H.R. 2283, the “Recognizing Community Organizations for Veteran Engagement and Recovery Act”

are provided to our nation's veterans. Although I have questions about a few of the bills being considered, I look forward to addressing our policy concerns and working with the minority on these bills moving forward. In accordance with the committee rules, the subcommittee has contacted the Congressional Budget Office seeking informal preliminary cost estimates for each of the bills being considered this morning. While many of the bills on our agenda will most likely have a we do not have estimates for all the bills on today's mark-up. None of the bills today, as introduced, include the offsets that would be necessary to move the bills forward. However, as we discussed what bills will go to the full committee mark-up and then to the floor, we will add offsets to ensure that we are in accordance with the House rules, and that we are protecting the American taxpayer. I look forward to working with Ranking Member Brownlee and the other members of the subcommittee to find offsets for the common sense proposals considered today. Of note, there are still multiple opportunities to improve and make changes to any of these bills. Ranking Member Brownlee and I will continue working with our colleagues on the committee and any stakeholders that have feedback on these bills, as we continue to work through the legislative process to bring the best bills forward. As I understand it, Ranking Member Brownlee, uh, are you going to forgo uh opening remarks?

I am in the interest of time.

Uh, thank you given uh the vote series coming up, it's greatly appreciated. Um, in uh that case, Ranking Member Brownlee, we're gonna get started. H R twenty-two eighty-three, the recognizing community organizations for veterans engagement and recovery act. I now call up call up H R twenty-two eighty-three. The clerk shall report the bill.

H R twenty-two eighty-three.

The text was circulated in advance pursuant to committee rules. Without objection, the first reading is dispensed with and the bill is now open for any amendment at any point. I recognize myself to offer an amendment in the nature of a substitute. clerk shall report the amendment in the nature of a substitute.

Amendment in the nature of a substitute to HR twenty two eight.

I ask unanimous consent that any further reading of the amendment in the nature of substitute be dispensed with. I ask that it be considered base text for the purposes of the m- of the mark-up. Without objection, so ordered. I now recognize myself for three minutes to explain the amendment in the nature of a substitute. The recover act, introduced by uh Chairman Bost, builds on the concept that we support veterans first. This is good work being done at the VA. There is good work. being done at the VA, but the fact of the matter is that we have poured untold millions of dollars into suicide prevention, but the suicide rate unfortunately remains unchanged. It's not that the VA does not work, but that the VA's gold standard treatment doesn't always work well for everyone or every veteran. For those people, Recover Act is an important piece of legislation that would open new doors to health and healing. This bill would connect veterans to organizations that have shown they can implement innovative and proven approaches to mental health care where the standard therapies have failed. My amendment in the nature of a substitute would require that grant recipients be fully licensed certified and accredited to deliver evidence-based results, and that they would have a demonstrated track record of delivering success. It would also require that providers in this program must demonstrate an understanding of unique veterans' issues. One of the key features of this ANS is the inclusion of family as a part of therapy by allowing grant funds to be used towards family or couples' therapy. There is truly no better caretaker than our loved ones. A veteran's family is an integral part of his or her identity and sense of self, and I truly believe that healing those relationships are a necessary part of healing overall. For these reasons, I am pleased to offer this ANS to such an important bill. I yield back the balance of my time. Do any members wish to be recognized to comment on the amendment and the nature of the substitute?

Uh, I wish not, so I'm sure.

Uh, the chair recognizes ranking member Brownlee for three minutes to speak on the amendment and the nature of the substitute.

Uh thank you uh Madam Chair, I must reiterate uh this morning my strong opposition to this legislation which I also expressed when it was considered at a hearing in January. Uh the VA also expressed significant concerns with this bill, which have not been addressed by this ANS. I must object to the very premise of creating a carve-out grant program for community providers of mental health, when such providers are already eligible to participate in VA's community care program. Like VA, I do not think a grant program is an appropriate mechanism for expanding veterans' access to mental health care. If a community provider or non-profit organization wants to be reimbursed for treating veterans who are not enrolled in VA health care, they should assist the veteran in enrolling in in enrolling in VA health care, or any other federal or commercial health plan for which they are eligible, and bill those payers for service. This bill serves no purpose but to drive more resources to community providers with fewer strings attached and even less accountability than currently exists under VA's existing uh community care program. While I appreciate that in the ANS the majority has added provisions requiring grantees to be accredited and submit plans for their providers to complete uh to complete continuing education with respect to veterans' issues. It does not go far enough. What is what is training with respect to veteran issues? Are we talking about training suicide prevention and lethal means safety? I don't think the majority intends for the training to relate to military and veteran cultural competency because the ANS has inexplicabil inex removed all references to culturally competent care that appeared in the original bill. At our legislative hearing on this bill in January, concerns were raised, by me, by VA's witnesses, and by the minority witness about the risk that this grant program would lead providers to double dip or even triple dip. In addition to receiving a grant, there was nothing barring barring them from also billing VA, Medicare, and other health plans for very same care for the very same veteran. I know that the chairwoman's A and S now prohibits grantees from using grant funds to duplicate payments made by by the VA any other federal payer, or any other health plan. However, because this is a grant program without any claim submitted as veterans are receiving care, there's no way for VA or for this committee to conduct oversight to ensure that these providers are not still billing other payers. This also gives us less oversight into the quality and safety of care delivered by grantees. We'll have no claims, no returned medical records, and no insight at all into whether veterans are actually receiving evidence-based treatments. Furthermore, the ANS now allows grantees to support activities that are not billable, reimbursable, or otherwise authorized by law. That sounds to me like we'd be making grants of up to one point five million dollars per year to cover administrative overhead. Are you gaveling me out, Madam

Yeah, I'm letting you know that your time is expiring.

Chair?

Well, I don't know how much longer we're going, like the word.

Uh, well, I will stop here for these reasons, I simply cannot support this legislation and I yield back.

Thank you, Ranking Member Brownlee, does any other member risk to be recognized to comment on the amendment in nature of substitute. The chair now recognizes Doctor Conaway for three minutes.

Uh, thank you, Madam Chair, and I won't take three minutes. I I just uh can't uh sit here as a a person of color and practice in this.

You can yield your time to ranking member Brownlee if you want.

Oh. I'll b- Well, uh just continuing along, I I'm just uh dismayed that the cultural competent care provisions have been removed from this bill. you know, that we have years and years of research uh telling us, telling us physicians, we physicians, uh that as we deliver our our care plans, present those care plans to the patients, as we discuss um, you know, the um diagnoses, uh that we need to understand uh the, a listener, understand uh who the decision makers are within a family. Some cultures, uh it's a family decision, these decisions, others they are not. Others uh are gonna be concerned about hearing bad news and that should be delivered. Others uh have a different attitude about it. And so if we want people uh we w- if we want good outcomes, if we want people to comply, to agree with and buy into care plans, we need to understand where people are coming from. And that's what culturally, that's all culturally competent care does. Um, it's been shown over and over again to improve outcomes and again, I just have to express my dismay uh that those provisions were taken out of this bill.

