[Congressional Record Volume 163, Number 179 (Friday, November 3, 2017)]
[House]
[Pages H8449-H8475]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
{time} 0915
COMMUNITY HEALTH AND MEDICAL PROFESSIONALS IMPROVE OUR NATION ACT OF
2017
Mr. WALDEN. Mr. Speaker, pursuant to House Resolution 601, I call up
the bill (H.R. 3922) to extend funding for certain public health
programs, and for other purposes, and ask for its immediate
consideration in the House.
The Clerk read the title of the bill.
The SPEAKER pro tempore (Mr. Byrne). Pursuant to House Resolution
601, in lieu of the amendment in the nature of a substitute recommended
by the Committee on Energy and Commerce printed in the bill, the
amendment printed in part A of House Report 115-382, modified by the
amendment printed in part B of the report, is adopted, and the bill, as
amended, is considered read.
The text of the bill, as amended, is as follows:
H.R. 3922
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Continuing Community Health
And Medical Professional Programs to Improve Our Nation,
Increase National Gains, and Help Ensure Access for Little
Ones, Toddlers, and Hopeful Youth by Keeping Insurance
Delivery Stable Act of 2017'' or the ``CHAMPIONING HEALTHY
KIDS Act''.
SEC. 2. TABLE OF CONTENTS.
The table of contents for this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
DIVISION A--CHAMPION ACT
Sec. 100. Short title.
TITLE I--EXTENSION OF PUBLIC HEALTH PROGRAMS
Sec. 101. Extension for community health centers, the National Health
Service Corps, and teaching health centers that operate
GME programs.
Sec. 102. Extension for special diabetes programs.
Sec. 103. Extension for family-to-family health information centers.
Sec. 104. Youth empowerment program; personal responsibility education.
TITLE II--OFFSETS
Sec. 201. Providing for qualified health plan grace period requirements
for issuer receipt of advance payments of cost-sharing
reductions and premium tax credits that are more
consistent with State law grace period requirements.
Sec. 202. Prevention and Public Health Fund.
DIVISION B--HEALTHY KIDS ACT
Sec. 300. Short title.
TITLE I--CHIP EXTENSION AND OTHER MEDICAID AND CHIP PROVISIONS
Sec. 301. Five-year funding extension of the Children's Health
Insurance Program.
Sec. 302. Extension of certain programs and demonstration projects.
Sec. 303. Extension of outreach and enrollment program.
Sec. 304. Extension and reduction of additional Federal financial
participation for CHIP.
Sec. 305. Modifying reductions in Medicaid DSH allotments.
Sec. 306. Puerto Rico and the Virgin Islands Medicaid payments.
TITLE II--OFFSETS
Sec. 401. Medicaid third party liability provisions.
Sec. 402. Treatment of lottery winnings and other lump-sum income for
purposes of income eligibility under Medicaid.
Sec. 403. Adjustments to Medicare Part B and Part D premium subsidies
for higher income individuals.
DIVISION A--CHAMPION ACT
SEC. 100. SHORT TITLE.
This division may be cited as the ``Community Health And
Medical Professionals Improve Our Nation Act of 2017'' or the
``CHAMPION Act''.
TITLE I--EXTENSION OF PUBLIC HEALTH PROGRAMS
SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS, THE
NATIONAL HEALTH SERVICE CORPS, AND TEACHING
HEALTH CENTERS THAT OPERATE GME PROGRAMS.
(a) Community Health Centers Funding.--Section
10503(b)(1)(E) of the Patient Protection and Affordable Care
Act (42 U.S.C. 254b-2(b)(1)(E)) is amended by striking
``2017'' and inserting ``2019''.
(b) Other Community Health Centers Provisions.--Section 330
of the Public Health Service Act (42 U.S.C. 254b) is
amended--
(1) in subsection (b)(1)(A)(ii), by striking ``abuse'' and
inserting ``use disorder'';
(2) in subsection (b)(2)(A), by striking ``abuse'' and
inserting ``use disorder'';
(3) in subsection (c)--
(A) in paragraph (1), by striking subparagraphs (B) through
(D);
(B) by striking ``(1) In general'' and all that follows
through ``The Secretary'' and inserting the following:
``(1) Centers.--The Secretary''; and
(C) in paragraph (1), as amended, by redesignating clauses
(i) through (v) as subparagraphs (A) through (E) and moving
the margin of each of such redesignated subparagraph 2 ems to
the left;
(4) by striking subsection (d) and inserting the following:
``(d) Improving Quality of Care.--
``(1) Supplemental awards.--The Secretary may award
supplemental grant funds to health centers funded under this
section to implement evidence-based models for increasing
access to high-quality primary care services, which may
include models related to--
``(A) improving the delivery of care for individuals with
multiple chronic conditions;
``(B) workforce configuration;
``(C) reducing the cost of care;
``(D) enhancing care coordination;
``(E) expanding the use of telehealth and technology-
enabled collaborative learning and capacity building models;
``(F) care integration, including integration of behavioral
health, mental health, or substance use disorder services;
and
``(G) addressing emerging public health or substance use
disorder issues to meet the
[[Page H8450]]
health needs of the population served by the health center.
``(2) Sustainability.--In making supplemental awards under
this subsection, the Secretary may consider whether the
health center involved has submitted a plan for continuing
the activities funded under this subsection after
supplemental funding is expended.
``(3) Special consideration.--The Secretary may give
special consideration to applications for supplemental
funding under this subsection that seek to address
significant barriers to access to care in areas with a
greater shortage of health care providers and health services
relative to the national average.'';
(5) in subsection (e)(1)--
(A) in subparagraph (B)--
(i) by striking ``2 years'' and inserting ``1 year''; and
(ii) by adding at the end the following: ``The Secretary
shall not make a grant under this paragraph unless the
applicant provides assurances to the Secretary that within
120 days of receiving grant funding for the operation of the
health center, the applicant will submit, for approval by the
Secretary, an implementation plan to meet the requirements of
subsection (k)(3). The Secretary may extend such 120-day
period for achieving compliance upon a demonstration of good
cause by the health center.''; and
(B) in subparagraph (C)--
(i) in the subparagraph heading, by striking ``and plans'';
(ii) by striking ``or plan (as described in subparagraphs
(B) and (C) of subsection (c)(1))'';
(iii) by striking ``or plan, including the purchase'' and
inserting the following: ``including--
``(i) the purchase'';
(iv) by inserting ``, which may include data and
information systems'' after ``of equipment'';
(v) by striking the period at the end and inserting a
semicolon; and
(vi) by adding at the end the following:
``(ii) the provision of training and technical assistance;
and
``(iii) other activities that--
``(I) reduce costs associated with the provision of health
services;
``(II) improve access to, and availability of, health
services provided to individuals served by the centers;
``(III) enhance the quality and coordination of health
services; or
``(IV) improve the health status of communities.'';
(6) in subsection (e)(5)(B)--
(A) in the heading of subparagraph (B), by striking ``and
plans''; and
(B) by striking ``and subparagraphs (B) and (C) of
subsection (c)(1) to a health center or to a network or
plan'' and inserting ``to a health center or to a network'';
(7) in subsection (e), by adding at the end the following:
``(6) New access points and expanded services.--
``(A) Approval of new access points.--
``(i) In general.--The Secretary may approve applications
for grants under subparagraph (A) or (B) of paragraph (1) to
establish new delivery sites.
``(ii) Special consideration.--In carrying out clause (i),
the Secretary may give special consideration to applicants
that have demonstrated the new delivery site will be located
within a sparsely populated area, or an area which has a
level of unmet need that is higher relative to other
applicants.
``(iii) Consideration of applications.--In carrying out
clause (i), the Secretary shall approve applications for
grants in such a manner that the ratio of the medically
underserved populations in rural areas which may be expected
to use the services provided by the applicants involved to
the medically underserved populations in urban areas which
may be expected to use the services provided by the
applicants is not less than two to three or greater than
three to two.
``(iv) Service area overlap.--If in carrying out clause (i)
the applicant proposes to serve an area that is currently
served by another health center funded under this section,
the Secretary may consider whether the award of funding to an
additional health center in the area can be justified based
on the unmet need for additional services within the
catchment area.
``(B) Approval of expanded service applications.--
``(i) In general.--The Secretary may approve applications
for grants under subparagraph (A) or (B) of paragraph (1) to
expand the capacity of the applicant to provide required
primary health services described in subsection (b)(1) or
additional health services described in subsection (b)(2).
``(ii) Priority expansion projects.--In carrying out clause
(i), the Secretary may give special consideration to expanded
service applications that seek to address emerging public
health or behavioral health, mental health, or substance
abuse issues through increasing the availability of
additional health services described in subsection (b)(2) in
an area in which there are significant barriers to accessing
care.
``(iii) Consideration of applications.--In carrying out
clause (i), the Secretary shall approve applications for
grants in such a manner that the ratio of the medically
underserved populations in rural areas which may be expected
to use the services provided by the applicants involved to
the medically underserved populations in urban areas which
may be expected to use the services provided by such
applicants is not less than two to three or greater than
three to two.'';
(8) in subsection (h)--
(A) in paragraph (1), by striking ``and children and youth
at risk of homelessness'' and inserting ``, children and
youth at risk of homelessness, homeless veterans, and
veterans at risk of homelessness''; and
(B) in paragraph (5)--
(i) by striking subparagraph (B);
(ii) by redesignating subparagraph (C) as subparagraph (B);
and
(iii) in subparagraph (B) (as so redesignated)--
(I) in the subparagraph heading, by striking ``abuse'' and
inserting ``use disorder''; and
(II) by striking ``abuse'' and inserting ``use disorder'';
(9) in subsection (k)--
(A) in paragraph (2)--
(i) in the paragraph heading, by inserting ``unmet'' before
``need'';
(ii) in the matter preceding subparagraph (A), by inserting
``or subsection (e)(6)'' after ``subsection (e)(1)'';
(iii) in subparagraph (A), by inserting ``unmet'' before
``need for health services'';
(iv) in subparagraph (B), by striking ``and'' at the end;
(v) in subparagraph (C), by striking the period at the end
and inserting ``; and''; and
(vi) by adding after subparagraph (C) the following:
``(D) in the case of an application for a grant pursuant to
subsection (e)(6), a demonstration that the applicant has
consulted with appropriate State and local government
agencies, and health care providers regarding the need for
the health services to be provided at the proposed delivery
site.'';
(B) in paragraph (3)--
(i) in the matter preceding subparagraph (A), by inserting
``or subsection (e)(6)'' after ``subsection (e)(1)(B)'';
(ii) in subparagraph (B), by striking ``in the catchment
area of the center'' and inserting ``, including other health
care providers that provide care within the catchment area,
local hospitals, and specialty providers in the catchment
area of the center, to provide access to services not
available through the health center and to reduce the non-
urgent use of hospital emergency departments'';
(iii) in subparagraph (H)(ii), by inserting ``who shall be
directly employed by the center'' after ``approves the
selection of a director for the center'';
(iv) in subparagraph (L), by striking ``and'' at the end;
(v) in subparagraph (M), by striking the period and
inserting ``; and''; and
(vi) by inserting after subparagraph (M), the following:
``(N) the center has written policies and procedures in
place to ensure the appropriate use of Federal funds in
compliance with applicable Federal statutes, regulations, and
the terms and conditions of the Federal award.''; and
(C) by striking paragraph (4);
(10) in subsection (l), by adding at the end the following:
``Funds expended to carry out activities under this
subsection and operational support activities under
subsection (m) shall not exceed 3 percent of the amount
appropriated for this section for the fiscal year
involved.'';
(11) in subsection (q)(4), by adding at the end the
following: ``A waiver provided by the Secretary under this
paragraph may not remain in effect for more than 1 year and
may not be extended after such period. An entity may not
receive more than one waiver under this paragraph in
consecutive years.'';
(12) in subsection (r)(3)--
(A) by striking ``appropriate committees of Congress a
report concerning the distribution of funds under this
section'' and inserting the following: ``Committee on Health,
Education, Labor, and Pensions of the Senate, and the
Committee on Energy and Commerce of the House of
Representatives, a report including, at a minimum--
``(A) the distribution of funds for carrying out this
section'';
(B) by striking ``populations. Such report shall include an
assessment'' and inserting the following: ``populations;
``(B) an assessment'';
(C) by striking ``and the rationale for any substantial
changes in the distribution of funds.'' and inserting a
semicolon; and
(D) by adding at the end the following:
``(C) the distribution of awards and funding for new or
expanded services in each of rural areas and urban areas;
``(D) the distribution of awards and funding for
establishing new access points, and the number of new access
points created;
``(E) the amount of unexpended funding for loan guarantees
and loan guarantee authority under title XVI;
``(F) the rationale for any substantial changes in the
distribution of funds;
``(G) the rate of closures for health centers and access
points;
``(H) the number and reason for any grants awarded pursuant
to subsection (e)(1)(B); and
``(I) the number and reason for any waivers provided
pursuant to subsection (q)(4).'';
(13) in subsection (r), by adding at the end the following
new paragraph:
``(5) Funding for participation of health centers in all of
us research program.--In addition to any amounts made
available pursuant to paragraph (1) of this subsection,
section 402A of this Act, or section 10503 of the Patient
Protection and Affordable Care
[[Page H8451]]
Act, there is authorized to be appropriated, and there is
appropriated, out of any monies in the Treasury not otherwise
appropriated, to the Secretary $25,000,000 for fiscal year
2018 to support the participation of health centers in the
All of Us Research Program under the Precision Medicine
Initiative under section 498E of this Act.''; and
(14) by striking subsection (s).
(c) National Health Service Corps.--Section 10503(b)(2)(E)
of the Patient Protection and Affordable Care Act (42 U.S.C.
254b-2(b)(2)(E)) is amended by striking ``2017'' and
inserting ``2019''.
(d) Teaching Health Centers That Operate Graduate Medical
Education Programs.--
(1) Payments.--Subsection (a) of section 340H of the Public
Health Service Act (42 U.S.C. 256h) is amended to read as
follows:
``(a) Payments.--
``(1) In general.--Subject to subsection (h)(2), the
Secretary shall make payments under this section for direct
expenses and indirect expenses to qualified teaching health
centers that are listed as sponsoring institutions by the
relevant accrediting body for, as appropriate--
``(A) maintenance of existing approved graduate medical
residency training programs;
``(B) expansion of existing approved graduate medical
residency training programs; and
``(C) establishment of new approved graduate medical
residency training programs.
``(2) Priority.--In making payments pursuant to paragraph
(1)(C), the Secretary shall give priority to qualified
teaching health centers that--
``(A) serve a health professional shortage area with a
designation in effect under section 332 or a medically
underserved community (as defined in section 799B); or
``(B) are located in a rural area (as defined in section
1886(d)(2)(D) of the Social Security Act).''.
(2) Funding.--Subsection (g) of section 340H of the Public
Health Service Act (42 U.S.C. 256h) is amended--
(A) by striking ``To carry out'' and inserting the
following:
``(1) In general.--To carry out'';
(B) by striking ``and $15,000,000 for the first quarter of
fiscal year 2018'' and inserting ``and $126,500,000 for each
of fiscal years 2018 and 2019, to remain available until
expended''; and
(C) by adding at the end the following:
``(2) Administrative expenses.--Of the amount made
available to carry out this section for any fiscal year, the
Secretary may not use more than 5 percent of such amount for
the expenses of administering this section.''.
(3) Annual reporting.--Subsection (h)(1) of section 340H of
the Public Health Service Act (42 U.S.C. 256h) is amended--
(A) by redesignating subparagraph (D) as subparagraph (H);
and
(B) by inserting after subparagraph (C) the following:
``(D) The number of patients treated by residents described
in paragraph (4).
``(E) The number of visits by patients treated by residents
described in paragraph (4).
``(F) Of the number of residents described in paragraph (4)
who completed their residency training at the end of such
residency academic year, the number and percentage of such
residents entering primary care practice (meaning any of the
areas of practice listed in the definition of a primary care
residency program in section 749A).
``(G) Of the number of residents described in paragraph (4)
who completed their residency training at the end of such
residency academic year, the number and percentage of such
residents who entered practice at a health care facility--
``(i) primarily serving a health professional shortage area
with a designation in effect under section 332 or a medically
underserved community (as defined in section 799B); or
``(ii) located in a rural area (as defined in section
1886(d)(2)(D) of the Social Security Act).''.
(4) Report on training costs.--Not later than March 31,
2019, the Secretary of Health and Human Services shall submit
to the Congress a report on the direct graduate expenses of
approved graduate medical residency training programs, and
the indirect expenses associated with the additional costs of
teaching residents, of qualified teaching health centers (as
such terms are used or defined in section 340H of the Public
Health Service Act (42 U.S.C. 256h)).
(5) Definition.--Subsection (j) of section 340H of the
Public Health Service Act (42 U.S.C. 256h) is amended--
(A) by redesignating paragraphs (2) and (3) as paragraphs
(3) and (4), respectively; and
(B) by inserting after paragraph (1) the following:
``(2) New approved graduate medical residency training
program.--The term `new approved graduate medical residency
training program' means an approved graduate medical
residency training program for which the sponsoring qualified
teaching health center has not received a payment under this
section for a previous fiscal year (other than pursuant to
subsection (a)(1)(C)).''.
(6) Technical correction.--Subsection (f) of section 340H
(42 U.S.C. 256h) is amended by striking ``hospital'' each
place it appears and inserting ``teaching health center''.
(7) Payments for previous fiscal years.--The provisions of
section 340H of the Public Health Service Act (42 U.S.C.
256h), as in effect on the day before the date of enactment
of this Act, shall continue to apply with respect to payments
under such section for fiscal years before fiscal year 2018.
(e) Application.--Amounts appropriated pursuant to this
section for fiscal year 2018 or 2019 are subject to the
requirements contained in Public Law 115-31 for funds for
programs authorized under sections 330 through 340 of the
Public Health Service Act (42 U.S.C. 254b-256).
(f) Conforming Amendments.--Section 3014(h) of title 18,
United States Code, is amended--
(1) in paragraph (1), by striking ``, as amended by section
221 of the Medicare Access and CHIP Reauthorization Act of
2015,''; and
(2) in paragraph (4), by inserting ``and section 101(e) of
the Community Health And Medical Professionals Improve Our
Nation Act of 2017'' after ``section 221(c) of the Medicare
Access and CHIP Reauthorization Act of 2015''.
SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS.
(a) Special Diabetes Program for Type I Diabetes.--Section
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C.
254c-2(b)(2)(C)) is amended by striking ``2017'' and
inserting ``2019''.
(b) Special Diabetes Program for Indians.--Subparagraph (D)
of section 330C(c)(2) of the Public Health Service Act (42
U.S.C. 254c-3(c)(2)) is amended to read as follows:
``(D) $150,000,000 for each of fiscal years 2018 and
2019.''.
SEC. 103. EXTENSION FOR FAMILY-TO-FAMILY HEALTH INFORMATION
CENTERS.
Section 501(c) of the Social Security Act (42 U.S.C.
701(c)) is amended--
(1) in paragraph (1)(A)--
(A) in clause (v), by striking ``and'' at the end;
(B) in clause (vi), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(vii) $6,000,000 for each of fiscal years 2018 and
2019.'';
(2) in paragraph (3)(C), by inserting before the period the
following: ``, and with respect to fiscal years 2018 and
2019, such centers shall also be developed in all territories
and at least one such center shall be developed for Indian
tribes''; and
(3) by amending paragraph (5) to read as follows:
``(5) For purposes of this subsection--
``(A) the term `Indian tribe' has the meaning given such
term in section 4 of the Indian Health Care Improvement Act
(25 U.S.C. 1603);
``(B) the term `State' means each of the 50 States and the
District of Columbia; and
``(C) the term `territory' means Puerto Rico, Guam,
American Samoa, the Virgin Islands, and the Northern Mariana
Islands.''.
SEC. 104. YOUTH EMPOWERMENT PROGRAM; PERSONAL RESPONSIBILITY
EDUCATION.
(a) Youth Empowerment Program.--
(1) In general.--Section 510 of the Social Security Act (42
U.S.C. 710) is amended to read as follows:
``SEC. 510. YOUTH EMPOWERMENT PROGRAM.
``(a) In General.--
``(1) Allotments to states.--For the purpose described in
subsection (b), the Secretary shall, for each of fiscal years
2018 and 2019, allot to each State which has transmitted an
application for the fiscal year under section 505(a) an
amount equal to the product of--
``(A) the amount appropriated pursuant to subsection (e)(1)
for the fiscal year, minus the amount reserved under
subsection (e)(2) for the fiscal year; and
``(B) the proportion that the number of low-income children
in the State bears to the total of such numbers of children
for all the States.
``(2) Other allotments.--
``(A) Other entities.--For the purpose described in
subsection (b), the Secretary shall, for each of fiscal years
2018 and 2019, for any State which has not transmitted an
application for the fiscal year under section 505(a), allot
to one or more entities in the State the amount that would
have been allotted to the State under paragraph (1) if the
State had submitted such an application.
``(B) Process.--The Secretary shall select the recipients
of allotments under subparagraph (A) by means of a
competitive grant process under which--
``(i) not later than 30 days after the deadline for the
State involved to submit an application for the fiscal year
under section 505(a), the Secretary publishes a notice
soliciting grant applications; and
``(ii) not later than 120 days after such deadline, all
such applications must be submitted.
``(b) Purpose.--
``(1) In general.--Except for research under paragraph (5)
and information collection and reporting under paragraph (6),
the purpose of an allotment under subsection (a) to a State
(or to another entity in the State pursuant to subsection
(a)(2)) is to enable the State or other entity to implement
education exclusively on sexual risk avoidance (meaning
voluntarily refraining from sexual activity).
``(2) Required components.--Education on sexual risk
avoidance pursuant to an allotment under this section shall--
``(A) ensure that the unambiguous and primary emphasis and
context for each topic
[[Page H8452]]
described in paragraph (3) is a message to youth that
normalizes the optimal health behavior of avoiding nonmarital
sexual activity;
``(B) be medically accurate and complete;
``(C) be age-appropriate; and
``(D) be based on adolescent learning and developmental
theories for the age group receiving the education.
``(3) Topics.--Education on sexual risk avoidance pursuant
to an allotment under this section shall address each of the
following topics:
``(A) The holistic individual and societal benefits
associated with personal responsibility, self-regulation,
goal setting, healthy decisionmaking, and a focus on the
future.
``(B) The advantage of refraining from nonmarital sexual
activity in order to improve the future prospects and
physical and emotional health of youth.
``(C) The increased likelihood of avoiding poverty when
youth attain self-sufficiency and emotional maturity before
engaging in sexual activity.
``(D) The foundational components of healthy relationships
and their impact on the formation of healthy marriages and
safe and stable families.
``(E) How other youth risk behaviors, such as drug and
alcohol usage, increase the risk for teen sex.
``(F) How to resist and avoid, and receive help regarding,
sexual coercion and dating violence, recognizing that even
with consent teen sex remains a youth risk behavior.
``(4) Contraception.--Education on sexual risk avoidance
pursuant to an allotment under this section shall ensure
that--
``(A) any information provided on contraception is
medically accurate and ensures that students understand that
contraception offers physical risk reduction, but not risk
elimination; and
``(B) the education does not include demonstrations,
simulations, or distribution of contraceptive devices.
``(5) Research.--
``(A) In general.--A State or other entity receiving an
allotment pursuant to subsection (a) may use up to 20 percent
of such allotment to build the evidence base for sexual risk
avoidance education by conducting or supporting research.
``(B) Requirements.--Any research conducted or supported
pursuant to subparagraph (A) shall be--
``(i) rigorous;
``(ii) evidence-based; and
``(iii) designed and conducted by independent researchers
who have experience in conducting and publishing research in
peer-reviewed outlets.
``(6) Information collection and reporting.--A State or
other entity receiving an allotment pursuant to subsection
(a) shall, as specified by the Secretary--
``(A) collect information on the programs and activities
funded through the allotment; and
``(B) submit reports to the Secretary on the data from such
programs and activities.
``(c) National Evaluation.--
``(1) In general.--The Secretary shall--
``(A) in consultation with appropriate State and local
agencies, conduct one or more rigorous evaluations of the
education funded through this section and associated data;
and
``(B) submit a report to the Congress on the results of
such evaluations, together with a summary of the information
collected pursuant to subsection (b)(6).
``(2) Consultation.--In conducting the evaluations required
by paragraph (1), including the establishment of evaluation
methodologies, the Secretary shall consult with relevant
stakeholders.
``(d) Applicability of Certain Provisions.--
``(1) Sections 503, 507, and 508 apply to allotments under
subsection (a) to the same extent and in the same manner as
such sections apply to allotments under section 502(c).
``(2) Sections 505 and 506 apply to allotments under
subsection (a) to the extent determined by the Secretary to
be appropriate.
``(e) Funding.--
``(1) In general.--To carry out this section, there is
appropriated, out of any money in the Treasury not otherwise
appropriated, $75,000,000 for each of fiscal years 2018 and
2019.
``(2) Reservation.--The Secretary shall reserve, for each
of fiscal years 2018 and 2019, not more than 20 percent of
the amount appropriated pursuant to paragraph (1) for
administering the program under this section, including the
conducting of national evaluations and the provision of
technical assistance to the recipients of allotments.''.
(2) Effective date.--The amendment made by this subsection
takes effect on October 1, 2017.
(b) Personal Responsibility Education.--
(1) In general.--Section 513 of the Social Security Act (42
U.S.C. 713) is amended--
(A) in subsection (a)(1)(A), by striking ``2017'' and
inserting ``2019''; and
(B) in subsection (a)(4)--
(i) in subparagraph (A), by striking ``2017'' each place it
appears and inserting ``2019''; and
(ii) in subparagraph (B)--
(I) in the subparagraph heading, by striking ``3-year
grants'' and inserting ``Competitive prep grants''; and
(II) in clause (i), by striking ``solicit applications to
award 3-year grants in each of fiscal years 2012 through
2017'' and inserting ``continue through fiscal year 2019
grants awarded for any of fiscal years 2015 through 2017'';
(C) in subsection (c)(1), by inserting after ``youth with
HIV/AIDS,'' the following: ``victims of human trafficking,'';
and
(D) in subsection (f), by striking ``2017'' and inserting
``2019''.
