[Congressional Record Volume 163, Number 59 (Wednesday, April 5, 2017)]
[House]
[Pages H2726-H2729]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SELF-INSURANCE PROTECTION ACT
Ms. FOXX. Mr. Speaker, pursuant to House Resolution 241, I call up
the bill (H.R. 1304) to amend the Employee Retirement Income Security
Act of 1974, the Public Health Service Act, and the Internal Revenue
Code of 1986 to exclude from the definition of health insurance
coverage certain medical stop-loss insurance obtained by certain plan
sponsors of group health plans, and ask for its immediate consideration
in the House.
The Clerk read the title of the bill.
The SPEAKER pro tempore (Mr. Rice of South Carolina). Pursuant to
House Resolution 241, the amendment in the nature of a substitute
recommended by the Committee on Education and the Workforce, printed in
the bill, shall be considered as adopted, and the bill, as amended,
shall be considered read.
The text of the bill, as amended, is as follows:
H.R. 1304
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Self-Insurance Protection
Act''.
SEC. 2. CERTAIN MEDICAL STOP-LOSS INSURANCE OBTAINED BY
CERTAIN PLAN SPONSORS OF GROUP HEALTH PLANS NOT
INCLUDED UNDER THE DEFINITION OF HEALTH
INSURANCE COVERAGE.
(a) ERISA.--Section 733(b)(1) of the Employee Retirement
Income Security Act of 1974 (29 U.S.C. 1191b(b)(1)) is
amended by adding at the end the following sentence: ``Such
term shall not include a stop-loss policy obtained by a self-
insured health plan or a plan sponsor of a group health plan
that self-insures the health risks of its plan participants
to reimburse the plan or sponsor for losses that the plan or
sponsor incurs in providing health or medical benefits to
such plan participants in excess of a predetermined level set
forth in the stop-loss policy obtained by such plan or
sponsor.''.
(b) PHSA.--Section 2791(b)(1) of the Public Health Service
Act (42 U.S.C. 300gg-91(b)(1)) is amended by adding at the
end the following new sentence: ``Such term shall not include
a stop-loss policy obtained by a self-insured health plan or
a plan sponsor of a group health plan that self-insures the
health risks of its plan participants to reimburse the plan
or sponsor for losses that the plan or sponsor incurs in
providing health or medical benefits to such plan
participants in excess of a predetermined level set forth in
the stop-loss policy obtained by such plan or sponsor.''.
[[Page H2727]]
(c) IRC.--Section 9832(b)(1)(A) of the Internal Revenue
Code of 1986 is amended by adding at the end the following
new sentence: ``Such term shall not include a stop-loss
policy obtained by a self-insured health plan or a plan
sponsor of a group health plan that self-insures the health
risks of its plan participants to reimburse the plan or
sponsor for losses that the plan or sponsor incurs in
providing health or medical benefits to such plan
participants in excess of a predetermined level set forth in
the stop-loss policy obtained by such plan or sponsor.''.
The SPEAKER pro tempore. The gentlewoman from North Carolina (Ms.
Foxx) and the gentleman from Virginia (Mr. Scott) each shall control 30
minutes.
The Chair recognizes the gentlewoman from North Carolina.
{time} 1445
General Leave
Ms. FOXX. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
include extraneous materials on H.R. 1304.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from North Carolina?
There was no objection.
Ms. FOXX. Mr. Speaker, I yield myself such time as I may consume.
I rise today in strong support of H.R. 1304, the Self-Insurance
Protection Act.
Mr. Speaker, across the country, hardworking men and women are
struggling to afford rising healthcare costs, and their options
continue to drop year after year. At the same time, employers, large
and small, are finding it harder to provide the type of high-quality,
affordable healthcare coverage their employees need.
With over 150 Americans relying on an employer-sponsored health plan,
Congress must do everything possible to ensure employers have the tools
they need to help control healthcare costs for working families.
Preserving access to self insurance is one simple step we can take as
part of that effort.
