[Congressional Record Volume 163, Number 50 (Wednesday, March 22, 2017)]
[House]
[Pages H2312-H2330]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SMALL BUSINESS HEALTH FAIRNESS ACT OF 2017
Ms. FOXX. Mr. Speaker, pursuant to House Resolution 210, I call up
the bill (H.R. 1101) to amend title I of the Employee Retirement Income
Security Act of 1974 to improve access and choice for entrepreneurs
with small businesses with respect to medical care for their employees,
and ask for its immediate consideration.
The Clerk read the title of the bill.
The SPEAKER pro tempore. Pursuant to House Resolution 210, in lieu of
the amendment recommended by the Committee on Education and the
Workforce printed in the bill, an amendment in the nature of a
substitute consisting of the text of Rules Committee Print 115-9 is
adopted and the bill, as amended, is considered read.
The text of the bill, as amended, is as follows:
H.R. 1101
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Small
Business Health Fairness Act of 2017''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Rules governing association health plans.
Sec. 3. Clarification of treatment of single employer
arrangements.
Sec. 4. Enforcement provisions relating to association
health plans.
Sec. 5. Cooperation between Federal and State authorities.
Sec. 6. Effective date and transitional and other rules.
SEC. 2. RULES GOVERNING ASSOCIATION HEALTH PLANS.
(a) In General.--Subtitle B of title I of the Employee
Retirement Income Security Act of 1974 is amended by adding
after part 7 the following new part:
``PART 8--RULES GOVERNING ASSOCIATION HEALTH PLANS
``SEC. 801. ASSOCIATION HEALTH PLANS.
``(a) In General.--For purposes of this part, the term
`association health plan' means a group health plan whose
sponsor is (or is deemed under this part to be) described in
subsection (b).
``(b) Sponsorship.--The sponsor of a group health plan is
described in this subsection if such sponsor--
``(1) is organized and maintained in good faith, with a
constitution and bylaws specifically stating its purpose and
providing for periodic meetings on at least an annual basis,
as a bona fide trade association, a bona fide industry
association (including a rural electric cooperative
association or a rural telephone cooperative association), a
bona fide professional association, or a bona fide chamber of
commerce (or similar bona fide business association,
including a corporation or similar organization that operates
on a cooperative basis (within the meaning of section 1381 of
the Internal Revenue Code of 1986)), for substantial purposes
other than that of obtaining or providing medical care;
``(2) is established as a permanent entity which receives
the active support of its members and requires for membership
payment on a periodic basis of dues or payments necessary to
maintain eligibility for membership in the sponsor; and
``(3) does not condition membership, such dues or payments,
or coverage under the plan on the basis of health status-
related factors with respect to the employees of its members
(or affiliated members), or the dependents of such employees,
and does not condition such dues or payments on the basis of
group health plan participation.
Any sponsor consisting of an association of entities which
meet the requirements of paragraphs (1), (2), and (3) shall
be deemed to be a sponsor described in this subsection.
``SEC. 802. CERTIFICATION OF ASSOCIATION HEALTH PLANS.
``(a) In General.--The applicable authority shall prescribe
by regulation a procedure under which, subject to subsection
(b), the applicable authority shall certify association
health plans which apply for certification as meeting the
requirements of this part.
``(b) Standards.--Under the procedure prescribed pursuant
to subsection (a), in the case of an association health plan
that provides at least one benefit option which does not
consist of health insurance coverage, the applicable
authority shall certify such plan as meeting the requirements
of this part only if the applicable authority is satisfied
that the applicable requirements of this part are met (or,
upon the date on which the plan is to commence operations,
will be met) with respect to the plan.
``(c) Requirements Applicable to Certified Plans.--An
association health plan with respect to which certification
under this part is in effect shall meet the applicable
requirements of this part, effective on the date of
certification (or, if later, on the date on which the plan is
to commence operations).
[[Page H2313]]
``(d) Requirements for Continued Certification.--The
applicable authority may provide by regulation for continued
certification of association health plans under this part.
``(e) Class Certification for Fully Insured Plans.--The
applicable authority shall establish a class certification
procedure for association health plans under which all
benefits consist of health insurance coverage. Under such
procedure, the applicable authority shall provide for the
granting of certification under this part to the plans in
each class of such association health plans upon appropriate
filing under such procedure in connection with plans in such
class and payment of the prescribed fee under section 807(a).
``(f) Certification of Self-Insured Association Health
Plans.--An association health plan which offers one or more
benefit options which do not consist of health insurance
coverage may be certified under this part only if such plan
consists of any of the following:
``(1) A plan which offered such coverage on the date of the
enactment of the Small Business Health Fairness Act of 2017.
``(2) A plan under which the sponsor does not restrict
membership to one or more trades and businesses or industries
and whose eligible participating employers represent a broad
cross-section of trades and businesses or industries.
``(3) A plan whose eligible participating employers
represent one or more trades or businesses, or one or more
industries, consisting of any of the following: agriculture;
equipment and automobile dealerships; barbering and
cosmetology; certified public accounting practices; child
care; construction; dance, theatrical and orchestra
productions; disinfecting and pest control; financial
services; fishing; food service establishments; hospitals;
labor organizations; logging; manufacturing (metals); mining;
medical and dental practices; medical laboratories;
professional consulting services; sanitary services;
transportation (local and freight); warehousing; wholesaling/
distributing; or any other trade or business or industry
which has been indicated as having average or above-average
risk or health claims experience by reason of State rate
filings, denials of coverage, proposed premium rate levels,
or other means demonstrated by such plan in accordance with
regulations.
``SEC. 803. REQUIREMENTS RELATING TO SPONSORS AND BOARDS OF
TRUSTEES.
``(a) Sponsor.--The requirements of this subsection are met
with respect to an association health plan if the sponsor has
met (or is deemed under this part to have met) the
requirements of section 801(b) for a continuous period of not
less than 3 years ending with the date of the application for
certification under this part.
``(b) Board of Trustees.--The requirements of this
subsection are met with respect to an association health plan
if the following requirements are met:
``(1) Fiscal control.--The plan is operated, pursuant to a
trust agreement, by a board of trustees which has complete
fiscal control over the plan and which is responsible for all
operations of the plan.
``(2) Rules of operation and financial controls.--The board
of trustees has in effect rules of operation and financial
controls, based on a 3-year plan of operation, adequate to
carry out the terms of the plan and to meet all requirements
of this title applicable to the plan.
``(3) Rules governing relationship to participating
employers and to contractors.--
``(A) Board membership.--
``(i) In general.--Except as provided in clauses (ii) and
(iii), the members of the board of trustees are individuals
selected from individuals who are the owners, officers,
directors, or employees of the participating employers or who
are partners in the participating employers and actively
participate in the business.
``(ii) Limitation.--
``(I) General rule.--Except as provided in subclauses (II)
and (III), no such member is an owner, officer, director, or
employee of, or partner in, a contract administrator or other
service provider to the plan.
``(II) Limited exception for providers of services solely
on behalf of the sponsor.--Officers or employees of a sponsor
which is a service provider (other than a contract
administrator) to the plan may be members of the board if
they constitute not more than 25 percent of the membership of
the board and they do not provide services to the plan other
than on behalf of the sponsor.
``(III) Treatment of providers of medical care.--In the
case of a sponsor which is an association whose membership
consists primarily of providers of medical care, subclause
(I) shall not apply in the case of any service provider
described in subclause (I) who is a provider of medical care
under the plan.
``(iii) Certain plans excluded.--Clause (i) shall not apply
to an association health plan which is in existence on the
date of the enactment of the Small Business Health Fairness
Act of 2017.
``(B) Sole authority.--The board has sole authority under
the plan to approve applications for participation in the
plan and to contract with a service provider to administer
the day-to-day affairs of the plan.
``(c) Treatment of Franchise Networks.--In the case of a
group health plan which is established and maintained by a
franchiser for a franchise network consisting of its
franchisees--
``(1) the requirements of subsection (a) and section 801(a)
shall be deemed met if such requirements would otherwise be
met if the franchiser were deemed to be the sponsor referred
to in section 801(b), such network were deemed to be an
association described in section 801(b), and each franchisee
were deemed to be a member (of the association and the
sponsor) referred to in section 801(b); and
``(2) the requirements of section 804(a)(1) shall be deemed
met.
The Secretary may by regulation define for purposes of this
subsection the terms `franchiser', `franchise network', and
`franchisee'.
``SEC. 804. PARTICIPATION AND COVERAGE REQUIREMENTS.
``(a) Covered Employers and Individuals.--The requirements
of this subsection are met with respect to an association
health plan if, under the terms of the plan--
``(1) each participating employer must be--
``(A) a member of the sponsor,
``(B) the sponsor, or
``(C) an affiliated member of the sponsor with respect to
which the requirements of subsection (b) are met,
except that, in the case of a sponsor which is a professional
association or other individual-based association, if at
least one of the officers, directors, or employees of an
employer, or at least one of the individuals who are partners
in an employer and who actively participates in the business,
is a member or such an affiliated member of the sponsor,
participating employers may also include such employer; and
``(2) all individuals commencing coverage under the plan
after certification under this part must be--
``(A) active or retired owners (including self-employed
individuals), officers, directors, or employees of, or
partners in, participating employers; or
``(B) the beneficiaries of individuals described in
subparagraph (A).
``(b) Coverage of Previously Uninsured Employees.--In the
case of an association health plan in existence on the date
of the enactment of the Small Business Health Fairness Act of
2017, an affiliated member of the sponsor of the plan may be
offered coverage under the plan as a participating employer
only if--
``(1) the affiliated member was an affiliated member on the
date of certification under this part; or
``(2) during the 12-month period preceding the date of the
offering of such coverage, the affiliated member has not
maintained or contributed to a group health plan with respect
to any of its employees who would otherwise be eligible to
participate in such association health plan.
``(c) Individual Market Unaffected.--The requirements of
this subsection are met with respect to an association health
plan if, under the terms of the plan, no participating
employer may provide health insurance coverage in the
individual market for any employee not covered under the plan
which is similar to the coverage contemporaneously provided
to employees of the employer under the plan, if such
exclusion of the employee from coverage under the plan is
based on a health status-related factor with respect to the
employee and such employee would, but for such exclusion on
such basis, be eligible for coverage under the plan.
``(d) Prohibition of Discrimination Against Employers and
Employees Eligible To Participate.--The requirements of this
subsection are met with respect to an association health plan
if--
``(1) under the terms of the plan, all employers meeting
the preceding requirements of this section are eligible to
qualify as participating employers for all geographically
available coverage options, unless, in the case of any such
employer, participation or contribution requirements of the
type referred to in section 2711 of the Public Health Service
Act are not met;
``(2) upon request, any employer eligible to participate is
furnished information regarding all coverage options
available under the plan; and
``(3) the applicable requirements of sections 701, 702, and
703 are met with respect to the plan.
``SEC. 805. OTHER REQUIREMENTS RELATING TO PLAN DOCUMENTS,
CONTRIBUTION RATES, AND BENEFIT OPTIONS.
``(a) In General.--The requirements of this section are met
with respect to an association health plan if the following
requirements are met:
``(1) Contents of governing instruments.--The instruments
governing the plan include a written instrument, meeting the
requirements of an instrument required under section
402(a)(1), which--
``(A) provides that the board of trustees serves as the
named fiduciary required for plans under section 402(a)(1)
and serves in the capacity of a plan administrator (referred
to in section 3(16)(A));
``(B) provides that the sponsor of the plan is to serve as
plan sponsor (referred to in section 3(16)(B)); and
``(C) incorporates the requirements of section 806.
``(2) Contribution rates must be nondiscriminatory.--
``(A) The contribution rates for any participating small
employer do not vary on the basis of any health status-
related factor in relation to employees of such employer or
their beneficiaries and do not vary on the basis of the type
of business or industry in which such employer is engaged.
``(B) Nothing in this title or any other provision of law
shall be construed to preclude an association health plan, or
a health insurance issuer offering health insurance coverage
in connection with an association health plan, from--
``(i) setting contribution rates based on the claims
experience of the plan; or
``(ii) varying contribution rates for small employers in a
State to the extent that such rates could vary using the same
methodology employed in such State for regulating premium
rates in the small group market with respect to health
insurance coverage offered in connection with bona fide
associations (within the meaning of section 2791(d)(3) of the
Public Health Service Act),
[[Page H2314]]
subject to the requirements of section 702(b) relating to
contribution rates.
``(3) Floor for number of covered individuals with respect
to certain plans.--If any benefit option under the plan does
not consist of health insurance coverage, the plan has as of
the beginning of the plan year not fewer than 1,000
participants and beneficiaries.
``(4) Marketing requirements.--
``(A) In general.--If a benefit option which consists of
health insurance coverage is offered under the plan, State-
licensed insurance agents shall be used to distribute to
small employers coverage which does not consist of health
insurance coverage in a manner comparable to the manner in
which such agents are used to distribute health insurance
coverage.
``(B) State-licensed insurance agents.--For purposes of
subparagraph (A), the term `State-licensed insurance agents'
means one or more agents who are licensed in a State and are
subject to the laws of such State relating to licensure,
qualification, testing, examination, and continuing education
of persons authorized to offer, sell, or solicit health
insurance coverage in such State.
``(5) Regulatory requirements.--Such other requirements as
the applicable authority determines are necessary to carry
out the purposes of this part, which shall be prescribed by
the applicable authority by regulation.
``(b) Ability of Association Health Plans To Design Benefit
Options.--Subject to section 514(d), nothing in this part or
any provision of State law (as defined in section 514(c)(1))
shall be construed to preclude an association health plan, or
a health insurance issuer offering health insurance coverage
in connection with an association health plan, from
exercising its sole discretion in selecting the specific
items and services consisting of medical care to be included
as benefits under such plan or coverage, except (subject to
section 514) in the case of (1) any law to the extent that it
is not preempted under section 731(a)(1) with respect to
matters governed by section 711, 712, or 713, or (2) any law
of the State with which filing and approval of a policy type
offered by the plan was initially obtained to the extent that
such law prohibits an exclusion of a specific disease from
such coverage.
``SEC. 806. MAINTENANCE OF RESERVES AND PROVISIONS FOR
SOLVENCY FOR PLANS PROVIDING HEALTH BENEFITS IN
ADDITION TO HEALTH INSURANCE COVERAGE.
``(a) In General.--The requirements of this section are met
with respect to an association health plan if--
``(1) the benefits under the plan consist solely of health
insurance coverage; or
``(2) if the plan provides any additional benefit options
which do not consist of health insurance coverage, the plan--
``(A) establishes and maintains reserves with respect to
such additional benefit options, in amounts recommended by
the qualified actuary, consisting of--
``(i) a reserve sufficient for unearned contributions;
``(ii) a reserve sufficient for benefit liabilities which
have been incurred, which have not been satisfied, and for
which risk of loss has not yet been transferred, and for
expected administrative costs with respect to such benefit
liabilities;
``(iii) a reserve sufficient for any other obligations of
the plan; and
``(iv) a reserve sufficient for a margin of error and other
fluctuations, taking into account the specific circumstances
of the plan; and
``(B) establishes and maintains aggregate and specific
excess/stop loss insurance and solvency indemnification, with
respect to such additional benefit options for which risk of
loss has not yet been transferred, as follows:
``(i) The plan shall secure aggregate excess/stop loss
insurance for the plan with an attachment point which is not
greater than 125 percent of expected gross annual claims. The
applicable authority may by regulation provide for upward
adjustments in the amount of such percentage in specified
circumstances in which the plan specifically provides for and
maintains reserves in excess of the amounts required under
subparagraph (A).
``(ii) The plan shall secure specific excess/stop loss
insurance for the plan with an attachment point which is at
least equal to an amount recommended by the plan's qualified
actuary. The applicable authority may by regulation provide
for adjustments in the amount of such insurance in specified
circumstances in which the plan specifically provides for and
maintains reserves in excess of the amounts required under
subparagraph (A).
``(iii) The plan shall secure indemnification insurance for
any claims which the plan is unable to satisfy by reason of a
plan termination.
Any person issuing to a plan insurance described in clause
(i), (ii), or (iii) of subparagraph (B) shall notify the
Secretary of any failure of premium payment meriting
cancellation of the policy prior to undertaking such a
cancellation. Any regulations prescribed by the applicable
authority pursuant to clause (i) or (ii) of subparagraph (B)
may allow for such adjustments in the required levels of
excess/stop loss insurance as the qualified actuary may
recommend, taking into account the specific circumstances of
the plan.
``(b) Minimum Surplus in Addition to Claims Reserves.--In
the case of any association health plan described in
subsection (a)(2), the requirements of this subsection are
met if the plan establishes and maintains surplus in an
amount at least equal to--
``(1) $500,000, or
``(2) such greater amount (but not greater than $2,000,000)
as may be set forth in regulations prescribed by the
applicable authority, considering the level of aggregate and
specific excess/stop loss insurance provided with respect to
such plan and other factors related to solvency risk, such as
the plan's projected levels of participation or claims, the
nature of the plan's liabilities, and the types of assets
available to assure that such liabilities are met.
``(c) Additional Requirements.--In the case of any
association health plan described in subsection (a)(2), the
applicable authority may provide such additional requirements
relating to reserves, excess/stop loss insurance, and
indemnification insurance as the applicable authority
considers appropriate. Such requirements may be provided by
regulation with respect to any such plan or any class of such
plans.
