[Congressional Record Volume 163, Number 52 (Friday, March 24, 2017)]
[House]
[Pages H2374-H2392]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROVIDING FOR CONSIDERATION OF H.R. 1628, AMERICAN HEALTH CARE ACT OF
2017
Mr. SESSIONS. Mr. Speaker, by direction of the Committee on Rules, I
call up House Resolution 228 and ask for its immediate consideration.
The Clerk read the resolution, as follows:
[[Page H2375]]
H. Res. 228
Resolved, That upon adoption of this resolution it shall be
in order to consider in the House the bill (H.R. 1628) to
provide for reconciliation pursuant to title II of the
concurrent resolution on the budget for fiscal year 2017. All
points of order against consideration of the bill are waived.
The amendments specified in section 2 of this resolution
shall be considered as adopted. The bill, as amended, shall
be considered as read. All points of order against provisions
in the bill, as amended, are waived. The previous question
shall be considered as ordered on the bill, as amended, and
on any further amendment thereto, to final passage without
intervening motion except: (1) four hours of debate equally
divided and controlled by the chair and ranking minority
member of the Committee on the Budget or their respective
designees; and (2) one motion to recommit with or without
instructions.
Sec. 2. The amendments referred to in the first section of
this resolution are as follows:
(a) The amendment printed in part A of the report of the
Committee on Rules accompanying this resolution modified by
the amendment printed in part B of that report.
(b) The amendment printed in part C of the report of the
Committee on Rules accompanying this resolution modified by
the amendments printed in part D and part E of that report.
The SPEAKER pro tempore (Mr. Womack). The gentleman from Texas is
recognized for 1 hour.
Mr. SESSIONS. Mr. Speaker, for the purpose of debate only, I yield
the customary 30 minutes to the gentleman from Massachusetts (Mr.
McGovern), my friend, pending which I yield myself such time as I may
consume. During consideration of this resolution, all time yielded is
for the purpose of debate only.
General Leave
Mr. SESSIONS. Mr. Speaker, I ask unanimous consent that all Members
may have 5 legislative days to revise and extend their remarks.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Texas?
There was no objection.
{time} 0915
Mr. SESSIONS. Mr. Speaker, I rise in support of this rule and the
underlying legislation.
This rule is a fair rule that adequately provides both sides of the
aisle with ample time to debate the merits of the underlying
legislation. In fact, the Rules Committee thought it was so important
that ample time be provided to this debate, that we are provided 4
hours of general debate on the underlying bill.
Mr. Speaker, in honor of our former President, Ronald Reagan, I wear
brown today. The former President, when he was President, believed that
wearing brown was good luck to him and good luck for the things which
he was undertaking. So, in honor of Ronald Reagan, I, too, wear my
brown jacket today.
Mr. Speaker, it has become abundantly clear that ObamaCare has failed
the American people. Our Nation's healthcare system today is broken and
only getting worse under the current law, known as the Affordable Care
Act, or ObamaCare.
Simply put, ObamaCare is collapsing, and it is collapsing fast.
Options and choices are disappearing for consumers, and an
anticompetitive marketplace has been created that firmly harms
patients.
How bad is it? Nearly one-third of all U.S. counties currently have
only one insurer offering plans on their State's exchanges. That is a
government-created monopoly, Mr. Speaker, and that kills the free
market, meaning no choices for the American people and higher costs are
what the American consumer and the healthcare market are finding.
And it is only continuing to get worse. As more and more insurers
leave the marketplace, prices will continue to rise, forcing healthy
individuals to make economic decisions not to purchase health care,
creating a self-defeating spiral of rising costs and less options. That
is why we must act, and act today, which is what we are doing.
It is no wonder that in such a government-controlled system that
premiums have increased by an average of 25 percent on the ObamaCare
exchanges this year alone. And it is no wonder that some 19.2 million
taxpayers chose to outright pay the individual mandate penalty or
claimed an exemption. What this means is that ObamaCare is not a good
option to these 19.2 million people.
Mr. Speaker, the American people, I believe, sent us to Washington,
D.C., to fix this issue. They are telling us directly: this must be
fixed now. And people certainly outside of Washington resent the
Federal Government telling them how to purchase health care and what
that healthcare marketplace would look like. But we really do not have
to tolerate this. We do not have to agree that we will accept the
status quo.
Mr. Speaker, I believe the American people are smart. I believe the
American people want independence, they love freedom, and they want to
know that they can make their own choices, because they believe they
make better choices than a one-size-fits-all plan out of Washington,
D.C.
What brings us here today, however, most assuredly, is a broken
system. So, Republicans offer today H.R. 1628, the American Health Care
Act of 2017, which will eliminate Washington's one-size-fits-all
healthcare policy for the American people. It dismantles the disastrous
ObamaCare taxes that are strangling the working middle class and
diminishing America's economic prowess. We will end this with the
opportunity to vote today to change the status quo.
It eliminates the onerous employer and individual mandates. It
prohibits health insurers from denying coverage and helps young adults
access health care by getting back into the marketplace while
stabilizing and restoring the free market opportunities for all
Americans.
Mr. Speaker, the American people are counting on Washington getting
it right this time. What does getting it right mean? Getting it right
means giving them the opportunity to exit a bad system and to have a
better chance at a new system.
This rule provides House Republicans with the opportunity to restore
exactly that--a better healthcare plan to provide the middle class and
low-income families who have been left behind on either side of the
aisle, and it gives them an opportunity to have tax advantages in the
employer marketplace.
Mr. Speaker, today, we will be dissecting this into three separate
areas. We will have Members of the Republican majority here to explain
that and the bill.
Mr. Speaker, I reserve the balance of my time.
Mr. McGOVERN. Mr. Speaker, I yield myself such time as I may consume.
(Mr. McGOVERN asked and was given permission to revise and extend his
remarks.)
Mr. McGOVERN. Mr. Speaker, I want to thank the gentleman from Texas
(Mr. Sessions), my friend, for yielding me the customary 30 minutes.
Mr. Speaker, the majority is rushing to congratulate itself for
finally having a bill to repeal the Affordable Care Act. For 7 years,
Republicans had nothing to actually replace the law with, but that
didn't stop them from making one empty political promise after another.
And after all that, what do we have in front of us today? This bill
will take away health care from 24 million hardworking Americans. It
forces families to pay higher premiums and deductibles, increasing out-
of-pocket costs. It is a crushing age tax, forcing Americans age 50 to
64 to pay premiums five times higher than what others pay for health
coverage, no matter how healthy they are. Not to mention the $880
billion cut to Medicaid or the fact that it steals from Medicare,
shortening the life of the Medicare trust fund by 3 years and
ransacking funds that seniors depend on to get the long-term care they
need.
I don't see anything there to be excited about. But then again, I
come from the old-fashioned school of thought that we should actually
take care of our fellow citizens as they grow older, rather than
tossing them off the ship without a life preserver.
It is no wonder that after developing such an ill-conceived and far-
reaching bill on the fly, the majority has had to try and jam this
legislation through our Chamber.
First, they rushed this bill through the committee process without
holding a single hearing, and without the benefit of a nonpartisan
Congressional Budget Office score outlining its costs and impacts.
Then the majority came out of a back room somewhere and filed four
managers' amendments in the dark of
[[Page H2376]]
night to try to appease the conservative and moderate holdouts,
including the infamous Buffalo bribe. The Republican leadership has
been trying to strong-arm their conference into voting for this bill
all week, and nobody knows how today's vote will go. The only thing we
do know is that this is a terrible bill that is only getting worse, not
better.
This thing has been a mess from beginning to end. Now, I know our
President prides himself on his negotiating skills, but this seems more
like the art of no deal to me, no matter what the final vote tally
looks like.
That brings us to this early morning, when we met at 7 a.m. in the
Rules Committee to report out this rule, which rewrites the bill to
make it far worse.
Last night, we were presented with a provision, concocted in some
back room, that boggles the mind with its cynicism. So what is this
mysterious grand bargain that will appease the Republican Conference
and finally buy Speaker Ryan enough votes to pass this disaster of a
bill? Well, Mr. Speaker, it is so cartoonishly malicious that I can
picture someone twirling their mustache as they drafted it in their
secret Capitol lair last night.
Republicans are killing the requirements that insurance plans cover
essential health benefits--essential health benefits. Now, perhaps you
are wondering: What are these so-called essential benefits? Well, I
will give you a partial list: emergency room trips, maternity care,
mental health care and substance abuse treatment, and prescription
drugs. These are the types of exotic, extravagant benefits that
Republicans apparently don't think are important for working Americans
to be able to afford.
It would be literally unbelievable if we weren't here considering it
right now, Mr. Speaker. Now, I have been awake since before dawn--
thanks to our Rules Committee meeting--so I know that this isn't a
nightmare. We are actually voting on a bill with a backroom deal, made
in the dark of night, that would take away any guarantee that plans
would cover these basic essential benefits.
And, of course, we have no idea what the costs will be or how many
people it will affect. We can't know those things until we get an
analysis from the nonpartisan Congressional Budget Office, which,
obviously, we will not have before we vote on this reckless
legislation.
And that is the real problem. Because every time you come out of a
back room, this bill gets worse. For the sake of our country, maybe we
should consider putting locks on the back rooms you huddle in.
President Trump keeps talking about crowd size. My colleagues across
the aisle keep talking about page size. This morning, in the Rules
Committee, Republicans kept saying that the fifth manager's amendment
is only 4 pages long. How bad could it be?
Well, they need to stop worrying about size and pay more attention to
how this bill will affect regular, working Americans. These 4 pages are
the worse 4 pages on this planet because of the terrible consequences
it will have on real people. It will be devastating for millions and
millions of Americans.
So, Mr. Speaker, instead of rushing this horrendous bill, patched
together with backroom deals, to the floor and voting on it just hours
after seeing the final product, we should be working together in a
bipartisan way to improve people's lives, and certainly not putting
them at risk. My colleagues seem too concerned about winning at any
cost to stop and think about the consequences for millions upon
millions of Americans. This is a lousy bill.
Mr. Speaker, I reserve the balance of my time.
Mr. SESSIONS. Mr. Speaker, I yield 10 minutes to the gentleman from
Lewisville, Texas (Mr. Burgess), a distinguished member of the Rules
Committee, a gentleman who sits on both the Energy and Commerce and the
Rules Committee. He is quite literally the most knowledgeable person on
health care in the United States Congress.
Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding.
Mr. Speaker, we all know why we are here--the problems that exist
within the Affordable Care Act. It is simply not working for the
American people--limited choice, costs going up, and millions without
access to care. Unfortunately, these are not just talking points, but
real issues affecting real Americans.
The Affordable Care Act has damaged the individual market. It has
driven insurers away from offering coverage. Now, we are seeing one-
third of all United States counties with only one insurer. And among
the plans that have chosen to remain in the markets, there have been
widespread, double-digit premium increases.
The individual markets are a death spiral and are failing to live up
to the promises made 7 years ago--that Americans would be able to
receive affordable health care. As we knew then, and we know now, this
was an empty promise that has left an estimated 19.2 million Americans
without coverage. What is worse, these individuals are forced to pay
the individual mandate penalty or seek a hardship exemption because of
the costs to purchase and use health insurance.
Nine months ago, Mr. Speaker, we began our Better Way plan to save
the Nation's healthcare system and to bring relief to the American
people. This plan, which served as the blueprint for the American
Health Care Act, laid out the policies to stabilize the collapsing
insurance markets and to repeal the more burdensome Affordable Care Act
taxes and mandates that have hindered innovation and limited access to
care. So let's take a look at what the American Health Care Act does.
First and foremost, it provides immediate relief to the State
insurance markets. As Republicans, we know that one-size-fits-all works
for no one and certainly did not work for the individual markets. The
States should have the flexibility to support their insurance markets
and ensure that plans can continue to provide options for coverage.
To do this, we relaxed two of the egregious market regulations that
were imposed under the Affordable Care Act: the mandate that premiums
cannot vary for younger and older Americans by more than a 3-to-1
ratio, and the mandate creating fixed actuarial values for plans.
The mandate limiting a plan's ability to set premiums by age has
driven up the cost for coverage for younger and healthier Americans and
has pushed away those seeking coverage by the millions. Of the 19.2
million Americans who have sidestepped the individual mandate, it
estimated that as many as 45 percent of these individuals are under the
age of 35. Without these younger Americans seeking coverage, the
markets have further plunged into death spirals, as insurers hike up
premiums year after year.
To change this, we are relaxing the ratio to 5-to-1. It will lower
premium costs and provide necessary opportunities to stabilize the
markets.
Additionally, we are repealing the actuarial values mandate to
provide insurers with additional flexibility to offer more coverage
options.
{time} 0930
To further supplement these efforts, we are establishing the Patient
and State Stability Fund. This fund provides States with $100 billion
over 10 years to promote innovative solutions to lower cost and
increase access to health care for unique patient populations in each
State. The goal is simple: to provide States with maximum flexibility
as to how they address the cost of care for their citizens.
The Congressional Budget Office estimated that a combination of the
Stability Fund and other proposed changes to the market would reduce
premiums by 10 percent by calendar year 2026. We all want patients to
have access to high-quality, affordably priced coverage. The Patient
and State Stability Fund can help to lower costs.
In Medicaid, in addition to supporting the insurance market, the
American Health Care Act provides needed reforms to the Medicaid
program. Without changes, the Medicaid expansion alone is expected to
cost $1 trillion over the next decade. Medicaid desperately needs
reform so that States can continue to provide coverage to children,
people with disabilities, and other vulnerable groups.
To address these concerns, the American Health Care Act first phases
out the Medicaid expansion, the expansion that has crippled State
budgets and limited States' ability to ensure that
[[Page H2377]]
resources will continue to be available for those vulnerable
populations.
Additionally, our bill helps further bend the Medicaid cost curve by
shifting programs toward per capita allotments. The per capita
allotments, an idea that originated during the Clinton administration,
will set limits on the annual cost for growth for per capita
expenditures for which the States will receive matching funds from the
Federal Government.
The American Health Care Act increases the amount of flexibility that
States have in managing their Medicaid programs. The bill scales back
the Affordable Care Act mandates that have limited a State's ability to
tailor their plans to the needs of their beneficiaries. States can and
should be trusted to manage the needs of their beneficiaries, and this
bill allows States to do that.
Additionally, the bill before us today furthers the goal of providing
the States with greater flexibility in managing their Medicaid programs
by providing States with the option to implement two additional
opportunities: work requirement and block grants for Medicaid.
This time around we chose to engage our State counterparts in the
discussion and listen--listen--to their input as we designed this bill.
At the top of their list were the desire to see the work requirement
built in and the opportunity to work with Medicaid as a block grant.
We don't tell them what to do. They are given the permission to do
what they feel is best for their citizens. Republicans trust the States
and trust the Governors and the elected leaders in those States.
Finally, the American Health Care Act provides additional resources
to bolster State safety net providers. The bill provides increases in
the community health center funding, offers enhanced funding to support
safety net providers in States that did not expand Medicaid, and ends
the cuts to the disproportionate share hospital payments.
We are committed, Mr. Speaker, to ensuring that our local providers
can continue to deliver lifesaving care. The American Health Care Act
turns this commitment into action. For millions of Americans in rural
and medically underserved areas, these actions will provide needed
relief that was undercut by the Affordable Care Act.