More than 60 percent of employers who offer healthcare coverage
choose to self-insure. This means that instead of purchasing a plan
from an insurance company, employers pay their employees' healthcare
costs directly. As a result, the employers have greater flexibility to
structure a healthcare plan to the unique needs of workers and their
families.
Although these plans provide important protections, they are free
from certain restrictive rules that force workers to purchase one-size-
fits-all benefits that they may not want or need. Self-insurance is a
popular option that often leads to lower health insurance premiums for
workers and their families.
In years with below average medical claims, any remaining healthcare
dollars can help offset premiums for workers the following year, or can
be used to help create new jobs and higher wages.
It is not just private sector employers who like the flexibility and
affordability of self-insured health coverage. It is also embraced by
labor organizations, schools, cities, and counties.
Of course, there is some level of risk associated with these plans.
That is why employers purchase stop-loss insurance, so that employees
can count on their healthcare coverage when they need it. Because it
simply serves as a financial backstop to an actual health insurance
policy, stop-loss has never been regulated as health insurance by the
Federal Government. Never.
But as we all know, the previous administration had a constant urge
to regulate practically every aspect of American life, regardless of
the consequences. It was only a matter of time before the Obama
administration made stop-loss insurance one of its regulatory targets,
even though many employers would find it nearly impossible to self-
insure as a result.
Limiting a popular free-market healthcare option that millions of
Americans rely on was a price they were willing to pay in order to push
their government-run healthcare scheme.
Fortunately for working families, the Obama administration was
unsuccessful, and we now have a new administration committed to
expanding, not limiting, affordable healthcare options. However, all
this highlights the need to protect access to self-insurance.
Employers need long-term certainty when it comes to the healthcare
benefits they provide, and working families deserve peace of mind that
they won't lose the plan they like because of a partisan, unnecessary
Federal regulation. The Self-Insurance Protection Act provides that
certainty and peace of mind by reaffirming existing law and preventing
Federal bureaucrats from regulating stop-loss as health insurance.
There is more we can and should do to promote affordable healthcare
coverage for working families. This legislation is one small step we
can take to ensure Americans can continue to benefit from flexible
healthcare plans that help lower costs.
I urge my colleagues to stand up for affordable healthcare options
for workers and employers by voting in favor of H.R. 1304.
Mr. Speaker, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, H.R. 1304, the Self-Insurance Protection Act, purports
to protect stop-loss insurers from being regulated at the Federal
level. It appears that we are considering a bill that is a solution in
search of a problem.
I am not opposed to stop-loss insurance or the purpose of stop-loss
insurance. It can be helpful in shielding employers from unforeseen
risks in many instances when they choose to self-insure and want to
protect themselves from unexpected and unusually high expenses.
Now, while many self-funded plans, in conjunction with the purchased
stop-loss, look like a traditional fully insured plan, stop-loss
coverage itself is not regulated at the Federal level. There is no
indication or suggestion that the administration would seek to regulate
stop-loss insurance, so the bill prohibits Federal regulation of stop-
loss insurance.
The Federal Government does not regulate stop-loss insurance today,
and doesn't look like it is going to seek to regulate self-insurance in
the foreseeable future, so it is difficult to ascertain exactly what
the purpose of the bill is.
But employers, particularly small ones, do face risks when self-
insuring. I think it is important that we ensure that employers are
aware of the risks and protect them and their employees when
appropriate. They can incur tremendous losses if the employee incurs a
serious injury or illness.
Employees are also at risk of receiving fewer benefits because many
consumer protections do not apply to self-funded plans.
Employers are legally prohibited from discriminating on the basis of
health status, but stop-loss insurers are not. Many policies have
provisions that will trigger immediate, even retroactive, increased
premiums when the stop-loss insurer receives greater-than-expected
claims.
To date, many States have taken action to regulate stop-loss
insurance in order to protect both businesses and workers. Some have
required a minimum, what is called attachment point. That is when the
stop-loss insurance kicks in. Others have restricted the selling of
stop-loss insurance with certain small group markets.