``(d) Adjustments for Excess/Stop Loss Insurance.--The
applicable authority may provide for adjustments to the
levels of reserves otherwise required under subsections (a)
and (b) with respect to any plan or class of plans to take
into account excess/stop loss insurance provided with respect
to such plan or plans.
``(e) Alternative Means of Compliance.--The applicable
authority may permit an association health plan described in
subsection (a)(2) to substitute, for all or part of the
requirements of this section (except subsection
(a)(2)(B)(iii)), such security, guarantee, hold-harmless
arrangement, or other financial arrangement as the applicable
authority determines to be adequate to enable the plan to
fully meet all its financial obligations on a timely basis
and is otherwise no less protective of the interests of
participants and beneficiaries than the requirements for
which it is substituted. The applicable authority may take
into account, for purposes of this subsection, evidence
provided by the plan or sponsor which demonstrates an
assumption of liability with respect to the plan. Such
evidence may be in the form of a contract of indemnification,
lien, bonding, insurance, letter of credit, recourse under
applicable terms of the plan in the form of assessments of
participating employers, security, or other financial
arrangement.
``(f) Measures To Ensure Continued Payment of Benefits by
Certain Plans in Distress.--
``(1) Payments by certain plans to association health plan
fund.--
``(A) In general.--In the case of an association health
plan described in subsection (a)(2), the requirements of this
subsection are met if the plan makes payments into the
Association Health Plan Fund under this subparagraph when
they are due. Such payments shall consist of annual payments
in the amount of $5,000, and, in addition to such annual
payments, such supplemental payments as the Secretary may
determine to be necessary under paragraph (2). Payments under
this paragraph are payable to the Fund at the time determined
by the Secretary. Initial payments are due in advance of
certification under this part. Payments shall continue to
accrue until a plan's assets are distributed pursuant to a
termination procedure.
``(B) Penalties for failure to make payments.--If any
payment is not made by a plan when it is due, a late payment
charge of not more than 100 percent of the payment which was
not timely paid shall be payable by the plan to the Fund.
``(C) Continued duty of the secretary.--The Secretary shall
not cease to carry out the provisions of paragraph (2) on
account of the failure of a plan to pay any payment when due.
``(2) Payments by secretary to continue excess/stop loss
insurance coverage and indemnification insurance coverage for
certain plans.--In any case in which the applicable authority
determines that there is, or that there is reason to believe
that there will be: (A) A failure to take necessary
corrective actions under section 809(a) with respect to an
association health plan described in subsection (a)(2); or
(B) a termination of such a plan under section 809(b) or
810(b)(8) (and, if the applicable authority is not the
Secretary, certifies such determination to the Secretary),
the Secretary shall determine the amounts necessary to make
payments to an insurer (designated by the Secretary) to
maintain in force excess/stop loss insurance coverage or
indemnification insurance coverage for such plan, if the
Secretary determines that there is a reasonable expectation
that, without such payments, claims would not be satisfied by
reason of termination of such coverage. The Secretary shall,
to the extent provided in advance in appropriation Acts, pay
such amounts so determined to the insurer designated by the
Secretary.
``(3) Association health plan fund.--
``(A) In general.--There is established on the books of the
Treasury a fund to be known as the `Association Health Plan
Fund'. The Fund shall be available for making payments
pursuant to paragraph (2). The Fund shall be credited with
payments received pursuant to paragraph (1)(A), penalties
received pursuant to paragraph (1)(B); and earnings on
investments of amounts of the Fund under subparagraph (B).
``(B) Investment.--Whenever the Secretary determines that
the moneys of the fund are in excess of current needs, the
Secretary may request the investment of such amounts as the
Secretary determines advisable by the Secretary of the
Treasury in obligations issued or guaranteed by the United
States.
``(g) Excess/Stop Loss Insurance.--For purposes of this
section--
``(1) Aggregate excess/stop loss insurance.--The term
`aggregate excess/stop loss insurance' means, in connection
with an association health plan, a contract--
``(A) under which an insurer (meeting such minimum
standards as the applicable authority may prescribe by
regulation) provides for payment to the plan with respect to
aggregate claims under the plan in excess of an amount or
amounts specified in such contract;
``(B) which is guaranteed renewable; and
``(C) which allows for payment of premiums by any third
party on behalf of the insured plan.
[[Page H2315]]
``(2) Specific excess/stop loss insurance.--The term
`specific excess/stop loss insurance' means, in connection
with an association health plan, a contract--
``(A) under which an insurer (meeting such minimum
standards as the applicable authority may prescribe by
regulation) provides for payment to the plan with respect to
claims under the plan in connection with a covered individual
in excess of an amount or amounts specified in such contract
in connection with such covered individual;
``(B) which is guaranteed renewable; and
``(C) which allows for payment of premiums by any third
party on behalf of the insured plan.
``(h) Indemnification Insurance.--For purposes of this
section, the term `indemnification insurance' means, in
connection with an association health plan, a contract--
``(1) under which an insurer (meeting such minimum
standards as the applicable authority may prescribe by
regulation) provides for payment to the plan with respect to
claims under the plan which the plan is unable to satisfy by
reason of a termination pursuant to section 809(b) (relating
to mandatory termination);
``(2) which is guaranteed renewable and noncancellable for
any reason (except as the applicable authority may prescribe
by regulation); and
``(3) which allows for payment of premiums by any third
party on behalf of the insured plan.
``(i) Reserves.--For purposes of this section, the term
`reserves' means, in connection with an association health
plan, plan assets which meet the fiduciary standards under
part 4 and such additional requirements regarding liquidity
as the applicable authority may prescribe by regulation.
``(j) Solvency Standards Working Group.--
``(1) In general.--Within 90 days after the date of the
enactment of the Small Business Health Fairness Act of 2017,
the applicable authority shall establish a Solvency Standards
Working Group. In prescribing the initial regulations under
this section, the applicable authority shall take into
account the recommendations of such Working Group.
``(2) Membership.--The Working Group shall consist of not
more than 15 members appointed by the applicable authority.
The applicable authority shall include among persons invited
to membership on the Working Group at least one of each of
the following:
``(A) A representative of the National Association of
Insurance Commissioners.
``(B) A representative of the American Academy of
Actuaries.
``(C) A representative of the State governments, or their
interests.
``(D) A representative of existing self-insured
arrangements, or their interests.
``(E) A representative of associations of the type referred
to in section 801(b)(1), or their interests.
``(F) A representative of multiemployer plans that are
group health plans, or their interests.
``SEC. 807. REQUIREMENTS FOR APPLICATION AND RELATED
REQUIREMENTS.
``(a) Filing Fee.--Under the procedure prescribed pursuant
to section 802(a), an association health plan shall pay to
the applicable authority at the time of filing an application
for certification under this part a filing fee in the amount
of $5,000, which shall be available in the case of the
Secretary, to the extent provided in appropriation Acts, for
the sole purpose of administering the certification
procedures applicable with respect to association health
plans.
``(b) Information To Be Included in Application for
Certification.--An application for certification under this
part meets the requirements of this section only if it
includes, in a manner and form which shall be prescribed by
the applicable authority by regulation, at least the
following information:
``(1) Identifying information.--The names and addresses
of--
``(A) the sponsor; and
``(B) the members of the board of trustees of the plan.
``(2) States in which plan intends to do business.--The
States in which participants and beneficiaries under the plan
are to be located and the number of them expected to be
located in each such State.
``(3) Bonding requirements.--Evidence provided by the board
of trustees that the bonding requirements of section 412 will
be met as of the date of the application or (if later)
commencement of operations.
``(4) Plan documents.--A copy of the documents governing
the plan (including any bylaws and trust agreements), the
summary plan description, and other material describing the
benefits that will be provided to participants and
beneficiaries under the plan.
``(5) Agreements with service providers.--A copy of any
agreements between the plan and contract administrators and
other service providers.
``(6) Funding report.--In the case of association health
plans providing benefits options in addition to health
insurance coverage, a report setting forth information with
respect to such additional benefit options determined as of a
date within the 120-day period ending with the date of the
application, including the following:
``(A) Reserves.--A statement, certified by the board of
trustees of the plan, and a statement of actuarial opinion,
signed by a qualified actuary, that all applicable
requirements of section 806 are or will be met in accordance
with regulations which the applicable authority shall
prescribe.
``(B) Adequacy of contribution rates.--A statement of
actuarial opinion, signed by a qualified actuary, which sets
forth a description of the extent to which contribution rates
are adequate to provide for the payment of all obligations
and the maintenance of required reserves under the plan for
the 12-month period beginning with such date within such 120-
day period, taking into account the expected coverage and
experience of the plan. If the contribution rates are not
fully adequate, the statement of actuarial opinion shall
indicate the extent to which the rates are inadequate and the
changes needed to ensure adequacy.
``(C) Current and projected value of assets and
liabilities.--A statement of actuarial opinion signed by a
qualified actuary, which sets forth the current value of the
assets and liabilities accumulated under the plan and a
projection of the assets, liabilities, income, and expenses
of the plan for the 12-month period referred to in
subparagraph (B). The income statement shall identify
separately the plan's administrative expenses and claims.
``(D) Costs of coverage to be charged and other expenses.--
A statement of the costs of coverage to be charged, including
an itemization of amounts for administration, reserves, and
other expenses associated with the operation of the plan.
``(E) Other information.--Any other information as may be
determined by the applicable authority, by regulation, as
necessary to carry out the purposes of this part.
``(c) Filing Notice of Certification With States.--A
certification granted under this part to an association
health plan shall not be effective unless written notice of
such certification is filed with the applicable State
authority of each State in which at least 25 percent of the
participants and beneficiaries under the plan are located.
For purposes of this subsection, an individual shall be
considered to be located in the State in which a known
address of such individual is located or in which such
individual is employed.
``(d) Notice of Material Changes.--In the case of any
association health plan certified under this part,
descriptions of material changes in any information which was
required to be submitted with the application for the
certification under this part shall be filed in such form and
manner as shall be prescribed by the applicable authority by
regulation. The applicable authority may require by
regulation prior notice of material changes with respect to
specified matters which might serve as the basis for
suspension or revocation of the certification.
``(e) Reporting Requirements for Certain Association Health
Plans.--An association health plan certified under this part
which provides benefit options in addition to health
insurance coverage for such plan year shall meet the
requirements of section 103 by filing an annual report under
such section which shall include information described in
subsection (b)(6) with respect to the plan year and,
notwithstanding section 104(a)(1)(A), shall be filed with the
applicable authority not later than 90 days after the close
of the plan year (or on such later date as may be prescribed
by the applicable authority). The applicable authority may
require by regulation such interim reports as it considers
appropriate.
``(f) Engagement of Qualified Actuary.--The board of
trustees of each association health plan which provides
benefits options in addition to health insurance coverage and
which is applying for certification under this part or is
certified under this part shall engage, on behalf of all
participants and beneficiaries, a qualified actuary who shall
be responsible for the preparation of the materials
comprising information necessary to be submitted by a
qualified actuary under this part. The qualified actuary
shall utilize such assumptions and techniques as are
necessary to enable such actuary to form an opinion as to
whether the contents of the matters reported under this
part--
``(1) are in the aggregate reasonably related to the
experience of the plan and to reasonable expectations; and
``(2) represent such actuary's best estimate of anticipated
experience under the plan.
The opinion by the qualified actuary shall be made with
respect to, and shall be made a part of, the annual report.
``SEC. 808. NOTICE REQUIREMENTS FOR VOLUNTARY TERMINATION.
``Except as provided in section 809(b), an association
health plan which is or has been certified under this part
may terminate (upon or at any time after cessation of
accruals in benefit liabilities) only if the board of
trustees, not less than 60 days before the proposed
termination date--
``(1) provides to the participants and beneficiaries a
written notice of intent to terminate stating that such
termination is intended and the proposed termination date;
``(2) develops a plan for winding up the affairs of the
plan in connection with such termination in a manner which
will result in timely payment of all benefits for which the
plan is obligated; and
``(3) submits such plan in writing to the applicable
authority.
Actions required under this section shall be taken in such
form and manner as may be prescribed by the applicable
authority by regulation.
``SEC. 809. CORRECTIVE ACTIONS AND MANDATORY TERMINATION.
``(a) Actions To Avoid Depletion of Reserves.--An
association health plan which is certified under this part
and which provides benefits other than health insurance
coverage shall continue to meet the requirements of section
806, irrespective of whether such certification continues in
effect. The board of trustees of such plan shall determine
quarterly whether the requirements of section 806 are met. In
any case in which the board determines that there is reason
to believe that there is or will be a failure to meet such
requirements, or the applicable authority makes such a
determination and so notifies the board, the board shall
immediately notify the qualified actuary engaged by the plan,
[[Page H2316]]
and such actuary shall, not later than the end of the next
following month, make such recommendations to the board for
corrective action as the actuary determines necessary to
ensure compliance with section 806. Not later than 30 days
after receiving from the actuary recommendations for
corrective actions, the board shall notify the applicable
authority (in such form and manner as the applicable
authority may prescribe by regulation) of such
recommendations of the actuary for corrective action,
together with a description of the actions (if any) that the
board has taken or plans to take in response to such
recommendations. The board shall thereafter report to the
applicable authority, in such form and frequency as the
applicable authority may specify to the board, regarding
corrective action taken by the board until the requirements
of section 806 are met.
``(b) Mandatory Termination.--In any case in which--
``(1) the applicable authority has been notified under
subsection (a) (or by an issuer of excess/stop loss insurance
or indemnity insurance pursuant to section 806(a)) of a
failure of an association health plan which is or has been
certified under this part and is described in section
806(a)(2) to meet the requirements of section 806 and has not
been notified by the board of trustees of the plan that
corrective action has restored compliance with such
requirements; and
``(2) the applicable authority determines that there is a
reasonable expectation that the plan will continue to fail to
meet the requirements of section 806,
the board of trustees of the plan shall, at the direction of
the applicable authority, terminate the plan and, in the
course of the termination, take such actions as the
applicable authority may require, including satisfying any
claims referred to in section 806(a)(2)(B)(iii) and
recovering for the plan any liability under subsection
(a)(2)(B)(iii) or (e) of section 806, as necessary to ensure
that the affairs of the plan will be, to the maximum extent
possible, wound up in a manner which will result in timely
provision of all benefits for which the plan is obligated.
``SEC. 810. TRUSTEESHIP BY THE SECRETARY OF INSOLVENT
ASSOCIATION HEALTH PLANS PROVIDING HEALTH
BENEFITS IN ADDITION TO HEALTH INSURANCE
COVERAGE.
``(a) Appointment of Secretary as Trustee for Insolvent
Plans.--Whenever the Secretary determines that an association
health plan which is or has been certified under this part
and which is described in section 806(a)(2) will be unable to
provide benefits when due or is otherwise in a financially
hazardous condition, as shall be defined by the Secretary by
regulation, the Secretary shall, upon notice to the plan,
apply to the appropriate United States district court for
appointment of the Secretary as trustee to administer the
plan for the duration of the insolvency. The plan may appear
as a party and other interested persons may intervene in the
proceedings at the discretion of the court. The court shall
appoint such Secretary trustee if the court determines that
the trusteeship is necessary to protect the interests of the
participants and beneficiaries or providers of medical care
or to avoid any unreasonable deterioration of the financial
condition of the plan. The trusteeship of such Secretary
shall continue until the conditions described in the first
sentence of this subsection are remedied or the plan is
terminated.
``(b) Powers as Trustee.--The Secretary, upon appointment
as trustee under subsection (a), shall have the power--
``(1) to do any act authorized by the plan, this title, or
other applicable provisions of law to be done by the plan
administrator or any trustee of the plan;
``(2) to require the transfer of all (or any part) of the
assets and records of the plan to the Secretary as trustee;
``(3) to invest any assets of the plan which the Secretary
holds in accordance with the provisions of the plan,
regulations prescribed by the Secretary, and applicable
provisions of law;
``(4) to require the sponsor, the plan administrator, any
participating employer, and any employee organization
representing plan participants to furnish any information
with respect to the plan which the Secretary as trustee may
reasonably need in order to administer the plan;
``(5) to collect for the plan any amounts due the plan and
to recover reasonable expenses of the trusteeship;
``(6) to commence, prosecute, or defend on behalf of the
plan any suit or proceeding involving the plan;
``(7) to issue, publish, or file such notices, statements,
and reports as may be required by the Secretary by regulation
or required by any order of the court;
``(8) to terminate the plan (or provide for its termination
in accordance with section 809(b)) and liquidate the plan
assets, to restore the plan to the responsibility of the
sponsor, or to continue the trusteeship;
``(9) to provide for the enrollment of plan participants
and beneficiaries under appropriate coverage options; and
``(10) to do such other acts as may be necessary to comply
with this title or any order of the court and to protect the
interests of plan participants and beneficiaries and
providers of medical care.
``(c) Notice of Appointment.--As soon as practicable after
the Secretary's appointment as trustee, the Secretary shall
give notice of such appointment to--
``(1) the sponsor and plan administrator;
``(2) each participant;
``(3) each participating employer; and
``(4) if applicable, each employee organization which, for
purposes of collective bargaining, represents plan
participants.