Let me just say, Mr. Speaker, it has been an interesting process. We
had a 27\1/2\-hour markup in the Energy and Commerce Committee. We have
had over 15 or 16 hours in the Rules Committee. This bill has been
almost talked to death. I want to just acknowledge that I appreciate
the input of the administration. I appreciate the fact that the
directive to us last night was to put our pencils down and turn our
papers in. It is time, Mr. Speaker.
This is a good bill. The rule deserves our support. The underlying
bill deserves our support.
Mr. McGOVERN. Mr. Speaker, I include in the Record a letter from the
AARP; a letter from the National Rural Health Association; a letter
from the American Society of Addiction Medicine; and a letter from the
American Medical Association--all strongly opposed to the Republican
bill.
AARP,
March 7, 2017.
Hon. Greg Walden,
Chairman, Committee on Energy and Commerce, House of
Representatives, Washington, DC.
Hon. Kevin Brady,
Chairman, Committee on Ways and Means, House of
Representatives, Washington, DC.
Hon. Frank Pallone,
Ranking Member, Committee on Energy and Commerce, House of
Representatives, Washington, DC.
Hon. Richard Neal,
Ranking Member, Committee on Ways and Means, House of
Representatives, Washington, DC.
Dear Chairmen and Ranking Members: AARP, with its nearly 38
million members in all 50 States and the District of
Columbia, Puerto Rico, and U.S. Virgin Islands, is a
nonpartisan, nonprofit, nationwide organization that helps
people turn their goals and dreams into real possibilities,
strengthens communities and fights for the issues that matter
most to consumers and families such as healthcare, employment
and income security, retirement planning, affordable
utilities and protection from financial abuse.
We write today to express our opposition to the American
Health Care Act. This bill would weaken Medicare's fiscal
sustainability, dramatically increase health care costs for
Americans aged 50-64, and put at risk the health care of
millions of children and adults with disabilities, and poor
seniors who depend on the Medicaid program for long-term
services and supports and other benefits.
Medicare
Our members and older Americans believe that Medicare must
be protected and strengthened for today's seniors and future
generations. We strongly oppose any changes to current law
that could result in cuts to benefits, increased costs, or
reduced coverage for older Americans. According to the 2016
Medicare Trustees report, the Medicare Part A Trust Fund is
solvent until 2028 (11 years longer than pre-Affordable Care
Act (ACA)), due in large part to changes made in the ACA. We
have serious concerns that the American Health Care Act
repeals provisions in current law that have strengthened
Medicare's fiscal outlook, specifically, the repeal of the
additional 0.9 percent payroll tax on higher-income workers.
Repealing this provision could hasten the insolvency of
Medicare by up to 4 years and diminish Medicare's ability to
pay for services in the future.
Prescription Drugs
Older Americans use prescription drugs more than any other
segment of the U.S. population, typically on a chronic basis.
We are pleased that the bill does not repeal the Medicare
Part D coverage gap (``donut hole'') protections created
under the ACA. Since the enactment of the law, more than 11.8
million Medicare beneficiaries have saved over $26.8 billion
on prescription drugs. We do have strong concerns that the
American Health Care Act repeals the fee on manufacturers and
importers of branded prescription drugs, which currently is
projected to add $25 billion to the Part B trust fund between
2017 and 2026. AARP believes Congress must do more to reduce
the burden of high prescription drug costs on consumers and
taxpayers and is willing to work with you on bipartisan
solutions.
Individual Private Insurance Market
About 6.1 million older Americans age 50-64 currently
purchase insurance in the non-group market, and nearly 3.2
million are currently eligible to receive subsidies for
health insurance coverage through either the federal health
benefits exchange or a state-based exchange (exchange). We
have seen a significant reduction in the number of uninsured
since passage of the ACA, with the number of 50-64 year old
Americans who are uninsured dropping by half.
Affordability of both premiums and cost-sharing is critical
to older Americans and their ability to obtain and access
health care. A typical senior seeking coverage through an
exchange has a median annual income of under $25,000 and
already pays significant out-of-pocket costs for health care.
We have serious concerns that the bill under consideration
will dramatically increase health care costs for 50-64 year
olds who purchase health care through an exchange due both to
the changes in age rating from 3:1 (already a compromise that
requires uninsured older Americans to pay three times more
than younger individuals) to 5:1 and reductions in current
subsidies for older Americans.
Age rating plus premium increases equal an unaffordable age
tax. Our previous estimates on the age-rating change showed
that premiums for current coverage could increase by up to
$3,200 for a 64-year-old, while reducing premiums by only
about $700 for a younger enrollee. Significant premium
increases for older consumers will make insurance less
affordable, will not address their expressed concern of
rising premiums, and will only encourage a small increase in
enrollment numbers for younger persons. In addition, the bill
proposes to change current subsidies based on income and
premium levels to a flatter tax credit. The change in
structure will dramatically increase premiums for older
consumers. We estimate that the bill's changes to current
law's tax credits could increase premium costs for a 55-year-
old earning $25,000 by more than $2,300 a year. For a 64-
year-old earning $25,000 that increase rises to more than
$4,400 a year, and more than $5,800 for a 64-year-old earning
$15,000. When we examined the impact of both the tax credit
changes and 5:1 age rating, our estimates find that, taken
together, premiums for older adults could increase by as much
as $3,600 for a 55-year-old earning $25,000 a year, $7,000
for a 64-year-old earning $25,000 a year and up to $8,400 for
a 64-year-old earning $15,000 a year. In addition to these
skyrocketing premiums, out-of-pocket costs could
significantly increase under the bill with the elimination of
cost sharing assistance in current law. The cost sharing
assistance has provided relief on out-of-pocket costs (like
deductibles and certain benefits) for low-income individuals
who are some of the most financially vulnerable marketplace
participants.
Medicaid and Long-Term Services and Supports
AARP opposes the provisions of the American Health Care Act
that create a per capita cap financing structure in the
Medicaid program. We are concerned that these provisions
could endanger the health, safety, and care of millions of
individuals who depend on the essential services provided
through Medicaid. Medicaid is a vital safety net and
intergenerational lifeline for millions of individuals,
including over 17.4 million low-income seniors and children
and adults with disabilities who rely on the program for
critical health care and long-term services and supports
(LTSS, i.e., assistance with daily
[[Page H2378]]
activities such as eating, bathing, dressing, managing
medications, and transportation).
Of these 17.4 million individuals: 6.9 million are ages 65
and older (which equals more than 1 in every 7 elderly
Medicare beneficiaries); 10.5 million are children and adults
living with disabilities; and about 10.8 million are so poor
or have a disability that they qualify for both Medicare and
Medicaid (dual eligibles). Dual eligibles account for almost
33 percent of Medicaid spending. While they comprise a
relatively small percentage of enrollees, they account for a
disproportionate share of total Medicare and Medicaid
spending.
Individuals with disabilities of all ages and older adults
rely on critical Medicaid services, including home and
community based services (HCBS) for assistance with daily
activities such as eating, bathing, dressing, and home
modifications; nursing home care; and other benefits such as
hearing aids and eyeglasses. People with disabilities of all
ages also rely on Medicaid for access to comprehensive acute
health care services. For working adults, Medicaid can help
them continue to work; for children, it allows them to stay
with their families and receive the help they need at home or
in their community. Individuals may have low incomes, face
high medical costs, or already spent through their resources
paying out-of-pocket for LTSS, and need these critical
services. For these individuals, Medicaid is a program of
last resort.
In providing a fixed amount of federal funding per person,
this approach to financing would likely result in
overwhelming cost shifts to states, state taxpayers, and
families unable to shoulder the costs of care without
sufficient federal support. This would result in cuts to
program eligibility, services, or both--ultimately harming
some of our nation's most vulnerable citizens. In terms of
seniors, we have serious concerns about setting caps at a
time when per-beneficiary spending for poor seniors is likely
to increase in future years. By 2026, when Boomers start to
turn age 80 and older, they will likely need much higher
levels of service--including HCBS and nursing home--moving
them into the highest cost group of all seniors. As this
group continues to age, their level of need will increase as
well as their overall costs. We are also concerned that caps
will not accurately reflect the cost of care for individuals
in each state, including for children and adults with
disabilities and seniors, especially those living with the
most severe disabling conditions.
AARP is also opposed to the repeal of the six percent
enhanced federal Medicaid match for states that take up the
Community First Choice (CFC) Option. CFC provides states with
a financial incentive to offer HCBS to help older adults and
people with disabilities live in their homes and communities
where they want to be. About 90 percent of older adults want
to remain in their own homes and communities for as long as
possible. HCBS are also cost effective. On average, in
Medicaid, the cost of HCBS per person is one-third the cost
of institutional care. Taking away the enhanced match could
disrupt services for older adults and people with
disabilities in the states that are already providing
services under CFC.
AARP has concerns with the removal of the state option in
Medicaid to increase the home equity limit above the federal
minimum. This takes away flexibility for states to adjust a
Medicaid eligibility criterion based on the specific
circumstances of each state and its residents beyond a
federal minimum standard.
Although we cannot support the American Health Care Act, we
are pleased that the bill does not repeal some of the
critical consumer protections included in the Affordable Care
Act, such as guaranteed issue, prohibitions on preexisting
condition exclusions, bans on annual and lifetime coverage
limits and allowing families to keep children on their
policies until the age of 26. Also, AARP does support
restoring the 7.5 percent threshold for the medical expense
deduction which will directly help older Americans struggling
to pay for health care, particularly the high cost of nursing
homes and other long-term services and supports.
We look forward to working with you to ensure that we
maintain a strong health care system that ensures robust
insurance market protections, controls costs, improves
quality, and provides affordable coverage to all Americans.
Sincerely,
Joyce A. Rogers,
Senior Vice President,
Government Affairs.
____
Vote NO to the American Health Care Act
The National Rural Health Association urges a NO vote on
the American Health Care Act (AHCA).
Rural Americans are older, poorer and sicker than other
populations. In fact, a January 2017 CDC report pronounced
that life expectancies for rural Americans have declined and
the top five chronic diseases are worse in rural America. The
AHCA does nothing to improve the health care crisis in rural
America, and will lead to poorer rural health outcomes, more
uninsured and an increase in the rural hospital closure
crisis.
Though some provisions in the modified AHCA bill will
improve the base bill, including increased tax credits for
Americans between the ages of 50 and 64 who would have seen
their premiums skyrocket under the current plan, the National
Rural Health Association is concerned that the bill still
falls woefully short in improving access and affordability of
health care for rural Americans. Additionally, the new
amendments to freeze Medicaid expansion enrollment as of Jan.
1, 2018, and reduce the Medicaid per-capita growth rate will
disproportionately harm rural America.
The AHCA will hurt vulnerable populations in rural
Americans, leaving millions of the sickest, most underserved
populations in our nation without coverage, and further
escalating the rural hospital closure crisis. According to
the Wall Street Journal, the ``GOP health plan would hit
rural areas hard . . . Poor, older Americans would see the
largest increase in insurance-coverage costs.'' The LA Times
reports ``Americans who swept President Trump to victory--
lower-income, older voters in conservative, rural parts of
the country--stand to lose the most in federal healthcare aid
under a Republican plan to repeal and replace the Affordable
Care Act.''
Let's be clear--many provisions in the ACA failed rural
America. The lack of plan competition in rural markets,
exorbitant premiums, deductibles and co-pays, the co-op
collapses, lack of Medicaid expansion, and devastating
Medicare cuts to rural providers--all collided to create a
health care crisis in rural America. However, it's beyond
frustrating that an opportunity to fix these problems is
squandered, and instead, a greater health care crisis will be
created in rural America.
Congress has long recognized the importance of the rural
health care safety net and has steadfastly worked to protect
it. And now, much of the protections created to maintain
access to care for the 62 million who live in rural America
are in jeopardy. We implore Congress to continue its fight to
protect rural patients' access to care. Three improvements
are critical for rural patients and providers:
1. Medicaid--Though most rural residents are in non-
expansion states, a higher proportion of rural residents are
covered by Medicaid (21% vs. 16%).
Congress and the states have long recognized that rural is
different and thus requires different programs to succeed.
Rural payment programs for hospitals and providers are not
`bonus' payments, but rather alternative, cost-effective and
targeted payment formulas that maintain access to care for
millions of rural patients and financial stability for
thousands of rural providers across the country. Any federal
health care reform must protect a state's ability to protect
its rural safety net providers. The federal government must
not abdicate its moral, legal, and financial responsibilities
to rural, Medicaid eligible populations by ensuring access to
care.
Any federal health care reform proposal must protect access
to care in Rural America, and must provide an option to a
state to receive an enhanced reimbursement included in a
matching rate or a per capita cap, specifically targeted to
create stability among rural providers to maintain access to
care for rural communities. Enhancements must be equivalent
to the cost of providing care for rural safety net providers,
a safeguard that ensures the enhanced reimbursement is
provided to the safety net provider to allow for continued
access to care. Rural safety net providers include, but not
limited to, Critical Access Hospitals, Rural Prospective
Payment Hospitals, Rural Health Clinics, Indian Health
Service providers, and individual rural providers.
2. Market Reform--Forty-one percent of rural marketplace
enrollees have only a single option of insurer, representing
70 percent of counties that have only one option. This lack
of competition in the marketplace means higher premiums.
Rural residents average per month cost exceeds urban ($569.34
for small town rural vs. $415.85 for metropolitan).
Rural Americans are more likely to have obesity, diabetes,
cancer, and traumatic injury; they are more likely to
participate in high risk health behaviors including smoking,
poor diet, physical inactivity, and substance abuse. Rural
Americans are more likely to be uninsured or underinsured and
less likely to receive employer sponsored health insurance.
Rural communities have fewer health care providers for
insurers to contract with to provide an adequate network to
serve the community.
Any federal health care reform proposal must address the
fact that insurance providers are withdrawing from rural
markets. Despite record profit levels, insurance companies
are permitted to cherry pick profitable markets for
participation and are currently not obliged to provide
service to markets with less advantageous risk pools.
Demographic realities of the rural population make the market
less profitable, and thus less desirable for an insurance
company with no incentive to take on such exposure. In the
same way that financial service institutions are required to
provide services to underserved neighborhoods, profitable
insurance companies should be required to provide services in
underserved communities.
3. Stop Bad Debt Cuts to Rural Hospitals--Rural hospitals
serve more Medicare patients (46% rural vs. 40.9% urban),
thus across-the-board Medicare cuts do not have across the
board impacts. A goal of the ACA was to have hospital bad
debt decrease significantly. However, because of unaffordable
health plans in rural areas, rural patients still cannot
afford health care. Bad debt among rural hospitals has
actually increased
[[Page H2379]]
50% since the ACA was passed. According to MedPAC ``Average
Medicare margins are negative, and under current law they are
expected to decline in 2016'' has led to 7% gains in median
profit margins for urban providers while rural providers have
experienced a median loss of 6%.
If Congress does not act, all the decades of efforts to
protect rural patients' access to care, could rapidly be
undone. The National Rural Health Association implores
Congress to act now to protect rural health care across the
nation.
____
American Society of
Addiction Medicine,
Rockville, MD, March 8, 2017.
Hon. Kevin Brady,
Chairman, Committee on Ways and Means, House of
Representatives, Washington, DC.