(2) Effective date.--The amendments made by this subsection
take effect on October 1, 2017.
TITLE II--OFFSETS
SEC. 201. PROVIDING FOR QUALIFIED HEALTH PLAN GRACE PERIOD
REQUIREMENTS FOR ISSUER RECEIPT OF ADVANCE
PAYMENTS OF COST-SHARING REDUCTIONS AND PREMIUM
TAX CREDITS THAT ARE MORE CONSISTENT WITH STATE
LAW GRACE PERIOD REQUIREMENTS.
(a) In General.--Section 1412(c) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18082(c)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (B)(iv)(II), by striking ``a 3-month
grace period'' and inserting ``a grace period specified in
subparagraph (C)''; and
(B) by adding at the end the following new subparagraphs:
``(C) Grace period specified.--For purposes of subparagraph
(B)(iv)(II), the grace period specified in this subparagraph
is--
``(i) for plan years beginning before January 1, 2018, a 3-
month grace period; and
``(ii) for plan years beginning on or after January 1,
2018--
``(I) in the case of an Exchange operating in a State that
has a State law grace period in place, such State law grace
period; and
``(II) in the case of an Exchange operating in a State that
does not have a State law grace period in place, a 1-month
grace period.
``(D) State law grace period.--For purposes of subparagraph
(C), the term `State law grace period' means, with respect to
a State, a grace period for nonpayment of premiums before
discontinuing coverage that is applicable under the State law
to health insurance coverage offered in the individual market
of the State.''; and
(2) in paragraph (3), by adding at the end the following
new sentence: ``The requirements of paragraph (2)(B)(iv)
apply to an issuer of a qualified health plan receiving an
advanced payment under this paragraph in the same manner and
to the same extent that such requirements apply to an issuer
of a qualified health plan receiving an advanced payment
under paragraph (2)(A).''.
(b) Report on Aligning Grace Periods for Medicaid,
Medicare, and Exchange Plans.--Not later than two years after
the date of full implementation of subsection (a), the
Comptroller General of the United States shall submit to
Congress a report on--
(1) the effects on consumers of aligning grace periods
applied under the Medicaid program under title XIX of the
Social Security Act, under the Medicare program under parts C
and D of title XVIII of such Act, and under qualified health
plans offered on an Exchange established under title I of the
Patient Protection and Affordable Care Act, including the
extent to which such an alignment of grace periods may help
to avoid enrollment status confusion for individuals under
such Medicaid program, Medicare program, and qualified health
plans; and
(2) the extent to which such an alignment of grace periods
may reduce fraud, waste, and abuse under the Medicaid
program.
SEC. 202. PREVENTION AND PUBLIC HEALTH FUND.
Section 4002(b) of the Patient Protection and Affordable
Care Act (42 U.S.C. 300u-11(b)) is amended by striking
paragraphs (3) through (8) and inserting the following new
paragraphs:
``(3) for fiscal year 2018, $900,000,000;
``(4) for fiscal year 2019, $500,000,000;
``(5) for fiscal year 2020, $500,000,000;
``(6) for fiscal year 2021, $500,000,000;
``(7) for fiscal year 2022, $500,000,000;
``(8) for fiscal year 2023, $500,000,000;
``(9) for fiscal year 2024, $500,000,000;
``(10) for fiscal year 2025, $750,000,000;
``(11) for fiscal year 2026, $1,000,000,000; and
``(12) for fiscal year 2027 and each fiscal year
thereafter, $2,000,000,000.''.
DIVISION B--HEALTHY KIDS ACT
SEC. 300. SHORT TITLE.
This division may be cited as the ``Helping Ensure Access
for Little Ones, Toddlers, and Hopeful Youth by Keeping
Insurance Delivery Stable Act of 2017'' or the ``HEALTHY KIDS
Act''.
TITLE I--CHIP EXTENSION AND OTHER MEDICAID AND CHIP PROVISIONS
SEC. 301. FIVE-YEAR FUNDING EXTENSION OF THE CHILDREN'S
HEALTH INSURANCE PROGRAM.
(a) Appropriation; Total Allotment.--Section 2104(a) of the
Social Security Act (42 U.S.C. 1397dd(a)) is amended--
(1) in paragraph (19), by striking ``and'';
(2) in paragraph (20), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new paragraphs:
``(21) for fiscal year 2018, $21,500,000,000;
``(22) for fiscal year 2019, $22,600,000,000;
``(23) for fiscal year 2020, $23,700,000,000;
``(24) for fiscal year 2021, $24,800,000,000; and
``(25) for fiscal year 2022, for purposes of making 2 semi-
annual allotments--
``(A) $2,850,000,000 for the period beginning on October 1,
2021, and ending on March 31, 2022; and
``(B) $2,850,000,000 for the period beginning on April 1,
2022, and ending on September 30, 2022.''.
[[Page H8453]]
(b) Allotments.--
(1) In general.--Section 2104(m) of the Social Security Act
(42 U.S.C. 1397dd(m)) is amended--
(A) in paragraph (2)--
(i) in the heading, by striking ``through 2016'' and
inserting ``through 2022''; and
(ii) in subparagraph (B)--
(I) in the matter preceding clause (i), by striking
``(19)'' and inserting ``(24)'';
(II) in clause (ii), in the matter preceding subclause (I),
by inserting ``(other than fiscal year 2022)'' after ``even-
numbered fiscal year''; and
(III) in clause (ii)(I), by inserting ``(or, in the case of
fiscal year 2018, under paragraph (4))'' after ``clause
(i)'';
(B) in paragraph (5)--
(i) by striking ``or (4)'' and inserting ``(4), or (10)'';
and
(ii) by striking ``or 2017'' and inserting ``, 2017, or
2022'';
(C) in paragraph (7)--
(i) in subparagraph (A), by striking ``2017'' and inserting
``2022'';
(ii) in subparagraph (B), in the matter preceding clause
(i), by inserting ``(or, in the case of fiscal year 2018, by
not later than the date that is 60 days after the date of the
enactment of the HEALTHY KIDS Act)'' after ``before the
August 31 preceding the beginning of the fiscal year''; and
(iii) in the matter following subparagraph (B), by striking
``or fiscal year 2016'' and inserting ``fiscal year 2016,
fiscal year 2018, fiscal year 2020, or fiscal year 2022'';
(D) in paragraph (9)--
(i) in the heading, by striking ``fiscal years 2015 and
2017'' and inserting ``certain fiscal years'';
(ii) by striking ``or (4)'' and inserting ``, (4), or
(10)''; and
(iii) by striking ``or fiscal year 2017'' and inserting ``,
2017, or 2022''; and
(E) by adding at the end the following new paragraph:
``(10) For fiscal year 2022.--
``(A) First half.--Subject to paragraphs (5) and (7), from
the amount made available under subparagraph (A) of paragraph
(25) of subsection (a) for the semi-annual period described
in such subparagraph, increased by the amount of the
appropriation for such period under section 301(b)(3) of the
HEALTHY KIDS Act, the Secretary shall compute a State
allotment for each State (including the District of Columbia
and each commonwealth and territory) for such semi-annual
period in an amount equal to the first half ratio (described
in subparagraph (D)) of the amount described in subparagraph
(C).
``(B) Second half.--Subject to paragraphs (5) and (7), from
the amount made available under subparagraph (B) of paragraph
(25) of subsection (a) for the semi-annual period described
in such subparagraph, the Secretary shall compute a State
allotment for each State (including the District of Columbia
and each commonwealth and territory) for such semi-annual
period in an amount equal to the amount made available under
such subparagraph, multiplied by the ratio of--
``(i) the amount of the allotment to such State under
subparagraph (A); to
``(ii) the total of the amount of all of the allotments
made available under such subparagraph.
``(C) Full year amount based on growth factor updated
amount.--The amount described in this subparagraph for a
State is equal to the sum of--
``(i) the amount of the State allotment for fiscal year
2021 determined under paragraph (2)(B)(i); and
``(ii) the amount of any payments made to the State under
subsection (n) for fiscal year 2021,
multiplied by the allotment increase factor under paragraph
(6) for fiscal year 2022.
``(D) First half ratio.--The first half ratio described in
this subparagraph is the ratio of--
``(i) the sum of--
``(I) the amount made available under subsection
(a)(25)(A); and
``(II) the amount of the appropriation for such period
under section 301(b)(3) of the HEALTHY KIDS Act; to
``(ii) the sum of--
``(I) the amount described in clause (i); and
``(II) the amount made available under subsection
(a)(25)(B).''.
(2) Technical amendment.--Section 2104(m)(2)(A) of such Act
(42 U.S.C. 1397dd(m)(2)(A)) is amended by striking ``the
allotment increase factor under paragraph (5)'' each place it
appears and inserting ``the allotment increase factor under
paragraph (6)''.
(3) One-time appropriation for fiscal year 2022.--There is
appropriated to the Secretary of Health and Human Services,
out of any money in the Treasury not otherwise appropriated,
$20,200,000,000 to accompany the allotment made for the
period beginning on October 1, 2021, and ending on March 31,
2022, under paragraph (25)(A) of section 2104(a) of the
Social Security Act (42 U.S.C. 1397dd(a)) (as added by
subsection (a)(3)), to remain available until expended. Such
amount shall be used to provide allotments to States under
paragraph (10) of section 2104(m) of such Act (as added by
subsection (b)(1)(E)) for the first 6 months of fiscal year
2022 in the same manner as allotments are provided under
subsection (a)(25)(A) of such section 2104 and subject to the
same terms and conditions as apply to the allotments provided
from such subsection (a)(25)(A).
(c) Extension of the Child Enrollment Contingency Fund.--
Section 2104(n) of the Social Security Act (42 U.S.C.
1397dd(n)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (A)(ii)--
(i) by striking ``2010, 2011, 2012, 2013, 2014, and 2016''
and inserting ``2010 through 2014, 2016, and 2018 through
2021''; and
(ii) by striking ``fiscal year 2015 and fiscal year 2017''
and inserting ``fiscal years 2015, 2017, and 2022''; and
(B) in subparagraph (B)--
(i) by striking ``2010, 2011, 2012, 2013, 2014, and 2016''
and inserting ``2010 through 2014, 2016, and 2018 through
2021''; and
(ii) by striking ``fiscal year 2015 and fiscal year 2017''
and inserting ``fiscal years 2015, 2017, and 2022''; and
(2) in paragraph (3)(A), in the matter preceding clause
(i), by striking ``or a semi-annual allotment period for
fiscal year 2015 or 2017'' and inserting ``or in any of
fiscal years 2018 through 2021 (or a semi-annual allotment
period for fiscal year 2015, 2017, or 2022)''.
(d) Extension of Qualifying States Option.--Section
2105(g)(4) of the Social Security Act (42 U.S.C.
1397ee(g)(4)) is amended--
(1) in the heading, by striking ``through 2017'' and
inserting ``through 2022''; and
(2) in subparagraph (A), by striking ``2017'' and inserting
``2022''.
(e) Extension of Express Lane Eligibility Option.--Section
1902(e)(13)(I) of the Social Security Act (42 U.S.C.
1396a(e)(13)(I)) is amended by striking ``2017'' and
inserting ``2022''.
(f) Assurance of Affordability Standard for Children and
Families.--
(1) In general.--Section 2105(d)(3) of the Social Security
Act (42 U.S.C. 1397ee(d)(3)) is amended--
(A) in the paragraph heading, by striking ``until october
1, 2019'' and inserting ``through september 30, 2022''; and
(B) in subparagraph (A), in the matter preceding clause
(i)--
(i) by striking ``2019'' and inserting ``2022''; and
(ii) by striking ``The preceding sentence shall not be
construed as preventing a State during such period'' and
inserting ``During the period that begins on October 1, 2019,
and ends on September 30, 2022, the preceding sentence shall
only apply with respect to children in families whose income
does not exceed 300 percent of the poverty line (as defined
in section 2110(c)(5)) applicable to a family of the size
involved. The preceding sentences shall not be construed as
preventing a State during any such periods''.
(2) Conforming amendments.--Section 1902(gg)(2) of the
Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended--
(A) in the paragraph heading, by striking ``until october
1, 2019'' and inserting ``through september 30, 2022''; and
(B) by striking ``September 30, 2019,'' and inserting
``September 30, 2022 (but during the period that begins on
October 1, 2019, and ends on September 30, 2022, only with
respect to children in families whose income does not exceed
300 percent of the poverty line (as defined in section
2110(c)(5)) applicable to a family of the size involved)''.
(g) CHIP Look-alike Plans.--
(1) Blending risk pools.--Section 2107 of the Social
Security Act (42 U.S.C. 1397gg) is amended by adding at the
end the following:
``(g) Use of Blended Risk Pools.--
``(1) In general.--Nothing in this title (or any other
provision of Federal law) shall be construed as preventing a
State from considering children enrolled in a qualified CHIP
look-alike program and children enrolled in a State child
health plan under this title (or a waiver of such plan) as
members of a single risk pool.
``(2) Qualified chip look-alike program.--In this
subsection, the term `qualified CHIP look-alike program'
means a State program--
``(A) under which children who are under the age of 19 and
are not eligible to receive medical assistance under title
XIX or child health assistance under this title may purchase
coverage through the State that provides benefits that are at
least identical to the benefits provided under the State
child health plan under this title (or a waiver of such
plan); and
``(B) that is funded exclusively through non-Federal funds,
including funds received by the State in the form of premiums
for the purchase of such coverage.''.
(2) Coverage rule.--
(A) In general.--Section 5000A(f)(1) of the Internal
Revenue Code of 1986 is amended in subparagraph (A)(iii), by
inserting ``or under a qualified CHIP look-alike program (as
defined in section 2107(g) of the Social Security Act)''
before the comma at the end.
(B) Effective date.--The amendment made by subparagraph (A)
shall apply with respect to taxable years beginning after
December 31, 2017.
SEC. 302. EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION
PROJECTS.
(a) Childhood Obesity Demonstration Project.--Section
1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b-
9a(e)(8)) is amended--
(1) by striking ``and $10,000,000'' and inserting ``,
$10,000,000''; and
(2) by inserting after ``2017'' the following: ``, and
$25,000,000 for the period of fiscal years 2018 through
2022''.
(b) Pediatric Quality Measures Program.--Section 1139A(i)
of the Social Security Act (42 U.S.C. 1320b-9a(i)) is
amended--
(1) by striking ``Out of any'' and inserting the following:
``(1) In general.--Out of any'';
[[Page H8454]]
(2) by striking ``there is appropriated for each'' and
inserting ``there is appropriated--
``(A) for each'';
(3) by striking ``, and there is appropriated for the
period'' and inserting ``;
``(B) for the period'';
(4) by striking ``. Funds appropriated under this
subsection shall remain available until expended.'' and
inserting ``; and''; and
(5) by adding at the end the following:
``(C) for the period of fiscal years 2018 through 2022,
$75,000,000 for the purpose of carrying out this section
(other than subsections (e), (f), and (g)).
``(2) Availability.--Funds appropriated under this
subsection shall remain available until expended.''.
SEC. 303. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.
(a) In General.--Section 2113 of the Social Security Act
(42 U.S.C. 1397mm) is amended--
(1) in subsection (a)(1), by striking ``2017'' and
inserting ``2022''; and
(2) in subsection (g)--
(A) by striking ``and $40,000,000'' and inserting ``,
$40,000,000''; and
(B) by inserting after ``2017'' the following: ``, and
$100,000,000 for the period of fiscal years 2018 through
2022''.
(b) Making Organizations That Use Parent Mentors Eligible
to Receive Grants.--Section 2113(f) of the Social Security
Act (42 U.S.C. 1397mm(f)) is amended--
(1) in paragraph (1)(E), by striking ``or community-based
doula programs'' and inserting ``, community-based doula
programs, or parent mentors''; and
(2) by adding at the end the following new paragraph:
``(5) Parent mentor.--The term `parent mentor' means an
individual who--
``(A) is a parent or guardian of at least one child who is
an eligible child under this title or title XIX; and
``(B) is trained to assist families with children who have
no health insurance coverage with respect to improving the
social determinants of the health of such children, including
by providing--
``(i) education about health insurance coverage, including,
with respect to obtaining such coverage, eligibility criteria
and application and renewal processes;
``(ii) assistance with completing and submitting
applications for health insurance coverage;
``(iii) a liaison between families and representatives of
State plans under title XIX or State child health plans under
this title;
``(iv) guidance on identifying medical and dental homes and
community pharmacies for children; and
``(v) assistance and referrals to successfully address
social determinants of children's health, including poverty,
food insufficiency, and housing.''.
(c) Exclusion From Modified Adjusted Gross Income.--Section
1902(e) of the Social Security Act (42 U.S.C. 1396a(e)) is
amended--
(1) in the first paragraph (14), relating to income
determined using modified adjusted gross income, by adding at
the end the following new subparagraph:
``(J) Exclusion of parent mentor compensation from income
determination.--Any nominal amount received by an individual
as compensation, including a stipend, for participation as a
parent mentor (as defined in paragraph (5) of section
2113(f)) in an activity or program funded through a grant
under such section shall be disregarded for purposes of
determining the income eligibility of such individual for
medical assistance under the State plan or any waiver of such
plan.''; and
(2) by striking ``(14) Exclusion'' and inserting ``(15)
Exclusion''.
SEC. 304. EXTENSION AND REDUCTION OF ADDITIONAL FEDERAL
FINANCIAL PARTICIPATION FOR CHIP.
Section 2105(b) of the Social Security Act (42 U.S.C.
1397ee(b)) is amended in the second sentence by inserting
``and during the period that begins on October 1, 2019, and
ends on September 30, 2020, the enhanced FMAP determined for
a State for a fiscal year (or for any portion of a fiscal
year occurring during such period) shall be increased by 11.5
percentage points'' after ``23 percentage points,''.
SEC. 305. MODIFYING REDUCTIONS IN MEDICAID DSH ALLOTMENTS.
Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C.
1396r-4(f)(7)(A)) is amended--
(1) in clause (i), in the matter preceding subclause (I),
by striking ``2018'' and inserting ``2020''; and
(2) in clause (ii), by striking subclauses (I) through
(VIII) and inserting the following:
``(I) $4,000,000,000 for fiscal year 2020; and
``(II) $8,000,000,000 for each of fiscal years 2021 through
2025.''.
SEC. 306. PUERTO RICO AND THE VIRGIN ISLANDS MEDICAID
PAYMENTS.
(a) Increased Cap.--Section 1108(g) of the Social Security
Act (42 U.S.C. 1308(g)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (A), by inserting ``(or, with respect
to fiscal years 2018 and 2019, increased by such percentage
increase plus one percentage point)'' after ``beginning of
the fiscal year''; and
(B) in subparagraph (B), by inserting ``(or, with respect
to fiscal years 2018 and 2019, increased by such percentage
increase plus one percentage point)'' after ``percentage
increase referred to in subparagraph (A)'';
(2) in paragraph (5)--
(A) in subparagraph (A), by striking ``subparagraph (B)''
and inserting ``subparagraphs (B), (C), (D), (E), and (F)'';
and
(B) by adding at the end the following new subparagraphs:
``(C) The amount of the increase otherwise provided under
subparagraph (A) for Puerto Rico shall be further increased
by $880,000,000.
``(D)(i) For the period beginning October 1, 2017, and
ending December 31, 2019, the amount of the increase
otherwise provided under subparagraph (A) for Puerto Rico
shall be further increased by $120,000,000 if the Financial
Oversight and Management Board for Puerto Rico established
under section 101 of the Puerto Rico Oversight, Management,
and Economic Stability Act (48 U.S.C. 2121) certifies by a
majority vote that Puerto Rico has taken reasonable and
appropriate steps during such period to--
``(I) reduce fraud, waste, and abuse under the program
under title XIX;
``(II) implement strategies to reduce unnecessary,
inefficient, or excessive spending under title XIX;
``(III) improve the use and availability of Medicaid data
for program operation and oversight; and
``(IV) improve the quality of care and patient experience
for individuals enrolled under the program under title XIX.
``(ii) As a condition of any additional increase pursuant
to clause (i), not later than October 1, 2018, Puerto Rico
shall submit to the Financial Oversight and Management Board
for Puerto Rico a report regarding steps taken to achieve
each of the goals described in subclauses (I) through (IV) of
clause (i).
``(E) Payments under section 1903(a)(8) for a quarter of a
fiscal year shall not be taken into account in applying
subsection (f) (as increased in accordance with this
paragraph and paragraphs (1), (2), (3), and (4)) to Puerto
Rico or the Virgin Islands for such fiscal year.
``(F)(i) For the period beginning October 1, 2017, and
ending December 31, 2019, the amount of the increase
otherwise provided under subparagraph (A) for the Virgin
Islands shall be further increased by an amount equal to the
per capita equivalent of the total amount of the increase
provided for Puerto Rico under subparagraphs (C) and (D) for
such period.
``(ii) For purposes of clause (i), the term `per capita
equivalent' means the ratio of--
``(I) the population of the Virgin Islands, as determined
by the most recent census estimate released by the Bureau of
the Census before September 4, 2017; to
``(II) the population of Puerto Rico, as so determined.''.
(b) Federal Match for Medical Personnel and Fraud
Reduction.--Section 1903(a) of the Social Security Act (42
U.S.C. 1396b(a)) is amended--
(1) in paragraph (2)(A), by inserting ``subject to
paragraph (8),'' before ``an amount'';
(2) in paragraph (6)--
(A) in subparagraph (B), by inserting ``subject to
paragraph (8),'' before ``75 per centum''; and
(B) by striking at the end ``plus'';
(3) in paragraph (7), by striking at the end the period and
inserting ``; plus'' ; and
(4) by adding at the end the following new paragraph:
``(8) for quarters during the period beginning January 1,
2018, and ending December 31, 2019, paragraphs (2)(A) and (6)
shall apply with respect to Puerto Rico and the Virgin
Islands as if--
``(A) the reference to `75 per centum' in paragraph (2)(A)
were a reference to `90 per centum'; and
``(B) the reference to `75 per centum' in paragraph (6)(B)
were a reference to `90 per centum'.''.
TITLE II--OFFSETS
SEC. 401. MEDICAID THIRD PARTY LIABILITY PROVISIONS.
(a) Medicaid Third Party Liability.--
(1) Delay of bipartisan budget act of 2013 third party
liability provisions.--
(A) In general.--Section 202(c) of the Bipartisan Budget
Act of 2013 (Public Law 113-67; 127 Stat. 1177; 42 U.S.C.
1396a note), as amended by section 211 of the Protecting
Access to Medicare Act of 2014 (Public Law 113-93; 128 Stat.
1047; 42 U.S.C. 1396a note) and section 220 of the Medicare
Access and CHIP Reauthorization Act of 2015 (Public Law 114-
10), is amended by striking ``2017'' and inserting ``2019''.
(B) Effective date; treatment.--The amendment made by
subparagraph (A) shall take effect on September 30, 2017, and
shall apply with respect to any open claims, including claims
generated or filed, after such date.
(2) Clarification of definitions applicable to third party
liability.--
(A) In general.--Section 1902 of the Social Security Act
(42 U.S.C. 1396a) is amended by adding at the end the
following new subsection:
``(nn) Responsible Third Party and Health Insurer
Definitions.--For purposes of subsection (a)(25) and section
1903(d)(2)(B):
``(1) Responsible third party.--The term `responsible third
party' means a health insurer, a pharmacy benefit manager to
the extent the pharmacy benefit manager provides information
under this title for the purpose of coordinating benefits, an
accountable care organization under section 1899, or any
other party that is, by statute, contract, or agreement,
legally responsible for payment of a
[[Page H8455]]
claim for a health care item or service. Such term does not
include a party if payment by such party has been made or can
reasonably be expected to be made under a workmen's
compensation law or plan of the United States or a State, or
under an automobile or liability insurance policy or plan
(including a self-insured plan), or under no fault insurance.
``(2) Health insurer.--The term `health insurer' means a
group health plan, as defined in section 607(1) of the
Employee Retirement Income Security Act of 1974, a self-
insured plan, a fully-insured plan, a service benefit plan, a
medicaid managed care plan under section 1903(m) or 1932, and
any other health plan determined appropriate by the
Secretary.''.
(B) Conforming amendments.--Section 1902(a)(25) of the
Social Security Act (42 U.S.C. 1396a(a)(25)) is amended--
(i) in subparagraph (A), in the matter preceding clause
(i), by striking ``third parties'' and all that follows
through ``item or service)'' and inserting ``responsible
third parties'';
(ii) in subparagraph (G), by striking ``health insurer''
and all that follows through ``item or service)'' and
inserting ``responsible third party'';
(iii) in subparagraph (I), in the matter preceding clause
(i), by striking ``health insurers'' and all that follows
through ``item or service'' and inserting ``responsible third
parties''; and
(iv) by inserting ``responsible'' before ``third'' each
place it appears in subparagraphs (A)(i), (A)(ii), (C), (D),
and (H).
(3) Removal of special treatment of certain types of care
and payments under medicaid third party liability rules.--
Section 1902(a)(25) of the Social Security Act (42 U.S.C.
1396a(a)(25)), as amended by section 202(c) of the Bipartisan
Budget Act of 2013 (after application of paragraph (1)), is
amended--
(A) in subparagraph (E)--
(i) in the matter preceding clause (i), by striking
``prenatal or preventive'' and all that follows through
``State plan'' and inserting ``items and services provided
under the program required under the State plan pursuant to
paragraph (62)''; and
(ii) in clause (i)--
(I) by striking ``such service'' and inserting ``such items
and services''; and
(II) by striking each place it appears ``such services''
and inserting ``such items and services'' each such place;
and
(B) by striking subparagraph (F).
