Providing For Consideration Of H.R. 3134, Defund Planned Parenthood Act Of 2015; Providing For Consideration Of H.R. 3504, Born-alive Abortion Survivors Protection Act; And For Other Purposes

Floor Speech

Mr. McGOVERN. Madam Speaker, I rise today in very strong opposition to H.R. 3134 and H.R. 3504 and in very strong opposition to the underlying closed rule.

Today, the House should be debating a bill to keep the government open before funding runs out at the end of the month. We have just 6 legislative days before there is a government shutdown--6 legislative days--and instead of tackling this, we are once again debating another Republican attack on women's health.

In 6 legislative days, the government might shut down; and I am worried because, judging from recent events within the Republican caucus, the right hand doesn't know what the extreme right hand is doing. They can't seem to get along with each other, and I am afraid yet there will be another catastrophe and everything will come to a halt, and the people that will suffer will be the people of this country whom we are supposed to represent.

Madam Speaker, in fact, the Republicans were in such a hurry to waste our time with this destructive legislation that one of the bills we are considering, H.R. 3504, had no hearings--not one, none--no markup, and this is the first time we are seeing the bill--and no amendments, by the way. Nobody can offer an amendment. It is totally closed.

Whatever happened to regular order? This process, Madam Speaker, stinks, and it is indefensible.

Of all the measures that have come before the Rules Committee, more than 75 percent have completely ignored regular order and were rushed to the floor without a legislative hearing and markup, denying the people's elected representatives the opportunity to hear the experts and speak up for their constituents. Well, when you look at the politically motivated legislation that regularly comes before this body, I guess it is easy to see why. This is not how the people's House is supposed to work.

Late last night, the Republican majority of the Rules Committee took another shortcut through a process called self-executing that let them slip an amendment offered by Mrs. Ellmers into today's legislation to redirect funding away from Planned Parenthood facilities. Under regular order, this amendment would have required three waivers--three. It would require three waivers from the committee to be considered on the House floor.

On top of that, the Ellmers amendment would have also violated section 302(f) of the Congressional Budget Act, which prohibits the consideration of legislation that exceeds a committee's allocation of budget authority. But the Republican-controlled Rules Committee said: Who cares? We are in charge. We don't care about the rules. We don't want to be fair. We don't want to be open. We don't want to be transparent. We are in charge, and we can do whatever we want.

Madam Speaker, this is just another attempt by the House majority to shut out debate on important issues and ignore the House rules when it is convenient for them. During this Congress alone, 118 waivers have been granted; 115 of those waivers, 97 percent, have been for Republicans. Instead of the House Rules Committee, we should be known as the House Break-the-Rules Committee, because that is all the Rules Committee seems to do. It breaks rules, goes around rules, and tries all kinds of trickery to be able to force legislation to the floor that limits debate and doesn't allow Members to offer amendments.

This legislative process in this House has become a joke. It is shameful, and this is not serious legislating.

With one bill after another, Republicans have repeatedly hurt our country's most vulnerable families, and these bills today are just the latest chapter. This is nothing new.

One of the first acts of the Republican House majority in 2011 was to drive us to the brink of a government shutdown over Planned Parenthood. In October 2013, Republicans did shut down the government by insisting on defunding the Affordable Care Act. Now, 2 years later, they are right back to threatening a Republican government shutdown over Planned Parenthood.

H.R. 3134, the so-called Defund Planned Parenthood Act of 2015, is a bad and a backward-thinking bill. In the 114th Congress, the House has already taken four anti-women's health votes and today sets the stage for us to take two additional votes to restrict women's access to women's health care. Incredibly, this is already twice the number of anti-women's health votes than at this same point in the 113th and 112th Congresses--and this Congress is not even half over.

In this Republican Congress, facts don't matter. We don't talk about facts. They are inconvenient and they are a nuisance--especially when they get in the way of their extremist political agenda.

The fact is that Planned Parenthood plays a critical role in protecting and providing access to critical health services for both women and men. One in five women has relied on a Planned Parenthood health center for care in her lifetime, and Planned Parenthood serves 2.7 million patients each year. One of the most important statistics that my Republican friends like to ignore is that more than 90 percent of what Planned Parenthood does nationally is preventive care, including cervical cancer screenings, breast cancer screenings, and family planning--not abortion services.

I just came from a luncheon a few minutes ago where we were honoring individuals who were leaders in the cancer prevention field, people who have advocated that it is important for all of us to be able to get checkups on a regular basis in order to prevent cancer; and here we are about to vote on a bill that, if the Republicans get their way, would limit and would eliminate access to lifesaving cancer screenings for countless individuals across this country.

What are you thinking? This is not the way we should be proceeding.

Add to this the fact that Planned Parenthood clinics are often one of the few affordable healthcare options available for many women--nearly 80 percent of women using Planned Parenthood clinics have incomes at or below 150 percent of poverty--and it is easy to see why a majority of Americans don't think Federal funding should be eliminated. In one recent poll, 63 percent of voters, including 72 percent of Independents, do not agree with my Republican friends that Federal funding for Planned Parenthood should be eliminated.