Hon. Richard Neal,
Ranking Member, Committee on Ways and Means, House of
Representatives, Washington, DC.
Hon. Greg Walden,
Chairman, Committee on Energy and Commerce, House of
Representatives, Washington, DC.
Hon. Frank Pallone,
Ranking Member, Committee on Energy and Commerce, House of
Representatives, Washington, DC.
Dear Chairman Brady, Chairman Walden, Ranking Member Neal
and Ranking Member Pallone: On behalf of the American Society
of Addiction Medicine (ASAM), the nation's oldest and largest
medical specialty society representing more than 4,300
physicians and allied health professionals who specialize in
the treatment of addiction, I am writing to share our views
on the American Health Care Act (AHCA) that is being
considered by the Ways and Means and Energy and Commerce
committees.
ASAM is very concerned that the AHCA's proposed changes to
our health care system will result in reductions in health
care coverage, particularly for vulnerable populations
including those suffering from the chronic disease of
addiction, and we cannot support the bill in its current
form.
More than 20 million Americans currently have health care
coverage due to the Affordable Care Act (ACA), including
millions of Americans with addiction. This coverage is a
critical lifeline for persons with addiction, many of whom
were unable to access effective treatment before the ACA's
expansion of Medicaid eligibility to low-income adults, and
its requirement that Medicaid expansion plans and plans sold
in the individual and small group market provide essential
health benefits (EHB) including addiction treatment services
at parity with medical and surgical services.
We are concerned that rolling back the Medicaid expansion,
sunsetting the EHB requirements for Medicaid expansion plans,
and capping federal support for Medicaid beneficiaries will
reduce coverage for and access to addiction treatment
services, changes that will be particularly painful in the
midst of the ongoing opioid epidemic. Moreover, while the
AHCA retains the EHB requirements for private plans, it
repeals the ACA's actuarial value requirements for those
plans. We are concerned that this could result in insurers
offering addiction treatment benefits in name only due to
higher costs and/or less robust benefits.
The Medicaid expansion in particular has led to significant
increases in coverage and treatment access for persons with
addiction. In states that expanded Medicaid, the share of
people with addiction or mental illness who were hospitalized
but uninsured fell from about 20 percent in 2013 to 5 percent
by mid-2015 and Medicaid expansion has been associated with
an 18.3 percent reduction in unmet need for addiction
treatment services among low-income adults. Rolling back the
Medicaid expansion and fundamentally changing Medicaid's
financing structure to cap spending on health care services
will certainly reduce access to evidence-based addiction
treatment and reverse much or all progress made on the opioid
crisis last year.
To be sure, ASAM supports flexibility in the Medicaid
program and has supported several states' applications for
1115 waivers to transform their addiction treatment systems
to offer all levels of care described by The ASAM Criteria;
Treatment Criteria for Addictive, Substance-Related, and Co-
Occurring Conditions. However, ASAM has seen for decades how
states underfund addiction treatment services and waste
federal dollars on inefficient and ineffective care when they
are left to decide how to manage their federal Medicaid
dollars without mandates for parity and accountability to
cover appropriate care. Based on this experience, we
commended the Congress for requiring accountability for the
$1 billion in funding sent to the states to combat the opioid
epidemic authorized by 21st Century Cures. This funding is an
additional lifeline to suffering communities, but it will
come to an end while patients will continue to need treatment
for the chronic disease of addiction. When it does, the
Medicaid program must continue to fund appropriate addiction
treatment at parity with medical and surgical services.
ASAM has long advocated for broad access to high-quality,
evidence-based, individualized and compassionate treatment
services for persons suffering from the chronic disease of
addiction. The critical need for access to this type of care
has been heightened and highlighted by our nation's ongoing
epidemic of opioid addiction and related overdose deaths. The
ACA's Medicaid expansion, EHB requirements for addiction
treatment coverage, and extension of parity protections to
the individual and small group market have surely reduced the
burden of this epidemic and saved lives. As you consider this
legislation, we hope that parity protections will continue to
apply individual, small and large group plans as well as
Medicaid plans through the transition. Finally, throughout
this process, we implore you to keep in mind how your
decisions will affect the millions of Americans suffering
from addiction who may lose their health care coverage
entirely or see reductions in benefits that impede access to
needed treatment.
Sincerely,
R. Jeffrey Goldsmith, MD, DLFAPA, DFASAM,
President, American Society of Addiction Medicine.
____
American Medical Association,
Chicago, IL, March 22, 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: Due to projections
that enactment of the American Health Care Act (AHCA) will
result in millions of Americans losing health insurance
coverage, the American Medical Association (AMA) must express
our opposition to the proposal currently before the House of
Representatives. The need to stabilize the individual
insurance market and make other improvements in the
Affordable Care Act is well understood. However, as
physicians, we also know that individuals who lack health
insurance coverage live sicker and die younger than those
with adequate coverage. We encourage all members of Congress
to engage in an inclusive and thorough dialogue on
appropriate remedies. We cannot, however, support legislation
that would leave health insurance coverage further out of
reach for millions of Americans.
Earlier this year, we shared with Congress key health
reform objectives that we believe are critical to improving
the health of the nation. Among these objectives are ensuring
that those currently covered do not lose their coverage,
maintaining market reforms, stabilizing and strengthening the
individual insurance market, ensuring that low and moderate-
income patients are able to secure affordable and adequate
coverage, and ensuring that Medicaid and other critical
safety net programs are maintained and adequately funded.
While we appreciate that the bill's authors have made efforts
to maintain some market reforms and that regulatory efforts
are underway to strengthen the individual insurance market,
as a whole the legislation falls short of the principles we
previously outlined.
Health insurance coverage is critically important. Without
it, millions of American families could be just one serious
illness or accident away from losing their home, business, or
life savings. The AMA has long supported the availability of
advanceable and refundable tax credits, inversely related to
income, as a means to assist individuals and families to
purchase health insurance. The credits proposed under the
AHCA are significantly less generous for those with the
greatest need than provided under current law. The reduced
purchasing power with the AHCA tax credits will put insurance
coverage out of reach for millions of Americans.
We also remain deeply concerned with the reduction of
federal support for the Medicaid program and the resulting
significant loss of coverage. Medicaid expansion has provided
access to critical services, including mental health and
substance abuse treatment, for millions. Not only will the
AHCA force many states to roll back coverage to these
millions of previously ineligible individuals, but the
significant reduction in federal support for the program will
inevitably have serious implications for all Medicaid
beneficiaries, including the elderly, disabled, children, and
pregnant women, as well.
We also continue to be concerned about provisions that
eliminate important investments in public health, and those
that inappropriately insert the federal government into
personal decisions about where Americans are allowed to
access covered health care services.
We continue to stand ready to work with Congress on
proposals that will increase the number of Americans with
quality, affordable health insurance coverage but for the
reasons cited above, urge members to oppose the American
Health Care Act.
Sincerely,
James L. Madara, MD.
Mr. McGOVERN. Mr. Speaker, I just want to say to my colleague from
Texas, he said this bill was talked to death. It was talked to death by
politicians. There were no hearings on this bill, so no experts came to
testify, and none of these people who are now writing to us in
opposition had the opportunity to be able to come before us and tell us
how awful this bill is.
Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr.
Hastings), a distinguished member of the Rules Committee.
Mr. HASTINGS. Mr. Speaker, today is a sad day for this institution.
Why are we here? Well, after 13 hours at the Rules Committee on
Wednesday,
[[Page H2380]]
did we report to the floor the Republicans' replacement to the
Affordable Care Act? No.
And why not? Because the legislation was not extreme enough. It
didn't hurt enough people. It didn't make enough people uninsured. It
didn't give a large enough tax break to the wealthiest among us.
That 13-hour exercise yielded nothing except to reveal the callous
depths of the Republican Party's attempt to deprive health care from 24
million people.
So after my friends on the other side of the aisle added yet another
manager's amendment, bringing the total to five, and after stripping
away essential health benefits, we are here this morning to push this
extreme, dangerous, and callous bill under martial law.
But why are we really here? Is this bill actually about improving
health care in this country? By my estimation, and by the analysis of
virtually every healthcare group--Mr. McGovern has introduced some of
them: hospitals, medical organizations, and the nonpartisan
Congressional Budget Office--the answer is a flat-out, resounding no.
Premiums are going to rise. Millions upon millions of people will
lose health coverage. Essential benefits will be stripped away, and 400
of the wealthiest Americans will get a substantial tax cut, while
Medicaid is being cut by $880 billion.
Mr. Speaker, during that 13-hour marathon meeting that yielded
nothing but a rule allowing Republicans to continue to ram this measure
through Congress, I quoted from Scripture, from the King James Bible,
Matthew 25:45. It says:
Then shall He answer them, saying, Verily, I say unto you,
inasmuch as you did it not to one of the least of these, you
did it not to me.
My friends on the other side of the aisle often cite Scripture in
their legislative motivations. I ask them now: How does cutting the
benefits from the least among us, while showering more wealth upon the
wealthiest among us, square with these teachings?
In addition, Mr. Speaker, I noted to them that we hear from them all
the time about liberty. So I noted that, in the Preamble to the
Constitution, the document that guides our great Nation and that we all
swear an oath to uphold, that we are entrusted to also, and I quote
from the Preamble, ``promote the general welfare.'' I also note for you
that this charge is placed before the first mention of the word
``liberty.''
Does stripping away of essential health benefits, which include
maternity and newborn care, pediatric services, and emergency services,
promote the general welfare?
Does cutting $880 billion from Medicaid promote the general welfare?
Does ensuring that, by 2026, 56 million people under the age of 64
will be left without coverage promote general welfare?
Finally, Mr. Speaker, in the debate at committee on this shameful
bill, I answered the Republican charge that this bill was about freedom
when I quoted a verse from Janis Joplin's ``Me and Bobby McGee.'' What
she was saying is: ``Freedom's just another word for nothin' left to
lose.''
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. McGOVERN. Mr. Speaker, I yield an additional 30 seconds to the
gentleman from Florida.
Mr. HASTINGS. Mr. Speaker, if this extreme bill becomes law, a bill
which has been rushed through Congress, amended without care, brought
before us without hearings, without a CBO score, without thoughtful
consideration, without a Democratic amendment being approved, and
without a clue, I fear--indeed, I know--that the American people will
find themselves with nothing left to lose when it comes to their and
their family's health care, which is the most perverse and wretched
kind of freedom as you may have ever seen.
Mr. SESSIONS. Mr. Speaker, I yield myself such time as I may consume,
and I thank the gentleman from Florida very much. In fact, the
gentleman is correct. We had an opportunity to quote the Bible, Janis
Joplin, and ZZ Top when we were doing our hearings. We had so much time
with each other, and I enjoyed the hours and hours that we had to
debate these essential items.
But the other side of the story is essential health benefits are not
being done away with. They are being transferred entirely to States.
States have asked for the ability to manage their own money, and manage
their own people's benefits of what would be required in the States. So
in no way should a person take away, well, we just did away with it. In
fact, we transferred the authority and the responsibility of essential
health benefits to the States because Governors have been asking for
this.
Mr. Speaker, I want to take just a moment to explain what I believe
is at the heart of the legislation and really, in reality, the key to
fixing health care. It is the second part of this.
We heard the gentleman from Lewisville, Texas, Dr. Burgess, speak
about the Energy and Commerce portions. I now would like to take a
minute to talk about the portions that come directly out of the Ways
and Means Committee.
The gentleman, Mr. Brady, from The Woodlands, Texas, today, spoke
about many of these; but at the heart of it, 170 million Americans
currently receive their health care through an employee-employer tax
advantage or tax benefits, an untaxed benefit whereby people who have
an employer who can provide their health care, it is not taxed--
pretaxed to the employee, allowing them to have a good healthcare
system. Well, all the while, millions of Americans pay higher premiums
out of their pockets in the individual market. Those are people that do
not have an employer who is able to help them. So that is not fair.
That does not help these people.
What we are doing here is putting together an addition of, really, a
great Republican idea; and it takes the important step to provide the
same tax-free benefits for those employer-sponsored plans that we will
give to regular employees, and it is called a tax credit. This tax
credit is going to work because it allows every single American that
does not receive the tax benefit at work to get it for themselves.
Who is this? Well, quite honestly, it is small-business owners; it is
low-income workers; it is entrepreneurs. It includes, really, a lot of
real estate agents and people that work for a small business, maybe
heating and air-conditioning systems like we have all across this
country. It will give their families an opportunity.
How much money? Well, we will provide them between $2,000 and $14,000
a year for their families to be able to have these opportunities to
purchase a nongovernment healthcare plan, meaning that, as they would
go to the marketplace, we are going to help these people through a tax
credit available January 1, providing them with an opportunity to
purchase health care on a benefit basis.
Why is this important? It saves money because what it does, it
creates two things: a family then has an insurance plan, including a
healthcare component that goes to the hospitalization; and secondly, it
gives them an opportunity to have their own doctor or healthcare plan
that they choose. This is important because many of these people end up
in the hospital in the most expensive kind of way we can provide health
care: at the emergency room.
So this gives these families parity in the marketplace. We believe
that that is important and is another part of this Republican
healthcare plan.
Mr. Speaker, I reserve the balance of my time.
Mr. McGOVERN. Mr. Speaker, I hear my friend talking about what came
out of the Ways and Means Committee. I will tell you what came out of
Ways and Means Committee: a $1 trillion tax cut for the wealthy.
Mr. Speaker, I yield 2 minutes to the gentleman from Colorado (Mr.
Polis), a distinguished member of the Rules Committee.
Mr. POLIS. Mr. Speaker, look, first of all, this rather outrageous
Republican healthcare bill still will cost 24 million Americans their
healthcare insurance; and if you are lucky enough not to be one of
those 24 million Americans, the nonpartisan Congressional Budget
Office, the head of which was appointed by a Republican, says it will
also increase the cost by 15 or 20 percent for those who are lucky
enough to keep their insurance.
[[Page H2381]]
In addition to that, it has a crushing age tax that forces people
aged 50 to 64 to pay premiums five times higher than what other
Americans pay for health care.
As if that age tax wasn't enough, in this new amendment, which most
of us only saw for the first time at 6:30 this morning, they increased
the Medicare tax for another 5 years by 1 percent, so Americans will
have to pay even more in taxes.
The last manager's amendment, which we just got the information on,
actually would increase the deficit by over $150 billion more than
their original bill, somehow without covering even one additional
American.
{time} 0945
So what is going on here?
They are creating a bill that has more taxes with this manager's
amendment, creating a bill that costs the American people more and
reduces the deficit more, and then pawns off the hard decisions to the
States, without giving them enough to maintain the essential benefits
that Americans rely on, like prescription drugs, rehabilitative care,
and mental health services.
They are not giving the States enough money to maintain those. And
then they are saying: But you, States, be the bad guys and you guys
make the cut so we in Washington can pat ourselves on the back and look
good, even while we increase the deficit by more than $150 billion more
than the original healthcare bill that was introduced last week and
even though we maintain the age tax that forces people between the age
of 50 and 64 to pay up to five times more than other Americans.
This is simply the wrong way to go. Sometimes you need to reboot,
restart, get together, look at real ideas that Democrats and
Republicans have put on the table to reduce costs and expand coverage.
