[Congressional Record Volume 164, Number 124 (Tuesday, July 24, 2018)]
[House]
[Pages H7095-H7100]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PROVIDING FOR CONSIDERATION OF H.R. 184, PROTECT MEDICAL INNOVATION ACT 
   OF 2017, AND PROVIDING FOR CONSIDERATION OF H.R. 6311, INCREASING 
ACCESS TO LOWER PREMIUM PLANS AND EXPANDING HEALTH SAVINGS ACCOUNTS ACT 
                                OF 2018

  Mr. BURGESS. Mr. Speaker, by direction of the Committee on Rules, I 
call up House Resolution 1011 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 1011

       Resolved, That upon adoption of this resolution it shall be 
     in order to consider in the House the bill (H.R. 184) to 
     amend the Internal Revenue Code of 1986 to repeal the excise 
     tax on medical devices. All points of order against 
     consideration of the bill are waived. The amendment printed 
     in the report of the Committee on Rules accompanying this 
     resolution shall be considered as adopted. The bill, as 
     amended, shall be considered as read. All points of order 
     against provisions in the bill, as amended, are waived. The 
     previous question shall be considered as ordered on the bill, 
     as amended, and on any further amendment thereto, to final 
     passage without intervening motion except: (1) one hour of 
     debate equally divided and controlled by the chair and 
     ranking minority member of the Committee on Ways and Means; 
     and (2) one motion to recommit with or without instructions.
       Sec. 2.  Upon adoption of this resolution it shall be in 
     order to consider in the House the bill (H.R. 6311) to amend 
     the Internal Revenue Code of 1986 and the Patient Protection 
     and Affordable Care Act to modify the definition of qualified 
     health plan for purposes of the health insurance premium tax 
     credit and to allow individuals purchasing health insurance 
     in the individual market to purchase a lower premium copper 
     plan. All points of order against consideration of the bill 
     are waived. In lieu of the amendment in the nature of a 
     substitute recommended by the Committee on Ways and Means, an 
     amendment in the nature of a substitute consisting of the 
     text of Rules Committee Print 115-83 shall be considered as 
     adopted. The bill, as amended, shall be considered as read. 
     All points of order against provisions in the bill, as 
     amended, are waived. The previous question shall be 
     considered as ordered on the bill, as amended, and on any 
     further amendment thereto, to final passage without 
     intervening motion except: (1) one hour of debate equally 
     divided and controlled by the chair and ranking minority 
     member of the Committee on Ways and Means; and (2) one motion 
     to recommit with or without instructions.

  The SPEAKER pro tempore. The gentleman from Texas is recognized for 1 
hour.
  Mr. BURGESS. Mr. Speaker, for the purpose of debate only, I yield the 
customary 30 minutes to the gentleman from Florida (Mr. Hastings), 
pending which I yield myself such time as I may consume. During 
consideration of this resolution, all time yielded is for the purpose 
of debate only.


                             General Leave

  Mr. BURGESS. Mr. Speaker, I ask unanimous consent that all Members 
have 5 legislative days to revise and extend their remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Texas?
  There was no objection.
  Mr. BURGESS. Mr. Speaker, House Resolution 1011 provides for the 
consideration of two bills aimed at removing some of the most 
burdensome aspects of the Affordable Care Act, and, as a result, moving 
toward lowering healthcare costs for the millions of Americans who are 
confronted daily with rising premiums, rising deductibles, and rising 
drug prices.
  With each bill, we take one step closer to ultimately eliminating the 
Affordable Care Act's government-run approach to healthcare and return 
to a market-driven solution that puts patients first.
  The first bill in today's rule, H.R. 184, the Protect Medical 
Innovation Act of 2017, would repeal the excise tax on medical devices 
imposed on American companies by the previously mentioned Affordable 
Care Act.
  The second bill in today's rule, H.R. 6311, the Increasing Access to 
Lower Premium Plans and Expanding Health

[[Page H7096]]