``(d) Additional Duties.--Except to the extent inconsistent
with the provisions of this title, or as may be otherwise
ordered by the court, the Secretary, upon appointment as
trustee under this section, shall be subject to the same
duties as those of a trustee under section 704 of title 11,
United States Code, and shall have the duties of a fiduciary
for purposes of this title.
``(e) Other Proceedings.--An application by the Secretary
under this subsection may be filed notwithstanding the
pendency in the same or any other court of any bankruptcy,
mortgage foreclosure, or equity receivership proceeding, or
any proceeding to reorganize, conserve, or liquidate such
plan or its property, or any proceeding to enforce a lien
against property of the plan.
``(f) Jurisdiction of Court.--
``(1) In general.--Upon the filing of an application for
the appointment as trustee or the issuance of a decree under
this section, the court to which the application is made
shall have exclusive jurisdiction of the plan involved and
its property wherever located with the powers, to the extent
consistent with the purposes of this section, of a court of
the United States having jurisdiction over cases under
chapter 11 of title 11, United States Code. Pending an
adjudication under this section such court shall stay, and
upon appointment by it of the Secretary as trustee, such
court shall continue the stay of, any pending mortgage
foreclosure, equity receivership, or other proceeding to
reorganize, conserve, or liquidate the plan, the sponsor, or
property of such plan or sponsor, and any other suit against
any receiver, conservator, or trustee of the plan, the
sponsor, or property of the plan or sponsor. Pending such
adjudication and upon the appointment by it of the Secretary
as trustee, the court may stay any proceeding to enforce a
lien against property of the plan or the sponsor or any other
suit against the plan or the sponsor.
``(2) Venue.--An action under this section may be brought
in the judicial district where the sponsor or the plan
administrator resides or does business or where any asset of
the plan is situated. A district court in which such action
is brought may issue process with respect to such action in
any other judicial district.
``(g) Personnel.--In accordance with regulations which
shall be prescribed by the Secretary, the Secretary shall
appoint, retain, and compensate accountants, actuaries, and
other professional service personnel as may be necessary in
connection with the Secretary's service as trustee under this
section.
``SEC. 811. STATE ASSESSMENT AUTHORITY.
``(a) In General.--Notwithstanding section 514, a State may
impose by law a contribution tax on an association health
plan described in section 806(a)(2), if the plan commenced
operations in such State after the date of the enactment of
the Small Business Health Fairness Act of 2017.
``(b) Contribution Tax.--For purposes of this section, the
term `contribution tax' imposed by a State on an association
health plan means any tax imposed by such State if--
``(1) such tax is computed by applying a rate to the amount
of premiums or contributions, with respect to individuals
covered under the plan who are residents of such State, which
are received by the plan from participating employers located
in such State or from such individuals;
``(2) the rate of such tax does not exceed the rate of any
tax imposed by such State on premiums or contributions
received by insurers or health maintenance organizations for
health insurance coverage offered in such State in connection
with a group health plan;
``(3) such tax is otherwise nondiscriminatory; and
``(4) the amount of any such tax assessed on the plan is
reduced by the amount of any tax or assessment otherwise
imposed by the State on premiums, contributions, or both
received by insurers or health maintenance organizations for
health insurance coverage, aggregate excess/stop loss
insurance (as defined in section 806(g)(1)), specific excess/
stop loss insurance (as defined in section 806(g)(2)), other
insurance related to the provision of medical care under the
plan, or any combination thereof provided by such insurers or
health maintenance organizations in such State in connection
with such plan.
``SEC. 812. DEFINITIONS AND RULES OF CONSTRUCTION.
``(a) Definitions.--For purposes of this part--
``(1) Group health plan.--The term `group health plan' has
the meaning provided in section 733(a)(1) (after applying
subsection (b) of this section).
``(2) Medical care.--The term `medical care' has the
meaning provided in section 733(a)(2).
``(3) Health insurance coverage.--The term `health
insurance coverage' has the meaning provided in section
733(b)(1).
``(4) Health insurance issuer.--The term `health insurance
issuer' has the meaning provided in section 733(b)(2).
``(5) Applicable authority.--The term `applicable
authority' means the Secretary, except that, in connection
with any exercise of the Secretary's authority regarding
which the Secretary is required under section 506(d) to
consult with a State, such term means the Secretary, in
consultation with such State.
``(6) Health status-related factor.--The term `health
status-related factor' has the meaning provided in section
733(d)(2).
``(7) Individual market.--
``(A) In general.--The term `individual market' means the
market for health insurance coverage offered to individuals
other than in connection with a group health plan.
``(B) Treatment of very small groups.--
``(i) In general.--Subject to clause (ii), such term
includes coverage offered in connection with a group health
plan that has fewer than 2 participants as current employees
or participants described in section 732(d)(3) on the first
day of the plan year.
[[Page H2317]]
``(ii) State exception.--Clause (i) shall not apply in the
case of health insurance coverage offered in a State if such
State regulates the coverage described in such clause in the
same manner and to the same extent as coverage in the small
group market (as defined in section 2791(e)(5) of the Public
Health Service Act) is regulated by such State.
``(8) Participating employer.--The term `participating
employer' means, in connection with an association health
plan, any employer, if any individual who is an employee of
such employer, a partner in such employer, or a self-employed
individual who is such employer (or any dependent, as defined
under the terms of the plan, of such individual) is or was
covered under such plan in connection with the status of such
individual as such an employee, partner, or self-employed
individual in relation to the plan.
``(9) Applicable state authority.--The term `applicable
State authority' means, with respect to a health insurance
issuer in a State, the State insurance commissioner or
official or officials designated by the State to enforce the
requirements of title XXVII of the Public Health Service Act
for the State involved with respect to such issuer.
``(10) Qualified actuary.--The term `qualified actuary'
means an individual who is a member of the American Academy
of Actuaries.
``(11) Affiliated member.--The term `affiliated member'
means, in connection with a sponsor--
``(A) a person who is otherwise eligible to be a member of
the sponsor but who elects an affiliated status with the
sponsor,
``(B) in the case of a sponsor with members which consist
of associations, a person who is a member of any such
association and elects an affiliated status with the sponsor,
or
``(C) in the case of an association health plan in
existence on the date of the enactment of the Small Business
Health Fairness Act of 2017, a person eligible to be a member
of the sponsor or one of its member associations.
``(12) Large employer.--The term `large employer' means, in
connection with a group health plan with respect to a plan
year, an employer who employed an average of at least 51
employees on business days during the preceding calendar year
and who employs at least 2 employees on the first day of the
plan year.
``(13) Small employer.--The term `small employer' means, in
connection with a group health plan with respect to a plan
year, an employer who is not a large employer.
``(b) Rules of Construction.--
``(1) Employers and employees.--For purposes of determining
whether a plan, fund, or program is an employee welfare
benefit plan which is an association health plan, and for
purposes of applying this title in connection with such plan,
fund, or program so determined to be such an employee welfare
benefit plan--
``(A) in the case of a partnership, the term `employer' (as
defined in section 3(5)) includes the partnership in relation
to the partners, and the term `employee' (as defined in
section 3(6)) includes any partner in relation to the
partnership; and
``(B) in the case of a self-employed individual, the term
`employer' (as defined in section 3(5)) and the term
`employee' (as defined in section 3(6)) shall include such
individual.
``(2) Plans, funds, and programs treated as employee
welfare benefit plans.--In the case of any plan, fund, or
program which was established or is maintained for the
purpose of providing medical care (through the purchase of
insurance or otherwise) for employees (or their dependents)
covered thereunder and which demonstrates to the Secretary
that all requirements for certification under this part would
be met with respect to such plan, fund, or program if such
plan, fund, or program were a group health plan, such plan,
fund, or program shall be treated for purposes of this title
as an employee welfare benefit plan on and after the date of
such demonstration.''.
(b) Conforming Amendments to Preemption Rules.--
(1) Section 514(b)(6) of such Act (29 U.S.C. 1144(b)(6)) is
amended by adding at the end the following new subparagraph:
``(E) The preceding subparagraphs of this paragraph do not
apply with respect to any State law in the case of an
association health plan which is certified under part 8.''.
(2) Section 514 of such Act (29 U.S.C. 1144) is amended--
(A) in subsection (b)(4), by striking ``Subsection (a)''
and inserting ``Subsections (a) and (f)'';
(B) in subsection (b)(5), by striking ``subsection (a)'' in
subparagraph (A) and inserting ``subsection (a) of this
section and subsections (a)(2)(B) and (b) of section 805'',
and by striking ``subsection (a)'' in subparagraph (B) and
inserting ``subsection (a) of this section or subsection
(a)(2)(B) or (b) of section 805''; and
(C) by adding at the end the following new subsection:
``(f)(1) Except as provided in subsection (b)(4), the
provisions of this title shall supersede any and all State
laws insofar as they may now or hereafter preclude, or have
the effect of precluding, a health insurance issuer from
offering health insurance coverage in connection with an
association health plan which is certified under part 8.
``(2) Except as provided in paragraphs (4) and (5) of
subsection (b) of this section--
``(A) In any case in which health insurance coverage of any
policy type is offered under an association health plan
certified under part 8 to a participating employer operating
in such State, the provisions of this title shall supersede
any and all laws of such State insofar as they may preclude a
health insurance issuer from offering health insurance
coverage of the same policy type to other employers operating
in the State which are eligible for coverage under such
association health plan, whether or not such other employers
are participating employers in such plan.
``(B) In any case in which health insurance coverage of any
policy type is offered in a State under an association health
plan certified under part 8 and the filing, with the
applicable State authority (as defined in section 812(a)(9)),
of the policy form in connection with such policy type is
approved by such State authority, the provisions of this
title shall supersede any and all laws of any other State in
which health insurance coverage of such type is offered,
insofar as they may preclude, upon the filing in the same
form and manner of such policy form with the applicable State
authority in such other State, the approval of the filing in
such other State.
``(3) Nothing in subsection (b)(6)(E) or the preceding
provisions of this subsection shall be construed, with
respect to health insurance issuers or health insurance
coverage, to supersede or impair the law of any State--
``(A) providing solvency standards or similar standards
regarding the adequacy of insurer capital, surplus, reserves,
or contributions, or
``(B) relating to prompt payment of claims.
``(4) For additional provisions relating to association
health plans, see subsections (a)(2)(B) and (b) of section
805.
``(5) For purposes of this subsection, the term
`association health plan' has the meaning provided in section
801(a), and the terms `health insurance coverage',
`participating employer', and `health insurance issuer' have
the meanings provided such terms in section 812,
respectively.''.
(3) Section 514(b)(6)(A) of such Act (29 U.S.C.
1144(b)(6)(A)) is amended--
(A) in clause (i)(II), by striking ``and'' at the end;
(B) in clause (ii), by inserting ``and which does not
provide medical care (within the meaning of section
733(a)(2)),'' after ``arrangement,'', and by striking
``title.'' and inserting ``title, and''; and
(C) by adding at the end the following new clause:
``(iii) subject to subparagraph (E), in the case of any
other employee welfare benefit plan which is a multiple
employer welfare arrangement and which provides medical care
(within the meaning of section 733(a)(2)), any law of any
State which regulates insurance may apply.''.
(4) Section 514(d) of such Act (29 U.S.C. 1144(d)) is
amended--
(A) by striking ``Nothing'' and inserting ``(1) Except as
provided in paragraph (2), nothing''; and
(B) by adding at the end the following new paragraph:
``(2) Nothing in any other provision of law enacted on or
after the date of the enactment of the Small Business Health
Fairness Act of 2017 shall be construed to alter, amend,
modify, invalidate, impair, or supersede any provision of
this title, except by specific cross-reference to the
affected section.''.
(c) Plan Sponsor.--Section 3(16)(B) of such Act (29 U.S.C.
102(16)(B)) is amended by adding at the end the following new
sentence: ``Such term also includes a person serving as the
sponsor of an association health plan under part 8.''.
(d) Disclosure of Solvency Protections Related to Self-
Insured and Fully Insured Options Under Association Health
Plans.--Section 102(b) of such Act (29 U.S.C. 102(b)) is
amended by adding at the end the following: ``An association
health plan shall include in its summary plan description, in
connection with each benefit option, a description of the
form of solvency or guarantee fund protection secured
pursuant to this Act or applicable State law, if any.''.
(e) Savings Clause.--Section 731(c) of such Act is amended
by inserting ``or part 8'' after ``this part''.
(f) Report to the Congress Regarding Certification of Self-
Insured Association Health Plans.--Not later than January 1,
2022, the Secretary of Labor shall report to the Committee on
Education and the Workforce of the House of Representatives
and the Committee on Health, Education, Labor, and Pensions
of the Senate the effect association health plans have had,
if any, on reducing the number of uninsured individuals.
(g) Clerical Amendment.--The table of contents in section 1
of the Employee Retirement Income Security Act of 1974 is
amended by inserting after the item relating to section 734
the following new items:
``Part 8. Rules Governing Association Health Plans
``801. Association health plans.
``802. Certification of association health plans.
``803. Requirements relating to sponsors and boards of trustees.
``804. Participation and coverage requirements.
``805. Other requirements relating to plan documents, contribution
rates, and benefit options.
``806. Maintenance of reserves and provisions for solvency for plans
providing health benefits in addition to health insurance
coverage.
``807. Requirements for application and related requirements.
``808. Notice requirements for voluntary termination.
``809. Corrective actions and mandatory termination.
``810. Trusteeship by the Secretary of insolvent association health
plans providing health benefits in addition to health
insurance coverage.
[[Page H2318]]
``811. State assessment authority.
``812. Definitions and rules of construction.''.
SEC. 3. CLARIFICATION OF TREATMENT OF SINGLE EMPLOYER
ARRANGEMENTS.
Section 3(40)(B) of the Employee Retirement Income Security
Act of 1974 (29 U.S.C. 1002(40)(B)) is amended--
(1) in clause (i), by inserting after ``control group,''
the following: ``except that, in any case in which the
benefit referred to in subparagraph (A) consists of medical
care (as defined in section 812(a)(2)), two or more trades or
businesses, whether or not incorporated, shall be deemed a
single employer for any plan year of such plan, or any fiscal
year of such other arrangement, if such trades or businesses
are within the same control group during such year or at any
time during the preceding 1-year period,'';
(2) in clause (iii), by striking ``(iii) the
determination'' and inserting the following:
``(iii)(I) in any case in which the benefit referred to in
subparagraph (A) consists of medical care (as defined in
section 812(a)(2)), the determination of whether a trade or
business is under `common control' with another trade or
business shall be determined under regulations of the
Secretary applying principles consistent and coextensive with
the principles applied in determining whether employees of
two or more trades or businesses are treated as employed by a
single employer under section 4001(b), except that, for
purposes of this paragraph, an interest of greater than 25
percent may not be required as the minimum interest necessary
for common control, or
``(II) in any other case, the determination'';
(3) by redesignating clauses (iv) and (v) as clauses (v)
and (vi), respectively; and
(4) by inserting after clause (iii) the following new
clause:
``(iv) in any case in which the benefit referred to in
subparagraph (A) consists of medical care (as defined in
section 812(a)(2)), in determining, after the application of
clause (i), whether benefits are provided to employees of two
or more employers, the arrangement shall be treated as having
only one participating employer if, after the application of
clause (i), the number of individuals who are employees and
former employees of any one participating employer and who
are covered under the arrangement is greater than 75 percent
of the aggregate number of all individuals who are employees
or former employees of participating employers and who are
covered under the arrangement,''.
SEC. 4. ENFORCEMENT PROVISIONS RELATING TO ASSOCIATION HEALTH
PLANS.
(a) Criminal Penalties for Certain Willful
Misrepresentations.--Section 501 of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1131) is amended by
adding at the end the following new subsection:
``(c) Any person who willfully falsely represents, to any
employee, any employee's beneficiary, any employer, the
Secretary, or any State, a plan or other arrangement
established or maintained for the purpose of offering or
providing any benefit described in section 3(1) to employees
or their beneficiaries as--
``(1) being an association health plan which has been
certified under part 8;
``(2) having been established or maintained under or
pursuant to one or more collective bargaining agreements
which are reached pursuant to collective bargaining described
in section 8(d) of the National Labor Relations Act (29
U.S.C. 158(d)) or paragraph Fourth of section 2 of the
Railway Labor Act (45 U.S.C. 152, paragraph Fourth) or which
are reached pursuant to labor-management negotiations under
similar provisions of State public employee relations laws;
or
``(3) being a plan or arrangement described in section
3(40)(A)(i),
shall, upon conviction, be imprisoned not more than 5 years,
be fined under title 18, United States Code, or both.''.
(b) Cease Activities Orders.--Section 502 of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1132) is
amended by adding at the end the following new subsection:
``(n) Association Health Plan Cease and Desist Orders.--
``(1) In general.--Subject to paragraph (2), upon
application by the Secretary showing the operation,
promotion, or marketing of an association health plan (or
similar arrangement providing benefits consisting of medical
care (as defined in section 733(a)(2))) that--
``(A) is not certified under part 8, is subject under
section 514(b)(6) to the insurance laws of any State in which
the plan or arrangement offers or provides benefits, and is
not licensed, registered, or otherwise approved under the
insurance laws of such State; or
``(B) is an association health plan certified under part 8
and is not operating in accordance with the requirements
under part 8 for such certification,
a district court of the United States shall enter an order
requiring that the plan or arrangement cease activities.
