Congressional Record, Volume 164 Issue 124 (Tuesday, July 24, 2018)

[Congressional Record Volume 164, Number 124 (Tuesday, July 24, 2018)]
[House]
[Pages H7100-H7106]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

PROVIDING FOR CONSIDERATION OF H.R. 6199, RESTORING ACCESS TO
MEDICATION ACT OF 2018, AND PROVIDING FOR PROCEEDINGS DURING THE PERIOD
FROM JULY 27, 2018, THROUGH SEPTEMBER 3, 2018

Mr. BURGESS. Mr. Speaker, by direction of the Committee on Rules, I
call up House Resolution 1012 and ask for its immediate consideration.
The Clerk read the resolution, as follows:

H. Res. 1012

Resolved, That upon adoption of this resolution it shall be
in order to consider in the House the bill (H.R. 6199) to
amend the Internal Revenue Code of 1986 to include certain
over-the-counter medical products as qualified medical
expenses. 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 now
printed in the bill, an amendment in the nature of a
substitute consisting of the text of Rules Committee Print
115-82 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. On any legislative day during the period from July
27, 2018, through September 3, 2018--
(a) the Journal of the proceedings of the previous day
shall be considered as approved; and
(b) the Chair may at any time declare the House adjourned
to meet at a date and time, within the limits of clause 4,
section 5, article I of the Constitution, to be announced by
the Chair in declaring the adjournment.
Sec. 3. The Speaker may appoint Members to perform the
duties of the Chair for the duration of the period addressed
by section 2 of this resolution as though under clause 8(a)
of rule I.
Sec. 4. Each day during the period addressed by section 2
of this resolution shall not constitute a calendar day for
purposes of section 7 of the War Powers Resolution (50 U.S.C.
1546).
Sec. 5. Each day during the period addressed by section 2
of this resolution shall not constitute a legislative day for
purposes of clause 7 of rule XIII.
Sec. 6. Each day during the period addressed by section 2
of this resolution shall not constitute a calendar or
legislative day for purposes of clause 7(c)(1) of rule XXII.

The SPEAKER pro tempore (Mr. Poe of Texas). 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 gentlewoman from California (Mrs. Torres),
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 1012 provides for the
consideration of an important bill to return control of healthcare
spending and budgeting back where it belongs: with the patient.
H.R. 6199, the Restoring Access to Medication and Modernizing Health
Savings Accounts Act of 2018, would amend the Internal Revenue Code of
1986 to include certain over-the-counter medical products as qualified
medical expenses for the purposes of spending one's own dollars within
a health savings account.
Today's resolution provides for a rule to allow H.R. 6199, the
Restoring Access to Medication and Modernizing Health Savings Accounts
Act of 2018, the standard practice for a tax-related measure on the
House floor. The rule provides for 1 hour of debate equally divided and
controlled between the chair and the ranking minority member of the
Committee on Ways and Means. The rule does, however, provide the
minority with the customary motion to recommit with or without
instructions.
Also included in the resolution before us today are the standard
provisions allowing the House of Representatives to continue to operate
while Members are home, working with their constituents during the
August district work period.
Mr. Speaker, I rise today to speak in support of the rule on H.R.
6199, the Restoring Access to Medication and Modernizing Health Savings
Accounts Act of 2018. This rule includes the work of various Members of
Congress on the important issue of modernizing health savings accounts.
While this legislation did not move through the Health Subcommittee of
the Energy and Commerce Committee, my fellow members on the other
Health Subcommittee, that of the Ways and Means Committee, have done
quality work in moving this package. Each bill was reported favorably
out of the Ways and Means Committee.
Mr. Speaker, I have long been a supporter of increasing flexibility
within our healthcare system, especially through the use of health
savings accounts. Health savings accounts allow patients to feel more
involved and to have more control over their healthcare spending. As
someone who has personally had a health savings account in the past, I
believe it to be a powerful tool but that qualified expenses have been
limited for too long.
This package will give more power to consumers by allowing them to
use their hard-earned savings that they put into their health savings
accounts on an expanded number of healthcare goods and services.
The first bill in this package, Promoting High-Value Healthcare
Through Flexibility for High-Deductible Health Plans Act, introduced by
Chairman Roskam, allows for first-dollar coverage flexibility for high-
deductible health plans. Many individuals, especially in the post-
Affordable Care Act world, have chosen to purchase high-deductible
health plans. While this is a reasonable choice for many consumers,
there are some who are faced with high out-of-pocket costs.
H.R. 6199 allows health plans to provide coverage for up to $250 per
year for individuals or $500 per year for families before they meet
their deductible. The goal of this provision is to incentivize services
that could reduce future healthcare costs, such as primary care visits
and telehealth services.
Additionally, under current law, individuals are unable to contribute
to an HSA if they participate in a direct primary care service
arrangement. Representative Erik Paulsen's Primary Care Enhancement
Act, which is included in this rule, enables patients to be able to
participate in a direct primary care service arrangement and remain
qualified to contribute to a health savings account. It also includes
direct primary care service arrangement fees as medical expenses.
Some individuals are fortunate enough to receive certain healthcare
services at or nearby their workplace through their employer.
Representative Mike Kelly's bipartisan Health

