[Congressional Record Volume 163, Number 77 (Thursday, May 4, 2017)]
[House]
[Pages H4149-H4170]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
AMERICAN HEALTH CARE ACT OF 2017
The SPEAKER pro tempore. Pursuant to clause 1(c) of rule XIX, further
consideration of the bill (H.R. 1628) to provide for reconciliation
pursuant to title II of the concurrent resolution on the budget for
fiscal year 2017, as amended, will now resume.
The Clerk read the title of the bill.
The SPEAKER pro tempore. Pursuant to House Resolution 308, the
further amendments printed in House Report 115-109 are considered as
adopted.
When consideration was postponed on Friday, March 24, 2017, 41\3/4\
minutes of the debate remained on the bill.
The gentlewoman from Tennessee (Mrs. Black) has 19\1/2\ minutes
remaining. The gentleman from Virginia (Mr. Scott) has 22\1/4\ minutes
remaining.
The Chair recognizes the gentlewoman from Tennessee.
General Leave
Mrs. BLACK. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks on
H.R. 1628, the American Health Care Act of 2017.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Tennessee?
There was no objection.
Mrs. BLACK. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today in favor of the American Health Care Act, a
bill that repeals the worst parts of ObamaCare and begins to repair the
damage it has caused. This bill brings choice and competition back into
the healthcare marketplace and puts healthcare decisions back into the
hands of patients and doctors where it belongs.
It has been a winding road to get to this point, but we are here
today to fulfill the promise that we made to the American people. I
will point out right now to those who say we should have just moved on
from healthcare reform, American families and individuals are suffering
from rising costs and barriers to getting the care that they need right
now.
Under ObamaCare, the situation is getting worse every day. In Iowa,
just yesterday, one of the last remaining insurers announced that it
will pull out of the ObamaCare exchanges, leaving nearly all of the
State's residents with no--and, yes, I will say again, nearly all of
the residents with no available health insurance plan for the purchase
under ObamaCare.
{time} 1230
And in a few of the Iowa counties which are the remaining insurers,
even that company is saying it might stop offering plans, leaving the
entire State without an insurance plan available under ObamaCare. That
is happening this very week. We can't wait a moment longer than
necessary to provide relief for the American people by repealing and
replacing ObamaCare.
I applaud the Members of this body who stuck with us during this
process and worked hard to make the bill better. I, myself, had
concerns about the bill as it was introduced. I worked hard to make
sure that the bill truly reflected my ideals and the views and desires
of my constituents. And when the bill came before the Budget Committee,
which I chair, I urged my members to stay in the fight and work to
improve the bill rather than stop it in its tracks.
And do you know what? Our members did just that, making some
recommendations that were eventually included in the various
amendments. That message was heard loud and clear by all of the members
of our Conference who have worked tirelessly to finalize a bill that
truly reflects our vision for healthcare reform.
Throughout this process, our commitment to undoing the damage done by
ObamaCare has remained steadfast. Day after day, my constituents call
my office begging us to do something to save them from ObamaCare, and
it is because ObamaCare is collapsing.
In my State of Tennessee, families are suffering. Premiums have
increased by 60 percent, while deductibles are so high that, even if
someone has an insurance card, it doesn't mean they have guaranteed
care.
There are parts of my State in Tennessee that don't have a single
insurance provider in the marketplace, and two-thirds of the counties
have only one provider. That is not competition. That is called a
monopoly.
While no legislation is perfect, this bill makes some important
changes to help American families get quality, affordable health
insurance: It zeros out the mandates, it repeals the taxes, and it
repeals the subsidies; it allows people to choose health insurance
plans to meet the unique needs of their families instead of purchasing
a one-size-fits-all plan mandated by a Washington bureaucrat; and it
modernizes Medicaid, a once-in-a-lifetime entitlement reform.
Ending Medicaid's open-ended funding structure will play an important
role in addressing our future budget deficits and our growing national
debt.
This is a particularly proud moment for me. I was working as a nurse
in Nashville in the 1990s when the Clinton administration pushed a
single-payer pilot program in Tennessee called TennCare. I saw
firsthand the negative impact government-run health care has on patient
care. I saw costs rise and the quality of care fall. It inspired me to
get involved in public service.
When in 2009 and 2010 I saw those same principles being debated and,
eventually, implemented on the national level, I thought my experience
in Tennessee could be valuable in the national debate; so, in 2011, I
sponsored the first piece of legislation that repealed a part of
ObamaCare. Today, we take the largest step yet in rescuing the American
people from this damaging, government-run healthcare system.
I, and many other Members of this body, have worked hard to make sure
that this bill truly reflects our visions for healthcare reform. I, for
one, cannot sit idly by and let this opportunity go to waste. Governing
is hard, but our constituents did not elect us to do what is easy. They
elected us to do what is right.
I urge my colleagues to join me in voting ``yes'' on the American
Health Care Act to rescue the American people from ObamaCare.
Mr. Speaker, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield myself such time as I may
consume, and I remind my colleague that her vote for this bill could
increase premiums for people with breast cancer in Tennessee by over
$38,000.
Mr. Speaker, let's begin with a few facts:
Since the passage of the Affordable Care Act, costs have gone up at
the lowest rate in 50 years;
Those with preexisting conditions get insurance at the standard rate;
Instead of millions of people losing their insurance every year, 20
million more people have insurance;
Personal bankruptcies are down 50 percent.
[[Page H4150]]
Still, all we hear are complaints, press releases, and promises about
something better. But CBO has debunked this proposal by pointing out
that 24 million fewer people will have insurance, that costs will go
up, and insurance will cover less.
So, whatever you think about the Affordable Care Act, this bill makes
things worse--except for millionaires, who get a tax cut.
Mr. Speaker, I reserve the balance of my time.
Mrs. BLACK. Mr. Speaker, it is my honor to yield 1\1/2\ minutes to
the gentleman from Tennessee (Mr. Roe), a physician and the chair of
the Veterans' Affairs Committee.
Mr. ROE of Tennessee. Mr. Speaker, 7 years ago, I stood right in this
well to debate the ACA, which the premise was to increase access and
decrease costs. We all agree with that. But that is not exactly what
happened.
In my district, in the State of Tennessee, over one-third of the
counties have no place they can buy insurance; and multiple counties in
my State, including the third largest, have no access. Premiums have
soared over 60 percent. Eighteen of the 23 co-ops went bankrupt,
including one in my State, which required people to search for other
coverage.
No matter what verbiage you hear, nothing in this bill changes how
veterans are treated under the law--nothing. The criticisms are flat-
out wrong. I am a veteran, doctor, and chairman of the Veterans'
Affairs Committee, and it ain't gonna happen.
In my State, and where I practiced medicine for over 30 years, listen
to this: 60 to 70 percent of the uncollectible debt now are people with
insurance.
So why do I support this bill?
One, it protects preexisting conditions;
Two, it puts patients ahead of special interests and restores a
physician-patient relationship;
Three, it reforms Medicaid so that first-class people don't get
second-class care; and
Four, it repeals individual mandates so that 160,000 Tennesseans
don't get fined for a product they cannot afford.
Mr. Speaker, this bill isn't perfect, but it is a huge improvement
over ObamaCare, and it is worthy of every Member's support.
Mr. SCOTT of Virginia. Mr. Speaker, I remind my colleague that his
vote for this bill could take healthcare protections away from over a
million people in Tennessee with preexisting conditions.
Mr. Speaker, I yield 1 minute to the gentlewoman from Oregon (Ms.
Bonamici), the vice ranking member of the Committee on Education and
the Workforce.
Ms. BONAMICI. Mr. Speaker, today the House is voting on a harmful
bill that puts the most vulnerable members of our community at risk. We
know that millions will lose coverage. And the Affordable Care Act
protects people with preexisting conditions--this bill does not. High-
risk pools don't work.
My constituents are scared, and so are people across this country.
Arden from Gearhart, Oregon, wrote to me, distraught, because she and
her daughter, Selah, could lose coverage. Arden took the loving step of
adopting a child with special needs, and now the support program they
rely on is at risk of being terminated by this bill.
This is a critical vote. I implore my colleagues to think about all
of the people like Arden and Selah in their communities. Think about
the millions across this country who risk losing coverage.
I implore my colleagues to do no harm. Vote ``no'' on this harmful
bill.
Mrs. BLACK. Mr. Speaker, I yield 4 minutes to the gentleman from
Oregon (Mr. Walden), the chair of the Energy and Commerce Committee,
who has worked tirelessly on this bill.
Mr. WALDEN. Mr. Speaker, I yield to the gentleman from Florida (Mr.
Webster), my colleague, for the purpose of a colloquy.
Mr. WEBSTER of Florida. I thank the chairman for yielding.
I have heard from my Governor, State officials, and providers about
the challenges on the ground in Florida and what they are facing. The
demographic issues in Florida raise significant challenges for the
State of Florida, and it is the Medicaid program.
Particularly, the State Medicaid program and providers face
challenges relating to the costs of caring for the most disadvantaged
and the elderly in Florida's nursing home program, as well as the
rising costs associated with Florida's aging population.
As the process moves forward, Florida's unique challenges must be
recognized and accounted for as we reallocate dollars for this
important safety net program.
Mr. WALDEN. I thank the gentleman from Florida for not only raising
this issue, but being a real partner in this legislation. I met with
your Governor as well, who has been very helpful in the discussions.
We believe that accounting for aging demographics of the Medicaid
program and broader population is an important factor we must consider
to ensure that any Medicaid reform is successfully implemented. I am
committed to working with the gentleman from Florida, our colleagues in
the Senate, and the Trump administration to ensure Florida's unique
challenges related to an aging Medicaid demographic are recognized and
accounted for appropriately.
Mr. Speaker, in the remaining part of my time, I would just like to
thank my colleagues for their work on this measure.
Making sure that people have access to affordable health care is
essential. It is something I would say that we all care about. We all
care about family members who have suffered from cancer or other
debilitating diseases or afflictions. We are trying to find a place
here that works for all Americans, where we have insurance markets that
are actually available where you can get an insurance product that
works for you that is affordable for you.
We know that today, in America, the insurance market and the
individual market--that is a very small segment, 7 percent of insurance
in America; that is what we are talking about here today--that that
market is collapsing before our eyes. In fact, in Iowa, I think they
just announced 94 in 99 counties, people there won't even have an
insurance product they can try to purchase on the exchange.
We have met with Governors and we have met with insurers. We have
said: What do we need to do to intercede to get this market back to
where it works? The proposals contained in our legislation are designed
to do exactly that: to get back to where consumers have choices when
they are required to buy insurance to take care of their families.
Those choices need to be affordable. They are not now, today.
In my own State of Oregon, premiums have gone up 50 percent in the
last 2 years. Meanwhile, the number of options that you have to choose
from has gone down--and continues to go down. Now, we haven't gone as
far as some States where you have either no option in most areas of the
State or just one, but how far off is it when insurers are failing,
people losing their opportunity to get affordable health insurance?
We take care of the disabled. We take care of the elderly. In fact,
we plus-up to medical CPI plus 1 to make sure that we take care of the
elderly and the disabled in our Medicaid program.
By the way, that is probably more than most States are spending
today.
So we have thought this through carefully. We care about people and
their medical condition and their families because we are all in this
together as Americans.
I think the bill we have before us today works. It works to take care
of those most in need. It works to make sure that the people can get
access to insurance.
I will tell you what. It is a first step in a many-step process to
also look at families who are dealing with opioid addition and what we
can do there. There are efforts at NIH, which we just supported
yesterday, to fund medical research so that we can get cures for those
who have diseases and other afflictions. We are fully committed to
improving health care not only for Americans, but around the globe,
through innovation and scientific discovery.
Mr. SCOTT of Virginia. Mr. Speaker, I remind my colleague that his
vote for this healthcare bill will take away protections for over
600,000 people in Oregon with preexisting conditions.
Mr. Speaker, I yield 1 minute to the gentleman from California (Mr.
Takano).
[[Page H4151]]
(Mr. TAKANO asked and was given permission to revise and extend his
remarks.)
Mr. TAKANO. Mr. Speaker, I include in the Record a letter from the
Consortium for Citizens with Disabilities, which states that this
legislation will dramatically cut Medicaid services that are vital to
people with disabilities and seniors.
Consortium for Citizens
with Disabilities,
April 28, 2017.
Dear Member of Congress: The Consortium for Citizens with
Disabilities (CCD) is strongly opposed to the amended
American Health Care Act. The amended American Health Care
Act retains the original bill's proposals to dramatically but
Medicaid services that are vital to people with disabilities
and seniors through per capita caps, which CCD has opposed.
The new amendments--including permitting states to seek
waivers from the protections for people with pre-existing
conditions and from the requirement to provide essential
health benefits--makes the amended AHCA even more harmful to
people with disabilities. We urge you to oppose this
legislation.
Medicaid provides services and supports that maintain the
health, function, independence, and well-being of 10 million
enrollees living with disabilities. For many people with
disabilities, being able to access timely needed care is a
life or death matter. The American Health Care Act changes
the way that the Federal Government funds Medicaid--rather
than paying states based on the actual costs of healthcare
for people in Medicaid, it sets a cap on the amount of
federal support, a cap that is totally unrelated to the
actual costs of needed care for enrollees. This cap is
designed to cut Medicaid, and the bill uses those cuts to pay
for unrelated tax cuts. Slashing federal support for
Medicaid, which is already a lean program, will force states
to cut services and eligibility that put the health and
wellbeing of people with disabilities at significant risk.
The newest amendments to the American Health Care Act make
the bill even more harmful to people with disabilities. The
new amendments would allow states to easily obtain waivers,
that would allow them to charge higher premiums to people
with pre-existing conditions, including people with
disabilities. They also would allow states to seek waivers
from the Affordable Care Act's requirement to provide
essential health benefits, including crucial services for
people with disabilities such as mental health and substance
use disorder services, prescription drugs, rehabilitative and
habilitative services and devices, preventative and wellness
services and chronic disease management, and pediatric
services. These waivers jeopardize the Affordable Care Act's
protections for people with pre-existing conditions,
including people with disabilities, and CCD opposes any roll-
back of those protections.
The ACA helped millions of people with disabilities and
others to gain access to affordable and comprehensive health
insurance. The amended American Health Care Act is
insufficient to help people with disabilities meet their
healthcare needs, and we urge you to oppose the bill should
it come to a vote.
Sincerely,
Health Task Force Co-chairs: Bethany Lilly, Bazelon Center
for Mental Health Law; Dave Machledt, National Health Law
Program; Peter Thomas, Brain Injury Association of America;
Julie Ward, The Arc of the United States.
Long Term Services and Supports Co-chairs: Alison Barkoff,
Center for Public Representation; Nicole Jorwic, The Arc of
the United States; Sarah Meek, Lutheran Services in America
Disability Network; Laura Weidner, National Multiple
Sclerosis Society.
Mr. TAKANO. Mr. Speaker, there are 7 million veterans who are
eligible for VA care but not enrolled at the VA. All of them could be
denied access to the tax credits in this bill, and each in this Chamber
needs to understand how.
On page 10, line 6 of manager's amendment No. 4, it states that an
individual is not eligible for tax credits if they are eligible for
care, as defined by U.S. Code 5000A(f)(1)(A). This code specifically
includes VA care. So this means that those 7 million veterans who are
eligible for VA care, even if they are not enrolled, would not have
access to the tax credits in this law.
This is not fear-mongering. This is not hyperbole. This is the text
of the bill we are voting on today. This bill jeopardizes health care
for up to 7 million veterans, and everyone should oppose it.
{time} 1245
Mrs. BLACK. Mr. Speaker, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 3 minutes to the
gentleman from Maryland (Mr. Hoyer), the Democratic whip.
(Mr. HOYER asked and was given permission to revise and extend his
remarks.)
Mr. HOYER. Mr. Speaker, Republicans now control all of our
government. Whatever happens to our healthcare system will be their
responsibility, including what has already happened since January with
the destabilizing of our insurance markets and health plans announcing
rate hikes due to uncertainty.
They will be held accountable for what happens. Today, Americans will
have an opportunity to see exactly where their Representatives stand.
This vote is a simple one. It votes to kick 24 million Americans off of
their health insurance coverage. I don't say that; CBO says that, which
is perhaps why we don't have a CBO report on the amendment. It includes
7 million people who are covered through their employers.
It is a vote to make coverage unaffordable for one in four Americans
with preexisting conditions and ration care through high-risk pools.
It is a vote to impose an age tax on older Americans, some $1,700 to
$14,600. That is quite a hike.
It is a vote to force Americans to pay more for less, to raise
premiums 24 to 29 percent, on average, over each of the next 2 years.
CBO says that, not me.
And no matter how Republicans try to spin it, healthcare advocates
from the AMA to AARP, to everybody that follows, have said that it ends
protections for those with preexisting conditions.
I repeat: It ends protections for those with preexisting conditions.
I repeat again: It ends protections for those with preexisting
conditions.
It takes away essential health benefits, like doctor visits,
emergency room visits, and prescription drugs. So this, Mr. Speaker,
will be a very instructive vote. It will show the American people if
Republicans stand with those who don't want to lose their coverage,
some 55 percent now and 75 percent saying fix it, don't repeal it--or
if they stand with a President who wants to claim a victory, but
doesn't even seem to know what his own TrumpCare bill says.
I recommend, as a political strategist who is concerned about 2018,
that you once again withdraw this bill. Instead, we ought to work
together to make sure that the Affordable Care Act works for all
Americans, and deliver on the promise that President Trump made--and
made from that rostrum--when he said that he wanted ``insurance for
everybody;'' not kick 24 million off, ``for everybody;'' not make
seniors pay more, ``for everybody;'' not to put Medicaid at risk, ``for
everybody'' that is ``far less expensive and far better.''
Mr. Speaker, I urge my colleagues: Come to your senses, defeat this
bill.
Mrs. BLACK. Mr. Speaker, I would like to remind the other side that
if they read the bill, they will see under section 137 it says:
No limiting access to coverage for individuals with
preexisting conditions. Nothing in this act shall be
construed as permitting health insurance insurers to limit
access to health coverage for individuals with preexisting
conditions.
Mr. Speaker, it is my honor to yield 4 minutes to the gentleman from
Texas (Mr. Brady), the chairman of the Ways and Means Committee.
Mr. BRADY of Texas. Mr. Speaker, I first want to thank Chairwoman
Black for her leadership on this effort, as well as Chairman Walden of
the Energy and Commerce Committee for incredible work.
As chairman on behalf of the Ways and Means Committee who work
alongside you, I am honored to speak in support of the American Health
Care Act because it guarantees coverage for those with preexisting
illnesses.
It guarantees coverage for those with preexisting illnesses. In fact,
this bill takes decisive action to repeal all of the bad parts, all of
the damage done by ObamaCare, and begin a thoughtful step-by-step
process to deliver a patient-centered healthcare system, not a
Washington-centered healthcare system, to the American people.
While ObamaCare has helped some, far more have been hurt by this law.
And more ObamaCare failures are piling up every day. Just yesterday,
Aetna announced it will exit Virginia's individual health market next
year. And it is not just the State's ObamaCare exchanges they are
leaving behind. Aetna will not offer any plans next year in the
individual market in Virginia.
The same thing is happening in Iowa. And my friends on the Democratic
aisle have done nothing to stop this--
[[Page H4152]]
nothing. But today, because of this bill, thousands of people will have
hope for a new plan to provide the healthcare coverage they need.
Millions of Americans throughout the country are facing just terrible
options.
People of Texas have been hit particularly hard. Between last year
and this year, nine healthcare insurers have exited ObamaCare exchanges
in the Lone Star State. No other State saw more insurers leave. For my
family, the failures of this law have come to mean some incredibly
tough choices. They have had to accept, under ObamaCare, you can't
access affordable coverage that is tailored to what they need. They
have had to learn how to get by as their monthly health premiums just
skyrocket each and every year--bigger than their mortgage payments.
They have had to choose between paying out of pocket for the care they
need or not getting care at all.
Under ObamaCare, the ability to receive treatment from a doctor you
know and who knows you has become a luxury that too many can't afford.
Today, with the American Health Care Act, the Republicans propose we
have an opportunity to provide immediate relief from this failing law.
More than that, we can provide Americans with real choices in health
care, not the painful decision they are forced to live with under
ObamaCare.