(4) Clarification of role of health insurers with respect
to third party liability.--
(A) In general.--Section 1902(a)(25) of the Social Security
Act (42 U.S.C. 1396a(a)(25)), as amended by paragraph (3), is
further amended by inserting after subparagraph (E) the
following new subparagraph:
``(F) that--
``(i) in the case of a State that provides medical
assistance under this title through a contract with a health
insurer, such contract shall specify any responsibility of
such health insurer (or other entity) with respect to
recovery of payment from responsible third parties pursuant
to the delegation or transfer by the State to such insurer
(or other entity) of a right described in subparagraph
(I)(ii); and
``(ii) in the case of a State that under a contract
described in clause (i) delegates or transfers to a health
insurer (or other entity) a right described in such clause,
the State shall provide assurances to the Secretary that the
State laws referred to in subparagraph (I), with respect to
each responsibility of such health insurer (or other entity)
specified under such clause, confer to such health insurer
(or other entity) the authority of the State with respect to
the requirements specified in clauses (i) through (iv) of
such subparagraph (I);''.
(B) Treatment of collected amounts.--Section 1903(d)(2)(B)
of the Social Security Act (42 U.S.C. 1396b(d)(2)(B)) is
amended by adding at the end the following: ``For purposes of
this subparagraph, reimbursements made by a responsible third
party to health insurers (as defined in section 1902(nn))
pursuant to section 1902(a)(25)(F)(ii) shall be treated in
the same manner as reimbursements made to a State under the
previous sentence.''.
(5) Increasing state flexibility with respect to third
party liability.--Section 1902(a)(25)(I) of the Social
Security Act (42 U.S.C. 1396a(a)(25)(I)) is amended--
(A) in clause (i), by striking ``medical assistance under
the State plan'' and inserting ``medical assistance under a
State plan (or under a waiver of the plan)'';
(B) by striking clause (ii) and inserting the following new
clause:
``(ii) accept--
``(I) any State's right of recovery and the assignment to
any State of any right of an individual or other entity to
payment from the party for an item or service for which
payment has been made under the respective State's plan (or
under a waiver of the plan); and
``(II) as a valid authorization of the responsible third
party for the furnishing of an item or service to an
individual eligible to receive medical assistance under this
title, an authorization made on behalf of such individual
under the State plan (or under a waiver of such plan) for the
furnishing of such item or service to such individual;'';
(C) in clause (iii)--
(i) by striking ``respond to'' and inserting ``not later
than 60 days after receiving''; and
(ii) by striking ``; and'' at the end and inserting ``,
respond to such inquiry; and''; and
(D) in clause (iv), by inserting ``a failure to obtain a
prior authorization,'' after ``claim form,''.
(6) State incentive to pursue third party liability for
newly eligibles.--Section 1903(d)(2)(B) of the Social
Security Act (42 U.S.C. 1396b(d)(2)(B)), as amended by
paragraph (4)(B), is further amended by adding at the end the
following: ``In the case of expenditures for medical
assistance provided during 2017 and subsequent years for
individuals described in subclause (VIII) of section
1902(a)(10)(A)(i), in determining the amount, if any, of
overpayment under this subparagraph with respect to such
medical assistance, the Secretary shall apply the Federal
medical assistance percentage for the State under section
1905(b), notwithstanding the application of section
1905(y).''.
(b) Compliance With Third Party Insurance Reporting.--
Section 1905 of the Social Security Act (42 U.S.C. 1396d) is
amended by adding at the end the following new subsection:
``(ee) Notwithstanding subsection (b), for any year
beginning after 2019, if a State fails to comply with the
requirements of section 1902(a)(25) with respect to each
calendar quarter in such year, the Secretary may reduce the
Federal medical assistance percentage by 0.1 percentage point
for calendar quarters in each subsequent year in which the
State fails to so comply.''.
(c) Application to CHIP.--
(1) In general.--Section 2107(e)(1) of the Social Security
Act (42 U.S.C. 1397gg(e)(1)) is amended--
(A) by redesignating subparagraphs (B) through (R) as
subparagraphs (C) through (S), respectively; and
(B) by inserting after subparagraph (A) the following new
subparagraph:
``(B) Section 1902(a)(25) (relating to third party
liability).''.
(2) Mandatory reporting.--Section 1902(a)(25)(I)(i) of the
Social Security Act (42 U.S.C. 1396a(a)(25)(I)(i)), as
amended by subsection (a)(5), is further amended--
(A) by striking ``(and, at State option, child'' and
inserting ``and child''; and
(B) by striking ``title XXI)'' and inserting ``title XXI''.
(d) Training on Third Party Liability.--Section 1936 of the
Social Security Act (42 U.S.C. 1396u-6) is amended--
(1) in subsection (b)(4), by striking ``and quality of
care'' and inserting ``, quality of care, and the liability
of responsible third parties (as defined in section
1902(nn))''; and
(2) by adding at the end the following new subsection:
``(f) Third Party Liability Training.--With respect to
education or training activities carried out pursuant to
subsection (b)(4) with respect to the liability of
responsible third parties (as defined in section 1902(nn) for
payment for items and services furnished under State plans
(or under waivers of such plans)) under this title, the
Secretary shall--
``(1) publish (and update on an annual basis) on the public
Internet website of the Centers for Medicare & Medicaid
Services a dedicated Internet page containing best practices
to be used in assessing such liability;
``(2) monitor efforts to assess such liability and analyze
the challenges posed by that assessment;
``(3) distribute to State agencies administering the State
plan under this title information related to such efforts and
challenges; and
``(4) provide guidance to such State agencies with respect
to State oversight of efforts under a medicaid managed care
plan under section 1903(m) or 1932 to assess such
liability.''.
(e) Development of Model Uniform Fields for States To
Report Third Party Information.--Not later than January 1,
2019, the Secretary of Health and Human Services shall, in
consultation with the States, develop and make available to
the States a model uniform reporting set of reporting fields
and accompanying guidance documentation that States shall use
for purposes of--
(1) reporting information to the Secretary within the
Transformed Medicaid Statistical Information System (T-MSIS)
(or a successor system); and
(2) collecting information that identifies responsible
third parties (as defined in subsection (nn) of section 1902
of the Social Security Act (42 U.S.C. 1396a), as added by
subsection (a)(2)(A)) and other relevant information for
ascertaining the legal responsibility of such third parties
to pay for care and services available under the State plan
(or under a waiver of the plan) under title XIX of the Social
Security Act (42 U.S.C. 1396 et seq.) or under the State
child health plan under title XXI of such Act (42 U.S.C. 1397
et seq.).
(f) Effective Date.--
(1) In general.--Except as provided in paragraph (2), this
section and the amendments made by this section (other than
as specified in the preceding provisions of this section)
shall take effect on October 1, 2019, and shall apply to
medical assistance or child health assistance provided on or
after such date.
(2) Exception if state legislation required.--In the case
of a State plan for medical assistance under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.), or a State
child health plan for child health assistance under title XXI
of such Act (42 U.S.C. 1397aa et seq.), that the Secretary of
[[Page H8456]]
Health and Human Services determines requires State
legislation (other than legislation appropriating funds) in
order for the plan to meet the additional requirement imposed
by the amendments made under this section, such plan shall
not be regarded as failing to comply with the requirements of
such title solely on the basis of its failure to meet this
additional requirement before the first day of the first
calendar quarter beginning after the close of the first
regular session of the State legislature that begins after
the date of the enactment of this Act. For purposes of the
previous sentence, in the case of a State that has a 2-year
legislative session, each year of such session shall be
deemed to be a separate regular session of the State
legislature.
SEC. 402. TREATMENT OF LOTTERY WINNINGS AND OTHER LUMP-SUM
INCOME FOR PURPOSES OF INCOME ELIGIBILITY UNDER
MEDICAID.
(a) In General.--Section 1902 of the Social Security Act
(42 U.S.C. 1396a) is amended--
(1) in subsection (a)(17), by striking ``(e)(14), (e)(14)''
and inserting ``(e)(14), (e)(15)''; and
(2) in subsection (e)(14), as amended by section 303(c), by
adding at the end the following new subparagraph:
``(K) Treatment of certain lottery winnings and income
received as a lump sum.--
``(i) In general.--In the case of an individual who is the
recipient of qualified lottery winnings (pursuant to
lotteries occurring on or after January 1, 2018) or qualified
lump sum income (received on or after such date) and whose
eligibility for medical assistance is determined based on the
application of modified adjusted gross income under
subparagraph (A), a State shall, in determining such
eligibility, include such winnings or income (as applicable)
as income received--
``(I) in the month in which such winnings or income (as
applicable) is received if the amount of such winnings or
income is less than $80,000;
``(II) over a period of 2 months if the amount of such
winnings or income (as applicable) is greater than or equal
to $80,000 but less than $90,000;
``(III) over a period of 3 months if the amount of such
winnings or income (as applicable) is greater than or equal
to $90,000 but less than $100,000; and
``(IV) over a period of 3 months plus 1 additional month
for each increment of $10,000 of such winnings or income (as
applicable) received, not to exceed a period of 120 months
(for winnings or income of $1,260,000 or more), if the amount
of such winnings or income is greater than or equal to
$100,000.
``(ii) Counting in equal installments.--For purposes of
subclauses (II), (III), and (IV) of clause (i), winnings or
income to which such subclause applies shall be counted in
equal monthly installments over the period of months
specified under such subclause.
``(iii) Hardship exemption.--An individual whose income, by
application of clause (i), exceeds the applicable eligibility
threshold established by the State, shall continue to be
eligible for medical assistance to the extent that the State
determines, under procedures established by the State (in
accordance with standards specified by the Secretary), that
the denial of eligibility of the individual would cause an
undue medical or financial hardship as determined on the
basis of criteria established by the Secretary.
``(iv) Notifications and assistance required in case of
loss of eligibility.--A State shall, with respect to an
individual who loses eligibility for medical assistance under
the State plan (or a waiver of such plan) by reason of clause
(i)--
``(I) before the date on which the individual loses such
eligibility, inform the individual--
``(aa) of the individual's opportunity to enroll in a
qualified health plan offered through an Exchange established
under title I of the Patient Protection and Affordable Care
Act during the special enrollment period specified in section
9801(f)(3) of the Internal Revenue Code of 1986 (relating to
loss of Medicaid or CHIP coverage); and
``(bb) of the date on which the individual would no longer
be considered ineligible by reason of clause (i) to receive
medical assistance under the State plan or under any waiver
of such plan and be eligible to reapply to receive such
medical assistance; and
``(II) provide technical assistance to the individual
seeking to enroll in such a qualified health plan.
``(v) Qualified lottery winnings defined.--In this
subparagraph, the term `qualified lottery winnings' means
winnings from a sweepstakes, lottery, or pool described in
paragraph (3) of section 4402 of the Internal Revenue Code of
1986 or a lottery operated by a multistate or
multijurisdictional lottery association, including amounts
awarded as a lump sum payment.
``(vi) Qualified lump sum income defined.--In this
subparagraph, the term `qualified lump sum income' means
income that is received as a lump sum from one of the
following sources:
``(I) Monetary winnings from gambling (as defined by the
Secretary and including gambling activities described in
section 1955(b)(4) of title 18, United States Code).
``(II) Damages received, whether by suit or agreement and
whether as lump sums or as periodic payments (other than
monthly payments), on account of causes of action other than
causes of action arising from personal physical injuries or
physical sickness.
``(III) Income received as liquid assets from the estate
(as defined in section 1917(b)(4)) of a deceased
individual.''.
(b) Rules of Construction.--
(1) Interception of lottery winnings allowed.--Nothing in
the amendment made by subsection (a)(2) shall be construed as
preventing a State from intercepting the State lottery
winnings awarded to an individual in the State to recover
amounts paid by the State under the State Medicaid plan under
title XIX of the Social Security Act (42 U.S.C. 1396 et seq.)
for medical assistance furnished to the individual.
(2) Applicability limited to eligibility of recipient of
lottery winnings or lump sum income.--Nothing in the
amendment made by subsection (a)(2) shall be construed, with
respect to a determination of household income for purposes
of a determination of eligibility for medical assistance
under the State plan under title XIX of the Social Security
Act (42 U.S.C. 1396 et seq.) (or a waiver of such plan) made
by applying modified adjusted gross income under subparagraph
(A) of section 1902(e)(14) of such Act (42 U.S.C.
1396a(e)(14)), as limiting the eligibility for such medical
assistance of any individual that is a member of the
household other than the individual who received qualified
lottery winnings or qualified lump-sum income (as defined in
subparagraph (K) of such section 1902(e)(14), as added by
subsection (a)(2) of this section).
SEC. 403. ADJUSTMENTS TO MEDICARE PART B AND PART D PREMIUM
SUBSIDIES FOR HIGHER INCOME INDIVIDUALS.
(a) In General.--Section 1839(i)(3)(C)(i)(II) of the Social
Security Act (42 U.S.C. 1395r(i)(3)(C)(i)(II)) is amended, in
the table, by striking the last row and inserting the
following new rows:
``More than $160,000 but less than $500,000..................80 percent
At least $500,000.......................................100 percent.''.
(b) Joint Returns.--Section 1839(i)(3)(C)(ii) of the Social
Security Act (42 U.S.C. 1395r(i)(3)(C)(ii)) is amended by
inserting before the period the following: ``except, with
respect to the dollar amounts applied in the last row of the
table under subclause (II) of such clause (and the second
dollar amount specified in the second to last row of such
table), clause (i) shall be applied by substituting dollar
amounts which are 175 percent of such dollar amounts for the
calendar year''.
(c) Inflation Adjustment.--Section 1839(i) of the Social
Security Act (42 U.S.C. 1395r(i)) is amended--
(1) in paragraph (5)--
(A) in subparagraph (A), by striking ``In the case'' and
inserting ``Subject to subparagraph (C), in the case'';
(B) in subparagraph (B), by striking ``subparagraph (A)''
and inserting ``subparagraph (A) or (C)''; and
(C) by adding at the end the following new subparagraph:
``(C) Treatment of adjustments for certain higher income
individuals.--
``(i) In general.--Subparagraph (A) shall not apply with
respect to each dollar amount in paragraph (3) of $500,000.
``(ii) Adjustment beginning 2027.--In the case of any
calendar year beginning after 2026, each dollar amount in
paragraph (3) of $500,000 shall be increased by an amount
equal to--
``(I) such dollar amount, multiplied by
``(II) the percentage (if any) by which the average of the
Consumer Price Index for all urban consumers (United States
city average) for the 12-month period ending with August of
the preceding calendar year exceeds such average for the 12-
month period ending with August 2025.''; and
(2) in paragraph (6)(B), by inserting ``(other than
$500,000)'' after ``the dollar amounts''.
The SPEAKER pro tempore. The bill shall be debatable for 1 hour
equally divided and controlled by the chair and ranking minority member
of the Committee on Energy and Commerce.
The gentleman from Oregon (Mr. Walden) and the gentleman from New
Jersey (Mr. Pallone) each will control 30 minutes.
The Chair recognizes the gentleman from Oregon.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, we are here today to consider a very, very important
public health bill, H.R. 3922, the CHAMPIONING HEALTHY KIDS Act. This
legislation funds a 5-year extension of the Children's Health Insurance
Program, known as CHIP, along with a 2-year extension of community
health centers and numerous other critically important public health
programs.
This bill will deliver quality healthcare and peace of mind to
millions of Americans. The patients and families helped by this
legislation are our neighbors and our friends. More than 8 million
children receive CHIP-funded coverage, and more than 25 million
patients are served by our community health centers and other important
programs.
This 5-year funding of CHIP marks one of the longest extensions of
the program since it was created 20 years ago. The policy we are
considering mirrors the bipartisan policy that has been introduced and
voted out of our sister
[[Page H8457]]
committee in the United States Senate.
Funding for these important programs expired September 30. The
committee worked on a bipartisan basis well before this deadline to try
and reach a bipartisan agreement on a range of policies to offset the
costs of this very critically important funding extension.
Three times, at the request of the Democrats, we delayed committee
action--three times. We tried to find offsets that were agreeable as we
have always been able to do before. Unfortunately, that was not the
case this time. These delays meant Congress went past the deadline of
September 30.
While States still have rollover CHIP funds available and the next
wave of community health center funds won't go out until next year, we
cannot wait any longer. Patients cannot wait any longer. Patients need
care, these critical programs need funding, and we must move forward.
In my district alone, there are 12 federally qualified health center
organizations, with 63 delivery sites. They leverage $41 million in
Federal money in order to serve more than 240,000 patients in Oregon's
Second District. These health centers--and I have visited many of
them--are prevention and public health in action, often serving as the
main provider of care for people for hundreds of miles around.
We are also extending the National Health Service Corps and the
Teaching Health Center Graduate Medical Education program. Now, Mr.
Speaker, these are really important workforce programs that place
qualified providers into some of the most underserved areas of our
country.
In addition to community health centers and the workforce programs,
this bill extends the funding for the Special Diabetes Program and the
Family-to-Family Health Information centers, the Personal
Responsibility Program, and the Youth Empowerment Program. These
locally based, patient-centered organizations provide comprehensive
services to those most in need.
Moreover, this legislation eliminates 2 years of the across-the-board
cuts to Medicaid allotments called for under the Affordable Care Act,
ObamaCare. We delay those cuts for disproportionate share hospitals for
2 years. Medicaid DSH funding represents an important component of many
State Medicaid programs and is particularly relied upon by many States
to help provide additional resources to key safety net providers.
Now, while this relief is only temporary and does not address the
larger structural challenges under ObamaCare, it would give Congress
time to explore what budget-neutral approaches there might be to
allocate existing DSH dollars on a more equitable and fair basis. In my
State alone of Oregon, hospitals have told me this relief in this bill,
just for them, represents $6.8 million over the next 2 years that they
can use to help low-income people get access to hospital care.
Now, in paying for this package--and this is the area where we have
the most disagreement with the Democrats--we have taken a fiscally
responsible approach, like using existing funding streams for
prevention and public health efforts, ensuring high-dollar lottery
winners are removed from the Medicaid program so its limited resources
can be prioritized for the most vulnerable, and stopping individuals on
the Affordable Care Act's exchanges from gaming the system.
The bill also asks Medicare's wealthiest 1 percent, people who are
retired and making $40,000 a month--not a year, a month--to pay about
$135 more for their Medicare just on parts B and D that is already
subsidized by 75 percent, just a little more so we can fund children's
health insurance for 5 years.
While it was not ultimately possible, unfortunately, to reach
consensus on some of the policies to offset the new funding in this
bill, there is broad bipartisan agreement on the core policies
contained in this legislation, and I believe there is bipartisan
support for many of the reasonable and fiscally responsible offsets
contained in H.R. 3922.
Mr. Speaker, this is good legislation. This is long-overdue
legislation. It reflects the good work done by your House Energy and
Commerce Committee, and I urge my colleagues to put politics aside
today and ensure these vital programs get the funding extensions they
need. We are over the deadline. It is time to act.
Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I rise today to speak in opposition to H.R. 3922, a
partisan bill to reauthorize the Children's Health Insurance Program,
or CHIP, as well as community health centers and other public health
programs.
It pains me to be here today, because this should not be a partisan
bill. I have tried for months to negotiate with Republicans to develop
a bipartisan compromise, but House Republicans chose to spend the first
9 months of this year trying to repeal the Affordable Care Act. They
failed, but now House Republicans are using the reauthorization of CHIP
and community health centers as a way to once again sabotage the ACA.
Make no mistake, Mr. Speaker: if Republicans can't repeal the ACA
outright, they will cripple it any time they can.
This time, Republicans are risking the healthcare of nearly 9 million
children and the care of families all around the country that use
community health centers. They are risking that care because this
partisan bill has no chance of ever becoming law.
By taking this route, Republicans are guaranteeing that CHIP and
community health centers will not be reauthorized until the end of the
year, and that is extremely unfortunate.
Mr. Speaker, I strongly support CHIP, our community health centers,
and all of our public health programs that are extended in this bill.
These programs have traditionally been bipartisan, but the bill before
us extends these programs by taking billions of dollars away from the
Affordable Care Act and undermining Medicare.
In short, this Republican bill offers a false choice. On one hand, it
strips healthcare away from upwards of 680,000 Americans and guts the
Prevention Fund, which pays for immunization and vaccines, lead
poisoning prevention, opioid treatment, and many other important
programs; on other hand, it reauthorizes these important programs.
Democrats strongly support reauthorization of these programs, but we
reject the way Republicans are paying for them.
Mr. Speaker, there are so many other policies that save money,
countless alternatives that Democrats have offered to Republicans for
months. Yesterday I offered an alternative that would have provided a
robust reauthorization and extension of these important programs, and
it was paid for in a commonsense way.
My alternative would have changed the timing of payments to Medicare
Advantage Plans. This approach was recommended by both the GAO and the
Office of the Inspector General, but Republicans rejected it in the
Rules Committee. They wouldn't even allow it to come before the full
House for a vote. And why is because they would rather use
reauthorization of CHIP and community health centers as another way to
sabotage the Affordable Care Act.
I simply reject that approach and strongly urge a ``no'' vote.
Mr. Speaker, I reserve the balance of my time.
Mr. WALDEN. Mr. Speaker, before I call on my next person to say
something here, there are 17,000 children in Mr. Pallone's district and
14 health centers that, if he votes ``no,'' he will be voting against.
By the way, the offset he recommended, people who are watching this
need to know, would violate statute and it would be a PAYGO violation.
That is why it was not acceptable.
See, this is the problem we faced. We delayed three times at their
request only to be offered up a pay-for that violates statute and
violates our PAYGO rules. We could not accept that. We have to operate
within the law like everyone else in America.
Mr. Speaker, I yield 4 minutes to the gentleman from Texas (Mr.
Burgess).
Mr. BURGESS. Mr. Speaker, I thank the gentleman for yielding the
time, for the recognition.
Let me just say, I want to thank members of the Health Subcommittee,
both sides of the dais, who have worked hard on this legislation, and
it is unfortunate that it was not brought to the floor of the House in
the month of September.
[[Page H8458]]
From a subcommittee perspective, we were ready. We had our
legislative hearings in June. We were delayed one time when the whole
House recessed after the shooting of the Members at the baseball
practice, but we rescheduled for 2 weeks later, and we had a successful
hearing. We had a good hearing; a lot of facts were laid out. We came
up with commonsense legislation that was offset in a responsible way.
The offsets are not draconian.
We have before us a bill today that will, in fact, fund some of the
Nation's most important public health programs. It does fund the State
Children's Health Insurance for 5 years, one of the longest extensions
for this program since its inception in 1996. It will ensure that
children and families who rely on this program will continue to receive
the access they need. It also includes, in a fiscally responsible way,
to delay the harmful ObamaCare-mandated cuts to safety net hospitals,
who also provide care to underserved patients.
Now, think about that for a minute. We are accused of undermining
ObamaCare, but here is a cut that ObamaCare mandates to your safety net
hospitals across the country--not just in Texas, but across the
country--and we are replacing that today in a fiscally responsible way.
It provides funding for community health centers, an important key
part of healthcare in communities across the country. It will help the
Americans who rely on these vital health services.
Not only does the bill provide assistance for underserved
populations, but it does so without adding to the national debt. The
Committee for a Responsible Federal Budget called this a responsible
health package, noting that the $18 billion cost is fully offset, with
savings beyond the 10-year budget window.
Other groups have also been supportive: Texas Hospital Association,
Texas Health Resources--for me back home--Children's Hospital, and a
number of healthcare organizations.
We have data from MACPAC, whose job it is to advise Congress on
Medicaid and CHIP policy; and MACPAC has advised us that, under current
law, there are no new Federal funds for State Children's Health
Insurance for fiscal year 2018 and beyond. Unless Congress acts to
renew funding, all States will experience a shortfall in CHIP funds for
2018, which means, if someone is contemplating a ``no'' vote on this
bill, if you are contemplating a ``no'' vote, you do need to be aware
that if you live in the States of Arizona and Minnesota, you ran out of
money in October of 2017; North Carolina, same situation. Oregon runs
out next month. Vermont runs out next month. You need to think about
your ``no'' vote before you apply it.
Every single U.S. territory, with the exception of Puerto Rico, ran
out of money in the month of October.
So those are a few facts that people do need to bear in mind, if they
vote ``no'' on this bill, what the actual implications of that are.
Yesterday, during debate on the rule, I heard a lot of discussion
about taking money out of the Prevention Fund. It doesn't take money
out of the Prevention Fund, but it does provide discretion for some
prevention and public health dollars. It takes it away from the
executive branch and redirects these dollars to proven public health
programs that enjoy broad bipartisan support in Congress, like
community health centers.
So we are fulfilling our Article I responsibility. We shouldn't just
be giving everything to the administration to decide how to spend
money, whether it be a Democratic or Republican administration. This is
the right thing to do.
I am proud of the work done by our subcommittee. I think our
subcommittee staff has performed admirably on both sides of the dais.
Mr. Speaker, I urge a ``yes'' vote on the bill. It is time to act, as
our chairman has said.
{time} 0930
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman
from California (Ms. Eshoo).
Ms. ESHOO. Mr. Speaker, I thank our distinguished ranking member.
Mr. Speaker, I rise today to oppose this bill, the so-called
CHAMPIONING HEALTHY KIDS Act. First of all, we are a month late and
many dollars short. It was the majority that brought it up late. We
didn't have anything to do with being late.
Secondly, we are playing political games with the lives of 14 percent
of the children in my congressional district who receive their health
insurance through the Children's Health Insurance Program and the five
federally qualified health centers in my congressional district. They
provide medical, dental, and mental health services to almost 55,000 of
my constituents every year.