Madam Speaker, we have also heard very little from my friends on the other side of the aisle about the consequences that defunding for Planned Parenthood would have for families across the country. One of the biggest myths perpetrated by Republicans is the idea that our Nation's community health centers--which I love, adore, respect, and support--could somehow magically pick up the slack overnight if Planned Parenthood is defunded.

For the millions of low-income women who depend on

Planned Parenthood clinics, this scenario would mean the loss of affordable and accessible contraceptive services and counseling, as well as breast and cervical cancer screenings and testing. The idea that our community health centers could, overnight, suddenly step up and cover millions of new patients is simply wrong and shows a fundamental misunderstanding by Republicans of how our country's healthcare system works.

In fact, the Guttmacher Institute recently found that, in 21 percent of counties with a Planned Parenthood health center, Planned Parenthood is the only safety net family planning provider. The report also states: ``In two-thirds of the 491 counties in which they are located, Planned Parenthood health centers serve at least half of all women obtaining contraceptive care from safety net health centers. In one-fifth of the counties in which they are located, Planned Parenthood sites are the sole safety net family planning center.''

This makes clear just how devastating it would be for these communities to recklessly cut funding for these vital health services for the people who need them most.

Everyone here in this Congress, every single one of us, with the snap of our fingers, can get health care; but with today's bills, Republicans seem to be saying that for families who are poor or who live in rural areas or where this is the only option for preventive care where they live are simply out of luck. Talk about cruel.

Madam Speaker, I have a recent article from the Health Affairs Blog, titled, ``Planned Parenthood, Community Health Centers, and Women's Health: Getting the Facts Right.'' It says: ``a claim that community health centers readily can absorb the loss of Planned Parenthood clinics amounts to a gross misrepresentation of what even the best community health centers in the country would be able to do were Planned Parenthood to lose over 40 percent of its operating revenues overnight as the result of a ban on Federal funding.''

I will enter the full article into the Record.

[From Health Affairs Blog, Sept. 8, 2015]

Quantifying Planned Parenthood's Critical Role in Meeting the Need for Publicly Supported Contraceptive Care
(By Jennifer Frost)

Over the past few months, legislative attempts to defund Planned Parenthood have flared at both the federal and state levels; these moves are clearly an attempt to shutter Planned Parenthood health centers, potentially depriving women of the contraceptive services and counseling, sexually transmitted infection (STI) testing and treatment, and breast and cervical cancer screening that they provide.

Although proponents of closing Planned Parenthood argue that other providers would be easily able to fill the hole torn in the safety net, credible evidence suggests this is unlikely. In some areas, Planned Parenthood is the sole safety-net provider of contraceptive care. And even where there are other safety-net providers, they, on average, serve far fewer contraceptive clients than do sites operated by Planned Parenthood.

As this debate swirls, the Guttmacher Institute received a request from the Congressional Budget Office (CBO) regarding the publicly supported contraceptive care provided by Planned Parenthood health centers across the country. To respond, Guttmacher staff conducted special tabulations of our Contraceptive Needs and Services 2010 report (the most recent year for which these data are available).

Our analysis shows unequivocally that Planned Parenthood plays a major role in delivering publicly supported contraceptive services and supplies to women who are in need of such care nationwide. In two-thirds of the 491 counties in which they are located, Planned Parenthood health centers serve at least half of all women obtaining contraceptive care from safety-net health centers. In one-fifth of the counties in which they are located, Planned Parenthood sites are the sole safety-net family planning center.

Further, the average Planned Parenthood health center serves significantly more contraceptive clients each year than do safety-net centers run by other types of providers, such as federally qualified health centers (FQHCs) or county health departments. As a result, Planned Parenthood centers serve a greater share of safety-net contraceptive clients than any other type of provider. And, Planned Parenthood sites are more likely to make contraceptive care quickly and easily accessible to the women who need it.

CONTRACEPTIVE CARE BY THE NUMBERS

Below are the key takeaways of Guttmacher's findings related to Planned Parenthood's provision of publicly supported contraceptive care.

Planned Parenthood health centers serve a considerable proportion of all clients obtaining contraceptive care from safety-net health centers.

In 2010, 36 percent of the 6.7 million U.S. women receiving contraceptive care from safety-net family planning health centers were served at Planned Parenthood centers. And there are some areas of the country where women rely particularly heavily on Planned Parenthood: In 18 states, Planned Parenthood health centers serve more than 40 percent of women obtaining contraceptive care from a safety-net family planning health center. In 11 of those 18 states, Planned Parenthood serves more than half the women obtaining contraceptive care from a safety-net health center.

Planned Parenthood health centers often serve most or all of the safety-net contraceptive clients in their county.

