On July 16th, 2009, the House Committee on Energy and Commerce began its markup of H.R. 3200 "America's Affordable Health Choices Act of 2009". Below are summaries, vote tallies, and text of amendments offered to H.R. 3200.
These Republican amendments were accepted by the committee:
An amendment offered by Rep. Cliff Stearns, R-FL., would prohibit the Government plan from receiving a 'bailout' from taxpayer funds. The anticipation of unlimited access to taxpayer funds is a recipe for irresponsible management and financial disaster. This is evident from the reckless decisions of Federally backed companies such as Fannie Mae and Freddie Mac during the mortgage crisis. This amendment will help protect the American taxpayer, government, and economy, from exposure to the dangerous new financial risks associated with this new government program; a socialization of risk should not be part of the public plan. Without access to a bailout, the Government plan would have to hold enough capital to backup its financial requirements as all responsible private insurance companies do. This would eliminate one of the many statutory advantages afforded to the Government plan that allows it to crowd private insurers out of the market. For text of this amendment, click here .
This amendment passed by voice vote.
An amendment offered by Rep. Anna Eshoo, D-CA., R-Jay Inslee, D-WA., and Rep. Joe Barton, R-TX., would create a pathway for non-pioneer drug companies to manufacture 'follow-on' biologics. Follow-on biologics are conceptually similar to generics in the prescription drug world, however, because of the complexities of the proteins involved in biologic drugs, the follow-on drug(or biosimilars) cannot be exact replicas, even though they achieves the same results. Currently these drugs are regulated in the same manner as regular prescription drugs, which does not reflect their unique nature. This amendment would create a regulatory frame work that would streamline the follow-on approval process and provide adequate protections for biologic drug innovators, allowing them to recoup their investments from the extremely expensive biologic drug development process. For a detailed vote tally and text of this amendment, click here .
This amendment passed by a vote of 47 to 11.
An Amendment offered by Rep. Phil Gingrey, R-Ga., would prevent the new "Center for Quality Improvement" created under this bill from developing methodologies for rationing care. Through this legislation, the Center would be charged with developing "new best practices" procedures for doctors to follow when administering care. This could place bureaucrats, not doctors and scientists, at the forefront of decision-making process for what care Americans can receive. England, which has centralized healthcare, has a similar agency called the National Institute for Health Clinical Excellence (NICE), that has been used to limit access to breast cancer drugs for terminally ill women and restrict access to lifesaving procedures like dialysis. This amendment would ensure that America doesn't take such a callous and calculating approach to its healthcare. For text of this amendment, click here .
This amendment passed by voice vote.
An amendment offered by Rep. Phil Gingrey, R-GA., would prevent government bureaucrats at the new Center for Comparative Effectiveness Research (CCER) from dictating to physicians what treatments they can or can't offer. In the legislation, the CCER is tasked with gauging what treatments and procedures are most cost effective. This manner of government sponsored research, in conjunction with the new Federal crowd-out health plan would represent the first step towards implementing a policy of bureaucrat health care rationing. This amendment will prevent this eventuality, ensuring that this new agency cannot take the next dangerous step and put a Federal bureaucrat between the American people and their doctors. For text of this amendment, click here .
This amendment passed by voice vote.
An amendment offered by Rep. Rogers, R-MI., would prevent the Federal government and private insurers from using Federal comparative effectiveness research for care rationing or limiting reimbursement levels. The current legislation creates a Center for Comparative Effectiveness Research (CCER) to conduct said research. While the bill prevents the CCER from using this research for rationing, the Center for Medicare and Medicaid Services or any other agency could still use comparative effectiveness research, including cost-effectiveness research, to make payment and coverage decisions to deny patients care. This amendment would prevent government and private agencies from rationing availability of life-saving drugs, therapies, and treatments based on government research, or limiting reimbursement for these services. For text of this amendment, click here .
This amendment passed by voice vote.
An amendment offered by Rep. Tim Murphy, R-PA., would require the new Center for Comparative Effectiveness Research and the new Health Choices Commission to consult with the specialty colleges and academies of medicine in determining any official recommendation or standards for best practices. For text of this amendment, click here .
