prevent
obesity and diabetes; $3.8 million to address chronic disease risk
factors among African Americans, American Indians, Latinos, and other
minorities; $3.3 million for community transformation grants in central
Michigan to address heart disease prevention and diabetes; and almost
$3 million for tobacco use prevention.
Here we are, at long last, the Republicans come forth with a pay-for,
and they are paying for it by taking away something that really, really
matters.
We have in front of us a Statement of Administration Policy, and I
ask that it be placed in the Record. It just repeats some of the points
that I have

[[Page H4530]]

made, so I will leave it just to be entered into the Record; and,
therefore, I will now say that we should not vote for this legislation.
It would repeal a part of ACA designed to help keep healthcare costs
under control, and so importantly, it would cut critical public health
and prevention funding.
I reserve the balance of my time.

Statement of Administration Policy

H.R. 1190--Protecting Seniors' Access to Medicare Act of 2015

(Rep. Roe, R-TN, June 15, 2015)

The Affordable Care Act has improved the American health
care system, on which Americans can rely throughout life.
After more than five years under this law, 16.4 million
Americans have gained health coverage. Up to 129 million
people who could have otherwise been denied or faced
discrimination now have access to coverage. And, health care
prices have risen at the slowest rate in nearly 50 years. As
we work to make the system even better, we are open to ideas
that improve the accessibility, affordability, and quality of
health care, and help middle-class Americans.
The Independent Payment Advisory Board (IPAB) will be
comprised of fifteen expert members, including doctors and
patient advocates, and will recommend to the Congress
policies that reduce the rate of Medicare growth and help
Medicare provide better care at lower costs. IPAB has been
highlighted by the non-partisan Congressional Budget Office
(CBO) economists, and health policy experts as contributing
to Medicare's long-term sustainability. The Board is
prohibited from recommending changes to Medicare that ration
health care, restrict benefits, modify eligibility, increase
cost sharing, or raise premiums or revenues. Under current
law, the Congress retains the authority to modify, reject, or
enhance IPAB recommendations to strengthen Medicare, and IPAB
recommendations would take effect only if the Congress does
not act to slow Medicare cost growth.
H.R. 1190 would repeal and dismantle the IPAB even before
it has a chance to work. The bill would eliminate an
important safeguard that, under current law, will help reduce
the rate of Medicare cost growth responsibly while protecting
Medicare beneficiaries and the traditional program. While
this safeguard is not projected to be needed now or for a
number of years given recent exceptionally slow growth in
health care costs, it could serve a valuable role should
rapid growth in health costs return.
CBO estimates that repealing the IPAB would increase
Medicare costs and the deficit by $7 billion over 10 years.
The Administration would strongly oppose any effort to offset
this increased Federal budget cost by reducing the Prevention
and Public Health Fund. The Affordable Care Act created this
Fund to help prevent disease, detect it early, and manage
conditions before they become severe. There has been
bipartisan and bicameral support for allocation of the Fund,
and the Congress directed uses of the Fund through FY 2014
and FY 2015 appropriations legislation. The Fund supports
critical investments such as tobacco use reduction and
programs to reduce health-care associated infections. By
concentrating on the causes of chronic disease, the Fund
helps more Americans stay healthy.
The Administration is committed to strengthening Medicare
for those who depend on it and protection of the public's
health. We believe that this legislation fails to accomplish
these goals. If the President were presented with H.R. 1190,
his senior advisors would recommend that he veto the bill.

Mr. RYAN of Wisconsin. Mr. Speaker, I yield 4 minutes to the
distinguished gentleman from Tennessee (Mr. Roe), the author of the
legislation.
Mr. ROE of Tennessee. Mr. Speaker, I rise as a proud sponsor of H.R.
1190, the Protecting Seniors' Access to Medicare Act. This bipartisan
legislation, which I introduced with my colleague, Linda T. Sanchez,
would repeal the Independent Payment Advisory Board, or IPAB.
Created by the Affordable Care Act, this panel of 15 unaccountable,
unelected bureaucrats exists to cut Medicare spending to meet arbitrary
budgets and have been given enormous powers to do so.
Listen to this carefully. Peter Orszag, President Obama's former
budget director, has noted IPAB represents the single biggest yielding
of power to an independent entity since the creation of the Federal
Reserve. Let me repeat that: the single biggest yielding of power to an
independent entity since the creation of the Federal Reserve.
Mr. Speaker, we just spent, in a bipartisan way, 3 years working
through SGR reform. Seventeen times, we kicked the can down the road so
our seniors wouldn't be denied access to care. This bill is basically
SGR on steroids. It trumps all the work we just did on SGR reform.
Any proposal made by IPAB will be considered using expedited
procedures, and without a three-fifths vote in the Senate, Congress can
only modify the type of cuts proposed, not the amount, so we have to do
the amount. If Congress doesn't act on IPAB's recommendation, the cuts
will automatically go into effect. To make matters worse, the Board is
exempt from administrative or judicial review.
On the projections between 2020 and 2024, the CBO can't tell me from
year to year, within the tens of billions of dollars, what the budget
deficit is going to be each year, so I don't put a lot of stock in
that.
If the President does not nominate individuals to serve on the IPAB
or if the IPAB fails to recommend cuts when required to do so, the
Secretary of Health and Human Services has the power to make the
changes unilaterally.