That is what this discussion should be about. Yet, to do that, we need
to defeat this rule now and go back to the starting point.
Mr. SESSIONS. Mr. Speaker, I yield 2 minutes to the gentleman from
Alabama (Mr. Byrne), a distinguished member of the Rules Committee.
Mr. BYRNE. Mr. Speaker, 7 years ago yesterday, the Affordable Care
Act, or ObamaCare, became law. Since then, this law has resulted in
canceled plans, higher premiums, fewer choices, increased deductibles,
and less freedom for the American people.
Don't just take my word for it. Former Democratic President Bill
Clinton said this about ObamaCare:
`` . . . the people who are out there busting it, sometimes 60 hours
a week, wind up with their premiums doubled and their coverage cut in
half, and it's the craziest thing in the world.''
I tend to agree with President Clinton on this. ObamaCare is crazy.
But for far too many Americans, it is the crazy reality they face every
day.
So today is about a rescue mission. Today is about bringing relief to
the families who are struggling under this failed law. Today it is
about passing the American Health Care Act.
ObamaCare is on a collision course with disaster. If Congress were to
sit back and do nothing, ObamaCare would implode. This would leave
millions of Americans with no insurance and the overall insurance
market in a dangerous condition for the rest of us. So Congress must
act.
That is where the American Health Care Act comes into play. This bill
repeals ObamaCare along with its costly taxes and burdensome mandates.
By doing this, we can lower premiums for hardworking Americans.
Most importantly, this bill gives Americans the freedoms, choices,
and control they desperately want and deserve.
So, Mr. Speaker, the vote today is for the family in Monroeville who
can't afford their premiums. The vote is for the small-business owner
in Daphne who had his plan canceled. The vote is for the mother in
Mobile whose deductible is too high. The vote is for the people in
southwest Alabama and across all of America who are struggling under
ObamaCare.
This is our chance. This is the bill. We have got to get this done.
Mr. McGOVERN. Mr. Speaker, I would respond to the gentleman from
Alabama with the words of another Alabama Member, Congressman Mo
Brooks, who this morning said:
This is one of the worst bills I've seen in my 30 years in
Congress.
Mr. Speaker, I yield 1 minute to the gentleman from Michigan (Mr.
Kildee).
Mr. KILDEE. Mr. Speaker, today is the day. In hearing my friends on
the other side of the aisle describe their efforts to improve health
care, I just wonder if we have the right bill on the floor. Because
looking at all the external analysis--the CBO, which I know you want to
discount, but there are many other organizations--what do they say
about this legislation?
It is a terrible bill. It increases costs that Americans will bear.
Despite the fact that we hear about decreasing premiums, all the
reports say that this will increase premiums and increase out-of-pocket
costs that Americans will have to put out in order to protect
themselves from disease.
It will provide less coverage. Twenty-four million Americans will
lose coverage. But even for those who might be able to have health
insurance without essential benefits assured, that will just be a
health insurance card, but not access to an emergency room, not access
to maternal care, not access to prescription drugs, not access to
hospitalization. Basically you will be able to get diagnosed, but you
won't get health care.
This is a terrible bill. We ought to reject it today.
Mr. SESSIONS. Mr. Speaker, I yield 5 minutes to the gentleman from
Georgia (Mr. Woodall), who will be describing the third piece of this,
and that is the putting together of the piece from the Budget
Committee.
Mr. WOODALL. Mr. Speaker, I appreciate all the hard work the Rules
Committee chairman has done in this bill. Mr. Speaker, I have the great
pleasure of serving on the Rules Committee, but I am the designee to
the Budget Committee.
This whole process that we are going through is a Budget Committee
process. It is called reconciliation. And as folks have talked about
it, they have talked about what the Ways and Means Committee has done
and what the Energy and Commerce Committee did. But then those two
bills come together in the Budget Committee, and we move the process
forward.
I can't help but notice my colleagues' frustration with the
amendments that have been made to this bill along the way. Generally,
we celebrate amendments that are made along the way because they
improve the work product. We do them together.
I point here, Mr. Speaker, to a tweet that the President sent out the
day the healthcare bill was introduced. The President said:
``Our wonderful new HealthCare Bill is now out for review and
negotiation.''
And that was true. It was out for review so everyone could read it,
and it was out for negotiation so that everyone could improve it.
We did that in the Budget Committee. We had four motions to instruct
that passed in the Budget Committee to provide Medicaid flexibility, to
make sure the tax credits were targeted to the right populations, to
ensure that able-bodied, working Americans had those incentives to both
get health care and be able to go back to work.
Now, every committee didn't have that experience. As my colleagues
have asked for a bipartisan process, you will remember that the Energy
and Commerce Committee spent 10 hours debating the title of the bill.
They spent 10 hours debating Democratic amendments to change the title
of the bill. Folks, we have opportunity after opportunity to make
things better, but it is incumbent upon us to choose that opportunity
to make things better.
So often we get wrapped around the partisan action. Folks let that
opportunity slip away. I am glad that we didn't do that.
Mr. Speaker, when I talk about what we did in the Budget Committee to
make it better, I am talking about focusing on the real problems. There
is not a member in this body that doesn't understand that what is
contributing to the ObamaCare death spiral is that young people are not
enrolling. Young people are not enrolling.
More Americans rejected ObamaCare and filed for an exemption or
agreed to pay the penalty than enrolled in ObamaCare. I don't care how
big your heart was when you passed the bill, you have to concede that
wasn't what you intended. And we can do better.
[[Page H2382]]
My friends are talking about the essential health benefits plan
today. Young people are particularly sensitive to that. They are price
sensitive in that way. We are talking in the Budget Committee about how
to preserve that flexibility for States to design plans that are right
for them.
How many times today have we heard folks say that prices are going to
increase for Americans between the age of 54 and 64?
I have heard it at least a dozen times. At the same time, my friends
are demanding that every healthcare plan in the State of Georgia cover
maternity benefits for those women between the age of 54 and 64. At the
same time, my friends are demanding that every plan in Georgia cover
pediatric benefits for those empty nesters between 54 and 64. That
doesn't make sense. It doesn't make sense. We in Georgia know it
doesn't make sense, and we can do better.
Mr. Speaker, 45 percent of the almost 20 million people who rejected
the Affordable Care Act and agreed to pay the fine or file an exemption
instead were under the age of 35. There is not a serious thinker in
this room who believes we can solve the insurance crisis in this
country without getting these folks back into the marketplace. And that
is what we did in the Budget Committee. That is what we have done
throughout this entire amendment process, and that is what the
amendments we considered in the Rules Committee this morning did as
well.
Mr. Speaker, since the passage of the Affordable Care Act, many
States have had to pass a lot of legislation in order to conform their
plans to new one-size-fits-all Federal mandates. But that is not the
story. The story is that, at the same time, States were passing their
own benefit mandates to serve their constituency better.
Mr. Speaker, Chairman Session's State of Texas passed a mandate that
orally administered anticancer medication be covered. The gentleman
from Texas has seen those groups in his office. He has seen those
families struggling. And what Texas said is: To respond to our people,
we are going to require every plan sold in the State of Texas cover
these issues.
In my home State, Mr. Speaker, we created a commission to look at
annually how to add more benefits, change those benefits, make sure we
are being responsive to folks in the best way that we can.
The gentleman from Colorado, his State did the very same thing. They
required coverage for acupuncture services. They required the selling
of child-only plans. They required coverage for fetal alcohol syndrome.
We do these things collaboratively, and we do these things together.
Mr. Speaker, I urge passage of the rule and passage of the underlying
legislation.
Mr. McGOVERN. Mr. Speaker, I notice the gentleman from Georgia relied
on a tweet from Donald Trump for his facts in explaining the bill. I
might suggest a more scholarly source, maybe, like, beginning with the
Congressional Budget Office, which says that 24 million people will
lose their health coverage as a result of the bill.
I will also point to the Quinnipiac poll that says only 17 percent of
the American people approve of what my Republicans friends are doing.
Seventeen percent is lower than Trump's rating. That is quite an
accomplishment.
Mr. Speaker, I yield 1 minute to the gentlewoman from California
(Mrs. Davis).
Mrs. DAVIS of California. Mr. Speaker, it has been hard keeping up
with all the changes over the last 24 hours. This process has been far
from transparent.
The CBO released a revised score last night that said that the
changes made to appease the Freedom Caucus will cost about $200 billion
more without doing or adding anything to increase coverage.
So how is that possible?
The latest edition to this healthcare disaster, the elimination of
minimum essential benefits, is something that I want to focus on very
briefly.
This change hits women especially hard. Insurance companies will no
longer have to cover maternity care, provide direct access to an OB/
GYN, or cover preventative services like cancer screening or birth
control.
Mr. Speaker, do we call this a mommy tax? Is this a mommy tax to
finance a millionaire tax cut?
I don't know.
Earlier this week, I gave my colleagues the opportunity to
demonstrate their commitment to women's health in a related bill, and,
Mr. Speaker, they didn't even allow a vote. I hear my colleagues
claiming that these changes are about choice. Forcing women to pay more
for the care they need is a choice I think we could do without.
Mr. Speaker, I urge opposition to this healthcare disaster.
Mr. SESSIONS. Mr. Speaker, I yield 2 minutes to the gentleman from
Oklahoma (Mr. Cole), the vice chairman of the Rules Committee.
Mr. COLE. Mr. Speaker, I thank the gentleman from Texas for his
remarkable leadership in this important debate.
Seven years ago, I was on this floor and I heard that, if you liked
your plan, you could keep it. I heard, if you liked your doctor, you
could keep that doctor. And I heard that healthcare costs were going to
drop by $2,500 per family. None of it was true.
I sit here now and look at my State, and I know what is happening
next year. The rates on the ObamaCare exchanges are going up by 69
percent. We are down to a single provider. That is what 7 years ago
brought us.
Today we have a chance to do something different, and everybody from
my State will do something different. They will vote for a plan that
actually does what it says it is going to do. Number one, they will be
able to actually have plans that are designed by Oklahomans, not by
bureaucrats in Washington, D.C. They will be able to have a tax credit,
if they are not already insured under Medicaid or Medicare or from
their employer. They will be able to have an individual tax credit to
purchase a plan that they design, that they like. They will be free of
the mandates of ObamaCare, free to make their own decisions, free of
the mandates that require them to buy insurance products that they
simply don't need.
I have got a lot of people in my district that are in their fifties
and sixties. Some of them might like to have children again, but they
are not likely to have children again, and they mostly don't want
maternity care.
So it is a pretty simple choice for us. It is a choice to be free and
make our own decisions. It is a choice to design our own plans. It is a
choice to have Federal assistance where we need it, but to be used
under our direction. It is an easy choice.
I urge the passage of this rule, and I urge the passage of the
underlying legislation.
{time} 1000
Mr. McGOVERN. Mr. Speaker, I include in the Record a statement from
NETWORK, the lobby for Catholic Social Justice; a letter from the
National Alliance on Mental Illness; a letter from the Mental Health
Liaison Group; and an article in the New York Times entitled ``Late GOP
Proposal Could Mean Plans That Cover Aromatherapy but Not
Chemotherapy.''
Dear Representative: NETWORK Lobby for Catholic Social
Justice urges you to vote NO on the American Health Care Act
(AHCA). This legislation fails to protect access to quality,
affordable healthcare for vulnerable communities. It would
widen the gaps in our society by making massive cuts to
Medicaid, giving large tax breaks to the very wealthiest
families and corporations, and threatening the health
security of American families.
Our faith teaches that access to healthcare is an essential
human right that is necessary to protect the life and dignity
of every person. The bill would drastically increase the
number of people without health insurance--and I know that
behind those numbers are millions of stories of families
facing medical bankruptcy, forgoing treatment, and losing
loved ones who could have been saved by preventative care.
The AHCA cuts Medicaid spending--an essential source of
care for millions of children, seniors, people with
disabilities, and people experiencing poverty in our nation--
and a per-capita cap would force states to ration care. The
legislation would also increase costs for older and sicker
patients and burden low- and moderate-income families with
much higher premiums by cutting $312 billion of financial
assistance for people purchasing health insurance on the
individual market. This is far from the Gospel mandate to
care for our most vulnerable sisters and brothers.
For any replacement to the ACA to be sufficient, it must
meet these 10 conditions--a Ten Commandments of Healthcare if
you will--and the AHCA breaks nine of 10 commandments:
[[Page H2383]]
1. Thou shalt provide affordable insurance and the same
benefits to all currently covered under the Affordable Care
Act. AHCA fails.
2. Thou shalt continue to allow children under the age of
26 to be covered by their parents' insurance.
3. Thou shalt ensure that insurance premiums and cost
sharing are truly affordable to all. AHCA fails.
4. Thou shalt expand Medicaid to better serve vulnerable
people in our nation. AHCA fails.
5. Thou shalt not undercut the structure or undermine the
purpose of Medicaid, Children's Health Insurance Program
(CHIP), and Medicare funding. AHCA fails.
6. Thou shalt create effective mechanisms of accountability
for insurance companies and not allow them to have annual or
lifetime caps on expenditures. AHCA partial fail.
7. Thou shalt not allow insurance companies to discriminate
against those with pre-existing conditions. AHCA partial
fail.
8. Thou shalt not allow insurance companies to discriminate
against women, the elderly, and people in poverty. AHCA
fails.
9. Thou shalt provide adequate assistance for people
enrolling and using their health coverage. AHCA fails.
10. Thou shalt continue to ensure reasonable revenue is in
the federal budget to pay for life-sustaining healthcare for
all. AHCA fails.
At its heart, this bill has lost sight of community and the
common good. Its biggest problem is that it lacks the
awareness that it is community which makes healthcare
effective. Healthcare is not just about the individual--it is
a communal good. The hyper individualism evident in the AHCA
is sucking the life out of our nation. Just focusing on one's
individual self is contrary to our Catholic faith and
contrary to our Constitution. We will track the vote and
score it in our 2017 voting record.
This dangerous legislation is not the faithful way forward
and must be rejected. Stand by Gospel principles and vote NO
on the AHCA.
Sincerely,
Sr. Simone Campbell, SSS,
Executive Director, NETWORK Lobby
for Catholic Social Justice.
____
National Alliance on
Mental Illness,
Arlington, VA, March 8, 2017.
Re The American Health Care Act.
Hon. Greg Walden,
Chairman, House Energy and Commerce Committee, House of
Representatives, Washington, DC.
Hon. Frank Pallone,
Ranking Member, House Energy and Commerce Committee, House of
Representatives, Washington, DC.
Dear Chairman Walden and Ranking Member Pallone: NAMI is
the nation's largest grassroots mental health organization
dedicated to building better lives for the millions of
Americans affected by mental illness. On behalf of our
nonprofit, nonpartisan organization, I am writing to express
our views on the American Health Care Act (AHCA), which seeks
to repeal and replace the Affordable Care Act (ACA).
The mental health crisis in our nation is well documented.
Half of all Americans with mental illness go without
treatment. Last year, Congress passed significant bipartisan
legislation to address the crisis in our nation's mental
health system. However, addressing the mental health needs in
our country relies on a foundation of affordable, quality
health coverage with fair and equal coverage of mental health
and substance use conditions. Thus, the importance of
Medicaid and insurance safeguards for individuals living with
mental illness cannot be overstated. Unfortunately, the
proposed reforms in the AHCA threaten to undermine the
historic progress being made to improve mental health and
substance use care.