[[Page H7101]]

Savings Account Improvement Act of 2018, which is included in this
package, addresses this issue.
While it is convenient and helpful to have access to such services,
these individuals should not be barred from having a health savings
account. This package creates a special rule that individuals can
receive free or discounted services offered by their employers onsite
or at retail medical clinics. These services may include physical
exams, immunizations, nonprescription drugs, treatment of employment-
related injuries, drug testing if required as a condition of
employment, hearing or vision screenings, or other services that are
not considered significant benefits in the nature of medical care.
Mr. Speaker, the post-Affordable Care Act world is riddled with
flaws, but one of the biggest problems is its failure to promote
consumer-driven healthcare. Expanding the use of health savings
accounts could go a long way to reverse this trend. Health savings
accounts give consumers incentives to manage their own healthcare costs
by coupling a tax-favored savings account used to pay medical expenses
with a high-deductible health plan that meets certain requirements for
deductibles and out-of-pocket expense limits. The funds in a health
savings account are owned by the individual and may be rolled over from
year to year.
Health savings accounts are not a novel idea. They have been around
since 2004, but current health savings account policy is
extraordinarily restrictive, making it harder for consumers to take
advantage of it.

I have spent several years in developing extensive reforms to
increase the potential for health savings accounts for consumers, and
H.R. 6199 includes meaningful improvements that we can, in fact, get
across the finish line now to help families now.
One of these improvements is the ability for spouses to contribute to
a health savings account under certain circumstances even if their
spouse has a flexible spending account. Under current law, one spouse
can reimburse expenses for their spouses' and other dependents' medical
expenses; therefore, the other spouse is considered to be ineligible
for an HSA.
This provision enables the spouse without the flexible spending
account to reimburse for medical expenses, with certain restrictions.
This is critical, as it gives individuals increased flexibility to save
for their own healthcare expenses that a shared flexible spending
account for the whole family may not provide.
Additionally, this bill allows for individuals to terminate or
convert their flexible spending account and health reimbursement
accounts into a health savings account under certain circumstances.
Employers would be able to allow their employees to convert their
flexible spending account and health reimbursement account balances
into health savings account funds if they enroll in a high-deductible
health plan with an HSA. This is critical in empowering patients and
allowing them the flexibility to change health plans without losing
their savings.
There is a dollar limitation of $2,650 for conversions for
individuals, $5,300 for families, and the funds transferred into the
HSA would count toward the enrollee's HSA contribution for that taxable
year.
H.R. 6199, the bill introduced by Representative Lynn Jenkins from
Kansas, makes commonsense, patient-centered reforms to help defray
costs for individuals. Over-the-counter medications, allergy and cold
medicines, antibiotic ointment, and pain relievers are historically
ineligible expenditures for HSA and other tax-favored healthcare
accounts. The ACA created a requirement in Federal law that forced
account holders to go to their doctor to obtain a prescription for
over-the-counter medications before purchasing them with their health
savings account or flexible spending account. Individuals who fail to
jump through these hoops and purchase over-the-counter medications
without a prescription, in fact, face a tax penalty for making a
nonqualified distribution.
This policy drives unnecessary utilization of doctor services,
decreases access to over-the-counter medications, and discourages
people from taking control of saving for their healthcare needs. H.R.
6199 repeals this harmful provision, puts consumers back in the
driver's seat, and allows them efficient access to appropriate
medications.
Lastly, this legislation permits individuals to invest their hard-
earned health savings account dollars into their physical fitness and
well-being. In many ways, income is a hurdle for individuals and
families who would like to participate in a physical activity, whether
they would like to pay for a membership at a fitness facility or pay
for their children to join a youth sports league. This legislation
opens the door for paying for such activities with health savings
account dollars.
Known originally as a standalone bill, the Personal Health Investment
Today Act, introduced by Representative Jason Smith, allows qualified
sports and fitness expenses to count as qualified medical expenses.
These particular expenses are capped at $500 a year for individuals and
$1,000 on a joint return.