{time} 1315

One person will make those changes for the entire country. Think
about that for a second. One person would have the ability to reshape a
program that has 55 million enrollees. Whatever you may think about the
President's healthcare law, this just isn't right.
After practicing medicine for more than 30 years, I can tell you that
no two patients are the same and that different approaches are required
for different needs. IPAB is blind to that fact and will ration
seniors' access to care through a one-size-fits-all payment policy.
Medicare desperately needs reform to ensure it continues to be there
for current beneficiaries and the next generation, but this is not the
way. We can do better.
It is time to go back to the drawing board. I urge my colleagues to
support this bill and put medical decisions back where they belong. Mr.
Speaker, that is between patients and doctors.
Mr. LEVIN. Mr. Speaker, I yield 3 minutes to the gentleman from
Washington (Mr. McDermott), ranking member on the Health Subcommittee.
(Mr. McDERMOTT asked and was given permission to revise and extend
his remarks.)
Mr. McDERMOTT. Mr. Speaker, I rise in opposition to this bill.
This legislation is a ghost hunt. It doesn't exist. There is no IPAB.
There is nobody that has been appointed. Nothing is going to happen
until 2024.
So the question you have to ask yourself is: Why are we out here?
Well, we are out here because some people think that trying to control
costs in health care is a bad idea.
If you go back and read the Medicare legislation when it was put in,
the AMA extracted from this Congress the right to charge their usual
and customary fees. They have been driving the costs, and we have been
trying to control it with all kinds of mechanisms all the way through
it. Only with the incidence of the ACA have we seen the curve come
down.
We have actually extended the life of Medicare to 2030. Right now, we
are spending 17 percent of our gross domestic product on health care.
When I came to this Congress, it was about 12 or 13 percent. It has
only gone up. We have not been able to do it ourselves. So the creators
of this bill said: Let's put something in on the outside that can give
us some suggestions.
Now, when we had Simpson-Bowles--and I know the chairman of the Ways
and Means Committee thought the Simpson-Bowles idea was a good idea--
what happened after it was brought out in public? Nothing. We ignored
it.
The reason for IPAB is to put pressure on the Congress to act to
control costs. I guess Republicans don't care about costs because they
don't understand that there are 10,000 people signing up for Social
Security every single day. That is 3.5 million people.
The numbers are going up. The costs are going to go up. People are
going to run around here saying we have got to cut benefits; we have
got to shift the costs to the old people; we have got to do all this.
The IPAB was a way to force the Congress to face the consequences of
their own inaction.
Dr. Roe is correct; we spent 16 years kicking the can down the road
on this issue of SGR. That was, again, an attempt to control costs. It
never worked. It was ill-conceived in the beginning.
This is an issue where there is some real muscle in it, and people
are afraid of that. They are afraid of it 9 years

[[Page H4531]]

out because they know how the Congress does. This is just another way
to try to undercut and make Medicare and the ACA not work.
Mr. Levin pointed out the other thing that is important, and that is
the place they look for the money is to go to community health, health
departments. Nobody needs health departments. Why do you need people
looking at restaurants to see if they are safe to go into, or to look
at the water supply or look at what is happening in sewage? You don't
need that stuff.
This $7 billion they are going to grab here is straight out of the
health departments of our country. Every one of your counties is going
to be facing the impact of this.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. LEVIN. I yield the gentleman an additional 1 minute.
Mr. McDERMOTT. The only thing that I think one can say is that it is
a bad idea to get rid of some muscle to force us to look at costs, but
it is worse to pay for it by taking money away from health departments.
They are the ones that always get cut.
Who wants inspectors? The other side says: We don't like regulations.
It is regulations that are ruining America. We have got to get those
regulations out.
You don't want regulations enforced in restaurants? Then take $7
billion away from it and see what kind of restaurant problems you start
to have.
Milwaukee had the cryptosporidium organism in the water supply. That
is a health problem that is dealt with by the actual health department
in the county. We are taking $7 billion to pay for this badly
constructed idea.
Mr. RYAN of Wisconsin. Mr. Speaker, I yield 2 minutes to the
gentleman from Tennessee (Mr. Roe).
Mr. ROE of Tennessee. Mr. Speaker, I have spent going on four decades
taking care of patients in rural east Tennessee, and I saw access
becoming more and more and more of a problem. It is a serious issue
now, as Medicare costs have gone up and up and up.
I have a mother who is almost 93. She has a difficult time affording
her health care and other needs that she has. One of the things I am
very concerned with, as Dr. McDermott said, we have 10,000 seniors a
day getting on that program. We need to leave those decisions to
doctors and patients, not to bureaucrats.
Let me give a little more information. There is a similar panel in
England called NICE, the National Institute for Health and Care
Excellence, I believe is what the acronym is. The other day, the Royal
College of Surgeons talked about how they noticed that over 75, almost
nobody got operated on for breast cancer, almost nobody over 75 got a
gall bladder operation, almost nobody over 75 got a knee fixed, and
almost nobody over 75 got a hip fixed. That is wrong, and that is
exactly the pathway we are going down if we don't stop this nonsense.