New York prohibits the sale of stop-loss insurance to small
employers, and prohibits employers from serving as their own third-
party administrators. North Carolina has chosen to regulate stop-loss
insurance as if it were normal health insurance, holding stop-loss
insurance to the same standards of others in the market.
Now, if States want to ban stop-loss insurance altogether, that
should be a State prerogative. States have taken these steps because,
frankly, self-insuring and stop-loss insurance come with greater risks
to both employers and employees. Stop-loss plans place annual limits on
services. Some place annual limits on services or exclude coverage for
certain benefits, such as prescription drugs.
Furthermore, the renewal of stop-loss insurance is not guaranteed, so
if an employer suddenly has high medical costs, the stop-loss insurer
can refuse to renew or charge so much that it is no longer affordable.
In the committee markup, the gentlewoman from Oregon (Ms. Bonamici)
offered a clarifying amendment to ensure that this legislation would
not be construed to restrict the ability of States to regulate stop-
loss insurance.
[[Page H2728]]
Chairwoman Foxx agreed to include such clarifying language in the
committee report, agreeing with the intent of that amendment. Based on
that understanding, that amendment was withdrawn.
The clarifying language is in the report, and that clarification is
vital to ensure that there is nothing in the bill that incorrectly can
be interpreted as to preempt or restrict a State's ability to regulate
stop-loss insurance as they see fit, or otherwise restrict effective
oversight and regulation of these policies at the State level. I
appreciate the majority's willingness to work with us on the inclusion
of that clarifying language.
Mr. Speaker, while I don't intend to oppose the legislation, I would
note that it seems to be a distraction from the Republicans' recent
failed attempt to repeal the Affordable Care Act. After 7 years of
complaints, the Republicans offered an alternative which was
demonstrably worse than the Affordable Care Act on every measure; more
people uninsured, higher prices, and the policy you end up getting is
worse.
Democrats will continue to resist any attempts to move this country
backwards by making health insurance less accessible and less
affordable to American families.
Mr. Speaker, I reserve the balance of my time.
Ms. FOXX. Mr. Speaker, I yield 5 minutes to the gentleman from
Tennessee (Mr. Roe), the author of the bill, a member of the Education
and the Workforce Committee, and chair of the Veterans' Affairs
Committee.
Mr. ROE of Tennessee. Mr. Speaker, I rise today in support of the
Self-Insurance Protection Act, H.R. 1304.
Mr. Speaker, I find it hardly plausible you could make something
worse where one-third of the counties in my district have no option to
buy any insurance on the exchange, and the third largest county in the
State of Tennessee has no option. So I would beg to differ, Mr.
Speaker.
We all want to ensure workers have access to high-quality, affordable
health coverage. That is exactly what this legislation is all about.
Self-insured plans offer high-quality healthcare coverage at a
reasonable cost for workers. This popular option allows employers to
pay their employees' healthcare costs directly and, if costs are lower
than expected, those savings can be reserved for later years to help
cover their workers' future healthcare costs.
One of the benefits to self-insurance is that employers have more
flexibility to customize their healthcare plans as they see fit for the
unique needs of their employees. These plans are also free from many of
the restrictive requirements associated with traditional healthcare
plans, requirements that limit choices and force employees to purchase
specific benefits they may not want or need.
As healthcare costs have risen, many employers have turned to this
cost-effective model. In fact, in 2016, more than 60 percent of all
employers offering health insurance coverage were self-insured, of the
160 million or so people in this country that have insurance through
their job.
Even the labor unions have embraced this approach. However, employers
may also take greater financial risk when providing this popular option
to workers. To help mitigate that risk, many employers opt to purchase
stop-loss insurance.
Stop-loss insurance is not health insurance, nor has it ever been
considered health insurance under Federal law. It does not process
medical claims, and it does not perform any other traditional function
of health insurance. What it does instead is provide employers choosing
to provide self-insurance with a financial backstop, protecting the
benefits of workers and their families.
