The speaker pro tempore the house will be the speaker pro tempore pursuant to House Resolution 600, the amendment in the nature of a substitute shall be considered as adopted and the bill as amended shall be considered read. The bill shall be debatable for one hour, equally divided among and controlled by the chair and ranking minority member of the committee on energy and commerce and the chair and ranking minority member on the committee on ways and means. The gentleman from minnesota, mr. Paulsen, and the gentleman from michigan, mr. Levin, will each control 15 minutes. The chair recognizes the gentleman from minnesota. Mr. Paulsen i ask unanimous consent that all members have five legislative days to revise and extend their remarks and insert extrages you materials on the bill into the record. The speaker pro tempore without objection, so ordered. Mr. Paulsen i rise in support of h. R. 849, the protecting seniors access to medicare act this discussion is not new, members. Republicans and democrats came together to pass this same bill back in 2015. This year, theres once again strong, bipartisan support, with 45 democratic members and 225 republican cosponsors. It passed out of the ways and Means Committee last month with bipartisan support too. This bill will repeal the independent payment Advisory Board or ipab created in obamacare or the Affordable Care act. The ipab puts 15 unelected bureaucrats in charge of medicare spending with significant unilateral powers to slash payments to providers, forcing them to stop seeing medicare patients without any accountability, judicial review or transparency. The boards Unprecedented Authority to alter medicare policy could reduce seen years access to health care and put the government rather than patient at the center of the Health Care System. Putting medicare on a sustainable financial footing is a top priority for all of us here in congress but passing the buck to a handful of unaccountable bureaucrats is not the right approach. Last year the medicare truss keys report stated that this was to be the year the ipabs authority to make cuts would be triggered. Fortunately, this years Trustees Report has given us slightly more time. But next year they can come back and move that date up once again. This is a cloud that will hang over providers and beneficiaries unless we act and pass this bill today. Some have stated that this bill does not solve any immediate problem and theyve questioned the need to act on the bill today. I believe that our seniors and our Health Care Providers are a priority. Why should we kick the can down the road when we can stop this today . There are letters of support from over 700 Bipartisan Groups representing patients, employers, hospitals, doctors, nurses, and other Health Care Professionals all voicing strong support for ipab repeal. They believe that the threat of this board is enough to warrant repeal and place the Decision Making back in the hands of elected members of congress, and i agree. With that, mr. Speaker, i reserve the balance of my time. The speaker pro tempore the gentleman reserves. The gentleman from michigan is recognized. Mr. Levin i yield myself such time as i may consume. The speaker pro tempore the gentleman is recognize. Mr. Levin mr. Speaker, this is really the question. Why in the world are we taking up a bill to terminate a board that does not exist . Why in the world are we doing so when premiums are rising . And action should be take ton strengthen them . Why in the world are we passing a bill that would increase the deficit by 17. 6 billion, pay for chip, the republicans say, but not this bill. So however you feel about ipab, this is the wrong time and the wrong bill for addressing it. The a. C. A. Enrollment period began yesterday. Because of actions of the Trump Administration, consumers across the country face confusion and instability in the market. Rather than addressing these urgent issues, were engaged today in a political exercise to repeal ipab. A board that has no members. Under provision that has never taken effect. And is not projected to be triggered before 2021. According to c. M. F. Actuaries. In september, every democratic member of the ways and Means Committee wrote to chairman brady urging bipartisan action to stabilize the insurance market. But after repeated requests, we never received a response from the chairman. And to date, the house has taken no action on behalf of consumers. In the meanwhile, the Trump Administration has continued to work to undermine the law and access to health care by, one, cutting out funding for costsharing assistance for moderate income enrollees, two, slashing funds to navigators that help consumers enroll in coverage. The biggest navigator in michigan had its funding cut by 90 . Shortening the enrollment period. Shutting down health care. Gov on weekends. And pr posing to chip away at tissue proposing to chip away at consume brother teches through executive knee yat. These have contributed to insurers exiting the market and raising premiums. It is nothing less than direct and deliberate sabotage and so instead the republicans today bring up a bill about a board that does not exist and the latest is, it would not until 2021 at the earliest. There are simple actions that we can take today to repair some of the damage and thereby improve the insurance market. Senator Lamar Alexander and patty mur way recently came to a bipartisan agreement that would provide funding for the costshare regular duckses and outreach and enrollment activities that strengthen the risk pool in the marketplace. Unfortunately, as we see today, our republican colleagues continue to ignore these and other important issues while allowing administration obsessed with repeal of a. C. A. To do so through executive action what could not be done legislatively. Whats more, theyre bringing to the floor today a bill that the Congressional Budget Office estimates will raise the deficit by 17. 