Restructuring Medicaid Threatens Mental Health Care
Medicaid is the single largest payer of mental health and
substance use services in the United States. Medicaid is also
the largest funding source for the country's public mental
health system. One in five of Medicaid's nearly 70 million
beneficiaries have a mental health or substance use disorder
diagnosis.
NAMI is deeply concerned with proposed provisions to
convert Medicaid financing into a per capita cap model. This
would limit federal funding to a lump sum for all enrollees
and, instead of providing more flexibility, would shift
financial risk for health care costs--including unexpected
costs, such as promising new innovations in treatment--to
states. Current estimates are that the per capita cap
provisions would shift an alarming $370 billion in Medicaid
costs to states over the next ten years. In the face of
budget shortfalls, states will be forced to cut people from
coverage, reduce health benefits and access to care, and/or
reduce already low provider payments, escalating our nation's
healthcare workforce crisis.
The AHCA would set per capita caps for Medicaid at current
funding levels, adjusted for medical inflation. Funding for
mental health and substance use services is already
inadequate in Medicaid programs and, under this model, could
not be improved without cutting other health care. Further,
the deep reductions in federal Medicaid funding would mean
that people with mental illness will face even more desperate
circumstances when trying to access critical mental health
care.
Freezing Medicaid Expansion Puts Lives at Risk
Nearly 1 out of 3 people covered by Medicaid expansion
lives with a mental health or substance use condition.
Medicaid expansion has proven to be a lifeline that helps
people with mental illness who typically fall through the
cracks. Medicaid expansion provides coverage to people with
mental health conditions who are too sick to navigate the
traditional Medicaid application process, who are just stable
enough not to qualify for disability (often because they are
coming out of a psychiatric hospital), or who have first
symptoms of a serious mental illness.
NAMI strongly urges the Committee to take further steps to
preserve enrollment in Medicaid expansion, rather than the
proposed end to new enrollment in 2020. Expanded eligibility
has brought mental health treatment and the hope of recovery
to millions affected by mental illness. It is helping keep
people healthier and productive in their communities.
Congress should not abandon this important means of improving
coverage for and access to critical mental health treatment.
NAMI also urges the Committee to reject provisions in the
AHCA that would lock enrollees out of Medicaid expansion
should they experience a lapse of coverage of more than one
month. This is a high price to pay for forgetting to pay a
premium while in the hospital or experiencing severe symptoms
of mental illness. Denying coverage only serves to further
de-stabilize lives with costly consequences for individuals,
families and communities.
Finally, NAMI is very concerned that the AHCA removes the
requirement for Medicaid expansion plans to cover essential
health benefits, including mental health and substance use
treatment. Congress' significant commitment to mental health
and substance use services in recent legislation should not
be jeopardized by making these vital services optional in
Medicaid. Our country can ill afford to weaken coverage at a
time when the need for mental health and substance use
treatment is so high.
Continuing Insurance Subsidies and Protections
To help Americans afford quality health insurance, NAMI
strongly urges the Committee to continue current levels of
federal support, tied to income, to purchase health care
coverage. Without assistance tied to income, more people with
mental illness will be unable to afford coverage for mental
health care. This threatens their overall health, resulting
in more costly and difficult-to-treat conditions and denying
people the chance to reach and maintain recovery and a stable
life in the community.
NAMI appreciates that the Committee included essential
insurance safeguards in the AHCA. These safeguards include
protecting Americans from losing or being denied coverage
because of pre-existing health conditions. This also includes
continuing to allow young adults to remain on their parent's
health insurance plans to age 26 and banning annual and
lifetime caps for insurance coverage.
Cutting corners in health coverage will keep people from
getting the treatment they need and will push people with
mental illness into costly emergency rooms, hospitals and
jails. Making the investment early in affordable, quality
mental health care promotes recovery and reduces the high
long-term financial burden to taxpayers in avoidable
disability, criminal justice involvement and hospital care.
NAMI urges the Committee to maintain coverage and services
for people with mental illness by preserving financial help
based on income, removing the proposed per capita cap
financing model for Medicaid and protecting expanded Medicaid
eligibility. We appreciate the challenges in reforming
America's health coverage and look forward to working with
you to improve mental health coverage and care for children
and adults throughout our nation.
Sincerely,
Mary Giliberti, J.D.,
Chief Executive Officer, NAMI.
____
Mental Health Liaison Group,
March 17, 2017.
Hon. Paul Ryan,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
House Minority Leader,
House of Representatives, Washington, DC.
Dear Speaker Ryan and Democratic Leader Pelosi: The Mental
Health Liaison Group (MHLG) wishes to express our serious
concerns about the provisions of the American Health Care Act
(AHCA) that would restructure the Medicaid program and end
the Medicaid expansion, as well as provisions of that
legislation that would significantly reduce the Federal
premium assistance that enrollees receive from the Federal
government to maintain continuous insurance coverage, and
impose a significant penalty for not maintaining continuous
coverage. We are also very concerned that the legislation
would eliminate required coverage for prevention and
treatment of mental illness and substance use disorders under
state Medicaid managed care and alternative benefit programs,
as Medicaid is the major source of Federal funding in every
state for mental health and substance use services.
[[Page H2384]]
The MHLG is a coalition of dozens of national organizations
representing consumers, family members, mental health and
substance use treatment providers, state behavioral health
agencies, advocates, payers, and other stakeholders committed
to strengthening Americans' access to mental health and
substance use services and programs.
The elimination of Medicaid expansion under the AHCA would
leave without coverage the 1.3 million childless, non-
pregnant adults with serious mental illness who were able,
for the first time, to gain coverage under Medicaid
expansion. It would also leave uncovered the 2.8 million
childless, non-pregnant adults with substance use disorders
who also gained coverage under expansion for the first time.
These are populations that Congress promised and worked to
serve with the passage of 21st Century Cures and the
Comprehensive Addiction and Recovery Act (CARA) of 2016,
respectively. And it is important to remember that untreated
mental health and substance use disorders intensify and serve
to increase the number of co-morbid medical conditions in
those populations, thereby multiplying total Medicaid program
costs.
Medicaid is the single largest payer for behavioral health
services in the United States, accounting for about 26
percent of behavioral health spending, and is the largest
source of funding for the country's public mental health
system. The Congressional Budget Office estimates the
Medicaid provisions of the AHCA would reduce Medicaid funding
over 10 years by $880 billion, or about 25 percent. With an
estimated 14 million people--one in five of Medicaid's 70
million enrollees--living with mental illness or substance
use disorders and depending heavily on Medicaid services,
allowing states to determine whether those services should be
covered could very well leave many low-income Americans
without access to medically necessary prevention and
treatment services.
Medicaid covers a broad range of behavioral health services
at low or no cost, including but not limited to psychiatric
hospital care, case management, day treatment, evaluation and
testing, psychosocial rehabilitation, medication management,
as well as individual, group and family therapy. In three
dozen states, Medicaid covers essential peer support services
to help sustain recovery. Additionally, because people with
behavioral health disorders experience a higher rate of
chronic physical conditions than the general population,
Medicaid's coverage of primary care is critical to help this
population receive needed treatment for both their behavioral
health and physical health conditions.
In states that have expanded Medicaid and which have been
particularly hard hit by the opioid crisis, such as Kentucky,
Maine, Pennsylvania, Ohio, and West Virginia, Medicaid pays
between 35 to 50 percent of medication-assisted treatment for
substance use disorders. CARA and 21st Century Cures were to
increase payment for those services, but the elimination of
mandated coverage under Medicaid would likely result in state
cost shifting, so that CARA moneys (should they be
appropriated) and moneys provided under 21st Century Cures
for prescription opioid addiction prevention and treatment
services would supplant, rather than supplement, the existing
Medicaid coverage of services in the states.
Similarly, converting Medicaid into a per capita cap block
grant program or a simple block grant program will shift
significant costs to states over time. Ultimately, states
will be forced to reduce their Medicaid rolls, benefits, and
already low payment rates to an already scarce workforce of
behavioral health providers. Mental health and substance use
disorder treatments and programs will be at high risk
because, even though they are cost-effective, they are
intensive and expensive. Furthermore, the elimination of the
ACA's required Medicaid managed care coverage of mental
health and substance use disorder services and the long-term
reduction of real funding dollars will leave states and
managed care plans no alternative but to reduce or eliminate
services in order to balance state Medicaid budgets and
operate within managed care organizations' capitated rates.
In addition, these cuts will hit children with serious
emotional disorders, as well as adults with mental illness.
Fifty percent of Medicaid beneficiaries are children.
Seventy-five percent of mental conditions emerge by late
adolescence. The loss of Medicaid-covered mental and
substance use disorder services for adults would result in
more family disruption and out-of-home placements for
children, significant trauma which has its own long-term
health effects, and a further burden on a child welfare
system that is struggling to meet the current demand for
foster home capacity. In addition, we estimate $4 to $5
billion in Medicaid assistance will be lost by schools for
specialized instructional support services, including mental
and behavioral health services.
More directly, the rollback of the maximum eligibility
level for children ages 6 to 19 from 133 percent of the
Federal Poverty Level to 100 percent FPL will undoubtedly
have the result of reducing access to mental health and
substance use disorder services, and critical Early and
Periodic Screening, Diagnostic, and Treatment (EPSDT)
services, for those older children. This is a particularly
problematic change since 5 percent (1.2 million) of
adolescents between the ages of 12 and 17 had substance use
disorders in 2015 and EPSDT screening is the most effective
early identifier for emergent mental health issues.
ahca changes to private insurance coverage
If Medicaid is not to provide the avenue for recovery for
individuals with mental illness or substance use disorders,
then the private insurance market may have to serve as an
alternative, but the $2,000 to $4,000 refundable tax credits
provided under the AHCA to subsidize insurance premiums
constitute a significant reduction in the advance premium tax
credits paid under the ACA, which averaged 72 percent of
gross premiums. Further, the 30 percent premium surcharge
required under AHCA to be imposed for a failure to maintain
continuous coverage will likely hit hardest the lowest-income
enrollees who will be struggling to maintain premium payments
for coverage. It will be particularly destructive for those
enrollees whose serious mental illness or substance use
disorders may render them cognitively impaired and thus
unable to maintain premium payment schedules until they
recover, when the sizeable surcharge will leave them unable
to pick up coverage. For the foregoing reasons, these
provisions of the AHCA leave us very concerned for the
continued well-being of the individuals with serious mental
illness and substance use disorders we have been better able
to serve since the implementation of the ACA's expanded
coverage.
We urge you to continue to protect these vulnerable
Americans' access to and coverage of vital mental health and
substance use disorder care and services, and to not reverse
the recent progress made with the enactment of key mental
health and substance use disorder prevention and treatment
reforms under the 21st Century Cures Act and CARA.
Sincerely,
American Art Therapy Association, American Association of
Child & Adolescent Psychiatry, American Association for
Marriage and Family Therapy, American Association for
Geriatric Psychiatry, American Association on Health and
Disability, American Dance Therapy Association, American
Foundation for Suicide Prevention, American Nurses
Association, American Psychiatric Association, American
Psychoanalytic Association (APsaA), American Psychological
Association, American Society of Addiction Medicine, Anxiety
and Depression Association of America, Association for
Ambulatory Behavioral Healthcare, Association for Behavioral
Health and Wellness, Bazelon Center for Mental Health Law,
Campaign for Trauma-Informed Policy and Practice, Children
and Adults with Attention-Deficit Hyperactivity Disorder
(CHADD), Clinical Social Work Association, Clinical Social
Work Guild 49-OPEIU.
Depression and Bi-Polar Support Alliance, Eating Disorders
Coalition, EMDR International Association, Global Alliance
for Behavioral Health and Social Justice, International
Certification & Reciprocity Consortium (IC&RC), The Jewish
Federations of North America, Mental Health America, National
Association for Children's Behavioral Health, The National
Association of County Behavioral Health and Developmental
Disability Directors (NACBHDD), The National Association for
Rural Mental Health (NARMH), National Association of Social
Workers, National Association of State Mental Health Program
Directors (NASMHPD), National Alliance on the Mental Illness
(NAMI), National Council for Behavioral Health, National
Disability Rights Network, National Federation of Families
for Children's Mental Health, National Health Care for the
Homeless Council, National Register of Health Service
Psychologists, No Health Without Mental Health (NHMH), School
Social Work Association of America, Trinity Health of
Livonia, Michigan, Young Invincibles.
____
[From the New York Times, Mar. 23, 2017]
Late G.O.P. Proposal Could Mean Plans That Cover Aromatherapy But Not
Chemotherapy
(By Margot Sanger-Katz)
Most Republicans in Congress prefer the type of health
insurance market in which everyone could ``choose the plan
that's right for them.''
Why should a 60-year-old man have to buy a plan that
includes maternity benefits he'll never use? (This is an
example that comes up a lot.) In contrast, the Affordable
Care Act includes a list of benefits that have to be in every
plan, a reality that makes insurance comprehensive, but often
costly.
Now, a group of conservative House members is trying to cut
a deal to get those benefit requirements eliminated as part
of the bill to repeal and replace the Affordable Care Act
moving through Congress. (The vote in the House is expected
later today.)
At first glance, this may sound like a wonderful policy.
Why should that 60-year-old man have to pay for maternity
benefits he will never use? If 60-year-old men don't need to
pay for benefits they won't use, the price of insurance will
come down, and more people will be able to afford that
coverage, the thinking goes. And people who want fancy
coverage with extra benefits can just pay a little more for
the plan that's right for them.
But there are two main problems with stripping away minimum
benefit rules. One is that the meaning of ``health
insurance''
[[Page H2385]]
can start to become a little murky. The second is that, in a
world in which no one has to offer maternity coverage, no
insurance company wants to be the only one that offers it.
Here is the list of Essential Health Benefits that are
required under the Affordable Care Act:
Ambulatory patient services (doctor's visits)
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance abuse disorder services,
including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services and devices
Laboratory services
Preventive and wellness services, and chronic disease
management
Pediatric services, including oral and vision care
The list reflects some lobbying of the members of Congress
who wrote it. You may notice that dental services are
required for children, but not adults, for example. But over
all, the list was developed to make insurance for people who
buy their own coverage look, roughly, like the kind of
coverage people get through their employer. A plan without
prescription drug coverage would probably be cheaper than one
that covers it, but most people wouldn't think of that plan
as very good insurance for people who have health care needs.
Under the Republican plan, the government would give people
who buy their own insurance money to help them pay for it. A
20-year-old who doesn't get coverage from work or the
government, for example, would get $2,000. If the essential
health benefits go away, insurance companies would be allowed
to sell health plans that don't cover, say, hospital care.
Federal money would help buy these plans.
But history illustrates a potential problem.
In the 1990s, Congress created a tax credit that helped
low-income people buy insurance for their children. Quickly,
it became clear that unscrupulous entrepreneurs were creating
cheap products that weren't very useful, and marketing them
to people eligible for the credit. Congress quickly repealed
the provision after investigations from the Government
Accountability Office and the Ways and Means Committee
uncovered fraud.