Savings Accounts Act of 2018, expands the availability and the use of 
health savings accounts to allow individuals and their families to save 
their own money and budget for the healthcare needs they have that 
otherwise would not be part of their budget.
  Today's resolution provides for a closed rule for H.R. 184, the 
Protect Medical Innovation Act of 2017. This is the standard practice 
for a tax-related measure on the House floor. The rule provides for 1 
hour of debate, equally divided and controlled by the chair and the 
ranking minority member on the Committee on Ways and Means. The rule 
does provide the minority with the customary motion to recommit with or 
without instructions.
  The second part of today's resolution provides for a closed rule for 
H.R. 6311, the Increasing Access to Lower Premium Plans and Expanding 
Health Savings Accounts Act of 2018. The rule provides for 1 hour of 
debate equally divided and controlled by the chair and the ranking 
minority member of the Committee on Ways and Means. The customary 
motion to recommit with or without instructions is provided to the 
minority.
  This week, Republicans in the House continue our efforts to increase 
more healthcare options while driving down premiums in the individual 
market. According to the Office of the Assistant Secretary for Planning 
and Evaluation at the Department of Health and Human Services, premiums 
on the exchange are 105 percent higher, on average, in calendar year 
2017, compared to premiums in the individual market in calendar year 
2013, which was the last year before the Affordable Care Act took 
effect.
  It is important that we continue to address the negative impact that 
the Affordable Care Act has had on the individual market and to help 
Americans across the country be more in charge of their healthcare 
purchases.
  Thus far, the Republican Congress has been successful in nullifying 
the individual mandate, repealing the Independent Payment Advisory 
Board, and delaying many of the harmful taxes on American businesses 
and American consumers. I am also encouraged by the actions of the 
administration in permitting more low-cost limited duration insurance 
plans and allowing access to association health plans for more small 
businesses.
  These are choices that are provided to the American people so that 
they, the American people, can be in the driver's seat, not the other 
way around with the ACA's government-approved one-size-fits-all 
healthcare model.
  With that in mind, two bills we are considering this week seek to 
expand and improve health savings accounts. Under the current rule, 
H.R. 6311, the Increasing Access to Lower Premium Plan and Expanding 
Health Savings Accounts Act of 2018, will enhance the benefit of tax-
preferred health accounts so that individuals can better plan and save 
for their healthcare needs, and, also, these individuals will see lower 
premiums on their healthcare plans.
  For the last several Congresses, I have argued to improve the utility 
of health savings accounts, and so I am pleased to see that these 
important policies are being advanced through the House this week.
  In addition to offering health insurance, many employers often 
arrange to reimburse their employees and their dependants some of their 
medical expenses that are not covered by health insurance. Health 
flexible spending accounts and health reimbursement arrangements are 
two of the more common arrangements offered by employers.
  I have heard the frustration of employees, many of whom are my 
constituents in north Texas, over forfeiting the remaining amounts in 
their flexible spending account at the end of each plan year. We can 
all agree that the healthcare needs and purchases vary from year to 
year, where one year a person may have more medical expenses than the 
next or the other way around.
  One of the provisions in H.R. 6311 eliminates the arbitrary ``use it 
or lose it'' rule and allows flexible spending account balances to be 
carried over to the next plan year within a reasonable annual flexible 
spending account contribution limit.
  Another provision allows working seniors that are covered under an 
HSA-eligible high deductible health plan and enrolled in Medicare part 
A to continue to contribute to their health savings account. Just 
because someone becomes eligible for Medicare because of age, they 
should not be prohibited from continuing to contribute to a health 
savings account.
  Under current law, there are annual health savings account 
contribution limits. In 2018, the limit for an individual was $3,450. 
For families, that amount was $6,900. While these limits are updated 
annually for inflation, they are significantly less than the combined 
limit on annual out-of-pocket deductible expenses.
  H.R. 6311 would allow individuals to increase their contributions to 
equal to the combined annual limit on the out-of-pocket and deductible 
expenses under their HSA-qualified insurance plan. That would be $6,550 
for an individual and $13,300 for a family this year.
  The Affordable Care Act limits the option of individuals enrolled in 
bronze and so-called copper, or catastrophic, plans to make HSA 
contributions. Also, only those under 30 or those that qualify for a 
hardship exemption are actually able to purchase the so-called copper 
health plan. That is a 50 percent actuarial value health plan.
  So, today, I am pleased that a bill that I introduced with 
Representative Roskam, H.R. 6314, the Health Savings Act of 2018, to 
expand the eligibility and the access to health savings accounts by 
allowing plans categorized as catastrophic and bronze plans in the 
individual and small group markets to qualify for HSA contributions. 
That is included in this bill.
  Lastly, I appreciate working with the Ways and Means Health 
Subcommittee Chairman Peter Roskam on H.R. 6311. One of the key 
provisions of the bill is to provide an off-ramp from ObamaCare's 
rising premiums and limited choices by allowing the premium tax credit 
to be used for qualified plans offered outside of the law's exchanges 
and healthcare.gov.
  In addition, it expands access to the lowest premium plans available, 
so-called copper or catastrophic plans, for all individuals purchasing 
coverage in the individual market and allows the premium tax credit to 
be used to offset the cost of such plans.

