August 1, 2007The gentleman from Texas.Mr. BARTON of Texas. Mr. Speaker,

I'd like to point out CBO scores this as$1.9 billion. So somebody is not tellingthe truth on the floor.

I yield 1 minute to a distinguishedmember of the committee, Mr. BUR-GESS of Texas.

Mr. BURGESS. Mr. Speaker, I thankthe chairman. One minute is scarcelyenough time to discuss what we need todiscuss today. So I would, just like thechairman of the full committee, putmy entire statement into the RECORD.

Mr. Speaker, I want to confine mycomments today to issues that sur-round issues for physician reimburse-ment. I had two amendments last nightin Rules Committee that were notmade in order that would have vastlyimproved physician reimbursement. In-stead, we have language in the Demo-cratic underlying bill that provides asmall uptick for the next 2 years, thenyou fall off the cliff, and then you'refrozen for the next 10 years. Hardlymeasures that will encourage people togo into the practice of medicine in thefuture.

I also want to reference section 651,the whole hospital exemption. Mr.Speaker, I would just point out that inthe Rules Committee it was made inorder that several hospitals would ac-tually be grandfathered out or carvedout of that exemption, and most ofthese hospitals lie in Democratic dis-tricts. I have a letter from 75 constitu-ents, physicians back in my homeState of Texas, who strongly object tothe whole hospital exemption in thisbill, and I will submit that for theRECORDas well.

The Democratic party is prepared to take itsfirst step toward cradle to grave governmentinvolvement in the lives of all Americans. The40-plus page SCHIP bill that was unveiled tothis committee in the wee hours of lastWednesday represents legislative malpractice.We shouldn't be surprised because we'vebeen here before. A handful of Democraticstaff, working behind closed doors, withoutany input from the real world have producedjust what we should expect: a bloated andcomplicated proposal that grows the size ofgovernment, diminishes state fiscal account-ability and an individual's personal responsi-bility, and likely erodes the independentprac-tice of medicine.

I doubt anybody in this body, RepublicanorDemocrat, really understandswhat is in thisproposal. We've not had one legislativehear-ing on this bill and haven't even taken this billthrough regularorder in the Energyand Com-merce Committee.As a memberof the HealthSubcommitteeof that panel, I'm disappointedin that fact because the subcommittee hasshown an ability to come together and workout partisandifferences. I haven't spokenwithChairman PALLONE,but I imagine he sharesthat sentimentto some degree.

Just recently, Republicansand Democratscame together to report out a bill that im-proves drug safety and FDA review of newdrugs and devices. We worked through ourdifferences and produced superior legislation.But all that bipartisancomity has been thrownout the window. Any rationalizationof how we

CONGRESSION AL RECORD - HOUSE

can vote on this bill and report to our constitu-ents that we conducted an in-depth review ofthis legislation would be farcical at best, espe-cially when we have learned that the RulesCommittee plans to report out a completelydifferent measure in the dark and early hoursthis coming Wednesday.

Kids need a safety net, but the safety netshouldn't apply to those that can and shouldhelp themselves. Taking money from tax-payers to give it to families that have the re-sources to purchase health insurance for theirchildren is irresponsible. And if affordable op-tions don't exist for these families, well forgetit, because this bill doesn't lift a finger to re-form an insurance market burdened by regula-tion and lack of choice.

On immigration, this bill all but ensures thatstates like mine and other border states will besaddled with more cost as it rewards those

that illegally enter our country. The debate onillegal immigration is often ruled by emotionbut the provisions in this bill relating to immi-grant health care are equally suited-this billmakes little to no effort to understand this dy-namic and only serves to pour gasoline on aninferno.

On Medicare, this bill misses the mark wide-ly. This bill would make a bad investment inan attempt to fix Medicare physician paymentand in doing so, members will find themselvesin the position of spending billions more in thefuture to fix the problem again.

We shouldn't fool ourselves that this is real-istic policy making. For those members aboutto head home and face their constituents atcoffees, lunches, and town halls they shouldbe wary of what Speaker PELOSIis force feed-ing this body.

BAYLORMEDICAL CENTER AT FRISCO,Frisco, TX, August 1, 2007.

Hon. MICHAEL C. BURGESS, MD,U.S. Congressman,Washington, DC.