Mark Pauly, a professor of health care management at the
Wharton School of the University of Pennsylvania, who tends
to favor market solutions in health care, said that while the
Obamacare rules are ``paternalistic,'' it would be
problematic to offer subsidies without standards. ``If
they're going to offer a tax credit for people who are buying
insurance, well, what is insurance?'' he said, noting that
you might end up with the government paying for plans that
covered aromatherapy but not hospital care. ``You have to
specify what's included.''
A proliferation of $1,995 plans that covered mostly
aromatherapy could end up costing the federal government a
lot more money than the current G.O.P. plan, since far more
people would take advantage of tax credits to buy cheap
products, even if they weren't very valuable.
There's another reason, besides avoiding fraud, that health
economists say benefit rules are important. Obamacare
requires insurers to offer health insurance to people who
have pre-existing illnesses at the same price as they sell
them to healthy people, and the Republican bill would keep
this rule. But if an insurance company designs a plan that
attracts a lot of sick people, it will be very expensive to
cover them, and the insurance company will either lose money
or end up charging extremely high prices that would drive
away any healthy customers.
Sherry Glied, the dean of the Robert F. Wagner Graduate
School of Public Service at New York University, who helped
work on the essential health benefits in the Obama
administration, raised the example of mental health benefits.
Parents of adolescents with schizophrenia will be sure to buy
insurance that covers only mental health services. Other
parents won't care about that benefit.
The result: Any company offering such benefits will end up
with a lot of customers requiring expensive hospitalizations,
while its competitors that drop them will get healthier
customers who are cheaper to insure. If mental health
services are optional, no insurance company will want to
offer them, lest all the families with sick children buy
their product and put them out of business.
And then healthy people who develop mental illness, or drug
addiction, will also learn that their illness isn't covered.
The result could be a sort of market failure: ``If you don't
require that these benefits are required, they often just get
knocked out of the market altogether,'' she said.
Before Obamacare passed, there were few federal standards
for health insurance bought by individuals, and it was not
uncommon to find plans that didn't include prescription drug
coverage, mental health services or maternity care. But plans
tended to cover most of the other benefits. That was in a
world where health insurers could discriminate against sick
people. In that era, insurers in most states could simply
tell the mother of a mentally ill child that she couldn't buy
insurance. That made it less risky for insurers to offer
mental health benefits to everyone else.
David Cutler, a professor at Harvard who helped advise the
Obama administration on the Affordable Care Act, said he
thinks the kind of insurance products that would be offered
under the proposed mix of policies could become much more
bare-bones than plans before Obamacare. He envisioned an
environment in which a typical plan might cover only
emergency care and basic preventive services, with everything
else as an add-on product, costing almost exactly as much as
it would cost to pay for a service out-of-pocket.
``Think of this as the if-you-have-rheumatoid-arthritis-
you-should-pay-$30,000 provision,'' he said. Such a system
would mean that Americans with costly problems--cancer,
opioid addiction, H.I.V.--would end up paying a substantially
higher share of their medical bills, while healthy people
would pay lower prices for insurance that wouldn't cover as
many treatments.
There is most likely a middle way. Republican lawmakers
might be comfortable with a system that shifts more of the
costs of care onto people who are sick, if it makes the
average insurance plan less costly for the healthy. But
making those choices would mean engaging in very real trade-
offs, less simple than their talking point.
Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentleman from
Indiana (Mr. Visclosky).
Mr. VISCLOSKY. Mr. Speaker, I rise in opposition to the rule and the
underlying legislation.
I believe that the purpose of any healthcare legislation should be to
improve the well-being of our Nation's citizens and to allow for access
to quality and affordable health care for all. I think, particularly,
the gentlemen from Massachusetts and Florida ably describe why today's
legislation fails those tests. I would add that it will also jeopardize
the healthcare coverage of over 429,000 Hoosiers currently enrolled in
Indiana's expansion of Medicaid, the Healthy Indiana Plan.
Further, I believe it is disingenuous that, if this bill is
successful, the House will have pushed numerous adverse consequences
until after the next congressional election.
Congress should work to improve the Affordable Care Act. Congress
should work to ensure affordable pharmaceutical products. Congress
should act for the health concerns still facing ordinary Americans. But
today's legislation does no such thing.
I find it unacceptable, and I urge my colleagues to oppose the
legislation.
Mr. Speaker, I rise in strong opposition to the American Health Care
Act.
I believe that the purpose of any health care legislation should be
to improve the health and well-being of our nation's citizens, and to
allow for access to quality and affordable health care for all.
That is why in the 111th Congress I was proud to support the
Affordable Care Act. As a result of this landmark legislation, 19
million people in the United States now have health insurance coverage
who did not before, and over nine-in-ten individuals in my home state
of Indiana now have health insurance.
Regretfully, according to the nonpartisan Congressional Budget
Office, the legislation we are considering today will leave
approximately 14 million more Americans without health care insurance
by 2018, and this number will continue to rise to an estimated 24
million by 2026.
I am especially concerned that the American Health Care Act will
jeopardize the health care coverage of the over 429,000 Hoosiers
currently enrolled in Indiana's expansion of Medicaid, also known as
the Healthy Indiana Plan.
Further, I believe it is especially disingenuous that if this bill
passes today, this institution will have pushed the financial cuts to
programs like the Healthy Indiana Plan conveniently until after the
next congressional election.
The Act before us also would negatively impact the health of millions
of women and men who receive the medical services provided by Planned
Parenthood. Additionally, it would not improve the well-being of our
nation's elderly by allowing providers to charge older enrollees up to
five times as much as younger individuals.
Finally, I would note with great concern that a provision was just
added to the American Health Care Act today that would remove the
requirement that insurers cover life-saving, essential health benefits,
including maternal and pediatric services, rehabilitative therapy, and
mental health and substance abuse treatment.
Congress should work to improve the Affordable Care Act and address
important health concerns facing ordinary Americans, such as the rising
cost of prescription drugs. But today's bill does no such thing.
It is unacceptable and I urge my colleagues to oppose this
legislation.
Mr. SESSIONS. Mr. Speaker, I reserve the balance of my time.
[[Page H2386]]
Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentlewoman from
California (Ms. Matsui).
Ms. MATSUI. Mr. Speaker, I thank the gentleman for yielding.
Mr. Speaker, we have heard a lot of rhetoric about how this bill
would supposedly fix our healthcare system. President Trump said that
his plan would provide insurance for everybody. That is not the bill
before us today.
The last-minute backroom changes have only made a bad bill worse.
Republicans stuck in a provision to strip away essential health
benefits for American families.
The list of services in jeopardy is long, devastating, and cruel,
services like emergency services, hospitalization, prescription drugs,
preventive care, and many other guarantees.
These are basic health services that every person in the country
deserves, like my constituent Elizabeth, whose daughter is guaranteed
pediatric care to treat her type 1 diabetes because of these essential
benefits. Without coverage, out-of-pocket costs would add up to more
than her entire year's salary.
I can't stand here and allow my Republican colleagues to say they are
saving people from ObamaCare while they are stripping away essential
care for families like Elizabeth's. I urge my colleagues to oppose this
bill.
Mr. SESSIONS. Mr. Speaker, I continue to reserve the balance of my
time.
Mr. McGOVERN. Mr. Speaker, I just want to take a second to summarize
this rule because people have been asking about it.
It is a closed rule. The only amendments allowed are amendments
offered by people who wrote the bill. Those amendments are fixes to
fixes to fixes to fixes in their bill and, in the words of Trump, sad.
I would just say, you know, usually when you have a lousy process you
have a lousy bill, and that is why only 17 percent of the American
people support what my Republican friends are doing.
I yield 1 minute to the gentleman from Texas (Mr. Castro).
Mr. CASTRO of Texas. Mr. Speaker, I come from the State, Texas, that
has the highest percentage of people who have absolutely no healthcare
coverage, who use the emergency room as their health provider, and who
also have serious health challenges.
For Texans, if this bill passes, it means that the following things
will no longer be in their insurance policy or they will be charged
jacked-up fees for them: outpatient care; emergency room trips; in-
hospital care; pregnancy, maternity, and newborn care; mental health
and substance abuse disorder services; prescription drugs;
rehabilitative services and habilitative services; lab tests;
preventative services; and pediatric services.
It should also be noted that, with this bill, about 660,000 Texans
would lose their healthcare coverage.
Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentleman from
Colorado (Mr. Perlmutter).
Mr. PERLMUTTER. Mr. Speaker, I thank the gentleman from Massachusetts
for yielding me time.
Mr. Speaker, this is a bad joke on America. Here we are, the choice
act:
The choice is get sick or go broke.
The choice is more coverage for average Americans or more tax cuts
for the rich, higher costs for families.
Twenty-four million people, at least, lose their coverage under the
choice act, or TrumpCare.
That is a bad joke. That is a bad choice.
Here is something: discrimination against older Americans. They have
five times the cost of younger Americans under TrumpCare, under their
choice act.
This hurts Medicare.
There are no savings in this bill--that was what the whole thing was
all about--but instead, we get less coverage for average Americans. We
get many people cut off their coverage, but we get big tax cuts for the
rich.
This is a bad joke. This bill should be defeated. This rule should be
defeated.
Mr. McGOVERN. Mr. Speaker, I would like to inquire of the gentleman
from Texas, if I can.
I know he has a few more speakers than he did yesterday, but we have
a ton over here, and if there is additional time that he could share
with us, we would appreciate it.
Mr. SESSIONS. Mr. Speaker, we are going to keep moving on. We were
allocated the same amount of time. I guess the answer would be no.
Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentlewoman from
Illinois (Ms. Kelly).
Ms. KELLY of Illinois. Mr. Speaker: ``Of all the forms of inequality,
injustice in healthcare is the most shocking and inhumane.''
Dr. King spoke these words because the health of our fellow Americans
is a moral imperative. What we have before us today is a morally
corrupt bill: morally corrupt because it claws away health insurance
from 24 million Americans, morally corrupt because it leaves nearly 1
million of my fellow Illinoisans without health insurance, morally
corrupt because 240,000 Illinois kids will no longer have the safety
and security of their current coverage.
When you cast your vote today, know that you own its aftermath here,
forward. Will you cast your vote for party or will you cast your vote
to do what is best in the lives of the people you represent?
Think of the last senior whose hand you shook at a townhall. Think of
the last child you hugged at a school visit. Does this bill do right by
them? Will they be better off?
If you have any doubt, vote ``no.'' Vote ``no,'' and kill this bad
bill.
Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentleman from
North Carolina (Mr. Price).
Mr. PRICE of North Carolina. Mr. Speaker, I rise today in strong
opposition to this misguided and shortsighted pay-more-for-less bill,
also known as TrumpCare.
In all my time in Congress, I have never seen such blatant disregard
for the interests of the American people.
Twenty-four million hardworking Americans will lose their coverage.
TrumpCare will raise premiums, while reducing critical premium
subsidies that millions depend on. Meanwhile, deductibles and out-of-
pocket expenses will go up.
Particularly hurt will be the Americans aged 50 to 64 who will have
to pay five times more than others for health coverage, no matter how
healthy they may be themselves.
TrumpCare then goes on to ransack the Medicaid funds that older
Americans rely on for long-term care, and it shortens the life of the
Medicare trust fund by 3 years.
North Carolina consumers in the insurance marketplace, many of them
insured for the first time, would face the second highest healthcare
cost increases in the entire country, an average of over $7,500. Again:
mainly older, poorer North Carolinians. For example, a 64-year-old
resident making $22,000 a year would see a premium spike of over
$14,000. That is over half of his income.
After years of trying to destroy the ACA, is this the best that
Speaker Ryan and President Trump can come up with? Defeat this bill.
Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentleman from
Rhode Island (Mr. Langevin).
Mr. LANGEVIN. Mr. Speaker, I rise in strong opposition to the
Republican effort to gut the Affordable Care Act, an effort that will
result in millions of people across the country and tens of thousands
of my constituents in Rhode Island to lose their health coverage, and
it will ultimately result in costs rising.
Before the ACA was passed, the House held 79 hearings over the course
of a year. Today's Republican plan was pushed through three committees
without a single hearing and with substantial changes being made behind
closed doors in the dead of night.
Mr. Speaker, I am a veteran of many healthcare debates, and I can
tell you this is not how sound policy is made, especially policy that
will have real consequences for hardworking Americans.
Since the passage of the ACA, I have had faith that Republicans and
Democrats could come together to strengthen the law and further improve
healthcare for all Americans. There is still that opportunity to come
together, Mr. Speaker, but the rule, along with the underlying bill,
has shaken that faith.
Supporting the rule means putting ideology above the well-being of
the American people. This does not have to be a zero-sum game. I know
that we can come together.
[[Page H2387]]
Let's defeat this rule and the bill. Come together in a bipartisan
way to fix the problems of the ACA.
Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentlewoman from
Hawaii (Ms. Gabbard).
Ms. GABBARD. Mr. Speaker, people in my home State of Hawaii and all
across the country are in desperate need of serious healthcare reform
to bring down costs and increase access to quality care.
The legislation before us, though, is not the answer. It perpetuates
the problems. It is a handout to insurance and pharmaceutical companies
that literally pulls the rug out from those who are most needy and most
vulnerable in our communities.
While corporations rake in over $600 billion in tax breaks, many low-
income Americans will see their coverage drop completely.
Medicaid, a program that one in five Americans depend on for basic
care, would be slashed by hundreds of billions of dollars, shifting
costs to already-strained State and local governments.
Our kupuna, our seniors, could see their premiums increase up to five
times more than young, healthy people under these new age rating rules
in this bill.
Simply put, we need a healthcare system that puts people before
profits. I urge my colleagues strongly to vote ``no'' against this
legislation.
Mr. McGOVERN. Mr. Speaker, I include in the Record the CBO score for
the underlying bill and the first four manager's amendments. We just
got it last night, and it is already out-of-date given the fifth
manager's amendment that was just submitted late last night.
U.S. Congress,
Congressional Budget Office,
Washington, DC, March 23, 2017.
Hon. Paul Ryan,
Speaker of the House, House of Representatives, Washington,
DC.
Dear Mr. Speaker: At your request, the Congressional Budget
Office and the staff of the Joint Committee on Taxation (JCT)
have prepared an estimate of the direct spending and revenue
effects of H.R. 1628, the American Health Care Act, as posted
on the website of the House Committee on Rules on March 22,
2017, incorporating manager's amendments 4, 5, 24, and 25.
As a result of those amendments, this estimate shows
smaller savings over the next 10 years than the estimate that
CBO issued on March 13 for the reconciliation recommendations
of the House Committee on Ways and Means and the House
Committee on Energy and Commerce. The estimated effects on
health insurance coverage and on premiums for health
insurance are similar to those estimated for the committees'
recommendations.
Effects on the Federal Budget
CBO and JCT estimate that enacting H.R. 1628, with the
proposed amendments, would reduce federal deficits by $150
billion over the 2017-2026 period; that reduction is the net
result of a $1,150 billion reduction in direct spending,
partly offset by a reduction of $999 billion in revenues (see
Tables 1 and 2). The provisions dealing with health insurance
coverage would reduce deficits, on net, by $883 billion (see
Table 3); the noncoverage provisions would increase deficits
by $733 billion, mostly by reducing revenues.
Pay-as-you-go procedures apply because enacting the
legislation would affect direct spending and revenues. CBO
and JCT estimate that enacting the legislation would not
increase net direct spending or on-budget deficits in any of
the four consecutive 10-year periods beginning in 2027.