                              {time}  1230

  I recognize not everyone will choose to have a health savings 
account, but they should have the option because HSAs represent a 
powerful tool to lower prices and improve access to quality care for 
everyone, and those are goals that we can all share.
  Now, it is well documented that many of the provisions contained 
within the Affordable Care Act have negative consequences on patients, 
both in access to care and in affordability. One of the provisions that 
has been universally criticized is that, on a large, bipartisan nature, 
its repeal was called for almost immediately after the passage of the 
Affordable Care Act. This is the tax on medical device manufacturers, 
or more commonly referred to as the medical device tax.
  It seems illogical that within a piece of legislation that was 
purported to make medical care available, more accessible to all 
Americans, the Federal Government would want to tax the very providers 
of medical innovation that create devices to improve the delivery of 
healthcare, but, nevertheless, that is exactly what happened when 
ObamaCare passed in 2010, and it was done as a means to pay for the 
astronomical price tag that accompanied the Affordable Care Act.
  This tax burden is unfair, and it actually increases costs that 
consumers pay at their doctors' offices. The tax has also been cited by 
dozens of medical device manufacturers who have or are considering 
moving their operations overseas so that they can continue to innovate 
without the heavy burden of this tax stifling their growth. This tax 
slows the creation of new techniques and devices, which will make the 
delivery of medicine more efficient, and it puts at risk the jobs that 
were created by the creation of such devices.
  For anyone who thinks that we are merely talking about the largest 
and most expensive pieces of technology found within a hospital--
basically, your MRI, CAT scans, and some surgical equipment--let's be 
clear that

[[Page H7097]]

this tax covers every piece of medical equipment, from those large 
machines to the smallest of items, including syringes used to deliver 
lifesaving antibiotics and vaccines. It continues to negatively impact 
a number of constituents in my district and, I am certain, in districts 
around the country, and it does continue to create a burden on a number 
of companies.
  The medical device tax has led to the elimination of thousands of 
good-paying jobs, and repealing it would be the first step to bringing 
those jobs back and stem the loss of future jobs within this vital 
industry that is helping to mitigate rising costs of healthcare due to 
the burdensome provisions within the Affordable Care Act.
  This is a tax on business, a tax on consumers, and a tax on 
innovation. To date, 33,000 jobs have been lost in the medical device 
industry since the passage of the Affordable Care Act, and it is 
projected that over 130,000 additional jobs are on the chopping block.
  Why would anyone be surprised about this? Excise taxes--and that is 
what this is, an excise tax--are meant to lead to a reduction in the 
consumption of the goods being taxed. We place an excise tax on 
cigarettes. We want to discourage people from smoking. We make it 
burdensome to afford a smoking habit.
  Did we really intend, with the passage of the Affordable Care Act by 
congressional Democrats in 2010, to make it more burdensome to use more 
efficient medical devices?
  H.R. 184 has bipartisan, bicameral support, with currently 277 
cosponsors. Republican leadership in the House has heard this request 
and heard the calls from many Members within this body and is moving 
this bill in a responsible way to put Americans back to work and lower 
healthcare costs for all.
  Mr. Speaker, I urge my colleagues to support today's rule and the 
underlying bill, and I reserve the balance of my time.
  Mr. HASTINGS. Mr. Speaker, I yield myself such time as I may consume, 
and I thank the gentleman from Texas for yielding me the customary 30 
minutes for debate.
  Mr. Speaker, I rise to debate this rule, but I would urge my 
colleague from Texas to be mindful that this ain't going nowhere, so we 
really are, when all is said and done, wasting our time. This is not 
likely to be taken up by the Senate in August, and why we are not doing 
other things, I simply cannot understand.
  The Protect Medical Innovation Act and the Increasing Access to Lower 
Premium Plans and Expanding Health Savings Accounts Act are worth 
considering. The gentleman from Texas certainly is an expert in this 
area and is most sincere. It is regrettable that the legislation, 
ultimately, that will pass the House of Representatives ain't going 
nowhere.
  Taken together, these measures do nothing to ameliorate the 
Republican attempt to eviscerate the Affordable Care Act, do nothing to 
curb rising drug costs, and do nothing to curtail skyrocketing premium 
hikes. Instead, H.R. 6311 continues the Republican majority's 
destructive path of undermining and destabilizing our health insurance 
markets.
  This package of six bills will likely lead to fewer choices and 
competition for moderate- and low-income families who do not have the 
disposable income to pay premium costs up front.
  In bringing up the second measure, H.R. 184, my friends across the 
aisle seem intent on ignoring the pressing issues facing our country, 
like passing sensible legislation that will address the country's 
ongoing gun violence epidemic, passing legislation that will protect 
our election infrastructure from hostile foreign hacking, or passing 
legislation that will help reunite the more than 2,500 separated 
children with their families. Rather, the Republican majority wants to 
waste valuable legislative time in repealing a tax that won't even be 
active until 2020.
  This is the last week before we go on a 5-week recess and we are 
doing nothing. Even worse, these bills are not offset and, taken 
together with tomorrow's bills, will add up to $90 billion to our 
deficit. They are not paid for. And I challenge my colleague on the 
floor handling this rule to tell me where the pay-fors are and, if 
there are none, why are they not paid for--$90 billion.