Thank you. The gentleman has yielded. Uh, does anyone else wish, does any other member wish to speak to the amendment in the nature of substitute? Uh, seeing none. There were no amendments filed to the amendment in the nature of substitute. Does any member wish to offer an amendment to the amendment in the nature of substitute? Hearing none, the question now occurs on agreeing to the amendment in the nature of a substitute to HR twenty-two, eighty-three. All those in favor say aye. Aye. All those opposed say no. In the opinion of the chair, the ayes have it, and the amendment in the nature of a substitute is agreed to.

Madam Chairwoman, I request a recorded vote.

A recorded vote has been requested pursuant to committee rules. This vote will be postponed. I now call up H R sixty nine ninety three. The clerk shall report the bill.

H R six nine nine three.

The text was circulated in advance pursuant to committee rules. Without objection, the first reading is dispensed with, and the bill is now open for an amendment at any point. I now recognize General Bergman to offer an amendment in the nature of a substitute. The clerk shall report the amendment in the nature of a substitute.

Amendment in the nature of a substitute, to H R six nine nine three.

I ask the man of his consent that further reading of the amendment in the nature of a substitute be dispensed with. I ask that it considered base text for purposes of the mark-up. Without objection, so ordered. General Bergman, you're recognized for three minutes to explain the amendment in the nature of a substitute.

Thank you, Madam Chair. Uh, this is extremely important that we're talking about the Beacon Act today. I wanna start with this. The bill before the subcommittee today is the product of serious bipartisan work. There's been a lot of back and forth with members, staff, stakeholders and experts to get this bill into a better place than where it started. This is not just the introduced version with a fresh coat of paint. This is a more disciplined, more accountable and more responsive product that reflects legitimate concerns raised by both sides. I hold up as an example here just the red-lined original version. That is, you could go through every page here, and the red line is a result of a bipartisan sit-down among people who wanted to make this better. Since two thousand, hundreds of thousands of veterans have sustained a traumatic brain injury. And for far too many, especially those suffering from chronic mild TBI, the effects do not just go away. They linger, they affect mental health, day-to-day functioning, family life, and long-term recovery. So the question is simple. Are we willing to responsibly test, evaluate, and learn more about the approaches that may help veterans recover? I believe we should be. Isn't that what we're supposed to do, is look at through research experimentation better ways to do things, no matter what the bill. The Beacon Act creates two targeted grant programs focused on the chronic mild TBI. One supports innovation and clinical evaluation. The other supports independent research aimed at identifying what actually works and what may warrant broader adoption. And let me address a few points directly. First, this bill does not, I repeat, does not privatize VA care. It does not move veterans out of the VA and it does not replace VA's existing treatment or research. The text is clear that these efforts are meant to supplement, not supplant the departments' work while coordinating with VA facilities for referrals, continuity of care, and dissemination of findings. VA stays in charge. Veterans stay connected to VA. Second, the bill is not about chasing fringe treatments. It is built around randomized, controlled trials, ethical studies, outcome measurement, and independent evaluation. In plain English, prove what works, prove what does not, and follow the evidence. Third, this bill includes real guardrails. It requires detailed applications, budget, evaluation plans, patient safety protections, and reporting on outcomes, expenditures, and adverse ad- adverse events We're collected. And if a grantee fails to comply, the secretary can suspend, modify, or terminate the grant. These programs also sunset after three years, with annual review and reporting to Congress. So this is the time-limited, accountable effort to build evidence and improve care. It is responsible, it is rigorous, and focused on getting better answers for veterans living with the lasting effects of termi-

Do any members wish to be recognized to comment on the amendment in nature of a substitute?

Uh, Madam Chair.

The chair now recognizes ranking member Brownlee. For three minutes.

Got it. Um, uh, thank you, uh, Madam Chair. I first want to note that I appreciate that this amendment in the nature of a subst substitute represents several improvements to the bill as drafted and that an effort was made to address several of the concerns committee democrats have raised with this legislation since the legislative hearing where it was considered in January unfortunately this ans does not reflect all of the changes that my staff have communicated to the sponsors that would be needed in order for democrats and ranking member to to be comfortable Moving forward with the legislation, in the absence of those changes in the ANS, my colleagues and I will be offering what we believe are common sense amendments to address these outstanding concerns, improve the legislation, and ensure that Congress can conduct necessary oversight of the grant programs this bill creates. I believe that in the pursuit of passing legislation that creates good policy, this committee must take every opportunity to discuss and debate amendments to legislation. The subcommittee mark-up is an important opportunity to ensure that we have a robust discussion before this bill advances to consideration at the full committee level and I hope my colleagues will be willing to engage in this process and recognize these amendment amendments for what they are a good faith effort to improve this legislation and ensure that legislation that passes out of this subcommittee is as strong as possible and reflects bipartisan efforts to serve veterans. In that spirit, I hope that all my colleagues will join us in discussing and supporting the amendments that we will offer to this ANS and with that I yield back.

The gentlelady yields. The chair now recognizes representative Van Orden for three minutes for uh any comments on

Thank you, Madam Chair. Uh, a couple of months ago I I buried a guy named Matt Burns. He's the twenty-second one of my friends. and colleagues that have committed suicide. Uh, he was a Navy SEAL, he was a machine gunner. He was a a rocketeer. He was a uh assistant breacher. Um, I was a special operations independent duty corpsman. Uh, and I was also his platoon chief. To my knowledge, Matthew never sustained a concussion. He didn't. Uh, he was honorably discharged after his service. But something was wrong with Matthew. he wound up, uh, like I said, killing himself. And we don't know why. And I'm, I'm personally done with going to funerals.

He didn't serve.

Is this legislation perfect? No. Is it an eighty percent solution? Yes. If I could get back eighty percent of my friends that have committed suicide, it's worth it. We don't have time. I'ma talk about another one of these bills later. We don't have time anymore. for discussion and debate and all this, you know, th- this is a solid piece of legislation that could potentially save more of my friends' lives. And so I strongly urge my colleagues to support this legislation. As written, I yield.

The gentleman yields. The chair now recognizes Doctor Morrison for three minutes for any comments she may have on the ANS.

Thank you, Madam Chair, and I have an amendment at the desk.

Um, we're not yet on amendments.

Oh, OK. Madam Chair, I will wait until we are.

The gentlelady yields. Does any other member wish to comment on the uh, ANS? Seeing none, does any member wish to offer an amendment to the amendment in the nature of a substitute? Excuse me?

Point of order, um, is this on the amendment number one?

This is on the ANS. And now we're gonna offer amendments.

And this is on the number one. So on that, it's not the amendment to the ANS.

I

Correct.

I just wanted to make sure.

Yes, sir.

Okay.

We're going there now. If we may proceed, the chair now recognize uh Representative Morrison to offer an amendment in the nature an amendment to the amendment in the nature of a substitute.

Thank you, Madam Chair. I do have an amendment to the amendment in the nature of a substitute at the desk.

The clerk shall report the amendment.

Morrison, amendment two.

I ask unanimous consent for the reading of the amendment be dispensed with, without objection, so ordered. Uh, the gentlelady, Doctor Morrison, uh, is now recognized for three minutes to explain the amendment to the ANS.