DEAR CONGRESSMAN BURGESS: We are phy-sicians that practice at Baylor Medical Cen-ter at Frisco. Today, we are writing to ex-press our deep concern about the language inthe S-CHIP bill (CHAMP Act) once again at-tempting to prohibit physicians from owningor investing in any hospitaL While this legis-lation contains many important and gen-erous provisions, such as the reauthorizationof SCHIP and the SGR fix, Section 651 vir-tually eliminates physician owned hospitalsfor no reason other than the enmity of cer-tain competitors.

Much has been written about the negativeeffect this ownership has had on our commu-nity hospitals where we also practice. Manyof the large hospital systems claim they arebeing harmed by physician-owned specialtyhospitals in their communities. Yet none ofthem has provided any factual data to sup-port their claim that they are unable to pro-vide "essential services" as a result of spe-cialty hospitals. In fact each of the last 6years the American Hospital Association hasreported a 6% increase in profits in theirmember hospitals. And many of their argu-ments (e.g. "specialty hospitals typically donot provide emergency care") simply is notaccurate.

The benefits of the physician ownershipmodel are so convincing that a growing num-ber of not-for-profit healthcare systems, in-cluding some of the largest members of theAmerican Hospital Association, have em-braced the concept of physician ownership.

MedPAC, CMS, and GAO have all studiedthis issue. Not one of them has concludedthat physician owned hospitals represent athreat to the community hospitals where

H9403they exist. To the contrary, some have con-cluded that the overall increase in quality ofcare greatly benefits the communities inwhich they exist.

We believe that a major part of our successis due to the fact that individual physiciansare partners in the ownership in the facility.As any business owner, we take pride in ourfacility and have worked hard to make surethe quality of medical care remains high.And frankly, we are much more aware of thecosts and how to better deliver care morecost effectively. Through disclosure policiesour patients are aware of the physician own-ership and our surveys reveal very high pa-tient satisfaction.

The best way to manage health care costsis to encourage physicians to become in-volved in the development of new models forthe delivery of surgical and other healthservices. Maintaining the status quo by giv-ing acute care hospitals protection frommarket forces will only lead to higher healthcare costs for us alL

When voting, please consider carefully thedecision you will be asked to make regardingphysician ownership, it will not only affectyour constituents' rights as a patient tohave the most convenient cost effective care,it will affect the deli very of health care forgenerations to come.

Sincere regards,Benton Ellis, MD: James Gill, MD: David

Layden, MD; James Montgomery, MD;Mark Allen, MD; Dawn Bankston, MD;F. Alan Barber, MD; Richard Bowman,MD; Dale Burleson, MD; CameronCarmody, MD; John Schweers, MD;William Cobb, MD; Stephen Courtney,MD; A. Joe Cribbins, MD; BruceDouthit, MD; Dennis Eisenberg, MD;Berry Fleming, MD; Richard Guyer,MD; Lloyd Haggard, MD; StephenHamn, MD; Andrea Ku, MD; BriantHerzog, MD; Stephen Hochschuler, MD;James Hudguns, MD; Fawzia Jaffee,MD; Warrett Kennard, MD; AdamKouyoumjian, DO; Jimmy Laferney,MD; Stephen Lieman, MD; SamuelLifshitz, MD; Earl Lund, MD; GaryMashigian, DPM; Mark McQuaid, MD;William Mitchell, MD; Dr. KeithMatheny; William Montgomery, MD;John Moore, MD; Mickey Morgan, MD;William Mulchin, MD; John Peloza,MD; Ralph Rashbaum, MD; Jon Ricks,MD; Alfred Rodriguez, MD; VinceRogenes, MD; David Rogers, MD; IvanRovner, MD; Michael Schwartz, MD;James Smrekar, MD; Robert Taylor,DPM; Ewen Tseng, MD; Gary Webb,MD; Stanley Whisenant, MD; MichaelWierschem, MD; Kathryn White, MD;Kathryn Wood, MD; Iddriss Yusufali,MD; Roger Skiles, MD; Scott Fitz-gerald, MD; Leonard Bays, MD; DonaldMackenzie, MD; Lloyd Haggard, MD;David Holder, MD; Joe Hughes, MD;David Perkins; Robert Purnell, MD;Eddie Pybatt, MD; Elaine Allen, MD;Steven Michelsen, DO.