There is a very good article in the New England Journal of Medicine
published in 2011. I recommend you all read it. It is a look back from
25 years. That is the only information they had. This particular author
was not for IPAB or against it; he just analyzed it.
Twenty-one of those 25 years, IPAB would have kicked in, meaning
those cuts would have happened. And I can tell you this right now: our
seniors better look at this with a laser beam on because their care is
going to be cut if this goes into effect. We need to get rid of it now,
before that happens.
Mr. LEVIN. Mr. Speaker, it is my pleasure to yield 3 minutes to the
gentlewoman from California (Ms. Linda T. Sanchez of California), a
very active member of our committee.
Ms. LINDA T. SANCHEZ of California. Mr. Speaker, I rise to speak
about H.R. 1190, the Protecting Seniors' Access to Medicare Act.
I am the Democratic lead, along with Congressman Phil Roe, and I am
proud of the bipartisan work we have done to repeal the unelected
bureaucracy known as the Independent Payment Advisory Board, or IPAB. I
proudly voted for the ACA, and I think time has shown that the law
works. The ACA has reduced the number of uninsured Americans, lowered
healthcare costs, prevented disease, and increased access to cures.
Despite the success of the law, no bill is perfect. I believe that
there are certain areas for improvement in the ACA, and I am committed
to working in a bipartisan manner to solve these issues and provide our
constituents with the world-class health care that they deserve.
The ACA is a good law and a few small tweaks can make it stronger,
and that is why I decided to reach across the aisle to work with
Congressman Roe on this legislation. Repealing IPAB is not the
exclusive purview of the Republican Party, and it is a bipartisan
effort.
Unfortunately, much like the last time Congress considered IPAB
repeal in 2012, an unpalatable pay-for undermined the bipartisan
support for a deal. I know Congressman Roe has worked tirelessly to
avoid repeating the pay-for battle that we had back in 2012 in order to
retain Democratic support.
Despite these efforts, Republican leadership has chosen to draw from
the prevention and public health fund to pay for H.R. 1190. This is
something that I simply cannot support, and it is with great
disappointment that I must cast my vote against H.R. 1190. I truly
believe that repealing IPAB is the right thing to do, but I cannot
support gutting a great provision in the ACA to get rid of a bad one.
The prevention and public health fund is an unprecedented investment
in public health to prevent costly and life-threatening diseases. The
fund has invested nearly $5.25 billion in States, cities, and
communities to keep our constituents healthy and safe before they need
costly, long-term care to manage their illnesses.
The fund also exists to prevent stroke, cancer, tobacco use, and
obesity, while also funding vital childhood immunization programs, and
invests in detecting, tracking, and responding to infectious diseases.
County public health departments rely on this fund to serve their
constituents, and I know my home State of California has received over
$195 million thus far.
Despite all this, the Republican leadership has decided to take
approximately $8.85 billion from the fund which actually helps lower
the cost of health care through prevention, eliminating the need,
ironically, for IPAB in the first place.
In closing, I again want to thank Congressman Roe and the 235
bipartisan cosponsors for their hard work. I am disappointed that I
must vote against my own bill, because I know the underlying policy is
good policy, but I cannot vote for something that drains an essential
fund from the ACA.
Mr. RYAN of Wisconsin. Mr. Speaker, may I inquire as to the time
allotment remaining?
The SPEAKER pro tempore. The gentleman from Wisconsin has 6\1/2\
minutes remaining. The gentleman from Michigan has 1\1/2\ minutes
remaining.
Mr. RYAN of Wisconsin. I yield 2 minutes to the gentleman from Ohio
(Mr. Wenstrup).
Mr. WENSTRUP. Mr. Speaker, let me take a couple of minutes to explain
why Americans fear the Independent Payment Advisory Board, as it
meddles with their health care.
As I stand here today, I will tell you that I am a physician, and I
can tell you what is already taking place within private insurance with
these peer reviews when you recommend something.
I recommended an MRI to a patient. That afternoon, I get on the
phone. The woman says: I have had a problem for 10 years. I have had
cortisone injections, physical therapy, blah, blah, blah.
I said: You need an MRI.
I am being denied the MRI by the insurance company because I have
only seen her once. And I said to the gentleman, the doctor on the
phone: How many times have you seen her?
None.
I said: What State do you have a license to practice in?
Not Ohio, which is where we were.
And so I said: Tell me your specialty.
My specialty is foot and ankle. This woman was in for a foot problem.
He said: I am an emergency room doctor.
I said: Well, then you would refer her to a specialist, which is
where she is today.
He said: Well, I am not going to let you get that MRI.
I said: I hope this call is monitored for quality assurance, because
I want someone to hear what you said to me today.