Thank you, Madam Chair. My amendment would strengthen oversight requirements throughout the bill. VA and Congress need to be able to perform robust oversight of the grant program to insure and protect VA's invent investment in TBI research. I appreciate the additions in the ANS offered to strengthen many of the oversight and reporting requirements in the bill. It's important to me that the language is enforceable, effective, and rooted in evidence-based science. This is especially true when establishing expectations reporting adverse events related to any clinical trials or care provided outside of VA to veterans. My amendment strengthens the requirement for grantees to track adverse events and report them to VA. My amendment also ensures that the grantees use ex- use accepted clinical standards to evaluate the success of the program and ensures VA also considers the cessation of the grant program as part of its annual review if it is demonstrated that the program is not working as intended or delivering on VA's investment. Finally, my amendment also expands the reporting requirements in the bill to ensure Congress and VA receive all the information necessary to evaluate whether the grant program is an effective use of VA investment I hope my colleagues will agree that my amendment further strengthens oversight and transparency for these grant programs with a clear focus on delivering for veterans. I urge my colleagues to vote in favor of this amendment and recognize the value of due diligence when it comes to oversight of taxpayer dollars. Passing this amendment safeguards meaningful progress toward delivering on the important aims researched at the VA. has successfully pursued for decades. With that, Madam Chair, I yield back.

The General Lady yields. The Chair now recognizes herself for three minutes uh in opposition to the amendment. At its core, this program is designed to expand access to innovative care and generate meaningful real-world outcomes for veterans. The amendment would pose additional prescriptive requirements and reporting layers that risk slowing down implementation and shifting the focus away from delivering care to veterans and towards compliance with the process. From a policy standpoint, Republicans have consistently supported efforts that prioritize results over bureaucracy. And given that the suicide rate has not moved in decades for our veterans, um, as has been previously stated, the time is now. This amendment would do the opposite. By mandating additional clinical standard language and expanding reporting requirements, it would insert federal micro-management into what should be a flexible outcomes-driven grant program. We already expect grantees to operate responsibly and deliver results. Overly rigid statutory requirements, like those that would be added here, can unintentionally exclude capable providers, delay program execution, and increase administrative burden without improving outcomes. At the end of the day, this program should be judged by whether it improves veterans' health outcomes not by how many reports are generated or how tightly Washington dictates clinical processes. Does any member wish to other member wish to comment on the amendment to the ANS? Seeing none, the question now occurs on agreeing to the Morrison

Oh, I have

amendment to the amendment in the nature of a substitute.

No. I I'm not commenting on her amendment. This is not we're not doing.

We're doing her amendment. OK. Uh, seeing none, the question now occurs on agreeing to the Morrison amendment to the amendment in nature of substitute. All of those in favor say aye. All of those opposed say no. No. In the opinion of the chair,

Madam Chairman, I request a recorded vote.

the noes A recorded vote has been requested. Pursuant to committee rules, this vote will be postponed. Does any other member uh have an amendment to the ANS?

I'm sure I have an amendment to the ANS.

The chair recognizes representative Conway to offer an amendment to the amendment in the nature of a substitute.

Thank you uh Madam Chair, my amendment would simply lower the maximum grant amount per grant.

Doctor Conway has an amendment at the desk. The clerk shall report the amendment.

Conway, amendment to the amendment in

I ask unanimous consent that further reading the

Thank you, Madam Chair. Uh, my amendment will simply lower the maximum grant amount per grantee uh for the grant program created in section two of this bill from five million to two and a half million per f- per fiscal year. This will ensure that the VA can invest in more clinical trial efforts to develop and improve treatments for mild TBI veterans while still respecting uh the investment necessary to ensure successful clinical trials. I agree wholeheartedly that we need to lean into this area as quickly as we can, and hopefully by bringing more um uh researchers to the table we can do just that. Uh given that the bill authorizes ten million in total grants under the first grant program setting, setting the maximum allowable award at five million dollars would mean that this grant program may only fund two clinical trials per fiscal year, if VA awards each grantee the highest amount possible. As a physician, I'm uh very aware that not every clinical trial is guaranteed to be successful. Therefore, I believe to the to give the VA the best possible chance of investing in successful trials we should spread the wealth uh and fund as many trials as we can. I want to acknowledge that I'm also aware of the cost of clinical trials. However, I would note that under this grant program, the VA does not have to be the only funding stream contributing to clinical trials. I would hope that the grantees under this legislation would agree with me, uh that this um uh effort will maximize VA investment and as many new trials as possible, and they would uh be able to pursue additional avenues of support uh for the clinical trials they pursue in order to insure uh that the VAA is n- is not the only responsible entity for um funding uh these uh contemplated trials. If we're serious about maximizing the developments and discoveries we make through this grant program, we need to insure that we're investing this funding wisely in seeking breakthroughs through as many routes as possible. My amendment will do exactly that and I urge my colleagues to support it. Thank you.

Doctor Conaway yields.

And I yield.

Uh, the chair now recognizes herself uh for three minutes in opposition of the amendment. Uh, I truly appreciate Doctor Conaway Co- Doctor Conaway's, excuse me Doctor Conaway, Doctor Conaway's uh salient remarks and the need to ensure that more research can exist. However, uh, this amendment that reduces the cap for an eligible uh entity uh that receives this grant from five million to two million dollars uh may s- uh not simply scale projects down in many cases it can force researchers to eliminate components of a study reduce enrollment for clinical research delay or restrict necessary milestones needed to complete the project and research underfunded projects often take longer to complete, require additional administrative cost, or fail to produce actionable outcomes. which is the point of these programs, actual outcomes. After the legislative hearing when the bill was first discussed, our side committed to work with my colleagues, our colleagues on the other side of the aisle, to hear their concerns. Uh, our staff worked with the minority to address those concerns and craft an ANS with all those in mind. The ANS reflects many changes from, uh, the original text, which I hope can demonstrate our collaboration during the negotiation process. Lowering the funding cap may discourage participation from smaller organizations, universities, and emerging research. institutions. Many of these institutions or entities rely on adequate funding levels to offset the administrative staffing and infrastructure cost associated with federal research grants if the available funding does not support a complete project fewer organizations may apply and fewer innovative ideas may be brought forward the outcome would narrow the field of applicants in an area where innovation is critically important at the end of the day, the goal of this program is not simply to fund research it's to fund research that produces meaningful results. Cutting the cap in half, risk slowing progress, discouraging participation, and reducing the effectiveness of a of a program as a whole. For this reason, I oppose this amendment. Does any other member wish to speak on the amendment to the ANS? Seeing none, the question now occurs on agreeing to the uh, Doctor Conaway amendment to the amendment in the nature of a substitute. All those in favor say aye.

Aye.

All those opposed say no. No. In the appendment

I request a recorded vote, please.

A recorded vote has been requested. Pursuant to committee rules, this vote will be postponed. Do any other members wish to offer an amendment to the ANS?

Uh, yes. Um, Madam Chair, I have an amendment to the amendment in the nature of a substitute to HR sixty nine ninety-three at the best.