AMENDMENTTO H.R. 3162

This amendment would modify Title III ofH.R. 3162 that addresses Medicare physicianreimbursement. While H.R. 3162 providestemporary relief to address scheduled Medi-care physician payment cuts, it does nothingto address the problem in the long-term, andwould in fact exacerbate the problem in thelong-term. The amendment does the following;

1. Reset to 2007 the base year for applica-tion of the Sustainable Growth Rate (SGR),and eliminates the Sustainable Growth Rate in2010. The practical effect of this on Medicarephysician payment would provide physicianswith overa 1 percentageincreasein2008and

H94042009, and stable and sustainable growth ratein payment from 2010 and into the future.

2. Makes available incentive payments forincreased quality reporting and implementationof health information technology.

3. Provides annual reports to physicians onbilling patterns under Medicare.

4. Provides an annual report tobeneficiaries on annual Medicaretures.

5. Mandates a study on whether quality re-porting requirements on health care dispari-ties.AMENDMENTTO H.R. 3162, AS REPORTED [By

THE COMMITTEE ON WAYS AND MEANS] OF-FERED By MR. BURGESS OF TEXAS

(CHAMP amendment)

Strike sections 301, 302, 303, 304, and 307,and insert the following sections (and redes-ignate sections 305 and 306 accordingly):

SEC. 301. RESETTING TO 2007 THE BASE YEARFOR APPLICATION OF SUSTAINABLEGROWTH RATE FORMULA; ELIMI.NATION OF SUSTAINABLE GROWTHRATE FORMULA IN 2010.

(a) IN GENERAL.-Section 1848(d)(4) of theSocial Security Act (42 U.S.C. 1395w-4(d)(4»is amended-

(1) in paragraph (4)-(A) in subparagraph (B), by striking "sub-

paragraph (D)" and inserting "subparagraphs(D) and (G)"; and

(B) by adding at the end the following newsubparagraph:

"(G) REBA SING TO 2007 FOR UPDATE ADJUST-

MENTS BEGINNING WITH 200s.-In determiningthe update adjustment factor under subpara-graph (B) for 2008 and 2009-

"(i) the allowed expenditures for 2007 shallbe equal to the amount of the actual expend-itures for physicians' services during 2007;

"(ii) subparagraph (B)(ii) shall not apply to2008; and

"(iii) the reference in subparagraph(B)(ii)(I) to 'April 1, 1996' shall be treated, be-ginning with 2009, as a reference to 'January1,2007'."; and

(2) by adding at the end the following newparagraph:

"(8) UPDATING BEGINNING WITH 2010.-Theupdate to the single conversion factor foreach year beginning with 2010 shall be thepercentage increase in the MEI (as defined insection 1842(i)(3» for that year.".

(b) CONFORMING SUNSET.-Section1848(f)(I)(B) of such Act is amended by insert-ing "(ending with 2008)" after "each suc-ceeding year".SEC. 302. QUALITY INCENTIVES.

(a) EXTENSION OF CURRENT QUALITY RE-PORTING SYSTEM AND TRANSITIONAL BONUSINCENTIVE PAYMENTS FOR 2008 AND 2009.-

(1) EXTENSIONOF QUALITY REPORTING SYS-TEM THROUGH 2009.-Section 1848(k) of the So-cial Security Act (42 U.S.C. 1395w(k» isamended-

(A) in the heading of paragraph (2)(B), byinserting "AND 2009" after "200S"; and

(B) in paragraphs (2)(B) and (4), by insert-ing "and 2009" after "2008" each place it ap-pears.

(2) EXTENSION OF AND INCREASE IN BONUSPAYMENTS FOR 200S AND 2009.-Section 101(c) ofthe Medicare Improvement and ExtensionAct of 2006 (division B of Public Law 109-432)is amended-

(A) in the heading, by inserting", 2008, AND2009" after "2007";

(B) in paragraph (1), by inserting "(or 3percent in the case of reporting periods be-ginning after December 31, 2007)" after "1.5percen t";

(C) in paragraph (4), by striking "singleconsolidated payment." and inserting "sin-

gle consolidated payment for each reporting

Medicareexpendi-

CONGRESSION AL RECORD - HOUSEperiod. Such payment shall be made for a re-porting period within 30 days after the datethat required information has been sub-mitted with respect to claims for such pe-riod."; and

(D) in paragraph (6)(C), by striking "theperiod beginning on July 1, 2007, and endingon December 31, 200?" and inserting "each ofthe five consecutive 6-month periods begin-ning on July 1, 2007, and ending on December31 2009"

ib) ESTABLISHMENTOF NEW QUALITYINCEN-TIVE SYSTEMEFFECTIVE IN 2010.-

(1) IN GENERAL.-Section 1848 of the SocialSecurity Act (42 U.S.C. 1395w) is amended bystriking subsection (k) and inserting the fol-lowing:

"(k) PHYSICIAN QUALITY INCENTIVE SYS-TEM.-

"(1) IN GENERAL.-The Secretary shall es-tablish a reporting system (in this sub-section referred to as the 'Physician QualityIncentive System' or 'System') for qualitymeasures relating to physicians' servicesthat focuses on disease-specific high costconditions. Not later than January 1, 2010.the Secretary shall-

"(A) identify the 10 health conditions thathave the highest proportion of spendingunder this part, due in part to a gap in pa-tient care, and for which reporting measuresare feasible; and

"(B) adopt reporting measures on theseconditions. based on measures developed bythe Physician Consortium of the AmericanMedical Association.

"(2) ADD-ONPAYMENT.-"(A) IN GENERAL.-The Secretary shall pro-

vide, in a form and manner specified by theSecretary, for a bonus or other add-on pay-ment for physicians that submit informationrequired on the conditions identified underparagraph (1).

"(B) AMOUNT.-Sucha bonus or add-on pay-ment shall be equal to 1.0 percent of the pay-ment amount otherwise computed under thissection.

"(C) TIMELY PAYMENTS.-Such a paymentshall be made, with respect to informationsubmitted for a month, by not later than 30days after the date the information is sub-mitted for such month.

"(D) DEDUCTIBLEAND COINSURANCE NOT AP-PLICABLE.-Such payment shall not be sub-ject to the deductible or coinsurance other-wise applicable to physicians' services underthis part.

"(E) USE OF REGISTRY.-In carrying outsubparagraph (A), the Secretary shall allowthe submission of the required informationthrough an appropriate medical registryidentified by the Secretary.

"(3) MONITORING.-The Secretary shallmonitor and report to Congress on an annualbasis physician participation in the Physi-cian Quality Incentive System, administra-tive burden encountered by participants,barriers to participation, as well as savingsaccrued to the Medicare program due toquality care improvements based on meas-ures established under the Physician QualityIncentive System.".

(2) EFFECTIVE DATE.-The amendmentmade by paragraph (1) shall apply to pay-ment for physicians' services for servicesfurnished in years beginning with 2010.SEC. 303. HEALTH INFORMATION TECHNOLOGY

(HIT) PAYMENTINCENTIVE.Section 1848 of the Social Security Act is

amended by adding at the end the followingnew subsection:

"(m) HEALTH INFORMATION TECHNOLOGYPAYMENTINCENTIVES.-

"(1) STANDARDS.-Not later than January1, 2008, the Secretary shall create standardsfor the certification of health informationtechnology used in the furnishing of physi-cians' services.

August 1, 2007"(2) ADD-ONPAYMENT.-The Secretary shall

provide for a bonus or other add-on paymentfor physicians that implement a health in-formation technology system that is cer-tified under paragraph (1). Such a bonusshall be equal to 3.0 percent of the paymentamount otherwise computed under this sec-tion, except that-

"(A) in no case may total of such bonusand the bonus provided under subsection(k)(2) exceed 6 percent of such paymentamount; and

"(B) such payments with respect to a phy-sician shall only apply to physicians' serv-ices furnished during a period of 36 consecu-tive months beginning with the first day ofthe first month after the date of such certifi-cation.

The bonus payment under this paragraphshall not be subject to the deductible or co-insurance otherwise applicable to physi-cians' services under this part.".SEC. 304. INFORMATION FOR PHYSICIANS ON

MEDICABEBILLINGS.(a) IN GENERAL.-Section 1848 of the Social

Security Act, as amended by section 201, isfurther amended by adding at the end thefollowing new subsection:

"(n) ANNUALREPORTINGOF INFORMATION TOPHYSICIANS.-

"(1) IN GENERAL.-The Secretary shall an-nually report to each physician informationon total billings by the physician (includinglaboratory tests and other items and servicesordered by the physician) under this title.Such information shall be provided in a com-parative format by code, weighting for prac-tice size, number of Medicare patients treat-ed, and relative number of Medicare bene-ficiaries in the geographical area.

"(2) CONFIDENTIALITY.-Information re-ported under paragraph (1) is confidentialand shall not be disclosed to other than thephysician to whom the information re-lates.".