  Mr. Speaker, I strongly believe that the epidemic of gun violence 
that plagues our communities must be addressed in a comprehensive 
manner and without further delay. Unfortunately, our Nation has 
witnessed far too many senseless deaths caused each day by firearms, 
and that continues to rise.
  Under a Republican majority, many commonsense reforms, such as the 
assault weapons ban--and somebody please tell me why anyone other than 
the military and law enforcement needs an assault weapon; I just, for 
the life of me, cannot understand it--were allowed to expire. I might 
add, flood insurance is getting ready to expire. We are not taking that 
measure up.
  Providing nearly unfettered access to a variety of firearms does not 
make any sense. Someone said to me, well, there are 103 kinds of 
automatic weapons; and I say ban them all because they don't have any 
business in the hands of people in the streets at all.
  While we need to preserve the rights of responsible gun owners--and I 
am one of them; I believe in the Second Amendment--we must focus more 
of our attention and efforts on keeping weapons out of the hands of 
dangerous individuals instead of attacking and undermining the 
healthcare for millions of hardworking Americans.
  While the present administration works to further the majority's aim 
of dismantling the most popular aspects of the Affordable Care Act, 
like keeping children on their parents' health insurance until the age 
of 26 and protecting people with preexisting conditions, these bills 
continue to balloon Federal spending and deficits.
  While we were promised increased revenue from the GOP tax cuts of 
2017, with the GOP falling back on tired talking points like tax cuts 
paying for themselves, we now have the Congressional Budget Office 
projecting over $1 trillion in budget deficits in 2020, even before 
legislation like this passes.
  Whatever happened to the conservative Republicans? Where did the 
fiscal conservative Republicans go, who are blowing up the deficit in 
this country? The amount of fiscal irresponsibility demonstrated by my 
friends across the aisle is shocking and will be a great detriment to 
all Americans in the future.
  Moreover, these pieces of legislation do nothing to holistically 
solve the most pressing concerns hardworking Americans have with 
healthcare: ever-increasing premiums, unstable health markets, and 
exploding drug costs. In fact, in the last year and a half, the 
majority has gone out of their way to destabilize health markets as 
much as they can.
  Instead of encouraging Americans to enroll in health insurance, the 
Department of Health and Human Services has created an advertising 
campaign explicitly undermining the individual insurance markets 
created under the Affordable Care Act. Republicans have cut the 
Department's budget for those grassroots organizations whose sole 
purpose is to assist folks in signing up for health insurance. How much 
of the budget did they cut? 92 percent.
  In addition to this, HHS has threatened States that try to lower 
premiums, and the Trump administration has even canceled cost-sharing 
reduction payments to insurers, which the CBO projects will leave 1 
million more people uninsured, raise premiums by 20 to 25 percent over 
the next 2 years, and increase the Federal deficit by $200 billion.
  Listen, people, when we started this business of the Affordable Care 
Act--as much as my friends on the other side who have the prerogative, 
in the majority, to be in disagreement with this measure as well as any 
others and to offer this thing that ain't going nowhere here today--the 
simple fact of the matter is, some few years back, we had 42 million 
Americans who were uninsured. We now have more than 42 million 
Americans uninsured, and that is wrong.
  I said yesterday in the Rules Committee, all of us, 535--the Senate 
and the House--and the six delegates, ought to be locked up up here 
until we come up with a sensible solution for the American people with 
reference to a crisis.
  It was said yesterday by the chair of this committee that the plan 
that is going to be offered--that we did offer and then they voted 
against--would be the best healthcare plan in the world. Well, it ain't 
the best healthcare plan