Under the Ways and Means Committee area, this starts by repealing the
law's crushing taxes and mandates, and that is where Ways and Means
takes action. Under ObamaCare, the individual and employer mandate
penalties allow Washington to strong-arm you, to strong-arm Americans
into ObamaCare plans you do not want and cannot afford.
Not anymore. Under the Republican plan, we repeal the individual and
employer mandate tax penalties so Americans have the freedom to make
the healthcare choices that are right for them. Under ObamaCare, over
$1 trillion of taxes were imposed on the American people. Under the
Republican plan, those taxes are gone that burden American small
businesses and families.
Under our plan, we provide increased health savings accounts so
Americans can save easier for the out-of-pocket costs that hit them
under any health care; and then we create a personal individual tax
credit so Americans can buy plans that are right for them, not what is
right for government.
Healthcare premiums, they can choose a plan that can go with them
from job to job, State to State, home to start a business, or a family,
and even into those preretirement years.
Today is about taking on a collapsing ObamaCare and replacing for the
American people health care that they want, that they can use, and that
they can afford; driven not by what Washington wants, but driven by
what American families need in their health care.
Mr. Speaker, I urge the support of this bill.
Mr. SCOTT of Virginia. Mr. Speaker, I remind my colleague that his
vote for this bill could take away protections of over 4.5 million
people with preexisting conditions in Texas who might have access to
coverage, but if they have diabetes, their rates could go up $5,000.
Mr. Speaker, I yield 1 minute to the gentlewoman from North Carolina
(Ms. Adams).
Ms. ADAMS. Mr. Speaker, I thank the gentleman for yielding.
After his latest failed attempt to roll back the ACA, Speaker Ryan
declared to the American people ``ObamaCare is the law of the land.''
Less than 50 days later, Paul Ryan shamefully is going against his word
trying to ram TrumpCare down our throats.
It is an embarrassment that we are wasting taxpayer dollars to again
consider TrumpCare--or as I called it ``Trump don't care''--a reckless
plan that does nothing to make health care better.
TrumpCare gives the rich and big corporations a $600 billion tax
break. It forces families to pay higher premiums and deductions,
placing health care out of their reach. TrumpCare forces seniors to pay
higher costs and changes Medicare as we know it. It strips essential
health benefits and protections for people with preexisting conditions.
What a pitiful display of partisan politics. TrumpCare is so bad,
Republicans have exempted themselves from it. They don't want
TrumpCare. The medical industry doesn't want TrumpCare. Democrats don't
want TrumpCare.
Why don't House Republicans listen?
The people don't want it, and I won't support it.
Mrs. BLACK. Mr. Speaker, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I include in the Record a letter
from Common Sense Kids Action that explains that: ``This jeopardizes
the health and well-being of America's kids and will alarm any parent
who understands the importance of health insurance for their children
and family.''
common sense kids action,
April 25, 2017.
Re H.R. 1628--OPPOSE.
Hon. Diane Black,
Chairwoman, House Budget Committee,
House of Representatives, Washington, DC.
Dear Representative Black: On behalf of the millions of
American kids and families who rely on comprehensive,
dependable health insurance to stay healthy and to get
medical treatment when they need it, we are writing to
respectfully express our strong opposition to your bill, H.R.
1628, the American Health Care Act (AHCA). We have added this
bill to our Common Sense Legislative Ratings Tool as an
``Against Kids'' bill and will communicate our position to
our parent and teacher members.
Common Sense is the nation's leading independent nonprofit
organization dedicated to helping kids thrive in a rapidly
changing world. We empower parents, teachers, and
policymakers by providing unbiased information, trusted
advice, and innovative tools to help them harness the power
of media and technology as a positive force in all kids'
lives. The policy arm, Common Sense Kids Action, is building
a movement of parents, teachers, business leaders, and others
dedicated to making kids our nation's top priority by
supporting policies at the state and federal level that
contribute to the building blocks of opportunity for kids.
Access to affordable and quality medical care for kids is
certainly one of those key building blocks.
Thanks to current law, including the Affordable Care Act,
Medicaid, and the Children's Health Insurance Program (CHIP),
95% of young children in the U.S. today have health
insurance. That's a remarkable achievement. With health
insurance, parents are more likely to seek medical care for
themselves and for their children, helping to prevent
illnesses from developing and shortening their duration when
they occur. However, the AHCA will result in 24 million fewer
Americans having coverage, including millions of children.
This jeopardizes the health and well-being of America's kids
and will alarm any parent who understands the importance of
health insurance for their children and family. The
Affordable Care Act certainly needs to be fixed, but if
Congress has the goal of making sure that all families and
businesses have access to affordable and comprehensive health
insurance, it could improve the law for everyone without
forcing millions of kids and their parents to lose access to
critical medical care.
As Congress continues to grapple with this issue, health
insurance programs, we think these facts about children's
health insurance from the Congressional Budget Office and the
Georgetown University Center for Children and Families are
important to keep in mind:
Ninety-five percent of children age 0-5 are insured today.
Forty-five million of those children access health care
through two programs: about 37 million through Medicaid (a
federal-state program) and 8 million through CHIP, the
Children's Health Insurance Program.
Children are the single-largest group of persons covered
under Medicaid.
Under the Affordable Care Act, as you know, many states
expanded Medicaid with help from the federal government,
increasing coverage for kids and families, including coverage
for mental health care.
Changes being considered, including under the AHCA, would
cut funding to Medicaid by as much as $880 billion over the
next 10 years.
The AHCA, when compared with current law, would result in
24 million fewer Americans with health insurance by the year
2026.
Even with changes recently suggested to your bill,
America's kids will be best served by strengthening the
Affordable Care Act and preserving Medicaid and CHIP, not by
repealing the Affordable Care Act and block granting or
establishing a per capita cap on Medicaid. We urge you to
keep our children's future foremost in your thinking,
withdraw your bill, and work on a bipartisan basis to support
measures that protect and strengthen children's health care.
Thank you for your consideration of our views and we would be
happy to talk with you at any time about this and other
issues that matter to America's children and families.
Sincerely,
Danny Weiss,
Vice President, Federal Policy,
Common Sense Media/Kids Action.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 1 minute to the gentleman
from New York (Mr. Jeffries).
(Mr. JEFFRIES asked and was given permission to revise and extend his
remarks.)
[[Page H4153]]
Mr. JEFFRIES. Mr. Speaker, I include in the Record a letter from
SEIU, which states:
This legislation will leave millions without health
insurance, and decimate the Medicare program.
SEIU,
May 2, 2017.
Dear Representative: On behalf of the 2 million members of
the Service Employees International Union (SEIU), America's
largest healthcare union, I write to voice strong opposition
to the American Health Care Act (AHCA). New provisions in the
legislation manage to make a bad bill worse. Not only does
the bill cause millions to lose insurance coverage, face
higher costs, and end Medicaid as we know it, but now it also
strips essential protections for those with pre-existing
conditions. The AHCA will leave millions of men, women, and
children without access to high quality, affordable health
care. The AHCA legislation unequivocally jeopardizes working
families' safety, health, and financial security.
The AHCA will leave millions of Americans without health
insurance and therefore without access to healthcare. The
last available estimate from the nonpartisan Congressional
Budget Office (CBO) estimated about 14 million fewer people
will have health insurance in 2018, and by 2026, 24 million
fewer people will have coverage compared to the current
baseline under the ACA. Unfortunately, we do not have more up
to date information. Despite the importance that healthcare
plays in the lives of working families, Congressional leaders
have indicated that they intend to hold a vote on the
legislation without knowing its impact.
The AHCA also decimates the Medicaid program, rationing and
endangering healthcare for children, seniors, people with
disabilities, and their families as well as for those who
have gained coverage as a result of the Medicaid expansion.
According to CBO, the legislation will cut federal funding
for Medicaid by $880 billion over ten years. Americans know
that Medicaid is working and realize the key role that the
program plays in helping families afford care--including
nursing home care and home and community-based services for
elderly and disabled individuals. Nearly 1 in 5 Americans are
covered under Medicaid and rely on it to get health services
Under the AHCA, those Americans would lose access to vital
care that may mean the difference between life and death.
Additionally, the AHCA would cap the amount of money states
receive in Medicaid funding from the federal government each
year, regardless of the cost of providing healthcare to those
who qualify. Medicaid is already a lean program especially
when measured on a per capita basis, and cuts from capping
federal funding will quickly force states to cut services,
limit enrollment, and decrease payments to hospitals and
other providers. Also, Medicaid is the largest payer for long
term care in the country. The program pays for more than 60
percent of all nursing home residents and for more than 3.2
million Americans with home- and community-based care, which
allows many older Americans and people with disabilities to
remain in their homes rather than move to a more expensive
institutional setting. States--which must balance budgets and
already face fiscal pressures--will not be able to make up
the lost federal dollars and will be forced to deny care. The
inevitable result will be that the AHCA will make it much
harder and more costly for older Americans, people with
disabilities, and their families to get services they need.
In addition, the legislation will effectively end the
Medicaid expansion, which provides health coverage to
millions of people earning low to moderate incomes. While the
bill purports to allow states to maintain the expansion,
states will only receive an enhanced match, or additional
funding, for people who enroll before 2020 and maintain
continuous coverage. It is widely understood that there is
significant churn on and off the program in this coverage
category, and thus over time the reimbursement rates for
states will drop. The resulting large cost shift to states
may lead them to eliminate coverage for this group
altogether. In fact, seven states have triggers that would
end the Medicaid expansion in their state if federal
reimbursement decreases.
Lastly, Medicaid provider rates are already extremely low
in most states. Cuts to Medicaid, capped funding, and
elimination of the Medicaid expansion would lead to further
reductions in rates for providers, leading to job and other
spending cuts in the health care industry that will have
ripple effects on the broader economy. We have serious
concerns that hospitals, especially those that serve
communities that may not have access to many providers, could
be forced to close or cut back services, further reducing
access to care in underserved areas.
Those who purchase coverage in the individual market do not
fare much better under the proposed bill. The AHCA provides
tax credits ranging from $2,000 to $4,000 to individuals to
purchase private insurance--substantially lower than the
ACA's current levels for the majority of those who receive
them. Unlike the ACA, it is unclear that people with access
to employer insurance that is unaffordable or inadequate will
be eligible for credits, which would mean that they will be
left without access to coverage and care. The bill also
creates an age tax on older Americans by letting insurance
companies charge people over 60 as much as five times what
they charge others for the same coverage. CBO found that
under the initial bill introduced, premiums for those between
age 50 and 65 would sky-rocket. Moreover, it is unclear what
coverage will be available on the individual market or if the
current healthcare marketplaces will even still exist under
this scheme. Between premiums and out of pocket costs like
deductibles, especially for those most in need of care due to
pre-existing conditions, illness, or age, the result could be
higher costs for less coverage.
A bad bill has managed to have been made even worse by the
``MacArthur-Meadows Amendment.'' The amendment guts essential
protections for those with pre-existing conditions. It would
allow states to charge those with pre-existing conditions
higher premiums by allowing states to very easily waive
community rating requirements, which currently prohibits this
practice. Furthermore it would grant states, through a waiver
that is approved by default, the ability to opt out of
essential health benefit requirements, a core set of medical
services, like hospitalizations, mental health, maternity
care and prescription drug coverage, which all insurers are
required to cover under the ACA. If states waive
requirements, insurers could leave those who are sick or with
pre-existing conditions out to fend for themselves and face
exorbitant costs to get life-saving care they need. Experts
agree that the funding included in the ``Upton-Long
Amendment'' is completely inadequate to protect those with
pre-existing conditions. The Administration and Congressional
Leaders promised to the American people that those with pre-
existing conditions would remain protected--this bill even
with added amendments defaults on that promise.
Another failure of the AHCA is that it hurts women by
freezing funding to providers like Planned Parenthood,
risking the health and well-being of the 2.5 million people
who rely on the organization for basic care. One in five
women in the United States has visited Planned Parenthood
clinics and for many low-income women of color, including
many of our members, Planned Parenthood is their essential
health provider. For these individuals, healthcare is not an
ideological struggle or about the politics of one policy
versus another; it is a necessity that could mean the
difference between sickness and health.
The real winners of the AHCA appear to be special interests
and the wealthy. The legislation repeals most if not all of
the ACA tax provisions for special interests like the
pharmaceutical and insurance industries, offsetting these
costs with the massive cuts to Medicaid described above. The
bill also maintains the so-called ``Cadillac tax,'' which
places a tax on workers who have robust health coverage,
merely delaying implementation to 2026. Implementation of the
tax will punish people who have decent insurance, and will
encourage employers to further shift health costs to workers.
Furthermore, the incentives for health savings accounts,
which encourage wealthier people to shelter pre-tax income,
are of little use to working households earning low-to
moderate incomes.
The AHCA is not care, it is chaos. The legislation creates
an environment of uncertainty and unaffordability for
Americans and is a bad deal for working families. The bill
radically restructures Medicaid as we know it and cuts
funding for the program significantly, endangers women's
health, and further enriches corporations, special interests,
and the wealthiest Americans at the expense of working
families' access to healthcare and financial stability. The
American people will hold you accountable for how you proceed
in this moment. We therefore respectfully ask you vote no on
the American Health Care Act and the proposed amendments to
the legislation when it comes to a vote in the House of
Representatives. We will add this vote to our legislative
scorecard. If you need any additional information please
contact Ilene Stein, Assistant Legislative Director.
Sincerely,
Mary Kay Henry,
International President.
Mr. JEFFRIES. Mr. Speaker, the House majority has once again made
clear that, under Republican rule, the system is rigged. The fix is in.
The deck is stacked against hardworking Americans, and exhibit A is
your reckless Republican healthcare plan. Under TrumpCare, 24 million
Americans will lose access to health insurance. Under TrumpCare, a
draconian age tax will be imposed on people between 50 and 64. Under
TrumpCare, costs will go up, premiums will go up, copays will go up,
deductibles will go up. Under TrumpCare, tens of millions of Americans
who are living with preexisting conditions will be screwed.
House Republicans are out to destroy the American healthcare system
as we know it, but you will be held accountable for the cruel and
unusual punishment that you have decided to inflict on the American
people.
Vote ``no'' against this draconian piece of legislation.
The SPEAKER pro tempore. The Chair would remind Members to direct
their remarks to this Chair.
Mrs. BLACK. Mr. Speaker, I reserve the balance of my time.
[[Page H4154]]
Mr. SCOTT of Virginia. Mr. Speaker, I include in the Record an
article in Consumer Reports dated May 2, 2017, entitled: ``How the
Affordable Care Act Drove Down Personal Bankruptcy.''
How the Affordable Care Act Drove Down Personal Bankruptcy
Expanded health insurance helped cut the number of filings by half
(By Allen St. John)
As legislators and the executive branch renew their efforts
to repeal and replace the Affordable Care Act this week, they
might want to keep in mind a little-known financial
consequence of the ACA: Since its adoption, far fewer
Americans have taken the extreme step of filing for personal
bankruptcy.
Filings have dropped about 50 percent, from 1,536,799 in
2010 to 770,846 in 2016 (see chart, below). Those years also
represent the time frame when the ACA took effect. Although
courts never ask people to declare why they're filing, many
bankruptcy and legal experts agree that medical bills had
been a leading cause of personal bankruptcy before public
healthcare coverage expanded under the ACA. Unlike other
causes of debt, medical bills are often unexpected,
involuntary, and large.
``If you're uninsured or underinsured, you can run up a
huge debt in a short period of time,'' says Lois Lupica, a
bankruptcy expert and Maine Law Foundation Professor of Law
at the University of Maine School of Law.
So did the rise of the ACA--which helped some 20 million
more Americans get health insurance--cause the decline in
bankruptcies?
The many experts we interviewed also pointed to two other
contributing factors: an improving economy and changes to
bankruptcy laws in 2005 that made it more difficult and
costly to file. However, they almost all agreed that expanded
health coverage played a major role in the marked, recent
decline.
Some of the most important financial protections of the ACA
apply to all consumers, whether they get their coverage
through ACA exchanges or the private insurance marketplace.
These provisions include mandated coverage for pre-existing
conditions and, on most covered benefits, an end to annual
and lifetime coverage caps. Aspects of the law, including
provisions for young people to be covered by a family policy
until age 26, went into effect in 2010 and 2011, before the
full rollout of the ACA in 2014.
``It's absolutely remarkable,'' says Jim Molleur, a Maine-
based bankruptcy attorney with 20 years of experience.
``We're not getting people with big medical bills,
chronically sick people who would hit those lifetime caps or
be denied because of pre-existing conditions. They seemed to
disappear almost overnight once ACA kicked in.''
The first attempt to repeal and replace the ACA, in March,
failed to gain enough Congressional support and never came to
a vote.
Then in April, details of a new replacement plan were
released. Although President Donald Trump has said that this
new version, like the first bill that was pulled from
consideration, will cover pre-existing conditions, the
revised law gives states broad latitude to allow insurance
companies to increase rates for consumers with an existing
illness.
A Rare and Costly Diagnosis
Since the start of the year, more than 2,000 consumers have
answered an online questionnaire from Consumer Reports'
advocacy and mobilization team, sharing their experiences
with the ACA. Katie Weber of Seattle was one of them.
In 2011, she had just landed her first job out of college,
as a teacher with AmeriCorps, she explains in a phone
interview. That's when the unusual numbness in her hand
began, which she--and her doctor--at first mistook for a
pinched nerve.
Then came debilitating headaches and nausea and,
ultimately, a diagnosis of medulloblastoma, a fast-growing
cancerous brain tumor.
The treatment for her tumor was straightforward: surgery,
radiation, then chemotherapy. Figuring out how to pay for it
was much less clear. She worried that the insurance she had
through AmeriCorps wouldn't cover enough of her bills.
``My dad said to me, `Your health is the most important
thing. If you have to declare bankruptcy at age 23, it's no
big deal,' '' Weber says.
Because of the ACA, she says, it never came to that. After
her year with AmeriCorps, the new healthcare law enabled her
to get coverage under her parents' insurance plan.
The ACA provisions required that the family's insurance
company cover her even though she had already been diagnosed
with cancer. That would not have been the case before the
ACA, which mandates the coverage of pre-existing conditions
for all consumers.
Later, when she aged out of her parents' insurance, Weber
was able to enroll in Apple Health, Washington state's
version of Medicaid, a program that was expanded once the ACA
was passed. That coverage, she says, has been crucial to her
financial and medical well-being, especially once the cancer
returned last fall.
Weber says she now spends more time discussing treatment
options and less time worrying how she'll pay for MRIs and
drugs. These are covered in full under her Apple Health
policy.
``Cancer is really expensive,'' she says. ``My insurance
saved my life.''
Numbers Plummet
If you want further testimony about how much personal
bankruptcies have dropped over the past decade, talk to Susan
Grossberg, a Springfield, Mass., attorney.
For more than 20 years she has helped consumers push the
financial reset button when debt triggered by divorce,
unemployment, or a costly illness or medical episode became
too much to handle. ``Medical debt can get really big really
quickly,'' Grossberg says. ``When you're in the emergency
room they're not checking your credit score while they're
caring for you.''
With the advent of the ACA--and before that, expanded state
healthcare in Massachusetts--she says fewer clients with
large medical debts walked through her door.
Grossberg adds that her bankruptcy business has slowed so
much that she has been forced to take on other kinds of legal
work--landlord-tenant and housing discrimination cases--to
cover her own bills.
The American Bankruptcy Institute suggested that veteran
Chicago bankruptcy attorney and trustee David Leibowitz could
also help parse the reasons for the decadelong decline.
First, he says, the Bankruptcy Abuse Prevention and
Consumer Protection Act of 2005 made it more difficult for
consumers to file for bankruptcy. The law required credit
counseling and income verification and forced many consumers
to seek protection under Chapter 13, which restructures, but
does not eliminate, most debt. The piles of paperwork also
meant most filers needed a lawyer, which made bankruptcy more
costly and therefore not an option for many poor consumers.
Then there was the economy. After a slow and steady
recovery following the housing crisis of 2008, Leibowitz
explains that American consumers generally had fewer problems
with their mortgages, better employment prospects, and
greater access to credit, which made them less likely to
file.
The final factor, according to Leibowitz, has been the ACA,
which afforded health coverage to many more consumers and
expanded protections for all.