(b) EFFECTIVE DATE.-The Secretary ofHealth and Human Services shall first pro-vide for reporting of information under theamendment made by subsection (a) for bil-lings during 2007.SEC.305.INFORMATIONFOR BENEFICIABIESON

MEDICAREEXPENDITURES.(a) IN GENERAL.-Section 1804of the Social

Security Act is amended by adding at theend the following new subsection:

"(d) ANNUAL REPORT ON INDIVIDUAL RE-SOURCE UTILIZATION.-The Secretary shallprovide for the reporting, on an annual basis,to each individual entitled to benefits underpart A or enrolled under part B, on theamount of payments made to or on behalf ofthe individual under this title during theyear involved. Such information shall be pro-vided in a format that compares suchamount with the average per capita expendi-tures in the region or area involved.".

(b) EFFECTIVE DATE.-The Secretary ofHealth and Human Services shall first pro-vide for reporting of information under theamendment made by subsection (a) for pay-ments made during 2007.SEC. 306. COLLECTION OF DATA ON MEDICARE

SAVINGS FROM PHYSICIANS' SERVoICES DIVERSION.

(a) IN GENERAL.-The Secretary of Healthand Human Services shall collect data on an-nual savings in expenditures in the Medicareprogram due to physicians' services that re-sulted in hospital or in-patient diversion.

(b) REPORT.-The Secretary shall transmitto Congress annually a summary of the datacollected under subsection (a).SEC. 307. STUDY OF REPORTING REQUIREMENTS

ON HEALTH CARE DISPARITIES.

(a) IN GENERAL.-The Secretary of Healthand Human Services shall provide for a study

of health care disparities in high-risk health

August 1, 2007condition areas and minority communitiesabout the impact reporting requirementsmay have on physician penetration in suchcommunities.

(b) REPORT.-The Secretary shall providefor the completion of the study by not laterthan January I, 2011, and shall submit toCongress a report on the study upon its com-pletion.

"(m) HEALTH INFORMATION TECHNOLOGYPAYMENTINCENTIVES.-

"(1) STANDARDS.-Not later than January1, 2008, the Secretary shall create standardsfor the certification of health informationtechnology used in the furnishing of physi-cians' services.

"(2) ADD-ONPAYMENT.-The Secretary shallprovide for a bonus or other add-on paymentfor physicians that implement a health in-formation technology system that is cer-tified under paragraph (1). Such a bonusshall be equal to 3.0 percent of the paymentamount otherwise computed under this sec-tion, except that-

"(A) in no case may total of such bonusand the bonus provided under subsection(k)(2) exceed 6 percent of such paymentamount; and

"(B) such payments with respect to a phy-sician shall only apply to physicians' serv-ices furnished during a period of 36 consecu-tive months beginning with the first day ofthe first month after the date of such certifi-cation.

The bonus payment under this paragraphshall not be subject to the deductible or co-insurance otherwise applicable to physi-cians' services under this part.".

AMENDMENT TO H.R. 3162

This amendment would modify section 704of H.R. 3162 that would require the Secretaryof HHS to develop a plan to implement fornever events. Never events, pursuant to H.R.3162, are defined as an event involving thedelivery of (or failure to deliver) physicianservices in which there is an error in medicalcare that is clearly identifiable, usually pre-ventable, and serious in consequences to pa-tients and that indicates a deficiency in thesafety and process controls of the servicesfurnished with respect to the physician, hos-pital, or ambulatory surgical center involved.This amendment would ensure that the identi-fication of a never event is confidential in na-ture, as it applies to patient work productunder Section 922 of the Public Health Serv-ice Act.

NEVER EVENTS

This amendment would ensure that theidentification of never events as required byCHAMP does not lead to frivolous lawsuitsagainst physicians.

While I may not agree with how "neverevents" are defined by this bill, I agree thatphysicians should be able to operate in an en-vironment that supports improvement of proc-esses and outcomes and not a punitive legalenvironment.

Under the bill, "never events" are definedas an event involving the delivery of (or failureto deliver) physician services in which there isan error in medical care that is clearly identifi-able, usually preventable, and serious in con-sequences to patients and that indicates a de-ficiency in the safety and process controls ofthe services furnished with respect to the phy-sician, hospital, or ambulatory surgical centerinvolved.

This simple amendment ensures that identi-fication of these "never events" would not beused in a legal proceeding and would be con-sidered patient work product as they are underotherareasof federallaw.