[[Page H4532]]

And then I asked the patient if she would go to her HR director and
call the insurance company and say: We are going to drop the insurance
because you are not letting the patients get the care their doctor
recommends.
And then we got it. Within 3 weeks, I had her better because I knew
what was wrong once I had the MRI.
Imagine trying to have that type of a discussion with the Independent
Payment Advisory Board. If they pick up their phone, will they have a
conversation with you about the patient?
This is a problem. This is what Americans are fearing today. And this
is why the Independent Payment Advisory Board should go away.
Mr. LEVIN. Mr. Speaker, I yield back the balance of my time.
Mr. RYAN of Wisconsin. It is a great bill. We should pass it. IPAB is
a bad agency. It should not have been created in the first place.
I yield back the balance of my time.

{time} 1330

Mr. PITTS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in support of H.R. 1190, the Protecting
Seniors' Access to Medicare Act of 2015.
Mr. Speaker, the bill before us today repeals the Independent Payment
Advisory Board, IPAB, one of the most ominous provisions in the
sweeping overhaul of health care known as the Affordable Care Act.
The stated purpose of IPAB is to reduce Medicare's per capita growth
rate. The Board is to be made up of 15 unelected, unaccountable
bureaucrats--by the way, you can't have a majority of docs on the
Board--who will be paid $165,300 a year to serve 6-year terms on the
Board.
This panel of 15 unelected and unaccountable government bureaucrats
is tasked with reducing Medicare costs through arbitrary cuts to
providers, limiting access to care for seniors. If Medicare growth goes
over an arbitrary target, the Board is required to submit a proposal to
Congress that would reduce Medicare's growth rate.
These recommendations will automatically go into effect, unless
Congress passes legislation that would achieve the same amount of
savings. In order to do so, Congress must meet an almost impossible
deadline and clear an almost insurmountable legislative hurdle.
The Board has the power to make binding decisions about Medicare
policy, with no requirement for public comment prior to issuing its
recommendations, and individuals and providers will have no recourse
against the Board because its decisions cannot be appealed or reviewed.
In other words, the Board will make major healthcare legislation
essentially outside the usual legislative process.
The Board is also limited in how it can achieve the required savings.
Therefore, IPAB's recommendations will be restricted to cutting
provider reimbursements. In many cases, Medicare already reimburses
below the costs of providing services; and we are already seeing
doctors refusing to take new Medicare patients--or Medicare patients at
all--because they cannot afford to absorb the losses.
Any additional provider cuts will lead to fewer Medicare providers,
and that means that beneficiary access will suffer. Seniors will be
forced to wait in longer and longer lines to be seen by an ever-
shrinking pool of providers or have to travel longer and longer
distances to find a provider willing to see them.
Clearly, Medicare growth is on an out-of-control trajectory that
endangers the solvency and continued existence of the program. IPAB,
however, is not the solution.
Mr. Speaker, the House voted 223-181 in 2012 to repeal the
Independent Payment Advisory Board. Today, H.R. 1190, Protecting
Seniors' Access to Medicare Act of 2015, enjoys the support of 235 of
our House colleagues who have signed on as cosponsors.
The time has come for the House to once again repeal this flawed
policy, and I urge all of my colleagues to support H.R. 1190.
I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in opposition to H.R. 1190. This bill would
repeal the Independent Payment Advisory Board, or IPAB, and pay for it
by drastically reducing our investment in prevention and public health.
Mr. Speaker, I do not support IPAB. I oppose independent commissions
playing a legislative role other than on the recommendatory basis. It
is not the job of an independent commission to make decisions on
healthcare policy for Medicare beneficiaries. Congress simply must stop
ceding legislative power to outside bodies.
However, IPAB remains an insignificant provision from the Affordable
Care Act, as it has not even been convened. Because of how well other
provisions of the ACA are working, Medicare cost growth rates are
projected to remain beneath IPAB targets through the entire budget
window, thereby not triggering the IPAB provisions until 2024 at the
earliest.
That said, I urge this House to oppose H.R. 1190, which would pay for
IPAB repeal by effectively gutting the Affordable Care Act's prevention
and public health fund, an incredibly significant provision from the
ACA.
The prevention and public health fund is a mechanism to provide
expanded and sustained national investments in prevention and public
health, to improve health outcomes, and to enhance healthcare quality.
The fund has worked to reduce tobacco use, promote community prevention
and use of preventive services, and combat healthcare associated
infections.
This year the fund will invest nearly $1 billion in programs that
will benefit every State, and these dollars go to proven, effective
ways to keep Americans healthier and more productive.
In my home State of New Jersey, we have received more than $47.5
million for prevention and public health fund programs. This bill would
walk back these and other important strides we have made in public
health and prevention.
This bill is yet another Republican attempt to attack and undermine
the Affordable Care Act. I urge my colleagues to vote ``no.''
Mr. Speaker, I ask unanimous consent to have the gentleman from
Maryland (Mr. Sarbanes) manage the remainder of the Committee on Energy
and Commerce time on the Democratic side.
The SPEAKER pro tempore (Mr. Jody B. Hice of Georgia). Is there
objection to the request of the gentleman from New Jersey?
There was no objection.
Mr. PITTS. Mr. Speaker, at this time, I am pleased to yield such time
as he may consume to the gentleman from Florida (Mr. Bilirakis), a
valued member of our Health Subcommittee.
Mr. BILIRAKIS. Mr. Speaker, I rise today in support of H.R. 1190, the
Protecting Seniors' Access to Medicare Act.
The President's healthcare law included the creation of the
Independent Payment Advisory Board, or IPAB. Despite its name, IPAB is
the opposite of independent, Mr. Speaker. IPAB is a group of 15
unelected members, unaccountable to the American people. IPAB's job is
to control Medicare spending. That sounds nice, but they only have one
way to do that, by cutting reimbursement rates for doctors and
hospitals.