Reauthorizing these historically bipartisan programs is critical to
the health and safety of not only my constituents but millions of
others across our country.
Today, the Republican majority is holding them hostage by insisting
to fund these programs by means-testing Medicare beneficiaries, kicking
individuals who purchase their health coverage on the marketplaces off
their insurance, and gutting the Public Health Prevention Fund
established in the Affordable Care Act.
Remember, the Republicans have set their budget based on eliminating
the Affordable Care Act. My State of California will run out of funding
for CHIP sometime between now and December. This has never happened
before in the history of this program.
The SPEAKER pro tempore. The time of the gentlewoman has expired.
Mr. PALLONE. Mr. Speaker, I yield an additional 30 seconds to the
gentlewoman from California.
Ms. ESHOO. Mr. Speaker, the community health centers in my district
have told me about the difficult decisions they have to make because
Congress has not reauthorized their funding, including layoffs of
physicians and closing clinics' doors. We are playing with people's
lives here.
If we can't find the funding for these important bipartisan programs,
then we don't deserve to be Members of Congress. I cannot support a
bill that hurts people instead of helping them.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume to
respond.
Mr. Speaker, my friend, and she is my friend from California,
obviously was not aware of the fact that it was her party, her leader,
who asked us on three occasions to delay bringing this to the floor,
including you could look at the CQ article from October 23 where Mr.
Pallone says he hopes it doesn't come to the floor.
This was a bipartisan agreement not to bring it until we could try to
work these things out. We were all trying to figure out how to get this
done.
When it comes to Medicare, remember, we are talking about people
making $40,000 a month paying $135 a month more. We can fully fund
children's health insurance for millions of children.
Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from
Washington (Mrs. McMorris Rodgers), the conference chairwoman.
Mrs. McMORRIS RODGERS. Mr. Speaker, I thank the chairman for his
tremendous leadership on the reauthorization of CHIP, including many
vital public health programs.
CHIP provides healthcare coverage for some 9 million children--more
than a million in Washington State. We all need to remember how
important this program is for the health of some of the most
vulnerable.
Some States, like mine, are expecting to run out of CHIP funding
soon. It is crucial that we move forward now.
This bill also reauthorizes the Teaching Health Center Graduate
Medical Education program, providing funding for 2 years, with a robust
increase. This not only preserves current programs like the Spokane
Teaching Health Center, but it also provides funding for the creation
of new programs in communities that need them.
Mr. Speaker, this bill makes a real difference to those who need
healthcare, and I encourage my colleagues to support it.
Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, it is the ultimate absurdity for my colleague, the
chairman of the Energy and Commerce Committee, to suggest that somehow
I control when a bill comes to the floor of the House of
Representatives.
The only reason that the Republicans ever delayed bringing this vote
to the floor is because they know and I know that, if this bill is
partisan, it will
[[Page H8459]]
never become law. It will go to the Senate, and it will sit there, and
the only way that it is going to become law is if it is a bipartisan
effort that actually accomplishes something and gets most people to
support it.
We could keep listening to the other side all day say: Oh, the
Democrats delayed the vote. The Democrats delayed the vote.
The vote shouldn't be held today. The vote should be delayed today
because this is going nowhere. This bill is going nowhere. They know
it. You want to keep saying it? You can say it all day for the next
hour, but it is the ultimate of absurdity.
Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Gene
Green), who is the ranking member of our Health Subcommittee.
Mr. GENE GREEN of Texas. Mr. Speaker, I thank my ranking member for
yielding time to me.
I rise to oppose H.R. 3922. I got elected to Congress to expand
access for healthcare. I am not a doctor, I am not a nurse, but as
Members of Congress, we can do as much damage as someone who isn't a
doctor or nurse by legislation that we see today.
And while I strongly support extending funding for the Children's
Healthcare Insurance Program and federally qualified health centers,
delaying cuts to disproportionate share hospital payments, advancing
our other bipartisan healthcare programs, this legislation includes
offsets that undermine access to cover these services.
Again, my goal in Congress was to expand healthcare, and this bill
restricts that access. Two-thirds of Medicaid dollars go to children.
If you cut Medicaid, you are cutting those children's benefits. This
bill cuts children from Medicaid, and it gives money to the children
who are less poor on CHIP. We need both programs. We don't need one or
the other.
Both CHIP and FQHCs are bedrocks of our healthcare system, providing
health insurance to almost 9 million lower-income children serving on
the front lines by providing high-quality primary and preventative care
to more than 25 million Americans.
Congress let funding for these programs expire last month, the first
time in our history, since the 1960s, that the FQHCs and the CHIP
program were not bipartisan. That is the step this House is making
today by doing this.
It should be bipartisan because it has always been bipartisan.
Unfortunately, instead of bipartisan negotiations looking for a
compromise, the process was derailed. The bill cuts, again, Medicaid.
Two-thirds are children, to help poor children, and limit their access.
The Prevention Fund funds the Centers for Disease Control. We have
any number of future illnesses that we need the CDC to have the ability
to fight that, and here we are, cutting vaccinations in our
communities. We are cutting infectious disease detection and
prevention.
Mr. Speaker, I urge my colleagues to vote ``no,'' and let's expand
access and not restrict it.
Mr. WALDEN. Mr. Speaker, I would point out there are about 50,000
kids that Mr. Green may be voting against today in the Houston area if
this goes down and we can't get this over to the Senate and work it out
with them. Twice he has voted to cut the Prevention Fund and use it for
other purposes.
Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from New Jersey
(Mr. Lance).
Mr. LANCE. Mr. Speaker, I rise in support of this legislation. This
package is the product of our work on the Energy and Commerce Committee
under the leadership of Chairman Walden. This legislation accomplishes
the very important goals of reauthorizing the Children's Health
Insurance Program, renewing funding for community health centers, and
extending critical resources for Medicaid in Puerto Rico.
One of the first votes I cast in Congress was for CHIP, creating a
fiscally responsible health program that now serves 8.5 million
children in the United States.
I continue to support community health centers and the work they do
in areas like Dover and Somerville, New Jersey, in the district I
serve.
We also cannot forget about the many families and children in Puerto
Rico, who also benefit from the Medicaid program. That is why I have
teamed up with Resident Commissioner Gonzalez-Colon, to make sure low-
cost Federal healthcare continues to be made available to our American
children in Puerto Rico.
Mr. Speaker, I urge passage of this legislation and for the United
States Senate to act as soon as possible.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ to the gentleman from New
York (Mr. Engel).
Mr. ENGEL. Mr. Speaker, I am deeply saddened by the situation we are
in today. Historically, CHIP and community health centers have been
bipartisan priorities. We are talking about programs that provide
healthcare for millions of American children and serve some of our
country's most vulnerable citizens.
Yet my Republican colleagues have inexplicably taken these programs
hostage, tucking into this bill new attempts to undermine Medicare,
sabotage the ACA, and strip hardworking Americans of their health
insurance, not to mention they are trying to extort these harmful
policy changes a month after they let CHIP and community health center
funding expire. This is absolutely unconscionable because, make no
mistake, these cuts will hurt the same Americans who depend on CHIP and
community health centers.
My Democratic colleagues and I care deeply about these programs. That
is why we have sounded the alarm for months, not just yesterday, for
months, and urged the majority to stop wasting time on ACA repeal and
get to work on renewing these lifelines for American families.
Mr. Speaker, I am disappointed that didn't happen, and I am
disappointed by what is happening now. I urge my colleagues to vote
``no.''
Mr. WALDEN. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from
Texas (Mr. Olson), a very important member of our committee.
Mr. OLSON. Mr. Speaker, I thank the chairman for yielding time to me.
Mr. Speaker, I rise today to strongly encourage my colleagues to
support the HEALTHY KIDS Act. There are many reasons to support this
bill, but, most importantly, it extends the Children's Health Insurance
Program, CHIP, until 2022.
CHIP ensures that children with incomes too low for Medicaid get
basic health insurance. Close to 400,000 children in Texas rely on CHIP
for access to quality healthcare services. We must act now.
Earlier this year, Hurricane Harvey left a path of destruction across
Texas. It put a major strain on our communities and resources that has
resulted in moments of uncertainty.
The bottom line is, we must act now. This bill responsibly provides
children in need with the proper resources to live a healthy life
without adding to our country's deficit.
Mr. Speaker, again, I strongly urge my colleagues to act now. Vote
for this bill.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman
from Colorado (Ms. DeGette), the ranking member of our Oversight
Subcommittee.
Ms. DeGETTE. Mr. Speaker, as one of the authors of the original bill
20 years ago, I rise to express deep disappointment that the House has
not been able to reach a bipartisan agreement on how to fund the
extension of CHIP.
The September 30 deadline has long passed, and now 9 million children
and families are waiting anxiously for us to figure this out. My home
State of Colorado is likely to run out of CHIP funding in January, with
termination notices going out to worried families in the next few
weeks.
Yet here we are with a partisan bill that asks us to pay for low-
income children's insurance on the backs of seniors and the most
vulnerable.
The bill also cuts the Affordable Care Act, which could result in
668,000 people enrolled in ACA plans losing their health insurance.
Nobody should have to lose coverage in order for others to keep it.
This is a false choice, and it is out of step with what the American
people have been calling on us to do. Only the 115th Congress could
find a way to make the CHIP bill partisan.
Irrespective of what happens today in this vote, I urge my colleagues
to get together across the aisle, across the Capitol, find a way to
reauthorize this important bill in a way that doesn't cut benefits for
other people. Let's
[[Page H8460]]
truly give kids these benefits that they need, and let's move on with
our business.
Mr. WALDEN. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from
Florida (Mr. Bilirakis), an incredible advocate for children and
healthcare in America.
Mr. BILIRAKIS. Mr. Speaker, I am so proud to serve on this great
committee under the chairman's leadership.
Mr. Speaker, I rise in support of this important bill, which
incorporates my bill, the Community CARE Act, which reauthorizes
funding for community health centers for the next 2 years.
Community health centers have a proven track record of providing
high-quality, cost-efficient healthcare to approximately 25 million
Americans, including 7 million children, and 300,000 veterans each
year. There are over 100 million coordinated and integrated patient
visits through the 1,400 community health centers across the country.
{time} 0945
This bill will reauthorize CHIP for the next 5 years. This program is
vital for the roughly 360,000 children on CHIP in Florida alone.
Additionally, this bill provides clarity for CHIP buy-in programs,
such as the one we have in Florida. This sets the rules of the road and
will ensure that 12,000 children in Florida's CHIP buy-in program will
continue to have access to CHIP.
Mr. Speaker, let's get this done now for our children. I urge passage
of this important piece of legislation.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman
from Illinois (Ms. Schakowsky).
Ms. SCHAKOWSKY. Mr. Speaker, the truth is that Republicans are
holding the Children's Health Insurance Program, 9 million kids, and
the Community Health Center program, 15 million people, hostage to
wreak even more havoc on our healthcare system and make children and
seniors sicker and undercut Medicare.
Paying for children's health insurance on the backs of seniors is
simply a disgrace. This bill would increase Medicare part D and part B
income-related premiums, charging higher income seniors the entire
cost. This is a structural attack on Medicare, and that is why the
AARP, which supports the Children's Health Insurance Program, opposes
this bill. Imposing a 100 percent premium is unfair because these
seniors already pay more, and it will drive many out of Medicare
altogether, undermining its solvency.
To make matters worse, the Republican income threshold is not based
on current income, but on a 2-year period. So, for example, seniors'
income is volatile, and if you sold your home, you could get a massive
premium penalty, even if you used the money you got from selling your
home to buy in to assisted living and that money wasn't available.
Income-related premiums are simply unnecessary. There are many other
ways to pay for the CHIP program without using Medicare as an ATM.
Democrats have offered reasonable alternatives, but Republicans opposed
all of them.
I urge my colleagues to oppose this legislation.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
Before I call on my next colleague, I just want to point out that, in
Ms. Schakowsky's district, all we are talking about here is seniors
making $41,000 a month--a month--would pay an extra 135 bucks so we can
fully fund children's health insurance, community health centers. All
these programs in here are funded. We use the Prevention Fund, which is
not allocated out in the out-years. It is just a pot of money you can
use for prevention and wellness. We actually use that to fund this as
well.
This is why we have been unable to reach agreement with the
Democrats. It is sad they have made this partisan.
I yield 1 minute to the gentleman from California (Mr. Costa).
Mr. COSTA. Mr. Speaker, I rise today to speak on behalf of the people
of the San Joaquin Valley in favor of H.R. 3922.
The people of the valley whom I represent in California did not send
me here to put the lives of children at risk. I have made a commitment
to improve access to healthcare for families that I have the honor to
represent here in the House. I will continue to meet that commitment.
The question is: Will Congress do the same and extend the Children's
Health Insurance Program?
My congressional district has perhaps the largest percentage of
children who qualify for the Children's Health Insurance Program in the
entire country. The coverage is vital to families throughout my
district, but it is particularly important to communities like Gustine,
Planada, Chowchilla, and Biola, where these healthcare clinics provide
such important, valuable healthcare to these children and their
families.
Approximately 71 percent of the children in my district receive their
medical coverage through the combination of the Children's Health
Insurance Program and Medicaid. We cannot let this end.
This bill is not perfect, to be sure, but these children cannot be
put at risk with further delays in funding for the important programs
that this bill extends. I urge my colleagues to support this
legislation.
Mr. PALLONE. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Florida (Ms. Castor), the vice ranking member of our committee.
Ms. CASTOR of Florida. Mr. Speaker, for decades now in America we
have worked together to make sure that kids can see a doctor and get
the care that they need. Working with pediatricians, families, and
advocates back home, we have reached a historic point where almost all
kids across the country have health insurance coverage.
The Children's Health Insurance Program, or CHIP, or known in Florida
as Florida KidCare, or Healthy Kids, has been an important piece of
this historic coverage level. CHIP simply is vital for families,
millions of hardworking families, so that their kids can get the
checkups, the immunizations, sometimes the critical care that they need
so they can be healthy and well.
Now, I chair the bipartisan Children's Healthcare Caucus. We educate
and advocate so that kids across America are healthy and well. So it is
especially disappointing this year that my Republican colleagues failed
to act before CHIP expired.
See, they were consumed all year long with ripping health coverage
away, decimating the Affordable Care Act, and radically changing health
services provided under Medicaid. In doing so, they let our kids down;
they let our families down. And then, at the 11th hour, after the
program expired, they come up with a very partisan bill rather than the
bipartisan bill that has been the historic backbone of Children's
Health Insurance.
Don't take it from me. A lot of the advocates across the country,
like pediatricians, obstetricians, gynecologists, March of Dimes, say:
Please don't fund CHIP based upon harmful cuts; don't have cuts
negatively impact the health of women, children, and families.
Pediatricians say: Don't jeopardize other important child health
policies in the process.
Let's go back to the drawing board as soon as possible, over the
weekend, next week; bring it back to the floor next week, so that
families and kids get the care that they need.
This bill today, unfortunately, is simply a delay.
Mr. WALDEN. Mr. Speaker, there they go again: delay, delay, delay;
and vote against kids, vote against their hospitals, and vote against
their doctors. That is why we couldn't get agreement.
I yield 1\1/2\ minutes to the gentleman from Indiana (Mr. Bucshon).
Mr. BUCSHON. Mr. Speaker, I rise today in strong support of the
CHAMPIONING HEALTHY KIDS Act, which extends the State Children's Health
Insurance Program, SCHIP, for another 5 years.
In 1997, Congress created S-CHIP in partnership with the States to
meet the healthcare needs of lower income kids. Last year, nearly
100,000 Hoosier kids received health insurance thanks to this critical
program. I am proud that this legislation will continue to protect
vulnerable children in the Eighth District of Indiana.
This bill also extends 2 years of funding for federally qualified
health centers, family-to-family health information centers, and other
important public health programs. This funding provides important
healthcare services, resources, and information for families in the
Eighth District and across America.
[[Page H8461]]
I urge my colleagues to support passage of the CHAMPIONING HEALTHY
KIDS Act.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman
from Vermont (Mr. Welch).
Mr. WELCH. Mr. Speaker, speaking to my chairman, Chairman Walden, I
accept your commitment and your leadership on insuring children, but I
am speaking to you because I reject the argument that, in order to fund
a health insurance program that all of us support, we have to
compromise health programs that benefit many other people, including in
Vermont. Let me just give an example.
The prevention program in Vermont is really helping people stay well.
We had $922,000 that was spent on immunization programs for our kids.
We had $377,000 for lead poisoning prevention. Lead poisoning is
brutal. We had $372,000 for heart disease prevention and control, and
we had over $209,000 for diabetes and prevention control.
So I acknowledge your commitment. I acknowledge the urgency with
which your side and our side supports CHIP. But why is it that, if we
support it, we don't pay for it? And instead of paying for it directly,
coming up with ways to eliminate waste in the healthcare system, we
take away our ability to immunize, to prevent lead poisoning, to reduce
heart disease? That is my question. The answer for me would be that we
go where the waste is.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. PALLONE. I yield the gentleman from Vermont an additional 30
seconds.
Mr. WELCH. The answer to me would be that our committee engages in
addressing the waste in healthcare, including high prescription drug
costs, rather than take it out of good programs.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
I appreciate the gentleman's sincerity. We work well together on lots
of issues. He has also voted to use this Prevention Fund for other
purposes in the past, as have I.
We don't touch the Prevention Fund for 2018, and there is $400
million left in 2019, and billions thereafter for the very important
programs the gentleman has articulated. We don't use all the money. We
leave money behind for these other purposes.
Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
The bottom line is, when you start cutting money from the Prevention
Fund, you are cutting prevention programs for kids, adults, the
disabled, and, most importantly, the opiates.
CDC spends a significant amount of money from the Prevention Fund
dealing with the opiate crisis, so don't tell me that somehow this is
okay. You are taking money away from opiate prevention. You are taking
money away from kids programs like lead poisoning and vaccines. It is
unbelievable how much is actually going to be lost from the Prevention
Fund because of this bill.
I am not interested in what happened in the past. I want to know what
is going to happen in the future. We have an opiate crisis. Don't take
money away from the Prevention Fund that is used to deal with that
crisis.
I reserve the balance of my time.
Mr. WALDEN. Mr. Speaker, I do think it is important to note that my
friend, and he is my friend from New Jersey, has twice voted to use
this Prevention Fund for other purposes, including the 2012 middle
class tax cut.
I yield 1\1/2\ minutes to the gentleman from Texas (Mr. Barton).
(Mr. BARTON asked and was given permission to revise and extend his
remarks.)
Mr. BARTON. Mr. Speaker, we have talked a lot today on the floor
about the children's component of this bill, the S-CHIP. It is a good
program. It covers about 45 percent of the low-income children in
Texas. It is a very worthwhile program and needs to be reauthorized and
funded.
I also want to talk about the community health centers. In Ennis,
Texas, there is the Nell Barton Hope Clinic Annex. Nell Barton was my
mother.
The Joe Barton Family Foundation purchased a building for the Hope
Clinic, which is a federally funded health center that is primarily
located in Waxahachie, Texas. Every day, several dozen low-income
people go to the Nell Barton Hope Clinic. Over the course of the year,
several thousand people go to the Hope Clinic in both Ennis and
Waxahachie. This bill reauthorizes those health centers for 2 years.
Now, my friends on the Democratic side, I am not sure what they are
complaining about. This is a program that funds healthcare for children
and for low-income people through the community health centers. It is
fully offset, and funding is increasing, Mr. Speaker, not decreasing,
but it is doing so in a way that it is offset. What is the big offset?
I hope we vote for this bill when it comes up for a vote later today.
{time} 1000
Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I just wanted to talk about this use of the Prevention
Fund. Democrats have never supported the type of drastic cuts to the
Prevention Fund that is in this proposal today. In fact, when faced
with such cuts, we voted ``no'' nine times. In the two cases where we
voted in favor of using some of the Prevention Fund as an offset,
neither cut placed the CDC programs and efforts at risk as this
legislation does today.
The Republican proposal would cut the Prevention Fund nearly in half
and leave a $400 million hole in funding for prevention and health
programs within the CDC's budget beginning in 2019. This cut would be
devastating to local, State and Federal efforts to protect the Nation's
health.
Unlike my Republican counterparts, what they contend, this cut to
these programs would not be made up in the annual appropriations
process, as evidenced by the proposed cut of $198 million to the CDC in
the House Republican fiscal year 2018 appropriations bill, and the
decrease of $580 million in CDC funding since 2010 when adjusted for
inflation.
Again, you talk about opiates, you talk about children's health
programs. These would be drastically cut because of what they are doing
today to the Prevention Fund.
Mr. Speaker, I reserve the balance of my time.
Mr. WALDEN. Mr. Speaker, before I yield to the gentleman from
Michigan, I would just point out that when Democrats joined Republicans
in voting for the 2012 middle class tax cut, we used $6.3 billion out
of the Prevention Fund they now say they never touched, yet they have.
Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Michigan
(Mr. Walberg).
Mr. WALBERG. Mr. Speaker, I rise today in support of H.R. 3922. I
want to thank Chairman Walden and Dr. Burgess for their leadership in
bringing this bill to the floor today.
The CHAMPIONING HEALTHY KIDS Act reauthorizes and funds a number of
programs important to my constituents, including the State Children's
Health Insurance Program, community health centers, and the Teaching
Health Center Graduate Medical Education program.
H.R. 3922 will continue CHIP for 5 years, allowing this successful
Federal-State partnership to provide health coverage for low-income
children and pregnant women. It also extends funding to federally
qualified health centers for 2 years, a key component of the healthcare
safety net; and helps address our increasing health provider shortages
by investing in the education and training of future health
professionals.
Of importance, this legislation is fully paid for with responsible
policies, such as measures to allow States to disenroll lottery winners
from Medicaid and prioritize the most vulnerable.
I am proud of the good work that was done by the Energy and Commerce
Committee to advance this legislation to the floor, and I encourage my
colleagues to vote ``yes'' on the bill and to ensure the programs are
available for the people who depend upon them.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman
from California (Ms. Matsui).
Ms. MATSUI. Mr. Speaker, I rise in opposition to H.R. 3922.
Mr. Speaker, the uncertainty that we have created for our community
health clinics and their patients is unacceptable. Each day it is a new
threat. Most
[[Page H8462]]
of the year it has been TrumpCare's severe cuts to Medicaid, which
health centers and their patients rely upon. Today it is a lack of
extension of the critical grant funding. Tomorrow or the next week, we
will be back to ripping Medicaid away to pay for the Republican's tax
cuts.
We have always extended CHIP and community health center funding on a
bipartisan basis, but, unfortunately, the bill before us today is not
bipartisan. The Prevention Fund, which would be slashed in this bill,
funds programs that are critical to children and families who rely upon
CHIP and community health centers. Many times these programs are even
run out of our community health centers and could not exist without the
Prevention Fund. These are things like childhood asthma prevention,
vaccines, and lead abatement.
It often takes someone going above and beyond a simple doctor's visit
to provide families with the resources they need to stay healthy. We
need to invest in these services. We cannot strip this funding from
critical prevention programs that children and families rely on. We
cannot allow programs like Medicare and Medicaid to be attacked and
raided.
Mr. Speaker, I urge my colleagues to vote ``no'' on H.R. 3922.
Mr. WALDEN. Mr. Speaker, once again, my dear friend from California
has twice voted to use these Prevention Funds for other things. By the
way, when we use them for community health centers, they are doing this
work on the ground, helping people with opioid addictions and other
healthcare issues.
Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Georgia
(Mr. Carter).
Mr. CARTER of Georgia. Mr. Speaker, I thank the chairman for yielding
and for his outstanding leadership on this very important committee.
Mr. Speaker, I rise today to implore my colleagues to put politics
aside for the sake of the 232,000 children in my State of Georgia and
the 8.9 million children across our Nation who are counting on us to
reauthorize CHIP. Twelve States will run out of CHIP funding before the
end of this year. So the idea of waiting around another 2 months before
acting on CHIP is simply unacceptable.
Let's be clear why we are here today. Instead of having this
discussion 2 months ago, we had to delay the Energy and Commerce
Committee markup of the CHAMPIONING HEALTHY KIDS Act, the CHIP bill,
because the other side of the aisle refused to even consider reasonable
offsets to pay for the program.
I ask my colleagues on the other side of the aisle: How was that
objection related to fighting for the middle class?
Even President Obama supported the change for high-income Medicare
beneficiaries in his annual budget.
How are we supposed to look parents in the eye back home and tell
them that we choose politics instead of choosing to relieve their
concerns about coverage?
Mr. Speaker, let's do our job and let's reauthorize CHIP.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman
from California (Mr. McNerney).
=========================== NOTE ===========================
November 3, 2017, on page H8462, the following appeared: 1\1/2\
minutes to gentleman California
The online version has been corrected to read: 1\1/2\ minutes to
the gentleman from California
========================= END NOTE =========================
Mr. McNERNEY. Mr. Speaker, I rise in opposition to H.R. 3922.
Mr. Speaker, it is critical that we authorize CHIP and community
health centers, but slashing essential public health funding is not the
right way to do it.
Treatment of chronic diseases accounts for 75 percent of our Nation's
healthcare spending, and many of these diseases can be prevented.
Unfortunately, H.R. 3922 does not do that at all. This bill cuts in
half the ACA Prevention and Public Health Fund that plays a critical
role in preventing and treating chronic diseases, including keeping
kids healthy.
The massive cuts to this funding will be devastating to my Central
Valley of California district. My district has the largest number of
tuberculosis cases in California for children under 5 years old.
Children in this age group are more likely to develop life-threatening
forms of TB since their immune systems are less mature. Public
officials in my district are relying on funding from the Prevention
Fund to address TB outbreaks.