In 68 percent of counties with a Planned Parenthood site (332 counties out of 491), these sites serve at least half the women obtaining publicly supported contraceptive services from a safety-net health center. And in 21 percent of counties with a Planned Parenthood site (103 counties), Planned Parenthood serves all of the women obtaining publicly supported contraceptive services from a safety-net health center.

The majority of women who need publicly supported contraceptive care live in counties with a Planned Parenthood health center.

Almost two-thirds (64 percent) of the 19 million women in need of publicly supported contraceptive services and supplies live in counties with a Planned Parenthood health center. Moreover, 30 percent of these women live in counties where Planned Parenthood serves the majority of those obtaining publicly supported contraceptive care from the family planning safety net. (Women are considered to be in need of publicly supported contraception if they have ever had sex; are aged 13-44; are able to become pregnant; are not pregnant, postpartum, nor trying to become pregnant; and either have a family income below 250 percent of the federal poverty level or are younger than age 20.)

Planned Parenthood health centers serve a greater share of safety-net contraceptive clients than do any other types of providers.

Although Planned Parenthood health centers comprise 10 percent of publicly supported safety-net family planning centers, they serve 36 percent of clients who obtain publicly supported contraceptive services from such centers. By contrast, centers operated by health departments serve 27 percent of safety-net contraceptive clients, FQHCs serve 16 percent, sites operated by hospitals serve 8 percent, and sites operated by other agencies serve 13 percent.

On average, Planned Parenthood health centers serve many more contraceptive clients per year than do other types of safety-net providers. Planned Parenthood health centers serve an average of 2,950 contraceptive clients per year, many times more than any other type of publicly supported health center. By contrast, those operated by hospitals serve an average of 770 contraceptive clients, health departments serve an average of 750, FQHCs serve 330, and centers operated by other types of agencies serve 680 contraceptive clients each year.

Planned Parenthood health centers are more likely to facilitate women's timely access to a wide range of contraceptive services and supplies.

Planned Parenthood sites are considerably more likely to offer a broad range of contraceptive methods than sites operated by other types of agencies. Specifically, 91 percent of Planned Parenthood health centers offer at least 10 of 13 reversible contraceptive methods, compared to between 48 percent and 53 percent of sites operated by other types of agencies.

Moreover, Planned Parenthood sites are particularly likely to help women who choose oral contraceptives to get their pills without having to make an additional trip to a pharmacy: 92 percent of Planned Parenthood health centers offer oral contraceptive supplies and refills on-site, as do 86 percent of health department sites. Considerably smaller proportions of sites operated by FQHCs and other types of agencies--37 percent and 55 percent, respectively--do so.

Finally, women are often able to get the care they need more quickly from Planned Parenthood than from other types of safety-net providers. Sixty-three percent of Planned Parenthood health centers offer same-day appointments, compared to between 30 percent and 40 percent of sites operated by other types of agencies. And the average wait for an appointment at a Planned Parenthood health center is 1.8 days, whereas wait times at sites operated by other types of agencies range from 5.3 to 6.8 days.

LOOKING AHEAD

We cannot predict whether or to what extent health centers operated by other providers could fill the significant gap in the family planning safety net that would be created if Planned Parenthood health centers were defunded--and therefore lost to the communities they serve. Certainly in the short term, it is doubtful that other providers could step up in a timely way to absorb the millions of women suddenly left without their preferred source of care and whether those providers could offer the same degree of accessible, quality contraceptive care offered by Planned Parenthood. (Indeed, Texas offers a cautionary tale; the state's family planning program for low-income women served far fewer women after Planned Parenthood health centers were cut out of the effort.)

What we do know is that women nationwide rely on Planned Parenthood health centers for the contraceptive services and supplies they need--and for women in many areas of the country, losing Planned Parenthood would mean losing their chosen provider and the only safety-net provider around.

Mr. McGOVERN. Here are some more facts.

For every patient served by a community health center today, nearly three residents of low-income communities remain without access to primary health care. By voting for a sudden cutoff in funding, we would create an immediate healthcare access crisis for millions of women, placing an enormous strain on community health centers and other providers.

Community health centers offer women's health services as part of comprehensive primary care programs. They simply cannot put their other responsibilities aside. With so many of our Nation's community health centers already struggling to meet the needs of our most vulnerable communities, the last thing we should be doing is trying to make their jobs harder.

Now, on top of all of this, Senator McConnell has already said that Senate Republicans do not have the votes to pass this bill and it will never reach the President's desk. So what are we doing here? This is not a rhetorical question. We are literally, as I said earlier, 6 legislative days away from another government shutdown; and instead of talking about how we are going to keep the doors open, how we are going to do what the people of the country have sent us here to do and keep government running, we are wasting time with this politically driven legislation that does nothing to make the country better.

Madam Speaker, the other bill before us, H.R. 3504, is not a simple restatement of the current born-alive law, by the way, which passed by a voice vote in 2002, no. Just so my colleagues understand, this bill fundamentally interferes with the sacred doctor-patient relationship and undermines doctors' clinical judgment and tells them how to provide medicine, or else they will face criminal penalties.