Unfortunately, the former administration threatened to regulate stop-
loss insurance as traditional health insurance, a move that would put
workers and their families at risk of losing access to the self-insured
market. While we now have a new administration that understands the
importance of providing more pathways to affordable healthcare
coverage, Congress must also act to ensure that no future
administration will be able to restrict the self-insurance option. The
Self-Insurance Protection Act does just that.
This legislation reaffirms longstanding policies, prevents future
bureaucratic overreach, and clarifies once and for all that stop-loss
insurance is not health insurance. By supporting H.R. 1304, we will
promote more choices and protect access to affordable healthcare
coverage options for families.
Let me put this all in English. I was the mayor of Johnson City,
Tennessee, where we had a self-insured plan for the teachers and for
the workers there at the city. The city provided an opportunity for
people to have health insurance for their families. We would accept
risks up to $250,000, and then we bought policies to protect the
taxpayers and the city from any costs that went above that.
What this plan also allowed us to do is put in incredibly innovative
health prevention, things like wellness programs, smoking cessation,
weight loss, diabetes screening, lowering cholesterol. We put all those
things in that plan, which helped hold--even with insurance premiums
going up, we were able to level insurance costs going up and,
therefore, save the employees and the teachers money in that community.
That is all it is.
Everybody buys insurance in this country to mitigate risk. When you
by homeowners insurance, you say: I will have $1,000 deductible. So if
I have a roof blow off, I can stand to pay $1,000, but my insurance
covers the rest.
That is all this is. It just protects risk.
Mr. Speaker, I urge my colleagues to support H.R. 1304.
Mr. SCOTT of Virginia. Mr. Speaker, I reserve the balance of my time.
Ms. FOXX. Mr. Speaker, I yield 3 minutes to the gentleman from
Michigan (Mr. Walberg), chairman of the Health, Employment, Labor, and
Pensions Subcommittee.
Mr. WALBERG. Mr. Speaker, I rise today in support of H.R. 1304, the
Self-Insurance Protection Act. I thank my good friend, Dr. Phil Roe,
for his leadership and insights on this issue.
{time} 1500
As the Affordable Care Act continues its death spiral--and indeed it
does, very clearly, and ultimately will leave people without
insurance--too many small businesses in the process and working
families in my district have been left without real options for
healthcare coverage that they can afford.
Self-insured plans are one solution that small businesses have tried
to push back against these rising costs. These policies provide
employers flexibility to design a healthcare plan tailored to the
unique needs of their workers and their families. Last year, over 60
percent of employers who offered healthcare coverage utilized self-
insured plans.
Unfortunately, the previous administration pursued regulations that
would jeopardize access to self-insured plans by redefining stop-loss
insurance as traditional health insurance under Federal law. Stop-loss
insurance does not pay our medical claims; rather, it is a tool--I
remind you--that simply provides protections for employers to guard
against a catastrophic medical claim.
Mr. Speaker, our constituents need more affordable healthcare
options, not fewer; and the bill before us will stop any future
administration from putting harmful limitations on self-insured plans.
To achieve meaningful healthcare reform, we must promote flexibility
and innovative options, not curtail them.
H.R. 1304 provides much-needed certainty to the workers and employers
who access quality care through self-insured healthcare plans. As
employers and their employees look to plan for the future, the Self-
Insurance Protection Act will help provide some long-term certainty
that these affordable health insurance options are available. I ask my
colleagues to join me in supporting this legislation and promoting
healthcare choice for American workers and for their employers.
Mr. SCOTT of Virginia. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, we are continuing to hear complaints about the
Affordable Care Act. Whatever someone thinks about the Affordable Care
Act, I think it is important to look at the replacement that was
offered just over a week ago which actually would have made
[[Page H2729]]
things worse. It would have increased the number of uninsured, it would
have increased the price, it would have reduced the quality of the
product, and it would have made it less likely that insurance companies
would come in and offer anything at all.