It is troubling that Republicans are using CHIP reauthorization to
take core public health services away from kids. It is also
frustrating, but not surprising, that the Republicans are making
another attempt to sabotage the Affordable Care Act. This legislation
is robbing Paul to pay Peter, and I urge my colleagues to vote against
it.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, sabotaging the Affordable Care Act; what we are doing is
putting off planned cuts to our hospitals that take care of low-income
people that those cuts called for under the Affordable Care Act. We are
putting those off so they can serve these low-income people. That, in
their language, is sabotaging the Affordable Care Act.
On the issue of using the Prevention Fund, my friend from California
who just spoke, has twice voted to use the Prevention Fund, including
for tax cuts in 2012 and for the 21st Century Cures Act last year. Now
we are using it for community health centers and children's health
insurance programs. This is an appropriate use of a fund that gets
replenished by law every year.
Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from Puerto
Rico (Miss Gonzalez-Colon), whose constituents and herself have
suffered such damage, such destruction as a result of the hurricanes.
Miss GONZALEZ-COLON of Puerto Rico. Mr. Speaker, I rise in strong
support of H.R. 3922, the CHAMPIONING HEALTHY KIDS Act.
I wanted to begin by first thanking Chairman Walden and Dr. Burgess
for their leadership in moving forward this critically needed
legislation. I am particularly thankful for those in the leadership and
all of my colleagues in the Energy and Commerce Committee for including
a $1 billion allocation to temporarily address Puerto Rico's impending
ObamaCare-created medical cliff, while also providing another year of
the disproportionate share hospital relief.
To put things in perspective, when we arrived in this Congress during
January of this year, more than 1 million Puerto Ricans were facing the
imminent possibility of losing their healthcare coverage due to a
funding shortfall resulting from ObamaCare's disparate application to
the island.
We moved quickly during the appropriations bill, and they allocated
$295 million to improve that situation. In this bill, we are allocating
$1 billion for Puerto Rico's Medicaid program. This is an important
step, but we still need to secure a permanent and equitable solution to
Puerto Rico's longstanding Medicaid inequalities, and that means
changing the FMAP for the island.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman
from New York (Ms. Velazquez).
Ms. VELAZQUEZ. Mr. Speaker, I want to thank the ranking member for
yielding.
Mr. Speaker, as Puerto Rico struggles to recover from the historic
damage of Hurricane Maria, this legislation shortchanges the island's
long-struggling healthcare system at exactly the time that Puerto Rico
most needs our help.
This legislation provides a measly sum of Puerto Rico's Medicaid
system. Even before Hurricane Maria made landfall, Speaker Ryan had
committed to help resolve Puerto Rico's looming Medicaid crisis, yet
this bill provides just $1 billion. We have no assurance or guarantee
that the next emergency supplemental will provide appropriate funds to
address this problem.
The fact is that our fellow citizens have been shortchanged by the
disparity in Medicaid funding. This forced the government of Puerto
Rico to borrow money to provide healthcare. So if you wonder where
Puerto Rico's financial crisis stems from, you can look right here at
the U.S. Congress. Yet the amount included in this bill is far from
sufficient to address even this year's shortfall. For the Puerto Rican
people who have already suffered so much, this funding level amounts to
an insult.
If ever there were a time to channel aid to the island's healthcare
system and fix the systemic problems that we sought in the system
underfunding, this is it.
The SPEAKER pro tempore (Mr. Collins of Georgia). The time of the
gentlewoman has expired.
Mr. PALLONE. Mr. Speaker, I yield an additional 30 seconds to the
gentlewoman from New York.
[[Page H8463]]
Ms. VELAZQUEZ. Mr. Speaker, there are a litany of reasons to oppose
this bill, but let's make it clear: one of them is that it will not do
enough for the people of Puerto Rico. These are U.S. citizens. They
have fought, shed blood, and died in every major conflict. Now they
need our help, and this bill does not supply it. Reject this bill. Vote
``no.''
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
How cynical what we just heard. How cynical.
Ms. Velazquez has 43,000 children in CHIP, $2 billion in DSH cuts in
her district, 43 health centers, and she is going to vote against $1
billion for the citizens of Puerto Rico and the Virgin Islands because
that is not enough.
Yes, we need to do more, so her answer is vote ``no'' today and deny
$1 billion.
Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from South
Carolina (Mr. Norman).
Mr. NORMAN. Mr. Speaker, today I rise in support of H.R. 3922.
Listening to my Democratic friends, it was said right by Chairman
Walden. It is cynical, and it is amazing that they could vote against
this bill.
Not only does this bill reauthorize public health programs vital to
Americans who need them most, but it does so in a fiscally responsible
manner. Reauthorizing CHIP for a 5-year period was an important
priority of children's healthcare providers in my district, but doing
so while saving billions is an impressive feat.
On top of that, providing funding for community health centers will
drastically improve rural health in South Carolina's Fifth District.
This bill is proof that the American people can trust their government
to provide essential services to citizens who cannot provide for
themselves, without saddling our children and grandchildren with debt.
Mr. Speaker, I would like to commend my colleague, Chairman Walden,
for his impressive efforts in striving toward a greater government.
{time} 1015
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman
from Massachusetts (Mr. Kennedy), who is a member of our committee.
Mr. KENNEDY. Mr. Speaker, this moment is a bit hard to stomach. It is
hard to stomach yet another attempt to sabotage the Affordable Care
Act, in the words of our colleagues, while extolling the virtues of
public health programs by cutting grace periods down to 30 days that
will result in hundreds of thousands of people losing access to their
insurance.
It is hard to stomach a $1 trillion tax cut being proposed for
wealthy adults at the same time that our Republican colleagues are
telling us that we can't afford to care for sick kids. It is hard to
stomach the indifference shown in this Chamber over the course of the
past month as CHIP lapses and panic sets in amongst families whose
lives depend on this program.
It is hard to stomach an idea that the only way to give them care is
to somehow take it away from somebody else, by gutting the Public
Health Fund in the midst of an opioid epidemic or scapegoating patients
who struggle to afford the monthly premiums and sometimes fall behind.
Why is it always those patients who are asked to sacrifice?
It is always those communities that are asked to do more with less.
Why do we somehow create a false choice on this floor today that
leads 9 million families to an impossible choice tomorrow?
For those families, CHIP is not a privilege or a line item in the
budget, it is a lifeline. They deserve the same decency and the same
urgency that our Republican colleagues showed the wealthy in their tax
plan yesterday.
Mr. WALDEN. Mr. Speaker, I yield myself such time as I may consume.
Wow. We are fully funding CHIP for 5 years. We are fully funding our
community health centers for 2 years. We are taking care of programs
for our citizens who have diabetes. And the pay-for that they are
objecting to most is we are asking the wealthiest seniors in America,
those making $40,000 a month, to pay $135 more for their Medicare so we
can do this work that is so important.
How ironic. How cynical. This is a pay-for that has been used before
for other programs. President Obama himself suggested in a budget that,
instead of the top earners, the $480,000 a year, a couple making over
$800,000 a year pay a little more as we do here, take it all the way
down to $80,000 a year.
We didn't do that. We just said, if you are making $480,000 a year,
roughly $40,000 a month, you will pay $135 more. They will not vote for
that cut to fund children's healthcare. We will.
That is what is going on here. This is where we could never get them
off dead center to make this bipartisan. It is a tragedy this is not a
bipartisan bill as it always has been. I, three times, delayed moving
this forward, including crossing the deadline of September 30, to try
to find common ground that would be bipartisan, and we could never get
there because they would never yield in a way where we could find
common ground.
So we must go to the Senate from here and we must get our work done
for the American people.
Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman
from Michigan (Mrs. Dingell).
=========================== NOTE ===========================
November 3, 2017, on page H8463, the following appeared: 1\1/2\
minutes to gentlewoman from
The online version has been corrected to read: 1\1/2\ minutes to
the gentlewoman from
========================= END NOTE =========================
Mrs. DINGELL. Mr. Speaker, I rise in strong opposition to this
legislation because it presents us with a choice that we should not
have to make. I take a backseat to nobody in this institution in terms
of fighting for children and families.
But we live in the United States of America, the greatest Nation in
the world. I reject the notion that we have to rob Peter to pay Paul
or, in this instance, jeopardize the future of Medicare and steal $6
billion from critical prevention programs to pay for children's
healthcare. They are all equal priorities, and we shouldn't have to
sacrifice the health of one population to pay for another. It is that
simple.
The changes that the bill makes to Medicare may sound innocuous--and
I have great respect for the chairman--but the reality is they will
threaten the future of Medicare.
Means testing Social Security is a good sound bite, but it is a very
slippery slope. I'm not worried about whether wealthy families can be
able to afford to pay for increased Medicare premiums, but I am worried
that these changes will result in wealthy people abandoning the program
in large numbers, which would worsen the risk pool and ultimately
increase the costs for middle- and lower-income seniors. It would
fracture completely the universal nature of Medicare and put the entire
program at risk. It is an unwise proposal that should be rejected.
Mr. WALDEN. Mr. Speaker, may I get a time count, please, on how much
each side has remaining?
The SPEAKER pro tempore. The gentleman from Oregon has 45 seconds
remaining. The gentleman from New Jersey has 4\1/2\ minutes remaining.
Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentleman from
Texas (Mr. Doggett).
Mr. DOGGETT. Mr. Speaker, the Children's Health Insurance Program
began as a truly bipartisan initiative, but now it is being overwhelmed
by Republican indifference. So low is it on their priority list that
they let the law expire. Three States have already required emergency
funding, and 400,000 Texas children are at risk if this program is not
continued.
In the face of this crisis, their response is: We won't put another
new dollar into this program unless we take it from Medicare
beneficiaries.
Why should we begin calling on those who rely on Medicare to pay for
non-Medicare purposes?
It is wrong.
The second way they propose to fund this bill is by reducing funding
for public health and prevention, whether it is for Zika and West Nile
virus, where I live down in Texas, or it is for the opioid crisis,
which is affecting our State like every other one.
Sure, we are glad to hear President Trump do a tweet and give a
speech. But he did not add any new dollars to fight this opioid crisis.
We need bold action, and it is not by reducing the Prevention and
Public Health Fund. It is by supporting our children.
Mr. WALDEN. Mr. Speaker, I will just point out that the gentleman who
just spoke has voted to cut the Prevention Fund before to use it for
other purposes.
[[Page H8464]]
Mr. Speaker, I reserve the balance of my time.
Mr. PALLONE. Mr. Speaker, I yield 1 minute to the gentlewoman from
Michigan (Mrs. Lawrence).
Mrs. LAWRENCE. Mr. Speaker, I rise today to support fully funding the
CHIP Act, but to oppose to the Republican bill.
Because of the reduction in the grace period, we are forcing
Americans to go into their own pocket. Although this bill will
reauthorize CHIP, it fails to show compassion for the low-income
families and children who do not have access to critical healthcare,
and it is a matter of life and death.
CHIP's impact is overwhelmingly felt in communities of color.
Together, CHIP and Medicaid help cover 52 percent of Hispanic and 54
percent of all Black children nationwide.
As Members of Congress, we have a duty to protect our Nation's
children. We need to support the millions of families who rely on this
vital program. This is not the right way. We need to work together in a
bipartisan manner to pass an important piece of legislation like CHIP
and not take away from our children but support them.
Mr. PALLONE. Mr. Speaker, how much time remains on each side?
The SPEAKER pro tempore. The gentleman from New Jersey has 2\1/2\
minutes remaining. The gentleman from Oregon has 45 seconds remaining.
Mr. PALLONE. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, I want to stress again that one of the pay-fors that the
Republicans don't talk about much is the fact that they are reducing
the grace period from 90 days to 30 days. So if someone misses a
payment on their insurance, they currently have 90 days to make up for
it. Under this bill, they will only have 30 days.
Now, the CBO estimates that over 500,000 people will lose their
health insurance and have to reapply for next year because of this
reduction in the grace period. I know my colleague from the other side
says: Well, that is too bad because they have the responsibility to pay
it.
But the fact of the matter is that a lot of people have a hard time
paying their monthly premium, and we should not be passing legislation
that ends up with half-a-million people losing their health insurance.
Again, this is a way to sabotage the Affordable Care Act. The
Affordable Care Act is trying to make more people covered, and has
succeeded in covering 95 percent of the people in this country.
Why in the world would we use a pay-for that cuts back on half-a-
million people who would lose their health insurance?
I want to emphasize, Mr. Speaker, we did not have to be here today.
We could have done a bipartisan bill without sabotaging the Affordable
Care Act. That is what concerns me most, Mr. Speaker. The Republicans
tried to repeal the Affordable Care Act. They failed, and now they are
trying to repeal it piece by piece.
The pay-fors that are in this legislation are unfair to the American
people. The Prevention Fund is used for opiate prevention and used for
kids for various programs. Don't cut back on that to pay for these
other things.
The grace period--half-a-million Americans are going to lose their
insurance because of the cutbacks in the grace period--another effort
to sabotage the Affordable Care Act.
Lastly, and probably even most important, again, the Republicans are
going against the Medicare program. They are trying to make cuts in the
Medicare program and restructure the Medicare program in a way that I
believe will hurt the Medicare program, reduce the amount of people in
the insurance pool, and ultimately lead to higher costs for middle
class and lower-income seniors and the disabled in the Medicare
program.
I urge my colleagues: Don't let the Republicans continue to sabotage
the Affordable Care Act. We could have done this on a bipartisan basis.
Passing this bill today does nothing for the Children's Health
Initiative or for community health centers because this bill is going
nowhere. It will end up in the Senate. The Senate will not take it up,
and we will be waiting around until Christmas to actually find a way to
fund these programs and put these programs at risk. Vote ``no.''
Mr. Speaker, I yield back the balance of my time.
Mr. WALDEN. Mr. Speaker, let's get this back where it belongs. We are
fully funding the Children's Health Insurance Program for 5 years and
community health centers for 2 years. The only sabotage of the
Affordable Care Act going on here today is stopping cuts for hospitals
in our districts that serve low-income people that would otherwise
occur under the Affordable Care Act. We do that for 2 years.
The Democrats don't think seniors making $40,000 a month--$40,000 a
month--should pay an extra $135 for their part B and part D Medicare so
we can take care of our community health centers and children who need
health insurance.
We delayed this bill coming to the floor at a bipartisan request to
find a bipartisan solution that was elusive, sadly. We have never had
this problem before, but we have it today. We must act.
Mr. Speaker, I urge a ``yes'' vote on this legislation, and I yield
back the balance of my time.
Ms. McCOLLUM. Mr. Speaker, I rise in opposition to the Community
Health and Medical Professionals Improve Our Nation (CHAMPION) Act of
2017 (H.R. 3922).
While I support reauthorizing funding for the Children's Health
Insurance Program (CHIP), the Federally Qualified Health Centers
(FQHCs), and various other important public health programs, I oppose
this bill because it cuts funding for public health, puts families at
risk of losing their health insurance, and weakens Medicare.
The health of children and expecting and new mothers is something
that we can all agree on. In my home state of Minnesota, CHIP funding
is essential for providing healthcare to 125,000 low income children
and 1,700 expecting and new mothers. Minnesota also depends on FQHC
funding with over 190,000 people receiving care from one of the more
than 70 community health centers in my state last year.
Unfortunately, House Republicans have turned these bipartisan issues
into an opportunity to divide us. The offsets included in this
legislation are unacceptable to me and to Minnesota families.
Once again, Republicans are using this legislation as yet another
opportunity to weaken the Affordable Care Act (ACA) by cutting $6.35
billion from the Prevention and Public Health Fund over the next ten
years. This fund, created by the ACA, directly funds our nation's
prevention, preparedness, and response capabilities.
If these Republican cuts become law, the Centers for Disease Control
and Prevention would be forced to provide less funding to cities,
states, and tribes to rapidly address public health crises. This money
includes funding for vaccines, flu prevention, and addressing the
opioid epidemic. When my home state of Minnesota had to recently deal
with a serious outbreak of measles, our community health officials
utilized these federal resources to rapidly contain the spread of
disease. Simply put, this irresponsible offset leaves American
communities more vulnerable to, and unprepared for, outbreaks of
disease.
In addition, this bill takes aim at yet another ACA provision by
shortening the 90-day grace period for individuals to pay premiums
before their insurer can terminate their coverage. The current grace
period allows low and moderate income families experiencing temporary
financial difficulties to remain covered by their health insurance.
Shortening this grace period from 90 days to 30 days would cause nearly
700,000 Americans to lose their health care and bars them from
purchasing health insurance until the next season.
I am also concerned by the provision that introduces means testing to
Medicare. A key strength of Medicare is its universal nature. All
Americans pay into Medicare and all Americans should receive at least
some benefit from it. This provision breaks that guarantee and sets a
dangerous precedent for the future. I am also concerned that it could
weaken the Medicare risk pool and increase costs for the taxpayer.
Mr. Speaker, even the Majority concedes that this bill is unlikely to
pass the Senate due to the partisan nature of its provisions.
Republicans need to stop playing games and reauthorize these programs
before Minnesota faces a critical December 1 deadline to continue
coverage for children and expecting mothers.
I urge my colleagues to vote against this measure and instead to work
together to fund CHIP and community health centers.
Ms. EDDIE BERNICE JOHNSON of Texas. Mr. Speaker, I rise today in
strong opposition to the bill being considered on the floor today, H.R.
3922, the CHAMPIONING HEALTHY KIDS Act. Unfortunately, this deceitfully
named measure to reauthorize the Children's Health
[[Page H8465]]
Insurance Program (CHIP) and Community Health Centers (CHCs) will
reauthorize these programs through FY19--but does so by kicking
thousands of Americans off private insurance.
Like many of my colleagues, I strongly support CHIP, CHCs, and other
critical public health initiatives. However, the bill in its current
form was drafted as yet another attempt by Republicans to undermine the
Affordable Care Act in order to justify its repeal. The bill is
misguided in its attempt to cut $6.35 billion over ten years from the
Prevention and Public Health Fund in order to fund the extension.
H.R. 3922 also reduces grace periods from 90 to 30 days, putting more
than 688,000 low- and moderate-income individuals at risk of losing
their state Marketplace coverage for simply paying their premiums in
the second of third month of the existing grace period. This grace
period is essential to low-income households that are barely making
ends meet. By reducing the current grace period, Republicans are
exposing thousands of families to risk due to a lack of health
coverage. It is frankly disgraceful that we would even consider
undermining these important public health programs in such a manner.
Mr. Speaker, CHIP, CHCs, the National Health Service Corps, and other
programs funded under this measure are vitally important to our nation
and the public health of our citizens. As the first registered nurse
elected to Congress, I understand the critical need for proper long-
term funding of our public health centers and programs. However, these
cuts to the Prevention and Public Health Fund represent a purely
political move by the GOP to undermine the ACA. I oppose this
controversial offset, not my support for health centers across America.
I urge my colleagues to oppose this measure so that we can find offsets
driven by policy, not politics, in order to sufficiently fund our
health centers and promote public health for all.
Ms. JACKSON LEE. Mr. Speaker, I rise to speak on House consideration
of H.R. 3922, Championing Healthy Kids Act, which would reauthorize the
State Children Health Insurance Program (S-CHIP).
As the founder and chair of the Congressional Children's Caucus, I am
well aware of the work that went into creating this important program.
I joined with members of the bipartisan Children's Caucus to champion
the worthy goals of S-CHIP.
Congress and President Clinton responded to the needs of 10 million
children in the United States who lacked health insurance, S-CHIP was
created in 1997 to insure children in families with too much income to
qualify for Medicaid and too little to afford private insurance.
I voted for the S-CHIP program when it came to the floor for a vote
as part of the Balanced Budget Act of 1997.
I worked tirelessly along with other members of the House to make
sure the S-CHIP program was created.
I voted to extend the life of the program when Congress reauthorized
S-CHIP in 2009 under the Children's Health Insurance Program
Reauthorization Act and again when it became part of the Patient
Protection and Affordable Care Act of 2010.
The program represented a grand bargain that allowed Democrats and
Republicans to agree that healthcare for the nation's children was a
laudable and achievable goal.
H.R. 3922, Championing Healthy Kids Act, is not a reauthorization of
the S-CHIP program it is political theater at its worse.
The leadership of the House is betraying all that this body has done
for 20 years to sustain and improve S-CHIP.
The bill before the House is political theater and not real
legislating--a partisan attack against Medicare that has no place in a
real bill about healthcare for children.
I am a strong supporter of S-CHIP and would vote for that program any
day it is brought to the House Floor.
This imposter S-CHIP bill is not worthy to be considered by this
body.
The motion to recommit this bill should be supported so that the
offensive offsets could be removed so that the bill can be brought back
to the full House for consideration.
After weeks of negotiations to reauthorize the Children's Health
Insurance Program (CHIP), Community Health Centers (CHCs) and other
important public health programs, which have always been bipartisan
priorities, House Republicans have decided to bring a partisan bill to
the Floor.
This bill will only further delay the reauthorization of these
programs, many of which expired on September 30th.
The bill passed out of the Energy and Commerce Committee at the
beginning of October with no Democratic support.
Democrats in Committee instead offered a package that invests in our
children and safety net providers, and does not sacrifice the nation's
health.
Democrats have made it clear for weeks that the pay-fors in this bill
are problematic.
Rather than working toward a bipartisan agreement, Republicans
revised their bill to include even steeper cuts to public health
programs, in addition to undermining the Affordable Care Act (ACA).
The bill includes woefully inadequate funding for Medicaid programs
in Puerto Rico and the U.S. Virgin Islands, which are facing
unprecedented demands on their health care systems following the
devastation caused by Hurricane Maria.
Puerto Rico Governor Ricardo Rossello last week requested $1.6
billion annually to deal with the state's underfunded Medicaid program
that is expected to be further strained by the short- and long-term
health implications of the natural disaster.
The approximately $1 billion over two years in Puerto Rico Medicaid
funding included in the Republican bill is not only insufficient, but
it would also require Puerto Rico and the U.S. Virgin Islands to match
those dollars at a time of increased demand and revenue collapse in
both territories, exacerbating delays in recovery.
This bill also seeks to cut $6.35 billion to the Prevention and
Public Health Fund (PPHF).
The Prevention Fund was created by the ACA to make national
investments in prevention and public health, to improve health
outcomes, to enhance health care quality, and reduce health care costs.
It has been used to increase awareness of and access to preventive
health services, such as cancer screenings, tobacco cessation and
childhood vaccines--as well as concentrating on preventing chronic
disease to help more Americans stay healthy.
Cutting these funds will have a devastating impact on public health
initiatives at the federal, state and local levels.
Republicans are also shortening the grace period for missed premium
payments from ninety days to thirty, which would result in up to
688,000 people losing health coverage.
House Republicans are insisting that in order to provide some of our
most vulnerable Americans with coverage, it must be paid for by
cancelling the health insurance of other Americans after a single
payment is missed.
While Republicans are pushing for tax cuts for the wealthy that
explode the deficit, when it comes to health coverage for children and
low-income Americans, Republicans are insisting that it be paid for at
the cost of weakening our health care system and pushing other
Americans off health insurance.
States have begun to use emergency funding, cut benefits, and will
soon begin sending disenrollment notices to thousands of families if
CHIP is not reauthorized.
Republicans' decision to advance a partisan bill rather than a
compromise has very real consequences for families across the country.
In 2016, 35,626,329 children in the United States had healthcare
coverage under S-CHIP or the Medicaid Child Program.
In 2016, although the state of Texas had 38 percent of our children
covered under the S-CHIP program, there were still 9.2 percent children
without health insurance coverage.
Paying for this package by weakening health care in America:
Shortening the grace period for missed premium payments will cause up
to 688,000 Americans to lose their health coverage.
Cutting $6.35 billion from the Prevention Fund will have a
devastating impact on public health initiatives at the federal, state
and local levels.
Requiring Medicare means testing of 100 percent for beneficiaries
making over $500,000. This provision will take away a benefit American
seniors have paid into their entire lives.
These offsets are even more egregious since they are being considered
just one week after House Republicans began the process of passing tax
cuts for the wealthy that is not offset and will add $1.5 trillion to
the deficit.
Instead of reauthorizing these programs, House Republicans wasted
time attempting to repeal the ACA.
There are better ways to pay for S-CHIP that do not put the guarantee
of Medicare at risk our nation's seniors.
1. Reduce tax expenditures for the top 1 percent of income-earners--
Our current tax code imposes higher tax rates on income earned through
hard work while providing preferential treatment to unearned financial
gains and allowing billions of dollars of stock profits and other
capital gains to pass tax-free to heirs of multi-million-dollar
fortunes. Reducing the benefit of these tax expenditures would help
rebalance the tax code so that it stops favoring wealth over work. CBO
has determined that 17 percent of the benefits of major ``tax
expenditures'' go to households in the top one percent of income
earners at a cost of more than $1.5 trillion over ten years. We could
reduce this benefit to pay for needed national priorities.
2. Cancel the tax break for corporate jets--Repeal tax breaks such as
those for corporate jets, which are allowed a faster depreciation
[[Page H8466]]
schedule than passenger and freight aircraft. Based on past Joint
Committee on Taxation estimates, repealing the tax break on corporate
jets alone would raise $3 billion over ten years.
3. Restrict deductions for egregious CEO bonuses when employees don't
get a raise--Repeal the exemption to the $1 million limit on
compensation for CEOs and other specified corporate employees that a
publicly traded corporation can deduct as a business expense, unless
their workers are getting paycheck increases that reflect increases in
worker productivity and the cost of living. Based on Joint Committee on
Taxation estimates, just limiting the deductibility of excessive CEO
compensation would raise $12 billion over ten years.
4. Close loopholes in the U.S. international corporate tax system
that encourage companies to invert, and ship jobs and profits
overseas--Prevent U.S. companies from ``inverting'' and pretending that
they are based in other countries purely to reduce their taxes. Enact
proposals that would limit the ability of corporations to reap
substantial tax benefits by shifting operations, capital, intellectual
property, and jobs overseas for tax purposes or to shelter their
profits from U.S. taxation in foreign tax havens. Based on estimates of
past proposals, over $500 billion over ten years could be raised under
such proposals.