``(2) Exception.--Paragraph (1) shall not apply in the case
of an association health plan or other arrangement if the
plan or arrangement shows that--
``(A) all benefits under it referred to in paragraph (1)
consist of health insurance coverage; and
``(B) with respect to each State in which the plan or
arrangement offers or provides benefits, the plan or
arrangement is operating in accordance with applicable State
laws that are not superseded under section 514.
``(3) Additional equitable relief.--The court may grant
such additional equitable relief, including any relief
available under this title, as it deems necessary to protect
the interests of the public and of persons having claims for
benefits against the plan.''.
(c) Responsibility for Claims Procedure.--Section 503 of
the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1133) is amended by inserting ``(a) In General.--''
before ``In accordance'', and by adding at the end the
following new subsection:
``(b) Association Health Plans.--The terms of each
association health plan which is or has been certified under
part 8 shall require the board of trustees or the named
fiduciary (as applicable) to ensure that the requirements of
this section are met in connection with claims filed under
the plan.''.
SEC. 5. COOPERATION BETWEEN FEDERAL AND STATE AUTHORITIES.
Section 506 of the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1136) is amended by adding at the end the
following new subsection:
``(d) Consultation With States With Respect to Association
Health Plans.--
``(1) Agreements with states.--The Secretary shall consult
with the State recognized under paragraph (2) with respect to
an association health plan regarding the exercise of--
``(A) the Secretary's authority under sections 502 and 504
to enforce the requirements for certification under part 8;
and
``(B) the Secretary's authority to certify association
health plans under part 8 in accordance with regulations of
the Secretary applicable to certification under part 8.
``(2) Recognition of primary domicile state.--In carrying
out paragraph (1), the Secretary shall ensure that only one
State will be recognized, with respect to any particular
association health plan, as the State with which consultation
is required. In carrying out this paragraph--
``(A) in the case of a plan which provides health insurance
coverage (as defined in section 812(a)(3)), such State shall
be the State with which filing and approval of a policy type
offered by the plan was initially obtained, and
``(B) in any other case, the Secretary shall take into
account the places of residence of the participants and
beneficiaries under the plan and the State in which the trust
is maintained.''.
SEC. 6. EFFECTIVE DATE AND TRANSITIONAL AND OTHER RULES.
(a) Effective Date.--The amendments made by this Act shall
take effect 1 year after the date of the enactment of this
Act. The Secretary of Labor shall first issue all regulations
necessary to carry out the amendments made by this Act within
1 year after the date of the enactment of this Act.
(b) Treatment of Certain Existing Health Benefits
Programs.--
(1) In general.--In any case in which, as of the date of
the enactment of this Act, an arrangement is maintained in a
State for the purpose of providing benefits consisting of
medical care for the employees and beneficiaries of its
participating employers, at least 200 participating employers
make contributions to such arrangement, such arrangement has
been in existence for at least 10 years, and such arrangement
is licensed under the laws of one or more States to provide
such benefits to its participating employers, upon the filing
with the applicable authority (as defined in section
812(a)(5) of the Employee Retirement Income Security Act of
1974 (as amended by this subtitle)) by the arrangement of an
application for certification of the arrangement under part 8
of subtitle B of title I of such Act--
(A) such arrangement shall be deemed to be a group health
plan for purposes of title I of such Act;
(B) the requirements of sections 801(a) and 803(a) of the
Employee Retirement Income Security Act of 1974 shall be
deemed met with respect to such arrangement;
(C) the requirements of section 803(b) of such Act shall be
deemed met, if the arrangement is operated by a board of
directors which--
(i) is elected by the participating employers, with each
employer having one vote; and
(ii) has complete fiscal control over the arrangement and
which is responsible for all operations of the arrangement;
(D) the requirements of section 804(a) of such Act shall be
deemed met with respect to such arrangement; and
(E) the arrangement may be certified by any applicable
authority with respect to its operations in any State only if
it operates in such State on the date of certification.
The provisions of this subsection shall cease to apply with
respect to any such arrangement at such time after the date
of the enactment of this Act as the applicable requirements
of this subsection are not met with respect to such
arrangement.
(2) Definitions.--For purposes of this subsection, the
terms ``group health plan'', ``medical care'', and
``participating employer'' shall have the meanings provided
in section 812 of the Employee Retirement Income Security Act
of 1974, except that the reference in paragraph (7) of such
section to an ``association health plan'' shall be deemed a
reference to an arrangement referred to in this subsection.
The SPEAKER pro tempore. The bill shall be debatable for 1 hour
equally divided and controlled by the chair and
[[Page H2319]]
ranking minority member of the Committee on Education and the
Workforce.
After 1 hour of debate, it shall be in order to consider the further
amendment printed in House Report 115-51, if offered by the Member
designated in the report, which shall be considered read and shall be
separately debatable for the time specified in the report equally
divided and controlled by the proponent and an opponent.
=========================== NOTE ===========================
March 22, 2017, on page H2319, the following appeared: order to
consider further amendment
The online version has been corrected to read: order to consider
the further amendment
========================= END NOTE =========================
The gentlewoman from North Carolina (Ms. Foxx) and the gentleman from
Virginia (Mr. Scott) each will control 30 minutes.
The Chair recognizes the gentlewoman from North Carolina.
General Leave
Ms. FOXX. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
include extraneous material on H.R. 1101.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from North Carolina?
There was no objection.
Ms. FOXX. Mr. Speaker, I yield myself such time as I may consume.
I rise today in support of H.R. 1101, the Small Business Health
Fairness Act of 2017.
Mr. Speaker, this week marks 7 years since ObamaCare was signed into
law. We all remember the promises former President Obama and Washington
Democrats made at the time.
Families were promised that their healthcare costs would go down.
They were promised more choices and more competition. Small businesses
and their employees were promised greater access to affordable health
care.
But for 7 years, we have watched as all of those promises were
broken. For 7 years, we have heard from families and small businesses
across the country that have seen their healthcare costs skyrocket and
their choices diminish.
Members of the House Education and the Workforce Committee recently
heard from Scott Bollenbacher, an Indiana small-business owner with 11
full-time employees. The company has been forced to switch healthcare
plans twice now under ObamaCare, and their only viable option this year
was a plan with a 78 percent premium increase.
Mr. Bollenbacher is one of countless small-business owners struggling
to make ends meet under a failed government takeover of health care.
Because of ObamaCare, 300,000 small-business jobs have been destroyed,
including nearly 8,000 in my home State of North Carolina.
{time} 1400
Additionally, an estimated 10,000 small businesses nationwide have
closed their doors, and small business employees have lost $19 billion
each year in wages.
It should come as no surprise that, since 2008, the share of small
businesses with fewer than 10 employees offering health coverage has
dropped 36 percent. It is not that they don't want to; it is that
onerous mandates and regulations have made it simply unaffordable to do
so.
Fortunately, relief is on the way. This week we are not only moving
to repeal ObamaCare, we are also advancing positive reforms that
promote affordable coverage for working families, including the Small
Business Health Fairness Act.
As its title implies, this important legislation is about fairness
for small businesses and their employees. Today, small businesses are
on an unfair playing field with larger companies and unions when it
comes to health care. Large businesses have the ability to negotiate
for more affordable healthcare costs for their employees, but small
businesses do not have the same advantage. Because of their size, small
businesses have limited bargaining power, which means their employees
can end up paying more for health insurance.
With millions of Americans employed by a small business, it is long
past time to level the playing field. That is exactly what this
commonsense legislation is about. This bill would empower small
businesses to band together through association health plans, or AHPs,
to purchase high-quality health care at a lower cost for workers.
This bill represents a first step toward a more competitive health
insurance market that crosses State lines. Under H.R. 1101, small
businesses in different States could join together through a group
health plan. These plans would have strong protections and solvency
requirements to ensure workers can count on healthcare coverage when
they and their families need it.
What does all of this mean: more choices, more freedom, and more
affordable health care for working families and small-business owners
like Scott Bollenbacher. This is a better way, one that stands in stark
contrast to ObamaCare's failed approach. Instead of more mandates, this
bill empowers individuals to access the high-quality, affordable
healthcare plan that meets their needs.
I want to thank my colleague Representative Sam Johnson for
championing, for years, the positive reforms in this bill.
I urge Members to vote ``yes'' on H.R. 1101 so we can level the
playing field for small businesses and expand affordable health
coverage for working families.
Mr. Speaker, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, today we are considering a bill that purports to make it
easier for small businesses to obtain coverage, and tomorrow we will
vote on a bill that will take away health insurance coverage for 24
million Americans and force everyone else to pay more for less. So not
only are we considering a bill today that will make things worse, we
are considering it a day before we vote on ruining health security for
working families in order to provide tax cuts for the wealthy.
As we debate the possible replacement of the Affordable Care Act, I
think it is instructive that we look back at what the situation was
before the ACA passed.
Listening to some, you would think that the costs weren't going up at
all. In fact, costs were going through the roof before the ACA, and
small businesses, particularly, were having spectacular cost
increases--and that is until somebody got sick. At that point, you were
unlikely to be able to afford any insurance at all.
Every year before the ACA, small businesses were dropping insurance
right and left, particularly after somebody got sick. Also, before the
Affordable Care Act, people with preexisting conditions couldn't get
insurance. Women were paying more than men. Millions of people were
losing their insurance every year.
Since then, the costs have continued to go up, but at the lowest rate
in the last 50 years. People with preexisting conditions can get
insurance at the standard rate. Small businesses can cover their
employees through the Affordable Care Act at the average cost, whether
or not anybody in their small business has cancer or diabetes. Women
are not paying more than men. Instead of millions of people losing
their insurance every year, 20 million more people have insurance.
In addition to that, families now enjoy strong consumer protections.
The full name of the Affordable Care Act is the Patient Protection and
Affordable Care Act. Now there are no caps on what an insurance company
pays, and they can't cancel your policy for anything other than
nonpayment. Preventive services such as cancer screenings are available
with no copay or deductible. Those up to 26 can stay on their parents'
policy, and the doughnut hole is being closed.
The ACA did not cure every problem, but it went a long way to making
Americans healthier and giving them some economic security. It could
have gone further if, in the past 7 years, Republicans would have been
willing to work with Democrats to build on the progress instead of
forcing over 60 votes to repeal all parts of the Affordable Care Act.
If we do anything now, we ought to improve the situation, not make it
worse. The Republican plan makes things worse. The CBO analysis
concluded that 24 million fewer people will have insurance, and most of
those that get insurance in the future will be paying more for policies
that don't deliver as much.
For seniors, particularly, the costs will skyrocket. And, in fact,
the prediction that the rates will go down in
[[Page H2320]]
the future are a result of the conclusion that so few seniors will be
able to buy insurance that they will no longer be in the insurance
pool.
The insurance pool would be younger, and, therefore, the costs would
go down. But that is only because seniors won't be able to afford the
insurance. Therefore, the insurance pool will be younger and cheaper
for those who can actually afford it, but that is not a good thing for
seniors who need the insurance and can't afford it.
So today we are considering another failed policy. The association
plan ideas have been studied for years, and it has been concluded that
it is a bad idea. Under the Affordable Care Act, essentially everybody
pays average. If you change that arithmetic so some can pay a little
less, then arithmetic matters. Everybody else is going to pay a little
more.
In the association plans, quite frankly, I will admit, they will
always work for the few that can get into them. That is because, if you
can draw out your own group, if they are healthier than average and can
pay less, they will pay less and the association will work. But if you
pull out a group and it turns out they are a little sicker than average
and the bids come in above average, then the association will dissolve
and everybody will go back into the insurance pool.
So if you can pull out a group, they will always pay less until
somebody gets sick, and then everybody jumps back into the insurance
pool. The higher cost groups will be left behind. The lower cost groups
will segment out, and then the rates will go down for a few and up for
everybody else.
This is exactly why the American Academy of Actuaries has said that
expanding association plans ``could result in unintended consequences
such as market segmentation that could threaten . . . viability and
make it more difficult for high-cost individuals and groups to obtain
coverage.''
One of the other problems is a lack of regulation. If a group is
allowed to circumvent State regulations, that policy may be cheaper
because the policy is not as good.
There are a lot of ways that you can save money. You can pull out a
group of just young men and save on maternity benefits. That would be
cheaper for them but more expensive for everybody else.
And what happens when a new spouse needs coverage and tries to get it
as an optional benefit? They won't be able to afford it.
Workers and businessowners are likely to get fewer benefits under the
association approach and will be disadvantaged compared to those in the
regular pool getting comprehensive benefits.
This is exactly why Consumers Union has stated that the legislation
is ``likely . . . to provide minimal and nonuniform benefits.''
Mr. Speaker, this bill will make it easier to set up these kinds of
associations and let them avoid State regulations, which could require
solvency, nice solvency requirements, and consumer protections. The
protections in this bill are not sufficient to protect consumers, and
most States would require stronger capital requirements than the bill
requires.
Much like the Republican replacement bill, this bill goes in the
wrong direction, so I urge my colleagues to vote ``no.''
Mr. Speaker, I reserve the balance of my time.
Ms. FOXX. Mr. Speaker, I yield 6 minutes to the gentleman from Texas
(Mr. Sam Johnson), the author of the bill.
Mr. SAM JOHNSON of Texas. Mr. Speaker, I thank the gentlewoman for
yielding.
I would like to start off by thanking Chairwoman Foxx and Chairman
Walberg for their strong support of my bill, the Small Business Health
Fairness Act.
Mr. Speaker, the legislation before us today is on an issue that has
long been near and dear to my heart: association health plans.
Association health plans would allow small businesses to join together
and provide healthcare coverage just like large corporations and unions
do today.
Association health plans are also a central part of replacing
ObamaCare with commonsense solutions.
You know, ObamaCare has been an absolute disaster. My constituents in
Collin County, Texas, have shared with me their negative experiences
with it since it became law nearly 7 years ago.
One of the groups hardest hit by ObamaCare is small businesses, the
backbone of our economy. Since 2008, over one-third of businesses with
fewer than 10 employees offering health insurance have dropped
insurance; and, you know, that is just wrong.
Because ObamaCare is failing, we need to repeal it and replace it
with better solutions for the American people. One of these solutions
is my association health plan bill.
What my bill does is simply allow small businesses to join together
through trade or professional organizations. As we all know, the basic
rule of insurance is the bigger the risk pool, the lower the cost.
Furthermore, my bill allows small businesses to join together across
State lines. My bill would also free small businesses from costly and
burdensome State and Federal requirements. This isn't anything
different from what large employers and unions already do. My bill is
simply about leveling the playing field for small businesses and their
hardworking employees.
This bill also has wide support from the business community,
including the United States Chamber of Commerce, the National
Federation of Independent Business, the National Retail Federation, and
the International Franchise Association.
Not everyone knows this, but I was a small-business owner myself
between my time in the Air Force and coming to Congress. In fact, I
established a home building business in north Texas from scratch, so I
can understand where small businesses are coming from.
For example, Bob Gibbons and his wife own a commercial real estate
business in my hometown of Plano, Texas. They have had a tough time
obtaining good, affordable health insurance, a problem that has gotten
worse since ObamaCare.
Bob sums up this entire issue pretty well in two sentences: ``Why
should someone's status as an employee give them preferential right to
decent group health coverage? Entrepreneurs are penalized when they
start a small business because they can't get comparable coverage.''
{time} 1415
Bob's experience underscores the entire point behind the Small
Business Health Fairness Act.
Mr. Speaker, I include Bob's letter in the Record, along with letters
from the cities of Frisco, Richardson, and Anna in my district.
REATA Commercial Realty, Inc.,
Plano, TX, March 2, 2017.
Re Association Health Plans.
Hon. Sam Johnson,
House of Representatives,
Washington, DC.
Dear Representative Johnson: I would like to register my
support of your recently introduced bill, H.R. 1101, which
would provide for association health plans. I am a small
business owner in your district in Plano, Texas. My wife and
I have been on a roller coaster of health coverage over the
years. We were covered by employer plans when I was an
employee (pre-ACA). Then we had to negotiate for an
individual plan when I started my own business (pre-ACA).
Then we were again covered by an employer plan when my wife
went to work (post-ACA). And now that she works with me, we
must navigate the purchase of an individual plan again, but
in the post-ACA failure environment.
I have always thought it was ridiculous that the only
decent health coverage was available to employees of
companies that provided it. Why should someone's status as an
employee give them a preferential right to decent group
health coverage? Entrepreneurs are penalized when they start
a small business because they can't get comparable coverage.
I was thrilled when I ran into Gabi Pate at a Plano Chamber
of Commerce Public Policy Committee meeting yesterday and
heard you were trying to help. Association health plans would
be a step in the right direction. At least then I could get
in on a group plan through trade associations, a chamber of
commerce or another qualified group. I truly hope that the
bill will allow for portability of that health coverage,
however, so I can leave the association if I choose and still
have coverage.
Thank you for your leadership in this area. Please don't
hesitate to contact me if you have any questions.
Sincerely,
Bob Gibbons.
[[Page H2321]]
____
Frisco Chamber of Commerce,
Frisco, TX, March 22, 2017.
On behalf of the Frisco Chamber of Commerce in Frisco,
Texas, I write in strong support of the Small Business Health
Fairness Act. The Frisco Chamber of Commerce provides
advocacy support for over 1,300 businesses of all sizes. We
consistently hear from our small business members about the
hardship in providing appropriate and adequate healthcare for
their employees at an affordable price. This legislation will
increase small businesses' bargaining power with health
insurance providers and ensure a level playing field for
smaller entities that want to help their workers and families
with healthcare costs.