5 billion over the next decade. I repeat, raise the deficit by 17. 5 billion over the next decade. And this is just a small preview of the coming g. O. P. Tax bill. Which would increase our nations debt by 1. 5 trillion, according to the republicans own budget resolution. And whatever happened to the crocodile tears we used to hear from republicans about the deficit . In terms of todays bill, lacking any offset, how about at least starting to address the staggering cost of prescription drugs, a step that would save both Senior Citizens and the Medicare Program money. Mr. Speaker, the American People need congress to take action to lower their Health Care Costs and to stabilize the markets. Hey do not need today an irrelevant political bill such as h. R. 849. If you support real steps to Lower Health Insurance premiums now, vote no on this bill. I reserve the balance of my time. The speaker pro tempore the gentleman reserves. The gentleman from minnesota is recognized. Mr. Paulsen let me start by saying that some of my colleagues on the other side of the aisle have called on us to work with them over and over again to find Common Ground, to make fixes in the flaws in obamacare. Today we have an opportunity do exactly that. We should all be joining together. Theres bipartisan support in this bill to eliminate this unnecessary and potentially very destructive body, one that i would define as a major flaw in the law. This is exact process weve been asking for, youve been asking for. The bill has been through regular order. Weve had countless hearings on this topic. Weve actually voted not once, but twice, in past congresses to repeal ipab to keep it from harming access to seen years care. Today were blinging this bill forward, this legislation forward, as a standalone provision, not tied to any other policies, to once and for all allow members to say whether they support or oppose this unaccountable board. Mr. Speaker, i would like to yield four minutes to the gentleman from tennessee, dr. Phil roe, with has been a tireless champ for seniors in tennessee and since day one has been working on this legislation to repeat ipab. The speaker pro tempore the gentleman is recognized for four minutes. Mr. Roe i rise mr. Roe i rise in support of h. R. 849, a bipartisan bill that repeals two sections of the Affordable Care act and terminates the ipab once and for all. I want to thank chairman brady and chairman walden. Cosponsor. Ad dr. Rueezz got more cosponsors than we ever before including 45 democrats. Seeing such strng bipartisan support only makes sense. Since we are doing away with ipab has been a bipartisan idea since it was first proposed. In december of 2009, i joined congressman richard neal and 72 other bipartisan members in writing then Speaker Pelosi expressing our opposition to the ipabs creation. On the day that the a. C. A. Passed the house, i filed legislation to repeal the ipab and received bipartisan support in every congress since. This is about access for seniors. And the ipab was not in the house version of the Affordable Care act. Only the senate sent that back over here. So it was not part of the house to begin with. We got lucky this summer that the medicare Trustees Report did not trigger ipab otherwise there would be requirements to cut medicare within a year. These cuts would have been made to provider reimbursements and would eliminate options. Peter orszag said this was the greatest creeding of power from the congress to a bureaucracy since the formation of the Federal Reserve and then stated that the board hasnt been formed. Means that one person makes these decisions, not the congress. The medicare recipients cant come to their elected official and effect changes in this ipab board if its enacted and it will be. One of the Major Concerns we hear today, this estimate will cost over 17 billion. The c. B. O. Describes its estimates as extremely uncertain because its certain that ipab will not be triggered. This is the dilemma we are in with the Sustainable Growth rate. Medicare says to doctors, you can provide care but if you provide too much, well ket your payments. Havoc. H s. G. R. Wreaked we cant put providers through this again and spent months and years getting that corrected knowing that members were concern about the offsets. We have a bill on the floor that all of our cosponsors can support. I look forward to seeing all 2 0 voting in favor of passage in order to preserve medicare for our nations seniors. We have a chance to send a strong support that seniors dont want to see it cut by a body of 15 unaccountable bureaucrats or the secretary of h. H. S. If the board is not impaneled. If there are hard decisions to be made, congress should not abdicate that duty to people who have no oversight or legal recourse. I urge my colleagues to support final passage of this bill and maintain Medicare Services for our nations seniors, because this is truly a bipartisan issue that will affect all seniors equally. I yield back the balance of my time. The gentleman yields back the balance of his time. The gentleman from michigan. R. Levin i yield five minutes the gentleman from wisconsin. Mr. Speaker, i rise today in opposition of the repeal of the independent payment Advisory Board. Mr. Kind this is another classic example of a solution in search of a problem. All the things that we should be working on in congress in a bipartisan fashion to improve and to fix the problems that exist within our Health Care System. We have legislation on the floor before us today that calls for the repeal of a nonexistent Commission Based on nonexist nt spending cuts proposed for medicare and nonexistent of rate in increasing spending which will add 17. 