Effects on Health Insurance Coverage
CBO and JCT estimate that, in 2018, 14 million more people
would be uninsured under the legislation than under current
law. The increase in the number of uninsured people relative
to the number under current law would reach 21 million in
2020 and 24 million in 2026 (see Table 4). In 2026, an
estimated 52 million people under age 65 would be uninsured,
compared with 28 million who would lack insurance that year
under current law.
Effects on Premiums
H.R. 1628, with the proposed amendments, would tend to
increase average premiums in the nongroup market before 2020
and lower average premiums thereafter, relative to
projections under current law. In 2018 and 2019, according to
CBO and JCT's estimates, average premiums for single
policyholders in the nongroup market would be 15 percent to
20 percent higher under the legislation than under current
law. By 2026, average premiums for single policyholders in
the nongroup market would be roughly 10 percent lower than
under current law.
Uncertainty Surrounding the Estimates
The ways in which federal agencies, states, insurers,
employers, individuals, doctors, hospitals, and other
affected parties would respond to the changes made by the
legislation are all difficult to predict, so the estimates in
this report are uncertain. But CBO and JCT have endeavored to
develop estimates that are in the middle of the distribution
of potential outcomes.
Comparison With the Previous Estimate
On March, 13, 2017, CBO and JCT estimated that enacting the
reconciliation recommendations of the House Committee on Ways
and Means and the House Committee on Energy and Commerce
(which were combined into H.R. 1628) would yield a net
reduction in federal deficits of $337 billion over the 2017-
2026 period. CBO estimates that enacting H.R. 1628, with the
proposed amendments, would save $186 billion less over that
period. That reduction in savings stems primarily from
changes to H.R. 1628 that modify provisions affecting the
Internal Revenue Code and the Medicaid program.
Over the 2017-2026 period, modifications to provisions
affecting the Internal Revenue Code that are not directly
related to the law's insurance coverage provisions would
reduce JCT's estimate of revenues by $137 billion. Reducing
the threshold for determining the medical care deduction on
individuals' income tax returns from 7.5 percent of income to
5.8 percent would reduce revenues by about $90 billion. Other
changes include adjusting the effective dates and making
other modifications to the provisions that repeal or delay
many of the changes in the Affordable Care Act, which would
reduce revenues by $48 billion.
A number of changes to the Medicaid program would reduce
CBO's estimate of savings by $41 billion over the 2017-2026
period. The reduction would result from revising the formula
for calculating the per capita allotments in Medicaid to
allow for faster growth of the per capita cost of aged,
blind, and disabled enrollees. The effects of changing that
formula would be offset somewhat by the effects of three
other provisions that would increase savings: reducing the
per capita allotment in Medicaid for the state of New York in
proportion to any financing the state receives from county
governments; providing states the option to make eligibility
for Medicaid conditional on satisfying work requirements for
enrollees who are not single parents of children under age 6
or who are not pregnant or disabled; and allowing states to
receive a block grant for Medicaid coverage of children and
some adults instead of funding based on a per capita cap.
Other smaller changes resulting from the manager's
amendments would reduce savings by an estimated $8 billion
over the period.
Compared with the previous version of the legislation, H.R.
1628, with the proposed amendments, would have similar
effects on health insurance coverage: Estimates differ by no
more than half a million people in any category in any year
over the next decade. (Some differences may appear larger
because of rounding.) For example, the decline in Medicaid
coverage after 2020 would be smaller than in the previous
estimate, mainly because of states' responses to the faster
growth in the per capita allotments for aged, blind, and
disabled enrollees--but other changes in Medicaid would
offset some of those effects.
The legislation's impact on health insurance premiums would
be approximately the same as estimated for the previous
version.
If you wish further details on this estimate, we will be
pleased to provide them.
Sincerely,
Keith Hall,
Director.
Mr. McGOVERN. This analysis confirms that the Republicans will give a
trillion-dollar tax break to the wealthiest people in this country, and
they will kick 24 million Americans off their health insurance.
I will say that is why we are packed with speakers on this side, and
there is probably only a couple of people on the gentleman's side,
because we are standing with the American people who are outraged by
this bill.
Mr. Speaker, I yield 1 minute to the gentleman from Rhode Island (Mr.
Cicilline).
Mr. CICILLINE. Mr. Speaker, last night we watched the President and
the House Republicans scramble to achieve political points at the
expense of the American people, working through the night. Imagine if
they worked this hard on a jobs bills or a bill that raised family
incomes or a bill to rebuild our infrastructure. But instead they are
trying to pass a tax cut for the rich disguised as a healthcare bill, a
bill that will require us to provide big, gigantic tax cuts.
To do that, they impose higher costs on families, higher premiums,
higher deductibles. They strip 24 million hardworking Americans from
health care, including 60,000 Rhode Islanders. They impose a crushing
age tax. They steal from Medicare, and they will destroy nearly 2
million jobs, all so they can give the wealthiest Americans and the
most powerful special interests a big, huge tax cut.
Shame on President Trump. Shame on the Republicans.
This is wrong for our country. We can do better than this. We need to
protect access to health care, not rob millions of Americans from
health care.
[[Page H2388]]
Mr. McGOVERN. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Connecticut (Ms. DeLauro).
Ms. DeLAURO. Mr. Speaker, the healthcare proposal proposed by
President Trump and Speaker Ryan raises premiums and deductibles. It
imposes an age tax on older Americans, making their health care
unaffordable. It throws millions--24 million--Americans off of their
insurance. It shifts the cost of health care to the States, and it
covers less and less people.
{time} 1015
It raises people's fears and insecurities about what this will do if
they get sick. It ends maternity care. It is quite outrageous when it
tells you that you can't go for emergency services any longer. It would
allow insurance companies to, once again, reimpose lifetime limits and
annual caps. It allows insurance companies to charge women 48 percent
more for the same insurance that any man would pay for.
So why would you be for this? Why? Who benefits? Who benefits?
We are going to provide 400 of the richest families in this Nation
with a $7 million tax cut every year. Those are not my words. Take a
look at what Families USA says. Take a look at what the Center on
Budget and Policy Priorities says about that.
Working people and older Americans are going to pay for a tax cut for
the richest people in this Nation. Older Americans are going to be hit
the hardest. Not only are they going to get an age tax, but they are
going to shift $170 billion out of the Medicare trust fund--a lifeline
for older Americans.
Do you know what? It makes me believe that this is the case: What
does the GOP stand for? Get Old People.
That is what this bill does. That is what people are going to vote
``yes'' for today. Let me just say this: We have an obligation. We have
an obligation to the people of this country to vote ``no'' today on
this misrepresented bill.
Mr. SESSIONS. Mr. Speaker, I yield 1 minute to the gentlewoman from
Wyoming (Ms. Cheney), who is the favorite daughter of Wyoming and
serves on the Rules Committee.
Ms. CHENEY. Mr. Speaker, there are a lot of charges and allegations
being made about what this bill would do, and the reality, Mr. Speaker,
is we are living today in the world that they have created on the other
side of this aisle. We are living today in a world with skyrocketing
costs, plummeting choices, and broken promises across the board.
When you talk about the situation with respect to women in
particular, when you talk about what is going to happen with maternity
care and with child care, Mr. Speaker, there is a fundamental
difference between what they believe on that side of the aisle and what
we believe over here.
What we believe over here is that every American--every individual,
and in that, we Republicans include women--we think women ought to have
the right to make their own choices and their own decisions about care.
We know that the kinds of insurance--the so-called insurance--that has
been provided under ObamaCare means that women have been denied access
to things like maternity care. When you can only get a policy with a
$6,000 deductible, that is not care and that is not insurance.
This bill today is fundamental to being able to keep our promises to
the American people, to being able to ensure that we have returned
authority, we have returned power, and, yes, resources into the hands
of individuals so people in Wyoming--in my home State--and all across
this country can make their own healthcare decisions and no longer be
forced to purchase things they don't want, don't need, and can't use to
get coverage.
Mr. McGOVERN. Mr. Speaker, I yield 30 seconds to the gentlewoman from
New Hampshire (Ms. Kuster).
Ms. KUSTER of New Hampshire. Mr. Speaker, all due respect to my
colleague from Wyoming, it is not liberty for a woman to be forced to
go to work within weeks of having a child. That is what this bill would
do.
Mr. Speaker, it is not liberty for people over 50 years old to be
required to pay increased fees and increased expenses simply to go to
the hospital, and it is not liberty to have their essential health
benefits stripped away. They might not even be able to go to a
hospital. It is not liberty for 7 million veterans to have a vets tax,
to have their benefits stripped away from an amendment that was
introduced in the middle of the night. That is not liberty. Vote ``no''
on this bill.
Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentleman from
Virginia (Mr. Connolly).
Mr. CONNOLLY. Mr. Speaker, I thank my friend from Massachusetts for
yielding me this time.
The Hippocratic Oath says ``primum non nocere''; ``first, do no
harm.''
This bill violates the Hippocratic Oath in all respects. Twenty-four
million people losing their health care, our friend from Wyoming thinks
that is a choice?
A string of benefits required to be covered by insurance companies to
protect consumers, to protect our loved ones when they get ill,
vitiated. Maybe that is popular in some parts of this country, but I
don't know where they are. This bill will unravel health care for all
Americans. It is the wrong path to take, and I urge defeat of this
legislation in its entirety.
Parliamentary Inquiry
Ms. KAPTUR. Mr. Speaker, I have a parliamentary inquiry.
The SPEAKER pro tempore. The gentlewoman will state her parliamentary
inquiry.
Ms. KAPTUR. Mr. Speaker, I want to ask why the Democratic microphone
is turned off. This happened to me the other day when the Republican
microphone was on over there.
The last two speakers we have not been able to hear as well as we
heard Ms. Cheney, and I want to know why that is.
I hope somebody hears my plea and that the Parliamentarian will take
care of this problem. This debate is too important to have our
microphones at a lower scale.
The SPEAKER pro tempore. The Chair has heard the complaint and will
look into it.
The Chair advises that he has had no problem hearing from each of the
speakers that have gone to the well or from the leadership tables
today.
The gentleman from Texas has 3\1/2\ minutes remaining and the
gentleman from Massachusetts has 3\1/2\ minutes remaining in this
debate on the rule.
Mr. SESSIONS. Mr. Speaker, I reserve the balance of my time.
Mr. McGOVERN. Mr. Speaker, I yield 30 seconds to the gentleman from
Florida (Mr. Crist).
Mr. CRIST. Mr. Speaker, this bill we are talking about takes about
$880 billion out of Medicaid. Medicaid is for the poor, and Medicaid is
for the disabled. We are in Lent. It is supposed to be the holiest
time. I want to read to you from Matthew 25, verse 45: Whatever you do
to the least of my brothers, you do unto Me.
Think about that before you vote for this bill. Please vote against
it. God bless.
Mr. SESSIONS. Mr. Speaker, I yield 1 minute to the distinguished
gentleman from Pasco, Washington (Mr. Newhouse), who is a member of the
Rules Committee.
Mr. NEWHOUSE. Mr. Speaker, I thank the gentleman for yielding.
Mr. Speaker, under the ACA, 5 to 6 million Americans were kicked off
their healthcare plans, including 300,000 of my fellow Washingtonians
who lost coverage despite repeated promises they could keep their
plans. A majority of Americans have faced skyrocketing costs, reduced
access to quality care, and fewer choices for their families. I believe
we can and we must do better.
Under this bill, Americans will have health care that fits individual
and family needs instead of federally mandated, one-size-fits-all
coverage that is simply unaffordable for far too many people. This bill
strengthens and guarantees access for the most vulnerable in our
communities.
The ACA has failed. I made a promise to the thousands of my
constituents who have told me of the devastation this law has wreaked
on their lives that I would not forget them. Americans in every
election since 2010 have said loud and clear the same thing, and it is
time that we listened.
Mr. Speaker, the American Health Care Act is the first major step in
keeping that promise, and I think that we need to take it.
Mr. McGOVERN. Mr. Speaker, I yield 30 seconds to the gentleman from
California (Mr. Panetta).
[[Page H2389]]
Mr. PANETTA. Mr. Speaker, I rise today in opposition of what has
become basically the complete repeal of the ACA. Don't get me wrong. I
have talked to small-business owners, and I have talked to patients who
have talked about the expenses of the ACA. But I have also heard from
people in my district on the central coast of California how much it
has benefited them, including 65,000 people who now have coverage under
Medicaid and 25,000 people who have gained it through the marketplace.
If the AHCA becomes law, we are not making it cheaper, and we are not
making it more accessible. Instead, all that is happening is that they
are fulfilling a campaign promise.
Mr. Speaker, we must make sure that the ACA is here. We cannot take
it away. We must make sure that we provide care, we provide coverage,
and we provide the covenant that we promised our constituents.
Mr. SESSIONS. Mr. Speaker, I reserve the balance of my time, and I am
prepared to close.
Mr. McGOVERN. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, I include in the Record a letter from 87 patient and
provider organizations, including the Cystic Fibrosis Foundation, which
is strongly opposed to this bill.
March 20, 2017.
Hon. Mitch McConnell,
Senate Majority Leader,
Washington, DC.
Hon. Paul Ryan,
Speaker of the House,
Washington, DC.
Dear Leader McConnell and Speaker Ryan: The undersigned
organizations write to express grave concern about proposals
put forth in the American Health Care Act (AHCA) to alter the
fundamental structure and purpose of Medicaid, a vital source
of health care for patients with ongoing health needs.
We feel compelled to speak out against proposals to phase
out Medicaid expansion and implement per capita caps, which
threaten the ability of Medicaid to provide critical health
care services to many of our most vulnerable citizens. These
proposals aim to achieve cost savings of approximately $880
billion, according to the Congressional Budget Office, at the
expense of tens of millions of patients who rely on Medicaid
for life-sustaining care. While we appreciate the
opportunities we have had to work with your staff, we cannot
support the Medicaid provisions in this bill and cannot
accept policies that prioritize cutting costs by limiting
patients' access to care.
Medicaid is Critical for Patients
Medicaid is a crucial source of coverage for patients with
serious and chronic health care needs. Pregnant women depend
on Medicaid, which covers roughly 50 percent of all births
including many high-risk pregnancies. Medicaid covers cancer
patients: nearly one-third of pediatric cancer patients were
enrolled in Medicaid in 2013 and approximately 1.52 million
adults with a history of cancer were covered by Medicaid in
2015. Over fifty percent of children and one-third of adults
living with cystic fibrosis rely on Medicaid to get the
treatments and therapies they need to preserve their health.
Nearly half of children with asthma are covered by Medicaid
or CHIP and adults with diabetes are disproportionally
covered by Medicaid as well. The patients we represent are
eligible for Medicaid through various pathways, including
through income-related and disability criteria.
Reject Per Capita Caps
The proposal to convert federal financing of Medicaid to a
per capita cap system is deeply troubling. This policy is
designed to reduce federal funding for Medicaid, forcing
states to either make up the difference with their own funds
or cut their programs by reducing the number of people they
serve and the health benefits they provide.
For patients with ongoing health care needs, this means
that Medicaid may no longer cover the care and treatments
they need, including breakthrough therapies and technology.
In order to save money, the per capita caps are set to grow
more slowly than expected Medicaid costs under current law.