This amendment passed by voice vote.
An amendment offered by Rep. John Sullivan, R-OK., would require the HHS Secretary to eliminate duplicative government programs, reducing waste and inefficiency in the realm of government healthcare. The new Democratic healthcare proposal creates massive new federal spending programs, many of which are charged with responsibilities already assigned to pre-existing programs. This amendment does not eliminate services, but ensures that services offered under the new system are administered in a more efficient manner. According to the current language the vast new roster of programs only add to the existing bureaucracy instead of replacing the appropriate portion. This amendment will lower administrative costs and help streamline the greatly expanded government healthcare system. For a detailed vote tally and text of this amendment, click here .
This amendment passed by a vote of 29 to 27.
Three Amendments were offered En Bloc.
An amendment offered by Rep. Michael Burgess, R-TX., would authorize States to create an option under Medicaid to allow individuals already on Medicaid that have annual prescription drug costs of over $200,000 to hold employment and be productive members of society. For text of this amendment, click here .
An amendment offered by Rep. Anna Eshoo, D-CA., and Rep. Mike Rogers, R-MI., allows the primary physicians, under section 1301 of the bill, to be eligible regardless of specialty. For text of this amendment, click here .
An amendment offered by Rep. Michael Burgess, R-TX., would ensure that all qualified health plans (including the public plan) under the bill will have a reasonable and accessible utilization review and appeals process so that insurance companies (or the public plan) aren't allowed to deny needed care and step in-between a patient and their doctor. For text of this amendment, click here .
These amendments passed by voiced vote.
An amendment offered by Rep. Ed Whitfield, R-KY., would place a moratorium on the reimbursement cuts to 10 of the top 11 procedures performed by interventional pain physicians in an Ambulatory Surgical Setting. It also includes accreditation language to ensure procedures performed in the ASC setting are required to be performed in an accredited setting, by a well-qualified physician as determined by HHS. This amendment helps ensure that valuable pain relieving procedures remain available to Americans in need. For text of this amendment, click here .
This amendment passed by voice vote.
Rep. Greg Walden, R-OR., offered two amendments en bloc.
The first amendment would help ensure that the demographics of the Medicare Payment Advisory Commission (MEDPAC) more accurately represent the demographics of Medicare recipients. Currently, approximately 26.8% of Medicare recipients live in rural areas. However, only 1 of MEDPAC's 17 commissioners has rural healthcare credentials. This amendment would require that 5 commissioners on MEDPAC be representatives of rural healthcare in order to more appropriately represent the Medicare population and its needs. For text of this amendment, click here .
The second amendment would help ensure that the new "Health Benefits Advisory Committee" established in the Democratic legislation accurately represents the interests of rural Americans. Currently 21 percent of the U.S. population lives in rural areas. Mr. Walden's amendment would ensure that at least one quarter of the Committee's members be practitioners who have legitimate experience practicing in a rural area for at least a five-year period preceding their appointment. For text of this amendment, click here .
Both amendments passed by voice vote.
Rep. Steve Buyer, R-IN., offered two amendments en bloc to protect veterans' access to health insurance.
One amendment would allow the Secretary of Defense and the Secretary of Veterans Affairs to retain sole authority over their respective health care systems. Under the bill's current language, HHS could impose coverage mandates on health plans offered to veterans and members of the military, limiting their access to critical treatments. Our service members and veterans require specialized medical care that is unique from civilian health care. This amendment would help ensure they have access to these unique services in the future. For text of this amendment, click here .
The other amendment would allow veterans enrolled in the VA health care system to obtain coverage through the new Health Insurance Exchange in addition to their VA coverage. Under the current language, if the new Health Choices Commissioner were to deem VA health care "qualified" coverage, recipients of that care would be prohibited from receiving additional coverage in the exchange. Conversely, if the Commissioner deemed VA care "non-qualified" coverage, a veteran would be forced to obtain health insurance in the "exchange" or be subject to an income tax penalty. In 2007, almost 80% of veterans enrolled in VA care had additional health coverage. This amendment would allow this to continue under the Democratic healthcare plan. For text of this amendment, click here .