CONGRESSIONAL RECORD - HOUSE

AMENDMENTTOH.R. 3162, AS REPORTED[BYTHE COMMITTEEONWAYS ANDMEANS]OFFERED BYMR. BURGESSOF TEXAS

(CHAMP Amendment)Amend section 704 (relating to never

events plan) by redesignating subsection (d)as subsection (e) and inserting after sub-section (c) the fOllowing:

(d) LIABILITYPROTECTION.-(1) IN GENERAL.-Section 922 of the Public

Health Service Act (42 U.S.C. 299b-22) (relat-ing to liability and confidentiality protec-tions) shall apply to never event informationunder this section in the same manner as itapplies to patient work product under suchsection 922.

(2) NEVER EVENT INFORMATIONDEFINED.-For purposes of this subsection the term"never event information" means informa-tion required to be provided by a hospital,ambulatory surgical center, or physicianunder the never events plan with respect toa determination to reduce or deny paymentunder title XVIII of the Social Security Actfor services furnished by the hospital, ambu-latory surgical center, or physician, respec-tively, on the basis of the finding of a neverevent.

AMENDMENT TO H.R. 3162

This amendment would prohibit the Sec-retary of Health and Human Services from ap-proving future State waivers that would coveradults other than pregnant adults under theState Children's Health Insurance Program.This amendment would also terminate existingState waivers that cover adults other thanpregnant adults under a State's Children'sHealth Insurance Program. SCHIP is designedto cover uninsured children, and taxpayerfunds used to cover adults cannot achieve thatgoal. This amendment would save State andFederal Governments hundreds of millions ofdollars that could be used to cover more unin-sured children.

ADULTS

Since Congress enacted SCHIP in 1997,States have been successful in making afford-able health insurance available to millions oflow-income children.

Prior to the enactment of SCHIP, low-in-come families that made too much money tobe eligible for Medicaid coverage found it dif-ficult to find affordable coverage for their chil-dren. Several million children were left withouthealth coverage for important preventativehealth services, forcing their families to seekcare in emergency departments and lackingvital continuity of care.

With the Federal and State partnership thatis the cornerstone of SCHIP, needy familieswere able to obtain health coverage for theirchildren that was previously just out of reach.

Unfortunately some States have extendedcoverage to adults under their SCHIP pro-gram, taking limited dollars away from theneeds of the children the program was in-tended to meet. One dollar a State spends onan adult is $1 not spent on a needy child. Thisamendment would eliminate this inequitabledevelopment that needs to be stopped dead inits tracks.

My bill would prohibit States from spendingeven a single SCHIP dollar on anyone but achild or a pregnant woman. Currently, 14States extend SCHIP coverage to adults andfour of those States cover more adults thanchildren in their programs.

We can debate coverage of adults and af-fordable options and States can take this re-sponsibility upon their shoulders as well. But

H9405we shouldn't spend a dollar dedicated to achild on an adult. It does a disservice to the

very needy children we're trying to providecoverage to.

AMENDMENT TO H.R. 3162, AS REPORTED [BYTHE COMMITTEE ON WAYS AND MEANS]OFFERED BY MR. BURGESS OF TEXAS

(CHAMP amendment)At the end of subtitle D of title I add the

following new section:SEC. . PROHIBITION OF SECTION1115 WAIV.

ERS FOR COVERAGEOF NONPREG.NANTADULTSUNDERSCRIP.

(a) IN GENERAL.-Section 2l07(f) of the So-cial Security Act (42 U.S.C. 1397gg) is amend-ed, as added by section 6102(a) of the DeficitReduction Act of 2005 (Public law 109-171) isamended-

(1) in the first sentence, by striking "child-less"; and

(2) by striking the second sentence.(b) CONFORMING AMENDMENTS.-Section

2l05(c)(1) of the Social Security Act (42U.S.C. 1397ee(c)(1)) is amended-

(1) in the first sentence, by striking "child-less"; and

(2) by striking the second sentence.(c) EFFECTIVE DATE.-The amendments

made by this section shall take effect on thedate of the enactment of this Act.

(d) TERMINATIONOF FUNDING OF COVERAGEUNDER CURRENT WAIVERs.-In the case ofany waiver, experimental, pilot, or dem-onstration project that would allow fundsmade available under title XXI of the SocialSecurity Act (42 U.S.C. 1397aa et seq.) to beused to provide child health assistance orother health benefits coverage to an adult(other than pregnant adult) that is approvedas of the date of the enactment of this Act,on and after such date the Secretary ofHealth and Human Services shall not extendor renew such a waiver or project in a man-ner that permits funds under the waiver orproject to be used for such purpose and shallotherwise take such action as is necessary topreven t the use of funds under the waiver orproject to be used for such purpose on andafter January 1, 2008.