Locally owned small businesses are a huge contributor in
the fabric of a business community. It is through the small
and medium businesses that we see the greatest job growth. It
is through the small and medium businesses that we see the
greatest increase in retail spending in the local
communities. However, while many see the benefit of a strong
small business community, they have been neglected in being
able to negotiate for competitive pricing in healthcare
costs.
For these reasons, the Frisco Chamber of Commerce strongly
supports the Small Business Health Fairness Act, which will
allow small businesses the opportunity to band together to
provide their employees with better, more affordable health
insurance coverage. With rising medical costs being a top
concern of both individuals and employers, the impact of this
increased availability of affordable insurance would be
significant.
Sincerely,
Tony Felker,
President/CEO.
____
Richardson, Texas,
Chamber of Commerce,
Richardson, TX, March 21, 2017.
Re Association Health Plans.
Hon. Sam Johnson,
House of Representatives,
Washington DC.
Dear Chairman Johnson: On behalf of the Richardson Chamber
of Commerce, a 5-star chamber, I write in strong support of
the Small Business Health Fairness Act. This legislation will
increase small businesses' bargaining power with health
insurance providers and ensure a level playing field for
smaller entities that want to help their workers and families
with health care costs. The Richardson Chamber of Commerce
commends you for your longstanding leadership on this
important issue to the small business community. With more
than 650 member organizations, the Richardson Chamber of
Commerce continues the goal of its founding fathers to serve
as the cornerstone of economic and community development for
the city of Richardson. In order to continue that growth, our
small businesses must be allowed to offer affordable
healthcare to their employees.
While the small business community's economic output is
great, its negotiating power in the health care market is at
a competitive disadvantage. The federal Employee Retirement
Income Security Act, which currently permits large
corporations and labor organizations to ``self-insure'' and
offer insurance with certain exemptions from state law, does
not provide small business with the same advantage. The law
must be reformed to empower small employers with the ability
to obtain and offer competitively priced health insurance.
For these reasons, the Richardson Chamber of Commerce and
our member companies, strongly support the Small Business
Health Fairness Act, which will allow small businesses the
opportunity to band together to provide their employees with
better, more affordable health insurance coverage. With
rising medical costs being a top concern of both individuals
and employers, the impact of this increased availability of
affordable insurance would be significant.
The Richardson Chamber commends your efforts to provide
small businesses with health care options in a thoughtful and
constructive manner. We look forward to working with you on
this key legislation.
Sincerely,
William C. Sproull,
President and CEO.
____
Greater Anna
Chamber of Commerce,
Anna, TX, March 21, 2017.
Hon. Sam Johnson,
House of Representatives,
Washington, DC.
Dear Representative Johnson: On behalf of the Greater Anna
Chamber of Commerce and our more than 200 members, including
a majority of small business, I would like to show our
support of the H.R. 101, the Small Business Health Fairness
Act. There are many small businesses in our community that
cannot currently economically and efficiently afford
healthcare for their employees. We hope this legislation will
help ease that affordability on both our businesses and
employees.
With better access to healthcare, employees could be more
willing to work at these smaller businesses instead of only
working for larger corporations. This will help our local
community by keeping our employees closer to their home,
families and children's schools. Again, we support for Small
Business Health Fairness Act and look forward to a better
solution to our current healthcare problem.
Best Regards,
Kevin Hall,
Executive Director,
Greater Anna Chamber of Commerce.
Mr. SAM JOHNSON of Texas. Mr. Speaker, by allowing small businesses
to band together, they can collectively purchase more affordable health
insurance for their employees.
Let's get this commonsense plan passed. Let's help those who power
our economy be able to get the health care they want, need, and deserve
for themselves and their workers.
Mr. Speaker, I urge all my colleagues to vote in favor of H.R. 1101.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 4 minutes to the
gentleman from New York (Mr. Espaillat).
Mr. ESPAILLAT. Mr. Speaker, I rise today in opposition to H.R. 1101,
the Small Business Health Fairness Act.
Mr. Speaker, the concept of association health plans, AHPs, is
nothing new. Versions of this bill have been around for many years.
They don't work.
Currently, AHPs are regulated by the States, ensuring the ability to
protect consumers. H.R. 1101, however, will yank association health
plans from the realm of State oversight by federally certifying them
and holding them to few, if any, regulatory requirements. This would
strip the States of the ability and fidelity to regulate beneficiary
protections that exist to protect their citizens.
Federally certifying AHPs will allow selective choice of which
benefits are provided and which persons can enroll. This is a complete
and total disservice to all individuals and citizens in a State's
health insurance market. Association health plans currently exist and
operate in New York State, serving many thousands of beneficiaries and
avail New Yorkers' protections, benefits guarantees, and avenues for
appeal through the Department of Financial Services.
This bill does nothing to offer guaranteed affirmative coverage. It
would permit preexisting conditions as a legitimate reason to exclude
individuals. It has no minimum threshold for anything resembling
essential health benefits, and it fails to offer a requirement for the
actuarial value of the insurance product to cover total health costs.
What then remains is not a health plan. In fact, what remains is
strikingly similar to what the American Health Care Act purports to
offer millions of Americans: less coverage for those enrolled and more
expense for those who are too sick, too old, and too poor to be
approached by an AHP.
AHPs would lead to higher costs for seniors and individuals who are
sicker and will dilute the risk pool of entire States, leading to
higher premiums and out-of-pocket expenses. Where the American Health
Care Act will unilaterally hurt all Americans, H.R. 1101 would
accomplish the same harm directed at the sickest and most underserved
in a more prejudicial manner.
Mr. Speaker, I offered an amendment to this bill, which was germane,
yet not made in order. My amendment would have protected the rights of
the States to regulate association health plans, to include regulation
of benefits, consumer protections, and rating restrictions. The goal of
my amendment was to ensure that all States and their constituents have
the same security and protections that my constituents have benefited
from over the past 7 years: consumer protections against surprise
billing and adverse selection, provider protection for prompt claim
payment and preauthorization, protection for local and regional
insurers so that large national insurance companies cannot cherry-pick
the good risk.
I certainly believe and would hope that my colleagues on the other
side of the aisle support program integrity and protecting our
constituents, which is what my amendment would have made clear.
Lastly, I would like to be clear that I am supportive of increasing
access to health care that is comprehensive and affordable for all
Americans. The bill before us does not do that. The American Health
Care Act certainly does not do that.
Mr. Speaker, I urge my colleagues to strongly oppose this rolling
back of health care.
Ms. FOXX. Mr. Speaker, I yield 2 minutes to the gentleman from
Michigan (Mr. Walberg), the chairman of the Subcommittee on Health,
Employment, Labor, and Pensions.
[[Page H2322]]
Mr. WALBERG. Mr. Speaker, I rise today in support of H.R. 1101, the
Small Business Health Fairness Act, a bill that will help people in
Michigan and across the country by expanding affordable coverage for
workers and their families.
I thank our colleague, Representative Sam Johnson of Texas, for
introducing this legislation. I really enjoyed hearing the gentleman
from Texas and his comments about this being common sense.
Representative Sam Johnson of Texas defines common sense and
patriotism. He has tirelessly championed this bill for years, and it is
a pleasure to join him in pushing for these positive reforms.
Mr. Speaker, health care in this country has become simply
unaffordable for far too many small businesses and working families.
The Patient Protection and Affordable Care Act has proved to be an
utter failure for most people in the United States. It is snowballing
out of control and rolling over working families and small businesses.
Ninety-five percent of small businesses have reported increased
health insurance costs over the past 5 years. A 2015 study by the
National Federation of Independent Businesses found that the cost of
health insurance is the principal reason that small businesses do not
offer coverage.
As a result, since 2008, 36 percent of small businesses with fewer
than 10 employees have stopped offering healthcare coverage to their
employees. It is not that they don't want to offer healthcare benefits.
The truth of the matter is that small businesses have been hit
especially hard by the government takeover of health care. Under
ObamaCare, the working families I speak to in my district are paying
more for less and finding they have fewer options for coverage.
H.R. 1101 is a key part of the third phase of our efforts to reform
our healthcare system so it works for all Americans. It aims to
increase the negotiating power of small businesses so they can bring
down health insurance costs for their employees.
Right now, small businesses are often on an unequal playing field
with larger companies and unions. Because they have few employees,
small businesses have limited bargaining power when it comes to
negotiating for lower insurance costs for their workers.
The SPEAKER pro tempore (Mr. Rogers of Kentucky). The time of the
gentleman from Michigan has expired.
Ms. FOXX. Mr. Speaker, I yield an additional 15 seconds to the
gentleman.
Mr. WALBERG. Mr. Speaker, this bill levels the playing field for
small businesses, allowing them to band together through association
health plans and negotiate the best deals to provide health care at a
lower cost. It also represents an important step toward purchasing
health insurance across State lines.
Today's vote is an immediate first step to help job creators provide
affordable healthcare options to their employees and a transition
toward a patient-centered healthcare system.
Mr. Speaker, I urge my colleagues to support this legislation.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 4 minutes to the
gentleman from Connecticut (Mr. Courtney).
Mr. COURTNEY. Mr. Speaker, again, as someone who was a small-business
employer for 27 years and provided health benefits for my staff, I am
acutely aware of the challenges in the small-business market which long
predate passage of the Affordable Care Act and which is still something
that we can do better in terms of helping folks deal with this issue,
which, again, is so important because small businesses are the job
creators in the American economy.
What I want to sort of point out is that this legislation, in my
opinion, is just a complete misfire. Let's, first of all, remind
everyone that there are over 670 association health plans existing in
America today.
The notion that the Affordable Care Act somehow is smothering or
stifling association health plans is, in fact, just factually false.
There are many that are in business, providing coverage, as has been
said by some of the prior speakers, for people in industries like
restaurants, et cetera. Again, we are not talking about some
existential threat that is out there in terms of association health
plans today.
The guts of this bill--and it is quite extraordinary coming from,
again, the Republican Party--is to preempt State Governments from
having any say over the solvency and the benefit design of plans that
operate under association health plans.
Back in the 1990s, there was a spate of problems with association
health plans going belly up because, again, there was no State
insurance solvency standards to make sure that there were funds set
aside to pay the bills of people who were employed in the businesses
that these plans were set up to serve.
As a result, Congress acted. We basically said that the Federal
Government was doing a lousy job in terms of protecting patients. And
we gave States the ability, through their State insurance departments,
to make sure that certain solvency standards were met and, as was
stated earlier, that they weren't able to cherry-pick just the
healthiest and leave the rest for the other segments of the health
insurance industry.
As a result of the fact that we made this change, again, the State
insurance commissioners all across America, Republican States and
Democratic States, have weighed in. They sent a letter on February 28
pleading with Congress not to do this, not to pass this bill which
eliminates their ability to protect the citizens of their States.
So this bill is actually an anti-states' rights bill because it is
basically saying the Federal Government is just going to step in and
wipe out the way in which these plans operate and just lead, again, a
race to the bottom, the lowest threshold of protections for patients;
and that is considered healthcare reform or somehow advancing the ball
in terms of helping small businesses.
There are many other ways to deal with this issue, and this is not
the right one. Again, this is not some new idea that we are debating.
This has been back and forth over the years, in the 1990s and the early
2000s. It predates the Affordable Care Act by decades, and it is just
an old chestnut that is being thrown out in the floor in the name of
some idea to sound like we are doing something for small businesses.
Again, under the Affordable Care Act, we set up a 50 percent tax
credit for businesses that qualify for it to make health insurance
affordable.
I did two townhalls back in my district. I had a plumber from the
next town over who, again, took advantage of that 50 percent tax
credit. He saved thousands of dollars in terms of providing health
benefits for his small business.
We can expand that tax credit to get a wider universe of small
businesses, and that is what we should be doing. We should be building
on what is successful, again, not watering down existing patient
protection and consumer protection laws that ensure that plans are
actually going to have enough funds to pay the bills when people get
sick or go to the hospital and certainly not be able to cherry-pick
what benefits are considered essential or not.
The SPEAKER pro tempore. The time of the gentleman from Connecticut
has expired.
Mr. SCOTT of Virginia. Mr. Speaker, I yield an additional 1 minute to
the gentleman.
Mr. COURTNEY. Mr. Speaker, we should not be allowing health plans to
decide we are not going to cover maternity or that they can pick and
choose what essential benefits that, again, the rest of the universe of
businesses have to provide now under the Affordable Care Act, which
are, again, based on sound medical research, not political decisions or
not just the whims of people who are running health plans, like
association health plans.
Again, this is the wrong approach. This is, again, turning the clock
backwards. It is not going to provide any protections, and it certainly
is not responding to some existential threat of association health
plans. There are 672 in operation today. Let's help them with programs
like tax credits. Let's not just sort of turn that whole sector of the
health insurance marketplace into the Wild West because it is patients
who are going to lose. Our citizens are going to lose. We can do better
than that as a Congress.
Mr. Speaker, again, I strongly urge a ``no'' vote on this measure.
[[Page H2323]]
Ms. FOXX. Mr. Speaker, I yield 2 minutes to the gentleman from
Tennessee (Mr. Roe), a distinguished colleague, a member of the
committee, and the chair of the Veterans' Affairs Committee.
{time} 1430
Mr. ROE of Tennessee. Mr. Speaker, I rise today in strong support of
H.R. 1101, the Small Business Health Fairness Act, sponsored by my good
friend and true American hero, Sam Johnson. I encourage all of my
colleagues to do the same. This bill is an important tool to help
empower small businesses to offer more affordable healthcare options to
their employees.
Mr. Speaker, as a former small-business owner myself, I know that
most small-business owners want to do the right thing and offer health
insurance to their employees. We did so in my practice.
But many of these businesses are struggling with the cost and
complexities of offering health insurance to their employees. ObamaCare
has exacerbated this problem for small businesses. Thousands of jobs
and thousands of small businesses have closed.
We have a better way. We are going to start by passing the American
Health Care Act, which will repeal many of ObamaCare's taxes and
mandates and replace it with free market reforms.
But there is much more that can be done. Perhaps the only thing that
has prevented ObamaCare from causing even more widespread damage was
the success of ERISA, employer-sponsored health insurance.
We believe small businesses deserve the same protections that large
businesses do, and that is why we are passing this legislation today.
The Small Business Health Fairness Act takes positive steps toward
creating a more competitive healthcare marketplace, lowering insurance
costs for many small employers.
Mr. Speaker, why would anybody care if association health plans got
together and allowed me to purchase insurance across a State line?
I have a community in my district where the State line on one side of
the street is Bristol, Virginia, on the other side is Bristol,
Tennessee. Why would it matter? Why couldn't I purchase that insurance
across the State line if it helped my employees and lowered costs?
And, by the way, Mr. Speaker, the Affordable Care Act is working so
well for consumers that 18 out of 23 of the co-ops went broke, leaving
hundreds of thousands of people to search for insurance coverage.
For the past 8 years, House Republicans have engaged the
administration and encouraged them to work with us to implement a more
patient-centered healthcare system; but, instead of working with us on
a common goal, they have layered on additional costs for small
businesses.
I again want to encourage my colleagues to support H.R. 1101.
Mr. SCOTT of Virginia. Mr. Speaker, would the Chair advise us how
much time is available on both sides?
The SPEAKER pro tempore. The gentleman from Virginia has 14\1/2\
minutes remaining, and the gentlewoman from North Carolina has 16\3/4\
minutes remaining.
Mr. SCOTT of Virginia. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I just wanted to point out a few letters that we have
received, one from the Diabetes Association, which includes, in part:
``The Association has serious concerns that AHPs would lead to a two-
tiered market, in which AHPs offer inadequate coverage to healthy
groups only, while State-regulated plans provide adequate coverage with
consumer protections but at an increasingly higher premiums. For these
reasons, we urge you to oppose the Small Business Health Fairness Act
of 2017, H.R. 1101.''
We have also received a letter, Mr. Speaker, from the National
Association of Insurance Commissioners. They said in their letter:
``The legislation as written would eliminate all State consumer
protections and solvency standards that ensure consumers receive the
coverage for which they pay their monthly premium. These protections
are the very core of a State regulatory system that has protected
consumers for nearly 150 years . . . history has demonstrated that AHP-
type entities have done more harm than good to small businesses.''
Mr. Speaker, we also received a letter from The Main Street Alliance,
which said: ``In short, H.R. 1101 would result in higher premiums and
poorer coverage for the most vulnerable small-business owners, would
destabilize the small group market, and would lead small-business
owners and employees to assume unnecessary financial risks.''
We also heard from the Consumers Union: ``Consumer's Union has long
raised the inadequacies of AHPs . . . and urges Congress to reject them
as likely to fragment the insurance risk pool and provide minimal and
nonuniform benefits exempt from State benefit mandates.''
We also heard from a long coalition of consumer groups, providers,
and labor unions which said that this bill would just move backward to
a two-tiered system that makes it harder to purchase comprehensible,
affordable coverage for all but a minority of small businesses.
Mr. Speaker, I include in the Record these letters.
American Diabetes Association,
March 21, 2017.
Hon. Paul Ryan,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Democratic Leader, House of Representatives,
Washington, DC.