Seniors rely on Medicare, as well as the doctors who will see them.
If this unelected, unaccountable Board cuts reimbursement rates,
doctors will stop seeing Medicare patients. That is bad for the 180,000
seniors in my district.
Support this bill, and let's abolish IPAB. I look forward to a
bipartisan vote in support of H.R. 1190.
Mr. SARBANES. Mr. Speaker, I am opposed to this legislation, H.R.
1190, for reasons that I will detail in a moment.
At this time, I yield such time as he may consume to the gentleman
from Maryland (Mr. Hoyer), the minority whip.
(Mr. HOYER asked and was given permission to revise and extend his
remarks.)
Mr. HOYER. The gentleman indicated there were 235 people for this
bill in this House. I just observed a few minutes ago there are 240
people for Export-Import Bank. We have brought this bill to the floor.
I would hope the gentleman would urge his side, when 60 of his folks
are for it, all of ours are for it, to bring the Export-Import Bank to
the floor because it is about jobs.
Having said that--and I want to acknowledge that I am a good friend
and

[[Page H4533]]

have great respect for the sponsor of this bill, Dr. Roe. He and I have
worked together on anaphylactic shock and the dangers caused by the
eating of peanuts. He is a good doctor. He is a good person.
We happen to disagree on this bill, however. This, essentially, will
be the 60th vote, over the next 2 days, 4 days, on the repeal of the
Affordable Care Act.
We obviously have a difference of opinion on the Affordable Care Act.
I believe it is working. I believe that millions of people are covered
by insurance. Because of the Affordable Care Act, millions of children
are covered under their parents' policy, and millions of seniors are
paying less for prescription drugs. Millions of people with a
preexisting condition have the confidence that they can get insurance.
The bill we are debating today and voting on next week would repeal
the Independent Payment Advisory Board, or IPAB, as it is referred to.
Now, I was disappointed at the reference of ``bureaucrats.'' It is
used as an epithet, unfortunately, not as a descriptive term.
The fact of the matter is these folks are appointed and they make
recommendations. They make recommendations to the Congress of the
United States, and the Congress of the United States can reject them;
and/or the President of the United States, if the Congress passes
legislation to set that aside, can consider it as well.
IPAB develops proposals to contain the rate of growth of Medicare
spending. The Board hasn't been formed. There are no members appointed
yet; yet Republicans are asking taxpayers to spend $7-plus billion over
the next 10 years to eliminate it. It is not that it has acted badly.
It is not that they are irresponsible. There are no people appointed to
this Board yet.
The Affordable Care Act has slowed the growth of healthcare costs to
its lowest rate in 50 years. That helps every American, whether they
are covered by the Affordable Care Act or private employer insurance or
self-insured.
As a result, CBO predicts that action by the Board would not even be
triggered until 2024, but the cuts to the prevention fund would act
now. Republicans are paying for this bill by cutting funding for
disease prevention and public health now. Even then, CBO reports that
this bill still bends the healthcare cost curve in the wrong direction
over the long run.
Today, as has been observed, we passed another bill. That one was
without offsets. That will create an additional $24 billion deficit.
Mr. Speaker, the House has a choice. It can continue the same old
partisan attacks against affordable health care and add billions to the
deficit, undermine prevention and public health, bringing deficit-
financed tax cuts passed by this Republican-led Congress up to $610.7
billion since January.
Somebody is going to pay that bill because we are not. My generation
is not being asked to pay for it, $610.7 billion.
It could reject, of course, the politics as usual and, instead, work
together in a bipartisan way to focus on creating jobs, lowering the
deficit, and investing in a competitive economy.
You heard the sponsor of this bill saying, I cannot support it, the
gentlewoman from California, because the proponents of this bill would
rather attack the Affordable Care Act than they would to pass this
bill.
Now, they want to pass this bill, but their priority is undermining
the Affordable Care Act, which is why they didn't work with
Congresswoman Sanchez and others who agree with them on the policy. I
have to disagree with them on the policy; but they have even put people
who agree with them in a place where they cannot support the
undermining of the Affordable Care Act and preventive health in
America.
Let's choose to work together to do what American people are asking
us to do, not undermine the critical healthcare reforms that are
containing costs, increasing access, and improving quality.
That is why I opposed the medical device tax bill, and that is why I
am urging my colleagues to defeat this one as well.
Mr. PITTS. Mr. Speaker, I would say to the distinguished minority
whip, I do support Ex-Im Bank and urge my leaders to act on it. We are
together on support of that.
Let me just mention a few things to correct the record. Number one,
we had Secretary Burwell before the committee earlier this year and Dr.
Larry Bucshon, on our Health Subcommittee, asked her specifically, when
the IPAB cuts would begin to take effect. She said in 2019. In fact,
the President's own budget request would begin the cuts of IPAB in
2019.
Now, you don't have to have the members of the IPAB appointed in
order to have the cuts. The law, IPAB, designates the Secretary of HHS
with the authority to make those cuts. To overcome those cuts, you
really have to have two-thirds votes in the House and the Senate, with
commensurate cuts from somewhere else in Medicare to replace those cuts
that you are overcoming.