Madam Speaker, this bill is a solution in search of a problem. We already have strong Federal and State laws to protect babies born alive. The bottom line is that these anti-women's health bills would limit women's access to safe, legal, reproductive health care.

Congress should be governing responsibly and working to solve the real issues our country is facing. We should be focused on growing our economy and creating jobs. I think you may have forgotten that that is an important priority of the American people because my friends never like to mention the word ``jobs.''

But we ought to be focused on creating jobs. We ought to be protecting access to health care, increasing college affordability, and building a better future. Instead, 30 conservative House Republicans have decided to take government funding hostage, and that is what we are here for.

The American people deserve better.

Finally, let's be clear. Let's all kind of clear the air and be honest about one thing. The debate we are having today really isn't about the quality of care provided by Planned Parenthood. That is really not what is at the heart of all this. This is an effort by my friends on the Republican side to kind of pursue their agenda of criminalizing and outlawing abortion in every circumstance.

Many of my colleagues on the other side have been very vocal about the fact that they want to criminalize abortion, even in cases of rape or incest. They would make a woman who is a victim of rape or incest a criminal. They would criminalize the doctors. That is what this is all about, trying to force their narrow agenda down the throats of the American people.

I would say to my colleagues that we ought to reject this and get down to the business of governing this country. This is not what we should be doing here today. This is an insult, I think, to women. This is an insult to the good people who work at Planned Parenthood who provide excellent care to millions of people across this country, and, quite frankly, it is an insult to the American people that, with 6 legislative days left before you shut the government down, this is what you choose to bring to the floor and not a bill to keep the government open.

Madam Speaker, I reserve the balance of my time.

Mr. McGOVERN. Madam Speaker, I yield myself such time as I may consume.

I just want to say to my colleague from North Carolina that I am not hiding behind procedural rules.

In fact, in the way that my Republican friends have brought this bill to the floor, you won't allow us to debate amendments. We can't. You have stifled debate.

So I guess I would ask you: What are you afraid of? Why can't we have a more open process on legislation that didn't even go through the committees of jurisdiction? You ought to open this place up. A little debate is not a bad thing. A little openness is a good thing.

Madam Speaker, I include for the Record the report by the Subcommittee on Oversight and Investigations, Democratic members and staff, basically that refers to the heavily edited videos that my colleagues refer to.

I will just read one line here:

To date, the committee has received no evidence--underline ``no evidence''--to substantiate the allegations that Planned Parenthood is engaged in the sale of fetal tissue for profit.

Furthermore, the committee has received no evidence to support the allegation that fetal tissue was procured without consent, that Planned Parenthood physicians altered the timing, method, or procedure of an abortion solely for the purposes of obtaining fetal tissue, or that Planned Parenthood physicians performed intact dilation and evacuation in order to preserve fetal tissue for research.

Thus far, the investigation has revealed that PPFA requires all affiliates to ensure compliance with all State and Federal laws and that specific PPFA guidance requires affiliates to ensure that reimbursement for fetal tissue is limited to actual cost.

HOUSE OF REPRESENTATIVES,

COMMITTEE ON ENERGY AND COMMERCE

Washington, DC, September 9, 2015.

Memorandum
To Subcommittee on Oversight and Investigations Democratic Members and Staff
From Committee on Energy and Commerce Democratic Staff
Re Update on the Committee's Ongoing Investigation of Planned Parenthood Federation of America

I. Introduction

This memorandum serves as an update on the Committee's ongoing investigation into claims regarding the alleged sale of fetal tissue by affiliates of Planned Parenthood Federation of America (PPFA) to tissue procurement organizations (TPOs). The review has included bipartisan briefings by Planned Parenthood officials as well as representatives from StemExpress, Novogenix Laboratories, and Advanced Bioscience Resources--three TPOs that partner with Planned Parenthood affiliates and other healthcare providers to collect specimens to supply to researchers working with fetal tissue.

In addition to these briefings, the Committee has received documents and written responses to a series of questions it posed in writing to PPFA regarding its ``practices relating to fetal tissue collection and sale or donation.'' To date, the Committee has received no evidence to substantiate the allegations that Planned Parenthood has engaged in the sale of fetal tissue for profit. Furthermore, the Committee has received no evidence to support the allegations that fetal tissue was procured without consent, that Planned Parenthood physicians altered the timing, method, or procedure of an abortion solely for the purposes of obtaining fetal tissue, or that Planned Parenthood physicians performed intact dilation and evacuation in order to preserve fetal tissue for research. Thus far, the investigation has revealed that PPFA requires all affiliates to ensure compliance with all state and federal laws and that specific PPFA guidance requires affiliates to ensure that reimbursement for fetal tissue is limited to actual costs.