As the gap between the capped allotment and actual costs
increases over time, states will be forced to constrain
eligibility, reduce benefits, lower provider payments, or
increase cost-sharing. Moreover, by capping the federal
government's contribution to Medicaid in this manner, states
will be less able to cover the cost of new treatments. This
could be devastating for people with serious diseases, for
whom groundbreaking treatments represent a new lease on life.
For people with cystic fibrosis, cancer, and other diseases,
new therapies can be game changers that improve quality of
life and increase life expectancy. In fact, we have already
seen Medicaid programs respond to current budget constraints
by using clinically inappropriate criteria to restrict access
to therapies old and new. A per capita cap will only
exacerbate the downward pressure on Medicaid budgets and will
further reduce access to these therapies for patients.
Pairing financing reforms with increased flexibility, as
has often been proposed, would further undermine Medicaid's
role as a safety net for patients. Without current guardrails
provided by federal requirements--coupled with reduced
federal funding--states will have the authority to reduce
benefits and eligibility as they see fit and to impose other
restrictions, such as waiting periods and enrollment caps.
These policies have serious implications for patients--for a
person with cancer, enrollment freezes and waiting lists
could mean a later-stage diagnosis when treatment costs are
higher and survival is less likely. For a person with
diabetes, this would risk the ability to adequately manage
the disease. Many of our patients rely on costly services
that will be quickly targeted for cuts if states are given
such flexibility, so it is imperative that current federal
safeguards remain in place.
Maintain Medicaid Expansion
While the AHCA has been described as preserving Medicaid
expansion for those already enrolled in coverage, we are
concerned that estimates show that eliminating the enhanced
match for any enrollee with even a small gap in coverage
would actually result in millions of people losing
coverage. By eliminating the enhanced federal match for
any enrollee with a gap in coverage, eventually states
will be on the hook for billions of dollars to continue
covering this population--an insurmountable financial
hurdle. Additionally, seven states have laws that would
effectively end Medicaid expansion immediately or soon
thereafter when the expansion match rate is eliminated.
Nearly half of adults covered by the Medicaid expansion
are permanently disabled, have serious physical or mental
conditions--such as cancer, stroke, heart disease,
arthritis, pregnancy, or diabetes--or are in fair or poor
health. Repealing Medicaid expansion will leave these
patients without coverage they depend upon to maintain
their health.
The proposed financing reforms are a fundamental shift away
from Medicaid's role as a safety-net for some of the most
vulnerable members of our society. Repealing Medicaid
expansion would leave millions without the health care they
rely on. Our organizations represent and provide care for
millions of Americans living with ongoing health care needs
who rely on Medicaid and we cannot support policies that pose
such a grave risk to patients.
We hope that we can continue our dialogue as you move
forward in this process to arrive at solutions that provide
all Americans with high-quality, affordable care regardless
of an individual's income, employment status, health status,
or geographic location.
Sincerely,
ADAP Advocacy Association; AIDS Action Baltimore; The AIDS
Institute; Alpha-1 Foundation; Alport Syndrome Foundation;
ALS Association; American Academy of Pediatrics; American
Behcet's Disease Association; American Congress of
Obstetricians and Gynecologists; American Diabetes
Association; American Lung Association; American Parkinson
Disease Association; American Society of Hematology; American
Thoracic Society; Amyloidosis Support Groups Inc.; ARPKD/CHF
Alliance; Arthritis Foundation; Batten Disease Support &
Research Association; Bladder Cancer Advocacy Network.
Bridge the Gap--SYNGAP Education and Research Foundation;
Bronx Lebanon Hospital Center Department of Family Medicine;
CADASIL Together We Have Hope Non-Profit; Cancer Support
Community; Child Neurology Foundation; Children's Cause for
Cancer Advocacy; Children's Dental Health Project; Chronic
Illness and Disability Partnership; Community Access National
Network; Congenital Adrenal Hyperplasia Research Education &
Support Foundation, Inc.; COPD Foundation; Cure HHT;
Cutaneous Lymphoma Foundation; Cystic Fibrosis Foundation;
Cystinosis Research Network; debra of America; Endocrine
Society; Fibrous Dysplasia Foundation; First Focus Campaign
for Children.
FORCE: Facing Our Risk of Cancer Empowered; Foundation for
Prader-Willi Research; Friedreich's Ataxia Research Alliance
(FARA); Genetic Alliance; Hannah's Hope Fund; Hide & Seek
Foundation for Lysosomal Disease Research; Hispanic Health
Network; Hope for Hypothalamic Hamartomas; Huntington's
Disease Society of America; Immune Deficiency Foundation; The
International Pemphigus and Pemphigoid Foundation; Kids v
Cancer; Latino Commission on AIDS; LFS Association (Li-
Fraumeni Syndrome Association); Liver Health Connection;
March of Dimes; Medicare Rights Center; MLD Foundation.
Moebius Syndrome Foundation; Muscular Dystrophy Association
(MDA); NASTAD (National Alliance of State & Territorial AIDS
Directors); National Alliance on Mental Illness; National
Coalition for Cancer Survivorship; National Health Law
Program; National Hemophilia Foundation; National Multiple
Sclerosis Society; National Organization for Rare Disorders;
National Patient Advocate Foundation; National Tay-Sachs &
Allied Diseases Association (NTSAD); National Urea Cycle
Disorders Foundation; National Viral Hepatitis Roundtable;
NBIA Disorders Association; Needle Exchange Emergency
Distribution (NEED); Parent Project Muscular Dystrophy
(PPMD); Parkinson Alliance; The PCD (Primary Ciliary
Dyskinesia) Foundation; Polycystic Kidney Disease Foundation;
Pulmonary Fibrosis Foundation.
PXE International; Rett Syndrome Research Trust;
Scleroderma Foundation; The
[[Page H2390]]
Sudden Arrhythmia Death Syndromes Foundation; T1D Exchange;
Trisomy 18 Foundation; Tuberous Sclerosis Alliance; United
Way Worldwide; VHL Alliance; Wilson Disease Association;
Wishes for Elliott: Advancing SCN8A Research.
Mr. McGOVERN. Mr. Speaker, I would say to my colleagues that this is
a sad day for this institution. This process has been awful. But this
is even a sadder day for the American people.
I remind my colleagues that we are supposed to care about one
another, especially the most vulnerable in our society. In this era of
Trump, Washington has become a mean place. It is a place where it has
become unfashionable to worry about the poor, about older Americans,
and about those who struggle.
There is absolutely no justification for giving huge tax breaks to
billionaires--$1 trillion in tax breaks to millionaires and
billionaires, and at the same time throwing 24 million people off of
health care and denying millions more essential healthcare protections.
Twenty-four million people--my Republican colleagues have lost their
human ability to feel what that means. That is the entire population of
Australia.
Mr. Speaker, I have a great deal of respect for my colleagues, but
when I look at this bill and I read this bill, I have to wonder: What
are you thinking? How could you do this?
I have come to the conclusion there are only two reasons--there are
only two ways you can vote for this bill. One is you don't know what is
in the bill; or two is you have to have a heart of stone, because this
bill is shameful. It is going to hurt people. It is going to hurt your
constituents.
Withdraw this bill or vote ``no'' on this bill, but this bill cannot
become law. The health care and healthcare protections for the American
people are too important.
Mr. Speaker, I urge all my colleagues--both Democrats and
Republicans--reject this. Vote ``no.''
Mr. Speaker, I yield back the balance of my time.
Mr. SESSIONS. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, I want to begin by thanking our colleagues, the
gentleman from Massachusetts leading the Rules Committee, and his
ranking members as they came from each of the committees, some 50
hours' worth of hearings and markups, including some 16 hours in the
Rules Committee to not only talk about and vet, but to understand more
clearly what we would be voting on.
Mr. Speaker, today is a bill that is a compromise bill, no doubt
about it. I had my own plan and I had my own ideas. I took 2 years to
get involved in this process. It is difficult to write a healthcare
bill. But it didn't have to be my bill; it had to be a bill that we
could all work together on.
President Trump has been a part of that. President Trump took time
out of his schedule to do this. It is important to the American people.
President Trump, more than any single Member of Congress, gave the
message to the American people about what was necessary and what he
would do. He is going to live up to that, and we should, too.
Mr. Speaker, the bottom line to this whole thing is we are going to
present a Republican plan, and we are going to stand behind what we
sell. It is better for the American people. But make no mistake about
it: we are transferring power, authority, and responsibility not just
to States, but also to the American people. It will be up to them to
make determinations about their own health care because, for the first
time, we will allow some 50 million Americans to have a tax equity, an
opportunity to use tax credits that will be available to families
anywhere from $2,000 for an individual to $14,000 for a family.
{time} 1030
This will empower people who have not found a fair shot at the tax
advantages it will give them: small-business owners; the American
people; the average worker in this country, including those who work
two or three different jobs; as well as those who are uninsured. We
believe it is a better shot, an opportunity. We are willing to put our
name on it and behind it.
For these reasons, Mr. Speaker, I urge us to move forward. There will
be 4 hours of debate that remain in this opportunity. For that reason,
I urge my colleagues to support this rule and the underlying bill.
Ms. JACKSON LEE. Mr. Speaker, I rise in opposition to the rule
governing House consideration of H.R. 1628, the ``American Health Care
Act of 2017,'' better known as ``Trumpcare.''
I oppose the rule, and the underlying legislation, for the following
reasons:
1. The rule under consideration is brought pursuant to ``martial
law'' rule passed yesterday which suspends the normal House procedure
and allows for same day consideration, debate, and vote of legislation
that will adversely affect the lives of everyone in America except for
the top 1 percent;
2. The underlying bill is less than 2 weeks old and has not had a
single hearing in any of the Committees of jurisdiction; and
3. The underlying bill does not reflect the input of nearly half the
Members of this body because the legislation was drafted in secret,
marked up in a single overnight session, and brought to the floor
without incorporating a single amendment or idea proposed by the
minority.
Mr. Speaker, none of us here has had a meaningful opportunity to
review the bill, ``Trumpcare 2.0'' we are being asked to vote on.
This bill has undergone significant revision from the one marked up
just last week by the Budget Committee of which I am a member.
Trumpcare 2.0 no doubt contains many sweeteners and olive branches
granted by the Administration and House Republican leaders in backroom
deals in a last ditch effort to secure the necessary votes of
Republican members to take away health care from 24 million Americans,
many of whom are among the most vulnerable persons in society.
None of these changes to the bill before us has been scored by the
Congressional Budget Office so we do not know exactly how many more
millions of Americans will be hurt.
But what is unlikely to change is that 14 million Americans will lose
Medicaid coverage and more than 52 million persons will be uninsured by
2026 under this Republican plan.
In addition to terminating the ACA Medicaid expansion, the
``Trumpcare'' converts Medicaid to a per-capita cap that is not
guaranteed to keep pace with health costs starting in 2020.
The combined effect of these policies is to slash $880 billion in
federal Medicaid funding over the next decade.
In short, Trumpcare represents a clear and present danger to the
financial and health security of American families, and to the very
stability of our nation's health care system overall.
We should follow regular order in the consideration of all
legislation, but especially in a matter with great importance to the
American people that could impact nearly 300 million people.
For these reasons, I believe the House should reject this rule and
the underlying bill.
Instead of trying to enact the largest transfer of wealth from the
bottom 99 percent to the top 1 percent in history, House Republicans
should work with Democrats to strengthen the Affordable Care Act which
has and continues to make life-affirming differences for the better in
the lives of more than 300 million Americans.
Mr. SESSIONS. Mr. Speaker, I yield back the balance of my time, and I
move the previous question on the resolution.
The SPEAKER pro tempore. The question is on ordering the previous
question.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. SESSIONS. 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 ordering the previous question will be
followed by 5-minute votes on:
Adopting the resolution, if ordered;
Suspending the rules and passing H.R. 1365; and,
Agreeing to the Speaker's approval of the Journal, if ordered.
The vote was taken by electronic device, and there were--yeas 236,
nays 186, not voting 7, as follows:
[Roll No. 191]
YEAS--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
[[Page H2391]]
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)
Duncan (TN)
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
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
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
NAYS--186
Adams
Aguilar
Barragan
Bass
Beatty
Bera
Beyer
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brady (PA)
Brown (MD)
Brownley (CA)
Bustos
Butterfield
Capuano
Carbajal
Cardenas
Carson (IN)
Cartwright
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
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.
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
Himes
Hoyer
Huffman
Jackson Lee
Jayapal
Jeffries
Johnson, E. B.
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kihuen
Kildee
Kilmer
Kind
Krishnamoorthi
Kuster (NH)
Langevin
Larsen (WA)
Larson (CT)
Lawrence
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
Moore
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)
Richmond
Rosen
Roybal-Allard
Ruiz
Ruppersberger
Ryan (OH)
Sanchez
Sarbanes
Schakowsky
Schiff
Schneider
Schrader
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shea-Porter
Sherman
Sinema
Sires
Slaughter
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--7
Higgins (NY)
Johnson (GA)
Lieu, Ted
Payne
Rush
Takano
Tsongas
{time} 1054
Messrs. O'HALLERAN, SCHNEIDER, and Mrs. TORRES changed their vote
from ``yea'' to ``nay.''
So the previous question was ordered.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore. The question is on the resolution.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Recorded Vote
Mr. McGOVERN. 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 230,
noes 194, not voting 5, as follows:
[Roll No. 192]
AYES--230
Abraham
Aderholt
Allen
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 (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)
Duncan (TN)
Dunn
Emmer
Farenthold
Faso
Ferguson
Fitzpatrick
Fleischmann
Flores
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gaetz
Gallagher
Garrett
Gibbs
Goodlatte
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
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
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
NOES--194
Adams
Aguilar
Amash
Barragan
Bass
Beatty
Bera
Beyer
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brady (PA)
Brooks (AL)
Brown (MD)
Brownley (CA)
Bustos
Butterfield
Capuano
Carbajal
Cardenas
Carson (IN)
Cartwright
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
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.
Ellison
Engel
Eshoo
Espaillat
Esty
Evans
Foster
Frankel (FL)
Fudge
Gabbard
Gallego
Garamendi
Gohmert
Gonzalez (TX)
Gosar
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)
Larson (CT)
Lawrence
Lawson (FL)
Lee
Levin
Lewis (GA)
Lipinski
Loebsack
Lofgren
Lowenthal
Lowey
Lujan Grisham, M.
Lujan, Ben Ray
Lynch
Maloney, Carolyn B.
Maloney, Sean
Massie
Matsui
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moore
Moulton
Murphy (FL)
Nadler
[[Page H2392]]
Napolitano
Neal
Nolan
Norcross
O'Halleran
O'Rourke
Pallone
Panetta
Pascrell
Pelosi
Perlmutter
Peters
Peterson
Pingree
Pocan
Polis
Price (NC)
Quigley
Raskin
Rice (NY)
Richmond
Rosen
Roybal-Allard
Ruiz
Ruppersberger
Ryan (OH)
Sanchez
Sarbanes
Schakowsky
Schiff
Schneider
Schrader
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shea-Porter
Sherman
Sinema
Sires
Slaughter
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--5
Lieu, Ted
Payne
Rush
Takano
Tsongas
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). There are 2 minutes
remaining.
{time} 1102
So the resolution was agreed to.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________