The chair recognize uh the ranking member to um

Brownlee Amendment Number One, Amendment Two D Number One.

I ask unanimous consent that further reading of the amendment be dispensed with, without objection so ordered. The ranking member is now recognized for three minutes to explain the amendment.

Uh, thank you, Madam Chair. My amendment strikes provisions in the ANS that direct VA to pay for the two grant programs using the existing budgets of VA's National Center for PTSD, and VA's mental health services. If Congress doesn't appropriate specific funds for the two grant programs. Creating a new pilot is not a cost-free undertaking for VA. If this bill becomes law, the department will be required to administer not one but two grant programs even in the absence of appropriated funding. Given that we are uh an authorizing committee and not an appropriating committee, we unfortunately have no direct control over whether sufficient funds will be appropriated to allow VA to carry out these grant programs. In the unfortunate event that sufficient funding is not appropriated, I worry this ANS leaves VA no choice but to divert funding from its existing funds for the National Center for PTSD and Veterans Mental Health Services to carry out these program these program grants I support investing in new research, but we must ensure we are pursuing these investments in a responsible manner text resources from existing VA research programs and clinical services. I can't recall ever seeing provisions like this in any other legislation we've advanced during my time on this committee, and I don't think we should set that precedent now. I appreciate that uh Representative Bergman's ANS includes language directing VA to carry out the grant programs in a way that he says supplements, and does not supplant. other clinical care and research funding. However, I can't see how this can be possible given that VA could be required to repurpose funds that have already been appropriated for these purposes. As many of my colleagues across the aisle have pointed out, there is a massive need for mental health services and PDSD care and research for veterans if we are serious about decreasing the annual suicide rate, as I know my colleagues are, we must existing research investments and dedicated funding streams for the provisions of care. That is not to take away from the need for more research into in improving TBI treatments, which certainly contributes to meeting the mental health needs of veterans. However, VA has a duty to ensure it can provide mental health care to all eligible veterans, not just those who may potentially receive experimental treatments through these grant programs. That is why it's important to ensure that this funding is new funding and that there is no risk that existing VA funding will be diverted to fulfill VA's requirement to administer this grant. I take uh Representative Bergman at his word that this is not his intent to divert that funding, and I appreciate the attempt to guard against that. However, removing the language entirely will also remove all doubt or uncertainty that existing programs would be impacted. I I would also note that the ANS not only includes language authorizing appropriations but also includes provisions to extend the authority to collect VA home loan fees to ensure that the costs of this legislation are covered given that we've we we're authorizing appropriations and we're including provisions to offset the cost of the legislation language that directs VA to use its existing funding should no longer be necessary I urge my colleagues to support my amendment to protect VA's existing funding for mental health and PDS.

The ranking member yields. The chair now recognizes General Bergman to speak in opposition to the amendment.

Thank you, Madam Chair. This amendment to the NS offered by Ms. Brownlee would eliminate the secretary's ability to utilize existing mental health and traumatic brain injury programs, even where those funds are used to supplement, not supplant, current services. That language was included in the ANS after conversations with the co-lead on this bill uh Representative Elfret to address concerns raised by the minority that the bill could draw resources away from existing programs. We took those concerns seriously and worked in a good faith bipartisan manner to incorporate language that preserves existing services while giving the department the flexibility it needs to stand these programs up quickly and responsibly. Striking that authority would create unnecessary funding uncertainty that could slow implementation and ultimately delay access to neural rehabilitation treatments for veterans suffering from TBI. Veterans should not be forced to wait because of unaffordable, excuse me, because of avoidable bureaucratic constraints caused by unnecessary funding restraints. The ANS already includes strong safeguards, clear oversight, accountability measures, and reporting requirements to ensure that all taxpayers' dollars are used appropriately. Removing this funding flexibility does not strengthen oversight. It only makes execution more difficult. At a time when we are working to expand treatment options, support research, and improve outcomes for veterans with TBI, This amendment moves us in the wrong direction. For these reasons, I strongly oppose this amendment. Madam Chair, I yield back.

The gentleman yields. Does any other member wish to comment on the amendment to the amendment in the nature of a substitute? Seeing none, the question now occurs on agreeing to the Brownlee amendment So s- number one to the amendment in the nature of a substitute. All those in favor say aye.

Aye.

All those opposed say no. No. In the opinion of the chair, the no's have it, and the amendment is not agreed to. You wish to ask for a recorded vote?

I, yes, I do, Madam Chair. Thank you for helping me out.

Uh, a recorded vote has been requested pursuant to committee rules. Uh, this vote will be postponed. I now recognize ranking member Brownlee to an offer amendment number two to the amendment in the nature of a substitute. Does the ranking member have amendment at the desk? The ranking member has an amendment at the desk. The clerk shall report the amendment.

Brownlee, amendment number two, amendment to the amendment,

I ask unanimous consent that further reading

ADE.

of the amendment be dispensed.

My amendment will prohibit grantees from receiving grants under both programs during the same fiscal year. As written, it's possible under the ANS for a single guarantee grantee to receive up to six point five million dollars in a single fiscal year, five million under the first grant program, and one point five million under the second. I don't believe the intent of the legislation is to allow one entity to double dip in both grant programs. Given that the two grant programs are structured very differently and have different objectives in terms of the outcomes they are designed to develop. To develop it would not make very much sense for one entity to receive both grants regardless. My amendment will simply ensure that the legislation is clear on this front, and ensure that VA and any eligible entities understand the intent of the bill. I hope my colleagues will recognize this as a clarifying amendment that it is and and that it is and join me in supporting it without a yield back.

The ranking member yields. I recognize myself for three minutes in opposition to the amendment. This amendment would limit entities receiving no more than one grant award through the Beacon Act per fiscal year. While I share uh the ranking member's sentiments towards double dipping, this would undercut exactly the kinds of outcomes this bill is trying to achieve. This amendment would treat entire entities as a single program, when in reality entities such as UCLA have multiple distinct programs regarding TBI and neural rehabilitation research. Programs like UCLA Operation MIND and the UCLA Brain Injury Research Center serve complementary but separate roles one generates research while the other provides care and generates evidence to improve care. Both play a meaningful role in improving veterans' mental health and needlessly creating barriers to funding these programs and others like them could hinder the advancement of their research. A one grant cap would force internal competition between mutually beneficial programs rather than funding the full continuum of care and research especially when there's limited programs available. This amendment would penalize how perform high-performing research institutions pillars of research and care in a complex and underfunded field. This amendment would force entities to fragment and thinly spread what is already limited funding across multiple programs. That alone will increase administrative overhead and reduce measurable impacts lowering competition in the industry, and increasing it among complementary programs. There is progress being made in TBI research and this amendment would risk weakening the needs uh required to continue that progress for effective research and treatment. For these reasons I oppose this amendment. Does any other member wish to comment on the amendment to the ANS? Seeing none. Seeing none, the question now occurs on agreeing to the Brownlee amendment number two to the amendment in the nature of substitute. All those in favor say aye.

Aye.

All those opposed say no. No. In the opinion of the chair, the noes have it and the amendment is not agreed to. Does the ranking member w-

I do indeed request a recorded vote.