The Committee received evidence that the individuals making these unsubstantiated claims misrepresented themselves in order to gain access to Planned Parenthood personnel and facilities, and that the videos released by the Center for Medical Progress (CMP) are incomplete, selectively edited, and intentionally misleading.

II. There Is No Evidence That Planned Parenthood or Its Affiliates Have Violated any Federal or State Laws

A. PPFA REQUIRES ALL AFFILIATES TO COMPLY WITH ALL STATE AND FEDERAL LAWS, INCLUDING LAWS PERTAINING TO THE DONATION OF FETAL TISSUE FOR RESEARCH
i. PPFA Guidance to Affiliates Regarding Human Fetal Tissue Donation Specifically Advises That It Is Illegal to Receive ``Valuable Consideration'' for Fetal Tissue, and Requires Affiliates to Ensure that Reimbursement Represents Actual Costs

The NIH Revitalization Act of 1993 established the legal standards governing fetal tissue donation. The law states, ``It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human fetal tissue for valuable consideration if the transfer affects interstate commerce.'' The law further provides: ``The term `valuable consideration' does not include reasonable payments associated with the transportation, implantation, processing, preservation, quality control, or storage of human fetal tissue.''

Current PPFA guidance on fetal tissue donation tracks federal law, and it clearly and explicitly prohibits affiliates from receiving valuable consideration for fetal tissue. The guidance also requires affiliates to ensure that reimbursement represents actual costs incurred by the affiliate. The current PPFA guidance, revised in May 2015, provides as follows:

Federal law prohibits the payment or receipt of money or any other form of valuable consideration for fetal tissue, regardless of whether the program to which the tissue is being provided is federally funded or not.

There are limited exceptions that allow reimbursement for actual expenses (e.g. storage, processing, transportation, etc.) of the tissue. If an affiliate chooses to accept reimbursement for allowable expenses, it must be able to demonstrate the reimbursement represents its actual costs. PPFA recommends that an affiliate consult with CAPS [Consortium of Abortion Providers] about steps to take to document and demonstrate actual cost. [emphasis in the original]

The guidance also advises affiliates that ``there are federal, and frequently, state laws that govern these activities, as well as ethical considerations. Great care must be taken to assure that these programs are above reproach in all respects.''

In a briefing with Committee staff, Dr. Raegan McDonald-Mosley, the Chief Medical Officer of PPFA, explained that PPFA accredits its affiliates. Affiliates are autonomous legal entities, with their own separate boards, executive personnel, and legal counsel.

Dr. McDonald-Mosley further described how PPFA oversees its affiliates and verifies their compliance with its fetal tissue donation guidance. Each affiliate is independently responsible for ensuring compliance with the guidance, as well as with all applicable state and federal laws.

PPFA oversees its affiliates through an accreditation process, whereby each affiliate is reviewed at least once every three years. Affiliates are evaluated on a range of hundreds of possible elements of performance, including, as of 2013, compliance with PPFA's fetal tissue donation guidance. Accreditation involves both offsite reviews of affiliate documentation as well as onsite reviews that include interviews with staff and direct observation of patient care. Non-compliance with PPFA required standards may affect an affiliate's accreditation status and result in actions that jeopardize that affiliate's ability to continue to use the Planned Parenthood trademark.

Although the precise language of PPFA's fetal tissue guidance has been revised over the years, affiliates have always been required to ensure that their tissue donation programs are in compliance with all state and federal laws, including the prohibition on receiving valuable consideration. For example, an earlier version of the guidance from 2001 provided to the Committee instructs affiliates that federal laws ``forbid the payment or receipt of valuable consideration for fetal tissue. However, they permit `reasonable payments associated with the transportation, implantation, processing, preservation, quality control, or storage' of fetal tissue.'' This guidance was reissued to affiliates in 2011.

Several years ago, PPFA undertook an effort to revise their Manual of Medical Standards and Guidelines (the Manual) by removing those sections not directly related to clinical care. According to Dr. McDonald-

Mosley, the Manual is a desk reference for clinicians for directing medical care. It is intended to assist practitioners in providing regular care for a patient and is revised on a two-year cycle. As a result of this revision effort, the fetal tissue guidance was separated from the Manual and is now a standalone document. It is distributed to affiliates through the PPFA intranet. Dr. Deborah Nucatola, who is PPFA's Senior Director for Medical Services and has had primary responsibility for the Manual since July 2009, explained to Committee staff that guidance on fetal tissue donation was removed from the Manual as part of this process to streamline and remove non-clinical information.

As of November 6, 2013, affiliates are now permitted to facilitate fetal tissue donation without prior approval from PPFA. PPFA distinguishes between ``core services,'' which all affiliates are required to provide, such as well-women visits and education and prescribing for all FDA-approved methods of contraception, and services which are voluntary or optional for affiliates to offer. Earlier versions of the fetal tissue guidance instructed affiliates to ``submit a written request to initiate an aborted tissue and/or blood donation program to PPFA for review and approval.'' According to PPFA, it ``implemented this policy change as part of a broader effort to reduce the administrative burden on affiliates and support affiliate service expansion.