Of course, not everyone sees such a direct connection
between the decline in bankruptcies and the emergence of the
ACA.
Thomas P. Miller, resident fellow at the American
Enterprise Institute and co-author of ``Why ObamaCare is
Wrong for America'' (HarperCollins, 2011), cautioned against
``reaching broad conclusions'' because the subject is so
complex.
``Certainly there are fewer people declaring bankruptcy,
and certainly fewer are declaring bankruptcy because of
healthcare spending,'' he says. But his earlier research
suggested that some studies exaggerated the degree to which
high healthcare bills cause bankruptcies. ``They tended to
reflect other problems with credit card balances well beyond
healthcare,'' he says. ``It stems from multiple causes.''
Figuring Out Why
Over the past decade, determining the cause-and-effect
relationship between medical debt and bankruptcy has become a
political football, particularly during the years the Obama
administration was trying to pass the ACA through Congress.
The truth is that it's not that easy to determine how many
bankruptcies are caused by medical debt. Examining the
paperwork doesn't always offer insight because debtors often
juggle their indebtedness, for example, using a credit card
to pay an outstanding medical bill while leaving other debts
unpaid.
But a 2014 study from Daniel Austin, a bankruptcy attorney
and, at the time, a professor at the Northeastern University
School of Law, offers some of the most in-depth research to
date.
Austin and his team selected a nationwide group of 100
bankruptcy filers meant to represent a cross-section of the
U.S. population, studied their paperwork, then followed up
with a survey asking filers, basically, ``Why?''
His team's research found that medical debt is the single
largest factor in personal bankruptcy. First, Austin analyzed
the paperwork of individual case files, which suggested that
medical bills were a factor in 18 percent of filings. But
when he directly asked the same filers, in a survey, the
number was even higher, with 25 percent citing medical bills
as a factor in their decision to file bankruptcy.
In addition to the nationwide group, Austin isolated a
group of 100 bankruptcy filers from Massachusetts.
Why Massachusetts? Because its citizens, starting in 2006,
had been covered by a comprehensive state healthcare
program similar to the ACA known as Romneycare, after the
state's former governor, Mitt Romney.
The differences between the two groups were striking. Even
though the Massachusetts filers owed substantially more in
unsecured debt (that is, debt not backed by a home, a car, or
another asset) than their counterparts in other states, they
reported less than half as much medical debt, which is also
unsecured.
``The average medical debt in Massachusetts in 2013 was
relatively low at just $3,041 (6 percent of total unsecured
debt) compared to $8,594 (20 percent of total unsecured debt)
nationwide,'' Austin writes in his 2014 study,
[[Page H4155]]
portions of which were published in the Maine Law Review.
``Only about 9 percent of Massachusetts debtors felt their
bankruptcy filing was a result of medical bills,'' Austin
explains. ``This compares to 25 percent for debtors from
[other] jurisdictions.'' Austin's research found that
comprehensive medical coverage in Massachusetts had all but
eliminated medical bills as a cause for bankruptcy.
``Not only in absolute numbers--they had much smaller
medical debt--but psychologically, medical debt did not loom
nearly as large for people in Massachusetts as it did for
other people in other states.'' And in 2010, four years after
Romneycare began, the state had a bankruptcy rate that was
about 30 percent lower than that of other states.
In Search of Certainty, Consistency
At its most basic level, health insurance allows consumers
to pay for the medical care they need. Each year, the Centers
for Disease Control and Prevention determines how well the
system is working by surveying Americans and asking a simple
but powerful question: Did you have problems paying medical
bills in the last 12 months?
The percentage of those reporting problems has dropped from
21.3 percent of households when they first asked the question
in 2011 to 16.2 percent in 2016. That's almost 13 million
fewer Americans no longer facing collection notices from a
doctor or hospital.
``It's been happening across the board, by race, by age, by
insurance status, by gender,'' says Robin Cohen, the study's
lead author.
But insurance is also about peace of mind. And judging from
the consumers who have shared their stories with Consumer
Reports, that certainty is in short supply as the fate of the
ACA is decided. People are wondering what comes next: Repeal?
Replace? Improve? Retain and neglect? No one really knows the
answer. Americans are concerned about how the future of
healthcare will affect them and their families.
In CR's Consumer Voices survey in January 2017, 55 percent
of consumers said they lacked confidence that they or their
loved ones would be able to afford insurance to secure that
care.
Don Shope of Ocean View, Del., said the availability of ACA
coverage gave him the confidence to leave a corporate job and
start his own consulting business. But now, with the ACA's
future in limbo, he and his wife are watching the action in
Washington and worrying that they might have to return to
jobs with benefits.
``I'm not a liberal or a conservative, a Democrat or a
Republican,'' Shope said in a phone interview. ``Our biggest
concern is that with repeal and replace we're going to be
left high and dry.''
He also believes in expanded health coverage for all. ``If
any American is sick, we should be willing to take care of
them,'' Shope says. ``It's the right thing to do. Economics
and profit shouldn't be part of the healthcare equation.''
Hanging On Every Dip and Turn
And then there's Kristin Couch, who has channeled the
uncertainty into her own brand of activism.
``I was kind of anxious,'' Couch says about the day in
March when Congress was set to vote on a less robust bill
that would replace the ACA.
The 31-year-old public relations executive, of Gainesville,
Ga., has started to follow health-care politics in the
intense, almost obsessive way some people follow sports. The
morning after Election Day, she called the offices of her
local congressional representatives, urging them to preserve
the protections the ACA offers.
Couch began caring about healthcare as a high school senior
when she was diagnosed with lupus and since then has become
something of a reluctant expert on how to manage not only her
treatment but also the insurance that pays for it.
With friends and neighbors she talks about the law in
simple but personal terms. ``I tell people, `I have a pre-
existing condition, and this has helped me,' '' she says of
the ACA. Couch follows the healthcare debate in Washington so
closely because she knows firsthand what happens when you
don't have adequate coverage.
Couch remembers the time, before the ACA, when a new
immunosuppressive drug that wasn't covered by her policy
became available. ``It was expensive,'' she explained in an
interview, ``but it worked, and I knew I needed it. Every
month I'd just put it on a credit card. When your medication
is thousands of dollars a month, that's the start of being in
debt.'' She considered bankruptcy but ultimately worked her
way out from under the pile of medical bills.
As a result of the ACA, her coverage shifted again when her
employer no longer offered a traditional plan and she had to
switch to one with a high $3,000 deductible. Initially she
was stunned by her out-of-pocket costs, but she quickly
realized that her total costs would be capped once she'd met
that threshold.
``It seemed scary and it seemed different,'' she explains.
``But it actually saved me money.'' And now, she says, ``I
don't have to worry about how much a new drug costs.''
So on the March day the House of Representatives was
supposed to vote on repealing the ACA, she worried that the
insurance she'd come to depend on was about to be yanked
away. Only after emerging from a client meeting did she learn
the vote had been canceled. ``I started crying I was so
happy,'' Couch recalls. ``It's like a weight has lifted.''
But Couch's relief was short-lived. Now she's back to
paying close attention to the rhetoric and vote-counting
deals in Washington, awaiting another possible vote on the
newly revised plan. ``I'm still optimistic,'' she said this
week. ``I think enough people will stand up and fight for the
coverage.''
Mr. SCOTT of Virginia. I yield 1 minute to the gentleman from New
Jersey (Mr. Norcross).
Mr. NORCROSS. Mr. Speaker, a month ago I was ready to speak right
here on the floor when this bill was abruptly removed. Apparently, it
wasn't bad enough that day, it wasn't harmful enough. But now it is
back worse than ever. So bad, it might actually pass.
I don't have a lot of time to explain, but let me tell you two groups
that are really going to say thank you: it is the billionaires and it
is the undertakers.
This bill will make health care more unaffordable and cause
preventable deaths. Meanwhile, it gives $600 billion--excuse me--$800
billion to the wealthy, to the billionaires. TrumpCare brings us higher
costs, less coverage, guts the benefits, has a crushing age tax, and
steals from Medicare. In my district alone, 43,000 people will lose
coverage. 9,000 of those are children. The elderly, Medicaid will be
lost, close to 2,000.
There is a reason they are trying to jam this down our throats. There
is no CBO score because they don't want to hear a score.
Mr. Speaker, let me make it plain. Let's put this bill in a coffin,
not Americans. Let's kill and bury this bill.
Mrs. BLACK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from
Louisiana (Mr. Scalise), our distinguished whip.
Mr. SCALISE. Mr. Speaker, I thank the chairwoman of the Budget
Committee for yielding.
I was in strong support of this bill, Mr. Speaker, that finally
provides relief to the American people across this country from the
failures of ObamaCare.
Just how bad is it failing?
You don't have to look any further than what happened in Iowa
yesterday, where literally they are going to have in 94 out of 99
counties nobody to write insurance for people that are in the ObamaCare
exchanges.
So what do the people, Mr. Speaker, that are opposed to this bill say
to those millions of people in Iowa who are about to have no place to
go to get health care?
What are the people that oppose this bill, Mr. Speaker, going to say
to the millions of people with preexisting conditions across the
country who are being faced with double-digit increases in their health
insurance every year and, oh, by the way, premiums and deductibles as
high as over $10,000, which are creaming those folks that are
struggling under the weight of this bill?
So what we are replacing it with, Mr. Speaker, are reforms that
actually lower premiums, that actually put patients back in charge of
their healthcare decisions so that elitists up here in Washington won't
tell you what you have to buy. You actually get to make that choice
yourself.
{time} 1300
You get to focus on plans that are good for your family at lower
costs so that you can be in charge. And, by the way, reforming the
Medicaid system, one of the most broken forms of health care so that
States actually have the ability to innovate and help low-income
families.
This bill is important, Mr. Speaker, to rescue the American people
from a law that has failed dismally. Let's end the skyrocketing premium
increases. Let's lower costs and put patients back in charge of their
healthcare decisions.
Mr. SCOTT of Virginia. Mr. Speaker, I remind my colleague that his
vote for this bill can take away protections for over 800,000 people
with preexisting conditions in Louisiana. For example, those with
breast cancer could see their premiums go up by over $34,000.
Mr. Speaker, I yield 1 minute to the gentlewoman from Delaware (Ms.
Blunt Rochester).
(Ms. BLUNT ROCHESTER asked and was given permission to revise and
extend her remarks.)
Ms. BLUNT ROCHESTER. Mr. Speaker, I include in the Record a letter
from AARP which makes clear
[[Page H4156]]
health care will be sabotaged under this bill, and healthcare costs for
older Americans will ``dramatically increase.''
[From the House Democratic Leader's Press Office, May 3, 2017]
AARP Press Release: New Changes to the AHCA Makes a Bad Bill Worse!
Dear Representative: Older Americans care deeply about
access to and affordability of health care. With the addition
of the Upton Amendment, as reported, we once again write to
share our opposition to the American Health Care Act (AHCA)
and urge you to vote NO. Changes under consideration that
would allow states to waive important consumer protections--
allowing insurance companies to once again charge Americans
with pre-existing conditions more because they've had cancer,
diabetes or heart disease--would make a bad bill even worse.
This would be devastating for the 25 million Americans 50-64
who have a deniable preexisting condition. The Upton
amendment would do little to reduce the massive premium
increases for those with pre-existing conditions.
Throughout consideration of the AHCA, we have been
expressing serious concerns about the impact that this
legislation will have on older Americans. The Congressional
Budget Office (CBO)'s last estimate further demonstrates the
harmful impact of this bill on older Americans and some of
our most vulnerable. Specifically, the American Health Care
Act will weaken the fiscal sustainability of Medicare;
dramatically increase premium and out-of-pocket costs for 50-
64 year olds purchasing coverage on the individual insurance
market; allow insurance companies to once again discriminate
against those with pre-existing conditions; substantially
increase the number of Americans without insurance; and put
at risk millions of children and adults with disabilities and
poor seniors who depend on the Medicaid program to access
long-term services and supports and other benefits.
Our members and others 50 years of age and older care
deeply about health care and want to know where their elected
leaders stand. Recognizing the importance of the upcoming
vote on the American Health Care Act, AARP intends to inform
our members, and others over age 50, how their elected
officials voted. We'll communicate the results of the vote in
our widely-circulated publications, in e-mail alerts, in our
online channels, and through the media. Again, we urge all
Representatives to vote NO on the American Health Care Act in
its current form.
Medicare
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 would remove billions from the Hospital Insurance
trust fund, hasten the insolvency of Medicare, and diminish
Medicare's ability to pay for services in the future.
Individual Private Insurance Market
Currently, about 25 million Americans age 50-64 have a pre-
existing condition, about 6.1 million 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). Since passage of the ACA,
the number of 50-64 year old Americans who are uninsured has
dropped by half. We are deeply concerned that the AHCA would
be a significant step backwards and result in millions of
older Americans who cannot afford their health care,
including many simply losing their health care. Based on CBO
estimates, approximately 14 million Americans will lose
coverage next year, while a total of 24 million Americans
would lose coverage over the next 10 years.
Affordability of both premiums and cost-sharing is critical
to older Americans and their ability to obtain and access
health care. A typical 50-64 year old 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--reinforced by the CBO
estimate--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 (or more) and reductions in
current tax credits for older Americans. CBO concluded that
the bill will substantially raise premiums for older people
and force many into lower quality plans.
Age rating plus reduced tax credits 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. In addition, the bill reduced
the tax credits available for older Americans to help
purchase insurance. We estimate that the bill's changes to
current law's tax credits alone could increase premium costs
by more than $5,800 for a 64-year old earning $15,000.
Overall, both the bill's tax credit changes and 5:1 age
rating would result in skyrocketing cost increases for older
Americans. In their analysis, CBO found that a 64 year old
earning $26,500 a year would see their premiums increase by
$12,900--758 percent--from $1,700 to $14,600 a year.
Current law prohibits insurance companies from
discriminating against individuals due to a pre-existing
condition. The bill would repeal pre-existing condition
protections and would once again allow insurance companies to
charge Americans more--we estimate up to $25,000 more--due to
a pre-existing condition. As a result, the 4o percent of 50-
to 64-year-olds (about 25 million people) who have a deniable
preexisting condition risk losing access to affordable
coverage. The Upton Amendment, which would add funds to
address the impact of premium increases for those with pre-
existing conditions, would do little to mitigate the massive
premium increase for some of the most vulnerable Americans.
AARP strongly opposes any weakening of the law's pre-existing
condition protections which benefit millions of Americans.
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. CBO found that the bill would cut Medicaid
funding by $880 billion over 2017-2026, about 25 percent less
than what it projects under current law. 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 activities such
as eating, bathing, dressing, managing medications, and
transportation). Older adults and people with disabilities
now account for over sixty percent of Medicaid spending, and
cuts of this magnitude will result in loss of benefits and
services for this vulnerable population.
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.
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.
Ms. BLUNT ROCHESTER. Mr. Speaker, I know in these polarized times we
often forget our actual connections to each other, but we are all
connected. A sick, uninsured employee affects the bottom line of a
small business. Uncompensated care in the emergency room, we all pay
the bill. When a child from an uninsured family goes to school with an
undiagnosed virus, not only does it impact his or her ability to learn,
it impacts other kids and puts them at risk. We are all connected.
As Martin Luther King so powerfully said: ``We may have come over on
different ships, but we are all in the same boat now.''
Mr. Speaker, it is time we start rowing together. Unfortunately, this
bill fails to recognize this. It still fails that we are connected,
and, instead of bringing us together, this simply divides us by
providing less coverage, imposing an age tax, forcing people to pay
more, and stripping key protections.
Mr. Speaker, I urge all my colleagues to vote ``no'' on H.R. 1628.
Mrs. BLACK. Mr. Speaker, I continue to reserve the balance of my
time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 1 minute to the gentleman
from Illinois (Mr. Krishnamoorthi).
(Mr. KRISHNAMOORTHI asked and was given permission to revise and
extend his remarks.)
Mr. KRISHNAMOORTHI. I include in the Record a letter from the
American Medical Association that states: ``Not only would the AHCA
eliminate health insurance coverage for millions of Americans, the
legislation would, in many cases, eliminate the ban against charging
those with underlying medical conditions vastly more for their
coverage.''
[[Page H4157]]
[From the American Medical Association, May 3, 2017]
AMA Warns that Proposed Changes to the American Health Care Act Do Not
Remedy Bill's Shortcomings
Despite Amendments to bill, millions of Americans would still lose
health insurance coverage
Chicago--American Medical Association (AMA) President
Andrew W. Gurman, M.D., issued the following statement today
about proposed changes to the American Health Care Act
(AHCA):
``None of the legislative tweaks under consideration
changes the serious harm to patients and the health care
delivery system if AHCA passes. Proposed changes to the bill
tinker at the edges without remedying the fundamental failing
of the bill--that millions of Americans will lose their
health insurance as a direct result of this proposal.
``High-risk pools are not a new idea. Prior to the
enactment of the Affordable Care Act, 35 states operated
high-risk pools, and they were not a panacea for Americans
with pre-existing medical conditions. The history of high-
risk pools demonstrates that Americans with pre-existing
conditions will be stuck in second-class health care
coverage--if they are able to obtain coverage at all.
``Not only would the AHCA eliminate health insurance
coverage for millions of Americans, the legislation would, in
many cases, eliminate the ban against charging those with
underlying medical conditions vastly more for their
coverage.''
``America should not go backward to the time when our
fellow citizens with pre-existing health conditions faced
high costs for limited coverage, if they were able to obtain
coverage at all. The AMA urges congressional leaders and the
Administration to pursue a bipartisan dialogue on alternative
policies that provide patients with access and coverage to
high quality care and preserve the safety net for vulnerable
populations.''
Background on high-risk pools
A January report from the American Academy of Actuaries
notes that ``enrollment has generally been low, coverage has
been limited and expensive, they require external funding,
and they have typically operated at a loss . . . Removing
high-risk individuals from the insured risk pools reduces
costs in the private market only temporarily. Over time, even
lower-cost individuals in the individual market can incur
high health care costs, which would put upward pressure on
premiums.''
According to the Kaiser Family Foundation: State high-risk
pools featured premiums above standard non-group market
rates--with most states capping them at 150%-200% of standard
rates. Many also featured high deductibles, some $5,000 or
more.
Despite the fact that many individuals were forced into
high-risk pools because of a pre-existing condition, nearly
all states excluded coverage for these conditions for 6-12
months.
Almost all high-risk pools imposed lifetime limits on
covered services, and some imposed annual limits.
Some states capped or closed enrollment.
Combined net losses for the state high-risk pools totaled
more than $1.2 billion for 2011, or $5,510 per enrollee, on
average.
Furthermore, a 2010 paper by James Capretta and Tom Miller
that appeared in National Affairs estimated that the cost of
adequately funded high risk pools would be $15 billion to $20
billion per year.
Mr. KRISHNAMOORTHI. Mr. Speaker, the country will not remember what
we say here today, but it will never forget what we do today,
especially if we make the wrong choice and adopt this bill.
The 159 million Americans whose employer-sponsored health care could
be cut would never forget. Neither would the 24 million Americans who
would lose their coverage or the 52 million people with preexisting
conditions who would struggle to find health insurance again.
If this bill passes, Mr. Speaker, no cancer survivor denied coverage
will forget, no survivor of sexual assault charged more for her ordeal
will forget, and no parent struggling to afford emergency surgery for a
newborn child could ever forget. They would not have that choice.
But today, we have one. We can choose to vote no and prevent millions
of Americans from losing their health care. We can choose the right
path rooted in morality, decency, and reason. I implore you, vote
``no.''
Mrs. BLACK. I continue to reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 1 minute to the gentleman
from New York (Mr. Espaillat).
(Mr. ESPAILLAT asked and was given permission to revise and extend
his remarks.)
Mr. ESPAILLAT. Mr. Speaker, I include in the Record a letter from
AFSCME which states this bill would cause millions to lose their health
coverage and return to the days when even inadequate coverage was
unaffordable.
AFSCME,
May 3, 2017.
House of Representatives,
Washington, DC.
Dear Representative: On behalf of the 1.6 million working
and retiree members of the American Federation of State,
County and Municipal Employees (AFSCME), I am writing to
express our continuing opposition to the American Health Care
Act (AHCA), notwithstanding the addition of the Upton
amendment.