A recorded vote has been requested. Pursuant to committee rules, this vote will be postponed. Are there any other amendments to the amendment in the nature of a substitute? Hearing none, since there are votes pending, we will move to uh to the next item on the agenda. On block number one, H R sixty-six fifty-two, H R sixty-four forty-four, H R fifty-nine ninety-nine. I now ask unanimous consent to consider on block the following three bills, which each have an amendment in the nature of a substitute, H R sixty-six fifty-two, H R sixty-

On block number one.

The bills were circulated in advance pursuant to committee rules. I ask that the reading of the bills be dispensed with and the bills be opened to amendment at any point. Without objection, so ordered. Does any member wish to speak on any of the bills included in the on block?

Madam Chair, I wish to speak.

The chair

Madam Chair, I wish to speak on six six five twelve.

The chair now recognizes the ranking member.

Uh, uh, thank you, um, Madam Chair, I'm glad that this On block concludes Doctor Conaway's bill, HR uh fifty ninety nine, the Veterans Opioid Emergency Treatment Act. This bill will help protect veterans from opioid overdoses by providing streamlined access to Naloxin Naloxin? Naloxin?

Naloxin.

Naloxin.

Thank you. For veterans at VA facilities. Uh opioid uh uh opioid overdoses has been devastating for the veteran community, but quick access to

Life-saving.

Can save lives. I thank Doctor Conaway for his work to improve access to life-saving opioid overdose medications for veterans. I'd also like to express my support for the ANS to Representative King's King-Hyne's bill, HR sixty-six fifty-two, the US Vets of the FAS Act. This legislation will improve access to care for veterans living in the freely associated states and US territories, including Representative King Hynde's home of the Norther Northern Mariana Mariana Islands. I understand committee staff recently returned from traveling there to see firsthand the unique needs of veterans living in this U. S. territory. I appreciate Representative King Hynde's leadership in meeting those needs through this legislation and am very proud to support it. I also understand that a super typh ty typhoon had impacted the Northern Mariana Islands. I think when I went to Mariana Islands many years ago, the same exact same thing happened. Um, and my thoughts are with Representative King-Hines, her family and the community there. I'm glad to support all of the legislation included in the en bloc and urge my colleagues to do the same I yield back.

The chair now recognizes Representative King-Hines for three minutes to speak on her amendment.

Thank you, Chairwoman Miller-Mixon, Ranking Member Brownlee, and and thank you uh for um Remembering the people of the Northern Marianas during this difficult time. And thank you for including my bill, HR six six five two, the US Vets of the Freely Associated States Act in today's subcommittee market mark-up. The United States recruits heavily in the freely associated states, the Federated States of Micronesia, the Republic of Marshall Islands, and the Republic of Palau, and residents of these nations served in our armed forces at exceptionally high rates yet when these veterans return home they face significant barriers to accessing the full benefits they have earned, particularly when it comes to medical care. Veterans in the freely associated States deserve dependable access to the care promised to them for their service. This bill reinforces the commitment Congress reaffirmed in twenty twenty four, renewal of the compact of freely asso of the free association and ensures that the Department of Veterans Affairs fulfills that obligation. H R six six five two requires the VA to merely provide telehealth and mail-order pharmacy services to veterans residing in FAS states. It's it also sets a clear timeline for finalizing agreements with fast governments and Hans's beneficiary travel support and institute's regular reporting to Congress to ensure accountability and progress. There's no mandate to construct hospitals or other facilities, no commitment to assign VA personnel to these islands and no requirement for significant new funding. When Congress renewed the COFA Act, the intent was clear, expand access to care and remove geographic or administrative barriers. Yet implementation has lagged and too many veterans are still waiting. This legislation does not create new or burdensome programs, it simply ensures that long-standing commitments are honored. It provides clarity, consistency, and accountability so that these veterans and their families can depend on the care they were promised. Veterans in the freely associated states have held their end of the bargain through their honorable service. Congress acted with clear intent to improve VA services for fast veterans in the renewal of the COFA. Now it is time for the VA to do its part. This legislation sends a clear message. The United States keeps its promises, especially to those who have served and to our closest allies. I urge my colleagues to support the amendment in the nature of a substitute to HR six six five two. Thank you and I yield back.

Uh, the gentlelady yields, uh, thank you, Representative King-Hines. Does any other member wish to speak on any of the amendments in the nature of a substitute HR sixty-six fifty-two, HR sixty-four forty-four? H R fifty nine ninety nine that are included in the en bloc. The chair now recognizes Doctor Conaway for three minutes to speak on uh his ANS uh H R fifty nine ninety nine.

Uh thank you uh Madam Chair uh for the opportunity to speak on my bill uh H R fifty nine ninety nine the Veteran Opioid Emergency Treatment Act. Uh this bill would direct the VA to provide an opioid antagonist such as Naloxone at no cost to veterans without need for a prescription. Earlier this year during a testimony that this committee uh took, a VA administrator stated that the VA already provides Naloxone without requiring co-payment uh although a prescription is still required. In the VA written testimony, they make it clear stating that all over the counter medications like Naloxone dispensed by a VHA require a prescription, which allows for accountability of procured pharmak- pharmaceuticals and stewardship of government resources. The current uh standard process at the VA for a veteran to obtain an opioid antagonist, such as naloxone, uh is that the veteran must receive a prescription from their VA health care provider, and only then will the veteran be able to obtain this life-saving treatment. While I appreciate the VA has taken steps to streamline um access to naloxone at its facilities, I'm sure we can all agree that the current process is flawed uh and that uh prescription requirements set unnecessary barriers for many veterans trying to access to naloxone. Uh, we must ensure that we eliminate as many obstacles as possible to allow veterans access to medication that may save their life in case of an opioid overdose. Uh, my common sense legislation works to fix fix this process by eliminating prescription requirements and co-payments. Uh, all veterans will have the ability to obtain an opioid antagonist such as naloxone. When studies show that two point eight million veterans reported having at least one substance use disorder in the previous year, and one in four veterans on long-term opioid treatment will be diagnosed with substance use disorder. It remains clear that this time of legislation must be voted favorably out of this subcommittee I encourage all my colleagues to support this bill and I yield back.

The gentleman yields. Does any other member wish to speak on any of the amendments to the en bloc? The chair now recognizes Doctor Morrison.

Thank you, Madam Chair. As one of the millions of physicians who did part of my training in the VA system, I've seen firsthand the unique veterans face when it comes to mental health, substance use, and overdose risk. As our country continues to confront the opioid crisis, I remain deeply concerned for our veterans, who research consistently shows are at higher risk of overdose death, often compounded by chronic pain, service-related injuries and trauma. My experience as a physician is a big part of what led me to serve in Congress, where I continue to see how difficult it is to navigate the health care system, especially for those with complex or stigmatized needs. Supporting veterans experiencing this elevated risk requires deliberate sustained effort to break down barriers to care. I'm proud to help advance policies that reflect the continued urgency to prevent overdose deaths among those that have sacrificed so much for us. I'm proud to partner with Congressman Conway on H R five nine nine nine, the Veteran Opioid Emergency Treatment Act. This initiative is an important step forward reducing barriers to accessing Naloxone a life-saving medication that can rapidly reverse an opioid overdose. In critical moments, access to this medication should never be limited by cost or the difficulty of securing an appointment. I'm encouraged to see this bill move forward in the process and grateful for its inclusion in today's mark-up. I look forward to continuing to work with Dr. Conway and my colleagues to carry this legislation forward and hope each member of this committee will join us in meeting veterans where they are, in helping save lives. I yield back, Madam Chair. Thank you.