{time} 1315

Passage of this provision will assist individuals and families across
the Nation in investing in their physical fitness, which can lead them
to healthier lives and stave off conditions such as diabetes and
obesity. These bills are an important example of the work we are doing
right now to advance Member-driven solutions that will improve
healthcare for all Americans.
Deductibles, out-of-pocket limitations have been steadily growing.
Congress should be taking steps to make it easier for Americans to
save, not restricting their options. The rule and the underlying bills
included in this package strengthen consumer power and increase
flexibility for patients in paying for their medical expenses.
I appreciate all of the work that the Members have put into the
provisions of this bill. I urge my colleagues to support today's rule
and the underlying legislation, and I reserve the balance of my time.
Mrs. TORRES. 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.
Mr. Speaker, $2 trillion, that is what this GOP Congress added to the
debt last year when they passed their tax scam, $2 trillion that has
been taken away from our children and grandchildren to give tax breaks
to corporations and the very wealthy.
And today, we take up three bills which are estimated to add another
$100 billion. I suppose in comparison to the tax scam, that may be
small potatoes, but this is real spending with no offsets and no effort
to even try to find an offset. When the 115th Congress finally ends, we
will have to put trillions on the Nation's credit card--trillions.
Next year, those of us who may be lucky enough to be back will have
the hard task of digging ourselves out of this hole, this wall of debt
that will have been created by the 115th Congress. We will have new
Members here who will need to deal with the decisions that we are
making here today.
Let me tell you about my experience in having to deal with those very
irresponsible decisions that put us and pushed us into debt.
In 2008, when I was first elected to the State legislature, I was
elected with a wall of debt of $15 billion. My first 30 days in office,
we passed four different budgets, and none of it added up. We simply
couldn't pay our bills. We had charged ourselves to a place that we
could no longer continue.
No one got paid for 6 or 7 months--no one, not the small contractors
doing business with the State of California, not the big contractors,
not our State employees, not even the members of the legislature. As a
matter of fact, I don't come from money, so every month I took a loan
to make my mortgage. And this is where the 115th Congress is leading us
today. There are no easy choices.
Mr. Speaker, this rule makes in order H.R. 6199, the Restoring Access
to Medication and Modernizing Health Savings Accounts Act of 2018. H.R.
6199 claims to restore access to medication and modernizes health
savings accounts. This bill makes minor changes that largely favor
higher income-earning individuals who can afford to set aside that
extra money for things like gym memberships.
This is not, however, the worst bill we have voted on this year. And
some

[[Page H7102]]

of us may end up even voting for it. After all, I support fixes to the
Affordable Care Act. We all do. However, it does not address the
destructive actions by President Trump that have disproportionately
affected low-income families.
After nearly 70 unsuccessful repeal attempts by this Congress, this
administration has, sadly, turned to chipping away at the Affordable
Care Act. President Trump has resorted to undoing key provisions of the
healthcare law without offering any working fixes, which ultimately
puts in jeopardy access to healthcare.
He has eliminated the individual mandate, which alone will increase
premiums by 9 or 10 percent, and he is expanding plans that offer
slimmer benefits and reduce consumer protection, also known as junk
plans, as they cover nothing.
Healthcare plans that can charge you more for being a woman or for
being older or for having a preexisting condition, these plans can also
outright deny coverage to anyone, putting 130 million Americans'
healthcare at risk. Expanding these volatile health plans into the
marketplace will also increase premiums between 1 and 4 percent.
Almost a year ago, the Trump administration announced that they were
canceling cost-sharing reduction payments which helped nearly 6 million
low-income Americans better afford medical services by lowering
deductibles and copayments. This alone caused premiums in 2018 to
increase by 20 percent, all while this majority won't even try to find
a $100 billion offset. Cutting cost-sharing payments increased the
deficit by $200 billion. The administration also recently cut
additional outreach and consumer education dollars to local
organizations by $10 million.
And this is not the first time that they cut these critical dollars.
From the very beginning of this administration, millions of dollars in
outreach, customer assistance and other help and total enrollment time
was cut out. Additionally, we are still waiting on a solution to combat
the rising prescription drug crisis, which was promised by this
administration.
The increasing cost of prescription drugs in combination with the
forecasted increase in medical price inflation will also raise premiums
between 5.7 and 6.5 percent next year.
Earlier this month, President Trump announced yet another sabotage:
that he will not make the $10.4 billion in risk adjustment payments,
which will also increase premiums. These risk adjustment payments
protect consumers by ensuring insurance companies don't cherry-pick
between the healthy and the sick.
It was very telling last week when the Ways and Means Committee
chairman said that GOP lawmakers were exploring a possible legislative
fix to restart the risk adjustment payments that President Trump
abruptly suspended. The House GOP leadership knows the harm President
Trump is causing. Why don't we do something about it today?