AMENDMENT TO H.R. 3162

This amendment would require a State sub-mitting a SCHIP waiver request to the Sec-retary of Health and Human Services to certifythat children in that state have access to anadequate level of pediatricians, pediatric spe-cialists and pediatric sub-specialists for tar-geted low-income children covered under theState's child health plan.

The State must include a survey conductedby the American Academy of Pediatrics, astate professional medical society, or otherqualified organization and the Secretary maynot approve a waiver application unless thesurvey is included in the State's submission.

ACCESSThis amendment would ensure that as

states seek to expand their CHIP programs,that an adequate number of pediatricians, pe-diatric specialists and sub-specialists are avail-able to meet increased demand by new pa-tients.

To quote the American Academy of Pediat-rics Workforce Committee, "an appropriate pe-diatrician workforce is essential to attain theoptimal physical, mental, and social health andwell-being for all infants, children, adolescents,and young adults. To fully realize such a work-force requires careful examination of theneeds of children and the consequences ofpolicies that influence the pediatrician work-force."

This amendment would attempt to achievethis goal, by requiring adequate access to

H9406these medical professionals as a condition ap-proval of a waiver submission.

The amendment would require the AmericanAcademy of Pediatrics or other state medicalsociety to survey and certify that the state'schildren have access to a sufficient number ofpediatricians and specialists, should a staterequest a waiver from federal SCHIP require-ments.

States have a variety of policy options toensure that an adequate physician workforceis available in the state and this amendmentwould encourage those states to exercisethose options.

The growth of the number of pediatriciansper child has been positive over the past dec-ade.

We should ensure that this momentum issustained and this amendment will do justthat.

I think this is an amendment that shouldhave broad bipartisan support because itsgoal is ensuring access to needed medicalprofessionals for our children.

More broadly, in the coming years thiscountry will face a physician workforce short-age and this committee and this Congressneeds to begin addressing this now.

I look forward to working with the membersof this committee on this very broad and com-plicated issue, but this amendment would be agood first step.

AMENDMENTTO H.R. 3162,AS REPORTED[BYTHE COMMITTEE ON WAYS AND MEANS]

Offeredby Mr. Burgessof Texas(CHAMP amendment)

Add at the end of subtitle E of title I thefollowing new section:SEC. . LIMITATION ONAPPROVALOF SCRIP

WAIVERS.The Secretary of Health and Human Serv-

ices shall not approve any application sub-mitted by a State for a waiver of any provi-sion of title XXI of the Social Security Actunless-

(1) the State has certified that there is ac-cess to an adequate level of pediatricians, pe-diatric specialists and pediatric sub-special-ists for targeted low-income children coveredunder the State child health plan under suchtitle; and

(2) the State includes in such applicationthe results of a survey, that may be con-ducted by the American Academy of Pediat-rics, a State professional medical society, orother qualified organization, that establishesthat such an adequate level exists on a percapi ta child basis.

Mr. DINGELL. Mr. Speaker, I yieldto the distinguished gentleman fromVirginia (Mr. MORAN) for purposes of aunanimous consent request.

Mr. MORAN of Virginia. Mr. Speak-er, I ask unanimous consent to insert astatement for the RECORD refuting thefact that this has anything to do withundocumented children. The fact isthat the current provision prohibitsundocumented children from gettinghealth care, but if we don't pass it, itwill deny tens of thousands of childrenwho are legally eligible.

Mr. BURGESS. I object.The SPEAKER pro tempore. Objec-

tion is heard.PARLIAMENTARY INQUIRY

Mr. BARTON of Texas. Mr. Speaker,parliamentary inquiry, where are we?

The SPEAKER pro tempore. Objec-tion has been heard. The gentleman ob-

CONGRESSIONAL RECORD-HOUSE

jected. It's for the gentleman fromMichigan to yield time.

Mr. BARTON of Texas. So Mr. DIN-GELL controls the time?

The SPEAKER pro tempore. That'scorrect.

Mr. DINGELL. Mr. Speaker, I yieldto the distinguished gentlewoman fromCalifornia (Ms. ESHOO)1 minute.

Ms. ESHOO. Mr. Speaker, I thank thedistinguished chairman of the Energyand Commerce Committee.