{time} 1345

So this is a Board that has tremendous power that will deal with
provider payments and cuts.
We just dealt with the SGR, the sustainable growth rate, in a
bipartisan manner. We acted to repeal the sustainable growth rate that
required cuts to provider payments for seniors, and it was supported
overwhelmingly.
But if you liked the SGR, you will love IPAB. This is the SGR on
steroids. It will be very difficult to overcome these 15 unelected
bureaucrats, experts, whatever you want to call them--it can't be a
majority of docs, by the way--or the Secretary, whoever makes the
recommendations.
We use the prevention fund as a pay-for, taking funds from the
prevention fund until 2025 to reach the $7.1 billion. But this
prevention fund gets $2 billion every year, beginning this year and
every year ad infinitum. So $2 billion in 2015, 2016, '17, '18, '19,
'20, '21, '30, '31, '40, '41. Every year, the Secretary gets $2 billion
to use at her sole discretion. She doesn't have to use it for public
health purposes. She has sole discretion on how this money is used.
Would you like to know some of the things she has used the money for
so far?
Well, $450 million was used for the Navigator program and
implementing the Affordable Care Act; $400,000 has been used for
pickle-ball; $235,000 for massage therapy, kick boxing, and Zumba
classes, whatever that is; $7.5 million on promoting free pet
neutering; $3 million for the New York Department of Health to lobby
for the passage of a soda tax; money for gardening projects, fast food,
small businesses, bike clubs.
Rather than spend money on questionable projects, lobbying campaigns
for higher taxes, and for Affordable Care Act media campaigns, H.R.
1190 would rather use these funds to protect Medicare seniors and their
health care because the money for the operation of IPAB, for these
salaries, for their travel, for all their expenses comes directly out
of the trust fund moneys for seniors, used for seniors and those with
disabilities. That is wrong.
We are constraining. We are not repealing the prevention fund to pay
for this, but we need to constrain the use of that fund. And good
public health policy ought to come before the Congress, not be at the
sole discretion of this one Secretary or czar or however you might want
to term it.
So, Mr. Speaker, I am pleased to speak in favor of this legislation,
H.R. 1190, and I urge the Members to support it.
I reserve the balance of my time.
Mr. SARBANES. Mr. Speaker, I yield myself such time as I may consume,
and I oppose H.R. 1190.
If the Republican appetite for the repeal of the Independent Payment
Advisory Board was based solely on its merits, I might be a little bit
more charitable about their bringing this bill to the floor because, as
you have seen from the speakers on our side, there is a legitimate
debate on the merits. I have some concerns myself about the IPAB. But,
unfortunately, I think that where this is coming from is this impulse,
this kind of ceaseless impulse to undermine and dismantle the
Affordable Care Act, and the evidence of that is in the pay-for.
Why would you want to go undermine the public health portion, really,
a significant commitment that was made through the ACA to begin to turn
our healthcare system towards prevention, towards public health?
Frankly,

[[Page H4534]]