The common theme here is an administration consistently undoing key
provisions in our healthcare system, putting Americans' health at risk,
increasing premiums, which fall squarely on the shoulders of our
families and will add billions of dollars to our deficit.
This isn't the Affordable Care Act. This is TrumpCare. This bill is
more of the same. Instead of finding solutions for the families that
need it the most, this bill will add $100 billion to the deficit.
We should be spending our time making positive, meaningful
improvements to our existing healthcare system that ensures millions of
Americans have access to affordable healthcare coverage.
We should be discussing legislation that puts downward pressure on
premiums so families don't have to worry year after year if they will
be able to afford healthcare coverage.
We should be helping to stabilize the marketplace so consumers can
choose from a variety of options that meet their unique family needs.
Instead, today, we are, sadly, wasting time discussing a bill that
fails to address the concerns of millions of Americans.
I am proud to be from California, a State that stands up for their
residents to ensure that they have access to healthcare coverage. In
fact, California's comprehensive outreach and marketing program was
credited with lowering premiums by 6 to 8 percent--real money.
California is proof that effective advertising and outreach can
increase enrollment, expand coverage, stabilize risk pools, and lower
premiums.
But this administration--and through inaction, this Congress--is
driving up healthcare prices for every American, including
Californians. So we will vote today on this bill, and it will probably
pass, and then it will die in the Senate. And while we send the Senate
more legislation that they will never take up, Americans will continue
to suffer.
Like I said, this isn't a bad bill, but it only benefits 6 percent of
Americans--6 percent, not the 14 percent who lack healthcare insurance
at all.
We must do more. We must help those who are falling further and
further behind while this Congress buries us in debt.
Mr. Speaker, I reserve the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, once again, I want to draw attention to an opinion
article in today's Wall Street Journal. The title of the article is
``TrumpCare Beats ObamaCare,'' July 23, 2018, penned by James Freeman.
``By prioritizing economic growth and reducing the tax and regulatory
burdens on U.S. business, Mr. Trump has helped to 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.''

{time} 1330

``For the first time in 6 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. .
. .''
``The Trump plan is repairing at least some of the damage caused by
ObamaCare. Notes the Journal:
``Among all private-sector workers offered medical benefits, 72
percent opted to take them,'' which is up from the 17 percent in 2010
when it began to decline.
Again, Mr. Speaker, this is to point out that this is all occurring
without a new government program. This is because of the strength of
the economy. This is what happens when you put the focus on creating
good jobs for American workers. This is the benefit that results.
I reserve the balance of my time, Mr. Speaker.
Mrs. TORRES. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, if we defeat the previous question, I will offer an
amendment to the rule to bring up Representative Ruiz's legislation,
H.R. 6479, which will ban junk insurance plans.
Mr. Speaker, 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
gentlewoman from California?
There was no objection.
Mrs. TORRES. Mr. Speaker, I yield 4 minutes to the distinguished
gentleman from California (Mr. Ruiz) to discuss our proposal.
Mr. RUIZ. Mr. Speaker, premiums are skyrocketing across the country,
caused by this administration's sabotage of the Affordable Care Act.
Just listen to the insurance company CEOs who are directly stating that
not funding cost-sharing reductions for point of care for patients who
are struggling to pay their bills will increase premiums. And also, by
not outreaching to more people and low-risk individuals to come into
the insurance pool, they are also increasing the premiums for everybody
else.
But rather than making healthcare more affordable for all middle
class families, this Congress is focusing on making healthcare more
affordable for the wealthy few.
Instead of protecting the 130 million Americans with preexisting
conditions, this Congress is sitting idly by as this administration
once again allows insurance companies to sell junk plans that don't
even cover basic healthcare services.

[[Page H7103]]

At a time when we should be stabilizing premiums by supporting risk-
adjustment transfers and ACA enrollment outreach, the majority is
refusing to act, simply ignoring the anticipated 18 percent increase in
premiums for hardworking Americans throughout our country because,
rather than help the American people, the majority would rather
sabotage the Affordable Care Act for their own political gain.
This is wrong. So I offer the majority and all the Members of the
House this choice: Members can support the previous question, ignore
the people who will be priced out of healthcare, and ignore all the
politically motivated actions by this administration to undermine
access to affordable healthcare in our Nation; or Members can defeat
the previous question so that we can bring up my bill, H.R. 6479, the
Stop Junk Health Plans Act, which will lower costs and will ensure that
Americans continue to have access to high-quality, affordable health
plans. It is that simple.
You see, in general, there are three out-of-pocket or more than three
out-of-pocket costs; in fact, one is the premiums, two is the
deductibles, three is the co-pays, and four is the out-of-pocket costs
Americans will have to pay if their health insurance doesn't cover
those specific services.
So only focusing on premiums is a message deception. You see, with
junk plans, that will increase out-of-pocket costs for patients because
these junk plans may offer Americans a less expensive premium; however,
the deductibles will be too expensive.
Also, if the majority goes after the essential health benefits and
allows insurance companies not to cover things like emergency care,
mental health, or prescription drugs, then they will be responsible for
those out-of-pocket costs.
Also, if the majority does not defend the protections of people with
preexisting illness--and insurance companies are now able to
discriminate against those with diabetes, heart conditions, asthma, et
cetera--then those individuals will have to pay more overall out-of-
pocket costs either because they were denied or because health
insurance companies will be able to charge them an exorbitant amount of
money.
So this is why it is so important to keep patient out-of-pocket costs
in perspective and not just focus on the political messaging tools of
narrowly focusing on premiums, because someone can buy a low-cost
premium health insurance, but, again, if it doesn't cover mental
health, prescription drugs, emergency care, or other forms of
guaranteed coverage under the Affordable Care Act, then they are going
to have to pay that completely out of pocket.
If the majority doesn't protect patients with preexisting illness,
then that is 180 million people in this country who have preexisting
illnesses who are going to have to pay more out of pocket.
So, therefore, we must focus and stabilize the health insurance
market; we must lower insurance costs by increasing enrollees into the
insurance market by low-risk individuals; we must protect essential
coverage and protect people with preexisting illness; and we must lower
drug prices and the cost of overall care.
I urge all my colleagues to make the right choice--the only choice--
that supports the American people, in this case, the out-of-pocket
costs.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mrs. TORRES. Mr. Speaker, I yield the gentleman from California an
additional 30 seconds.
Mr. RUIZ. Mr. Speaker, I urge Members to defeat the previous
question. I urge Members to do the right thing, to think strategically,
and to think about the overall out-of-pocket costs.

Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I was serving in the United States House of
Representatives when the congressional Democrats passed the Affordable
Care Act. I was serving in the House of Representatives when the
implementation of ObamaCare happened at the end of calendar year 2013.
I have got to tell you something. The President told me I had a junk
insurance plan. I was covered by a health savings account in those
years. Then-President Obama told me I had a junk insurance plan and
that I was going to get something better.
I have got to tell you something. I didn't get something better. I
went through healthcare.gov. I bought an unsubsidized ObamaCare policy,
the bronze plan. I am like any other consumer. I bought on price.
What is the cheapest thing I could afford? That was the bronze plan.
The premium was unbelievable. It was three times what I had paid for a
premium before for my so-called junk insurance which I had had for
years, which had covered every medical contingency that had occurred in
my family's life for a number of years. But now I have to buy this
policy that the premium was unbelievably high. But that wasn't the
worst part, Mr. Speaker. The worst part was the deductible.
Now, look, I had a health savings account. I bought one as soon as
the old medical savings accounts were allowed with the passage of the
Kennedy-Kassebaum bill in, I think it was, July of 1996. The rules got
written the next year. People were allowed to buy medical savings
accounts. I bought one. I converted to a health savings account in
2004.
I thought I knew what a high deductible was. That was the whole
purpose, after all, of having that medical savings account and, now,
health savings account. You have a higher deductible so your premiums
are going to be a little bit lower.
My premium certainly wasn't lower, but that deductible was something
unlike anything I had ever seen. I went from a $3,500 deductible in my
old health savings account with what then-President Obama said was a
junk insurance policy. I went from a $3,500 premium to a $6,800 premium
for just an individual. This is not a family policy, just for an
individual.
Now, let me tell you something, Mr. Speaker. Someone wakes up at 3 in
the morning with a kidney stone, the worst pain they have ever had in
their life. They go to the emergency room basically to get a shot of
morphine and an appointment with a urologist the next day and hopefully
pass the darn thing. That exercise can cost in excess of $4,000. If you
have a $6,800 deductible, guess what. That is all on you. Your coverage
is meaningless at that point. And at the same time, you are having to
pay a very expensive premium for coverage that is not there when you
need it.
I am not an expert on this, Mr. Speaker, but I would call that junk
insurance. That is what then-President Obama and the Congressional
Democrats brought us with the passage of the so-called Affordable Care
Act. I would far rather go back to those days before.
Most people don't understand why it is they have less coverage now
and it costs them more money. Yeah, they heard the argument, if you
like your doctor, you can keep your doctor; if you like your coverage,
you can keep your coverage. They recognize that perhaps that was
political hyperbole. But what they do not understand is: Why am I
having to pay so much more now to get so much less?
Mr. Speaker, I submit that the ability for individuals to buy health
savings accounts is not junk insurance. That is coverage that people
can use. That is help for right now.
Mr. Speaker, I reserve the balance of my time.
Mrs. TORRES. Mr. Speaker, I yield myself the balance of my time to
close.
Mr. Speaker, in the first 12 months of this administration, 3.2
million people have lost their healthcare because of the sabotage of
this administration. As a matter of fact, last year, we had the highest
increase in the number of uninsured since the ACA was passed.
When the ACA was passed, I was not in Congress. I was a State
legislator in California, where we embraced the ACA, where we made it
work for our families, and where we reached out to our constituents and
asked: How can we make it better?
This is not the ceiling; this is the floor.
As State representatives, we felt that we had an urgency to act, to
make it better and make it work for our constituents. That is what we
did, and that is why the California exchange is so successful.