The amendments passed by voice vote.
An amendment offered by Rep Shimkus, R-IL., would add language to the bill ensuring that there is no religious discrimination for patients seeking spiritual care under plans in the new Health Insurance Exchange. For text of this amendment, click here .
This amendment passed by voice vote.
These Republican amendments were voted down by the Democrats:
An amendment offered by Rep. Joe Barton, R-TX. and Rep. Nathan Deal, R-GA., would provide low-income Americans with alternatives to subpar welfare health programs such as Medicaid or SCHIP by allowing these individuals to use their share of Medicaid or SCHIP funds to purchase high quality private insurance. Empowering these Americans with the freedom to choose the health plan most appropriate for themselves and their families will save on extraneous costs and provide Americans with access to higher quality care. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 33 to 21.
An amendment offered by Rep. Nathan Deal, R-GA., would require that the millions of new people who will be "automatically enrolled" in Medicaid under this legislation demonstrate that they are American citizens. Currently, there are 11.1 million illegal aliens residing in the United States. This amendment would prevent the crippling burden of providing free healthcare to these non-citizens from falling on the shoulders of the U.S. taxpayer. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 29 to 28.
An amendment offered by Rep. Nathan Deal, R-GA., would allow doctors in emergency rooms to focus on medical emergencies instead of potential liabilities. Under this amendment, emergency room doctors would be shielded from liability lawsuits if they refer non-emergency patients, such as those with a common cold, to other health facilities. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 35 to 23.
An amendment offered by Rep. Joe Pitts, R-PA., would prohibit the Federal government from mandating that any health insurance plan provide coverage for abortion(except in cases involving a danger to the mother's life, rape, or incest) . For a detailed vote tally and the text of this amendment, click here .
This amendment passed by a vote of 31 to 27.
Chairman Waxman, D-CA., later called for a revote on the Pitts Amendment, voting it down by a vote of 30 to 29. For a detailed vote tally, click here.
An amendment offered by Rep. Joe Barton, R-TX., would provide health coverage to the millions of Americans who are "uninsurable" because of pre-existing conditions, by requiring states to have high-risk pools. This would allow these individuals to mitigate their collective risk and increase their purchasing power, thus making private insurance affordable. Additionally, these groups would be eligible for support from federal funds This amendment would address the problem directly instead of as a footnote in broad, sweeping health reforms. The current democratic proposal uses this issue as an excuse to advance the ideological agenda of greater centralization and government control in the realm of health care, which will lead to a single-payer system with care-rationing and long wait times. This amendment would instead bring healthcare to the uninsurable without simultaneously downgrading the healthcare of everyone else. Mr. Barton's amendment would cost approximately $2 billion a year compared to roughly $100 billion a year for the Democratic plan. For a detailed vote tally and text of this amendment, click here
This amendment was voted down 35 to 22.
An Amendment offered by Rep. Mike Rogers, R-MI., would put a safety mechanism to prevent seniors from losing their health insurance coverage through Medicare Advantage. Medicare advantage provides seniors with government subsidized access to a plethora of different private insurance plans so they can choose the best health coverage plan for their specific needs. The Democrats' new health care legislation will gut the Medicare Advantage program's funding, potentially forcing millions of seniors to lose their premium tailored health plans. Mr. Rogers' amendment would prevent this by requiring the Secretary of HHS to certify that no private plan will be forced out of the Medicare Advantage program because of funding cuts before any of these cuts are made. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 34 to 20.
An amendment offered by Rep. Phil Gingrey, R-GA., would prevent government bureaucrats at the new Center for Quality Improvement from dictating to physicians what treatments they can or can't offer. In the legislation, the Center is tasked with determining what treatments and procedures are most cost effective. This manner of government sponsored research, in conjunction with the new Federal crowd-out health plan would represent the first step towards implementing a policy of bureaucrat health care rationing. This amendment will prevent this eventuality, ensuring that this new agency cannot take the next dangerous step and put a Federal bureaucrat between the American people and their doctors. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down, 33 to 24.