we need as many resources as we can muster to put behind that. And the
pay-for for this repeal would take $8.85 billion that has been set
aside for the prevention and public health fund away from that fund and
undermine all of the various activities that are being funded by it.
I don't know why it is that our colleagues on the other side cannot
restrain themselves when it comes to this shiny object of repealing the
ACA when we now have plenty of evidence at our fingertips as to the
positive impact that the Affordable Care Act is having: 3 million young
people who now can stay on the health insurance coverage of their
parents, who were not covered before; millions more that are benefiting
from the health exchanges across the country; seniors who now have less
anxiety about falling into the so-called doughnut hole under the part D
prescription drug benefit program because, under the ACA, we are
beginning to close that doughnut hole; insurance companies now being
barred from discriminating against people based on a preexisting
condition; preventive care screening for our seniors under the Medicare
program; tests and other screenings that they used to have to come out
of pocket for, now that is completely covered as a result of the
Affordable Care Act.
You ask the average person out there about any of those things I just
mentioned, and they say: Why would we want to give these up?
These are important to our health, important to the strength of our
families and our community. Yet our colleagues just don't seem to be
able to help themselves when it comes to wanting to attack the
Affordable Care Act.
Furthermore, if you view this IPAB as an important mechanism in terms
of controlling costs, as has already been said, the trigger mechanism
would not kick in for a number of years here anyway. In other words,
the costs are being controlled currently. So that basis for sort of the
urgency of it now in terms of bringing these other pay-fors into the
mix doesn't make a whole lot of sense.
Let's acknowledge that one of the reasons that that trigger isn't
going to come any time soon is because, again, the Affordable Care Act
is working when it comes to controlling costs. So that is the other
side of the discussion. The Affordable Care Act is working in terms of
providing more coverage and improving treatment and management of
chronic care on the one hand, and the evidence is that it is also
reducing cost on the other hand. So it makes sense to try to preserve
that, and I think the public health fund and prevention fund is a
critical piece.
I urge my colleagues to oppose this legislation for the reasons
enumerated.

I reserve the balance of my time.
Mr. PITTS. I reserve the balance of my time.
Mr. SARBANES. Mr. Speaker, I yield myself the balance of my time.
I just want to read into the Record, so that we have this
information, a couple of observations from some of the groups out there
that are most engaged in prevention and public health across the
country and the perspective that they bring in terms of this offset, of
undermining and depleting the prevention and public health fund.
The American Lung Association said, using money from the prevention
fund as a pay-for would have a devastating effect on our Nation's
public health.
The American Heart Association: Cardiovascular disease is a leading
cause of death in the United States and is our most costly disease. The
fund supports evidence-based initiatives like WISEWOMAN, a preventive
health services program that provides lifestyle programs and health
counseling that help low-income, uninsured, and underinsured women ages
40 to 54 prevent, delay, or control heart disease and stroke.
The American Cancer Society Cancer Action Network observes that the
national breast and cervical cancer early detection program is funded
in 31 States through the fund.
And there are others that have observed--the March of Dimes, the
Campaign for Tobacco-Free Kids--that it doesn't make any sense to go
raid the prevention and public health fund to support this repeal of
the IPAB.
For those reasons and the others that have been presented here today,
I urge my colleagues to oppose H.R. 1190.
I yield back the balance of my time.
Mr. PITTS. Mr. Speaker, I yield myself the balance of my time.
While the programs enumerated by the gentleman from Maryland are
laudable, there is nothing in the prevention and public health fund
that guarantees that these will be funded or that they are priorities.
It is at the sole discretion of the Secretary as to what she would
allocate the funds for. And rightly, these kinds of funds should come
before Congress, and Congress should approve these kinds of public
health funds.
I might mention that CBO estimates that H.R. 1190, the Protecting
Seniors' Access to Medicare Act of 2015, as amended, would have no
budgetary effect on fiscal years 2015-16. It would reduce direct
spending by $1.8 billion over the 2016-2020 period, and reduce the
direct spending by $45 million over the 2016-25 period.
With that, Mr. Speaker, I urge Members to support H.R. 1190, the
Protecting Seniors' Access to Medicare Act, and repealing IPAB.
I yield back the balance of my time.
Mr. PASCRELL. Mr. Speaker, I reluctantly rise in opposition to the
Protecting Seniors' Access to Medicare Act. It was critical that the
Affordable Care Act (ACA) included the cutting edge delivery and
payment reforms that it did. But, I have never believed that the
Independent Payment Advisory Board (IPAB) will be effectively able to
fulfill its stated mission of cost containment. I have concerns with
how IPAB will operate and that it gives up important Congressional
authority over payment.
For these reasons, I am a proud cosponsor of this bill, but once
again, the House Republican majority has decided to kill the
bipartisanship of this bill with a controversial pay-for. My Republican
colleagues continue to prove that they would rather have an anti-ACA
talking point rather than a real solution.
Since the Affordable Care Act became law, my home state of New Jersey
has received more than $20 million for evidence-based programs to
prevent heart attacks, strokes, cancer, obesity, and smoking from the
ACA's Prevention and Public Health Fund. This bill, as it is being
considered today, would completely gut this fund by cutting $8.8
billion--nearly $2 billion more than is needed to pay for repealing
IPAB.
Mr. Speaker, I urge my Republican colleagues to work with Democrats
to find an agreeable way to pay for this bill, and I urge opposition to
this bill in its current form.
Mr. GENE GREEN of Texas. Mr. Speaker, I rise in opposition to H.R.
1190, the Protecting Seniors' Access to Medicare Act.
While I support repealing the Independent Payment Advisory Board
(IPAB), I oppose offsetting the cost of repeal with funds from the
Prevention and Public Health Fund.
The Prevention and Public Health Fund is the nation's single largest
investment in prevention programs. Established under the Affordable
Care Act, the Fund represents an unprecedented investment in preventing
disease, promoting wellness, and protecting our communities against
public health emergencies.
Since its creation, the Fund has invested in a broad range of
evidence-based initiatives. These include community prevention
programs, research, surveillance and tracking efforts, increased access
to immunizations, and tobacco prevention programs.
Much of this work is done through partnerships with state and local
governments, which leverage Prevention Fund dollars to best meet the
local need. These monies have been used for important work, such as
controlling the obesity epidemic, detecting and responding to
outbreaks, and reducing health disparities.
Congress has a distinct responsibility to formulate and fund programs
and initiatives that promote public health and wellness. The Prevention
and Public Health Fund is one means by which Congress fulfils this
obligation.
While I opposed the creation of the IPAB and support its repeal,
gutting the Fund would be a significant step backwards on the path
towards improving our nation's health. Rescinding $8.85 billion to
offset the costs of H.R. 1190 will have a devastating effect on our
nation's health. It is not an acceptable trade off.
We spend billions of dollars on treating disease once people become
sick. This investment in prevention is a key component of efforts to
improve health and bend the health care cost curve. Using this money to
pay for other priorities will only damage the long-term health of our
nation.
I urge my colleagues to protect the federal government's only
dedicated investment in prevention and vote against H.R. 1190.
Ms. JACKSON LEE. Mr. Speaker, I rise in opposition to H.R. 1190, the
Protecting Seniors' Access to Medicare Act of 2015, which repeals the
Independent Payment Advisory Board (IPAB), that was established under
the ACA in response to high rates of growth in Medicare expenditures
and charged with developing proposals to ``reduce the per capita rate
of growth in Medicare spending.''