The harm that AHCA will impose on ordinary Americans is
breathtaking in scope. As the Congressional Budget Office has
detailed, 24 million will lose their health care coverage.
The Medicaid program will be cut by $839 billion and
restructured, ending the guarantee that the federal
government will fund a specified share of state Medicaid
costs. The bill makes coverage more expensive, especially for
lower-income families and older workers and it undermines the
financial strength of Medicare. And the MacArthur amendment
makes a very bad bill worse by allowing states to opt out of
Affordable Care Act protections that ensure that people with
pre-existing conditions will be able to obtain comprehensive,
affordable health care. Moreover, the MacArthur amendment
would allow insurance companies to re-impose caps on annual
and lifetime limits, even in employer-sponsored coverage,
putting the health care of those with catastrophic illnesses
or injuries at risk.
Under the Upton amendment, grants to states that could be
used for high-risk pools will be increased by 6% or $8
billion over five years. This is a paltry increase. Even the
conservative Mercatus Center described the increase as a
``pittance.'' High-risk pools would still be grossly
underfunded, even if states put all of the $138 billion in
grant funding into them. We urge the Congress not to ignore
the previous experience with state high-risk pools. By
segregating those with pre-existing conditions into separate
coverage we know they will face higher premiums, benefit
exclusions, annual and lifetime limits on coverage and
waiting lists.
It is unacceptable that this bill eliminates $500 billion
in taxes on the wealthiest 2%, health insurers,
pharmaceutical manufacturers and medical device makers, while
taking health care away from millions. Moreover, the bill
retains the 40% tax on high cost health plans, which will
undermine employer-sponsored insurance for working families
by hollowing out coverage and increasing out-of-pocket
expenses, although it delays the implementation for six
years.
The bottom line is that this bill would cause millions to
lose their health coverage. Most of those with pre-existing
conditions would return to the days when even inadequate
coverage was unaffordable. The bill would drive up costs for
those who are older and lower-income, shift costs to states,
fail to protect employer-sponsored coverage, weaken public
health and undermine the solvency of the Medicare trust fund
all the while providing tax cuts for the wealthy and well-
connected.
The priorities demonstrated by this bill are upside down.
We urge you to oppose this bill.
Sincerely,
Scott Frey,
Director of Federal Government Affairs.
Mr. ESPAILLAT. Mr. Speaker, I strongly oppose this bill. We all
should. Protecting ACA is the top issue for my constituents.
Constituents like Leslie Gauthier who, without the protections of the
ACA, would not have gotten the treatment for leukemia that she was
diagnosed just at the age of 22.
Leslie is now in remission thanks to ObamaCare. For Leslie, the ACA
protections like essential health benefits were a matter of life and
death. This Republican bill would destroy those patient protections.
Under the ACA in my district: a 5-percent drop in uninsured rates;
subsidies based on income and region and not on age; Medicaid Expansion
covering of 156,000 people will be lost.
The President promised not to cut Medicaid. This bill guts it by $880
billion. This bill is a gut punch to America. Pregnant women seeking
health care, kicked to the curb. Patients with preexisting conditions,
kicked to the curb. Senior citizens who will have to pay more for less,
kicked to curb. Over 24 million people, including 6.5 million Latinos,
kicked to the curb.
Mr. Speaker, we demand Republicans stop kicking to the curb
Americans. Stop this bill.
Mrs. BLACK. Mr. Speaker, I continue to reserve the balance of my
time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield to the gentlewoman from
California (Ms. Lee) for the purpose of a unanimous consent request.
(Ms. LEE asked and was given permission to revise and extend her
remarks.)
Ms. LEE. Mr. Speaker, I include in the Record the Service Employees
International Union's letter voicing strong opposition to the deadly
American Health Care Act for their 2 million Members.
[[Page H4158]]
SEIU,
May 2, 2017.
Dear Representative: On behalf of the 2 million members of
the Service Employees International Union (SEIU), America's
largest healthcare union, I write to voice strong opposition
to the American Health Care Act (AHCA). New provisions in the
legislation manage to make a bad bill worse. Not only does
the bill cause millions to lose insurance coverage, face
higher costs, and end Medicaid as we know it, but now it also
strips essential protections for those with pre-existing
conditions. The AHCA will leave millions of men, women, and
children without access to high quality, affordable health
care. The AHCA legislation unequivocally jeopardizes working
families' safety, health, and financial security.
The AHCA will leave millions of Americans without health
insurance and therefore without access to healthcare. The
last available estimate from the nonpartisan Congressional
Budget Office (CBO) estimated about 14 million fewer people
will have health insurance in 2018, and by 2026, 24 million
fewer people will have coverage compared to the current
baseline under the ACA. Unfortunately, we do not have more up
to date information. Despite the importance that healthcare
plays in the lives of working families, Congressional leaders
have indicated that they intend to hold a vote on the
legislation without knowing its impact.
The AHCA also decimates the Medicaid program, rationing and
endangering healthcare for children, seniors, people with
disabilities, and their families as well as for those who
have gained coverage as a result of the Medicaid expansion.
According to CBO, the legislation will cut federal funding
for Medicaid by $880 billion over ten years. Americans know
that Medicaid is working and realize the key role that the
program plays in helping families afford care--including
nursing home care and home and community-based services for
elderly and disabled individuals. Nearly 1 in 5 Americans are
covered under Medicaid and rely on it to get health services.
Under the AHCA, those Americans would lose access to vital
care that may mean the difference between life and death.
Additionally, the AHCA would cap the amount of money states
receive in Medicaid funding from the federal government each
year, regardless of the cost of providing healthcare to those
who qualify. Medicaid is already a lean program especially
when measured on a per capita basis, and cuts from capping
federal funding will quickly force states to cut services,
limit enrollment, and decrease payments to hospitals and
other providers. Also, Medicaid is the largest payer for long
term care in the country. The program pays for more than 60
percent of all nursing home residents and for more than 3.2
million Americans with home- and community-based care, which
allows many older Americans and people with disabilities to
remain in their homes rather than move to a more expensive
institutional setting. States--which must balance budgets and
already face fiscal pressures--will not be able to make up
the lost federal dollars and will be forced to deny care. The
inevitable result will be that the AHCA will make it much
harder and more costly for older Americans, people with
disabilities, and their families to get services they need.
In addition, the legislation will effectively end the
Medicaid expansion, which provides health coverage to
millions of people earning low to moderate incomes. While the
bill purports to allow states to maintain the expansion,
states will only receive an enhanced match, or additional
funding, for people who enroll before 2020 and maintain
continuous coverage. It is widely understood that there is
significant churn on and off the program in this coverage
category, and thus over time the reimbursement rates for
states will drop. The resulting large cost shift to states
may lead them to eliminate coverage for this group
altogether. In fact, seven states have triggers that would
end the Medicaid expansion in their state if federal
reimbursement decreases.
Lastly, Medicaid provider rates are already extremely low
in most states. Cuts to Medicaid, capped funding, and
elimination of the Medicaid expansion would lead to further
reductions in rates for providers, leading to job and other
spending cuts in the health care industry that will have
ripple effects on the broader economy. We have serious
concerns that hospitals, especially those that serve
communities that may not have access to many providers, could
be forced to close or cut back services, further reducing
access to care in underserved areas.
Those who purchase coverage in the individual market do not
fare much better under the proposed bill. The AHCA provides
tax credits ranging from $2,000 to $4,000 to individuals to
purchase private insurance--substantially lower than the
ACA's current levels for the majority of those who receive
them. Unlike the ACA, it is unclear that people with access
to employer insurance that is unaffordable or inadequate will
be eligible for credits, which would mean that they will be
left without access to coverage and care. The bill also
creates an age tax on older Americans by letting insurance
companies charge people over 60 as much as five times what
they charge others for the same coverage. CBO found that
under the initial bill introduced, premiums for those between
age 50 and 65 would sky-rocket. Moreover, it is unclear what
coverage will be available on the individual market or if the
current healthcare marketplaces will even still exist under
this scheme. Between premiums and out of pocket costs like
deductibles, especially for those most in need of care due to
pre-existing conditions, illness, or age, the result could be
higher costs for less coverage.
A bad bill has managed to have been made even worse by the
``MacArthur-Meadows Amendment.'' The amendment guts essential
protections for those with pre-existing conditions. It would
allow states to charge those with pre-existing conditions
higher premiums by allowing states to very easily waive
community rating requirements, which currently prohibits this
practice. Furthermore it would grant states, through a waiver
that is approved by default, the ability to opt out of
essential health benefit requirements, a core set of medical
services, like hospitalizations, mental health, maternity
care and prescription drug coverage, which all insurers are
required to cover under the ACA. If states waive
requirements, insurers could leave those who are sick or with
pre-existing conditions out to fend for themselves and face
exorbitant costs to get life-saving care they need. Experts
agree that the funding included in the ``Upton-Long
Amendment'' is completely inadequate to protect those with
pre-existing conditions. The Administration and Congressional
Leaders promised to the American people that those with pre-
existing conditions would remain protected--this bill even
with added amendments defaults on that promise.
Another failure of the AHCA is that it hurts women by
freezing funding to providers like Planned Parenthood,
risking the health and well-being of the 2.5 million people
who rely on the organization for basic care. One in five
women in the United States has visited Planned Parenthood
clinics and for many low-income women of color, including
many of our members, Planned Parenthood is their essential
health provider. For these individuals, healthcare is not an
ideological struggle or about the politics of one policy
versus another; it is a necessity that could mean the
difference between sickness and health.
The real winners of the AHCA appear to be special interests
and the wealthy. The legislation repeals most if not all of
the ACA tax provisions for special interests like the
pharmaceutical and insurance industries, offsetting these
costs with the massive cuts to Medicaid described above. The
bill also maintains the so-called ``Cadillac tax,'' which
places a tax on workers who have robust health coverage,
merely delaying implementation to 2026. Implementation of the
tax will punish people who have decent insurance, and will
encourage employers to further shift health costs to workers.
Furthermore, the incentives for health savings accounts,
which encourage wealthier people to shelter pre-tax income,
are of little use to working households earning low-to
moderate incomes.
The AHCA is not care, it is chaos. The legislation creates
an environment of uncertainty and unaffordability for
Americans and is a bad deal for working families. The bill
radically restructures Medicaid as we know it and cuts
funding for the program significantly, endangers women's
health, and further enriches corporations, special interests,
and the wealthiest Americans at the expense of working
families' access to healthcare and financial stability. The
American people will hold you accountable for how you proceed
in this moment. We therefore respectfully ask you vote no on
the American Health Care Act and the proposed amendments to
the legislation when it comes to a vote in the House of
Representatives. We will add this vote to our legislative
scorecard. If you need any additional information please
contact Ilene Stein, Assistant Legislative Director.
Sincerely,
Mary Kay Henry,
International President.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 1 minute to the
gentlewoman from California (Ms. Maxine Waters).
(Ms. MAXINE WATERS of California asked and was given permission to
revise and extend her remarks.)
Ms. MAXINE WATERS of California. Mr. Speaker, I will include in the
Record a letter from the Association of American Medical Colleges which
states: ``Treatment of essential health benefits and health status
underwriting dilutes protections for many Americans and would leave
individuals with preexisting conditions facing higher premiums and
reduce access to vital care.''
Mr. Speaker, I rise to caution those Republicans who have allowed
themselves to be persuaded by this President into supporting this
terrible bill which would leave millions of Americans without health
care and raise the cost of care for millions more. You are going to pay
a terrible price for not protecting your constituents.
TrumpCare will cause 24 million Americans to lose their health
coverage and slash Medicaid by $880 billion; for older Americans,
premiums, deductibles, and copayments will skyrocket. Those between the
ages of 50 and 64 will be forced to pay premiums five times higher than
what others pay for the same coverage.
[[Page H4159]]
This crushing age tax will fall on some of the most vulnerable
members of our society, elderly people on fixed incomes who often have
serious health issues.
Meanwhile, hidden in this bill is an outrageous tax break for
billionaires. TrumpCare gives $600 billion in tax cuts to large
corporations and wealthy people, including $2.8 billion to the 400
richest families in America. The MacArthur amendment made this bill
even worse by jettisoning protections for people with preexisting
conditions.
Mrs. BLACK. Mr. Speaker, I continue to reserve the balance of my
time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 1 minute to the gentleman
from Michigan (Mr. Conyers).
Mr. CONYERS. Mr. Speaker, I have been here for five decades, and I
can't recall a time when we have debated something so obviously harmful
to seniors and working people in this country. This bill strips health
care from 24 million people. It requires seniors to pay sometimes 100
percent or more of their income in premiums.
This legislation drastically and dramatically cuts Medicaid, directly
contradicting President Trump's claim not to.
In Michigan, half of all children rely on Medicaid. In my district
alone, 56,000 people will lose coverage, including 16,000 children and
3,200 seniors.
Let's be clear. If we pass this bill, people will die. Health care is
a right and not a privilege.
Mrs. BLACK. Mr. Speaker, I continue to reserve the balance of my
time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 1 minute to the gentleman
from Minnesota (Mr. Walz), the highest ranking enlisted soldier ever
elected to Congress.
(Mr. WALZ asked and was given permission to revise and extend his
remarks.)
Mr. WALZ. Mr. Speaker, I include in the Record a letter from the
Paralyzed Veterans of America urging rejection of the latest version of
the American Health Care Act.
Paralyzed Veterans of America,
Washington, DC, May 3, 2017.
Hon. Paul Ryan,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives,
Washington, DC.
Dear Speaker Ryan and Leader Pelosi: Paralyzed Veterans of
America (PVA) urges rejection of the latest version of the
American Health Care Act (AHCA). PVA is the nation's only
Congressionally-chartered veterans' service organization
solely dedicated to representing veterans with spinal cord
injury and/or disease. Consequently, we are very concerned
about the conflicting information circulating about this
legislation and the adverse impact it could have on our
members and millions of other people with disabilities.
As we understand it, the AHCA cuts $880 billion out of the
Medicaid program in order to finance tax cuts that will
explode the deficit and largely assist upper income
individuals, corporations, and providers. The Medicaid
changes are particularly devastating to people with
disabilities. Under the cap and cut proposal, the federal
government would no longer share in the costs of providing
health care services and community services beyond the capped
amount. This would eliminate the enhanced federal match for
the Community First Choice Option under Medicaid that
provides attendant care services in the community. Thanks to
this program, many poor veterans with serious non-service-
connected disabilities have been able to move from nursing
homes into their communities. The AHCA also weakens Medicaid
by ending the Medicaid expansion earlier and offering
Medicaid block grants to states. Data from the Robert Wood
Johnson Foundation shows expansion has helped thousands of
veterans and their caregivers.
For veterans and PVA members in particular, the AHCA
continues several problematic policies of the ACA as well as
troubling new provisions that could affect the ability of
many veterans and their family members to afford health
insurance in the private market. The underlying AHCA bill:
Continues to exclude CHAMPVA beneficiaries--dependents of
the most catastrophically disabled veterans--from the
dependents' coverage policy up to age 26.
Fails to remove the prohibition on enrollment into the VA
health care system for Priority Group 8 veterans, thus
denying these veterans access to the principal health care
system for veterans.
Denies access to tax credits making health insurance
affordable to anyone eligible for a host of other federal
health programs, including those ``eligible'' for coverage
under Title 38 health care programs. This would prevent many
veterans who may be ``eligible for'' but not enrolled in the
VA health care system from accessing these tax credits
intended to help people buy insurance.
Not only do the changes made to the original version of the
AHCA continue its failure to protect veterans and people with
disabilities, they make these circumstances worse. The latest
changes would allow states to seek waivers that would allow
insurers to charge higher premiums to people with pre-
existing conditions, including people with disabilities. The
new amendments also would allow states to seek waivers from
the ACA's requirement that certain essential health benefits
must be provided, including crucial services for people with
disabilities such as prescription drugs, rehabilitative and
habilitative services and devices, preventative and wellness
services and chronic disease management. The combination of
these changes would make it nearly impossible for people with
pre-existing conditions to find affordable plans that cover
basic health care services.
Throughout these past few months, the American people have
been calling for a bipartisan effort to improve the nation's
health care system. Congress should heed these voices, stop
its pursuit of the flawed American Health Care Act and work
together through regular order to strengthen all Americans'
access to affordable, high quality health care.
Sincerely,
Carl Blake,
Associate Executive Director.
Mr. WALZ. Mr. Speaker, there are many reasons that people may come to
the conclusion this is not the piece of legislation for them. I would
argue most egregious amongst this is the manner in which it was done.
There was clearly an error made on the 7 million veterans you heard
about. I do not question a single Member's commitment in here to caring
for veterans. You did not do it on purpose. You did it because you had
to, to meet the arcane rules of the Senate, so you stripped it out, and
you will, by all intents and purposes, fix it in the Senate.
For you, I would say good luck with that. But for the Members who are
sitting here: Why would we not debate this? Why would we not fix it?
Why would we not go through regular order so all of us would ensure
there is not a loophole that would deny coverage to 7 million veterans.
This is too important to rush. It is too important to make errors like
this. It is darn sure too important to count on the Senate to fix it.
And it was our responsibility.
So here we sat with 30 seconds among 15 of us to make points that are
important to the American public.
Mr. Speaker, I urge my colleagues: reject this. Come back and do it
right, and provide the health care our veterans deserve.
The SPEAKER pro tempore. Members are again reminded to address their
remarks to the Chair.
Mrs. BLACK. Mr. Speaker, I continue to reserve the balance of my
time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 1 minute to the
gentlewoman from Hawaii (Ms. Hanabusa).
(Ms. HANABUSA asked and was given permission to revise and extend her
remarks.)
Ms. HANABUSA. Mr. Speaker, I include in the Record a letter from Save
Medicaid in Schools, a coalition of dozens of organizations. This
letter states that this bill jeopardizes health care for the Nation's
most vulnerable children: students with disabilities and students in
poverty.
May 2, 2017.
Re The American Health Care Act Vote
Hon. Mitch McConnell,
Majority Leader, U.S. Senate,
Washington, DC.
Hon. Paul Ryan,
Speaker, House of Representatives,
Washington, DC.
Hon. Chuck Schumer,
Minority Leader, U.S. Senate,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives, Washington, DC.
Dear Majority Leader McConnell, Speaker Ryan, Minority
Leader Schumer, and Minority Leader Pelosi: The undersigned
member organizations of the Save Medicaid in the Schools
Coalition are concerned that the American Health Care Act
(AHCA) jeopardizes healthcare for the nation's most
vulnerable children: students with disabilities and students
in poverty. Specifically, the AHCA reneges on Medicaid's 50+
year commitment to provide America's children with access to
vital healthcare services that ensure they have adequate
educational opportunities and can contribute to society by
imposing a per-capita cap and shifting current and future
costs to taxpayers in every state and Congressional district.
While children currently comprise almost half of all Medicaid
beneficiaries, less than one in five dollars is spent by
Medicaid on children. Accordingly, a per-capita cap, even one
that is based on different groups of beneficiaries, will
disproportionally harm children's access to care, including
services received at school. Considering these unintended
consequences, we urge a `no'' vote on The American Health
Care Act (AHCA).
[[Page H4160]]
Medicaid is a cost-effective and efficient provider of
essential health care services for children. School-based
Medicaid programs serve as a lifeline to children who can't
access critical health care and health services outside of
their school. Under this bill, the bulk of the mandated costs
of providing health care coverage would be shifted to the
States even though health needs and costs of care for
children will remain the same or increase. Most analyses of
the AHCA project that the Medicaid funding shortfall in
support of these mandated services will increase, placing
states at greater risk year after year. The federal
disinvestment in Medicaid imposed by the AHCA will force
States and local communities to increase taxes and reduce or
eliminate various programs and services, including other non-
Medicaid services. The unintended consequences of the AHCA
will force states to cut eligibility, services, and benefits
for children.
The projected loss of $880 billion in federal Medicaid
dollars will compel States to ration health care for
children. Under the per-capita caps included in the AHCA,
health care will be rationed and schools will be forced to
compete with other critical health care providers--hospitals,
physicians, and clinics--that serve Medicaid-eligible
children. School-based health services are mandated on the
States and those mandates do not cease simply because
Medicaid funds are capped by the AHCA. As with many other
unfunded mandates, capping Medicaid merely shifts the
financial burden of providing services to the States.