[[Page H7104]]

But that didn't happen in other States controlled by Republican
legislators and Republican Governors. Unfortunately, they chose to do
the opposite, and that has hurt their constituents.
Mr. Speaker, the bill we are considering today will add another $100
billion to our national debt. That is not a small thing.
When the bill comes due for this expenditure, how are we going to pay
for it? What is the plan? Where is the budget? Where is the fiscal
conservancy here?
Will the House GOP majority then go after the least fortunate
Americans by cutting Medicaid? Or maybe they will go after American
seniors and cut Medicare and Social Security.
These are the questions people will be asking themselves when they
exercise their American civic duty this fall. Americans will have to
decide: Are trillions in tax cuts for wealthy corporations worth it to
me if it means that I can't go to the doctor?
That is why we have to offer real solutions, and we can start by
paying for these bills today.
Mr. Speaker, I urge my colleagues to oppose the previous question and
the rule because we owe it to our future generations who will have to
answer for our actions here today.
Mr. Speaker, I yield back the balance of my time.
Mr. BURGESS. Mr. Speaker, I yield myself the balance of my time.
First off, Mr. Speaker, let me reference an article from the
Investor's Business Daily from April 10 of this year. I am quoting
Investor's Business Daily:
``When the Congressional Budget Office released its updated budget
forecast, everyone focused on the deficit number. But buried in the
report was the Congressional Budget Office's tacit admission that it
vastly overestimated the cost of the Trump tax cuts because it didn't
account for the strong economic growth they would generate.
``Among the many details in the report, the one reporters focused on
was the Congressional Budget Office's forecast that the Federal deficit
would top $1 trillion in 2020. . . .''
Most of the news accounts blame the tax cuts.
I am continuing to quote here:
``But there's more to the story that the media overlooked.
``First, the CBO revised its economic forecast sharply upward this
year and next.
``Last June, the CBO said GDP growth for 2018 would be just 2
percent. Now it figures growth will be 3.3 percent''--this was last
April, Mr. Speaker; I suspect it is probably going to be higher at the
end of this quarter--``a significant upward revision. It also boosted
its forecast for 2019 from a meager 1.5 percent to a respectable 2.4
percent.''

{time} 1345

Mr. Speaker, the tax cuts are working to boost economic growth.
Obviously, the story is far from completed, but the revenue generated
by that increased growth is more than enough to offset the tax cuts
that were passed by this body last December.
Mr. Speaker, today's rule allows the House to take another step in
fixing the problems created by the Affordable Care Act and returning
control of healthcare spending back to patients, where it belongs.
H.R. 6199, the Restoring Access to Medication Act of 2018, will allow
those Americans with health savings accounts to use those accounts to
pay for over-the-counter medications, the practice which existed up
until the Democrats took away that ability in the Affordable Care Act.
This is the right thing to do.
I want to thank Representative Jenkins for her leadership on this
legislation and the Members who contributed to the package that is
before us today. I urge my colleagues to support today's rule and
support the underlying bills.
The material previously referred to by Mrs. Torres is as follows:

An Amendment to H. Res. 1012 Offered by Ms. Torres

At the end of the resolution, add the following new
sections:
Sec. 7. Immediately upon adoption of this resolution the
Speaker shall, pursuant to clause 2(b) of rule XVIII, declare
the House resolved into the Committee of the Whole House on
the state of the Union for consideration of the bill (H.R.
6479) to amend title XXVII of the Public Health Service Act
to include short-term limited duration plans in the
definition of individual health insurance coverage. The first
reading of the bill shall be dispensed with. All points of
order against consideration of the bill are waived. General
debate shall be confined to the bill and shall not exceed one
hour equally divided and controlled by the chair and ranking
minority member of the Committee on Energy and Commerce.
After general debate the bill shall be considered for
amendment under the five-minute rule. All points of order
against provisions in the bill are waived. At the conclusion
of consideration of the bill for amendment the Committee
shall rise and report the bill to the House with such
amendments as may have been adopted. The previous question
shall be considered as ordered on the bill and amendments
thereto to final passage without intervening motion except
one motion to recommit with or without instructions. If the
Committee of the Whole rises and reports that it has come to
no resolution on the bill, then on the next legislative day
the House shall, immediately after the third daily order of
business under clause 1 of rule XIV, resolve into the
Committee of the Whole for further consideration of the bill.
Sec. 8. Clause 1(c) of rule XIX shall not apply to the
consideration of H.R. 6479.
____

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 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.
Mrs. TORRES. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule
XX, this 15-minute vote on ordering the

[[Page H7105]]

previous question on House Resolution 1012 will be followed by 5-
minutes votes on:
Adoption of House Resolution 1012, if ordered;
Ordering the previous question on House Resolution 1011; and
Adoption of House Resolution 1011, if ordered.
The vote was taken by electronic device, and there were--yeas 224,
nays 184, not voting 20, as follows:

[Roll No. 368]