The gentlelady yields. Does any other member wish to speak on the amendments in the nature of seeing none? Does any member wish to offer an amendment to either of the amendments in the nature of a substitute included in the en bloc? Hearing none, the question now occurs on agreeing to each of the amendments in the nature of a substitute included on the en bloc. All those in favor say aye.

Aye.

Aye. All those opposed say no. In the opinion of the chair, the ayes have it. Without objection, the motion to reconsider is laid upon the table. I r- now recognize ranking member Brownlee for a motion.

Thank you, Madam Chair, I move that the bills

There is a motion to favorably forward the bills included in the en bloc to the full committee. All those in favor say aye.

Aye.

Aye. All those opposed say no. And the opinion of the chair, the ayes have it, and the bills are favorably forwarded to the full committee. The motion to reconsider. My apologies. I now uh bring up H R six thousand and one, the Veterans with ALS Reporting Act. I now call up H R six six zero zero one. The clerk shall report the bill.

H R six zero zero one.

The text was circulated in advance pursuant to committee rules. Without objection, the first reading is dispensed with. This bill is now open for an amendment at any point. Without objection, so ordered. Do any members wish to speak on the bill?

Madam Chair, I wish to speak.

The chair now recognizes ranking min- member Brownlee for three minutes to speak on the bill.

Thank you, Madam Chair. This bill will require VA to improve research a- access to clinical trials and data reporting on veterans with ALS to ensure we are doing all we can to support those fighting this devastating disease. ALS, sometimes called Lou Gehrig's disease, is a tragic and always fatal disease. It robs patients of their ability to control their muscles. To this day, neither the cause nor prevention of ALS is fully understood and there is no cure. However, we do know that veterans are about one point five times more likely than non-veterans to get ALS. We still don't know enough about why veterans are at such higher risk. It's clear that VA as an agency and Congress as a matter of policy must take the prevalence of ALS very seriously. VA already takes steps to do this by recognizing ALS as a service-connected disability and veterans diagnosed with ALS immediately receive a one hundred percent disability rating VA is also undertaking research into the causes and ways of treating ALS Representative Crow's bill will simply require VA to take additional steps to collect data on the prevalence of ALS within veteran communities and to develop strategies to lower the incidence of ALS among veterans. Perhaps most importantly, the bill requires VA to create a strategy for increasing access to clinical trials for veterans with ALS. For veterans with ALS and their families, access to a clinical trial can be a lifetime to hope and to living more comfortably in the face of a devastating disease. No veteran who has served their country should face an ALS diagnosis without being provided every possible tool to to fight it. I know every member of this committee wants to do everything we can to help veterans in this fight. I thank Representative Crow for his leadership on his legislation and I urge all of my colleagues to support this critical bill to show this committee's commitment to helping veterans with ALS. I yield back.

The ranking member yields, the chair now recognizes Representative Van Worden for three minutes.

Thank you, Madam Chair. Um, hey, I do appreciate the uh sentiment for HR six zero zero one, but honestly, it does nothing. It it is a study. Uh, and it's not supposed to take place for another year. Uh, that will be a year to get it done here, a year to study, another year to try to figure out this strategy and implementation. Fifty percent of the veterans that are diagnosed with ALS today will be dead by then. So, I've been in Congress for three years, and I've realized that we study a lot of stuff and we don't, we don't, we don't do much. And it's time to do something about this. So I have a piece of legislation that will be shortly introduced that actually forces the VA to act. Um, Lou Gehrig died eighty-five years ago. And we've been studying ALS and, and uh, the ranking member very aptly pointed out that the fact that we already know that veterans are one and a half times. more likely to get ALS. We already know all these things, and it's time to time to start acting. I I referenced this earlier, we the one thing we can never get back is time. And and Congress is is fantastic at one thing and that's wasting time. And and I appreciate Mister Crow's sentiment, we're both special operations uh operators, and uh I understand what he's trying to accomplish, but I don't think we're gonna accomplish anything by doing this. And I believe once you read the legislation it'll be very shortly introduced, you'll find out that within ninety days uh the VA is gonna have to do something and every single uh veteran that has diagnosed with ALS will have the VO have thirty days maximum to get them involved in any type of potential program that can help them including experimental treatments and so with that I I'm I I strongly oppose this piece of legislation legislation for those stated reasons and I encourage my colleagues to do so I yield.

The gentleman yields. Does any other member wish to speak on The chair now recognizes Doctor Dexter for three minutes.

Thank you so much, Madam Chair, and and I r- respect very much the intention, um, of my colleague to take action. This is a very, uh, extraordinary disease. That all being said, the fact that we don't know why veterans are more likely to have ALS, the understanding that we still fail to have around the underlying etiology for the disease absolutely means we need ongoing study, and this is an important bill for us to have that information that is veteran-centered. I know you all know this, but I am a pulmonary and critical care doctor. That is what we diagnose, and if you don't know what the situation is that predisposes people to developing the illness, you cannot anticipatory l- or you cannot understand when someone comes in with shortness of breath, to think about ALS. It is not one of the top things you think about because it is a r- relatively rare disease, but when you know, for instance, silicosis, when there are certain occupational predispositions that we know, we don't know what it is with ALS yet. So it is absolutely imperative that study is in- embarked upon. So, I - I don't disagree that analysis paralysis is sometimes a way of kicking the can down the f- the road. That is not the situation here. We need to understand what the situational and occupational um um issues or exposures are that predispose people to this illness. So this is a very important piece of legislation, and I do absolutely agree with the ranking member that we all want the right thing for our veterans. We can do two things at once. We can consider whether taking action when we know the diagnosis is important and appropriate. We also need to know how physicians and clinicians can anticipate that somebody should be watched for evidence of it before it's ever diagnosed and and this disease process is one that you can um keep people high functioning and independent for longer if you know the diagnosis before it's already too late without a yield back.

The gentle lady yields. Does any member wish to offer an amendment to any of these things? Hearing none, I round now recognize ranking member Brownlee for an emot for a motion.

Madam Chair. Um.

For a motion?

The

May I respond?

the the chair Does another member wish to speak on the amendment and yield their time to Representative Vanwarden? The chair now recognizes Dr. Murphy.

I'll yield my time.

The chair now recognizes Representative Vanwarden.

Thank you, and I would just like to respond to my colleague, um, I agree with what you said, but that's not what this legislation says, at all. That that is not in the written word that you're discussing. It's just not there. So, that's the issue. And we have to w- we, when you say we can do th- two things at once, that's what my legislation does. This does one thing at once, and it kicks the can down the road, and again, as I said, by the time any action would be taken by the Veterans Affairs Administration, fifty percent of the veterans that are diagnosed with ALS today during this hearing will be dead. And that's unacceptable. But I I truly appreciate your sentiment, ma'am. It's just that's just not what the legislation says. I yield.