An amendment offered by Rep. Rogers, R-MI., would prevent the Federal government's comparative effectiveness research from being used for care rationing or limiting reimbursement levels by any government or private entity. The current legislation creates an Agency for Healthcare Research and Quality(AHRQ) to conduct said research. Under the current legislation, the AHRQ, the Center for Medicare and Medicaid Services or any other agency could use comparative effectiveness research, including cost-effectiveness research, to make payment and coverage decisions to deny patients care. This amendment would prevent government agencies from rationing availability of life-saving drugs, therapies, and treatments based on government research, or limiting reimbursement for these services. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down, 35 to 23.
An amendment offered by Rep. Nathan Deal, R-GA., would prohibit the Federal government from taxing or withholding benefits from States whose health plans don't comply with the new arbitrary essential benefits mandates that the HHS Secretary is authorized to make under this legislation. These could include mandated coverage of abortion or Botox injections, and if States don't comply they would face an 8% tax on their employee payroll or drastic cuts in Federal grants. States are already struggling to balance their budgets. New Federal taxes on State governments or restrictions on critical grants could mean the breaking point for stretched-thin State budgets. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 35 to 20.
An amendment offered by Rep. Lee Terry, R-NE., would reauthorize funding for abstinence education in our Nation's schools. Abstinence education programs teach students far more than just how to “say no”. Students learn the value of building healthy relationships, they build critical skills in decision-making and self-efficacy, and they gain medically accurate information on contraceptives and STDS. Additionally, while achieving these objectives, these programs have not decreased condom use in sexually active teens. This amendment would not cut funding for Comprehensive Sex Education programs, which receive four times as much funding as abstinence education programs, it will only ensure that teens retain access to an invaluable perspective on their personal and sexual development. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 29 to 26.
An amendment offered by Rep. Lee Terry, R-NE, would prohibit the creation of an $35.3 billion Community Wellness Fund unless the projected budget deficit for the next fiscal year is less than $1 trillion. Under the current legislation, this money could be given out to any program that is tangentially related to community wellness. This could include building jungle gyms, bike trails, parks, or even paying people to drink diet soda instead of regular soda. This amendment would require that Congress have the budget in order before it can squander $35.3 billion in the name of community wellness. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 33 to 23.
An amendment offered by Rep. Cliff Stearns, R-FL., would amend the section of the bill entitled "Protecting the Choice to keep Current Coverage" to include appropriate language in keeping with this section's title. Currently, this section contains language forcing all employer health plans to comply with new mandates from the Secretary of HHS within five years of the bill's enactment, thus essentially preventing Americans from keeping their current plans. This amendment would replace these provisions with the statement "Nothing in this Act shall be construed to prevent or limit individuals from keeping their current health coverage". This language far more closely represents the section title's intent as well as President Obama's promise to the American people. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 32 to 26.
An amendment offered by Rep. Michael Burgess, R-TX., would fix the problem with the Medicare physician payment scheme. Due to changes put in place by the Democrats last year, physicians now face a 21% cut in their Medicare reimbursements in 2010. The current flawed payment scheme would be replaced with an inflation adjusted payment index that reimburses physicians for the cost of care. This fix would prevent seniors from losing their doctors simply because their doctors can't make ends meet under the Medicare’s new under-payment scheme. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 32 to 20.
An amendment offered by Rep. Michael Burgess, R-TX., would remove the public plan from the new Democratic health reform proposal, preventing it from crowding out private health insurance programs. The current government health plan is granted numerous insurmountable advantages over private insurers. These include nearly unlimited access to tax-payer funds, exemptions from state and local taxes, the ability to undercut healthcare providers--passing costs on to private insurers, exemptions from financial stability requirements, and protections from trial lawyers. The advantages afforded to the government plan will inevitably drive private insurers out of the market, trapping Americans in a centralized, bureaucratic, government healthcare system subject to longer wait times, care-rationing, and regressive price controls. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 35 to 24.