[[Page H7098]]

in the world. The best healthcare plans in the world are in Denmark, 
Sweden, Switzerland, Australia, and a whole bunch of other places other 
than America.
  And while the Trump administration has pushed junk healthcare plans, 
even the organizations that originally lobbied the administration for 
access to these plans now say they no longer want to use them.
  All in all, as a result of these policies, as I have indicated, 4 
million fewer Americans have health insurance than when Donald John 
Trump took office, and healthcare costs continue to rise unabated.
  I need not remind my colleagues that people in the United States pay 
far more for healthcare than in any other industrialized nation on 
Earth, and, in most cases, they get far less. We spend over 18 percent 
of our gross domestic product on healthcare, compared to most other 
countries, which spend less than 10 percent, with much of the disparity 
occurring thanks to higher drug prices and administrative overhead.

                              {time}  1245

  Despite the money we pour into our healthcare, the United States has 
the shortest life expectancy and highest infant mortality of any modern 
industrialized nation--let me repeat that--the shortest life 
expectancy, and the highest infant mortality of any modern 
industrialized nation.
  We have far fewer physicians--and we had better do something about 
that; not in this measure, not in the Affordable Healthcare Act. We had 
better get busy trying to figure out how to provide more physicians, 
more nurses, more research for a variety of measures that are oncoming 
that our Nation is going to be confronted with.
  We have fewer hospital beds and, in perhaps what is the most 
depressing statistic of all of U.S. healthcare, the United States is 
one of only 13 countries in the world where the rate of maternal 
mortality, defined as the death of a mother in the year after she gives 
birth, is now worse than it was 25 years ago.
  And here we are, continuing to jaw jack about something that ain't 
going nowhere, and we have situations in our country that all of us 
know something about, all of us care about. There is no Republican in 
the House or Democrat in the House that doesn't care about their 
constituents and their healthcare. And at the very same time, what we 
are winding up doing is arguing with each other and nothing is getting 
done, and that is just dead wrong for this country.
  Black women, in particular, are three times more likely to die from 
health-related issues to their pregnancy. How can we seemingly pay for 
more healthcare now than at any point in our Nation's history and, yet, 
at the same time, be getting worse care than we were decades ago?
  We have a fundamentally broken system. The majority doesn't seem to 
have any way of fixing it, and I am not even sure that they want to fix 
it. Indeed, they seem to be going out of their way making it somehow 
worse.
  Now I hear all of the voices out there. I had a constituent call the 
other day to tell me that I wasn't as liberal as his people were, 
liberal, and that I didn't understand this whole healthcare system.
  And I told him: Listen, man, in 1992, when I ran for office, I ran on 
the premise of universal healthcare for every American, period. And 
when we did the Affordable Healthcare Act, it ultimately got called the 
ObamaCare Act.
  I have said in the Rules Committee repeatedly, it probably should 
have been called the Hastings/ObamaCare Act, or perhaps we would have 
done what Dr. Burgess asked us to do and it would be called the Burgess 
Healthcare Act.
  I don't care what it is called. It needs to be called something that 
is going to help every American, and not just a handful, and certainly 
not the richest people in this country who don't even need any 
healthcare. They have been at the socialized healthcare business for 
all of their lives and, therefore, people like Donald John Trump don't 
need to worry about this kind of thing.
  It is those people that are vulnerable. It is those people on 
Medicaid in Florida and other States that didn't expand Medicaid, 