The gentleman yields his time. Back to Doctor Murphy. Doctor Murphy yields back. I now recognize Ranking Member Brownlee for a motion.

Uh, thank you, Madam Chair. I move that H. R. sixty O one be favorably reported to the full committee.

There is a motion to favorably forward the bill, H R six thousand one, to the full committee. All those in favor say aye.

Aye.

Aye. All those opposed say no. In the opinion of the chair, the ayes have it, and the bill is uh favorably forwarded to the full committee. I now call up H R sixty eight forty eight, the Whole Health for Veterans Act. The clerk shall report the bill.

H R six eight four eight. To amend, ta-

The text was circulated in advance pursuant to committee rules. Without objection, the first reading is to dispense with. The bill is now open for amendment at any point. Without objection, so ordered. I now recognize myself for three minutes to speak on the bill. Whole health can be an important part in complete and integrated view of a person's health. We support efforts that help veterans take a more proactive role in their health and their well-being, uh, and some of them are, have already demonstrated their effectiveness, uh, in trials and others have not. But supporting whole health does not mean we ignore real concerns with how the policy is structured. The bill would effectively eliminate meaningful co-pays for a broad category of services, and replace them with either no cost sharing or a capped monthly fee when some of these um uh events have not been proven to be uh clinically effective. This raises a serious cons- concern and issue, cost and utilization. When you significantly reduce or eliminate cost sharing, utilization increases. That is not speculation, that's a well-established principle in health care policy. And when utilization increases without guardrails, costs rise accordingly. Um, without appropriate cost sharing, there is little or no mechanism to ensure these services are used efficiently, or prioritized for those who need them the most, or that they're effective. And I have heard repetitively, um, in our hearings from the minority that they don't want displaced cost from the VA. There must be a responsible path forward that supports whole health while maintaining reasonable cost sharing targeting access and ensuring long-term sustainability but eliminating co-pays without those safeguards is not that path. Um, and I'm willing to work with, uh, the min- minority to ensure, uh, that there are mechanisms, uh, for, uh, addressing these concerns. For these reasons, I have serious concerns with this legislation. That said, we do not have the cost estimate of this bill and are looking forward to working, and hopefully collaborating, um, on this idea. Do any members wish to speak on this bill?

Madam Chair, I wish to speak.

The chair now recognizes Ranking Member Brantley for three minutes to speak on the bill.

Uh, thank you, Madam Chair. I support uh this bill, the Whole Health for Veterans Act, which will allow more veterans to access the integrative and complimentary therapies available to veterans through VA's Whole Health program. The Whole Health program helps veterans take a holistic approach to their own health with the support of VA which offers services like nutrition counseling strength and mobility classes yoga tai chi and even alternative therapies for pain management and mental health. From twenty seventeen up until earlier this year, whole health services were non-billable. Veterans were exempt from paying copays for services like exercise classes, and guided imagery and meditation. VA published a proposed regulation in January twenty twenty five to formally exempt whole health services from copays. However, for reasons that have not been explained to us, VA later reversed course and started charging fifteen dollar co-pays per visit in October of twenty twenty five. This only applies to veterans in priority group six, seven and eight who are already responsible for outpatient co-payments. This means that a veteran who has attended yoga classes three times a week to help improve their strength, mindfulness and overall health was suddenly faced with paying forty-five dollars a week, for an activity they had previously been free. While this doesn't affect all veterans, just those in lower priority groups, it's easy to see how quickly those co-pays will add up and how this will serve as a deterrent. I know my colleagues agree that veterans deserve access to any services or treatments that a veteran finds helpful to their mental or physical health, even those that may go beyond traditional health care services. Veterans shouldn't be subjected to burdensome co-payments, especially as the cost of living continues to increase and veterans are stretched thinner financially than ever before. I thank Representative Delisio for his leadership in ensuring veterans can continue to afford the services they rely on, and I urge all my colleagues who believe in support the veterans' holistic health needs to support this legislation.

Does any other member wish to speak on the bill? Seeing none, does any member wish to offer an amendment to any to this bill? Hearing none, I now recognize ranking member Brownlee for a motion. Forward the bill.

Yep. I move that HR sixty-eight forty-eight be reported favorably to the full committee.

There is a motion to favorably afford the bill, HR sixty-eight forty-eight, to the full committee. All those in favor say aye.

Aye.

Aye. All opposed say no. In the opinion of the chair, the ayes have it, and the bills are favorably forwarded to the full committee. The chair will now proceed with the postponed votes. The question now occurs on agreeing to the amendment in the nature of a substitute to H R twenty-two, eighty-three. All those in favor say aye. Aye. All those opposed say no. In the opinion of the chair, the ayes have it, and the amendment in the nature of a substitute is agreed to. Is a report yeah, I know. Is a reported vote requested? That was a vote requested by the committee. The ranking members requesting a reported vote. The clerk will now call the roll.

Madam Chair.

Uh, yes.

Madam Chair, aye. Mister Bergman. Mister Bergman, aye. Doctor Murphy. Doctor Murphy, aye. Mister Van Orden. Mister Van Orden, aye. Miss K- Mrs. Kiggins. Mrs. Kiggins, aye. Mister Hamade. Mister Hamade, aye. Miss King-Hines. Madam Ranking Member.

No.

Madam Ranking Member, no. Miss Schiffless-McCormick. Ms. Schifflis-McCormick, no. Dr. Dexter.

No.

Dr. Dexter, no. Mr. Conaway.

No.

Dr. Conaway, no. Miss Morrison. Dr. Morrison. Dr. Morrison, no.

Have all members voted? Does any member wish to change their vote? Hearing none, the clerk will announce the total.

Madam Chair, there are seven ayes and five nays.

The amendment in the nature of a substitute to HR twenty-two eighty-three as amendment is agreed to without objection the motion to reconsider is laid on I now recognize representative Bergman for a motion.

Madam Chair, I move that the subcommittee favorably forward H R two two eight three as amended to the full committee.

All all those in favor say aye, aye, all those opposed say no.

No.

And the opinion of the chair, the ayes have it. The motion is agreed to. The question now occurs on the motion to favorably forward H R twenty-two eighty-three as amendment. The clerk will call the we already did that. H R twenty-two eighty-three as amendment is favorably forwarded to the full committee. Sorry, I have duplicate pages. The question now occurs to agreeing to the amendment to the amendment in the nature of a substitute offered by Representative Morrison to H. R. sixty-nine ninety oh we no we have to vote on those, a recorded vote was asked for. The clerk will call the roll.

Madam Chair. Madam Chair.

Yes.

Madam Chair, no. Mister Bergman.

No.

Mister Bergman, no. Doctor Murphy. Dr. Murphy, no. Mr. Van Orten. Mr. Van, Mr. Van Orten, no. Mrs. Kiggins. Mrs. Kiggins, no. Mr. Hamade. Mr. Hamade, no. Miss King-Hines. Miss King-Hines, no. Madam Ranking Member.