Dear Speaker Ryan and Leader Pelosi: On behalf of the
nearly 30 million Americans living with diabetes and the 86
million more with prediabetes, the American Diabetes
Association (Association) is writing to express our strong
opposition to the Small Business Health Fairness Act (H.R.
1101). This legislation is nearly identical to legislation
considered by previous Congresses and that last passed the
House of Representatives in 2003. The Association opposed
that legislation and writes now to express our strong
concerns with this bill and the impact it will have for
people with, and at risk for, diabetes.
The legislation would create federally certified
association health plans (AHPs) with the goal of making
coverage more affordable for small businesses by allowing
them to band together to purchase coverage on behalf of a
larger insurance pool. We share the goal of making coverage
more affordable, but not at the expense of required consumer
protections, signed into law in 47 states, which ensure
people with diabetes have access to the services and
financial protection they need.
H.R. 1101 would broadly exempt AHPs from critical state
benefit standards, solvency rules, and consumer protections,
including requirements to cover health services essential to
those with diabetes. Specifically, H.R. 1101 would confer on
AHPs wide authority to:
Determine benefits to be covered: Other than requiring AHPs
to meet limited federal requirements for ERISA-governed
plans, H.R. 1101 would give AHPs broad discretion to omit
important health benefits.
Determine eligibility for coverage: While H.R. 1101 would
require AHPs to comply with ERISA non-discrimination
provisions, the AHP board would retain sole discretion to
approve applications for participation in the plan and to set
premiums based on an employer's health care claims
experience.
Maintain inadequate reserves: H.R. 1101 applies federally
determined solvency standards that are weaker than state
standards, exposing plan members to the risk of insolvency
and unpaid medical bills.
Because AHPs would compete with state-regulated plans on an
uneven playing field, they would likely cherry-pick healthy
small employer groups, making the risk pool in the state-
regulated market less healthy and more costly. In addition,
those who obtain coverage through an AHP would likely have
benefits that lack coverage for essential services and would
expose them to higher out-of-pocket costs and potential plan
insolvencies. In fact, numerous AHPs offered in the past have
gone insolvent and left consumers uninsured and with unpaid
medical bills.
The Association has serious concerns that AHPs would lead
to a two-tiered market, in which AHPs offer inadequate
coverage to healthy groups only, while state-regulated plans
provide adequate coverage with consumer protections but at
increasingly higher premiums. For these reasons, we urge you
to oppose the Small Business Health Fairness Act of 2017,
H.R. 1101.
If you have questions or would like to discuss this issue,
please contact Rob Goldsmith, Director, Federal Government
Affairs.
Sincerely,
Lashawn McIver, MD, MPH,
Senior Vice President of Advocacy,
American Diabetes Association.
[[Page H2324]]
National Association of Insurance Commissioners & the
Center for Insurance Policy and Research,
February 28, 2017.
Hon. Virginia Foxx,
Chair, Committee on Education and the Workforce, House of
Representatives, Washington, DC.
Hon. Robert C. Scott,
Ranking Member, Committee on Education and the Workforce,
House of Representatives, Washington, DC.
Dear Madame Chairwoman and Mr. Ranking Member: The U.S.
House Education and the Workforce Committee is once again
scheduled to consider legislation that would allow a new
category of health insurance company, ``Association Health
Plans (AHPs),'' to form and operate outside the authority of
state regulators and beyond the reach of proven state
consumer protections and solvency laws. This bill, H.R. 1101,
would adversely impact consumers and the National Association
of Insurance Commissioners (NAIC) urges you to oppose it.
The NAIC, which represents the nation's insurance
regulators, shares the sponsors' concern for the growing
number of small business owners and employees who cannot
afford adequate coverage. However, the root cause of this
problem is the steadily rising cost of healthcare merely
reflected in premiums, and this legislation would do nothing
to address that reality. In fact, we fear the legislation
could actually increase the cost of insurance for many small
businesses whose employees are not members of an AHP.
Even more troubling than prescribing a treatment that does
not address the underlying disease, the legislation would
actually harm consumers by further segmenting the small group
market, eliminating critical state consumer protections, and
could lead to increased fraud and plan failures. This
legislation would encourage AHPs to ``cherry-pick'' healthy
groups by designing benefit packages and setting rates so
that unhealthy groups are disadvantaged. This, in turn, would
make existing state risk pools even riskier and more
expensive for insurance carriers, thus making it even harder
for sick groups to afford insurance. In addition, the
legislation as written would eliminate all state consumer
protections and solvency standards that ensure consumers
receive the coverage for which they pay their monthly
premium. These protections are the very core of a state
regulatory system that has protected consumers for nearly 150
years. As we have already seen in the past when such plans
were allowed under federal law, consumers will be left with
unpaid claims and nowhere to turn when they are harmed. A
prior law along the lines of H.R. 1101 was repealed because
it was found to harm consumers; the same mistake should not
be made again.
We recognize that supporters of AHPs are well intentioned,
looking for solutions to the same problems we are seeking to
address, but history has demonstrated that AHP-type entities
have done more harm than good to small businesses. A far
broader approach to the existing problems--one that addresses
healthcare spending, allows more innovation, and permits more
state flexibility--is necessary to bring real relief to small
businesses. The federal government and the states need to
work with healthcare providers, insurers and consumers to
implement effective reforms that will curb spending and make
insurance more affordable to small businesses. Rehashing
strategies that have failed would not be a step forward. It
is time to move on and find more effective solutions.
Sincerely,
Ted Nickel,
NAIC President, Commissioner, Wisconsin Office of the
Commissioner of Insurance.
Eric A. Cioppa,
NAIC Vice President, Superintendent, Maine Bureau of
Insurance.
Julie Mix McPeak,
NAIC President-Elect, Commissioner, Tennessee Department of
Commerce & Insurance.
David C. Mattax,
NAIC Secretary-Treasurer, Commissioner of Insurance, Texas
Department of Insurance.
____
The Main Street Alliance,
Washington, DC, March 8, 2017.
Chairwoman Virginia Foxx,
Washington, DC.
Ranking Member Bobby Scott,
Washington, DC.
Dear Chairwoman Foxx, Ranking Member Scott, and Members of
the House Education and Workforce Committee: On behalf of the
Main Street Alliance, I write to express opposition to the
``Small Business Health Fairness Act'' (H.R. 1101). The Main
Street Alliance is a national network of small business
owners across the country. Access to affordable, high-quality
health coverage has been a core concern for small businesses
for years, and slowing the skyrocketing rate increases
continues to be a top priority for our membership.
Unfortunately, the proposed legislation would erode important
gains in premium stabilization while causing our business
owners to assume unnecessary financial risks.
As you may know, prior to the Affordable Care Act (ACA)
small business owners paid substantially more on average for
health coverage and received fewer comprehensive benefits
than larger companies. They also experienced broad
unpredictability in costs, with premiums varying wildly from
year to year. One employee's expensive illness could cause
the insurance rates for the whole firm to spike in subsequent
years.
Critical market reforms instituted through the ACA
addressed many of these concerns. Insurance companies in the
individual and small-group market--including association
health plans--can no longer charge small firms higher
premiums based on their business sector, an employee's health
status, age, or gender. Nor can they offer sub-par plans that
exclude essential services, such as maternity care or
pediatric care. Instead, they must now base their pricing on
the cost of covering all individuals in the market, not just
one firm. Participating in this larger risk pool means that
small business owners, like their larger counterparts, are no
longer vulnerable to sharp swings in their rates based on the
health of a few employees. It also means that they can expect
a basic quality assurance with any health plan they select.
H.R. 1101 would undermine these protections by allowing
small employer groups and individuals to join together to
obtain health insurance through an unregulated association
health plan (AHP). These plans would be exempt from the ACA
reforms identified above, along with any state laws. This
would allow them to ``cherry pick'' good risk through the
design of the benefit package or choice of service area. AHPs
could also have limited risk simply due to the types of
businesses that belong to the association. While AHPs may
save money in the short-term by avoiding costs of consumer
protections, enrollees would receive less robust coverage and
may be left without important protections right when they
need them the most.
Furthermore, the bill would destabilize the small group and
individual market by exacerbating adverse selection, driving
up costs for the most vulnerable enrollees. Under the
proposed legislation, AHPs would compete with other small
group and individual market plans. The proposed legislation
would allow employers with younger, healthier workforces to
withdraw their employees from a state's small group market
thus leaving behind small businesses with older and sicker
employees. While the rates may drop for those businesses that
belong to associations, which offer health coverage, premiums
will increase for the remaining. This adverse selection would
make it harder for higher-cost individuals or groups to
obtain coverage.
Finally, the proposed legislation could expose employers
and employees to financial ruin. The proposed legislation
would allow certain AHPs to self-insure and accept insurance
risk. Because of the current regulatory void, AHPs are not
subject to state solvency requirements that are in place to
ensure insurance companies have sufficient resources to avoid
financial failure. As with unregulated multiple employer
welfare arrangements, AHPs could experience bankruptcies--
leaving millions of small employers and workers without
health coverage due to insolvencies.
In short, H.R. 1101 would result in higher premiums and
poorer coverage for the most vulnerable small business
owners, would destabilize the small group market, and would
lead small business owners and employees to assume
unnecessary financial risks. The Main Street Alliance
strongly urges you to oppose the legislation.
Please feel free to contact Michelle Sternthal, Policy
Director for the Main Street Alliance, with any questions.
Sincerely,
Amanda Ballantyne,
National Director.
____
ConsumersUnion,
March 21, 2017.
House of Representatives,
Washington, DC.
Dear Representative: We are writing today to oppose the
Small Business Health Fairness Act (H.R. 1101) and the
proposed rules for association health plans.
Today, small businesses are already able to join together
to purchase coverage through Association Health Plans (AHPs).
These AHPs are currently regulated by the states, just like
other insurance in the small group market. H.R. 1101 would
allow an AHP to be entirely exempt from state regulation by
being self-insured or following the rules of a single state
nationwide.
ConsumersUnion has long raised the inadequacies of AHPs as
a solution to improving access and strengthening the health
of insurance markets, and urges Congress to reject them as
likely to fragment the insurance risk pool and to provide
minimal and non-uniform benefits exempt from state benefit
mandates. These plans would split the healthy from the sick
and drive up costs for those who do not enroll in them.
As a non-partisan, independent organization that has
advocated for the best consumer products and policies for
more than 80 years, we believe that altering the rules for
AHPs as proposed in this bill would undermine consumers'
access to fairly priced, quality health coverage.
Our objections are that:
AHPs would be offered alongside other small group and
individual market plans.
[[Page H2325]]
However, they would operate under different rules. Past
experience shows this is likely to lead to cherry-picking,
adverse selection, and increased costs for sicker individuals
and small businesses. Put another way, this would lead to
health risk being segmented with the less healthy consumers
excluded from the AHP risk pool. A core, long-held
ConsumersUnion principle is to support broad pooling of risk
as fairer and more cost-effective for consumers. We do not
support lower rates for healthiest consumers at the expense
of older or sicker consumers.
This Act would undermine state consumer protection laws by
restricting the ability of states to regulate AHPs. This loss
of protections could lead to increased fraud, inadequate
coverage and consumer-unfriendly benefit designs. In July
2003, Consumer Reports profiled similar plans in a story
entitled Phony Health Insurance. The story noted that
fraudulent sales and financial instability stiffed consumers
for $65 million in unpaid medical bills.
This Act would give AHPs sole discretion to select what
type of care they will and will not include in their
products; this is a departure from current policy, which only
permits AHPs that meet insurance standards set for the
individual and small group market. Consumers who buy into
these plans will lose the guarantees of care created by the
ACA's essential health benefits and actuarial value
requirements--likely unknowingly--and will have difficulty
knowing what AHPs cover.
It is unlikely that these AHPs will be able to attract
enough members to be able to negotiate more effectively with
providers, compared to large insurers already operating in
these states. Consequently, we do not believe that these
designs will lower costs for consumers.
Multiple Employer Welfare Arrangements (MEWAs) once
operated in a regulatory vacuum similar to the one proposed
through H.R. 1101. Self-funded MEWAs had no clear regulatory
authority, as initially it appeared that ERISA exempted them
from state-level regulatory oversight. Multiple MEWA
bankruptcies resulted, and consumers had limited avenue for
redress. In the absence of clear regulatory authority over
AHPs, insolvencies could leave millions of small employers
and workers without health coverage or redress. Current state
solvency standards have a 150 year track record of protecting
consumers and should not be undermined.
We believe there are much better, time-tested ways to
increase the availability, affordability, and accessibility
of health insurance for consumers--approaches that rely on
the wise and accepted insurance principles of broad pooling
of risks and avoidance of risk selection--without resorting
to the detrimental effects of H.R. 1101. We note that the
National Association of Insurance Commissioners, as well as
the American Academy of Actuaries, has similar, grave
concerns about this Act.
Sincerely,
Laura MacCleery,
Vice President, Consumer Policy and Mobilization, Consumer
Reports.
Lynn Quincy,
Associate Director, Health Policy, Consumer Policy and
Mobilization, Consumer Reports.
Mr. SCOTT of Virginia. Mr. Speaker, I reserve the balance of my time.
Ms. FOXX. Mr. Speaker, I now yield 1\1/2\ minutes to the gentleman
from Ohio (Mr. Chabot), the distinguished chairman of the Small
Business Committee.
Mr. CHABOT. Mr. Speaker, I want to thank the gentlewoman from North
Carolina for her leadership on this issue.
Mr. Speaker, I rise to voice my strong support for H.R. 1101, the
Small Business Health Fairness Act. I thank my colleagues from Ways and
Means and from the Education and the Workforce Committee for getting
this great idea onto paper and moving this bill forward today.
As chairman of the House Small Business Committee, I am always very
appreciative to see Members from across this body find solutions for
small businesses. That is exactly what this bill is.
For virtually any one of us in this Chamber, it can be said that
hundreds of thousands of our constituents depend on small businesses
for their livelihoods. They have been looking to those same small
businesses for options, as ObamaCare has done the opposite of what it
was supposed to do and it has diminished choices for workers.
By allowing small businesses to join together through association
health plans, the Small Business Health Fairness Act would give small
business employees at least as many choices as those who happen to work
for larger companies.
Association health plans have long been a solution suggested by small
businesses that share their views with me and other members of the
Small Business Committee. This bill puts that idea finally into action.
Mr. Speaker, in our current state of affairs, there are fewer and
fewer healthcare options available for hardworking Americans. This bill
addresses that problem for our hardest hit small businesses and
communities.
While we begin the hard work of making health care not only
affordable but worth buying at all, this bill is an important step in
giving Americans the certainty and choices that they want. I would urge
my colleagues on both sides of the aisle to support this bill.
Mr. SCOTT of Virginia. Mr. Speaker, I reserve the balance of my time.
Ms. FOXX. Mr. Speaker, I yield 2 minutes to the distinguished
gentleman from Georgia (Mr. Allen), a member of our committee.
Mr. ALLEN. Mr. Speaker, I thank the chairwoman for her leadership on
this important bill.
Mr. Speaker, today I rise in support of H.R. 1101, the Small Business
Health Fairness Act.
Since 2008, the number of small businesses offering health insurance
to its employees has dwindled nearly 36 percent. The culprit? Well,
ObamaCare.
You know, the American people deserve choice. I have lived this
reality. I owned and operated a small business for over 40 years back
home in Georgia. I know how ObamaCare premium increases hurt and, in
some cases, affect a business' ability to provide health care for its
employees.
I believe the greatest gift God gave me as a small-business owner was
the ability to give others a good job along with the dignity and
respect they deserve to provide for their family, their community,
their church, and, yes, this Nation.
All hardworking American small-business owners should be able to give
their employees these same opportunities. For this reason, I am a
strong supporter of the Small Business Health Fairness Act legislation,
which would allow small businesses to band together and purchase health
care for workers and their families at a lower cost.
Folks, this is innovation. This is what the small business community
does. Small businesses are the backbone of America. I will fight for
their strength and their survival.
Mr. SCOTT of Virginia. Mr. Speaker, I reserve the balance of my time.
Ms. FOXX. Mr. Speaker, I now yield 2 minutes to the distinguished
gentleman from Michigan (Mr. Mitchell), a member of the committee.
Mr. MITCHELL. I thank the gentlewoman from North Carolina for
yielding me time.
Mr. Speaker, I rise in support of the Small Business Health Fairness
Act. We have all talked a lot about our plan to repeal and replace
ObamaCare. This legislation is a key component of our rescue mission
for health care in America.
Small businesses have been hit particularly hard by ObamaCare's
mandates, skyrocketing costs, and limited choices. Small-business
owners, many of whom want to provide health care for their employees,
have told me that they are struggling to do so because of ObamaCare.
This legislation would level the playing field for small businesses
by allowing them to band together to increase bargaining power to lower
costs. It would expand affordable care for families trying to secure
health insurance through their employer and lower costs for small
businesses with limited resources.
In addition, this bill includes strong protections for patients with
preexisting conditions, a top priority of mine and many of my
colleagues as we work for healthcare reform in America.
Today we are acting on our promises to deliver relief from ObamaCare.
We are returning power where it belongs, choice where it belongs: to
patients and doctors, not Washington.
I urge you to support the Small Business Health Fairness Act.