5. Close the ``carried interest'' loophole taxing hedge fund
managers' compensation at lower capital gains rates--End the loophole
which allows certain investment managers at hedge funds and private
equity firms to pay capital gains tax rates (up to a maximum of just 20
percent) on income received as compensation for services they provided,
rather than ordinary income tax rates up to 39.6 percent that all other
working Americans pay on the compensation they receive for their labor.
Past estimates show closing this loophole would raise over $19 billion
over ten years.
States have begun to use emergency funding, cut benefits, and will
soon begin sending disenrollment notices to thousands of families if
CHIP is not reauthorized.
It is time for the House Leadership to stop playing politics with
health insurance coverage for our nation's most vulnerable children and
pass a clean S-CHIP bill.
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to House Resolution 601, 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.
Motion to Recommit
Mr. CLYBURN. Mr. Speaker, I have a motion to recommit at the desk.
The SPEAKER pro tempore. Is the gentleman opposed to the bill?
Mr. CLYBURN. I am opposed in its current form.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Mr. Clyburn moves to recommit the bill H.R. 3922 to the
Committee on Energy and Commerce with instructions to report
the same back to the House forthwith with the following
amendment:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Continuing Community Health
and Medical Professional Programs to Improve Our Nation and
Keep Insurance Delivery Stable Act of 2017'' or the
``CHAMPION KIDS Act of 2017''.
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--MEDICAID AND PUBLIC HEALTH EXTENDERS
Sec. 101. Extension for community health centers and the National
Health Service Corps.
Sec. 102. Extension for special diabetes programs.
Sec. 103. Reauthorization of program of payments to teaching health
centers that operate graduate medical education programs.
Sec. 104. Extension for family-to-family health information centers.
Sec. 105. Youth empowerment program; personal responsibility education.
Sec. 106. Decreasing reduction in Medicaid DSH allotments.
Sec. 107. Increase in territorial cap for Medicaid payments.
Sec. 108. Puerto Rico and United States Virgin Island Disaster Relief
Medicaid.
Sec. 109. Delay of Bipartisan Budget Act of 2013 third party liability
provisions.
TITLE II--CHIP
Sec. 201. Five-year funding extension of the Children's Health
Insurance Program.
Sec. 202. Extension of certain programs and demonstration projects.
Sec. 203. Extension of outreach and enrollment program.
Sec. 204. Extension of additional Federal financial participation for
CHIP.
TITLE III--OFFSET
Sec. 301. Implementation of Office of Inspector General recommendation
to delay certain Medicare plan prepayments.
TITLE I--MEDICAID AND PUBLIC HEALTH EXTENDERS
SEC. 101. EXTENSION FOR COMMUNITY HEALTH CENTERS AND THE
NATIONAL HEALTH SERVICE CORPS.
(a) Community Health Centers Funding.--Section
10503(b)(1)(E) of the Patient Protection and Affordable Care
Act (42 U.S.C. 254b-2(b)(1)(E)) is amended by striking
``2017'' and inserting ``2019''.
(b) Other Community Health Centers Provisions.--Section 330
of the Public Health Service Act (42 U.S.C. 254b) is
amended--
(1) in subsection (b)(1)(A)(ii), by striking ``abuse'' and
inserting ``use disorder'';
(2) in subsection (b)(2)(A), by striking ``abuse'' and
inserting ``use disorder'';
(3) in subsection (c)--
(A) in paragraph (1), by striking subparagraphs (B) through
(D);
(B) by striking ``(1) In general'' and all that follows
through ``The Secretary'' and inserting the following:
``(1) Centers.--The Secretary''; and
(C) in paragraph (1), as amended, by redesignating clauses
(i) through (v) as subparagraphs (A) through (E) and moving
the margin of each of such redesignated subparagraph 2 ems to
the left;
(4) by striking subsection (d) and inserting the following:
``(d) Improving Quality of Care.--
``(1) Supplemental awards.--The Secretary may award
supplemental grant funds to health centers funded under this
section to implement evidence-based models for increasing
access to high-quality primary care services, which may
include models related to--
``(A) improving the delivery of care for individuals with
multiple chronic conditions;
``(B) workforce configuration;
``(C) reducing the cost of care;
``(D) enhancing care coordination;
``(E) expanding the use of telehealth and technology-
enabled collaborative learning and capacity building models;
``(F) care integration, including integration of behavioral
health, mental health, or substance use disorder services;
and
``(G) addressing emerging public health or substance use
disorder issues to meet the health needs of the population
served by the health center.
``(2) Sustainability.--In making supplemental awards under
this subsection, the Secretary may consider whether the
health center involved has submitted a plan for continuing
the activities funded under this subsection after
supplemental funding is expended.
``(3) Special consideration.--The Secretary may give
special consideration to applications for supplemental
funding under this subsection that seek to address
significant barriers to access to care in areas with a
greater shortage of health care providers and health services
relative to the national average.'';
(5) in subsection (e)(1)--
(A) in subparagraph (B)--
(i) by striking ``2 years'' and inserting ``1 year''; and
(ii) by adding at the end the following: ``The Secretary
shall not make a grant under this paragraph unless the
applicant provides assurances to the Secretary that within
120 days of receiving grant funding for the operation of the
health center, the applicant will submit, for approval by the
Secretary, an implementation plan to meet the requirements of
subsection (l)(3). The Secretary may extend such 120-day
period for achieving compliance upon a demonstration of good
cause by the health center.''; and
(B) in subparagraph (C)--
(i) in the subparagraph heading, by striking ``and plans'';
(ii) by striking ``or plan (as described in subparagraphs
(B) and (C) of subsection (c)(1))'';
(iii) by striking ``or plan, including the purchase'' and
inserting the following: ``including--
``(i) the purchase'';
(iv) by inserting ``, which may include data and
information systems'' after ``of equipment'';
(v) by striking the period at the end and inserting a
semicolon; and
(vi) by adding at the end the following:
``(ii) the provision of training and technical assistance;
and
``(iii) other activities that--
``(I) reduce costs associated with the provision of health
services;
``(II) improve access to, and availability of, health
services provided to individuals served by the centers;
``(III) enhance the quality and coordination of health
services; or
``(IV) improve the health status of communities.'';
(6) in subsection (e)(5)(B)--
(A) in the heading of subparagraph (B), by striking ``and
plans''; and
(B) by striking ``and subparagraphs (B) and (C) of
subsection (c)(1) to a health center or
[[Page H8467]]
to a network or plan'' and inserting ``to a health center or
to a network'';
(7) by striking subsection (s);
(8) by redesignating subsections (g) through (r) as
subsections (h) through (s), respectively;
(9) by inserting after subsection (f), the following:
``(g) New Access Points and Expanded Services.--
``(1) Approval of new access points.--
``(A) In general.--The Secretary may approve applications
for grants under subparagraph (A) or (B) of subsection (e)(1)
to establish new delivery sites.
``(B) Special consideration.--In carrying out subparagraph
(A), the Secretary may give special consideration to
applicants that have demonstrated the new delivery site will
be located within a sparsely populated area, or an area which
has a level of unmet need that is higher relative to other
applicants.
``(C) Consideration of applications.--In carrying out
subparagraph (A), the Secretary shall approve applications
for grants under subparagraphs (A) and (B) of subsection
(e)(1) in such a manner that the ratio of the medically
underserved populations in rural areas which may be expected
to use the services provided by the applicants involved to
the medically underserved populations in urban areas which
may be expected to use the services provided by the
applicants is not less than two to three or greater than
three to two.
``(D) Service area overlap.--If in carrying out
subparagraph (A) the applicant proposes to serve an area that
is currently served by another health center funded under
this section, the Secretary may consider whether the award of
funding to an additional health center in the area can be
justified based on the unmet need for additional services
within the catchment area.
``(2) Approval of expanded service applications.--
``(A) In general.--The Secretary may approve applications
for grants under subparagraph (A) or (B) of subsection (e)(1)
to expand the capacity of the applicant to provide required
primary health services described in subsection (b)(1) or
additional health services described in subsection (b)(2).
``(B) Priority expansion projects.--In carrying out
subparagraph (A), the Secretary may give special
consideration to expanded service applications that seek to
address emerging public health or behavioral health, mental
health, or substance abuse issues through increasing the
availability of additional health services described in
subsection (b)(2) in an area in which there are significant
barriers to accessing care.
``(C) Consideration of applications.--In carrying out
subparagraph (A), the Secretary shall approve applications
for applicants in such a manner that the ratio of the
medically underserved populations in rural areas which may be
expected to use the services provided by the applicants
involved to the medically underserved populations in urban
areas which may be expected to use the services provided by
such applicants is not less than two to three or greater than
three to two.'';
(10) in subsection (i) (as so redesignated)--
(A) in paragraph (1), by striking ``and children and youth
at risk of homelessness'' and inserting ``, children and
youth at risk of homelessness, homeless veterans, and
veterans at risk of homelessness''; and
(B) in paragraph (5)--
(i) by striking subparagraph (B);
(ii) by redesignating subparagraph (C) as subparagraph (B);
and
(iii) in subparagraph (B) (as so redesignated)--
(I) in the subparagraph heading, by striking ``abuse'' and
inserting ``use disorder''; and
(II) by striking ``abuse'' and inserting ``use disorder'';
(11) in subsection (l) (as so redesignated)--
(A) in paragraph (2)--
(i) in the paragraph heading, by inserting ``unmet'' before
``need'';
(ii) in the matter preceding subparagraph (A), by inserting
``and an application for a grant under subsection (g)'' after
``subsection (e)(1)'';
(iii) in subparagraph (A), by inserting ``unmet'' before
``need for health services'';
(iv) in subparagraph (B), by striking ``and'' at the end;
(v) in subparagraph (C), by striking the period at the end
and inserting ``; and''; and
(vi) by adding after subparagraph (C) the following:
``(D) in the case of an application for a grant pursuant to
subsection (g)(1), a demonstration that the applicant has
consulted with appropriate State and local government
agencies, and health care providers regarding the need for
the health services to be provided at the proposed delivery
site.'';
(B) in paragraph (3)--
(i) in the matter preceding subparagraph (A), by inserting
``or subsection (g)'' after ``subsection (e)(1)(B)'';
(ii) in subparagraph (B), by striking ``in the catchment
area of the center'' and inserting ``, including other health
care providers that provide care within the catchment area,
local hospitals, and specialty providers in the catchment
area of the center, to provide access to services not
available through the health center and to reduce the non-
urgent use of hospital emergency departments'';
(iii) in subparagraph (H)(ii), by inserting ``who shall be
directly employed by the center'' after ``approves the
selection of a director for the center'';
(iv) in subparagraph (L), by striking ``and'' at the end;
(v) in subparagraph (M), by striking the period and
inserting ``; and''; and
(vi) by inserting after subparagraph (M), the following:
``(N) the center has written policies and procedures in
place to ensure the appropriate use of Federal funds in
compliance with applicable Federal statutes, regulations, and
the terms and conditions of the Federal award.''; and
(C) by striking paragraph (4);
(12) in subsection (m) (as so redesignated), by adding at
the end the following: ``Funds expended to carry out
activities under this subsection and operational support
activities under subsection (n) shall not exceed 3 percent of
the amount appropriated for this section for the fiscal year
involved.'';
(13) in subsection (q) (as so redesignated), by striking
``grants for new health centers under subsections (c) and
(e)'' and inserting ``operating grants under subsection (e),
applications for new access points and expanded service
pursuant to subsection (g)'';
(14) in subsection (r)(4) (as so redesignated), by adding
at the end the following: ``A waiver provided by the
Secretary under this paragraph may not remain in effect for
more than 1 year and may not be extended after such period.
An entity may not receive more than one waiver under this
paragraph in consecutive years.'';
(15) in subsection (s)(3) (as so redesignated)--
(A) by striking ``appropriate committees of Congress a
report concerning the distribution of funds under this
section'' and inserting the following: ``Committee on Health,
Education, Labor, and Pensions of the Senate, and the
Committee on Energy and Commerce of the House of
Representatives, a report including, at a minimum--
``(A) the distribution of funds for carrying out this
section'';
(B) by striking ``populations. Such report shall include an
assessment'' and inserting the following: ``populations;
``(B) an assessment'';
(C) by striking ``and the rationale for any substantial
changes in the distribution of funds.'' and inserting a
semicolon; and
(D) by adding at the end the following:
``(C) the distribution of awards and funding for new or
expanded services in each of rural areas and urban areas;
``(D) the distribution of awards and funding for
establishing new access points, and the number of new access
points created;
``(E) the amount of unexpended funding for loan guarantees
and loan guarantee authority under title XVI;
``(F) the rationale for any substantial changes in the
distribution of funds;
``(G) the rate of closures for health centers and access
points;
``(H) the number and reason for any grants awarded pursuant
to subsection (e)(1)(B); and
``(I) the number and reason for any waivers provided
pursuant to subsection (r)(4).''; and
(16) in subsection (s) (as so redesignated) by adding at
the end the following new paragraph:
``(5) Funding for participation of health centers in all of
us research program.--In addition to any amounts made
available pursuant to paragraph (1) of this subsection,
section 402A of this Act, or section 10503 of the Patient
Protection and Affordable Care Act, there is authorized to be
appropriated, and there is appropriated, out of any monies in
the Treasury not otherwise appropriated, to the Secretary
$25,000,000 for fiscal year 2018 to support the participation
of health centers in the All of Us Research Program under the
Precision Medicine Initiative under section 498E of this
Act.''.
(c) National Health Service Corps.--Section 10503(b)(2)(E)
of the Patient Protection and Affordable Care Act (42 U.S.C.
254b-2(b)(2)(E)) is amended by striking ``2017'' and
inserting ``2019''.
(d) Conforming Amendment.--Section 3014(h)(1) of title 18,
United States Code, is amended by striking ``, as amended by
section 221 of the Medicare Access and CHIP Reauthorization
Act of 2015,''.
SEC. 102. EXTENSION FOR SPECIAL DIABETES PROGRAMS.
(a) Special Diabetes Program for Type I Diabetes.--Section
330B(b)(2)(C) of the Public Health Service Act (42 U.S.C.
254c-2(b)(2)(C)) is amended by striking ``2017'' and
inserting ``2019''.
(b) Special Diabetes Program for Indians.--Section
330C(c)(2) of the Public Health Service Act (42 U.S.C. 254c-
3(c)(2)) is amended--
(1) in subparagraph (C), by striking ``and'' at the end;
(2) in subparagraph (D), by striking the period at the end
and inserting ``and $112,500,000 for the period consisting of
the second, third, and fourth quarters of fiscal year 2018;
and''; and
(3) by adding at the end the following:
``(E) $150,000,000 for fiscal year 2019.''.
SEC. 103. REAUTHORIZATION OF PROGRAM OF PAYMENTS TO TEACHING
HEALTH CENTERS THAT OPERATE GRADUATE MEDICAL
EDUCATION PROGRAMS.
(a) Payments.--Subsection (a) of section 340H of the Public
Health Service Act (42 U.S.C. 256h) is amended to read as
follows:
``(a) Payments.--
``(1) In general.--Subject to subsection (h)(2), the
Secretary shall make payments under this section for direct
expenses and indirect expenses to qualified teaching health
[[Page H8468]]
centers that are listed as sponsoring institutions by the
relevant accrediting body for--
``(A) maintenance of existing approved graduate medical
residency training programs;
``(B) expansion of existing approved graduate medical
residency training programs; and
``(C) establishment of new approved graduate medical
residency training programs, as appropriate.
``(2) Priority.--In making payments pursuant to paragraph
(1)(C), the Secretary shall give priority to qualified
teaching health centers that--
``(A) serve a health professional shortage area with a
designation in effect under section 332 or a medically
underserved community (as defined in section 799B); or
``(B) are located in a rural area (as defined in section
1886(d)(2)(D) of the Social Security Act).''.
(b) Funding.--Subsection (g) of section 340H of the Public
Health Service Act (42 U.S.C. 256h) is amended--
(1) by striking ``To carry out'' and inserting the
following:
``(1) In general.--To carry out'';
(2) by striking ``and $15,000,000 for the first quarter of
fiscal year 2018'' and inserting ``, $15,000,000 for the
first quarter of fiscal year 2018, $111,500,000 for the
period consisting of the second, third, and fourth quarters
of fiscal year 2018, and $126,500,000 for fiscal year 2019,
to remain available until expended''; and
(3) by adding at the end the following:
``(2) Administrative expenses.--Of the amount made
available to carry out this section for any fiscal year, the
Secretary may not use more than 5 percent of such amount for
the expenses of administering this section.''.
(c) Annual Reporting.--Subsection (h)(1) of section 340H of
the Public Health Service Act (42 U.S.C. 256h) is amended--
(1) by redesignating subparagraph (D) as subparagraph (H);
and
(2) by inserting after subparagraph (C) the following:
``(D) The number of patients treated by residents described
in paragraph (4).
``(E) The number of visits by patients treated by residents
described in paragraph (4).
``(F) Of the number of residents described in paragraph (4)
who completed their residency training at the end of such
residency academic year, the number and percentage of such
residents entering primary care practice (meaning any of the
areas of practice listed in the definition of a primary care
residency program in section 749A).
``(G) Of the number of residents described in paragraph (4)
who completed their residency training at the end of such
residency academic year, the number and percentage of such
residents who entered practice at a health care facility--
``(i) primarily serving a health professional shortage area
with a designation in effect under section 332 or a medically
underserved community (as defined in section 799B); or
``(ii) located in a rural area (as defined in section
1886(d)(2)(D) of the Social Security Act).''.
(d) Report on Training Costs.--Not later than March 31,
2019, the Secretary of Health and Human Services shall submit
to the Congress a report on the direct graduate expenses of
approved graduate medical residency training programs, and
the indirect expenses associated with the additional costs of
teaching residents, of qualified teaching health centers (as
such terms are used or defined in section 340H of the Public
Health Service Act (42 U.S.C. 256h)).
(e) Definition.--Subsection (j) of section 340H of the
Public Health Service Act (42 U.S.C. 256h) is amended--
(1) by redesignating paragraphs (2) and (3) as paragraphs
(3) and (4), respectively; and
(2) by inserting after paragraph (1) the following:
``(2) New approved graduate medical residency training
program.--The term `new approved graduate medical residency
training program' means an approved graduate medical
residency training program for which the sponsoring qualified
teaching health center has not received a payment under this
section for a previous fiscal year (other than pursuant to
subsection (a)(1)(C)).''.
(f) Technical Correction.--Subsection (f) of section 340H
(42 U.S.C. 256h) is amended by striking ``hospital'' each
place it appears and inserting ``teaching health center''.
(g) Payments for Previous Fiscal Years.--The provisions of
section 340H of the Public Health Service Act (42 U.S.C.
256h), as in effect on the day before the date of enactment
of this Act, shall continue to apply with respect to payments
under such section for fiscal years before fiscal year 2018.
SEC. 104. EXTENSION FOR FAMILY-TO-FAMILY HEALTH INFORMATION
CENTERS.
Section 501(c) of the Social Security Act (42 U.S.C.
701(c)) is amended--
(1) in paragraph (1)(A)--
(A) in clause (v), by striking ``and'' at the end;
(B) in clause (vi), by striking the period at the end and
inserting ``; and''; and
(C) by adding at the end the following new clause:
``(vii) $6,000,000 for each of fiscal years 2018 and
2019.'';
(2) in paragraph (3)(C), by inserting before the period the
following: ``, and with respect to fiscal years 2018 and
2019, such centers shall also be developed in all territories
and at least one such center shall be developed for Indian
tribes''; and
(3) by amending paragraph (5) to read as follows:
``(5) For purposes of this subsection--
``(A) the term `Indian tribe' has the meaning given such
term in section 4 of the Indian Health Care Improvement Act
(25 U.S.C. 1603);
``(B) the term `State' means each of the 50 States and the
District of Columbia; and
``(C) the term `territory' means Puerto Rico, Guam,
American Samoa, the Virgin Islands, and the Northern Mariana
Islands.''.
SEC. 105. YOUTH EMPOWERMENT PROGRAM; PERSONAL RESPONSIBILITY
EDUCATION.
(a) Youth Empowerment Program.--
(1) In general.--Section 510 of the Social Security Act (42
U.S.C. 710) is amended to read as follows:
``SEC. 510. YOUTH EMPOWERMENT PROGRAM.
``(a) In General.--
``(1) Allotments to states.--For the purpose described in
subsection (b), the Secretary shall, for each of fiscal years
2018 and 2019, allot to each State which has transmitted an
application for the fiscal year under section 505(a) an
amount equal to the product of--
``(A) the amount appropriated pursuant to subsection (e)(1)
for the fiscal year, minus the amount reserved under
subsection (e)(2) for the fiscal year; and
``(B) the proportion that the number of low-income children
in the State bears to the total of such numbers of children
for all the States.
``(2) Other allotments.--
``(A) Other entities.--For the purpose described in
subsection (b), the Secretary shall, for each of fiscal years
2018 and 2019, for any State which has not transmitted an
application for the fiscal year under section 505(a), allot
to one or more entities in the State the amount that would
have been allotted to the State under paragraph (1) if the
State had submitted such an application.
``(B) Process.--The Secretary shall select the recipients
of allotments under subparagraph (A) by means of a
competitive grant process under which--
``(i) not later than 30 days after the deadline for the
State involved to submit an application for the fiscal year
under section 505(a), the Secretary publishes a notice
soliciting grant applications; and
``(ii) not later than 120 days after such deadline, all
such applications must be submitted.
``(b) Purpose.--
``(1) In general.--Except for research under paragraph (5)
and information collection and reporting under paragraph (6),
the purpose of an allotment under subsection (a) to a State
(or to another entity in the State pursuant to subsection
(a)(2)) is to enable the State or other entity to implement
education exclusively on sexual risk avoidance (meaning
voluntarily refraining from sexual activity).
``(2) Required components.--Education on sexual risk
avoidance pursuant to an allotment under this section shall--
``(A) ensure that the unambiguous and primary emphasis and
context for each topic described in paragraph (3) is a
message to youth that normalizes the optimal health behavior
of avoiding nonmarital sexual activity;
``(B) be medically accurate and complete;
``(C) be age-appropriate; and
``(D) be based on adolescent learning and developmental
theories for the age group receiving the education.
``(3) Topics.--Education on sexual risk avoidance pursuant
to an allotment under this section shall address each of the
following topics:
``(A) The holistic individual and societal benefits
associated with personal responsibility, self-regulation,
goal setting, healthy decisionmaking, and a focus on the
future.
``(B) The advantage of refraining from nonmarital sexual
activity in order to improve the future prospects and
physical and emotional health of youth.
``(C) The increased likelihood of avoiding poverty when
youth attain self-sufficiency and emotional maturity before
engaging in sexual activity.
``(D) The foundational components of healthy relationships
and their impact on the formation of healthy marriages and
safe and stable families.
``(E) How other youth risk behaviors, such as drug and
alcohol usage, increase the risk for teen sex.
``(F) How to resist and avoid, and receive help regarding,
sexual coercion and dating violence, recognizing that even
with consent teen sex remains a youth risk behavior.
``(4) Contraception.--Education on sexual risk avoidance
pursuant to an allotment under this section shall ensure
that--
``(A) any information provided on contraception is
medically accurate and ensures that students understand that
contraception offers physical risk reduction, but not risk
elimination; and
``(B) the education does not include demonstrations,
simulations, or distribution of contraceptive devices.
``(5) Research.--
``(A) In general.--A State or other entity receiving an
allotment pursuant to subsection (a) may use up to 20 percent
of such allotment to build the evidence base for sexual risk
avoidance education by conducting or supporting research.
[[Page H8469]]
``(B) Requirements.--Any research conducted or supported
pursuant to subparagraph (A) shall be--
``(i) rigorous;
``(ii) evidence-based; and
``(iii) designed and conducted by independent researchers
who have experience in conducting and publishing research in
peer-reviewed outlets.
``(6) Information collection and reporting.--A State or
other entity receiving an allotment pursuant to subsection
(a) shall, as specified by the Secretary--
``(A) collect information on the programs and activities
funded through the allotment; and
``(B) submit reports to the Secretary on the data from such
programs and activities.
``(c) National Evaluation.--
``(1) In general.--The Secretary shall--
``(A) in consultation with appropriate State and local
agencies, conduct one or more rigorous evaluations of the
education funded through this section and associated data;
and
``(B) submit a report to the Congress on the results of
such evaluations, together with a summary of the information
collected pursuant to subsection (b)(6).
``(2) Consultation.--In conducting the evaluations required
by paragraph (1), including the establishment of evaluation
methodologies, the Secretary shall consult with relevant
stakeholders.
``(d) Applicability of Certain Provisions.--
``(1) Sections 503, 507, and 508 apply to allotments under
subsection (a) to the same extent and in the same manner as
such sections apply to allotments under section 502(c).
``(2) Sections 505 and 506 apply to allotments under
subsection (a) to the extent determined by the Secretary to
be appropriate.
``(e) Funding.--
``(1) In general.--To carry out this section, there is
appropriated, out of any money in the Treasury not otherwise
appropriated, $75,000,000 for each of fiscal years 2018 and
2019.
``(2) Reservation.--The Secretary shall reserve, for each
of fiscal years 2018 and 2019, not more than 20 percent of
the amount appropriated pursuant to paragraph (1) for
administering the program under this section, including the
conducting of national evaluations and the provision of
technical assistance to the recipients of allotments.''.
(2) Effective date.--The amendment made by this section
takes effect on October 1, 2017.