[[Page H4535]]

I oppose this bill strongly because by repealing IPAB before it has a
chance to work, the bill would eliminate an important safeguard that
will help reduce the rate of Medicare cost growth responsibly while
protecting Medicare beneficiaries.
Mr. Speaker, H.R. 1190 is nothing but another attempt, in a long line
of House Republican efforts to undermine both the Medicare guarantee
and the Affordable Care Act.
Repealing IPAB cost over $7 billion during the course of a ten year
period according to the Congressional Budget Office (CBO).
Republicans have chosen to pay for the cost of this repeal with cuts
to the ACA's Prevention and Public Health Fund.
This fund has invested nearly $5.25 billion into programs that
support a number of public health initiatives, including obesity
prevention and childhood immunization.
It has been used to increase awareness of and access to preventive
health services and reduce tobacco use--concentrating on the causes of
chronic disease to help more Americans stay healthy.
Eliminating these funds in the name of damaging the sustainability of
Medicare is a two-pronged attack on our nation's public health.
After more than five years under the Affordable Care Act, 16.4
million Americans have gained health coverage; up to 129 million people
who could have otherwise been denied or faced discrimination now have
access to coverage.
Mr. Speaker, given the real challenges facing our nation, it is
irresponsible for the Republican majority to continue bringing to the
floor bills that have no chance of becoming law and would harm millions
of Americans if they were to be enacted.
House Republicans have tried 58 times to undermine the Affordable
Care Act, which has enabled more than 16 million previously uninsured
Americans to know the peace of mind that comes from having access to
affordable, accessible, high quality health care.
Their record to date is 0-58; it will soon be 0-59 because the
President has announced that he will veto this bill if it makes it to
his desk.
Mr. Speaker, I ask my colleagues to look at the facts before
prematurely repealing sections of the ACA that have significant
negative impacts on Americans currently insured.
The Independent Payment Advisory Board recommends to Congress
policies that reduce the rate of Medicare growth and help Medicare
provide better care at lower costs.
IPAB has been highlighted by the non-partisan CBO, economists, and
health policy experts as contributing to Medicare's long-term
sustainability.
The Board is already prohibited from recommending changes to Medicare
that ration health care, restrict benefits, modify eligibility,
increase cost sharing, or raise premiums or revenues.
Under current law, the Congress retains the authority to modify,
reject, or enhance IPAB recommendations to strengthen Medicare, and
IPAB recommendations would take effect only if the Congress does not
act to slow Medicare cost growth.
Despite the Supreme Court's upholding of the law's constitutionality,
the reelection of President Obama, and Speaker John Boehner's
declaration that: ``Obamacare is the law of the land,'' Republicans
refuse to stop wasting time and taxpayer money in their effort to take
away the patient protections and benefits of the Affordable Care Act.
Mr. Speaker, I ask that we stop wasting our time in taking away
healthcare protections and benefits and work to ensure that we support
the current law.
A law that is providing access to an industry once denied to so many
Americans and now supports millions.
I urge my colleagues to join me in voting against H.R. 1190.
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to House Resolution 319, the previous question is ordered on
the bill, as amended.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. PITTS. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.

____________________