Medicaid Enables Schools to Provide Critical Health Care for Students
A school's primary responsibility is to provide students
with a high-quality education. However, children cannot learn
to their fullest potential with unmet health needs. As such,
school district personnel regularly provide critical health
services to ensure that all children are ready to learn and
able to thrive alongside their peers. Schools deliver health
services effectively and efficiently since school is where
children spend most of their days. Increasing access to
health care services through Medicaid improves health care
and educational outcomes for students. Providing health and
wellness services for students in poverty and services that
benefit students with disabilities ultimately enables more
children to become employable and attend higher-education.
Since 1988, Medicaid has permitted payment to schools for
certain medically-necessary services provided to children
under the Individuals with Disabilities Education Act (IDEA)
through an individualized education program (IEP) or
individualized family service program (IFSP). Schools are
thus eligible to be reimbursed for direct medical services to
Medicaid-eligible students with an IEP or IFSP. In addition,
districts can receive Medicaid reimbursements for providing
Early Periodic Screening Diagnostic and Treatment Benefits
(EPSDT), which provide Medicaid-eligible children under age
21 with a broad array of diagnosis and treatment services.
The goal of EPSDT is to assure that health problems are
diagnosed and treated as early as possible before the
problems become complex and treatment is more expensive.
School districts use their Medicaid reimbursement funds in
a variety of ways to help support the learning and
development of the children they serve. In a 2017 survey of
school districts, district officials reported that two-thirds
of Medicaid dollars are used to support the work of health
professionals and other specialized instructional support
personnel (e.g., speech-language pathologists, audiologists,
occupational therapists, school psychologists, school social
workers, and school nurses) who provide comprehensive health
and mental health services to students. Districts also use
these funds to expand the availability of a wide range of
health and mental health services available to students in
poverty, who are more likely to lack consistent access to
healthcare professionals. Further, some districts depend on
Medicaid reimbursements to purchase and update specialized
equipment (e.g., walkers, wheelchairs, exercise equipment,
special playground equipment, and equipment to assist with
hearing and seeing) as well as assistive technology for
students with disabilities to help them learn alongside their
peers.
School districts would stand to lose much of their funding
for Medicaid under the AHCA. Schools currently receive
roughly $4 billion in Medicaid reimbursements each year. Yet
under this proposal, states would no longer have to consider
schools as eligible Medicaid providers, which would mean that
districts would have the same obligation to provide services
for students with disabilities under IDEA, but no Medicaid
dollars to provide medically-necessary services. Schools
would be unable to provide EPSDT to students, which would
mean screenings and treatment that take place in school
settings would have to be moved to physician offices or
hospital emergency rooms, where some families may not
visit regularly or where costs are much higher.
In addition, basic health screenings for vision, hearing,
and mental health problems for students would no longer be
possible, making these problems more difficult to address and
expensive to treat. Moving health screenings out of schools
also reduces access to early identification and treatment,
which also leads to more costly treatment down the road.
Efforts by schools to enroll eligible students in Medicaid,
as required, would also decline.
The Consequences of Medicaid Per Capita Caps Will Potentially Be
Devastating for Children
Significant reductions to Medicaid spending could have
devastating effects on our nation's children, especially
those with disabilities. Due to the underfunding of IDEA,
districts rely on Medicaid reimbursements to ensure students
with disabilities have access to the supports and services
they need to access a Free and Appropriate Public Education
(FAPE) and Early Intervention services. Potential
consequences of this critical loss of funds include:
Fewer health services: Providing comprehensive physical and
mental health services in schools improves accessibility for
many children and youth, particularly in high-needs and hard-
to-serve areas, such as rural and urban communities. In a
2017 survey of school district leaders, half of them
indicated they recently took steps to increase Medicaid
enrollment in their districts. Reduced funding for Medicaid
would result in decreased access to critical health care for
many children.
Cuts to general education: Cuts in Medicaid funding would
require districts to divert funds from other educational
programs to provide the services as mandated under IDEA.
These funding reductions could result in an elimination of
program cuts of equivalent cost in ``non-mandated'' areas of
regular education.
Higher taxes: Many districts rely on Medicaid
reimbursements to cover personnel costs for their special
education programs. A loss in Medicaid dollars could lead to
deficits in districts that require increases in property
taxes or new levies to cover the costs of the special
education programs.
Job loss: Districts use Medicaid reimbursement to support
the salaries and benefits of the staff performing eligible
services. Sixty-eight percent of districts use Medicaid
funding to pay for direct salaries for health professionals
who provide services for students. Cuts to Medicaid funding
would impact districts' ability to maintain employment for
school nurses, physical and occupational therapists, speech-
language pathologists, school social workers, school
psychologists, and many other critical school personnel who
ensure students with disabilities and those with a variety of
educational needs are able to learn.
Fewer critical supplies: Districts use Medicaid
reimbursement for critical supplies such as wheelchairs,
therapeutic bicycles, hydraulic changing tables, walkers,
weighted vests, lifts, and student-specific items that are
necessary for each child to access curriculum as closely as
possible to their non-disabled peers. Replacing this
equipment would be difficult if not impossible without
Medicaid reimbursements.
Fewer mental health supports: Seven out of ten students
receiving mental health services receive these services at
school. Cuts to Medicaid would further marginalize these
critical services and leave students without access to care.
Noncompliance with IDEA: Given the failure to commit
federal resources to fully fund IDEA, Medicaid reimbursements
serve as a critical funding stream to help schools provide
the specialized instructional supports that students with
disabilities need to be educated alongside their peers.
We urge you to carefully consider the important benefits
that Medicaid provides to our nation's most vulnerable
children. Schools are often the hub of the community, and
converting Medicaid's financing structure to per-capita caps
threatens to significantly reduce access to comprehensive
health and mental and behavioral health care for children
with disabilities and those living in poverty. We look
forward to working with you to avert the harmful and
unnecessary impacts the AHCA would impose on Medicaid, which
has proven to benefit children in a highly effective and
cost-effective manner.
If you have questions about the letter or wish to meet to
discuss this issue further, please do not hesitate to reach
out to the coalition co-chairs: John Hill, Sasha Pudelski and
Kelly Vaillancourt Strobach.
Sincerely,
AASA, The School Superintendents Association, Accelify,
American Civil Liberties Union, American Dance Therapy
Association, American Federation of Teachers, American
Foundation for the Blind, American Occupational Therapy
Association, American Psychological Association, Association
of Assistive Technology Act Programs, Association of
Educational Service Agencies, Association of School Business
Officials International (ASBO), Association of University
Centers on Disabilities, Autistic Self Advocacy Network,
Center for American Progress, Center for Public
Representation, Clearinghouse on Women's Issues, Colorado
School Medicaid Consortium, Conference of Educational
Administrators of Schools and Programs for the Deaf, Council
for Exceptional Children, Council of Administrators of
Special Education, Council of Parent Attorneys and Advocates,
Disability Rights Education & Defense Fund.
Division for Early Childhood of the Council for Exceptional
Children (DEC), Health and Education Alliance of Louisiana,
Healthy Schools Campaign, Healthmaster Holdings LLC, Higher
Education Consortium for Special Education, Judge David L.
Bazelon Center for Mental Health Law, LEAnet, a national
coalition of local education agencies,
[[Page H4161]]
Learning Disabilities Association of America, Lutheran
Services in America Disability Network, Michigan Association
of Intermediate School Administrators, Michigan Association
of School Administrators, National Association of Pediatric
Nurse Practitioners, National Association of School Nurses,
National Association of School Psychologists, National
Association of Social Workers, National Association of State
Directors of Special Education (NASDSE), National Association
of State Head Injury Administrators.
National Black Justice Coalition, National Black Justice
Coalition, National Center for Learning Disabilities,
National Association of Councils on Developmental
Disabilities, National Disability Rights Network, National
Down Syndrome Congress, National Education Association,
National Health Law Program, National Respite Coalition,
National Rural Education Advocacy Collaborative, National
Rural Education Association, National School Boards
Association, Paradigm Healthcare Services, School Social Work
Association of America, School-Based Health Alliance, Share
Our Strength, Society for Public Health Education, Teacher
Education Division of the Council for Exceptional Children,
The Arc of the United States, United Way Worldwide.
Ms. HANABUSA. Mr. Speaker, I rise in strong opposition to the
TrumpCare Act. I am fortunate to have been born and raised in Hawaii
where we are taught to never forget our seniors, our kupuna.
AARP, with a national membership of 38 million and over 150,000 in
Hawaii, remains steadfastly opposed to TrumpCare. The amendment
proposed today makes the bill worse. And for our kupuna in Hawaii and
nationally, they will have no relief from the age tax.
This chart shows how much more at age 64 a person will pay in
premiums, almost $6,800 in Hawaii where we have one of the best health
cares. A 55-year-old will see a premium increase of almost $3,600 a
year. Why? What did the seniors do that TrumpCare wants to penalize
them and pay such a premium when they are moving towards retirement?
TrumpCare is out to get those 50 to 64 with this terrible age tax.
Vote against H.R. 1628. These numbers will not be different in your
districts.
Mrs. BLACK. I continue to reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, could you advise us how much time
is remaining on both sides?
The SPEAKER pro tempore. The gentleman from Virginia has 5\1/2\
minutes remaining, and the gentlewoman from Tennessee has 2\1/2\
minutes remaining.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 1 minute to the
gentlewoman from Illinois (Mrs. Bustos).
(Mrs. BUSTOS asked and was given permission to revise and extend her
remarks.)
{time} 1315
Mrs. BUSTOS. Mr. Speaker, I include in the Record letters from the
United Steelworkers, the AFL-CIO, and the International Brotherhood of
Teamsters in relation to this bill.
United Steelworkers,
May 3, 2017.
House of Representatives,
Washington, DC.
Dear Representative: On behalf of the members of the United
Steelworkers union (USW), I continue to urge you to oppose
the American Health Care Act (AHCA), despite proposed
amendments. This legislation will adversely affect every
American's health insurance benefits including workplace
plans, Medicare, Medicaid, and the individual market.
This harmful and partisan legislation will cause tens of
millions to lose insurance coverage over the next decade.
Deductibles and premiums are expected to rise. In short,
rather than reducing costs of health care, this bill will
simply shift costs to working Americans and their families
while cutting taxes for the wealthy and corporations.
The MacArthur Amendment allows states to opt out of certain
protections under the Affordable Care Act such as the
requirements that insurers provide plans with a minimum
package of services and don't discriminate against people
with pre-existing conditions. The amendment also lets states
allow insurance companies to charge older people up to five
times what they charge younger people. This amendment will
allow for an uneven patchwork of insurance coverage across
the country and will make insurance cost prohibitive for many
working and retired Americans. Although lawmakers are working
to address the treatment of individuals with pre-existing
conditions, none of the proposals have adequately addressed
the costs associated with removal of the Affordable Care
Act's protections for those individuals.
Overall, the AHCA is a transfer of wealth from working
Americans to the very wealthy and to corporations including
the pharmaceutical industry, insurance companies, and medical
device manufacturers. It removes taxes on the very wealthy
and on corporations, giving the wealthiest 400 household an
average tax cut of about $7 million each. Meanwhile, the bill
retains the ``Cadillac Tax'' which puts the burden of the
cost of this legislation squarely on the backs of middle
class working families.
Most of our members are covered under employer-negotiated
insurance plans. However, the AHCA removes the employer-
mandate included in the Affordable Care Act. This
dramatically changes the incentive and landscape for
employer-sponsored insurance, which threatens the system that
provides insurance for millions of hard-working Americans.
CBO estimated that 7 million people will lost their workplace
coverage as a result of this bill.
The AHCA also undoes protections and assistance for older
Americans and our members who are retirees with dramatically
increased out-of-pocket costs to Americans who are older but
not yet eligible for Medicare. For those who will or
currently rely on Medicare this bill reduces the solvency of
the program by three years by repealing taxes on the wealthy
and on corporations.
Additionally, this bill makes perilous cuts to Medicaid
which provides health care to low-income Americans who have
been laid off, work at low-paying jobs, are disabled, or are
elderly. This will strain already limited state budgets,
restrict the needy Americans who are eligible for assistance,
and eliminate needed services.
Our members who work in the health care industry may also
be affected by job losses and strained budgets caused by the
passage of this bill. Providers (our employers) may be
subjected to lower reimbursement rates from state Medicaid
programs as a result of the federal cuts. Also, the costs of
uncompensated care will rise as millions of Americans lose
health insurance but still need health care treatment for
illnesses and injuries. Once again, hard-working middle class
health care workers will have to bear the costs of this
harmful legislation.
The amendments to the bill do not change the fundamental
flaws in the legislation enough to make it worthy of your
support. Harmful tax cuts are retained, and the bill would
not do anything to reduce costs or to prevent Americans from
losing health insurance--in fact, this bill would make those
problems worse.
The American Health Care Act is a harmful piece of
legislation that does not solve the problems in our current
health insurance system. Despite amendments, the costs of
this bill would still be borne by working families, making
health care less affordable and less accessible. The United
Steelworkers strongly opposes the AHCA and we urge you to
vote against it.
Sincerely,
Leo W. Gerard,
International President.
____
AFL-CFO,
May 4, 2017.
House of Representatives,
Washington, DC.
Dear Representative: On behalf of the 12.5 million working
people represented by the AFL-CFO, I urge you to oppose the
American Health Care Act (AHCA, H.R. 1628). In a stunning
fashion, this bill takes health coverage away from about 24
million people while providing massive tax cuts for the
wealthy and large corporations. No one in good conscience can
support this legislation.
It is important to understand what is driving Republicans
to pursue a massive roll back in health coverage. While it is
packaged as health care reform, a straightforward look at
this legislation shows that it is fundamentally designed to
pare back public commitments to health coverage in order to
benefit the wealthy.
House Speaker Paul Ryan publically boasted that the AHCA is
a ``trillion dollar tax cut'' that will benefit corporations
and pave the way for further tax ``reform.'' He made clear
that repealing the Affordable Care Act (ACA) taxes is a major
aim of the bill. The tax cuts, however, largely go to higher
earners and corporations. The one ACA tax left intact is the
only one that predominantly impacts working people--the so-
called ``Cadillac'' tax on workplace health benefits.
There are terrible human costs to this upward
redistribution of wealth. Millions of individuals will again
face the dilemma of choosing between getting life-saving
medical treatment and meeting their families' basic financial
needs.
The AHCA replaces ACA subsidies that support a minimum
level of coverage with tax credits so small that at least 3
million people will be unable to afford coverage in the
individual market, according to the Congressional Budget
Office (CBO). Millions more will find that they can only
afford skimpy coverage that will leave them exposed to
substantial costs should they face major sickness,
undoubtedly increasing the number of medical bankruptcies.
The bill allows insurers to require that seniors in the
individual market pay five times as much in premiums as
younger adults, imposing an ``age tax.''
The bill also decimates Medicaid, ending the program as we
know it--placing seniors, people with disabilities, and
children in jeopardy of losing access to care. The AHCA
slashes the program by $839 billion dollars over ten years,
and CBO estimates that these cuts will result in 14 million
people losing their coverage. In using the program as a
[[Page H4162]]
piggy bank, without efforts to improve the services it
provides, the AHCA manages to shift resources away from many
of the nation's most vulnerable people as part of its
redistribution project.
Medicare is not spared either. The bill pulls approximately
$77 billion from the Medicare Hospital Insurance Trust Fund
to provide a tax cut to the wealthy, shortening the lifespan
of the fund. An additional $28 billion is extracted from
Medicare's trust fund for outpatient medical services, to
provide a tax break for pharmaceutical companies.
Employer-based health insurance, the nation's major source
of coverage, also gets hit. The AHCA preserves the so-called
``Cadillac'' tax on workplace health coverage that will
impact more than 42 percent of large employer plans when it
goes into effect. Economists predict the tax will cause
employers to hollow-out the coverage provided in their plans,
exposing workers to higher out-of-pocket costs, such as
deductibles and copays. In some cases, employers are expected
to drop coverage altogether. The bill also eliminates the
penalty that employers face when they do not comply with the
ACA's employer shared responsibility requirements. 030
estimates that seven million people will lose employer-based
coverage under the AHCA.
These sacrifices in health coverage finance stunning tax
cuts for the very wealthy and corporations. The legislation
provides the 400 highest-income households with an average
annual tax cut of $7 million each. Large corporations see
impressive windfalls. The AHCA gives insurance companies
alone $145 billion in tax relief, while medical device makers
get $20 billion, and pharmaceutical companies benefit by
paying less into Medicare.
The reasons for opposing this legislation, which sacrifices
health coverage for millions to support tax cuts for the few,
are clear. We hope you stand with working people when you
make your choice.
Sincerely,
William Samuel,
Director,
Government Affairs Department.
____
International Brotherhood
of Teamsters,
May 4, 2017.
House of Representatives,
Washington, DC.
Dear Representative: On behalf of the 1.4 million members
of the International Brotherhood of Teamsters and their
families, I urge you to vote no on the American Health Care
Act (AHCA) today. The Teamsters have long opposed proposals
to tax worker health benefits and this legislation retains
the 40 percent excise tax on high quality health care plans
which would ultimately reduce the health benefits that hard
working Americans receive and increase their out of pocket
costs. The amendments added to the bill do nothing to allay
Teamster concerns nor address the fundamental flaws of the
underlying bill. The amendments make the bill worse than
before by opening the door to the erosion or elimination of
minimum coverage and pre-existing condition protections and
by allowing insurers to charge older adults much higher
premiums. It does not change the fact that the millions of
American families will lose health insurance.
Congress should be looking for ways to strengthen the
middle class instead of promoting policies that will
ultimately take money from their hard earned paychecks and
reduce, and make more costly, the health care benefits they
receive.
The American Health Care Act remains fatally flawed
Accordingly, I call on you to oppose and vote no on the
American Health Care Act when it comes to the floor today.
Sincerely,
James P. Hoffa,
General President.
Mrs. BUSTOS. Mr. Speaker, this is not how Washington is supposed to
work. We are supposed to improve the lives of hardworking people.
Instead, this reckless and dangerous TrumpCare bill would undermine
both the health and the economic security of millions of Americans,
people like Emily Carlson.
Emily is a small-business owner and mother of two from rural
Abingdon, Illinois. She lives with MS, a lifelong and very expensive
preexisting condition. Before healthcare reform, Emily and her husband,
Kevin, a farmer, often had to sit around the table at night, go over
their bills, and decide between sickness or debt from one month to the
next. If this bill passes, that is a choice they are going to have to
face once again.
For families like the Carlsons, TrumpCare means higher costs, fewer
choices, and worse coverage.
TrumpCare is a bad deal for Americans, but it is devastating for
rural Americans. Right now, there are nearly 700 rural hospitals at
risk of closure. This bill will pull the plug on far too many of them,
killing thousands of jobs and ripping the economic heart out of small
towns across our Nation.
It is time to put hardworking families first. Do the right thing, and
vote against this bill.
Mrs. BLACK. Mr. Speaker, I reserve the balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 1 minute to the
gentlewoman from New Hampshire (Ms. Shea-Porter).
(Ms. SHEA-PORTER asked and was given permission to revise and extend
her remarks.)
Ms. SHEA-PORTER. Mr. Speaker, I include in the Record a letter from
the American Cancer Society, which states cancer patients and survivors
need affordable, accessible insurance coverage with no preexisting
condition exclusions or annual and lifetime caps and that high-risk
pools have failed to meet these basic needs.
American Cancer Society
Cancer Action Network,
Washington, DC, May 3, 2017.
Hon. Paul Ryan,
Speaker of the House, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives,
Washington, DC.
Dear Speaker Ryan and Minority Leader Pelosi: The American
Cancer Society Cancer Action Network (ACS CAN) is deeply
concerned about the reports of additional amendments to the
American Health Care Act (AHCA), including one that would
allegedly add $8 billion in new spending for state high-risk
pools. This amendment is particularly egregious because it
would further incent states to apply for waivers from
current-law market rules that protect patients with pre-
existing conditions.
Historically, state high-risk pools have fallen short of
providing coverage of prevention, treatment and follow-up
care for cancer patients and survivors. Segmenting people
with cancer and other serious illnesses away from the private
marketplace and into high-risk pools absent an adequate and
permanent source of public funding has never been an adequate
solution.