5 billion over the next 10 years because this bill isnt paid for. And they are coming forward with this legislation to add another 18 billion on the debt on the same day they release a tax bill that calls for 1. 5 trillion worth of deficit spending because the tax bill hasnt been offset. At some point and some time, we have to take a bipartisan stand on fiscal responsibility in this place again, because its not happening today. Instead, we should be working on shortterm Practical Solutions to stabilize and bring more certainty to the Health Insurance marketplace. In light of what the administration is doing to completely undermine the marketplace today. We ought to be working on reform proposals that will accomplish medical homes and valuebased purchasing and bundling arrangements and different alternative payment models to get us to a system of value and quality and outcomes and away from the fee for service, payment for the value of service regardless of results. Lets be honest, the real cost driver in our federal budget has been Health Care Costs because we have an aging population. Thats the work we should be working on together is the Delivery System reform and payment reform and aligning the incentives and telling our Health Care Providers you will be compensated on good results, not on how much you do. Theres a lot within the Affordable Care act giving our providers the very tools in order to accomplish that. And we ought to be enhancing that today. Instead, we are wasting time on a commission accord to c. M. S. Says at the very earliest it might be comprised in 2021. But even then, it warns us with the mission we have given it, congress, you need to deal with and come back with recommendations and up to us toe make corrective action at that time. All this talk about unelected bureaucrats and making these decisions belies what the act calls for. This was another important Cost Containment tool that was put into the Affordable Care act to restrain the growth of Health Care Spending. We need more of those type of ideas rather than efforts today to remove those tools and then see unbrideled Health Care Spending in the future. What is disturbing. I know there is a lot of Common Ground in this area and the American People wouldnt know it with this ping pong ball going back and forth and the chaos and confusion its causing. Thats unfortunate. Instead today we ought to first ake steps to stabilize the insurance exchanges rather than to limit the enrollment which started yesterday. They have cut by 90 funding for marketing of the exchanges and cut by 50 funding for our navigateors back home to help people get Affordable Care and ended the cost sharing payments which increases the health care of everyone else. And the other segment of the population we should be focused on is that 5 or 6 of the population that are in the individual market that dont qualify for premium tax credits, they are getting hammered and you would think that would be bipartisan commonality to provide relief to individuals who are in the individual market expressing these private premiums. And instead nothing is being done on that front. My friend from michigan we should be having hearings about the cost of prescription drugs in the committee. That is one of the main cost ivers and there is deafening ears in the handful of congress. President trump promised during the course of his campaign to try to take some action in a bipartisan to address the drug costs. May i have one additional minute . Mr. Levin additional minute. Mr. Kind it was an initiative that the president was interested in trying to address. Again, yet, nothing is being done. This legislation, much to do about nothing because there is nothing pending and nothing would be pending according to c. M. S. Until 2021. We are wasting time and opportunity to address the real problems in finding the real fixes that are needed in the Health Care System. And im confident there is bipartisan overlap having worked with my colleagues on the committee and across the aisle on many of these measures that i mentioned here today. I encourage my colleagues to vote no and it keeps an eye on riseicing costs, Congress Needs to take future action if the rate of growth starts spinning out of control. I yield back. The speaker pro tempore the gentleman from minnesota is recognized. Mr. Paulsen i recognize mr. Rothfus who is a tireless advocate on these issues. Mr. Rothfus i rise today in strong support of h. R. 849 the protecting seniors access to medicare act. The ipab was created under the a. C. A. And consists of a panel of 15 unelected unaccountable bureaucrats with the authority to single hand he hadly cut medicare spending. Ipab reveals the truth that government rather than the patient is at the center of our Nations Health care policy and repealing ipab, we begin to help get rid of the notion that the mentality that washington knows best when it comes to our health care. Its imperative we act now before we put nominees on the board and access to care is decreased or denied. My constituents rely on these funds. Im proud to seekonk working together in a bipartisan manner on this commonsense legislation to keep patients and doctors in contr