Mr. SCOTT of Virginia. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, the bad idea in this plan has been exposed in one of the
letters that I mentioned. I said there are a lot of consumer groups,
and I just want to name the groups that signed the letter. The American
Nurses Association; the Alliance for Retired Americans; the American
Cancer Society Cancer Action Network; the American Diabetes
Association; the American Federation
[[Page H2326]]
of State, County and Municipal Employees; the Association of
Reproductive Health Professionals; Bazelon Center for Mental Health
Law; Community Catalyst; Consumers Union; Families USA; International
Union, United Automobile, Aerospace and Agricultural Implement Workers
of America--the UAW; NARAL Pro-Choice America; the National Council of
La Raza; the National Education Association; the National Institute for
Reproductive Health; National Partnership for Women and Families;
National Women's Health Network; Raising Women's Voices for the Health
Care We Need; and the Service Employees International Union all oppose
this legislation.
Mr. Speaker, I reserve the balance of my time.
Ms. FOXX. Mr. Speaker, I yield 2 minutes to the distinguished
gentleman from Minnesota (Mr. Lewis), a member of our committee.
Mr. LEWIS of Minnesota. Mr. Speaker, I thank the gentlewoman from
North Carolina for her leadership here and on the committee as well.
Mr. Speaker, I rise today in support of H.R. 1101, the Small Business
Health Fairness Act.
It is amazing as a freshman in this body to watch this debate over
what we are trying to do on this side when we know what has already
transpired, what has been done:
The Affordable Care Act was going to lower our premiums $2,500. That
is what the President said. But they went up by $4,800.
In my home State of Minnesota, we have seen back-to-back increases of
55 and 67 percent, 100,000 people thrown off their plan.
We have got 1,000 counties in this country with just one insurer.
The exchanges are imploding. As young, healthy people can't afford
the premiums, they drop out, and the pools only have the older and the
sicker.
We have job lock, where people trying to start a small business can't
get the same tax advantages or purchasing power as those in big
companies.
So what to do? We are going to stabilize the insurance markets
through choice and competition, and that is what H.R. 1101 does. It
lowers premiums. It enlarges pools. We do that. We must do that to save
the health insurance markets and health care in America. That is the
agenda of H.R. 1101. That is the agenda of what we are trying to do in
global healthcare reform.
So today, as we debate how to fix health care in America, let us not
forget the status quo and the debacle it is. So I stand and I urge my
colleagues to support this bill, and I further urge my colleagues to
finish the job over what we are starting on real healthcare reform.
Mr. SCOTT of Virginia. Mr. Speaker, I just want to quote from another
letter that we received from Blue Cross Blue Shield Association. They
say: ``We have very serious concerns that H.R. 1101 would create
preferential rules that would allow an AHP to be entirely exempt from
State regulation by being self-insured or follow the rules of a single
State nationwide. Research clearly shows that creating special rules
for AHPs and exempting them from State regulation would lead to major
problems, including . . . increased insolvency risk . . . increased
costs for older, sicker workers.'' Therefore, they are also in
opposition to this legislation.
I include in the Record the entire letter.
BlueCross BlueShield Association,
Washington, DC, March 7, 2017.
Hon. Virginia Foxx,
Chair, Committee on Education and the Workforce, House of
Representatives, Washington, DC.
Hon. Robert C. Scott,
Ranking Member, Committee on Education and the Workforce,
House of Representatives, Washington, DC.
Dear Madam Chairwoman and Mr. Ranking Member: The Blue
Cross and Blue Shield Association shares your commitment to
ensuring small employers are able to provide their employees
with high quality, affordable health coverage. However, we
are concerned that H.R. 1101, the ``Small Business Health
Fairness Act'' would not accomplish this critical goal, as it
does not reflect key principles that are essential to
ensuring a viable private health insurance market: (1) all
competitors should abide by the same set of rules; and (2)
states should have clear authority to regulate.
Today, small businesses are able to join together to
purchase coverage through association health plans (AHPs).
AHPs are currently regulated by the states, just like other
insurance in the small group market, and can be a good option
for small employers who want to provide their employees with
affordable coverage.
We have very serious concerns that H.R. 1101 would create
preferential rules that would allow an AHP to be entirely
exempt from state regulation by being self-insured or follow
the rules of a single state nationwide. Research clearly
shows that creating special rules for AHPs and exempting them
from state regulation would lead to major problems,
including:
Increased insolvency risk: The legislation as drafted would
allow for some AHPs to be entirely exempt from state
regulation, and instead operate under very limited federal
rules and oversight. Past experiences with these kinds of
arrangements left millions without health coverage and unpaid
claims due to insolvencies.
Increased costs for older, sicker workers: Ultimately, H.R.
1101 would make it much harder for small employers with
older, sicker workers to obtain coverage. This is because
lower-cost groups would move to a more loosely regulated AHP
with fewer benefit and rating rules, while older and/or high-
cost groups would remain in traditional insurance plans.
Attached is a compendium of research findings, which
provides overwhelming evidence that AHP legislation would
make health insurance less accessible, less affordable and
less secure for small employers and individual consumers.
We look forward to working with you on solutions that can
be taken to improve access and affordability for small
employers.
Sincerely,
Alissa Fox,
Senior Vice President.
{time} 1445
Mr. SCOTT of Virginia. Mr. Speaker, I reserve the balance of my time.
Ms. FOXX. Mr. Speaker, I have no further speakers, and I reserve the
balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield myself the balance of my
time.
Mr. Speaker, association plans will help the fortunate few who can
get in so long as the members of that association remain healthier than
average. But everybody else will pay more. Furthermore, these plans,
when they are formed under the bill, will evade important State
regulations that could improve solvency and provide important consumer
protections.
This is not unlike the philosophy, I guess, on the other replace bill
where 24 million fewer people will have insurance; the rest will pay
more and get less; while millionaires benefit with huge tax cuts. In
this, the fortunate few benefit to the expense of everybody else.
I would hope we would defeat the legislation.
Mr. Speaker, I yield back the balance of my time.
Ms. FOXX. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, some of our colleagues on the other side of the aisle
have spent a lot of their time extolling ObamaCare and indicating that
we should just stay with what we have, but we all know that ObamaCare
is failing.
Republicans are on a rescue mission. We truly do have a better way.
As some of my colleagues have stated, we will be passing the American
Health Care Act tomorrow. What we are doing here with this bill is
something we could not include in that legislation that will round out
what it is we want to do with keeping our promise in what we promised
last year in our program called A Better Way.
Let me just talk a little bit about the failures of ObamaCare. As my
colleagues have said, all the promises were broken: if you wanted to
keep your doctor, you could keep your doctor; if you wanted to keep
your healthcare plan, you could keep your healthcare plan. Those
promises were the most obvious ones that went away. The cost of health
care would be going down, and none of that happened.
Mr. Speaker, in addition to that, there is a 25 percent average
increase in premiums this year for millions of Americans trapped in
ObamaCare, healthcare.gov exchanges. Nearly one-third of U.S. counties
have only one insurer offering exchange plans; 4.7 million Americans
were kicked off their healthcare plans by ObamaCare. There was $1
trillion in new taxes, mostly falling on families and job creators; 18
failed ObamaCare co-ops out of 23, which my colleague from Tennessee so
eloquently pointed out.
These were established as an alternative to the public option. Those
healthcare co-ops collapsed, costing
[[Page H2327]]
taxpayers nearly 1.9 billion and forcing patients to find new
insurance; $53 billion in new regulations requiring more than
176,800,000 hours of paperwork. ObamaCare regulations are driving up
healthcare premiums and costing small-business employees at least $19
billion annually.
As I said in the hearing that we had on this bill, the Democrats want
a coercive system. Republicans want a system based on freedom.
Today we have an opportunity to make a real difference in the lives
of hardworking men and women who are employed by small business. We
have an opportunity to deliver much-needed relief to small-business
owners who are trying to do the right thing and provide high-quality
healthcare coverage for their employees. This legislation represents a
truly positive reform that will help lower healthcare costs for working
families and put small businesses on a fair and level playing field.
Small businesses are the backbone of our Nation's economy, and there
is no reason why they should be at a disadvantage when it comes to
finding an affordable healthcare plan. They should be treated in the
same fashion as larger businesses and have the ability to craft
healthcare plans that meet the needs of their employees. If we want to
encourage small businesses to offer health care at a lower cost to
workers, this is one commonsense step we can make.
Again, I thank our colleague, Congressman Sam Johnson, a true patriot
and servant of this country, for his longtime support of this
legislation.
I urge my colleagues to vote ``yes'' on H.R. 1101, the Small Business
Health Fairness Act, which will help more Americans access high-
quality, affordable health care.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. All time for debate on the bill has expired.
Amendment No. 1 Offered by Ms. Herrera Beutler
Ms. HERRERA BEUTLER. Mr. Speaker, I have an amendment at the desk.
The SPEAKER pro tempore. The Clerk will designate the amendment.
The text of the amendment is as follows:
Add at the end of section 6 the following:
(c) Coordination With Existing Law.--Nothing in this Act
shall require plans to become certified under section 802 of
the Employee Retirement Income Security Act of 1974, as
amended by this Act, or require plans that are not certified
under such section to comply with the requirements under part
8 of such Act, except to the extent provided in section 809
of such Act.
The SPEAKER pro tempore. Pursuant to House Resolution 210, the
gentlewoman from Washington (Ms. Herrera Beutler) and a Member opposed
each will control 5 minutes.
The Chair recognizes the gentlewoman from Washington.
Ms. HERRERA BEUTLER. Mr. Speaker, I thank Chairwoman Foxx and the
Committee on Education and the Workforce for their work on this
important bill that will benefit small businesses and the families who
work for them.
My amendment to the Small Business Health Fairness Act provides a
straightforward clarification to ensure that existing association
health plans can continue to operate and provide high-quality,
affordable care to as many people as possible.
This amendment safeguards association health plans that have been
successfully operating under State and Federal law--many of them for
decades. We will be making certain that they would not inadvertently be
disadvantaged by new Federal legislation or regulation or vulnerable to
efforts to restrict access and limit choices.
Why do we need this amendment?
Because I fear what happened in my State will happen in others, where
the insurance commissioner attempted to reject 42 out of about 60
association health plans. His office interpreted ObamaCare as giving
him a mandate as justification for attempting to eliminate virtually
all of these popular plans. By adopting my amendment, it will make
crystal clear in the underlying bill that this won't be tolerated, and
it will support both existing and future association health plans.
Talk to one of the nearly 400,000 individuals in my home State of
Washington who get their care from an association plan, and you will
find out why so many Washington businesses renew their plans every
year.
Our State has been fortunate to have a robust AHP market that has
become essential to providing cost-effective choices to small-business
employers, thanks to bipartisan legislation enacted in the mid-1990s.
In the case of one association plan operating in my State, roughly 40
percent of participating small-business employers did not previously
offer health coverage.
My amendment is supported by the U.S. Chamber of Commerce. In its
letter to me, which I include in the Record, the U.S. Chamber indicated
that it shares my interest in making sure that State-based association
health plans that currently exist are able to continue operating in
accordance with existing State and Federal law. My amendment is also
supported by the Association of Washington Business.
Chamber of Commerce of the
United States of America,
Washington, DC, March 20, 2017.
Hon. Jaime Herrera Beutler,
House of Representatives,
Washington, DC.
Dear Congresswoman Herrera Beutler: Thank you for your
attention to the concerns raised by the Association of
Washington Businesses regarding H.R. 1101, the ``Small
Business Health Fairness Act.'' The U.S. Chamber of Commerce
has several state chambers of commerce members that provide
state-based quality health care coverage to their member
companies. The Chamber shares your interest in making sure
that the state-based Association Health Plans that currently
exist are able to continue to operate in accordance with
existing state and federal law without being disadvantaged by
this new federal legislation.
The Chamber appreciates your commitment to small businesses
and to ensuring that current affordable coverage options
continue to be available alongside new options in a
nondiscriminatory and fair environment. Thank you for your
dedication and efforts, and we look forward to continuing to
work with you to advance the priorities and interest of
business.
Sincerely,
Randel K. Johnson.
Ms. HERRERA BEUTLER. Mr. Speaker, I am confident that the underlying
legislation before us today will improve the ability of small
businesses to access affordable, high-quality health coverage in every
State across the country. However, first, this body should, as clearly
as possible, ensure that those States that already have successfully
operating association health plans are not disrupted, which is what my
amendment would do.
I urge my colleagues to support this amendment, and I thank the
chairwoman for her work on this.
Mr. Speaker, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I ask unanimous consent to claim
the time in opposition, although I am not opposed to the amendment.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman?
There was no objection.
The SPEAKER pro tempore. The gentleman is recognized for 5 minutes.
Mr. SCOTT of Virginia. Mr. Speaker, I appreciate the intent of the
amendment offered by the gentlewoman from Washington, which seems to
allow health association plans that are currently in existence to
continue to operate under existing State and Federal law. In fact,
giving States the ability to regulate association plans is very
important. That is why I oppose the underlying bill.
The amendment also points out another interesting fact, and that is
associations currently exist under current law, and the underlying bill
simply unravels most of the regulations that apply to them, and this
amendment would at least maintain State regulations.
We know that this bill creates winners and losers. The winners are
those who are young and healthy enough to be invited into an
association. The losers are small businesses and employers who are
older, sicker, or just have more costly health bills. There is no
guarantee that plans under this legislation will have the standard
level of benefits or consumer protections, and that is why I am
disappointed that the majority failed to rule any Democratic amendments
submitted to the Rules Committee in order, although each and every one
was germane.
The gentleman from New York (Mr. Espaillat), who is a member of the
committee, offered an amendment that
[[Page H2328]]
would have protected the ability of the States to regulate any
association health plan, including regulation related to benefits,
consumer protections, and rating restrictions. Representative Torres
from California offered an amendment to ensure that association plans
cover 10 essential health benefits under the Patient Protection and
Affordable Care Act.
One amendment was offered by Representatives Susan Davis of
California and Suzanne Bonamici from Oregon--both committee members--
would have required association plans to provide for women's health
benefits, including maternity care.
Representatives Bonamici, Davis, and Wilson also offered an amendment
to prevent this legislation from taking effect if it would lead to
increased premiums for older workers. These older workers will not be
able to get into the associations because they would increase average
costs of the association, and the point of the association is to get
away from high-cost enrollees like older Americans. So these older
people will be left out of the pool with other older and sicker workers
where they will necessarily be paying more.
It is simple arithmetic. Their amendment would have been particularly
important because we know that the Republican replacement plan contains
an age tax that will severely disadvantage older populations.
None of the Democratic amendments, although germane, were allowed
under the rule, and there does not seem to be any earnest attempt to
look to try to correct the shortcomings of the bill. So while I do not
intend to oppose this amendment, I do not think the amendment is enough
of an improvement of the bill, nor does it change the underlying fact
that the legislation does not adequately protect small businesses,
workers, and their families, nor does it help those left behind who are
not invited into the association who will necessarily be paying more.
Mr. Speaker, if those on the other side of the aisle want to go on a
rescue mission, they ought to improve things, not make things worse.
For most Americans, this bill will make things worse, and, tomorrow, 24
million Americans will be left out while many others will be paying
more for less while millionaires get huge tax cuts. That is not an
improvement.
Mr. Speaker, I reserve the balance of my time.
Ms. HERRERA BEUTLER. Mr. Speaker, how much time do I have remaining?
The SPEAKER pro tempore. The gentlewoman has 2\1/2\ minutes
remaining.
Ms. HERRERA BEUTLER. Mr. Speaker, I would just like to say that part
of the reason this underlying bill is so critical is because we just
don't believe one size fits all. When it comes to health coverage, we
need to make sure that there are many different options for families,
individuals, and businesses. We are clarifying basically a technical
change here that allows continued existing plans to operate.
Who can be opposed to existing plans operating and offering more
options and more plans?
This is exactly what Republicans are doing right now. We are fighting
to make sure that the families and the people we represent have those
options and their choices, that they can keep their doctor, that their
health premiums will come down, that they can maybe get a plan through
their work, or maybe they will be able to get into the individual
market and self-insure--options--because one size does not fit all,
which is why this bill is crucial and why my amendment to this bill
makes it better. That is why we are going to move forward and make sure
that more Americans have access to care--not just on paper--but care
that gets them to in to the doctor, that gets them the care that they
need, whether it is a specialist or a primary care doctor.
Mr. Speaker, I yield back the balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I would point out that when one
size fits all, everybody can benefit; but when you start picking and
choosing winners and losers, some will benefit and many others will
lose. Under this bill, a fortunate few who get into association plans
will benefit; everybody else loses.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to the rule, the previous question is ordered on the bill,
as amended, and on the amendment offered by the gentlewoman from
Washington (Ms. Herrera Beutler).
The question is on the amendment by the gentlewoman from Washington
(Ms. Herrera Beutler).
The amendment was agreed to.
The SPEAKER pro tempore. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
{time} 1500
Motion to Recommit
Ms. SHEA-PORTER. Mr. Speaker, I have a motion to recommit at the
desk.
The SPEAKER pro tempore. Is the gentlewoman opposed to the bill?
Ms. SHEA-PORTER. I am opposed in its current form.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Ms. Shea-Porter moves to recommit the bill H.R. 1101 to the
Committee on Education and the Workforce, with instructions
to report the same back to the House forthwith with the
following amendment:
Page 15, after line 22, insert the following:
``(6) Substance use disorder treatment.--Notwithstanding
subsection (b), the plan provides for coverage for substance
use disorder treatment, including opioid use disorder
treatment, consistent with the substance use disorder
services defined as an essential health benefit by the
Secretary under subparagraph (E) of section 1302(b)(1) of the
Patient Protection and Affordable Care Act (42 U.S.C.