This overhaul affected other services besides facilitation of tissue donation; PPFA no longer requires prior approval for an affiliate to offer certain other non-core services.''
ii. PPFA Guidance to Affiliates Includes Additional Requirements Pertaining to Fetal Tissue Transplantation Research, Although This is Not Required by Law

Federal law imposes additional requirements on providers and on researchers when the donated tissue is used in federally funded research involving the transplantation of human fetal tissue for therapeutic purposes. Under the statute, human fetal tissue may be used in federally funded research on the transplantation of fetal tissue if the attending physician declares in writing 1) that the woman's consent for abortion was obtained prior to requesting or obtaining consent to donate the fetal tissue for research; 2) that the timing, method, or procedure used to terminate the pregnancy were not altered in order to obtain the tissue; 3) that the abortion was performed in accordance with applicable state law; and 4) the woman has been fully informed of the physician's interest, if any, in the research, and of any medical or privacy risks associated with the tissue donation.

According to the National Institutes of Health (NIH), the federal government has not funded any fetal tissue transplantation research since 2007. The federal rules relating to the timing and method of abortion are therefore not applicable to any recent fetal tissue donations in the United States. However, PPFA's fetal tissue donation guidance nonetheless incorporates these requirements as recommended practices for affiliates. The 2015 PPFA guidance provides:

Federal law establishes additional requirements applicable whenever the research involving fetal tissue is conducted or supported by the federal government. PPFA recommends that these requirements be adhered to without regard to whether the tissue donation program is federally supported or not. These requirements are:

1. That the client's consent to donate not be sought until after she has decided to have an abortion and has signed the consent form for the abortion.

2. That the client acknowledge that the blood or tissue is being donated as a gift and that she will not be paid.

3. That the client acknowledge that she has not been told and that she has no control over who will get the donated blood and/or tissue or what it will be used for.

4. That there will be no changes to how or when the abortion is done in order to obtain the blood or tissue.

The guidance further instructs affiliates that ``It must be documented that no substantive alteration in the timing of terminating the pregnancy or of the method used was made for the purpose of obtaining the blood and/or tissue.''

Similarly, earlier versions of the PPFA guidance required the clinician to make a notation that: ``[a]borted tissue was donated,'' ``[c]onsent for the abortion was obtained prior to requesting or obtaining consent for the tissue donation,'' and ``[n]o substantive alteration in the timing of terminating the pregnancy or of the method used was made for the purpose of obtaining the tissue.'' Previous versions of the guidance also required specific language in consent forms used for tissue donation. These versions were issued under the previous system, in which affiliates were required to seek service approval from PPFA for tissue donation programs.

Appended to PPFA's May 2015 guidance is a recommended sample consent form, which prompts the patient who is donating tissue to affirm the following statements:

Before I was shown this consent, I had already decided to have an abortion and signed a consent form for it.

I agree to give my blood and/or the tissue from the abortion as a gift to be used for education, research, or treatment.

I understand I have no control over who will get the donated blood and/or tissue or what it will be used for.

I have not been told the name of any person who might get my donation.

I understand there will be no changes to how or when my abortion is done in order to get my blood or the tissue.

I understand I will not be paid.

I understand that I don't have to give my blood or pregnancy tissue, and this will not affect my current or future care at (affiliate name).

Earlier versions of the guidance included a substantially similar consent form, although use of the consent form was required rather than recommended under the previous system of service approvals by PPFA, and substantive deviations from the consent form required approval from PPFA Medical Services.

B. THERE IS NO EVIDENCE THAT PLANNED PARENTHOOD AFFILIATES KNOWINGLY RECEIVED VALUABLE CONSIDERATION IN EXCHANGE FOR FETAL TISSUE

The Committee has received no evidence that any Planned Parenthood affiliate or employee ever received any ``valuable consideration'' for donated fetal tissue. The information and the documentary evidence received by the Committee support Planned Parenthood's assertions that the few affiliates that have participated in fetal tissue donation comply with the requirement to limit reimbursement to reasonable payments associated with facilitating tissue donation.

In an August 27, 2015, letter to congressional leaders, PPFA President Cecile Richards listed the reimbursement rates at affiliates that are currently or were recently participating in fetal tissue donation. At present, only two out of PPFA's 59 affiliates are participating in fetal tissue donation, and only one affiliate is receiving any reimbursement for costs. An additional four affiliates facilitated fetal tissue donation for research in the past five years. The California affiliate that is currently participating receives a reimbursement of $60 per tissue specimen from a TPO. The other four affiliates, which had participated in fetal tissue donation programs in the past five years, either sought no reimbursement or had reimbursement rates ranging from $45 to $55 per tissue specimen. The letter states, ``[i]n every case, the affiliates report that these amounts were intended to recover only their costs, as allowed under the federal law and our guidance.'' The evidence received by the Committee during the course of this investigation supports this assertion.