Between 1976 and 2010, 35 states created high-risk pools to
cover individuals who could not otherwise purchase insurance
in the private market, usually because of a pre-existing
condition. Every one of those risk pools experienced net
operating losses year after year. Furthermore, high-risk
pools did not result in lower premiums. All of them set
premiums above the non-group market average or standard rate
in the state, usually by 150-200 percent. Only a few states
provided additional premium assistance for low-income
individuals, leaving many who could not afford premiums
priced out of the program. Most states also imposed waiting
periods before covering pre-existing conditions. An
individual with a prior cancer diagnosis often had to wait 6-
12 months before the high-risk pool would cover the costs
associated with cancer treatment or follow-up survivorship
care. Most states imposed limitations on coverage with either
lifetime or annual limits. And most plans offered deductibles
of $1,000 or higher. Neither AHCA, nor the new amendment
would fully protect patients from any of those conditions.
Cancer patients and survivors need insurance coverage that
is affordable, readily accessible, and protects them from
pre-existing condition exclusions, annual and lifetime caps
on coverage and extraordinary out-of-pocket costs. Past
experience has shown that high-risk pools failed to meet
these basic needs, yet still were a drain on state budgets.
As we have indicated in our earlier letters, there are
reasonable fixes that could be made to the current law. We
stand ready to work with you to develop policies that improve
the law and encourage a robust health insurance market that
provides affordable and comprehensive coverage options.
Sincerely,
Christopher W. Hansen,
President.
Ms. SHEA-PORTER. Mr. Speaker, I oppose this cruel bill on behalf of
my constituents, especially those it would hurt the most: people with
preexisting conditions, older Americans, veterans, and lower income
people.
If this bill passes, we will go back to the days when people with
preexisting conditions could be denied coverage or charged more, when
insurers could decide whether or not to cover basic care like
hospitalization, and when sick babies might hit their insurer's
lifetime coverage limit before they could even walk.
Under this bill, older Americans will pay more. In fact, Americans
aged 50 to 64 would pay premiums five times higher than others.
Veterans will lose access to tax credits that make private coverage
affordable, and lower income people will be hurt.
Taking away Medicaid expansion would put affordable coverage out of
reach for millions and set us back in the fight against the heroin,
fentanyl, and opioid crisis.
Instead of this cruel bill, let's come together to improve health
care, not take health insurance away from millions just to give tax
credits to the wealthiest. We are better than that.
[[Page H4163]]
Mrs. BLACK. Mr. Speaker, I yield 30 seconds to myself.
The American Health Care Act has gone through many fits and starts
over the last few months. This bill begins to fulfill our promise to
the American people by reducing costs for American families. It
eliminates ObamaCare's burdens on small businesses and families and
protects those with preexisting conditions. We must continue to work to
build on this.
I yield 1 minute to the gentleman from California (Mr. McCarthy), our
majority leader.
Mr. McCARTHY. Mr. Speaker, I thank the gentlewoman from Tennessee for
yielding, but, more importantly, I thank Congresswoman Diane Black for
more than four decades as a nurse, for caring for the sick, for her
passion for the unborn, and for her work on this legislation.
Now, Mr. Speaker, Americans are a practical people. We know that we
can have fair health care that helps those who need it without trapping
everyone in a government-run system dreamed up by Washington's central
planners.
Now, contrary to our freedom, ObamaCare forced the American people to
purchase insurance. Contrary to our well-being, ObamaCare imposed taxes
we cannot bear. Contrary to what is responsible and right, ObamaCare
made Medicaid unsustainable for the people most in need. And contrary
to common sense, ObamaCare regulations continued to drive up the cost
of insurance beyond what people can afford.
You want to know how ObamaCare is working? Just read this week's
papers. Now, let me take you all the way back to yesterday. This is the
headline: ``Medica, the last insurer selling individual health policies
in most of Iowa, likely to exit.''
Now, 94 of the 99 counties will have no insurer in Iowa. Ninety-four
of the 94 counties in Iowa will have no insurer.
Here is another headline from yesterday: ``Aetna will exit ObamaCare
markets in Virginia in 2018.''
Humana left the ObamaCare exchanges. Blue Cross left Nebraska. United
Healthcare left all but a handful of markets this year.
Mr. Speaker, we have roughly 3,000 counties in all of America. One-
third, 1,022, only have one provider. Soon, more counties will have
none.
So do you know what doesn't cover preexisting conditions? A
healthcare system that doesn't have coverage. No options means no
coverage. That is the road ObamaCare is leading us down, and doing
nothing leaves too many Americans out in the cold.
Now, Mr. Speaker, we will not stand for that. We tried the ObamaCare
way. It is failing remarkably, and the American people are demanding a
change.
Now we have a chance to do something great. We could have care
without control, stability without centralization, and support without
mandates. We have a chance to listen to the American people and repeal
and replace ObamaCare.
The American Health Care Act will repeal the individual and employer
mandates. It will repeal ObamaCare taxes. It will repeal ObamaCare
rules. It will repeal ObamaCare subsidies. And it will do what is right
by stopping taxpayer funding for abortion providers and by refocusing
Medicaid on those who most need it. We replace all of that with a
system that protects those with preexisting conditions.
Mr. Speaker, I heard a lot about this bill, and this bill is not
2,000 pages. It is less than 130. But, Mr. Speaker, I have heard things
on this floor that are not true.
So let me state it one more time. We will replace all that with a
system that protects those with preexisting conditions and then reduces
premiums through the tried-and-true process of fair competition.
As the price of insurance decreases, we give those who still can't
quite afford it a step up through tax credits and expanded health
savings accounts. This is fundamental and structural reform.
Now, Mr. Speaker, since I have had the honor to stand on this floor
and serve in this House, this body has done many good things. We have
stood time and again for what was best for our country, struggling
against other branches for so long. Many times that required us to dig
in our heels and stop something terrible. It is good to stop bad things
from happening, but it is great to make good things happen. Finally,
after years of waiting, we have the chance to do something good today.
This bill is not perfect. No bill could be. The question is not: Why
can't it be made perfect? The question is: Do we retreat or do we act?
Do we take this great leap to repeal and replace ObamaCare, extend a
hand to our fellow citizens most in need and break free from Washington
control, or do we continue to wait for a day that is already here in
the hope of a better day that may never come?
We were not sent here to wait. We are called to action. This is our
opportunity. Mr. Speaker, I do not want to read another day of
headlines of more people going without insurance, without insurance
without preexisting conditions, without coverage.
Today we will do something good. That is why today we will act.
Mr. SCOTT of Virginia. Mr. Speaker, I remind my colleague that his
vote for this bill could take away protections for preexisting
conditions from almost 6 million people in California who would have
access to coverage. Those with diabetes could see their premiums go up
by $5,000 a year.
Mr. Speaker, I yield to the gentleman from Florida (Mr. Crist) for
the purpose of a unanimous consent request.
(Mr. CRIST asked and was given permission to revise and extend his
remarks.)
Mr. CRIST. Mr. Speaker, this is a terrible bill. This bill will cut
24 million Americans out of health insurance. This bill will gut
Planned Parenthood in the first year, affecting women across the
country. And it will cut $850 billion out of Medicaid hurting the poor
and the disabled in our country. It is unconscionable.
The SPEAKER pro tempore. Is the gentleman from Virginia yielding for
the purpose of debate?
Mr. SCOTT of Virginia. No. Just for the purpose of a unanimous
consent request.
The SPEAKER pro tempore. The gentleman is engaging in debate. The
time of the gentleman will be deducted.
Mr. SCOTT of Virginia. Would the Speaker advise how much time is
remaining?
The SPEAKER pro tempore. The gentleman has 3\1/4\ minutes remaining.
Mr. SCOTT of Virginia. Mr. Speaker, I yield to the gentleman from New
York (Mr. Engel) for the purpose of a unanimous consent request.
(Mr. ENGEL asked and was given permission to revise and extend his
remarks.)
Mr. ENGEL. Mr. Speaker, I rise in strong opposition to this bill, and
I include in the Record a statement of the American Hospital
Association against the bill.
I just want to say this bill can have a very simple slogan: American
people are going to pay more and get less. That is what this bill does.
Statement on the American Health Care Act
(By Rick Pollack, President and CEO, American Hospital Association,
April 27, 2017)
The latest version of the AHCA continues to put health
coverage in jeopardy for many Americans. Our top concern is
what this change could mean for older and sicker patients,
including those with preexisting conditions, such as cancer
patients and those with chronic conditions. For these
reasons, along with our previously stated concerns about the
AHCA, we cannot support the bill. However, we urge Congress
to continue to work with stakeholders on a solution that
provides meaningful coverage.
The amendment proposed this week would dramatically worsen
the bill. The changes included put consumer protections at
greater risk by allowing states to waive the essential health
benefit standards, which could leave patients without access
to critical health services and increase out-of-pocket
spending. This could allow plans to set premium prices based
on individual risk for some consumers, which could
significantly raise costs for those with pre-existing
conditions.
Additionally, the Congressional Budget Office has not yet
scored the amendment. However, CBO previously projected that
the AHCA would result in 24 million fewer people covered in
2026. It is unlikely this amendment would improve these
coverage estimates.
As the backbone of America's health safety-net, hospitals
and health systems must protect access to care for those who
need it and ensure that the most vulnerable patients are not
left behind. The AHCA continues to fall far short of that
goal.
Mr. SCOTT of Virginia. Mr. Speaker, I yield to the gentleman from
Georgia (Mr. David Scott) for the purpose of a unanimous consent
request.
[[Page H4164]]
Mr. DAVID SCOTT of Georgia. Mr. Speaker, I ask unanimous consent to
make one point: It is most shameful to take $882 billion out of
Medicaid to help the poor--
The SPEAKER pro tempore. The gentleman is not making a unanimous
consent request.
Mr. DAVID SCOTT of Georgia.--and give it to the wealthy. That is the
wrong thing to do.
The SPEAKER pro tempore. The gentleman is not recognized.
Mr. SCOTT of Virginia. Mr. Speaker, would the Speaker advise again
how much time is remaining?
The SPEAKER pro tempore. The gentleman has 3\1/4\ minutes remaining.
Mr. SCOTT of Virginia. Mr. Speaker, I yield 2\1/4\ minutes to the
gentleman from South Carolina (Mr. Clyburn).
Mr. CLYBURN. Mr. Speaker, I rise in strong opposition to the
Republican's pay-more-for-less healthcare plan.
I often repeat the 1966 observation of Martin Luther King, Jr., that,
of all the inequalities that exist, the injustice in health care is the
most egregious and inhumane.
On the day it was passed, I observed that the Affordable Care Act is
the Civil Rights Act of the 21st century. Repealing the Affordable Care
Act would be inhumane and put egregious forms of discrimination back
into our healthcare delivery system.
My Republican colleagues and President Trump have promised more
coverage and less cost for everyone. However, this plan would allow all
States to eliminate essential health benefits, such as maternity and
newborn coverage, prescription drugs, hospitalization, emergency
coverage, and mental health services. It would also allow States to tax
older Americans five times more than younger Americans.
Republicans are reneging on their promise to protect Americans with
preexisting conditions. Without essential health benefits standards,
protections for those with preexisting conditions will exist in name
only.
Repeal of the essential health benefits would drive a race to the
bottom, with insurers dropping coverage for everything from
chemotherapy to high-cost drugs.
It would precipitate a proliferation of junk policies that have
historically plagued unsuspecting low-income communities for years.
People with preexisting conditions who need these and other costly
services would not be able to find the coverage they need at any price,
much less an affordable one. We took a giant step away from this with
the ACA, but this Republican bill takes us back to that era where
people with preexisting conditions are left in the cold.
Adding money to a State slush fund is not a solution. Repealing the
ACA would, once again, institutionalize inhumanity and egregiousness.
{time} 1330
Mrs. BLACK. Mr. Speaker, I am prepared to close, and I reserve the
balance of my time.
Mr. SCOTT of Virginia. Mr. Speaker, I yield the balance of my time to
the gentlewoman from California (Ms. Pelosi), the Democratic leader,
for our closing statement.
Ms. PELOSI. Mr. Speaker, I thank the gentleman for yielding. I thank
him, Congressman Scott, I thank Frank Pallone, John Yarmuth, Ritchie
Neal, our ranking members, who have done such excellent work on this
debate on the values of our country.
Mr. Speaker, our colleague, Mr. Clyburn, began his remarks quoting
Reverend Dr. Martin Luther King, and I want to join him. I think those
words bear repeating. Over 50 years ago, Dr. King said: ``Of all of the
forms of inequality, injustice in health care is the most shocking and
the most inhumane because it often results in physical death.''
We come to the floor with the moral force of Dr. Martin Luther King's
words in our hearts: Affordable health care is a civil right, a
fundamental right for every person in our country, not just the
privileged few.
And so, in the spirit of Mr. Clyburn and Dr. King, let us be
prayerful about how we go forward on this very personal issue about the
well-being of every person in our country.
Speaker Ryan once called this bill an act of mercy. There is no mercy
here. Indeed, inequality and inhumanity is exactly what TrumpCare has
in store for the American people. But when he said it is an act of
mercy, here is what others said.
From the beginning, TrumpCare was a moral monstrosity that will
devastate seniors, children, and hardworking Americans. That was from
me. But don't take it from me.
Sister Simone Campbell said: This is not the faithful way forward and
must be rejected.
The Catholic Health Association wrote: We strongly encourage the full
House to reject this replacement bill.
And the United Methodist Church, opposing TrumpCare, this is what
they said: People will die because of efforts like this to roll back
health care.
Lutheran Services in America said: TrumpCare will jeopardize the
health care and long-term services and supports of millions of
Americans.
The Episcopal Church said: TrumpCare falls woefully short of our
spiritual calling to care for the least of these, as well as the noble
values upon which our great Nation was founded.
And all that was said before the Republicans decided to destroy the
protections of Americans with preexisting conditions.
I grant our Republican friends their position. I respect them and
their constituents who sent them here. But I reject the wrong
priorities in TrumpCare--tax cuts for the rich at the expense of the
health insurance for tens of millions of working families across
America.
TrumpCare very clearly spotlights the differences in priorities
between Democrats and Republicans in Congress. It has stepped forward
in the longstanding Republican belief that Medicare should wither on
the vine, that Medicaid should be shrunken, and that Social Security
should be privatized.
If you believe in the health and well-being of the American people,
you must reject this bill before us now. It is what TrumpCare--here is
what it means to the American people. You know, much has been said
about policy here today and over time. Much has been said about
politics, what are the politics of this.
What is really important is what this means to the American people.
And they know they are listening. They know what it means to them.
It means, TrumpCare does, it forces families to pay higher premiums
and deductibles, increasing out-of-pocket costs. Higher costs.
Less coverage. TrumpCare will take away health care from more than 24
million hardworking Americans.
A crushing age tax. TrumpCare forces Americans aged 50 to 64 to pay
premiums five times higher than what others pay for health coverage, no
matter how healthy they are.
It steals from Medicare. TrumpCare shortens the life of the Medicare
trust fund and ransacks funds that seniors depend on to get long-term
care they need. That is why it is consistent with their wither on the
vine for Medicare philosophy.
And then, if that were not bad enough, and they couldn't pass their
bill because it was that bad, they moved further away from the American
people by gutting key protections. TrumpCare eviscerates essential
health benefits such as maternity care, prescription drugs, emergency
coverage, prenatal care, and guts protections for Americans with
preexisting medical conditions.
As bad as TrumpCare was the first time around, you know, it was dead.
It died. It died right here on the floor. Now it has come back to life
like a zombie, even more scary than before, and it is even worse.
If Republicans had their way, Americans with preexisting conditions
will be pushed off their insurance and segregated into high-risk pools,
where they will face soaring costs, worse coverage, and restricted
care.
TrumpCare means huge premium increases. It is a frightening future
for families who need affordable, dependable care the most.
Now, on the floor, the Republicans have recklessly, and some would
say fraudulently, claimed that TrumpCare covers Americans with
preexisting conditions. It does not.
As Robert Graboyes at the conservative Mercatus Center said about the
Upton amendment: ``. . . the $8 billion amount is a pittance. Spread
over 5 years, it is a fifth of a pittance.''
As Karen Pollitz from the Kaiser Family Foundation said, the Upton
[[Page H4165]]
amendment will cover the costs for only 1 percent of the individual
market. Others have given it up to 5 percent; 1 to 5 percent. Does that
mean covering? No.
Forcing a vote without a CBO score shows that the Republicans are
afraid of the facts. They are afraid of learning the full consequences
of their plan to push Americans with preexisting conditions into the
cold or, as my colleague from New York said, off the sidewalk.
If Republicans thought they were really protecting people, they
wouldn't be afraid of the facts. But they are also afraid of the truth,
and the truth that would come forth if we knew the facts. And they are
afraid that the American people would find out that this is not a
healthcare bill, this is a tax bill disguised as a health bill.
This is a bill that is one of the biggest transfers of wealth from
the middle class to the richest people and corporations in America.
This is a tax bill not a healthcare bill. That is why they have to do
it now so they can get on with their tax bill.
But the suffering TrumpCare will inflict on the sick is all too
clear. That is why this disastrous bill has been condemned by the
American Medical Association, the American Cancer Society, the American
Diabetes Association, the American Heart Association, the American Lung
Association, the American Society of Clinical Oncology, the Cystic
Fibrosis Foundation, AIDS United, the Children's Hospital Association,
AARP, the March of Dimes. The list goes on and on--the American Cancer
Society.
Instead of reading all of these pages, I include them for the Record.
Trumpcare--pulled from the House Floor by Speaker Paul Ryan
on March 24--already meant higher health costs, more than 24
million Americans losing their health coverage, gutting key
protections, a crushing Age Tax, and stealing from Medicare.
Amazingly, Republicans have managed to make Trumpcare even
worse. The MacArthur Amendment would completely gut the
protections for people with pre-existing conditions by
allowing states to waive essential health benefits and
community rating rules, which prevent insurers from charging
people with pre-existing conditions more. This will make it
all but impossible for millions of Americans fighting illness
to afford the coverage they desperately need.
As seen below, over the last few days, the number of health
care, consumer, seniors, children, disability and other
groups that are speaking out against Trumpcare continues to
grow.
A Coalition of Patient Advocacy Groups, Including American
Cancer Society, American Heart Association, American Lung
Association, American Diabetes Association, and March of
Dimes: ``In March, our patient advocacy organizations
collectively urged Congress to ensure that any changes made
to the Patient Protection and Affordable Care Act (ACA)
provide affordable, accessible and adequate coverage and do
not result in a loss of coverage for any Americans. The AHCA
would do the opposite, causing at least 24 million Americans
to lose health insurance, according to the non-partisan
Congressional Budget Office. . . . We are alarmed by recent
harmful changes to AHCA . . . These changes include allowing
states to waive the requirement for essential health benefits
. . . Another change allows states to waive protections
against health status rating. Weakening these rules would
enable insurers to charge higher prices to people with pre-
existing conditions, possibly making insurance unaffordable
for those who need it most. . . . The individuals and
families we represent cannot go back to a time when people
with pre-existing conditions could be denied coverage or
forced to choose between purchasing basic necessities and
affording their health care coverage. Given these factors, we
oppose the latest draft of the AHCA. We urge Members of
Congress to reject this legislation.'' [5/1/17]
American Academy of Pediatrics, American College of
Physicians, American Congress of Obstetricians and
Gynecologists, National Association of Nurse Practitioners in
Women's Health, National Partnership for Women & Families:
``Rather than support recent gains in women's access to
healthcare and coverage, the MacArthur Amendment and AHCA
turn back the clock and reverse hard-won progress. . . . The
MacArthur Amendment would enable states to waive EHBs
including those for maternity and newborn care, preventive
services, and services for mental health and substance use
disorders; [and] to waive community rating rules. . . .