900,000 of them in my State, that are left to the mercies of the 
system.
  And what do they do? All of us know what they do. When they have 
healthcare, they go to the hospital, to the emergency room, generally 
speaking, they are treated, and then those taxpayers in those 
respective jurisdictions wind up paying for it.
  So why don't we get our act together and try to do something about it 
now?
  I have proudly advocated for multiple pieces of legislation that will 
improve and strengthen the Medicare system, including H.R. 676, the 
Expanded and Improved Medicare for All Act, which will provide all 
individuals residing in the United States and the United States 
territories, with affordable healthcare, including that which is 
medically most necessary, such as primary and preventative care, 
dietary and nutritional therapies, prescription drugs, emergency care, 
long-term care, mental health services, dental services, and vision 
care. Underscore preventative care. And if we did more in that arena, 
we wouldn't have as much of a problem as we do today.
  Medicare for All will save taxpayers hundreds of dollars a month. 
Now, I firmly believe that we must focus priorities in the interest of 
the American people to ensure that our citizens have continued access 
to healthcare services.
  So when we come back here in September, when we finish all of our 
fighting in November, and we have somebody that is going to get 
elected, 435 of us will return here and be sworn in in January. Let's 
all make a commitment that we are going to work together, together, to 
get all of the resources, the tremendous minds, the incredible staffs 
that work here in this institution together, and try to make sure that 
we do the right thing by the American people and pass a measure that 
will cause everyone to have affordable care.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  The gentleman is quite correct in identifying the other body as 
sometimes an obstacle to good public policy, for it was 1 year ago that 
the other body blocked a health care reform that this body had passed 
the previous May.
  But, Mr. Speaker, I want to draw the House's attention to an article 
in today's Wall Street Journal. The title of the article is ``TrumpCare 
beats ObamaCare.'' And I just want to quote a little bit from this 
article.
  To set the stage, in December, with the repeal of the individual 
mandate, and quoting here: ``But while many people didn't realize it at 
the time, it turns out that Mr. Trump has been helping to improve an 
important source of insurance coverage since virtually the moment he 
took office.''
  Continuing to quote here: ``By prioritizing economic growth and 
reducing the tax and regulatory burdens on U.S. business, Mr. Trump has 
helped create an economy with more job openings than ever before. As if 
by magic, the invisible hand of a freer marketplace is now generating 
new benefits as employers compete to fill all those open positions.''

  Continuing to quote here: ``For the first time in six years, the 
share of U.S. workers offered health insurance through their employer 
has risen, a sign a tighter labor market is prompting businesses to 
offer more generous benefits.''
  So, Mr. Speaker, I simply submit that the activities of the Trump 
administration have, indeed, improved the healthcare landscape in this 
country. That is something we should acknowledge and embrace.
  I reserve the balance of my time.
  Mr. HASTINGS. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, if we defeat the previous question, I am going to offer 
an amendment to the rule that would change the rules of the House to 
prevent any legislation from being considered that would reduce the 
guaranteed benefits for individuals enrolled in either Medicare or 
Medicaid programs.
  I ask unanimous consent to insert the text of my amendment in the 
Record, along with extraneous material, immediately prior to the vote 
on the previous question.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Florida?
  There was no objection.
  Mr. HASTINGS. Mr. Speaker, I urge my colleagues to vote ``no'' and 
defeat

[[Page H7099]]