The May 2015 tissue donation guidance notes that affiliates ``must be able to demonstrate the reimbursement represents its actual costs.'' Dr. McDonald-Mosley explained that the way that each affiliate determines cost is fact-specific to that affiliate. Dr. Nucatola stated that fetal tissue donation is not a revenue stream for affiliates, and that reimbursement should generally be reasonable for the impact it has on the clinic.

Both the statute governing fetal tissue donation and Planned Parenthood's May 2015 guidance on pregnancy tissue donation outline the exceptions for reimbursement. The types of costs that may arise for clinics facilitating tissue donation include staff time to identify patients who are interested in donating fetal tissue, staff time spent explaining fetal tissue donation and securing consent, staff time spent drawing maternal blood samples, space in the pathology lab, storage of supplies, sterilization of equipment, and other related costs.

In a briefing with the Committee, Cate Dyer, the Chief Executive Officer of StemExpress, stated that it is her understanding that the valuable consideration requirement applies to all fetal tissue her company obtains. The contracts between StemExpress and two Planned Parenthood affiliates state, ``The reasonable costs associated with the services specified in this Agreement shall be fifty-five dollars ($55.00) per POC [product of conception] determined in the clinic to be usable.'' According to Dyer, the reimbursement covers the space and storage at the Planned Parenthood facility, particularly within the lab and pathology departments, sterilization of equipment, and staff participation in consent and facilitating involvement in the clinic. Additionally, clinic staff is also involved in obtaining maternal blood samples for StemExpress, so that the company can screen for infectious diseases. Dyer stated that she believed Planned Parenthood is losing money on fetal tissue donation, given the amount of staff time involved and space StemExpress takes up at the clinics.

In a briefing with Committee staff, Dr. Ben Van Handel, the Executive Director of Novogenix Laboratories, confirmed that at the affiliate where Novogenix has a contract, Planned Parenthood set the price of $45 for services rendered on a per specimen basis. The contract between Novogenix and the Planned Parenthood affiliate states, ``Novogenix will reimburse [the Planned Parenthood affiliate] for reasonable administrative costs associated with the identification of potential donors, as well as the obtaining of informed consent.''

Similarly, in a briefing with Committee staff, Advanced Bioscience Resources (ABR) confirmed that the reimbursement rate at the Planned Parenthood affiliate with which they partner is $60 per patient product of conception. it The contract between ABR and the Planned Parenthood affiliate states:

[Affiliate] will provide, and ABR will pay the reasonable costs for, services and facilities ..... associated with obtaining consents and with the removal of fetal organs and tissues from POCs [products of conception], and their processing, preservation, quality control, transportation, and storage; including appropriate space in which ABR employees can work, disposal services for non-used portions of cadaveric materials, and for seeking consent for donation of tissues and organs from appropriate donors, and maintaining records of such consents so that verification of consent can be supported.

C. THERE IS NO EVIDENCE THAT PLANNED PARENTHOOD PHYSICIANS CONDUCTED INTACT DILATION AND EVACUATION TO PRESERVE FETAL TISSUE

To date, the Committee has received no evidence that any physician employed by Planned Parenthood affiliates has performed an ``intact'' dilation and evacuation (D&E) to preserve fetal tissue for research. CMP claims suggesting that Planned Parenthood physicians are violating the Partial Birth Abortion Act in order to preserve fetal tissue for research appear to have no basis in fact.

There are three primary methods of surgical abortion: D&E, induction of labor, and hysterotomy. D&E is the only method available at Planned Parenthood facilities. In a briefing with Committee staff, Dr. McDonald-Mosley stated to the Committee that the confusion over ``intact'' fetuses is the result of deceptive video editing by CMP, and that she believes that the ``intactness'' that Planned Parenthood staff are referring to is the intactness of the tissue and specific organs. She noted that during most procedures, such as a D&E, the fetus is not delivered intact. She stated there is no evidence that Planned Parenthood staff are removing the fetus in an intact manner.

Similarly, Dr. Nucatola explained that it would be rare for a patient to be sufficiently dilated to deliver an intact fetus. When questioned whether it was possible to do a D&E resulting in an intact fetus, she stated that while possible, no Planned Parenthood physician would intentionally perform such a procedure because to do so would be illegal.

Representatives of all three TPOs also stated to the Committee that the donated fetal tissue specimens they receive do not include intact fetuses.

D. THERE IS NO EVIDENCE THAT PLANNED PARENTHOOD PHYSICIANS ALTERED THE TIMING, METHOD, OR PROCEDURE SOLELY FOR THE PURPOSE OF OBTAINING FETAL TISSUE FOR RESEARCH

To date, the Committee has not obtained any evidence that Planned Parenthood physicians altered the timing, method, or procedure of an abortion solely for the purpose of obtaining fetal tissue for research. The law requires physicians to certify that ``no alteration of the timing, method, or procedures used to terminate the pregnancy was made solely for the purposes of obtaining the tissue.'' Although this section of the law applies only to federally funded research involving transplantation of human fetal tissue for therapeutic purposes, Planned Parenthood has voluntarily incorporated the principles of the law into its tissue donation guidance. The PPFA May 2015 guidance instructs affiliates that ``[i]t must be documented that no substantive alteration in the timing of terminating the pregnancy or of the method used was made for the purpose of obtaining the blood and/or tissue.''