(b) Personal Responsibility Education.--
(1) In general.--Section 513 of the Social Security Act (42
U.S.C. 713) is amended--
(A) in subsection (a)(1)(A), by striking ``2017'' and
inserting ``2019''; and
(B) in subsection (a)(4)--
(i) in subparagraph (A), by striking ``2017'' each place it
appears and inserting ``2019''; and
(ii) in subparagraph (B)--
(I) in the subparagraph heading, by striking ``3-year
grants'' and inserting ``Competitive prep grants''; and
(II) in clause (i), by striking ``solicit applications to
award 3-year grants in each of fiscal years 2012 through
2017'' and inserting ``continue through fiscal year 2019
grants awarded for any of fiscal years 2015 through 2017'';
(C) in subsection (c)(1), by inserting after ``youth with
HIV/AIDS,'' the following: ``victims of human trafficking,'';
and
(D) in subsection (f), by striking ``2017'' and inserting
``2019''.
(2) Effective date.--The amendments made by this subsection
take effect on October 1, 2017.
SEC. 106. DECREASING REDUCTION IN MEDICAID DSH ALLOTMENTS.
Section 1923(f)(7)(A) of the Social Security Act (42 U.S.C.
1396r-4(f)(7)(A)) is amended--
(1) in clause (i), in the matter preceding subclause (I),
by striking ``2018'' and inserting ``2023''; and
(2) in clause (ii), by striking subclauses (I) through
(VIII) and inserting the following:
``(I) $5,000,000,000 for fiscal year 2023;
``(II) $5,500,000,000 for fiscal year 2024; and
``(III) $6,000,000,000 for fiscal year 2025.''.
SEC. 107. INCREASE IN TERRITORIAL CAP FOR MEDICAID PAYMENTS.
Section 1108(g)(5) of the Social Security Act (42 U.S.C.
1308(g)(5)) is amended--
(1) in subparagraph (A)--
(A) by striking ``subparagraph (B)'' and inserting
``subparagraphs (B), (C), and (D)''; and
(B) by striking ``2019'' and inserting ``2022''; and
(2) by adding at the end the following new subparagraphs:
``(C) The amount of the increase otherwise provided under
subparagraph (A) for--
``(i) Puerto Rico shall, after application of subparagraph
(B), be further increased by $1,600,000,000 for each of
fiscal years 2018 through 2022; and
``(ii) the Virgin Islands shall be further increased by
$55,000,000 for each of fiscal years 2018 through 2022.
``(D) The amount of the increase otherwise provided under
subparagraph (A) for Guam, the Northern Mariana Islands, and
America Samoa, respectively, shall be further increased by
such amounts that the total amount of increases under this
subparagraph is equal to $150,000,000. In applying the
previous sentence, the Secretary shall increase amounts for
such territories in such a proportion as would be applied
under subparagraph (A) if such territories were the only
territories to which such subparagraph applied.''.
SEC. 108. PUERTO RICO AND UNITED STATES VIRGIN ISLAND
DISASTER RELIEF MEDICAID.
(a) Simplified Eligibility Determinations and
Redeterminations.--
(1) In general.--Notwithstanding any provision of title XIX
of the Social Security Act (42 U.S.C. 1396 et seq.), a State
shall, as a condition of participation in the Medicaid
program under such title and without submitting an amendment
to the State Medicaid plan--
(A) use streamlined procedures described in paragraph (2)
in processing applications and determining and redetermining
eligibility for medical assistance under the State Medicaid
plan for DRM-eligible Maria Survivors during the DRM coverage
period; and
(B) provide, in the case of such a Survivor, for medical
assistance under the State Medicaid plan to such Survivor
during such period based on the family income level
eligibility requirements established under the State Medicaid
plan or, if higher, under the State Medicaid plan of the
State in which such Survivor resided as of September 17,
2017.
(2) Streamlined procedures.--The streamlined procedures
described in this paragraph, with respect to a State and an
applicant for medical assistance under the State Medicaid
plan, are the following:
(A) Common application form.--Use of a common 1-page
application form developed by the Secretary of Health and
Human Services, in consultation with the National Association
of State Medicaid Directors. Such form shall--
(i) require an applicant to provide an expected address for
the duration of the DRM coverage period and to agree to
update that information if it changes during such period;
(ii) include notice regarding the penalties for making a
fraudulent application;
(iii) require the applicant to assign to the State any
rights of the applicant (or any other person who is a DRM-
eligible Maria Survivor and on whose behalf the applicant has
the legal authority to execute an assignment of such rights)
under any group health plan or other third-party coverage for
health care; and
(iv) require the applicant to list any health insurance
coverage which the applicant was enrolled in immediately
prior to submitting such application.
(B) Self-attestation.--Self-attestation by the applicant
for medical assistance under the State Medicaid plan that the
applicant is a DRM-eligible Maria Survivor, including with
respect to citizenship, identity, immigration status, and
income requirements.
(C) No documentation.--No requirement for documentation
evidencing the basis on which the applicant qualifies to be a
DRM-eligible Maria Survivor.
(D) Issuance of eligibility card.--Issuance of a DRM
assistance eligibility card to an applicant who completes
such application, including the self-attestation required
under subparagraph (B). Such card shall be valid as long as
the DRM coverage period is in effect and shall be accompanied
by notice of the termination date for the DRM coverage period
and, if applicable, notice that such termination date may be
extended. If the President extends the DRM coverage period,
the State shall notify DRM-eligible Maria Survivors enrolled
in the State Medicaid plan of the new termination date for
the DRM coverage period.
(E) Deemed eligibility.--If an applicant completes the
application and presents it to a provider or facility
participating in the State Medicaid plan that is qualified to
make presumptive eligibility determinations under such plan
(which at a minimum shall consist of facilities identified in
section 1902(a)(55) of the Social Security Act (42 U.S.C.
1396a(a)(55)) and it appears to the provider that the
applicant is a DRM-eligible Maria Survivor based on the
information in the application, the applicant will be deemed
to be a DRM-eligible Maria Survivor eligible for medical
assistance under the State Medicaid plan.
(F) Continuous eligibility.--Continuous eligibility,
without the need for any redetermination of eligibility, for
the duration of the DRM coverage period.
(b) No Continuation of DRM Assistance.--
(1) In general.--Except as provided in paragraphs (2) and
(3), no DRM assistance shall be provided after the end of the
DRM coverage period.
(2) Presumptive eligibility.--In the case of any DRM-
eligible Maria Survivor who is receiving DRM assistance from
a State in accordance with this section and who, as of the
end of the DRM coverage period, has an application pending
for medical assistance under the State Medicaid plan for
periods beginning after the end of such period, the State
shall provide such Survivor with a period of presumptive
eligibility for medical assistance under the State Medicaid
plan (not to exceed 60 days) until a determination with
respect to the Survivor's application has been made.
(3) Pregnant women.--In the case of a DRM-eligible Maria
Survivor who is receiving DRM assistance from a State in
accordance with this section and whose pregnancy ended during
the 60-day period prior to the end of the DRM coverage
period, or who is pregnant as of the end of such period, such
Survivor shall continue to be eligible for DRM assistance
after the end of the DRM coverage period, including (but not
limited
[[Page H8470]]
to) all pregnancy-related and postpartum medical assistance
available under the State Medicaid plan, through the end of
the month in which the 60-day period (beginning on the last
day of her pregnancy) ends.
(c) Treatment of Maria Survivors Provided Assistance Prior
to Date of Enactment.--Any Maria Survivor who is provided
medical assistance under a State Medicaid plan in accordance
with guidance from the Secretary during the period that
begins on September 17, 2017, and ends on the date of
enactment of this Act shall be treated as a DRM-eligible
Maria Survivor, without the need to file an additional
application, for purposes of eligibility for medical
assistance under this section.
(d) Scope of Coverage.--
(1) In general.--A State providing medical assistance under
a State Medicaid plan to a DRM-eligible Maria Survivor
pursuant to this section shall provide medical assistance
that is either--
(A) equal in amount and scope to the medical assistance
that would otherwise be made available to such Survivor if
the Survivor were a State resident enrolled in the State
Medicaid plan; or
(B) if greater in amount and scope, equal in amount and
scope to the medical assistance that would have been made
available to such Survivor under the State Medicaid plan of
the State in which such Survivor resided as of September 17,
2017.
Coverage for such medical assistance for DRM-eligible Maria
Survivors shall be retroactive to items and services
furnished on or after September 17, 2017 (or in the case of
applications for DRM assistance submitted after January 1,
2018, the first day of the 5th month preceding the date on
which such application is submitted).
(2) Children born to pregnant women.--In the case of a
child born to a DRM-eligible Maria Survivor who is provided
DRM assistance during the DRM coverage period, such child
shall be treated as having been born to a pregnant woman
eligible for medical assistance under the State Medicaid plan
and shall be eligible for medical assistance under such plan
in accordance with section 1902(e)(4) of the Social Security
Act (42 U.S.C. 1396a(e)(4)). The Federal medical assistance
percentage applicable to the State Medicaid plan shall apply
to medical assistance provided to a child under such plan in
accordance with the preceding sentence and Federal payments
for such assistance shall not be considered to be payments
under this section.
(e) 100 Percent Federal Matching Payments.--
(1) In general.--Notwithstanding section 1905(b) of the
Social Security Act (42 U.S.C. 1396d(b)), subject to
paragraph (2), the Federal medical assistance percentage or
the Federal matching rate otherwise applied under section
1903(a) of such Act (42 U.S.C. 1396b(a)) shall be 100 percent
for--
(A) providing DRM assistance to DRM-eligible Maria
Survivors during the DRM coverage period in accordance with
this section;
(B) costs directly attributable to administrative
activities related to the provision of such DRM assistance;
and
(C) DRM assistance provided in accordance with paragraph
(2) or (3) of subsection (b) after the end of the DRM
coverage period.
(2) Limitation.--
(A) Territories.--Payments provided to a State that is a
territory (as defined in section 1108(c)(1) of the Social
Security Act (42 U.S.C. 1308(c)(1))) in accordance with this
subsection shall be subject to subsections (f) and (g) of
section 1108 of the Social Security Act (42 U.S.C. 1308).
(B) Other states.--
(i) In general.--In the case of States not described in
subparagraph (A), the difference between--
(I) the total amount of payments made to such States in
accordance with this subsection, by reason of the Federal
medical assistance percentage or the Federal matching rate
applied under paragraph (1); and
(II) the total amount of payments that would otherwise be
made to such States if the Federal medical assistance
percentage and the Federal matching rate under section
1905(b) of the Social Security Act and 1903(a) of such Act
were applied;
may not exceed the amount appropriated under clause (ii).
(ii) Appropriations.--There are appropriated, out of any
amounts in the Treasury not otherwise appropriated,
$1,000,000,000 for the DRM coverage period for purposes of
making payments in accordance with this subsection to States
not described in subparagraph (A).
(3) Exemption from error rate penalties.--All payments
attributable to providing DRM assistance in accordance with
this section shall be disregarded for purposes of section
1903(u) of the Social Security Act (42 U.S.C. 1396b(u)).
(f) Verification of Status as a Maria Survivor.--
(1) In general.--A State shall make a good faith effort to
verify the status of an individual who is enrolled in the
State Medicaid plan as a DRM-eligible Maria Survivor under
the provisions of this section. Such effort shall not delay
the determination of the eligibility of the Survivor for DRM
assistance under this section.
(2) Evidence of verification.--A State may satisfy the
verification requirement under paragraph (1) with respect to
an individual by showing that the State obtained information
from the Social Security Administration, the Internal Revenue
Service, or the State Medicaid Agency for the State from
which the individual is from (if the individual was not a
resident of such State on any day during the week preceding
September 17, 2017).
(g) Provider Payment Rates.--In the case of any DRM
assistance provided in accordance with this section to a DRM-
eligible Maria Survivor that is covered under the State
Medicaid plan (as applied without regard to this section) the
State shall pay a provider of such assistance the same
payment rate as the State would otherwise pay for the
assistance if the assistance were provided under the State
Medicaid plan (or, if no such payment rate applies under the
State Medicaid plan, the usual and customary prevailing rate
for the item or service for the community in which it is
provided).
(h) Application to Individuals Eligible for Medical
Assistance.--Nothing in this section shall be construed as
affecting any rights accorded to an individual who is a
recipient of medical assistance under a State Medicaid plan
who is determined to be a DRM-eligible Maria Survivor but the
provision of DRM assistance to such individual shall be
limited to the provision of such assistance in accordance
with this section.
(i) Definitions.--In this section:
(1) DRM assistance.--The term ``DRM assistance'' means
medical assistance under a State Medicaid plan for a DRM-
eligible Maria Survivor during the DRM coverage period.
(2) DRM coverage period.--
(A) In general.--The term ``DRM coverage period'' means the
period beginning on September 17, 2017, and, subject to
subparagraph (B), ending on the date that is 24 months after
the date of enactment of this Act.
(B) Secretary authority to extend drm coverage period.--The
Secretary may extend the DRM coverage period for an
additional 12 months. Any reference to the term ``DRM
coverage period'' in this section shall include any extension
under this subparagraph.
(3) DRM-eligible maria survivor defined.--
(A) In general.--The term ``DRM-eligible Maria Survivor''
means a Maria Survivor whose family income does not exceed
the income eligibility standard which would apply to the
Survivor under the State Medicaid plan of the State in which
the Survivor applies for medical assistance.
(B) No resources, residency, or categorical eligibility
requirements.--Eligibility under subparagraph (A) shall be
determined without application of any resources test, State
residency, or categorical eligibility requirements.
(C) Definition of child.--For purposes of subparagraph (A),
a DRM-eligible Maria Survivor shall be determined to be a
``child'' in accordance with the definition of ``child''
under the State Medicaid plan.
(4) Maria survivor.--
(A) In general.--The term ``Maria Survivor'' means an
individual who, on any day during the week preceding
September 17, 2017, had a primary residence in Puerto Rico or
the Virgin Islands.
(B) Treatment of current medicaid beneficiaries.--Nothing
in this section shall be construed as preventing an
individual who is otherwise entitled to medical assistance
under a State Medicaid plan from being treated as a Maria
Survivor under this section.
(C) Treatment of homeless persons.--For purposes of this
section, in the case of an individual who was homeless on any
day during the week described in subparagraph (A), the
individual's ``residence'' shall be deemed to be the place of
residence as otherwise determined for such an individual
under title XIX of the Social Security Act (42 U.S.C 1396 et
seq.).
(5) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(6) State.--The term ``State'' has the meaning given that
term for purposes of title XIX of the Social Security Act (42
U.S.C 1396 et seq.).
(7) State medicaid plan.--The term ``State Medicaid plan''
means a State plan under title XIX of the Social Security Act
(42 U.S.C. 1396 et seq.) (or a waiver of such plan).
SEC. 109. DELAY OF BIPARTISAN BUDGET ACT OF 2013 THIRD PARTY
LIABILITY PROVISIONS.
(a) In General.--Section 202(c) of the Bipartisan Budget
Act of 2013 (Public Law 113-67; 127 Stat. 1177; 42 U.S.C.
1396a note), as amended by section 211 of the Protecting
Access to Medicare Act of 2014 (Public Law 113-93; 128 Stat.
1047; 42 U.S.C. 1396a note) and section 220 of the Medicare
Access and CHIP Reauthorization Act of 2015 (Public Law 114-
10), is amended by striking ``2017'' and inserting ``2019''.
(b) Effective Date; Treatment.--The amendment made by
subparagraph (A) shall take effect on September 30, 2017, and
shall apply with respect to claims pending, generated, or
filed after such date.
TITLE II--CHIP
SEC. 201. FIVE-YEAR FUNDING EXTENSION OF THE CHILDREN'S
HEALTH INSURANCE PROGRAM.
(a) Appropriation; Total Allotment.--Section 2104(a) of the
Social Security Act (42 U.S.C. 1397dd(a)) is amended--
(1) in paragraph (19), by striking ``and'';
(2) in paragraph (20), by striking the period at the end
and inserting a semicolon; and
(3) by adding at the end the following new paragraphs:
[[Page H8471]]
``(21) for fiscal year 2018, $21,500,000,000;
``(22) for fiscal year 2019, $22,600,000,000;
``(23) for fiscal year 2020, $23,700,000,000;
``(24) for fiscal year 2021, $24,800,000,000; and
``(25) for fiscal year 2022, for purposes of making 2 semi-
annual allotments--
``(A) $2,850,000,000 for the period beginning on October 1,
2021, and ending on March 31, 2022; and
``(B) $2,850,000,000 for the period beginning on April 1,
2022, and ending on September 30, 2022.''.
(b) Allotments.--
(1) In general.--Section 2104(m) of the Social Security Act
(42 U.S.C. 1397dd(m)) is amended--
(A) in paragraph (2)--
(i) in the heading, by striking ``through 2016'' and
inserting ``through 2022''; and
(ii) in subparagraph (B)--
(I) in the matter preceding clause (i), by striking
``(19)'' and inserting ``(24)'';
(II) in clause (ii), in the matter preceding subclause (I),
by inserting ``(other than fiscal year 2022)'' after ``even-
numbered fiscal year''; and
(III) in clause (ii)(I), by inserting ``(or, in the case of
fiscal year 2018, under paragraph (4))'' after ``clause
(i)'';
(B) in paragraph (5)--
(i) by striking ``or (4)'' and inserting ``(4), or (10)'';
and
(ii) by striking ``or 2017'' and inserting ``, 2017, or
2022'';
(C) in paragraph (7)--
(i) in subparagraph (A), by striking ``2017'' and inserting
``2022'';
(ii) in subparagraph (B), in the matter preceding clause
(i), by inserting ``(or, in the case of fiscal year 2018, by
not later than the date that is 60 days after the date of the
enactment of the CHAMPION KIDS Act of 2017)'' after ``before
the August 31 preceding the beginning of the fiscal year'';
and
(iii) in the matter following subparagraph (B), by striking
``or fiscal year 2016'' and inserting ``fiscal year 2016,
fiscal year 2018, fiscal year 2020, or fiscal year 2022'';
(D) in paragraph (9)--
(i) in the heading, by striking ``fiscal years 2015 and
2017'' and inserting ``certain fiscal years'';
(ii) by striking ``or (4)'' and inserting ``, (4), or
(10)''; and
(iii) by striking ``or fiscal year 2017'' and inserting ``,
2017, or 2022''; and
(E) by adding at the end the following new paragraph:
``(10) For fiscal year 2022.--
``(A) First half.--Subject to paragraphs (5) and (7), from
the amount made available under subparagraph (A) of paragraph
(25) of subsection (a) for the semi-annual period described
in such subparagraph, increased by the amount of the
appropriation for such period under section 201(b)(3) of the
CHAMPION KIDS Act of 2017, the Secretary shall compute a
State allotment for each State (including the District of
Columbia and each commonwealth and territory) for such semi-
annual period in an amount equal to the first half ratio
(described in subparagraph (D)) of the amount described in
subparagraph (C).
``(B) Second half.--Subject to paragraphs (5) and (7), from
the amount made available under subparagraph (B) of paragraph
(25) of subsection (a) for the semi-annual period described
in such subparagraph, the Secretary shall compute a State
allotment for each State (including the District of Columbia
and each commonwealth and territory) for such semi-annual
period in an amount equal to the amount made available under
such subparagraph, multiplied by the ratio of--
``(i) the amount of the allotment to such State under
subparagraph (A); to
``(ii) the total of the amount of all of the allotments
made available under such subparagraph.
``(C) Full year amount based on growth factor updated
amount.--The amount described in this subparagraph for a
State is equal to the sum of--
``(i) the amount of the State allotment for fiscal year
2021 determined under paragraph (2)(B)(i); and
``(ii) the amount of any payments made to the State under
subsection (n) for fiscal year 2021,
multiplied by the allotment increase factor under paragraph
(6) for fiscal year 2022.
``(D) First half ratio.--The first half ratio described in
this subparagraph is the ratio of--
``(i) the sum of--
``(I) the amount made available under subsection
(a)(25)(A); and
``(II) the amount of the appropriation for such period
under section 201(b)(3) of the CHAMPION KIDS Act of 2017; to
``(ii) the sum of--
``(I) the amount described in clause (i); and
``(II) the amount made available under subsection
(a)(25)(B).''.
(2) Technical amendment.--Section 2104(m)(2)(A) of such Act
(42 U.S.C. 1397dd(m)(2)(A)) is amended by striking ``the
allotment increase factor under paragraph (5)'' each place it
appears and inserting ``the allotment increase factor under
paragraph (6)''.
(3) One-time appropriation for fiscal year 2022.--There is
appropriated to the Secretary of Health and Human Services,
out of any money in the Treasury not otherwise appropriated,
$20,200,000,000 to accompany the allotment made for the
period beginning on October 1, 2021, and ending on March 31,
2022, under paragraph (25)(A) of section 2104(a) of the
Social Security Act (42 U.S.C. 1397dd(a)) (as added by
subsection (a)(3)), to remain available until expended. Such
amount shall be used to provide allotments to States under
paragraph (10) of section 2104(m) of such Act (as added by
subsection (b)(1)(E)) for the first 6 months of fiscal year
2022 in the same manner as allotments are provided under
subsection (a)(25)(A) of such section 2104 and subject to the
same terms and conditions as apply to the allotments provided
from such subsection (a)(25)(A).
(c) Extension of the Child Enrollment Contingency Fund.--
Section 2104(n) of the Social Security Act (42 U.S.C.
1397dd(n)) is amended--
(1) in paragraph (2)--
(A) in subparagraph (A)(ii)--
(i) by striking ``2010, 2011, 2012, 2013, 2014, and 2016''
and inserting ``2010 through 2014, 2016, and 2018 through
2021''; and
(ii) by striking ``fiscal year 2015 and fiscal year 2017''
and inserting ``fiscal years 2015, 2017, and 2022''; and
(B) in subparagraph (B)--
(i) by striking ``2010, 2011, 2012, 2013, 2014, and 2016''
and inserting ``2010 through 2014, 2016, and 2018 through
2021''; and
(ii) by striking ``fiscal year 2015 and fiscal year 2017''
and inserting ``fiscal year 2015, 2017, and 2022''; and
(2) in paragraph (3)(A), in the matter preceding clause
(i), by striking ``or a semi-annual allotment period for
fiscal year 2015 or 2017'' and inserting ``or in any of
fiscal years 2018 through 2021 (or a semi-annual allotment
period for fiscal year 2015, 2017, or 2022)''.
(d) Extension of Qualifying States Option.--Section
2105(g)(4) of the Social Security Act (42 U.S.C.
1397ee(g)(4)) is amended--
(1) in the heading, by striking ``through 2017'' and
inserting ``through 2022''; and
(2) in subparagraph (A), by striking ``2017'' and inserting
``2022''.
(e) Extension of Express Lane Eligibility Option.--Section
1902(e)(13)(I) of the Social Security Act (42 U.S.C.
1396a(e)(13)(I)) is amended by striking ``2017'' and
inserting ``2022''.
(f) Assurance of Affordability Standard for Children and
Families.--
(1) In general.--Section 2105(d)(3) of the Social Security
Act (42 U.S.C. 1397ee(d)(3)) is amended--
(A) in the paragraph heading, by striking ``until october
1, 2019'' and inserting ``through september 30, 2022''; and
(B) in subparagraph (A), in the matter preceding clause
(i)--
(i) by striking ``2019'' and inserting ``2022''; and
(ii) by striking ``The preceding sentence shall not be
construed as preventing a State during such period'' and
inserting ``During the period that begins on October 1, 2019,
and ends on September 30, 2022, the preceding sentence shall
only apply with respect to children in families whose income
does not exceed 300 percent of the poverty line (as defined
in section 2110(c)(5)) applicable to a family of the size
involved. The preceding sentences shall not be construed as
preventing a State during any such periods''.
(2) Conforming amendments.--Section 1902(gg)(2) of the
Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended--
(A) in the paragraph heading, by striking ``until october
1, 2019'' and inserting ``through september 30, 2022''; and
(B) by striking ``September 30, 2019,'' and inserting
``September 30, 2022 (but during the period that begins on
October 1, 2019, and ends on September 30, 2022, only with
respect to children in families whose income does not exceed
300 percent of the poverty line (as defined in section
2110(c)(5)) applicable to a family of the size involved)''.
SEC. 202. EXTENSION OF CERTAIN PROGRAMS AND DEMONSTRATION
PROJECTS.
(a) Childhood Obesity Demonstration Project.--Section
1139A(e)(8) of the Social Security Act (42 U.S.C. 1320b-
9a(e)(8)) is amended--
(1) by striking ``and $10,000,000'' and inserting ``,
$10,000,000''; and
(2) by inserting after ``2017'' the following: ``, and
$25,000,000 for the period of fiscal years 2018 through
2022''.
(b) Pediatric Quality Measures Program.--Section 1139A(i)
of the Social Security Act (42 U.S.C. 1320b-9a(i)) is
amended--
(1) by striking ``Out of any'' and inserting the following:
``(1) In general.--Out of any'';
(2) by striking ``there is appropriated for each'' and
inserting ``there is appropriated--
``(A) for each'';
(3) by striking ``, and there is appropriated for the
period'' and inserting ``;
``(B) for the period'';
(4) by striking ``. Funds appropriated under this
subsection shall remain available until expended'' and
inserting ``; and''; and
(5) by adding at the end the following:
``(C) for the period of fiscal years 2018 through 2022,
$75,000,000 for the purpose of carrying out this section
(other than subsections (e), (f), and (g)).
``(2) Availability.--Funds appropriated under this
subsection shall remain available until expended.''.
SEC. 203. EXTENSION OF OUTREACH AND ENROLLMENT PROGRAM.
(a) Extension and Reauthorization.--Section 2113 of the
Social Security Act (42 U.S.C. 1397mm) is amended--
(1) in subsection (a)(1), by striking ``2017'' and
inserting ``2022''; and
(2) in subsection (g)--
(A) by striking ``and $40,000,000'' and inserting ``,
$40,000,000''; and
[[Page H8472]]
(B) by inserting after ``2017'' the following: ``, and
$100,000,000 for the period of fiscal years 2018 through
2022''.