Supporters of the bill claim this bill maintains protections
for those with preexisting conditions, but allowing states to
waive coverage of EHB and charge people more based on their
health status renders the promise of coverage for preexisting
conditions to be meaningless. . . . Women and families must
not be made to suffer, lose access to care and coverage, and
pay higher healthcare costs. . . . The AHCA and the MacArthur
Amendment turn the clock back on women's health and should
not move forward.'' [5/1/17]
Association of American Medical Colleges: ``This week, the
House could vote on a new version of the American Health Care
Act that includes the MacArthur amendment. . . . The
[MacArthur] amendment's treatment of essential health
benefits and health status underwriting dilutes protections
for many Americans and would leave individuals with
preexisting conditions facing higher premiums and reduced
access to care. The shortcomings in the underlying bill
remain the same. The original analysis from the Congressional
Budget Office indicated that 14 million Americans would lose
their health insurance coverage as early as next year, and as
many as 24 million by 2024. Nothing in the bill has changed
that alters the fact that this legislation would lead to
fewer Americans with quality insurance, less affordable
coverage for those who have it, and the destabilization of
the current Medicaid program.'' [5/2/17]
Children's Hospital Association: ``On behalf of our
nation's children's hospitals and the patients and families
they serve, Children's Hospital Association (CHA) continues
to oppose the newly modified American Health Care Act (AHCA)
and strongly urges the House of Representatives to reject the
bill. Recently adopted changes only worsen the AHCA by
putting children with preexisting conditions at increased
risk of losing health care coverage and failing to correct
the Medicaid cuts that would impact over 30 million kids. . .
. The block grant option in particular would be devastating
to children as it eliminates Medicaid's EPSDT (Early and
Periodic Screening, Diagnostic, and Treatment) benefit which
ensures children receive immunizations, mental health
assessments and vision, eye and hearing exams as well as
other medical services they might need. CHA urgently asks
members of Congress to vote against the AHCA.'' [4/27/17]
Children's Leadership Council: ``The Children's Leadership
Council opposes the American Health Care Act (AHCA) because
it would jeopardize health care for millions of babies,
children, youth and families. We urge you to vote NO on this
legislation. . . . The ACHA's changes to Medicaid would
radically restructure a program that has worked for more than
50 years to support children's health. The Medicaid cap would
shift $839 billion to states, forcing them to cut
eligibility, benefits, or provider rates that could have
disastrous health consequences. There is no question that the
massive cuts to Medicaid, increased premiums likely for
millions of families, and eliminating the Essential Health
Benefits requirements under current law will seriously harm
children and families. . . . This legislation is a dangerous
step backward.'' [5/1/17]
Consortium for Citizens with Disabilities: ``The Consortium
for Citizens with Disabilities (CCD) is strongly opposed to
the amended American Health Care Act. The amended American
Health Care Act retains the original bill's proposals to
dramatically cut Medicaid services that are vital to people
with disabilities and seniors through per capita caps, which
CCD has opposed. . . . The newest amendments to the American
Health Care Act make the bill even more harmful to people
with disabilities. The new amendments would allow states to
easily obtain waivers that would allow them to charge higher
premiums to people with pre-existing conditions, including
people with disabilities. They would also allow states to
seek waivers from the Affordable Care Act's requirement to
provide essential health benefits, including services for
people with disabilities . . . We urge you to oppose the bill
should it come to a vote.'' [4/28/17]
National Education Association: ``Apparently, snatching
health care coverage from children and families was not
enough for House Republican leaders and the Trump
administration. To make a terrible bill even worse, a new
amendment to the American Health Care Act (AHCA) would allow
states to jettison existing essential health benefit
requirements and permit insurance companies to charge people
with pre-existing conditions more than they charge healthy
people. . . . If the AHCA and new amendment are enacted,
millions of kids and families would effectively lose the
health care coverage they need. The new amendment also
threatens to make insurance for people with pre-existing
conditions prohibitively expensive.'' [4/27/17]
American Society of Clinical Oncology: ``On behalf of the
American Society of Clinical Oncology (ASCO), I write to
express our strong opposition to the American Health Care Act
(AHCA), as currently amended. . . . Studies show that when
cancer patients do not have adequate insurance they receive
less care, receive it later, and have worse outcomes than
those with better insurance coverage. . . . The AHCA as
currently constructed will create or worsen barriers to care.
It will add costs to the system, decrease access to
appropriate treatment and increase existing disparities of
care. We are especially concerned with provisions allowing
state waivers that could erode important protections for
people with cancer, including pre-existing condition
safeguards, coverage of essential services, and access to
affordable health insurance. . . . ASCO strongly opposes
passage of the AHCA in its current form.'' [4/27/17]
American Thoracic Society: ``On behalf of the 16,000
members of the American Thoracic Society (ATS), I want to
voice my grave concerns with the latest legislative proposal
developed to repeal and replace the Affordable Care Act
(ACA). . . . The ATS opposes any
[[Page H4166]]
legislation that does not ensure affordable health insurance
coverage for Americans currently insured under the ACA. We
are concerned that allowing states to waive important
insurance reforms in the Affordable Care Act will lead to
reduced coverage for many Americans and significant price
increases for patients with preexisting conditions. Further,
we are concerned that reliance on ``high risk pools'' will
not adequately meet the health insurance needs of many
Americans with pre-existing conditions. We note that previous
attempts at implementing state-based high risk pools have
been largely unsuccessful. Members of the ATS serve a large
and diverse patient population, including patients with
respiratory diseases, critical illnesses and sleep disorders
such as asthma, COPD, pneumonia, sepsis and obstructive sleep
apnea. Our patients cannot afford to lose affordable health
insurance coverage for any period of time.'' [4/27/17]
Lutheran Services in America: ``Lutheran Services in
America continues to oppose the drastic and unnecessary
restructure of the Medicaid guarantee to a per capita cap
system as proposed in the American Health Care Act (AHCA).
Furthermore, we oppose the bill's new provisions that
eliminate protections for people with pre-existing conditions
as these provisions would be devastating to people with
chronic diseases and disabilities. . . . In addition, the
modified bill maintains the AHCA's drastic cuts and
fundamental restructuring of the Medicaid program, shifting
significant risks and costs to states, and to the people who
need and provide Medicaid services. . . . Lutheran Services
in America respectfully urges members of Congress to reject
this or any legislation that would erode Medicaid, increase
the number of uninsured and/or decrease protections for
preexisting conditions.'' [4/28/17]
Planned Parenthood Federation of America: ``The latest
Republican proposal to repeal the Affordable Care Act is the
worst legislation for women's health in a lifetime. It
eliminates the community rating provision, allowing insurers
to charge people with pre-existing conditions an exorbitant
amount for coverage. Despite the fact that the proposal
claims to maintain the current prohibition on gender rating,
it still allows insurers to once again discriminate against
women and charge more for being a woman. Eliminating the
community rating provision disproportionately affects women,
since insurers can claim having given birth, having had a C-
section, or having been a survivor of domestic violence is a
so-called pre-existing condition. For example, a woman who
had breast cancer could be charged more than $28,000 per year
for coverage and a woman who was previously pregnant could be
charged more than $17,000 per year for . . . They took a bad
bill that would result in 24 million people losing their
insurance and higher premiums and actually made it worse. [4/
27/17]
Federal AIDS Policy Partnership: ``The undersigned 77
organizations are writing to strongly urge you to oppose the
amended American Health Care Act (AHCA) on behalf of the 24
million or more Americans estimated to lose coverage,
including tens of thousands of people with HIV. . . .
Healthcare coverage can be a life or death issue for people
living with HIV, and in the three years that the Patient
Protection and Affordable Care Act (ACA) coverage has been
available it has made a critical difference. . . . We cannot
afford to go back to the pre-ACA sick care system that
focused on treating disability and disease rather than
preventing it. Please support access to healthcare coverage
for the more than 52 million Americans living with pre-
existing conditions, including 1.1 million living with HIV.
We hope we can count on you to oppose the amended American
Health Care Act.'' [5/1/17]
AIDS United: ``AIDS United seeks a health care system that
will eventually enable the end of HIV in the United States.
AHCA makes major changes to the U.S. health care system that
would, if passed, worsen the provision of HIV prevention
services for people at risk for HIV and the treatment and
care for people living with HIV. . . . AIDS United is
especially concerned that the [MacArthur] amendment, far from
improving the situation, will make it easier for insurance
companies to raise rates on people living with HIV, people
with other chronic conditions and the elderly. . . . AIDS
United notes that thanks to Congress's strong response over
many years, the U.S. has made substantial progress in
responding to the HIV epidemic. However, doing so requires a
strong health care system that can ensure that people living
with HIV are able to access care and treatment . . . H.R.
1628 will reverse some of the gains that we have made in
ensuring coverage for both prevention and treatment. AIDS
United urges you to decide to vote no and publicly state
your position prior to any vote.'' [4/28/17]
American College of Nurse-Midwives: ``On behalf of the
American College of Nurse-Midwives, . . . we strongly urge
the House of Representatives to vote NO on the revised
American Health Care Act (ACHA). The legislation, in its
current form, would further impeded access to healthcare and
coverage for millions of women and newborns. Midwives stand
for improving access to quality care and coverage for women
and newborns . . . including, but not limited to, coverage
and access to a full range of preventative, reproductive and
sexual health services under state Medicaid programs and
coverage and access to essential health benefits (EHBs),
including maternity and newborn care. The newly-revised AHCA
language will end this guarantee and radically turn back the
clock on the progress made in women's health. Specifically,
the ``MacArthur Amendment'' would enable states to apply for
the ability to waive EHBs, including those for maternity and
newborn care, to waive community rating rules, and to shift
patient with preexisting conditions or illnesses into high-
risk pools. These provisions, if adopted, could have dire
consequences for women's health and health coverage.'' [4/27/
17]
AARP: ``This harmful legislation still puts an Age Tax on
older Americans and puts vulnerable populations at risk
through a series of backdoor deals that attempt to shift
responsibility to states. Older Americans need affordable
health care services and prescriptions. This legislation
still goes in the opposite direction, increasing insurance
premiums for older Americans and not doing anything to lower
drug costs. AARP continues to oppose legislation that would
impose an Age Tax, eliminate protections for pre-existing
conditions, weaken Medicare, erode seniors' ability to live
independently because of billions of dollars in Medicaid
cuts, and give sweetheart deals to drug and insurance
companies while doing nothing to lower the cost of health
care or prescription drugs. We intend to let all 38 million
of our members know exactly how their Representative votes on
this bill in newsletters, in our publications, on social
media and in other formats.'' [4/26/17]
American Medical Association: ``After reviewing the
MacArthur Amendment to H.R. 1628, the American Health Care
Act (AHCA), the American Medical Association (AMA) remains
opposed to passage of this legislation. As we have previously
stated, we are deeply concerned that the AHCA would result in
millions of Americans losing their current health insurance
coverage. Nothing in the MacArthur amendment remedies the
shortcomings of the underlying bill. The MacArthur Amendment
would allow states to apply for waivers for critical consumer
protections provided in the Affordable Care Act (ACA),
including . . . . the requirements that health insurers must
cover certain essential health benefits, and the ban on
health status underwriting. The current ban on health status
underwriting protects individuals from being discriminated
against by virtue of their medical conditions. Prior to the
passage of the ACA, such individuals were routinely denied
coverage and/or priced out of affordable coverage. We are
particularly concerned about allowing states to waive this
requirement because it will likely lead to patients losing
their coverage.'' [4/27/17]
American College of Physicians: ``The College strongly
believes in the first, do no harm principle. Therefore, we
continue to urge that Congress move away from the
fundamentally flawed and harmful policies that would result
from the American Health Care Act and from the changes under
consideration--including the proposed ``Limited Waiver''
amendment--that would make the bill even worse for
patients.'' [4/24/17]
American Hospital Association: ``The latest version of the
AHCA continues to put health coverage in jeopardy for many
Americans. Our top concern is what this change could mean for
older and sicker patients, including those with pre-existing
conditions, such as cancer patients and those with chronic
conditions. For these reasons, along with our previously
stated concerns about the AHCA, we cannot support the bill. .
. . The amendment proposed this week would dramatically
worsen the bill. The changes included put consumer
protections at greater risk by allowing states to waive the
essential health benefit standards, which could leave
patients without access to critical health services and
increase out-of-pocket spending. This could allow plans to
set premium prices based on individual risk for some
consumers, which could significantly raise costs for those
with pre-existing conditions.'' [4/27/17]
America's Essential Hospitals: ``This latest version of the
AHCA is not an improvement. It's simply bad policy that will
cut a lifeline of health care for millions of Americans. The
legislation also would leave unchanged more than $800 billion
in Medicaid cuts over the next decade, breaking the nation's
safety net and saddling state, local governments, and
taxpayers with new costs for indigent care. The nation has
spoken on the AHCA: only 17 percent of the public support it
and their elected representatives have rejected it once
already.'' [4/26/17]
Catholic Health Association: ``It is critically important
to look at this bill for what it is. It is not in any way a
health care bill. Rather, it is legislation whose aim is to
take significant funding allocated by Congress for health
care for very low income people and use that money for tax
cuts for some of our wealthiest citizens. This is contrary to
the spirit of who we are as a nation, a giant step backward
that should be resisted.'' [4/27/17]
U.S. Conference of Catholic Bishops: ``It is deeply
disappointing to many Americans that, in modifying the
American Health Care Act to again attempt a vote, proponents
of the bill left in place its serious flaws, including
unacceptable modifications to Medicaid that will endanger
coverage and affordability for millions of people, according
to reports,'' said Bishop Dewane. ``Sadly, some of the
recently proposed amendments--especially those designed to
give states flexibility--lack apparent safeguards to ensure
quality of care. These additions could severely impact many
people with pre-existing
[[Page H4167]]
conditions while risking for others the loss of access to
various essential coverages.'' [4/27/17]
American Nurses Association: ``The new bill is an even
further departure from our principles; endangers consumer
protections put into place by the ACA. [4/26/17]
American Cancer Society Cancer Action Network: ``The
American Cancer Society Cancer Action Network (ACS CAN) is
deeply concerned about a proposed amendment to the American
Health Care Act (AHCA) that would create an option for states
to obtain waivers from the Essential Health Benefits (EHB)
and the community rating rule. These two rules work together
to guarantee access to comprehensive and affordable insurance
that covers cancer prevention and treatment for patients and
survivors with pre-existing conditions. . . . In short, the
proposal could lead to bare bones coverage plans that push
significant costs onto patients who access care.'' [4/20/17]
American Lung Association: ``The American Lung Association
requests that Representatives oppose the American Health Care
Act (AHCA) with the new amendment by Rep. MacArthur. The
American Lung Association opposes the MacArthur amendment
because would allow states to opt-out of the Essential Health
Benefits (EHB)--resulting in millions of Americans having
inadequate care. . . . All Americans--regardless of the state
in which they live--need adequate coverage for the range of
essential health services and treatments including life-
saving cancer screening.'' [4/26/17]
March of Dimes: ``Women and children need quality,
affordable insurance coverage to be born healthy and lead
healthy, productive lives. Unfortunately, in its current
form, the MacArthur amendment to American Health Care Act
will deny millions of pregnant women, babies, and their
families the affordable coverage and quality services they
need. . . . The MacArthur amendment will offer states and
health plans numerous opportunities to charge people with
pre-existing conditions higher rates, design plans that
explicitly exclude the services they are most likely to need,
and erect barriers to care.'' [4/26/17]
Families USA: ``America's families must be heard. By now,
it should be clear to House Republicans and the Trump
Administration from all the town halls, letters, phone calls
and tweets that this is not what people want. They do not
want to return to the dark days when insurers were free to
charge the sick and old more for coverage and offered
policies that covered very little, often leaving people to
cope with staggering medical bills. It's time for President
Trump and the GOP to drop this harmful effort to undermine
the nation's health care system. It's time to move on.'' [4/
26/17]
American Psychological Association: ``We are writing on
behalf of the American Psychological Association and the
American Psychological Association Practice Organization to
express our opposition to the American Health Care Act, as
recently revised and proposed for floor consideration. Our
organizations comprise nearly 115,700 members and affiliates,
who are clinicians, researchers, educators, consultants, and
students.'' [4/26/17]
Arc of the United States: ``The Arc of the United States is
strongly opposed to the amended American Health Care Act. The
amended American Health Care Act retains the original bill's
proposals to dramatically cut Medicaid services that are
vital to people with disabilities and seniors through per
capita caps. The new amendments make the AHCA even more
harmful to people with disabilities.'' [4/26/17]
Chronic Illness and Disability Partnership: ``On behalf of
the Chronic Illness and Disability Partnership as well as
allied organizations, we are writing to strongly urge you to
oppose the American Health Care Act (AHCA), with or without
the amendment to allow states to waive community rating and
Essential Health Benefits protections (the MacArthur
Amendment). If enacted, the amended bill will only increase
the 24 million Americans estimated to lose coverage under the
AHCA, including millions of individuals living with chronic
conditions and disabilities. The MacArthur Amendment seeks to
deliver cheaper insurance to healthy Americans by
undercutting crucial Essential Health Benefits requirements
and excluding the most vulnerable Americans from the private
insurance market by allowing states to remove crucial
consumer protections.'' [4/27/17]
Democratic Governors Association: ``This new proposal is
nothing more than the reheated leftovers of the failed
Trumpcare bill. Just like last month's bill, this one would
slash Medicaid funding, throw millions out of health coverage
and leave states holding the bag. The only fresh idea in this
proposal is a new way to raise insurance rates on sick
people. States are happy to work with the federal government
on strengthening health care, but we never asked for the
flexibility to jack up premiums on people with pre-existing
conditions. Congress should again reject this disastrous
proposal that would wreck state budgets and cut millions off
of health coverage.'' [4/27/17]
National Nurse United: ``The original version of the
American Health Care Act posed a mortal threat to the health
and well-being of our patients, and to the health security of
our country. The new version, which incorporates changes
negotiated between the House Freedom Caucus and Congressman
Tom MacArthur, will be even worse for our patients. This new
version has not yet received a score from the Congressional
Budget Office, and it should not be considered by the House
until a CBO score has been made public.'' [4/26/17]
Leadership Council of Aging Organizations: ``While LCAO is
made up of organizations that often have different
perspectives on public policies, as a coalition LCAO strongly
opposes the American Health Care Act (AHCA) of 2017, which
would cause at least 24 million Americans to lose their
health care insurance. We strongly oppose the Medicaid cuts
and caps that remain the core of the American Health Care
Act. Over six million older adults rely on Medicaid. Among
the non-Medicare population, Americans aged 50-64 are the
most likely to face health challenges and have pre-existing
conditions. The AHCA will expose these older Americans to
significantly higher premiums and health care costs, if they
can afford to purchase coverage at all. We are also deeply
disappointed that there is a push to vote on the bill without
a revised estimate from the Congressional Budget Office on
how it will impact Americans. We fear and expect that the
proposed changes will increase the number of uninsured beyond
the current estimate of 24 million. For these reasons, as
well as other harms that would result for older Americans and
their families, LCAO opposes AHCA and urges members to vote
against it.''
Common Sense Kids Action: ``On behalf of the millions of
American kids and families who rely on comprehensive,
dependable health insurance to stay healthy and to get
medical treatment when they need it, we are writing to
respectfully express our strong opposition to your bill, H.R.
1628, the American Health Care Act (AHCA). Thanks to current
law, including the Affordable Care Act, Medicaid, and the
Children's Health Insurance Program (CHIP), 95% of young
children in the U.S. today have health insurance. That's a
remarkable achievement. However, the AHCA will result in 24
million fewer Americans having coverage, including millions
of children. Even with changes recently suggested to your
bill, America's kids will be best served by strengthening the
Affordable Care Act and preserving Medicaid and CHIP, not by
repealing the Affordable Care Act and block granting or
establishing a per capita cap on Medicaid. We urge you to
keep our children's future foremost in your thinking,
withdraw your bill, and work on a bipartisan basis to support
measures that protect and strengthen children's health
care.''
American Hospital Association: ``The latest version of the
AHCA continues to put health coverage in jeopardy for many
Americans. Our top concern is what this change could mean for
older and sicker patients, including those with pre-existing
conditions, such as cancer patients and those with chronic
conditions. For these reasons, along with our previously
stated concerns about the AHCA, we cannot support the bill.
The amendment proposed this week would dramatically worsen
the bill. The changes included put consumer protections at
greater risk by allowing states to waive the essential health
benefit standards, which could leave patients without access
to critical health services and increase out-of-pocket
spending. Additionally, the Congressional Budget Office has
not yet scored the amendment. However, CBO previously
projected that the AHCA would result in 24 million fewer
people covered in 2026. As the backbone of America's health
safety-net, hospitals and health systems must protect access
to care for those who need it and ensure that the most
vulnerable patients are not left behind. The AHCA continues
to fall far short of that goal.''