There are limited methods of abortion. At Planned Parenthood affiliates, there are two methods of an early abortion: (1) a medication abortion, and (2) surgical abortion involving mechanical or manual aspiration. For abortions after approximately 13 weeks gestation, the only surgical abortion method available at a Planned Parenthood facility is D&E. A physician's decision about which method to use is made in consultation with the patient.

PPFA has not identified any cases in which changes in methods for abortions were made for the purposes of fetal tissue donation. It is reasonable for providers to make small adjustments in technique for clinical reasons, and such small adjustments would not constitute a change in method or procedure. As is common across the medical profession, techniques are different for each physician, and physicians commonly make clinical judgments to adjust their approach in the course of a surgery.

Dr. Nucatola confirmed that changing the position of the fetus is not a change in the method or procedure; instead, it often needs to be done for patient safety. Although she does not personally change the position of the fetus in her practice, she believes that some physicians may need to convert the fetus to breech position in order to perform the abortion procedure safely; it is a matter of skill and experience.

All Planned Parenthood staff emphasized that patient safety is their top priority. Dr. McDonald-Mosley stated, ``The ultimate goal is the safety of the patient.'' Dr. Nucatola said, ``Patient safety comes first.'' PPFA's August 27, 2015, letter reiterated the same message: ``Our patient's health is our paramount concern.''

Mr. McGOVERN. These heavily edited videos that my friends keep on referring to, again, I think is just a cover for what really is behind all of this, and that is their attempt to criminalize and outlaw abortion in all circumstances.

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Mr. McGOVERN. Madam Speaker, let me just state three facts here: We know that these videos that have been mentioned have been selectively edited; we know for a fact that 90 percent of what Planned Parenthood does is preventive care, including screenings for cervical cancer, nothing to do with abortion; and we know for a fact, because it is the law, that no taxpayer dollars can be used to pay for abortion.

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Mr. McGOVERN. Madam Speaker, the bills that the rule will make in order that are before us today, these bills and others are ongoing attacks that are part of the Republican drumbeat for a government shutdown over women's healthcare choices. It isn't enough to attack women's health. Republicans are now willing to take down the entire Federal Government in their political attacks.

As I mentioned at the outset in my opening statement, the facts are the facts; and I know for some of my colleagues, they are inconvenient and they like to avoid talking about them, but the reality is that these videos that my colleagues are referring to have been selectively edited.

We also know that 90 percent of what Planned Parenthood does is preventive care: cervical cancer screenings, important lifesaving procedures that benefit women. They do preventive care that benefits men as well.

It is also important for my colleagues to realize that there are no Federal funds, no taxpayer dollars that go to fund abortion. That is illegal. That is the law of the land. That is the Hyde amendment.

To shut down these important preventive healthcare services, to kind of advance this agenda that my colleagues on the other side of the aisle have, which is to criminalize abortion under all circumstances--including, many of my colleagues advocate no exceptions even for rape or incest. A young girl who was a victim of rape or incest would be a criminal if she had an abortion.

This is all about taking away a woman's right to choose. That is what this is all about. Planned Parenthood happens to be the pawn, the latest pawn in this debate.

It is interesting. I watched the Republican debate last night. It was really quite entertaining. I heard Donald Trump and Marco Rubio and Ted Cruz say that they would be open to putting civil rights activist Rosa Parks on the $10 bill, but Republicans might be surprised to learn that Rosa Parks sat on the national board of Planned Parenthood Federation of America, the organization that my Republican friends, including the people who invoked her name last night, are now trying to defund.

This is about preserving access to good, quality health care, and I really regret the fact that this has become such a political wedge issue in this Congress, but I get it. I know where my colleagues are coming from. That you would take up the time of this House to do this, which the Senate won't take up and which the President wouldn't sign even if they did, at a time when we have 6 legislative days left before the Federal Government shuts down, I don't know what my colleagues are thinking.

Part of what your job is is to keep this government running; and instead of doing that, we are doing these rightwing message bills that don't even go through regular order, that committees of jurisdiction don't even have a chance to consider, when every Member, Republican or Democrat, is told you can't even amend any of this stuff no matter what kind of idea you have.

This whole process is disgraceful. We need to get our priorities in order here. We ought to protect women's healthcare services; we ought not to be defunding an organization like Planned Parenthood, which does good work all across this country; and we ought to be bringing a bill to the floor to keep this government running.

Madam Speaker, I urge my colleagues to vote ``no'' and defeat the previous question and vote ``no'' on the rule.

I yield back the balance of my time.

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