Mr. Speaker, today is one of the mostexciting days since I've come to theCongress, having been elected first in1992. I think today is a day of history,a day of history for the children of ourcountry, because the fact is that thereare nearly 9 million American childrenwithout guaranteed access to healthcare in our Nation today. I think thatis a national shame.

Today, we correct that. We build on asuccessful bipartisan program of Re-publican and Democratic Governors, ofleaders in the Congress past, of a pro-gram that has worked.

It has not been riddled by fraud, andwhat we do today very simply is add 5million American children in the rollsof health care. It is private insurancefor almost all of the States.

We also strengthen Medicare. I wouldsuggest that my friends on this side ofthe aisle are on the wrong side of his-tory.

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Mr. BARTON of Texas. Mr. Speaker,I yield 1 minute to the distinguishedgentleman of the committee from thegreat State of Florida (Mr. STEARNS).

(Mr. STEARNS asked and was givenpermission to revise and extend his re-marks.)

Mr. STEARNS. Mr. Speaker, I wouldsay to the gentlelady from Californiawho said this is a great day in history,it was a great day in history when, in1997, the Republicans, who had the ma-jority, initiated and started this pro-gram. The Democrats are saying this isa great day, what a great day, when theRepublicans started the SCHIP pro-gram.

Now, this bill, you have heard it allbefore. Obviously, it creates a new en-titlement, crowds out private insur-ance with government coverage, offersperverse incentives to States; and, myfriends, it contains a huge tax increase,with more on the way. Lastly, it pun-ishes Medicare beneficiaries. This isvery troubling, particularly in Florida.We have so many seniors that actuallyuse Medicare Advantage.

The fact that they are going to elimi-nate this program to pay for this isreally outrageous. It will dispropor-tionately harm racial minorities andrural senior citizens by taking fundsaway from Medicare Advantage, a suc-cessful, lower-cost option for healthcare for seniors and use it to enroll andfederally insure adult men and womenwho have the ability to work and re-ceive health care from their employersin the open market.

August 1, 2007Mr. STARK. Mr. Speaker, I yield to

the distinguished member of the Waysand Means Committee, a member ofthe Health Subcommittee, the gen-tleman from Georgia (Mr. LEWIS).

Pending that, I would explain that heknows that the NAACP, in a letter ofendorsement, has said that this legisla-tion fills a much-needed gap that cur-rently exists in health care services forsome of the most vulnerable citizens,low-income children, seniors and thedisabled.

Mr. LEWIS of Georgia. Mr. Speaker,health care is a basic human right. It isunacceptable to see a young child diebecause his family could not afford forhim to see a dentist. This should never,ever, happen in the United States ofAmerica. It is wrong. It must not betolerated any longer, and today we said"no more".

This bill would give 6 million chil-dren access to health care. For our sen-iors who rely on Medicare, this billhelps our low-income seniors andmakes prevention more affordable.

I applaud the work of Chairman RAN-GEL and Chairman STARK for makingthese important improvements. I amproud to have worked on this bill tohelp those who suffer from chronic kid-ney disease and end-stage renal diseasereceive the highest quality care and totake the first of many steps towardspreventing these terrible diseases.

Until we can make health care rightfor every American, we have a moralmission, a mission and a mandate tostart with the most vulnerable amongus, our children and our seniors. Wecan do no less. Vote "yes" on theCHAMP Act. Do it now. Do it today.

Mr. BARTON of Texas. Mr. Speaker,could I inquire of the time remainingon each side on this part of the bill?

The SPEAKER pro tempore. The gen-tleman from Texas has 18 minutes re-maining, and the gentleman fromMichigan has 221/2minutes remaining.

The gentleman from California has 19minutes remaining, and the gentlemanfrom Louisiana has 30 minutes remain-ing.

Mr. BARTON of Texas. Mr. Speaker,I yield 1 minute to a distinguishedmember of the committee from thegreat State of Illinois (Mr. SHIMKUS),the winning pitcher on the congres-sional baseball team.

(Mr. SHIMKUS asked and was givenpermission to revise and extend his re-marks.)

Mr. SHIMKUS. Mr. Speaker, underthe current Illinois SCHIP program, itcovers up to 200 percent of poverty,$41,300 in annual income for a family offour; 26,830, or 31 percent of all familieswith children under the age of 18, inmy district are already eligible for ei-ther Medicaid or SCHIP.

In this bill, Democrats have opposedcutting at least $194 billion in Medicarespending. Specifically, the Democratshave proposed cutting Medicare spend-ing for 6,070 seniors in my district who