(b) Making Organizations That Use Parent Mentors Eligible
to Receive Grants.--Section 2113(f) of the Social Security
Act (42 U.S.C. 1397mm(f)) is amended--
(1) in paragraph (1)(E), by striking ``or community-based
doula programs'' and inserting ``, community-based doula
programs, or parent mentors''; and
(2) by adding at the end the following new paragraph:
``(5) Parent mentor.--The term `parent mentor' means an
individual who--
``(A) is a parent or guardian of at least one child who is
an eligible child under this title or title XIX; and
``(B) is trained to assist families with children who have
no health insurance coverage with respect to improving the
social determinants of the health of such children, including
by providing--
``(i) education about health insurance coverage, including,
with respect to obtaining such coverage, eligibility criteria
and application and renewal processes;
``(ii) assistance with completing and submitting
applications for health insurance coverage and renewal;
``(iii) a liaison between families and representatives of
State plans under title XIX or State child health plans under
this title;
``(iv) guidance on identifying medical and dental homes and
community pharmacies for children; and
``(v) assistance and referrals to successfully address
social determinants of children's health, including poverty,
food insufficiency, housing, and environmental hazards.''.
(c) Exclusion From Modified Adjusted Gross Income.--Section
1902 of the Social Security Act (42 U.S.C. 1396a) is
amended--
(1) in subsection (a)(17), by striking ``(e)(14), (e)(14)''
and inserting ``(e)(14), (e)(15)'';
(2) in subsection (e), in the first paragraph (14),
relating to income determined using modified adjusted gross
income, by adding at the end the following new subparagraph:
``(J) Exclusion of parent mentor compensation from income
determination.--Any nominal amount received by an individual
as compensation, including a stipend, for participation as a
parent mentor (as defined in paragraph (5) of section
2113(f)) in an activity or program funded through a grant
under such section shall be disregarded for purposes of
determining the income eligibility of such individual for
medical assistance under the State plan or any waiver of such
plan.''; and
(3) in subsection (e), by striking ``(14) Exclusion'' and
inserting ``(15) Exclusion''.
SEC. 204. EXTENSION OF ADDITIONAL FEDERAL FINANCIAL
PARTICIPATION FOR CHIP.
Section 2105(b) of the Social Security Act (42 U.S.C.
1397ee(b)) is amended in the second sentence by inserting
``and during the period that begins on October 1, 2019, and
ends on September 30, 2020, the enhanced FMAP determined for
a State for a fiscal year (or for any portion of a fiscal
year occurring during such period) shall be increased by 11.5
percentage points'' after ``23 percentage points,''.
TITLE III--OFFSET
SEC. 301. IMPLEMENTATION OF OFFICE OF INSPECTOR GENERAL
RECOMMENDATION TO DELAY CERTAIN MEDICARE PLAN
PREPAYMENTS.
(a) Medicare Advantage Payments.--Section 1853(a)(1) of the
Social Security Act (42 U.S.C. 1395w-23(a)(1)) is amended--
(1) in subparagraph (A), in the matter preceding clause
(i)--
(A) by striking ``subsections (e), (g), (i), and (l)'' and
inserting ``subparagraph (J), subsections (e), (g), (i), and
(l),''; and
(B) by inserting ``(or, for months beginning with January
2019, on the date specified in subparagraph (J))'' after ``in
advance''; and
(2) by adding at the end the following new subparagraph:
``(J) Timing of payments.--
``(i) In general.--With respect to monthly payments under
this section for months in a year (beginning with 2019), the
date specified in this subparagraph with respect to a payment
for a month is the first business day occurring on or after
the applicable date defined in clause (ii).
``(ii) Applicable date.--For purposes of clause (i), with
respect to a year (beginning with 2019), the term `applicable
date' means, with respect to a payment for--
``(I) January of such year, January 2nd;
``(II) February of such year, February 5th;
``(III) March of such year, March 10th;
``(IV) April of such year, April 15th;
``(V) May of such year, May 20th;
``(VI) June of such year, June 25th;
``(VII) July and each succeeding month (other than
December) of such year, the first day of the next month; and
``(VIII) December of such year, December 24th.''.
(b) Conforming Amendment to Part D.--Section 1860D-15(d)(1)
of the Social Security Act (42 U.S.C. 1395w-115(d)(1)) is
amended by inserting ``and shall be made consistent with the
timing of monthly payments to MA organizations under section
1853(a)(1)(J)'' after ``as the Secretary determines''.
Mr. CLYBURN (during the reading). Mr. Speaker, I ask unanimous
consent to dispense with the reading.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from South Carolina?
There was no objection.
Mr. WALDEN. Mr. Speaker, I reserve a point of order against the
motion to recommit.
The SPEAKER pro tempore. The gentleman's point of order is reserved.
Pursuant to the rule, the gentleman from South Carolina is recognized
for 5 minutes in support of his motion.
Mr. CLYBURN. Mr. Speaker, the Republicans have reserved a point of
order against this motion.
Let me be clear about what this means. The Republican leadership does
not want a vote on providing proper CHIP funds to our United States
territories, including Puerto Rico and the Virgin Islands.
There may be a point of order against this provision, but it is the
same point of order that applies to the Republicans' bill.
Do you know what that means?
They waive the point of order for their bill, but they will not waive
the point of order for this bill.
I won't take up too much time, Mr. Speaker. I just want the body to
know that the Republican leadership is, once again, rigging the game in
favor of the majority.
This isn't about hurting me and the Democratic Members of this body,
no. This hurts the people who are already struggling in Puerto Rico and
the Virgin Islands.
{time} 1030
To my friends on the other side of the aisle, you may hide behind
procedural tactics, but the fact remains that doing so denies our
United States citizens living in the territories the proper funding
that the Governor has requested to recover
Mr. Speaker, this is the final amendment to the bill which will not
kill the bill nor send it back to committee. If adopted, the bill will
immediately proceed to final passage as amended.
It has been 34 days, Mr. Speaker, since Republicans allowed the
Children's Health Insurance Program and Community Health Centers to
expire. These proven programs insure 9 million children and serve 27
million people.
The bill before us is the latest in a long line of cynical attempts
by President Trump and Republican Leaders to sabotage and undermine the
Affordable Care Act. We ought not be funding efforts to treat
infectious diseases like the flu and measles by taking away the funds
needed to prevent those illnesses from occurring in the first place.
Mr. Speaker, this bill turns on its head that adage, ``an ounce of
prevention is worth a pound of cure.'' Instead of joining President
Trump's campaign to sabotage the ACA, the Members of this body,
Republicans and Democrats, should join to reauthorize CHIP and CHCs for
5 years, fully paid for without robbing Peter to pay Paul.
Mr. Speaker, I yield back the balance of my time.
Mr. WALDEN. Mr. Speaker, I withdraw my reservation of a point of
order.
The SPEAKER pro tempore. The reservation of a point of order is
withdrawn.
Mr. WALDEN. Mr. Speaker, I claim the time in opposition to the motion
to recommit.
The SPEAKER pro tempore. The gentleman from Oregon is recognized for
5 minutes.
Mr. WALDEN. Mr. Speaker, today, Members of this House can deliver
peace of mind to parents of over 8 million low-income children who
depend on the Children's Health Insurance Program. The House can extend
funding for important public health programs, including resources for
the critical work community health centers do in our communities and in
my district and yours. This bill will help deliver much-needed
healthcare resources to our friends and fellow citizens in the Virgin
Islands and in Puerto Rico.
Yet we have heard complaints about how this package is paid for.
Well, let us be clear how this bill funds healthcare for kids and
important public health priorities like community health centers.
In paying for this package, we have taken a fiscally responsible and
reasonable approach. Our bill funds kids' healthcare by allowing States
to dis-enroll lottery winners--these are winners making $80,000 or
above--from the low-income Medicaid program. We ensure high-dollar
lottery winners are removed from the Medicaid program so that those
resources can go to Medicaid-eligible, low-income people in our
districts.
Our bill directs funding from the Prevention and Public Health Fund
to finance important prevention and public
[[Page H8473]]
health needs, like funding the National Health Service Corps, Teaching
Health Center Graduate Medical Education, Family-to-Family Health
Information Centers, and community health centers. If these are not
important programs for prevention, wellness, and public health, I don't
know what are.
Our bill before us today, which I predict will have bipartisan
support, directs funds from the Prevention Fund for important public
health priorities that have long had bipartisan support. We are using a
bipartisan fund to pay for bipartisan healthcare support for health and
wellness, which was its intent from the beginning.
Most recently, nearly every House Republican and Democrat supported
this idea just a year ago. Just a year ago, when we passed the 21st
Century Cures Act, we said: Here is a health and wellness fund and a
Prevention Fund that makes sense for cures, make sense for, we believe
today, our community health centers, and for Children's Health
Insurance.
Our bill also asks the wealthiest among us, the 1 percent of
beneficiaries, those making $40,000 a month, over half-a-million
dollars a year--that is an individual--to pay a little more to help
fund health insurance for low-income children. I think they are willing
to do that, and I think we should be as well.
On multiple budgets, President Obama said this is a reasonable way to
pay for other priorities. That was bipartisan. It is bipartisan today.
These reasonable pay-fors have been opposed by some in the Democratic
leadership. Some House Democrats want to use children's healthcare and
funding for community health centers as a bargaining chip for a bigger
end-of-the-year goulash, yet kids and our frontline providers can't
wait any longer.
In just a few weeks, States like Minnesota run out of funding for the
Children's Health Insurance Program. At the request of my colleagues on
the other side of the aisle, we have agreed to postpone it time and
again, but time has run out. The negotiations did not end as we all
hoped they would.
But we can't wait any longer. It is time for this House to deliver
peace of mind to the families that rely on these critical programs. It
is time to vote ``yes.''
Mr. Speaker, I urge my colleagues to vote ``no'' on the motion to
recommit and to approve the underlying bill, and I yield back the
balance of my time.
Ms. BLUNT ROCHESTER. Mr. Speaker, I thank my friend and mentor, the
gentleman from South Carolina, for his kind words and for yielding.
Mr. Speaker, we deal with important issues every day in this House,
but there are few issues as meaningful to so many lives as the
Children's Health Insurance Program.
At this time the divisions in this House mimic those in our nation.
And on many issues, those divisions can be challenging to bridge.
One of my top priorities as a new Member of this body is to help
bridge those divides, instead of widening them.
I hope that my colleagues--both Democrats and Republicans--will tell
me if I fall short on that commitment.
One of the few things that does not divide us is the importance of
children's healthcare and the CHIP program.
When it was signed into law 20 years ago, this landmark legislation
meant so much to me.
First, as a mother of then 9-year-old, Alyssa, and 11-year-old, Alex
I deeply understood the fear a parent could feel with a sick child and
no insurance.
But also because at that time, I was the Deputy Secretary of Health &
Social Services for Delaware.
And I had the honor of helping implement the law and seeing thousands
of children who had never had healthcare get the coverage they
deserved.
From the 600,000 children across the nation who were the program's
first enrollees in 1998 to the nearly 9,000,000 children in 2016.
Kids across this country owe their yearly check-ups, their
immunizations, and their doctor's office lollipops to this program.
And in Delaware we owe a big debt to the CHIP program, Medicaid, and
the Affordable Care Act.
Today, 97 percent of Delaware's children obtain medical coverage
because of these programs.
In 1997, the legislation passed in a Republican Congress with a
Democratic President, highlighting how this truly was not a partisan
issue.
That's why it's disappointing to me that we aren't moving forward on
renewing the Children's Health Insurance Program with that same
reasonable, bipartisan approach.
The bill before us today forces us to choose between healthcare for
children and healthcare for other vulnerable populations.
Choosing between prevention and healthcare for kids is unacceptable--
particularly in a nation as great as ours.
I have spoken to many of you over the past 10 months.
I know that the people I have met in both political parties know--in
their hearts--that we should not play games with the healthcare of our
children.
I know that it may seem hard to oppose one's party leadership. But
today I ask you to consider whether this is one of those rare times . .
. those rare subjects . . .
Where we can come together to stand up for the those in need . . .
And to stand up for a clean reauthorization of the Children's Health
Insurance Program.
That's what our motion to recommit does.
Let's step back and consider whether we can use our common desire to
deliver healthcare to our children, as a moment to surprise the public
. . .
To set a new tone for how we deal with one another . . . and how we
address issues on which both of our parties fundamentally agree.
Please join with me on this vote to put our children first--they're
watching.
The SPEAKER pro tempore. Without objection, the previous question is
ordered on the motion to recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Mr. CLYBURN. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule
XX, this 15-minute vote on the motion to recommit will be followed by
5-minute votes on the question of passage of H.R. 3922, if ordered, and
approval of the Journal, if ordered.
The vote was taken by electronic device, and there were--yeas 187,
nays 231, not voting 14, as follows:
[Roll No. 605]
YEAS--187
Adams
Aguilar
Barragan
Bass
Beatty
Bera
Beyer
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brady (PA)
Brown (MD)
Brownley (CA)
Bustos
Butterfield
Capuano
Carbajal
Cardenas
Carson (IN)
Cartwright
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly
Conyers
Cooper
Correa
Costa
Courtney
Crist
Crowley
Cuellar
Cummings
Davis (CA)
Davis, Danny
DeFazio
DeGette
Delaney
DeLauro
DelBene
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Ellison
Engel
Eshoo
Espaillat
Esty (CT)
Evans
Foster
Frankel (FL)
Fudge
Gabbard
Gallego
Garamendi
Gomez
Gonzalez (TX)
Gottheimer
Green, Al
Green, Gene
Grijalva
Hanabusa
Hastings
Heck
Higgins (NY)
Himes
Hoyer
Huffman
Jayapal
Jeffries
Johnson (GA)
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kihuen
Kildee
Kilmer
Kind
Krishnamoorthi
Kuster (NH)
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee
Levin
Lewis (GA)
Lieu, Ted
Lipinski
Loebsack
Lofgren
Lowenthal
Lowey
Lujan Grisham, M.
Lujan, Ben Ray
Lynch
Maloney, Carolyn B.
Maloney, Sean
Matsui
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moore
Moulton
Murphy (FL)
Nadler
Napolitano
Neal
Nolan
Norcross
O'Halleran
O'Rourke
Pallone
Panetta
Pascrell
Payne
Pelosi
Perlmutter
Peterson
Pingree
Polis
Price (NC)
Quigley
Raskin
Rice (NY)
Richmond
Rosen
Roybal-Allard
Ruiz
Ruppersberger
Rush
Ryan (OH)
Sanchez
Sarbanes
Schakowsky
Schiff
Schneider
Schrader
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shea-Porter
Sherman
Sinema
Sires
Slaughter
Smith (WA)
Soto
Speier
Suozzi
Swalwell (CA)
Takano
Thompson (CA)
Thompson (MS)
Titus
Tonko
Torres
Tsongas
Vargas
Veasey
Vela
Velazquez
Visclosky
Walz
Wasserman Schultz
Waters, Maxine
Watson Coleman
Welch
Yarmuth
NAYS--231
Abraham
Allen
Amash
Amodei
Arrington
Babin
Bacon
Banks (IN)
Barletta
Barr
Barton
Bergman
Biggs
Bilirakis
Bishop (MI)
Bishop (UT)
Blackburn
Blum
Bost
Brady (TX)
Brat
Brooks (IN)
Buchanan
Buck
Bucshon
Budd
Burgess
[[Page H8474]]
Byrne
Calvert
Carter (GA)
Carter (TX)
Chabot
Cheney
Coffman
Cole
Collins (GA)
Collins (NY)
Comer
Comstock
Conaway
Cook
Costello (PA)
Cramer
Crawford
Culberson
Curbelo (FL)
Davidson
Davis, Rodney
Denham
Dent
DeSantis
DesJarlais
Diaz-Balart
Donovan
Duffy
Duncan (SC)
Duncan (TN)
Dunn
Emmer
Estes (KS)
Farenthold
Faso
Ferguson
Fitzpatrick
Fleischmann
Flores
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gaetz
Gallagher
Garrett
Gianforte
Gibbs
Gohmert
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (LA)
Graves (MO)
Griffith
Grothman
Guthrie
Handel
Harper
Harris
Hartzler
Hensarling
Herrera Beutler
Hice, Jody B.
Higgins (LA)
Hill
Holding
Hollingsworth
Hudson
Huizenga
Hultgren
Hunter
Hurd
Issa
Jenkins (KS)
Jenkins (WV)
Johnson (LA)
Johnson (OH)
Jones
Jordan
Joyce (OH)
Katko
Kelly (MS)
Kelly (PA)
King (IA)
King (NY)
Kinzinger
Knight
Kustoff (TN)
Labrador
LaHood
Lamborn
Lance
Latta
Lewis (MN)
LoBiondo
Long
Loudermilk
Love
Lucas
Luetkemeyer
MacArthur
Marchant
Marino
Marshall
Massie
Mast
McCarthy
McCaul
McClintock
McHenry
McKinley
McMorris Rodgers
McSally
Meadows
Meehan
Messer
Mitchell
Moolenaar
Mooney (WV)
Mullin
Newhouse
Noem
Norman
Nunes
Olson
Palazzo
Palmer
Paulsen
Pearce
Perry
Pittenger
Poe (TX)
Poliquin
Posey
Ratcliffe
Reed
Reichert
Renacci
Rice (SC)
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rohrabacher
Rokita
Rooney, Francis
Rooney, Thomas J.
Ros-Lehtinen
Roskam
Ross
Rothfus
Rouzer
Royce (CA)
Russell
Rutherford
Sanford
Scalise
Schweikert
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Smith (MO)
Smith (NE)
Smith (NJ)
Smith (TX)
Smucker
Stefanik
Stewart
Stivers
Taylor
Tenney
Thompson (PA)
Thornberry
Tiberi
Tipton
Trott
Turner
Valadao
Wagner
Walberg
Walden
Walker
Walorski
Walters, Mimi
Weber (TX)
Webster (FL)
Wenstrup
Westerman
Williams
Wilson (SC)
Wittman
Womack
Woodall
Yoder
Yoho
Young (AK)
Young (IA)
Zeldin
NOT VOTING--14
Aderholt
Bishop (GA)
Black
Bridenstine
Brooks (AL)
Gutierrez
Jackson Lee
Johnson, E. B.
Johnson, Sam
LaMalfa
Peters
Pocan
Upton
Wilson (FL)
{time} 1058
Messrs. BARTON, PALAZZO, CALVERT, SMITH of Texas, COLLINS of New
York, WITTMAN, Ms. GRANGER, Messrs. HOLDING, SCALISE, and Ms. HERRERA
BEUTLER changed their vote from ``yea'' to ``nay.''
Ms. JAYAPAL, Messrs. TAKANO, LANGEVIN, and DAVID SCOTT of Georgia
changed their vote from ``nay'' to ``yea.''
So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
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.
Mr. PALLONE. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. This is a 5-minute vote.
The vote was taken by electronic device, and there were--yeas 242,
nays 174, not voting 16, as follows:
[Roll No. 606]
YEAS--242
Abraham
Allen
Amodei
Arrington
Babin
Bacon
Banks (IN)
Barletta
Barr
Barton
Bera
Bergman
Bilirakis
Bishop (MI)
Bishop (UT)
Blackburn
Blum
Bost
Brady (TX)
Brat
Brooks (IN)
Buchanan
Buck
Bucshon
Budd
Burgess
Byrne
Calvert
Carbajal
Carter (GA)
Carter (TX)
Chabot
Cheney
Coffman
Cole
Collins (GA)
Collins (NY)
Comer
Comstock
Conaway
Cook
Correa
Costa
Costello (PA)
Cramer
Crawford
Cuellar
Culberson
Curbelo (FL)
Davidson
Davis, Rodney
Denham
Dent
DeSantis
DesJarlais
Diaz-Balart
Donovan
Duffy
Duncan (SC)
Duncan (TN)
Dunn
Emmer
Estes (KS)
Farenthold
Faso
Ferguson
Fitzpatrick
Fleischmann
Flores
Fortenberry
Foxx
Franks (AZ)
Frelinghuysen
Gaetz
Gallagher
Garrett
Gianforte
Gibbs
Gohmert
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (LA)
Graves (MO)
Griffith
Grothman
Guthrie
Handel
Harper
Harris
Hartzler
Hensarling
Herrera Beutler
Hice, Jody B.
Higgins (LA)
Hill
Holding
Hollingsworth
Hudson
Huizenga
Hultgren
Hunter
Hurd
Issa
Jenkins (KS)
Jenkins (WV)
Johnson (LA)
Johnson (OH)
Jones
Jordan
Joyce (OH)
Katko
Kelly (MS)
Kelly (PA)
Kind
King (IA)
King (NY)
Kinzinger
Knight
Kustoff (TN)
Labrador
LaHood
Lamborn
Lance
Latta
Lewis (MN)
Lipinski
LoBiondo
Loebsack
Long
Loudermilk
Love
Lucas
Luetkemeyer
MacArthur
Marchant
Marino
Marshall
Mast
McCarthy
McCaul
McClintock
McHenry
McKinley
McMorris Rodgers
McSally
Meadows
Meehan
Messer
Mitchell
Moolenaar
Mooney (WV)
Mullin
Murphy (FL)
Newhouse
Noem
Norman
Nunes
O'Halleran
Olson
Palazzo
Palmer
Paulsen
Pearce
Perry
Peterson
Pittenger
Poe (TX)
Poliquin
Posey
Ratcliffe
Reed
Reichert
Renacci
Rice (SC)
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rohrabacher
Rokita
Rooney, Francis
Rooney, Thomas J.
Ros-Lehtinen
Rosen
Roskam
Ross
Rothfus
Rouzer
Royce (CA)
Russell
Rutherford
Sanford
Scalise
Schneider
Schrader
Schweikert
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Sinema
Smith (MO)
Smith (NE)
Smith (NJ)
Smith (TX)
Smucker
Stefanik
Stewart
Stivers
Taylor
Tenney
Thompson (PA)
Thornberry
Tiberi
Tipton
Trott
Turner
Valadao
Wagner
Walberg
Walden
Walker
Walorski
Walters, Mimi
Weber (TX)
Webster (FL)
Wenstrup
Westerman
Wilson (SC)
Wittman
Womack
Woodall
Yoder
Yoho
Young (AK)
Young (IA)
Zeldin
NAYS--174
Adams
Aguilar
Amash
Barragan
Bass
Beatty
Beyer
Biggs
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brady (PA)
Brown (MD)
Brownley (CA)
Bustos
Butterfield
Capuano
Cardenas
Carson (IN)
Cartwright
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly
Conyers
Cooper
Courtney
Crist
Crowley
Cummings
Davis (CA)
Davis, Danny
DeFazio
DeGette
Delaney
DeLauro
DelBene
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Ellison
Engel
Eshoo
Espaillat
Esty (CT)
Evans
Foster
Frankel (FL)
Fudge
Gabbard
Gallego
Garamendi
Gomez
Gonzalez (TX)
Gottheimer
Green, Al
Green, Gene
Grijalva
Hanabusa
Hastings
Heck
Higgins (NY)
Himes
Hoyer
Huffman
Jayapal
Jeffries
Johnson (GA)
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kihuen
Kildee
Kilmer
Krishnamoorthi
Kuster (NH)
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee
Levin
Lewis (GA)
Lieu, Ted
Lofgren
Lowenthal
Lowey
Lujan Grisham, M.
Lujan, Ben Ray
Lynch
Maloney, Carolyn B.
Maloney, Sean
Massie
Matsui
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moore
Moulton
Nadler
Napolitano
Neal
Nolan
Norcross
O'Rourke
Pallone
Panetta
Pascrell
Payne
Pelosi
Perlmutter
Pingree
Polis
Price (NC)
Quigley
Raskin
Rice (NY)
Richmond
Roybal-Allard
Ruiz
Ruppersberger
Rush
Ryan (OH)
Sanchez
Sarbanes
Schakowsky
Schiff
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shea-Porter
Sherman
Sires
Slaughter
Smith (WA)
Soto
Suozzi
Swalwell (CA)
Takano
Thompson (CA)
Thompson (MS)
Titus
Tonko
Torres
Tsongas
Vargas
Veasey
Vela
Velazquez
Visclosky
Walz
Wasserman Schultz
Waters, Maxine
Watson Coleman
Welch
Yarmuth
NOT VOTING--16
Aderholt
Bishop (GA)
Black
Bridenstine
Brooks (AL)
Gutierrez
Jackson Lee
Johnson, E. B.
Johnson, Sam
LaMalfa
Peters
Pocan
Speier
Upton
Williams
Wilson (FL)
Announcement by the Speaker Pro Tempore
The SPEAKER pro tempore (during the vote). There are 2 minutes
remaining.
{time} 1106
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
Stated for:
Mr. PETERS. Mr. Speaker, my vote was not recorded on rollcall No. 606
on H.R. 3922--The Community Health and Medical Professionals Improve
Our Nation Act due to my attendance at the Vatican's Health of People,
Health of Planet and Our Responsibility: Climate Change, Air Pollution
and Health. I intended to vote ``aye.''
Mr. LaMALFA. Mr. Speaker, on rollcall No. 606 on passage of H.R.
3922, I am not recorded due to a family concern. Had I been present, I
would have voted ``yea.''
[[Page H8475]]
PERSONAL EXPLANATION
Ms. SPEIER. Mr. Speaker, due to an unavoidable conflict, I missed the
following votes on November 1, 2, and 3. Had I been present, I would
have voted ``yea'' on rollcall No. 597, ``nay'' on rollcall No. 604,
``yea'' on rollcall No. 605, and ``nay'' on rollcall No. 606.
PERSONAL EXPLANATION
Mrs. BLACK. Mr. Speaker, I was unavoidably detained. Had I been
present, I would have voted ``yea'' on rollcall No. 604, and ``yea'' on
rollcall No. 606.
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