YEAS--224

Abraham
Aderholt
Allen
Amash
Amodei
Arrington
Babin
Bacon
Banks (IN)
Barletta
Barr
Barton
Bergman
Biggs
Bilirakis
Bishop (MI)
Bishop (UT)
Blum
Bost
Brady (TX)
Brat
Brooks (AL)
Brooks (IN)
Buchanan
Buck
Bucshon
Budd
Burgess
Byrne
Calvert
Carter (GA)
Carter (TX)
Chabot
Cheney
Cloud
Coffman
Cole
Collins (GA)
Collins (NY)
Comer
Comstock
Conaway
Cook
Costello (PA)
Cramer
Crawford
Culberson
Curbelo (FL)
Curtis
Davidson
Davis, Rodney
Denham
DeSantis
DesJarlais
Diaz-Balart
Donovan
Duffy
Duncan (SC)
Duncan (TN)
Dunn
Emmer
Estes (KS)
Faso
Ferguson
Fitzpatrick
Fleischmann
Flores
Fortenberry
Foxx
Frelinghuysen
Gaetz
Gallagher
Garrett
Gianforte
Gibbs
Gohmert
Goodlatte
Gosar
Gowdy
Granger
Graves (GA)
Graves (LA)
Griffith
Grothman
Guthrie
Handel
Harper
Harris
Hensarling
Herrera Beutler
Hice, Jody B.
Higgins (LA)
Hill
Holding
Hollingsworth
Hudson
Huizenga
Hultgren
Hunter
Hurd
Issa
Jenkins (KS)
Jenkins (WV)
Johnson (LA)
Johnson (OH)
Johnson, Sam
Jones
Jordan
Joyce (OH)
Katko
Kelly (MS)
Kelly (PA)
King (NY)
Kinzinger
Knight
Kustoff (TN)
Labrador
LaHood
LaMalfa
Lamborn
Lance
Latta
Lesko
Lewis (MN)
LoBiondo
Loudermilk
Love
Lucas
Luetkemeyer
MacArthur
Marchant
Marino
Marshall
Massie
Mast
McCarthy
McCaul
McClintock
McHenry
McKinley
McMorris Rodgers
McSally
Meadows
Mitchell
Moolenaar
Mooney (WV)
Mullin
Newhouse
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
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 (NE)
Smith (NJ)
Smith (TX)
Smucker
Stefanik
Stewart
Stivers
Taylor
Tenney
Thompson (PA)
Thornberry
Tipton
Trott
Turner
Upton
Valadao
Wagner
Walberg
Walden
Walker
Walorski
Walters, Mimi
Weber (TX)
Webster (FL)
Wenstrup
Westerman
Williams
Wilson (SC)
Wittman
Womack
Woodall
Yoho
Young (AK)
Young (IA)
Zeldin

NAYS--184

Adams
Aguilar
Barragan
Bass
Beatty
Bera
Beyer
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brady (PA)
Brown (MD)
Brownley (CA)
Bustos
Butterfield
Capuano
Carbajal
Cardenas
Carson (IN)
Cartwright
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly
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.
Engel
Espaillat
Esty (CT)
Evans
Foster
Frankel (FL)
Fudge
Gabbard
Gallego
Garamendi
Gomez
Gonzalez (TX)
Gottheimer
Green, Al
Green, Gene
Grijalva
Gutierrez
Hastings
Heck
Higgins (NY)
Himes
Hoyer
Huffman
Jackson Lee
Jayapal
Johnson (GA)
Johnson, E. B.
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kihuen
Kildee
Kilmer
Kind
Krishnamoorthi
Kuster (NH)
Lamb
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee
Levin
Lewis (GA)
Lieu, Ted
Loebsack
Lofgren
Lowenthal
Lowey
Lujan Grisham, M.
Lujan, Ben Ray
Lynch
Maloney, Carolyn B.
Maloney, Sean
Matsui
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moulton
Murphy (FL)
Nadler
Napolitano
Neal
Nolan
Norcross
O'Halleran
O'Rourke
Pallone
Panetta
Pascrell
Payne
Pelosi
Perlmutter
Peters
Peterson
Pingree
Pocan
Polis
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
Smith (WA)
Soto
Suozzi
Swalwell (CA)
Takano
Thompson (CA)
Thompson (MS)
Titus
Tonko
Torres
Tsongas
Vargas
Veasey
Vela
Velazquez
Visclosky
Wasserman Schultz
Waters, Maxine
Watson Coleman
Welch
Wilson (FL)
Yarmuth

NOT VOTING--20

Black
Blackburn
Ellison
Eshoo
Graves (MO)
Hanabusa
Hartzler
Jeffries
King (IA)
Lipinski
Long
Messer
Moore
Noem
Price (NC)
Rokita
Smith (MO)
Speier
Walz
Yoder

{time} 1412

So the previous question was ordered.
The result of the vote was announced as above recorded
Stated against:
Ms. ESHOO. Mr. Speaker, I was unable to be present during rollcall
vote No. 368 on July 24, 2018. Had I been present, on rollcall vote No.
368, I would have voted ``no.''
The SPEAKER pro tempore. The question is on the resolution.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.