18022(b)(1)).''.
Ms. SHEA-PORTER (during the reading). Mr. Speaker, I ask unanimous
consent to dispense with the reading.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from New Hampshire?
There was no objection.
The SPEAKER pro tempore. The gentlewoman from New Hampshire is
recognized for 5 minutes.
Ms. SHEA-PORTER. Mr. Speaker, this is the final amendment to the
bill, which will not kill the bill or send it back to committee. If
adopted, the bill will immediately proceed to final passage, as
amended.
Mr. Speaker, I rise today on behalf of the families and communities
across the Nation that are confronting a public health threat of our
time: the heroin, fentanyl, and prescription opioid crisis.
This motion would simply ensure that the health insurance plans that
today's bill would permit must still cover substance use disorder
treatment, including for opioids, as an essential health benefit.
Under current law, we require insurers to cover this treatment.
Before the Affordable Care Act, many insurers either didn't cover
treatment at all or imposed onerous requirements that blocked people
from getting needed care.
H.R. 1101 would roll back that guarantee. It would allow association
health plans to return to the kind of skimpy coverage that left so many
people struggling with an opioid disorder in dire straits at critical
moments. We know there is often a narrow window of opportunity--after
an overdose, for example--for someone to commit to treatment, and these
are the moments when being able to make a single phone call can make
all the difference.
This week's debate about health care is extremely important. Will we
decide to work together to improve the American people's access to
quality, affordable health care or weaken benefits and kick 24 million
or more of our constituents off their plans? We all need to speak up on
behalf of those whose lives have been turned around because they can
now access health care.
As I talk to families, medical professionals, and law enforcement
officials in my district, I hear stories that highlight the dramatic
impact that improved access to coverage has had in making treatment a
real option for people with substance use disorder. This week, we see
that base of coverage is under serious threat. In fact, experts
estimate that repealing the Affordable Care Act's coverage provisions
would cause about 2.8 million Americans with a substance use disorder
to lose some or all of their coverage. The quality of that coverage is
also at risk.
[[Page H2329]]
Thanks to the Affordable Care Act, insurance must now cover treatment
for behavioral health and substance use disorder, just the same as it
would cover any other medical service. These parity protections mean
insurers must cover treatment for substance use disorder with
comparable cost-sharing, with no surprises like annual visit limits,
higher copays, or frequent preauthorization requirements and medical
necessity reviews.
Badly needed facilities are opening because plans now cover these
services. I recently visited a recovery home for pregnant women and new
mothers in my district. They were able to open the doors this year in
my hometown only because it could rely on Medicaid expansion.
Legislation like H.R. 1101 would cause fewer people to have this
coverage, meaning fewer facilities can open and treat.
Many of you know that my home State of New Hampshire is on the front
lines of the heroin, fentanyl, and prescription opioid crisis. Our
communities are struggling, and helping people get treatment is key to
turning the tide. I have met people who couldn't be in a recovery
facility without Medicaid expansion.
Today, Members of Congress can say to my constituents in New
Hampshire and their constituents across this great Nation: we hear you.
We know your sons and daughters, your nieces and nephews, your
neighbors and friends are struggling, and we have your back.
We believe all Americans deserve good health insurance they can count
on when they need it most. We aren't going to pull the rug out from
under people who are about to turn their lives around.
I urge my colleagues to support this motion, which would not delay
passage of the underlying bill.
Mr. Speaker, I yield back the balance of my time.
Ms. FOXX. Mr. Speaker, I rise in opposition to the motion to
recommit.
The SPEAKER pro tempore. The gentlewoman from North Carolina is
recognized for 5 minutes.
Ms. FOXX. Mr. Speaker, this motion is nothing more than a last-ditch
attempt to defeat a commonsense bill that will help expand access to
affordable healthcare coverage for working families. In fact, this
motion represents the same failed approach to health care we have
experienced in recent years.
We have seen what happens when the Federal Government dictates the
kind of health insurance individuals can and cannot buy. Healthcare
costs skyrocket and patients have fewer choices.
While our Democrat colleagues offer a motion that doubles down on a
failed approach to health care, my Republican colleagues and I are
offering the American people a better way.
The Small Business Health Fairness Act is about empowering
individuals, families, and small-business owners so more Americans have
access to affordable healthcare coverage. By rejecting this motion and
supporting the underlying bill, we can take an important step in
keeping our promise to deliver free-market, patient-centered healthcare
solutions.
I urge my colleagues to vote ``no'' on the motion to recommit and
``yes'' on the Small Business Health Fairness Act.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. Without objection, the previous question is
ordered on the motion to recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Ms. SHEA-PORTER. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule
XX, this 15-minute vote on the motion to recommit will be followed by
5-minute votes on passage of the bill, if ordered; and the motion to
suspend the rules and pass H.R. 1238.
The vote was taken by electronic device, and there were--yeas 179,
nays 233, not voting 17, as follows:
[Roll No. 185]
YEAS--179
Adams
Aguilar
Barragan
Beatty
Bera
Beyer
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brady (PA)
Brownley (CA)
Bustos
Butterfield
Capuano
Carbajal
Cardenas
Cartwright
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Clark (MA)
Clarke (NY)
Clay
Cleaver
Cohen
Connolly
Conyers
Cooper
Correa
Costa
Courtney
Crist
Crowley
Cuellar
Cummings
Davis (CA)
Davis, Danny
DeFazio
DeGette
Delaney
DeLauro
DelBene
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Duncan (TN)
Ellison
Engel
Eshoo
Espaillat
Esty
Evans
Foster
Frankel (FL)
Fudge
Gabbard
Gallego
Garamendi
Gonzalez (TX)
Gottheimer
Green, Al
Green, Gene
Grijalva
Gutierrez
Hanabusa
Hastings
Heck
Higgins (NY)
Himes
Hoyer
Huffman
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson, E. B.
Jones
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kihuen
Kildee
Kilmer
Kind
Krishnamoorthi
Kuster (NH)
Langevin
Larsen (WA)
Lawson (FL)
Lee
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren
Lowenthal
Lowey
Lujan Grisham, M.
Lujan, Ben Ray
Lynch
Maloney, Carolyn B.
Maloney, Sean
Matsui
McCollum
McGovern
McNerney
Meeks
Meng
Moulton
Murphy (FL)
Nadler
Napolitano
Neal
Nolan
Norcross
O'Halleran
O'Rourke
Pallone
Panetta
Pascrell
Pelosi
Perlmutter
Peters
Peterson
Pingree
Pocan
Polis
Price (NC)
Quigley
Raskin
Rice (NY)
Rosen
Roybal-Allard
Ruiz
Ruppersberger
Ryan (OH)
Sanchez
Sarbanes
Schakowsky
Schiff
Schneider
Schrader
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shea-Porter
Sherman
Sires
Smith (WA)
Soto
Speier
Suozzi
Swalwell (CA)
Thompson (CA)
Thompson (MS)
Titus
Tonko
Torres
Vargas
Veasey
Vela
Velazquez
Visclosky
Walz
Wasserman Schultz
Waters, Maxine
Watson Coleman
Welch
Wilson (FL)
Yarmuth
NAYS--233
Abraham
Aderholt
Allen
Amash
Amodei
Arrington
Babin
Bacon
Banks (IN)
Barletta
Barr
Barton
Bergman
Biggs
Bilirakis
Bishop (MI)
Bishop (UT)
Black
Blackburn
Blum
Bost
Brady (TX)
Brat
Bridenstine
Brooks (AL)
Brooks (IN)
Buchanan
Buck
Bucshon
Budd
Burgess
Byrne
Calvert
Carter (GA)
Carter (TX)
Chabot
Chaffetz
Cheney
Coffman
Cole
Collins (GA)
Collins (NY)
Comer
Comstock
Conaway
Cook
Costello (PA)
Cramer
Crawford
Culberson
Curbelo (FL)
Davidson
Davis, Rodney
Denham
Dent
DeSantis
DesJarlais
Diaz-Balart
Donovan
Duffy
Duncan (SC)
Dunn
Emmer
Farenthold
Faso
Ferguson
Fitzpatrick
Fleischmann
Flores
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gaetz
Gallagher
Garrett
Gibbs
Gohmert
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (LA)
Graves (MO)
Griffith
Grothman
Guthrie
Harper
Harris
Hartzler
Hensarling
Herrera Beutler
Hice, Jody B.
Higgins (LA)
Hill
Holding
Hollingsworth
Hudson
Huizenga
Hultgren
Hunter
Hurd
Issa
Jenkins (KS)
Jenkins (WV)
Johnson (LA)
Johnson (OH)
Johnson, Sam
Jordan
Joyce (OH)
Katko
Kelly (MS)
Kelly (PA)
King (IA)
King (NY)
Kinzinger
Knight
Kustoff (TN)
Labrador
LaHood
LaMalfa
Lamborn
Lance
Latta
Lewis (MN)
LoBiondo
Long
Loudermilk
Love
Lucas
Luetkemeyer
MacArthur
Marchant
Marino
Marshall
Massie
Mast
McCarthy
McCaul
McClintock
McHenry
McKinley
McMorris Rodgers
McSally
Meadows
Meehan
Messer
Mitchell
Moolenaar
Mooney (WV)
Mullin
Murphy (PA)
Newhouse
Noem
Olson
Palazzo
Palmer
Paulsen
Pearce
Perry
Pittenger
Poe (TX)
Poliquin
Posey
Ratcliffe
Reed
Reichert
Renacci
Rice (SC)
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rohrabacher
Rokita
Rooney, Francis
Rooney, Thomas J.
Ros-Lehtinen
Roskam
Ross
Rothfus
Rouzer
Royce (CA)
Russell
Rutherford
Sanford
Scalise
Schweikert
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Smith (MO)
Smith (NE)
Smith (NJ)
Smith (TX)
Smucker
Stefanik
Stewart
Stivers
Taylor
Tenney
Thompson (PA)
Thornberry
Tiberi
Tipton
Trott
Turner
Upton
Valadao
Wagner
Walberg
Walden
Walker
Walorski
Walters, Mimi
Weber (TX)
Webster (FL)
Wenstrup
Westerman
Williams
Wilson (SC)
Wittman
Womack
Woodall
Yoder
Yoho
Young (AK)
Young (IA)
Zeldin
NOT VOTING--17
Bass
Brown (MD)
Carson (IN)
Clyburn
Larson (CT)
Lawrence
Lieu, Ted
McEachin
Moore
Nunes
Payne
Richmond
Rush
Sinema
Slaughter
Takano
Tsongas
[[Page H2330]]
{time} 1530
Mr. BISHOP of Michigan, Ms. GRANGER, Messrs. GOSAR, and YOUNG of
Alaska changed their vote from ``yea'' to ``nay.''
So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
Stated for:
Mr. LARSON of Connecticut. Mr. Speaker, on March 22nd, 2017--I was
not present for rollcall vote 185. If I had been present for this vote,
I would have voted ``yea.''
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Recorded Vote
Mr. SCOTT of Virginia. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. This is a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 236,
noes 175, not voting 18, as follows:
[Roll No. 186]
AYES--236
Abraham
Aderholt
Allen
Amash
Amodei
Arrington
Babin
Bacon
Banks (IN)
Barletta
Barr
Barton
Bergman
Biggs
Bilirakis
Bishop (MI)
Bishop (UT)
Black
Blackburn
Blum
Bost
Brady (TX)
Brat
Bridenstine
Brooks (AL)
Brooks (IN)
Buchanan
Buck
Bucshon
Budd
Burgess
Byrne
Calvert
Carter (GA)
Carter (TX)
Chabot
Chaffetz
Cheney
Coffman
Cole
Collins (GA)
Collins (NY)
Comer
Comstock
Conaway
Cook
Costello (PA)
Cramer
Crawford
Cuellar
Culberson
Curbelo (FL)
Davidson
Davis, Rodney
Denham
Dent
DeSantis
DesJarlais
Diaz-Balart
Donovan
Duffy
Duncan (SC)
Duncan (TN)
Dunn
Emmer
Farenthold
Faso
Ferguson
Fitzpatrick
Fleischmann
Flores
Foxx
Franks (AZ)
Frelinghuysen
Gaetz
Gallagher
Garrett
Gibbs
Gohmert
Goodlatte
Gosar
Gottheimer
Gowdy
Granger
Graves (LA)
Graves (MO)
Griffith
Grothman
Guthrie
Harper
Harris
Hartzler
Hensarling
Herrera Beutler
Hice, Jody B.
Higgins (LA)
Hill
Holding
Hollingsworth
Huizenga
Hultgren
Hunter
Hurd
Issa
Jenkins (KS)
Jenkins (WV)
Johnson (LA)
Johnson (OH)
Johnson, Sam
Jones
Jordan
Joyce (OH)
Katko
Kelly (MS)
Kelly (PA)
King (IA)
King (NY)
Kinzinger
Knight
Kustoff (TN)
Labrador
LaHood
LaMalfa
Lamborn
Lance
Latta
Lewis (MN)
LoBiondo
Long
Loudermilk
Love
Lucas
Luetkemeyer
MacArthur
Marchant
Marino
Marshall
Massie
Mast
McCarthy
McCaul
McClintock
McHenry
McKinley
McMorris Rodgers
McSally
Meadows
Meehan
Messer
Mitchell
Moolenaar
Mooney (WV)
Mullin
Murphy (PA)
Newhouse
Noem
Nunes
Olson
Palazzo
Palmer
Paulsen
Pearce
Perry
Peterson
Pittenger
Poe (TX)
Poliquin
Posey
Ratcliffe
Reed
Reichert
Renacci
Rice (SC)
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rohrabacher
Rokita
Rooney, Francis
Rooney, Thomas J.
Ros-Lehtinen
Roskam
Ross
Rothfus
Rouzer
Royce (CA)
Russell
Rutherford
Sanford
Scalise
Schrader
Schweikert
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Smith (MO)
Smith (NE)
Smith (NJ)
Smith (TX)
Smucker
Stefanik
Stewart
Stivers
Taylor
Tenney
Thompson (PA)
Thornberry
Tiberi
Tipton
Trott
Turner
Upton
Valadao
Wagner
Walberg
Walden
Walker
Walorski
Walters, Mimi
Weber (TX)
Webster (FL)
Wenstrup
Westerman
Williams
Wilson (SC)
Wittman
Womack
Woodall
Yoder
Young (AK)
Young (IA)
Zeldin
NOES--175
Adams
Aguilar
Barragan
Beatty
Bera
Beyer
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brady (PA)
Brownley (CA)
Bustos
Butterfield
Capuano
Carbajal
Cardenas
Cartwright
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Clark (MA)
Clarke (NY)
Clay
Cleaver
Cohen
Connolly
Conyers
Cooper
Correa
Costa
Courtney
Crist
Crowley
Cummings
Davis (CA)
Davis, Danny
DeFazio
DeGette
Delaney
DeLauro
DelBene
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Ellison
Engel
Eshoo
Espaillat
Esty
Evans
Foster
Frankel (FL)
Fudge
Gabbard
Gallego
Garamendi
Gonzalez (TX)
Green, Al
Green, Gene
Grijalva
Gutierrez
Hanabusa
Hastings
Heck
Higgins (NY)
Himes
Hoyer
Huffman
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson, E. B.
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kihuen
Kildee
Kilmer
Kind
Krishnamoorthi
Kuster (NH)
Langevin
Larsen (WA)
Larson (CT)
Lawson (FL)
Lee
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren
Lowenthal
Lowey
Lujan Grisham, M.
Lujan, Ben Ray
Lynch
Maloney, Carolyn B.
Maloney, Sean
Matsui
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moulton
Murphy (FL)
Nadler
Napolitano
Neal
Nolan
Norcross
O'Halleran
O'Rourke
Pallone
Panetta
Pascrell
Pelosi
Perlmutter
Peters
Pingree
Pocan
Polis
Price (NC)
Quigley
Raskin
Rice (NY)
Rosen
Roybal-Allard
Ruiz
Ruppersberger
Ryan (OH)
Sanchez
Sarbanes
Schakowsky
Schiff
Schneider
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shea-Porter
Sherman
Sires
Smith (WA)
Soto
Speier
Suozzi
Swalwell (CA)
Thompson (CA)
Thompson (MS)
Titus
Tonko
Torres
Vargas
Veasey
Vela
Velazquez
Visclosky
Walz
Wasserman Schultz
Waters, Maxine
Watson Coleman
Welch
Wilson (FL)
Yarmuth
NOT VOTING--18
Bass
Brown (MD)
Carson (IN)
Clyburn
Fortenberry
Graves (GA)
Hudson
Lawrence
Lieu, Ted
Moore
Payne
Richmond
Rush
Sinema
Slaughter
Takano
Tsongas
Yoho
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). There are 2 minutes
remaining.
{time} 1539
Mr. CLEAVER changed his vote from ``aye'' to ``no.''
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
Stated for:
Mr. YOHO. Mr. Speaker, I was unavoidably detained. Had I been
present, I would have voted ``yea'' on rollcall No. 186.
Mr. FORTENBERRY. Mr. Speaker, I was inadvertently detained. Had I
been present, I would have voted ``yea'' on rollcall No. 186.
____________________