[Congressional Record Volume 164, Number 124 (Tuesday, July 24, 2018)]
[House]
[Pages H7119-H7124]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                 PROTECT MEDICAL INNOVATION ACT OF 2017

  Mr. PAULSEN. Mr. Speaker, pursuant to House Resolution 1011, I call 
up the bill (H.R. 184) to amend the Internal Revenue Code of 1986 to 
repeal the excise tax on medical devices, and ask for its immediate 
consideration.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Pursuant to House Resolution 1011, the 
amendment printed in House Report 115-860 is adopted, and the bill, as 
amended, is considered read.
  The text of the bill, as amended, is as follows:

                                H.R. 184

       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 ``Protect Medical Innovation 
     Act of 2018''.

     SEC. 2. REPEAL OF MEDICAL DEVICE EXCISE TAX.

       (a) In General.--Chapter 32 of the Internal Revenue Code of 
     1986 is amended by striking subchapter E.
       (b) Conforming Amendments.--
       (1) Subsection (a) of section 4221 of such Code is amended 
     by striking the last sentence.
       (2) Paragraph (2) of section 6416(b) of such Code is 
     amended by striking the last sentence.
       (c) Clerical Amendment.--The table of subchapters for 
     chapter 32 of such Code is amended by striking the item 
     relating to subchapter E.
       (d) Effective Date.--The amendments made by this section 
     shall apply to sales after December 31, 2019.

  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 Ways and Means.
  The gentleman from Minnesota (Mr. Paulsen) and the gentleman from 
Massachusetts (Mr. Neal) each will control 30 minutes.
  The Chair recognizes the gentleman from Minnesota.


                             General Leave

  Mr. PAULSEN. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days within which to revise and extend their 
remarks and include extraneous material on the bill H.R. 184, currently 
under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Minnesota?
  There was no objection.
  Mr. PAULSEN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, today, the House will vote on H.R. 184, the Protect 
Medical Innovation Act, which will finally repeal the medical device 
excise tax and eliminate a burden on patients and the companies that 
create and produce lifesaving medical devices for people all over the 
world.
  The medical device industry is truly an American success story, 
directly employing more than 400,000 people. In Minnesota alone, more 
than 35,000 people are employed at almost 700 companies, mostly small 
companies that you have never heard of. Many of them were started by a 
doctor or an engineer or an entrepreneur in the garage or in the 
backyard with an idea to improve or help save someone's life. In fact, 
80

[[Page H7120]]

percent of all medical device companies have less than 50 employees, 
and 93 percent have less than 500 employees. The jobs they provide are 
good, rewarding jobs that pay above-average salaries.
  Mr. Speaker, America is a net exporter in medical devices, one of the 
other reasons why it is an American success story. But back in 2013, 
the Affordable Care Act imposed a new 2.3 percent excise tax on all 
medical devices.