the previous question so that we may protect these critical programs 
for this generation and the next.
  Mr. Speaker, I would be prepared now to advise my colleague from 
Texas that I have no further speakers, and I am prepared to close when, 
and if, he is.
  Mr. BURGESS. Mr. Speaker, I am prepared to close as well.
  Mr. HASTINGS. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, in closing, this place, the people's House, should be 
about approaching our congressional responsibilities and daily 
activities in a manner that is fair and respectful to all Americans; in 
a manner where the appropriate committee of jurisdiction holds hearings 
and markups; in a manner where experts in the field are respected and 
consulted; in a manner where Members of both political parties have the 
ability to offer amendments and debate the contents of bills that come 
to the House floor.
  Unfortunately, in this historically closed-off, Republican run House, 
that is not the case. And let me make it very clear. Even though in the 
Ways and Means and the Appropriations Committee, as a matter of 
practice, we allow for closed rules, we now have, with these three 
rules that are likely to be finished today, we have 95 closed rules. 
This is 2018, and not in the history of the people's House has the 
process been as closed.
  When the Speaker of the House of Representatives began this session, 
he indicated that it would be the most open session that we would have. 
And yet, it is not the case.
  I spoke earlier about immigration, and I saw this morning where the 
majority leader has determined, even though having promised his own 
conference that he would have a vote on immigration, he ain't gonna do 
it.
  Now, something is wrong with this process and it needs to be 
corrected, and we can correct it going forward. We will make 100, and 
then we will be historically referenced as the most closed Congress in 
the history of the United States of America.
  What we see are my friends across the aisle, bending over backwards 
to reward a very specific and elite constituency. Week after week, the 
powerful gun lobby is rewarded as Republican leadership refuses to 
bring up even the most commonsense gun violence prevention legislation.
  The next week, like today, the powerful medical insurance lobby 
chalks up a win as this Republican-led Congress votes in favor of 
special interests over the interests of hardworking Americans.
  Some other people that make out like bandits that we never talk about 
are the insurance companies. I could spend a whole hour talking about 
how they are benefiting while we are about the business of tying each 
other in knots with verbiage rather than with substantive legislation.
  Mr. Speaker, while there is no quick fix to any of these measures, 
not to gun violence, opioid addiction, the immigration problems, and 
ongoing foreign cyber attacks on our election system's infrastructure, 
we simply must engage in the complicated and difficult process of 
improving our country's current policies.
  I, as well as my colleagues on this side of the aisle, stand ready to 
work with Members of Congress to bring commonsense legislation to the 
floor that will benefit all Americans and not just the rarified few.
  Mr. Speaker, I am going to urge a ``no'' vote on the rule and a 
``no'' vote on the previous question. This measure we are debating here 
today ain't going nowhere, and I yield back the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
  The gentleman from Florida is making a point about open rules, and I 
do feel obligated to point out in the 111th Congress--that was the 
Congress that was the first 2 years of President Obama's 
administration--in the 111th Congress, under Speaker Pelosi, the 
majority had zero open rules. That is zero open rules in the 2 years in 
which we saw the passage of the Affordable Care Act, the passage of 
Dodd-Frank; the House-passed Waxman/Markey, which was a cap-and-trade 
global warming bill, so significant pieces of legislation passed the 
floor of this House, all under closed rules.
  But, Mr. Speaker, today's rule brings forward two pieces of 
legislation that will have a meaningful impact on Americans' healthcare 
costs, including the premiums and the prices they pay for medicines.

                              {time}  1300

  H.R. 184, the Protect Medical Innovation Act of 2017, which will 
repeal the Affordable Care Act's ill-conceived medical device tax, and 
H.R. 6311, the Increasing Access to Lower Premium Plans and Expanding 
Health Savings Account Act of 2018, which will provide greater freedom 
for Americans to use their own money to pay for medical expenses out of 
their health savings accounts, both of these build on the House's work 
over the past 2 years to make healthcare a more patient-centered 
market.
  Mr. Speaker, I certainly want to thank Representatives Paulsen and 
Roskam for their work on these measures. I urge my colleagues to 
support today's rule and move the debate forward on this legislation.
  The material previously referred to by Mr. Hastings is as follows:

          An Amendment to H. Res. 1011 Offered by Mr. Hastings

       At the end of the resolution, add the following new 
     section:
       Sec. 3. Rule XXI of the Rules of the House of 
     Representatives is amended by adding at the end the following 
     new clause:
       ``Restrictions on Consideration of Legislation That Would 
     Cut Medicare or Medicaid.
       13. (a) It shall not be in order to consider a bill, joint 
     resolution, motion, amendment, amendment between the Houses, 
     or conference report which includes any provision described 
     in paragraph (b).
       (b) A provision referred to in paragraph (a) is a provision 
     which, if enacted into law, would result in either of the 
     following:
       (1) a reduction of guaranteed benefits for individuals 
     entitled to, or enrolled for, benefits under the Medicare 
     program under title XVIII of 18 such Act (42 U.S.C. 1395 et 
     seq.); or
       (2) a reduction of benefits or eligibility for individuals 
     enrolled in, or eligible to receive medical assistance 
     through, a State Medicaid plan or waiver under title XIX of 
     such Act (42 U.S.C. 1396 5 et seq.).
       (c) It shall not be in order to consider a rule or order 
     that waives the application of paragraph (a). As disposition 
     of any point of order under paragraph (a) or this paragraph 
     (except a point of order against an amendment pursuant to 
     paragraph (a)), the Chair shall put the question of 
     consideration with respect to the measure, order, conference 
     report, or rule as applicable. The question of consideration 
     shall be debatable for 10 minutes by the Member initiating 
     the point of order and for 10 minutes by an opponent, but 
     shall otherwise be decided without intervening motion except 
     one that the House adjourn.''
                                  ____


        The Vote on the Previous Question: What It Really Means

       This vote, the vote on whether to order the previous 
     question on a special rule, is not merely a procedural vote. 
     A vote against ordering the previous question is a vote 
     against the Republican majority agenda and a vote to allow 
     the Democratic minority to offer an alternative plan. It is a 
     vote about what the House should be debating.
       Mr. Clarence Cannon's Precedents of the House of 
     Representatives (VI, 308-311), describes the vote on the 
     previous question on the rule as ``a motion to direct or 
     control the consideration of the subject before the House 
     being made by the Member in charge.'' To defeat the previous 
     question is to give the opposition a chance to decide the 
     subject before the House. Cannon cites the Speaker's ruling 
     of January 13, 1920, to the effect that ``the refusal of the 
     House to sustain the demand for the previous question passes 
     the control of the resolution to the opposition'' in order to 
     offer an amendment. On March 15, 1909, a member of the 
     majority party offered a rule resolution. The House defeated 
     the previous question and a member of the opposition rose to 
     a parliamentary inquiry, asking who was entitled to 
     recognition. Speaker Joseph G. Cannon (R-Illinois) said: 
     ``The previous question having been refused, the gentleman 
     from New York, Mr. Fitzgerald, who had asked the gentleman to 
     yield to him for an amendment, is entitled to the first 
     recognition.''
       The Republican majority may say ``the vote on the previous 
     question is simply a vote on whether to proceed to an 
     immediate vote on adopting the resolution . . . [and] has no 
     substantive legislative or policy implications whatsoever.'' 
     But that is not what they have always said. Listen to the 
     Republican Leadership Manual on the Legislative Process in 
     the United States House of Representatives, (6th edition, 
     page 135). Here's how the Republicans describe the previous 
     question vote in their own manual: ``Although it is generally 
     not possible to amend the rule because the majority Member 
     controlling the time will not yield for the purpose of 
     offering an amendment, the same result may be achieved by 
     voting down the previous question on the rule. . . . When the 
     motion for the previous question is defeated, control of the 
     time passes to the Member

[[Page H7100]]

     who led the opposition to ordering the previous question. 
     That Member, because he then controls the time, may offer an 
     amendment to the rule, or yield for the purpose of 
     amendment.''
       In Deschler's Procedure in the U.S. House of 
     Representatives, the subchapter titled ``Amending Special 
     Rules'' states: ``a refusal to order the previous question on 
     such a rule [a special rule reported from the Committee on 
     Rules] opens the resolution to amendment and further 
     debate.'' (Chapter 21, section 21.2) Section 21.3 continues: 
     ``Upon rejection of the motion for the previous question on a 
     resolution reported from the Committee on Rules, control 
     shifts to the Member leading the opposition to the previous 
     question, who may offer a proper amendment or motion and who 
     controls the time for debate thereon.''
       Clearly, the vote on the previous question on a rule does 
     have substantive policy implications. It is one of the only 
     available tools for those who oppose the Republican 
     majority's agenda and allows those with alternative views the 
     opportunity to offer an alternative plan.

  Mr. BURGESS. Mr. Speaker, I yield back the balance of my time, and I 
move the previous question on the resolution.
  The SPEAKER pro tempore. The question is on ordering the previous 
question.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. HASTINGS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________