An amendment offered by Rep. Joe Barton R-TX., would prevent a trigger in the legislation from doubling this bills new tax 'surcharge' in 2012. Currently, the house legislation requires the Office of Management and Budget (OMB) to conduct a study in 2012 to determine whether or not division B of the legislation will bring $700 million in savings. If it does not, Americans making under $1 million would be hit with a tax hike as high as 5.4% to pay for the ineffective and expensive democratic healthcare plan. As said by House Democrats: “many successful small businesses -- the very kind business that should lead in creating jobs and help us emerge from this recession -- will be taxed at over 50 percent.” This surtax “will discourage entrepreneurial activity and job growth.” Mr. Barton's amendment would alter the trigger to prevent this occurrence. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 33 to 25.
An amendment offered by Rep. Burgess, R-TX., would institute common-sense liability protections to reduce the costs of "defensive medicine" to the healthcare system. Defensive medicine is the term used to describe unnecessary tests and procedures which are conducted to prevent lawsuits. Currently, these extraneous procedures are estimated to costs roughly $70 billion a year. Furthermore, studies also show that the system fail injured patients with claims taking on average five years to resolve and roughly 60 cents out of every dollar spent in the malpractice system going to lawyers or administrative costs1 here .
This amendment was voted down 32 to 23.
An Amendment offered by Rep. Shadegg, R-AZ., would require the new government plan to negotiate payment rates with health care providers. Currently, the government plan intends to link its payment rates to those of other government health programs which under-reimburse for services. Requiring the government plan to negotiate rates just as other insurance companies do will help prevent the new government plan from undercutting private insurance companies and driving them out of business. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 29 to 29.
An amendment offered by Rep. Steve Buyer, R-IN., would allow employers to provide insurance premium discounts to employees who participate in prevention and wellness programs by amending current law, and eliminating restrictions in the current legislation. These programs encourage people to take proactive responsibility of their own health, promoting longer life spans, healthier lifestyles, and lower care costs. For a detailed vote tally and text of this amendment, click here
This amendment was voted down 34 to 24.
An amendment offered by Rep. Bart Stupak, D-MI., and Rep. Joe Pitts, R-PA., would prevent the Democratic health reform bill from allowing taxpayer dollars to subsidize abortions. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 31 to 27.
An amendment offered by Rep. George Radanovich, R-CA. would move to create a true level playing field between private insurers and the government plan by requiring the government plan to be subject to the same standards and business environment as private plans. Currently, the government plan doesn't have to pay state premium taxes, state and local property taxes, corporate taxes, market rates for buildings, equipment, and services, or finance its own start-up costs. Additionally, the government option would have exclusive access to government agency data, special protections from lawsuits, exemption from financial stability requirements, and the implicit financial backing of the entire U.S. Treasury. Finally, the government option could undercut healthcare providers by only paying for a portion of services, forcing providers to shift costs onto private insurers. These provisions don't exist to keep private plans honest, they exist to drive them out of business. This amendment will eliminate the exhaustive list of exclusive benefits afforded to the government plan, thus leveling the playing field with private insurers so that the American people really can keep their health insurance plans if they want to. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 32 to 23.
An amendment offered by Reps. Terry, R-NE., Gingrey, R-GA., and Blunt, R-MO., would allow all Americans access to the exact same coverage plan as the Federal Health Benefits (FEHB) Plan. The FEHB plan offers premium coverage to Members of Congress, allowing them to choose from a multitude of private insurance providers. Passage of this amendment would meet President Obama's "guarantee that every uninsured American could get the same kind of health care that Members of Congress give themselves" as opposed to forcing all Americans into the substandard, bureaucrat-run healthcare system that will result from this bill. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 31 to 28.
An amendment offered by Rep. Joe Barton, R-TX., Rep Nathan Deal, R-GA., and Rep. Bart Stupak, D-MI., would create an office within the Health and Human Services Department to work with public and private entities to collect, analyse, and publicly disclose price and risk-adjusted quality information for healthcare services. This added transparency would not only bring to light a greater understanding of the problems in the healthcare system, but also empower Americans with the informed choices they need to bring greater competition to the marketplace. In turn, this competition will bring lower prices, greater efficiency, and higher quality. For a copy of this amendment, click here .