If we are going to amend the Affordable Care Act, we ought to improve
it. We ought to make things better. We should first do no harm with the
Affordable Care Act, and we should not allow this administration to
sabotage the Affordable Care Act. When they said it might implode, we
have to be careful that they are not doing the implosion. There are
things that this administration can do to undermine the Affordable Care
Act and sabotage it, and we would hope that we would join in a
bipartisan effort to make sure that that does not happen.
Mr. Speaker, I reserve the balance of my time.
Ms. FOXX. Mr. Speaker, I yield 2 minutes to the distinguished
gentleman from Michigan (Mr. Mitchell) who is a member of our
committee.
Mr. MITCHELL. Mr. Speaker, I thank the gentlewoman from North
Carolina for yielding.
Mr. Speaker, I rise today in support of the Self-Insurance Protection
Act, of which I am a proud cosponsor. Restoring health care is more
than one bill--our plan has always included a series of efforts to
directly address the challenges facing our healthcare system. The
challenges resulted from ObamaCare. This legislation is one such
effort, part of a series of measures to increase choice and access.
This bill would make it easier for families to get health insurance
from their employers.
As my colleagues have noted, more than 160 million Americans get
their insurance from an employer. Of that, 60 percent of employers
offering healthcare coverage are self-insured, meaning employers
directly reimburse healthcare providers and employees for medical
expenses. These self-insured plans provide more flexibility than
traditional healthcare plans, as they can be designed and operated to
meet the unique needs of workers and families. For many years, the
company I led, in fact, was self-insured, and we bought stop-loss
coverage.
For most self-insured employers, choosing to buy stop-loss insurance
simply assists them in avoiding catastrophic losses. It is a business
insurance policy. Regulating it like a traditional healthcare insurance
would restrict access to self-insured plans dramatically.
We should be making it easier, not harder, for employers to offer
their employees comprehensive health packages, and it certainly should
not be left to an unelected bureaucrat to decide which types of plans
or which benefits work for American families.
This legislation is a simple, straightforward approach to protect
self-insured healthcare plans. It offers clarity, reaffirming
longstanding policies recognizing that stop-loss insurance is a
distinct business insurance and prevents bureaucrats from--one more
time--tinkering with our economy and damaging health care.
I urge my colleagues to support this legislation, as it is an
important measure to promote and to increase access to health care.
Mr. SCOTT of Virginia. Mr. Speaker, I yield myself the balance of my
time.
Mr. Speaker, this bill prohibits Federal regulation of stop-loss
insurance. The Federal Government does not regulate stop-loss
insurance. It does not affect the States' ability to regulate the
insurance, and that is where it should be done. So the bill does no
harm. I would hope that, after this bill, we will refocus our efforts
into addressing some of the challenges with the Affordable Care Act by
first doing no harm, not going backwards like the bill did several days
ago where the costs went up, the number of insurers went down, and the
quality of the insurance was worse. We can improve healthcare coverage
in this country, but we can't do it if the first step is a backward
step.
Mr. Speaker, I yield back the balance of my time.
Ms. FOXX. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, we all want workers and employers to have access to
high-quality, affordable healthcare coverage, and that is exactly what
this legislation is about.
Our Nation faces significant healthcare challenges. Costs are
soaring, and choices are diminishing. This legislation will in no way
address all of these challenges; however, it is one step we can take to
protect access to affordable healthcare options for workers and
employers.
Let's give workers and employers who rely on self-insured healthcare
plans a little bit of certainty and peace of mind today by passing this
commonsense legislation.
Mr. Speaker, I urge Members to vote in favor of the Self-Insurance
Protection Act, and I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Duncan of Tennessee). All time for
debate has expired.
Pursuant to House Resolution 241, the previous question is ordered on
the bill, as amended.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Ms. FOXX. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER. Pursuant to clause 8 of rule XX, further proceedings on
this question will be postponed.
____________________