Recorded Vote

Mrs. TORRES. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. This is a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 229,
noes 179, not voting 20, as follows:

[Roll No. 369]

AYES--229

Abraham
Aderholt
Allen
Amash
Amodei
Arrington
Babin
Bacon
Banks (IN)
Barletta
Barr
Barton
Bergman
Biggs
Bilirakis
Bishop (MI)
Bishop (UT)
Blum
Bost
Brady (TX)
Brat
Brooks (AL)
Brooks (IN)
Buchanan
Buck
Bucshon
Budd
Burgess
Byrne
Calvert
Carter (GA)
Carter (TX)
Chabot
Cheney
Cloud
Coffman
Cole
Collins (GA)
Collins (NY)
Comer
Comstock
Conaway
Cook
Costello (PA)
Cramer
Crawford
Culberson
Curbelo (FL)
Curtis
Davidson
Davis, Rodney
Denham
DeSantis
DesJarlais
Donovan
Duffy
Duncan (SC)
Duncan (TN)
Dunn
Emmer
Estes (KS)
Faso
Ferguson
Fitzpatrick
Fleischmann
Flores
Fortenberry
Foxx
Frelinghuysen
Gaetz
Gallagher
Garrett
Gianforte
Gibbs
Gohmert
Goodlatte
Gosar
Gottheimer
Gowdy
Granger
Graves (GA)
Graves (LA)
Griffith
Grothman
Guthrie
Handel
Harper
Harris
Hensarling
Herrera Beutler
Hice, Jody B.
Higgins (LA)
Hill
Holding
Hollingsworth
Hudson
Huizenga
Hultgren
Hunter
Hurd
Issa
Jenkins (KS)
Jenkins (WV)
Johnson (LA)
Johnson (OH)
Johnson, Sam
Jones
Jordan
Joyce (OH)
Katko
Kelly (MS)
Kelly (PA)
King (NY)
Kinzinger
Knight
Kustoff (TN)
Labrador
LaHood
LaMalfa
Lamb
Lamborn
Lance
Latta
Lesko
Lewis (MN)
LoBiondo
Loudermilk
Love
Lucas
Luetkemeyer
MacArthur
Marchant
Marino
Marshall
Massie
Mast
McCarthy
McCaul
McClintock
McHenry
McKinley
McMorris Rodgers
McSally
Meadows
Mitchell
Moolenaar
Mooney (WV)
Mullin
Murphy (FL)
Newhouse
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
Rooney, Francis
Rooney, Thomas J.
Ros-Lehtinen
Roskam
Ross
Rothfus
Rouzer
Royce (CA)
Russell
Rutherford
Sanford
Scalise
Schneider
Schweikert
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Sinema
Smith (NE)
Smith (NJ)
Smith (TX)
Smucker
Stefanik
Stewart
Stivers
Suozzi
Taylor
Tenney
Thompson (PA)
Thornberry
Tipton
Trott
Turner
Upton
Valadao
Wagner
Walberg
Walden
Walker
Walorski
Walters, Mimi
Weber (TX)
Webster (FL)
Wenstrup
Westerman
Williams
Wilson (SC)
Wittman
Womack
Woodall
Yoho
Young (AK)
Young (IA)
Zeldin

NOES--179

[[Page H7106]]

Deutch
Dingell
Doggett
Doyle, Michael F.
Engel
Eshoo
Espaillat
Esty (CT)
Evans
Foster
Frankel (FL)
Fudge
Gabbard
Gallego
Garamendi
Gomez
Gonzalez (TX)
Green, Al
Green, Gene
Grijalva
Gutierrez
Hastings
Heck
Higgins (NY)
Himes
Hoyer
Huffman
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson, E. B.
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kihuen
Kildee
Kilmer
Kind
Krishnamoorthi
Kuster (NH)
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee
Levin
Lewis (GA)
Lieu, Ted
Loebsack
Lofgren
Lowenthal
Lowey
Lujan Grisham, M.
Lujan, Ben Ray
Lynch
Maloney, Carolyn B.
Maloney, Sean
Matsui
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moulton
Nadler
Napolitano
Neal
Nolan
Norcross
O'Halleran
O'Rourke
Pallone
Panetta
Pascrell
Payne
Pelosi
Perlmutter
Peters
Peterson
Pingree
Pocan
Polis
Quigley
Raskin
Rice (NY)
Richmond
Rosen
Roybal-Allard
Ruiz
Rush
Ryan (OH)
Sanchez
Sarbanes
Schakowsky
Schiff
Schrader
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shea-Porter
Sherman
Sires
Smith (WA)
Soto
Swalwell (CA)
Takano
Thompson (CA)
Thompson (MS)
Titus
Tonko
Torres
Tsongas
Vargas
Veasey
Vela
Velazquez
Visclosky
Wasserman Schultz
Waters, Maxine
Watson Coleman
Welch
Wilson (FL)
Yarmuth

NOT VOTING--20

Black
Blackburn
Diaz-Balart
Ellison
Graves (MO)
Hanabusa
Hartzler
King (IA)
Lipinski
Long
Messer
Moore
Noem
Price (NC)
Rokita
Ruppersberger
Smith (MO)
Speier
Walz
Yoder

Announcement by the Speaker Pro Tempore

The SPEAKER pro tempore (during the vote). There are 2 minutes
remaining.

{time} 1420

So the resolution was agreed to.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.

____________________