This amendment was voted down by a show of hands, 28 to 18.
An amendment offered by Rep. John Shadegg, R-AZ., would require the GAO to regularly gather data on the 5 year survival rates for breast cancer patients. If it is determined that after the implementation of the government plan, survival rates have decreased, the Government plan would be discontinued, to restore the higher of survival rate. Currently, the 5 year survival rate for breast cancer patients in America is over 90%, more than 12 points higher than the rate in England, which has a centralized, government-run healthcare system. American survival rates for breast cancer rank among the highest in the world; this amendment would help ensure they stay that way. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 36 to 22.
An amendment offered by Rep. Mike Rogers, R-MI., and Rep. Phil Gingrey, R-GA., would help ensure that Americans retain the freedom to choose Health Savings Accounts (HSAs), Federal Savings Accounts, and High-Deductible Health Plans (HDHPs) as options for healthcare coverage. Currently more than 8 million Americans are enrolled in a HSA or HDHP; that is more than those enrolled in SCHIP and comparable to the number enrolled in the Federal Health Benefits Plan. This amendment helps fulfill President Obama's promise that all Americans can keep their health insurance if they like it by preventing the new Health Choices Commissioner from ruling these plans 'unqualified' and requiring the Commissioner to make such plans available in the new Health Insurance Exchange. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 33 to 26.
An amendment offered by Rep. Phil Gingrey, R-GA., would ensure that any savings obtained in the Medicare program from the provisions of this act be put back into the program to help secure its fiscal solvency. Currently, the Democratic Health Plan cuts $500 billion from Medicare with $156.3 billion being cut from reimbursement funds for Medicare Advantage. This will result in losses of coverage and availability for critical health services for senior citizens. This amendment would provide that such cuts are at least used to pay down the $37.8 trillion in unfunded Medicare obligations, so that Medicare can continue to function in the future. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 35 to 23.
An amendment offered by Rep. Ralph Hall, R-TX., would help prevent cuts to Medicare Advantage from falling disproportionately on rural Americans. The current language in the bill would result in Medicare Advantage funding cuts in excess of 20% in many rural areas. Medicare advantage plans have reduced unnecessary hospitalizations and readmission rates for beneficiaries with such conditions as diabetes and heart disease, leading to greater efficiency and saved costs in administered care. Mr. Hall's amendment would help mitigate the effect of these program cuts for rural and low-income areas. For a detailed vote tally and text of this amendment, click here .
This amendment was voted down 31 to 27.
Other notable amendments:
Rep. Anthony Weiner, D-N.Y., took a unique stand on Medicare by offering an amendment that would abolish the nation’s primary medical program for senior citizens. His "message" amendment was supposed to highlight what the sharp-tongued Weiner called "the hypocrisy" of Republican opposition to the Democrats’ government-run health care plan. The Weiner farce was shrugged off as a political gesture on a bipartisan vote of 57-0, with the congressman opposing his own amendment. "Mr. Weiner’s got nowhere to go but up on his next amendment," said one congressman as the vote was announced. For a detailed vote tally and text of this amendment, click here .
For information on this amendment, click here .
An amendment offered by Rep. Capps D-CA., would allow for immediate federal funding of elective abortion coverage through the public plan, permit taxpayer subsidies of private plans that cover elective abortion, and mandate that all areas of the country contain one private plan that covers abortion. For a detailed vote tally and text of this amendment, click here .
This amendment passed by a vote of 30 to 28.
An amendment offered by Rep. Betty Sutton, D-OH., would authorize the HHS Secretary to issue $150 million in grants for community outreach programs that would enroll more people in public health welfare programs such as Medicaid and SCHIP. Unfortunately, the eligibility requirements for these grants were made so broad that groups like ACORN could receive these government grants, denying more qualified, health-focused groups access to these valuable funds. For a detailed vote tally and text of this amendment, click here .
This amendment passed by a vote of 36 to 23.
H.R. 3200 "America's Affordable Health Choices Act of 2009" was reported out of the Committee on Energy and Commerce by a vote of 31 to 28.
For a detailed vote tally, click here .