Yes.

Madam Ranking Member, aye. Miss Schifflis-McCormick. Miss Schifflis-McCormick, aye. Dr. Dexter. Dr. Dexter, aye. Mr. Conaway. Mr. Conaway, aye. Dr. Morrison. Dr. Morrison, aye.

Have all members voted? Does any member wish to change their vote? Hearing none, the clerk will now announce the total.

Madam Chair, the vote is five ayes and seven nays.

The amendment is not agreed to. Without objection, the motion to reconsider is laid upon the table. Okay. H R sixty nine ninety three is a min- uh, excuse me, the amendment is not agreed to. The question now occurs on agreeing to the amendment to the amendment and the nature of a substitute offered by Dr. Conaway to H. R. sixty nine ninety three. The clerk will call the roll.

Madam Chair.

No.

Madam Chair, no. Mister Bergman.

No.

Mister Bergman, no. Doctor Murphy. Doctor Murphy, no. Mister Van Orten.

No.

Mister Van Orten, no. Mrs. Kiggins. Mrs. Kiggins, no. Mister Hamadeh. Mister Hamadeh, no. Mrs. King-Hines. Mrs. King-Hines, no. Madam Ranking Member.

Yes.

Madam Ranking Member, no. Or I.

Yes.

Miss Schifflis-McCormick. Miss Schifflis-McCormick, I. Doctor Dexter. Doctor Dexter, aye. Mister Connolly, Doctor Connolly, aye. Doctor Morrison, Doctor Morrison, aye.

Have all members voted? Does any member wish to change their vote? Hearing none, the clerk shall report the total.

Madam Chair, there are five ayes and seven nays.

The amendment is not agreed to. Without objection, the motion to reconsider is laid upon the table. The question now occurs on agreeing to the amendment and the amendment of the nature of a substitute offered uh, amendment number one offered by Representative Brownlee to HRC

Madam Chair. Madam Chair, no. Mister Bergman. Mister Bergman, no. Doctor Murphy. Doctor Murphy, no. Mister Van Orden. Mister Van Orden, no. Mrs. Kiggins. Mrs. Kiggins, no. Mister Hamade. Mister Hamade, no. Miss King-Hines. Miss King-Hines, no. Madam Madam Ranking Ranking Member.

Yes.

Madam Ranking Member, aye. Miss Schifflis-McCormick. Miss Schifflis-McCormick, aye. Doctor Dexter. Doctor Dexter, aye. Mister Conaway. Mr. Conaway, aye. Doctor Morrison. Doctor Morrison, aye.

Have all members voted? Does any member wish to change their vote? Hearing none, the clerk will now announce the total.

Madam Chair, the vote is five ayes and seven nays.

The amendment is not agreed to. Without objection, the motion reconsider is laid upon the table. The question now occurs on agreeing to amendment number two to the amendment in the nature of a substitute offered by ranking member Brownlee to HR sixty-nine ninety-three. The clerk will report the role.

Madam Chair.

No.

Madam Chair, no. Mister Bergman. Mister Bergman. Mister Bergman, no. Doctor Murphy. Doctor Murphy, no. Mister Van Orden.

No.

Mister Van Orden, no. Mrs. Kiggins. Mrs. Kiggins, no. Mister Hamade. Mister Hamade, no. Mrs. King-Hines. Miss King-Hines, no. Madam Ranking Member.

Yes.

Madam Ranking Member, I'm Miss Schifflis-McCormick. Miss Schifflis-McCormick, I, Doctor Dexter. Doctor Dexter, I, Mister Conaway.

Yes.

Mister Conaway, I, Doctor Morrison. Doctor Co- Doctor Morrison, aye.

Have all members voted? Does anyone wish to change their vote? If not, the clerk will report uh the total.

Madam Chair, there are five ayes and seven nays.

The amendment is not agreed to. Without objection, the motion to reconsider is laid upon the table. The question now occurs on agreeing to the amendment in the nature of a substitute to H. R. sixty-nine ninety-three. All those in favor say aye. Aye. All those opposed say no. In the opinion of the chair, the ayes have it, and the

Madam Chair requests a roll call vote.

In the opinion of the chair, the ayes have it, and the of the nature of substitute, a roll call vote has been called. The clerk will r- call the roll?

Madam Chair.

Yes.

Madam Chair, aye. Mister Bergman. Mister Bergman, aye. Doctor Murphy. Doctor Murphy, aye. Mister Van Orden. Mister Van Orden, aye. Miss Kiggins. Miss Kiggins, aye. Mister Hamaday. Mister Hamaday, aye. Miss King-Hines. Madam Ranking Member?

No.

Madam Ranking Member, no. Miss Schiffles-McCormick. Miss Schiffles-McCormick, no. Doctor Dexter.

No.

Doctor Dexter, no. Mister Conaway. Doctor Conaway, no. Miss Doctor Morrison. Doctor Mor- Doctor Morrison, no.

Have all members voted? Does any member wish to change their vote? Hearing none, the clerk will announce the total.

Madam Chair, the vote is seven ayes and five nays.

The amendment in the nature of a substitute to H R sixty nine ninety three as amendment Without objection, the motion to reconsider is laid on the table.

Madam Chair, I request a roll call vote. No, no, no. I I

We just did a roll call vote.

We just uh, uh, sorry, sorry, sorry.

That's okay. Um, I I now recognize Representative uh, Doctor General Bergman for a motion.

Madam Chair, I move that the subcommittee favorably forward HR six nine R nine R three as amended to the full committee.

All those in favor say aye. Aye, all those opposed say no.

No.

In the opinion of the chair, the ayes have it.

This is when I say I'm requesting a recorded vote.

Okay. The ranking member has requested a quarter vote. The clerk will call the roll.

Madam Chair.

Uh, yes.

Madam Chair, aye, Mister Bergman. Mister Bergman, aye, Doctor Murphy. Doctor Murphy, aye, Mister Van Orden. Mister Van Orden, aye, Mrs. K Kiggins. Mrs. Kiggins, aye, Mister Hamadeh. Mr. Hamade, aye, Miss King-Hines. Miss King-Hines, aye, Madam Ranking Member.

No.

Madam Ranking Member, no, Miss Schiffles-McCormick.

No.

Miss Schiffles-McCormick, no, Doctor Dexter. Doctor Dexter, no, Doctor Conaway. Doctor Conaway, no, Doctor Morrison. Doctor Morrison, no.

Have all members voted? Does any member wish to change their vote? Hearing none, the clerk will announce the total.

Madam Chair, the vote is seven ayes and five nays.

H. R. sixty-nine ninety-three as amendment is favorably forwarded to full committee. I think uh that it's uh this is very timely. I ask uh unanimous consent that the committee staff be authorized to make technical clerical and conforming changes to the bill favorably forwarded today. Hear hearing no objection so ordered, I thank their members for their attendance today, I thank the subcommittee for the mark-up, and I thank all members for making sure we finish before votes are called. Thank you very much. The hearing is adjourned.

That was sweet.