Ms. PELOSI. Mr. Speaker, under TrumpCare, families, seniors,
vulnerable children, Americans with disabilities, people struggling to
overcome addiction, and the sick will lose their health care. Rural
hospitals will be closed. Nearly 2 million jobs will be destroyed
across America. Seven million veterans will lose access to tax credits
for health care.
And all of this, to give a massive tax cut to the richest in America.
TrumpCare is a billionaire's tax cut, again, disguised as a healthcare
bill. It is Robin Hood in reverse, one of the largest, again, transfers
of wealth from working families to the rich in our country.
Today, we honor the visions of our Founders, we can, who risked
everything. They risked everything, their lives, their liberty, their
sacred honor, to advance the right to life, liberty, and the pursuit of
happiness; the life, a healthier life, the freedom to pursue your
happiness, the freedom from being job-locked or policy-locked because
of what the Republicans want to do today.
Today, we fight to preserve affordable health care as the right of
every American, again, not the privileged few.
Today, we fight for children like Zoe Madison Lihn. Zoe was born with
a congenital heart defect in May of 2010. She faced her first of three
heart surgeries at 15 hours old. By 6 months old, Zoe was halfway to
her lifetime limit her insurer had placed on her. She
[[Page H4168]]
faced a grim future, not only using up her lifetime limit by preschool
but by carrying a preexisting condition that will require attention and
care for the rest of her life.
Under the Affordable Care Act, Zoe is protected, but TrumpCare puts
her future in danger.
I wish that our Members who vote for this bill, I hope you make time
to sit down with the parents of a newborn with a heart condition, or a
young woman who just learned she had breast cancer, the family of loved
ones struggling with a disease or a chronic condition, any of the tens
of millions of Americans who are rightfully terrified of what TrumpCare
will mean in their lives.
Mr. Speaker, we have, with this bill, a right, a wonderful
opportunity. This is one of the best civics lessons we can engage in.
Because of what happened following the election, the American people
are engaged. They are paying attention. I am not saying in a political
way, I am saying in a personal way.
A former Speaker said: All politics is local. In the case of health
care, all politics is personal when it comes to health care. And so,
this civics lesson will teach the American people a number of things.
As special as we think we are when we come to the floor here, most
Americans don't know who their Member of Congress is. But they will
now, when they find out that you voted to take away their health care.
They will know when you put an age tax on them, or undermine Medicare
and Medicaid and the rest.
Oh, yeah, they are paying attention because it is really personal
with them and their families. So I think we have to get ready for that.
I have Members, I have colleagues who have the mantle of being a
moderate. You vote for this bill, you have walked the plank from
moderate to radical. And you are walking the plank for what? A bill
that will not be accepted by the United States Senate. Why are you
doing this?
Do you believe in what is in this bill?
Some of you have said: Well, they will fix it in the Senate. But you
have every provision of this bill tattooed on your forehead. You will
glow in the dark on this one. You will glow in the dark. So don't walk
the plank, especially unnecessarily.
Our responsibility to the sick and the hurt is Biblical. It is
fundamental to who we are.
As Pope Francis said: ``Health is not a consumer good but a universal
right, so access to health services cannot be a privilege.''
Today, let us declare, once again, that affordable health care must
be the right of every American, not the privileged few.
So I ask you, my colleagues, does TrumpCare lower health costs?
Does TrumpCare provide better health care?
Does TrumpCare protect seniors and families?
Is TrumpCare good for our veterans?
Is there any caring in TrumpCare at all?
For the sake of our values, to honor our responsibilities to our
Founders, life, liberty, and the pursuit of happiness, to our veterans
who protect us, and to our children whose aspirations are our guide, I
urge my colleagues to vote ``no'' on this disastrous TrumpCare bill.
The SPEAKER pro tempore. Members are reminded to address their
remarks to the Chair.
Mr. SCOTT of Virginia. Mr. Speaker, I yield back the balance of my
time.
Mrs. BLACK. Mr. Speaker, it really is my privilege now to yield 1
minute to the distinguished gentleman from Wisconsin (Mr. Ryan), the
Speaker of the House.
Mr. RYAN of Wisconsin. First off, there are a few people I would like
to thank. I would like to thank the committee chairs. I would like to
thank Chairman Walden, Chairman Brady, Chairman Black, Chairman
Sessions.
I want to thank the members of those committees: Energy and Commerce,
Ways and Means, Budget, and Rules.
I want to thank all the Members who made constructive contributions
throughout this entire deliberative, bottom-up organic process.
I want to thank the President of the United States for his steadfast
leadership.
{time} 1345
Mr. Speaker, in his address in this Chamber, he called on Congress to
act; and today we take the next step to repeal and replace ObamaCare.
I want to thank Vice President Pence, Secretary Price, Director
Mulvaney, and all of their teams.
Mr. Speaker, there is a fundamental and urgent choice at the heart of
this debate. We can continue with the status quo under ObamaCare, and
we know what this looks like. It means even higher premiums, even fewer
choices, even more insurance companies pulling out, even more
uncertainty, and even more chaos.
Look at what has happened in Iowa this week. As is the case in so
many areas in this country, Iowa is down to one insurer. That, of
course, is not a choice. But now that one insurer is saying that it
will have to pull out of 94 of the 99 counties in Iowa. This is
happening right now. So tens of thousands of Iowans will go from having
one option to no options. That is not a choice. This is a crisis, and
it is happening right now.
What protection is ObamaCare if there is no healthcare plan to
purchase in your State?
This is the direction ObamaCare is rapidly heading. So we can
continue with this status quo or we can put this collapsing law behind
us and end this failed experiment. Let's make it easier for people to
afford their health insurance. Let's give people more choices and more
control over their care. Let's make insurance companies come in and
compete for your business. Let's return power from Washington to the
States. Let's help give people peace of mind. Let's put the patient,
not bureaucrats, at the center of this system. This bill does all of
those things. This bill delivers the promises that we have made to the
American people.
A lot of us have been waiting 7 years to cast this vote. Many of us
are here because we pledged to cast this very vote to repeal and
replace ObamaCare, to rescue people from this collapsing law.
Are we going to meet this test? Are we going to be men and women of
our word? Are we going to keep the promises that we made? Or are we
going to falter?
No. After all of this--after seeing what is happening in Iowa and
around the country, after seeing this law collapsing while we witness
it across the country and knowing all this turmoil that is coming, we
will not falter. We will replace; and today is the day that we are
going to do this.
Today this House has the opportunity to do more than just fulfill a
promise. We have the opportunity to raise our gaze and set a bold
course for our country. We have the opportunity to show that we have
got the resolve to tackle the big challenges in this country before
they tackle us; to stop the drift of arrogant, Big Government policies
in our lives, and to begin a new era of reform based on liberty and
self-determination, giving people choices and letting them control
their own destinies.
That is the day that is before us right here. So let us pass this
bill to take the next step to put ObamaCare behind us; let us pass this
bill to build a better healthcare system for American families; and let
us pass this bill to leave this country better than we found it because
that is why we are here.
That is what is at stake today. That is why I am going to be so proud
to cast my vote for this legislation, and I urge all of my colleagues
to do the same.
Mrs. BLACK. Mr. Speaker, I yield back the balance of my time.
Mrs. BEATTY. Mr. Speaker, I rise today in strong opposition to the
Republicans' latest version of Trumpcare.
Trumpcare will cover fewer people, provide weaker protections, and
result in higher costs.
Trumpcare will eviscerate essential health benefits and protections
for pre-existing conditions and make it all but impossible for millions
of Americans fighting illness to afford the health coverage they
desperately need.
Trumpcare will mean higher costs for less coverage.
It will result in 24 million hard-working Americans losing health
coverage.
It will destroy protections for Americans with pre-existing
conditions and gut Essential Health Benefits, such as maternity,
prescription drug coverage, and emergency coverage.
[[Page H4169]]
Trumpcare will create a crushing age tax--it will force Americans
aged 50-64 to pay premiums five times higher than what others pay for
health coverage, no matter how healthy they are.
Mr. Speaker, healthcare should be a right for all, not just the
privileged few. I will vote against Trumpcare and urge all my
colleagues to vote no.
Ms. LEE. Mr. Speaker, I rise once again in strong opposition to H.R.
1628, which is a bill to take away health care from 24 million
Americans.
Whether you believe it or not, health care is a basic right.
This shameful bill steals from the most vulnerable among us,
including seniors, veterans, people living with HIV, children, and the
disabled. And this new bill is even more dangerous and destructive than
when they brought it to the Floor last time.
It would, yes, rip away health care from 24 million people. It would
reduce benefits, make families pay more for less, and transfer $600
billion in tax cuts to the very wealthy.
This is outrageous.
Access to women's health is denied by defunding Planned Parenthood.
Medicaid, as we know it, will end. Healthcare costs for working
families and seniors will skyrocket.
It allows states to eliminate essential health benefits like
maternity care, cancer screenings, and emergency care.
Mr. Speaker, this is not a health bill at all. This is a massive tax
giveaway to the wealthy.
Let me tell you, as a woman of faith, I am appalled and I am saddened
by the hypocrisy displayed in this bill by people who say they are
religious.
I want to remind you--in the Scriptures, the Book of Mark, chapter
12:31, we are reminded to love your neighbor as yourself.
I hope Republicans remember to love their neighbor as themselves
today and vote ``no'' on this mean-spirited, evil and morally bankrupt
bill.
This is a matter of life and death, and the American people deserve
better.
Mr. DANNY K. DAVIS of Illinois. Mr. Speaker, first of all, the
Affordable Healthcare Act is the best thing that has happened to
healthcare in the U.S. since the mid 1960's when Congress passed
Medicare and Medicaid. More than twenty million people in our country
have health insurance coverage now who never had it before.
In Illinois, 36 percent of children receive coverage through Medicaid
with approximately 3.1 million people covered overall.
There are 649,000 Illinoisans enrolled under the Affordable Care Act,
this bill AHCA would repeal and replace the ACA.
Implementation of the AHCA will lead to a loss of coverage for 24
million people nationwide.
Overall 44,296 Illinoisans covered under the ACA and 252,612 covered
under Medicaid expansion will be in danger of curtailed coverage.
Healthcare professionals and activists have worked hard over the past
fifty years to improve healthcare access and delivery and it would be a
shame to have us go backwards.
Passage of the AHCA would probably cause real estate taxes in Cook
County to go up in order to keep Stroger Hospital and its other health
services adequately funded to meet the health needs of the medically
indigent in Cook County.
Practically every professional healthcare group in America is opposed
to the AHCA.
It will spell disaster for residents of Illinois.
Mr. NADLER. Mr. Speaker, the Republicans have rushed this bill to the
floor before they even had a chance to print the text, let alone get a
CBO score. They are pushing this bill through without any analysis so
that the American people won't know how terrible this bill really is--
how many millions of people will lose their health insurance, how much
premiums will skyrocket for those with pre-existing conditions, how
little money they will actually save. And all to score empty political
points or to impress Donald Trump, a man who has demonstrated again and
again that he does not know or care what is in this bill, and just
wants to ``win.''
This bill is the same terrible legislation the Republicans failed to
pass in March, but with amendments to make it even more cruel to the
American people. The bill will kick 24 million people off their health
insurance and eliminate employer-provided coverage for seven million
people. The bill creates an ``age tax'' that would allow insurers to
charge older Americans five times as much as a younger person for the
same plan. The bill raises premiums 30 percent for people who allow
their insurance to lapse for any reason. The bill cuts $880 billion out
of Medicad and forces states to ration care to the millions of families
and children who rely on it, in clear violation of Donald Trump's
campaign pledge. The bill gives the wealthiest Americans a trillion
dollar tax cut and cuts taxes on drug companies and health insurance
companies that pay their CEOs more than $500,000.
But that bill wasn't terrible enough to get the votes of the right
wing of the Republicans in the House, so the Republicans made it even
crueler. The amendments the Republicans will add today allow states to
waive the essential health benefits requirements for insurance plans,
meaning you could lose coverage for services as basic as hospital
stays, prescription drugs, or doctor visits. States will also be able
to waive the guarantee against discrimination against people with pre-
existing conditions. Of course, the Republicans are saying that
insurance companies cannot deny people coverage, but insurers will be
able to charge people whatever they want. The Center for American
Progress estimates that premiums could increase by over $36,000 per
year for people diagnosed with breast cancer. Pregnancy will result in
a $17,000 increase in premiums. Asthma, a $4,000 increase. The high
risk pools Republicans are touting will do nothing to protect people by
sequestering the sickest Americans in pools and then drastically
underfunding them. The Republicans are hiding from these numbers behind
the so-called Upton Amendment, which provides a paltry $8 billion to
cover some extra costs for those with pre-existing conditions. But even
the conservative Mercatus Foundation found that to be less than a
pittance compared with the skyrocketing costs for those who need it.
Every day, we are finding new egregious consequences of this
legislation. Last night, the New York Times reported that passing this
bill will cut special education programs to over 2500 students with
disabilities. Yesterday, the Center for Budget and Policy Priorities
reported that the tax credits Republicans are proposing in this bill
will be totally unusable in states like California and New York because
of state laws that require coverage of abortion. Reports have come out
that sexual assault and domestic violence would, once again, be
considered a pre-existing condition, making insurance unaffordable for
survivors. The Wall Street Journal reported that the bill could allow
employers to reinstate lifetime caps and eliminate out-of-pocket caps
for their employees' insurance plans, leaving the 159 million Americans
who get insurance through their employer with no insurance coverage
when they need it most. That's right--if you think that because you
don't buy insurance on the exchange and therefore don't have to worry
about this bill, you're wrong. I have no doubt that in the time it
takes to read this statement another round of articles and reports will
come out finding even more abhorrent consequences of this contemptible
piece of legislation.
So I ask my Republican colleagues--who are you passing this bill for?
Are you so out of touch with the lives of real Americans that you no
longer understand what it means to struggle to pay your medical bills?
Have you traveled so far from the values you claim to uphold that you
are willing to force parents to watch their children die of curable
diseases because they have reached the lifetime cap on covered costs
that your bill reinstates, and they can no longer afford to pay for
treatment? Are you willing to gamble away their lives and the lives of
their children just to say you passed a bill to repeal the Affordable
Care Act?
Shame on any member who votes for this cowardly, cruel bill and tries
to sell this bill to their constituents as a win for the American
people. Shame on this House for even considering a bill that could
leave the most vulnerable in our country--children born with
disabilities, women fleeing domestic violence, older Americans too sick
to buy insurance but too young to enroll in Medicare--at the mercy of
insurance companies and fate. Shame on you for playing political games
with people's lives.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise in opposition
to the American Care Act. After seven years, the Republicans have
released a plan that works to kick people off health insurance very
quickly, increases out-of-pocket costs, and punishes older and sicker
Americans. This is not the package that I envisioned.
Some of the key features of the Affordable Care Act that millions of
people relied on would be gone under this proposal. Under the
Affordable Care Act, states could expand Medicaid, but this proposal
would freeze enrollment to expanded Medicaid at January 1, 2020. On
that date, enrollees who drop off of Medicaid due to income changes
would not be able to return to Medicaid coverage if they dropped on for
one full month. The proposal also changes Medicaid funding to a per
capita cap system which will lead to deep cuts to Medicaid in my home
state of Texas. This punishes low-income Americans who would otherwise
have no access to health insurance.
This piece of legislation forces Americans to pay more and get less.
The average subsidy under the American Health Care Act will likely be
about 60 percent of the average subsidy under current law. Deductibles
and out-of-pocket spending in the individual market will have to
increase due to the elimination of requirements that insurance plans
cover a certain value. Americans will pay more for their
[[Page H4170]]
premiums, more for their care, more on out-of-pocket expenses and
deductibles; all the while giving tax breaks to the wealthy and the
tanning industry.
One amendment to this bill would repeal the Essential Health
Benefits, the ten coverage rules set up by the Affordable Care Act. The
Affordable Care Act required insurers to cover ten ``Essential Health
Benefits'' from maternity care, mental health, and prescription drugs,
to hospitalization and outpatient care. If this is repealed,
comprehensive health insurance will become virtually unavailable in the
individual market. This means that individuals with pre-existing
conditions would not be protected. Younger and healthier people
benefit, older and sicker people suffer.
Another amendment would allow states to waive out of the Affordable
Care Act's ban on pre-existing conditions. However, Members of Congress
and their staff would be protected from this provision and would be
guaranteed coverage of pre-existing conditions.
Mr. Speaker, the public has spoken about this so-called
``replacement'' bill. People will live or die as a result of this
legislation. The Republican leadership has rushed this bill to the
floor without any consideration and I urge you all to consider its
harmful effects. Your constituents are asking you to work with us to
repair the Affordable Care Act. Work with us.
Ms. ESHOO. Mr. Speaker, include in for the Record a letter from
common sense kids action:
Common sense kids action,
April 25, 2017.
Re H.R. 1628--OPPOSE
Hon. Diane Black,
Chairwoman, House Budget Committee, House of Representatives,
Washington, DC.
Dear Representative Black: On behalf of the millions of
American kids and families who rely on comprehensive,
dependable health insurance to stay healthy and to get
medical treatment when they need it, we are writing to
respectfully express our strong opposition to your bill, H.R.
1628, the American Health Care Act (AHCA). We have added this
bill to our Common Sense Legislative Ratings Tool as an
``Against Kids'' bill and will communicate our position to
our parent and teacher members.
Common Sense is the nation's leading independent nonprofit
organization dedicated to helping kids thrive in a rapidly
changing world. We empower parents, teachers, and
policymakers by providing unbiased information, trusted
advice, and innovative tools to help them harness the power
of media and technology as a positive force in all kids'
lives. The policy arm, Common Sense Kids Action, is building
a movement of parents, teachers, business leaders, and others
dedicated to making kids our nation's top priority by
supporting policies at the state and federal level that
contribute to the building blocks of opportunity for kids.
Access to affordable and quality medical care for kids is
certainly one of those key building blocks.
Thanks to current law, including the Affordable Care Act,
Medicaid, and the Children's Health Insurance Program (CHIP),
95% of young children in the U.S. today have health
insurance. That's a remarkable achievement. With health
insurance, parents are more likely to seek medical care for
themselves and for their children, helping to prevent
illnesses from developing and shortening their duration when
they occur. However, the AHCA will result in 24 million fewer
Americans having coverage, including millions of children.
This jeopardizes the health and well-being of America's kids
and will alarm any parent who understands the importance of
health insurance for their children and family. The
Affordable Care Act certainly needs to be fixed, but if
Congress has the goal of making sure that all families and
businesses have access to affordable and comprehensive health
insurance, it could improve the law for everyone without
forcing millions of kids and their parents to lose access to
critical medical care.
As Congress continues to grapple with this issue, health
insurance programs, we think these facts about children's
health insurance from the Congressional Budget Office and the
Georgetown University Center for Children and Families are
important to keep in mind:
Ninety-five percent of children age 0-5 are insured today.
Forty-five million of those children access health care
through two programs: about 37 million through Medicaid (a
federal-state program) and 8 million through CHIP, the
Children's Health Insurance Program.
Children are the single-largest group of persons covered
under Medicaid.
Under the Affordable Care Act, as you know, many states
expanded Medicaid with help from the federal government,
increasing coverage for kids and families, including coverage
for mental health care.
Changes being considered, including under the AHCA, would
cut funding to Medicaid by as much as $880 billion over the
next 10 years.
The AHCA, when compared with current law, would result in
24 million fewer Americans with health insurance by the year
2026.
Even with changes recently suggested to your bill,
America's kids will be best served by strengthening the
Affordable Care Act and preserving Medicaid and CHIP, not by
repealing the Affordable Care Act and block granting or
establishing a per capita cap on Medicaid. We urge you to
keep our children's future foremost in your thinking,
withdraw your bill, and work on a bipartisan basis to support
measures that protect and strengthen children's health care.
Thank you for your consideration of our views and we would be
happy to talk with you at any time about this and other
issues that matter to America's children and families.
Sincerely,
Danny Weiss,
Vice President, Federal Policy.
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to House Resolution 228, 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.
Recorded Vote
Mr. SCOTT of Virginia. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.
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