                              {time}  1600

  Mr. Speaker, 2.3 percent may not sound like much, but it wasn't a tax 
on profits; it was a tax on sales, on revenue. Usually the government 
puts an excise tax on things we want to discourage, like tobacco, 
alcohol, or gas-guzzling automobiles.
  Why would we want to discourage medical innovation? Only in 
Washington would you impose a tax on lifesaving medical devices and 
then think you are going to help reduce healthcare costs.
  Guess what? The device tax caused the loss of over 29,000 jobs. Now, 
with strong bipartisan support, we have been able to eliminate this 
onerous tax with suspensions. The last time we suspended this tax, 
companies responded by hiring more engineers and more technicians and 
putting more money into research and development projects for these 
new, lifesaving technologies.
  But these innovators need certainty. They need predictability. And a 
permanent repeal is needed to especially help startup companies from 
where the next generation of inventions and innovation will come.
  Investors will hold back capital in new companies when there is a 
threat of an excise tax starting back up because it already takes 8 to 
10 years, Mr. Speaker, for these companies to become profitable in the 
first place. This tax raises the bar and makes it even more difficult 
for them to become profitable.
  I have had many conversations with companies that I represent in my 
community about what this excise tax means to them. I remember having a 
conversation with a medium-sized company owner who said that without 
this tax they would be able to have a few more projects online, which 
meant they would hire two more engineers and two more technicians. 
Other companies to which I have spoken said they would be able to 
directly invest more in research and development, creating more high-
paying jobs, invent better products. Ultimately, it is about helping 
more patients.
  The good news, Mr. Speaker, is there is strong recognition that we 
need to eliminate this tax on a bipartisan basis, because it is such 
bad policy. In fact, very few bills have such strong bipartisan 
support: 277 cosponsors. Mr. Speaker, 44 of those cosponsors are 
Democrats across the aisle.
  I pledge that I will continue working with Senator Klobuchar in the 
Senate across the aisle, and my colleagues, to get this over the finish 
line, because there are very few issues that would unite an Elizabeth 
Warren and a Ted Cruz, but this, Mr. Speaker, is one of them.
  Mr. Speaker, I would encourage all Members to support this 
legislation, and I reserve the balance of my time.
  Mr. NEAL. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, this week has been dubbed ``health week'' on the House 
floor. However, based on the legislation we are considering, it is hard 
to take that challenge seriously. The bills before us today simply 
don't do very much. Instead, we should be considering measures that go 
to the heart of what Americans need: lower healthcare costs and high-
quality care. That includes lower drug costs and prescription benefits 
that should be extended to all members of the American family based on 
the following notion that we should continue to make sure that 
preexisting conditions remain part of the Affordable Care Act.
  More and more families are facing difficult healthcare decisions. All 
too often, it comes down to not going to an important doctor 
appointment or cutting pills in half or stopping the taking of 
prescription medicines altogether. This, coupled with other challenges 
Americans face at home, like retirement security, addiction issues, and 
education costs, will make it harder, not easier, for them to move 
forward.
  At home in western Massachusetts, I hear about how people need to 
make complicated decisions for their families. Congress can simplify 
these things by bringing bills to the floor that truly address the cost 
of healthcare without making consumers shoulder more of the cost and 
give tax benefits to the wealthy, leaving patients to ever growing 
medical bills.
  Unfortunately, I have not seen any efforts to address these growing 
costs in a meaningful way. Instead, our Republican colleagues continue 
to lead efforts to sabotage critical health programs. This has led to 
more uncertainty for American families. This uncertainty also impacts 
the marketplace and leads to premium increases and adds to the burden 
for American families already having trouble making ends meet.
  Instead of placing more anxiety on individuals facing discrimination 
for preexisting conditions, we should protect and strengthen already 
existing programs like Medicare and Medicaid.
  The legislation before us is another billion, billion, billions of 
dollars in unpaid tax cuts. This is on top of the $2.3 trillion this 
Congress has already passed into law, all with borrowed money. 
Republicans are using the deficit, which they keep making larger, to 
justify the deep cuts they plan to make to Medicare, Social Security, 
and Medicaid. These bills will only intensify Republican calls for 
further cuts to those critical programs.
  American families need certainty, Mr. Speaker. What is happening to 
our Nation's healthcare at the moment is anything but. It is another 
obstacle for families to get a leg up and ensure their children and 
grandchildren are safe and have opportunities well into the future.
  The same is true for our seniors and those working to prepare for 
retirement. They should be in a place knowing they can retire without 
anxiety and have health programs they can count on in their later 
years.
  The bills before us this day do nothing to solve problems for 
everyday Americans. Instead, it leaves them further behind, with 
increased healthcare costs, lower coverage, and certainly sacrifices 
the quality of care they might receive.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PAULSEN. Mr. Speaker, I yield 2 minutes to the gentleman from 
Indiana (Mr. Banks), someone who represents a State that is steeped in 
medical technology jobs and has been a leader in championing the repeal 
of this tax.

  Mr. BANKS of Indiana. Mr. Speaker, I thank the gentleman from 
Minnesota, who has been the foremost leader in the House of 
Representatives for a very long time to permanently repeal the medical 
device tax.
  Mr. Speaker, there are more than 7,000 medical device companies in 
the United States that contribute hundreds of billions of dollars to 
our economy every year. These companies employ over 400,000 Americans, 
while creating lifesaving technologies that benefit patients around the 
world.
  Many of these manufacturers are located, as my colleague said, in my 
home district of northeast Indiana. In fact, Warsaw, Indiana, in my 
district, is known as the orthopedic capital of the world.
  There is no doubt that this tax was incredibly destructive while it 
was in effect. Data from the U.S. Department of Commerce indicates that 
29,000 jobs were lost in the industry between 2012 and 2015. Suspension 
of the tax has reduced some of the damage, but long-term investments 
and planning are impossible without full repeal.
  Without permanent repeal, we will never be able to fully recover the 
jobs destroyed by ObamaCare, and patients will continue to be denied 
new, lifesaving products.
  The Protect Medical Innovation Act will ensure that the medical 
device industry does not just survive but thrives, and this commonsense 
and bipartisan legislation would permanently repeal the medical device 
tax and, thereby, remove a mindless roadblock to economic growth and 
patient health.
  I want to thank my friend again, Representative Paulsen, for his 
tireless efforts on this issue, and I urge my colleagues to support 
passage of H.R. 184.
  Mr. NEAL. Mr. Speaker, I yield 3 minutes to the gentleman from New

[[Page H7121]]

Jersey (Mr. Pascrell), who is a well-known champion of Americans' 
healthcare plans.
  Mr. PASCRELL. Mr. Speaker, I know the great intentions of the sponsor 
of this legislation. That is not in question. What is in question is 
that we have very, very short memories when it comes to healthcare.
  We made a commitment when we put the Affordable Care Act together. We 
knew it wasn't perfect, and obviously since then we have tried to make 
some changes, but we haven't had much cooperation from the other side.
  It wasn't mindless. In fact, the medical device industry agreed to 
the conclusion. In sitting down in negotiations we started out with one 
thought in mind, regardless of what we were talking about: we shall pay 
for what we vote on, unlike some other legislation that will go 
nameless right now.
  We devised the Affordable Care Act so that it could be paid for and 
we would not have to add to the deficit. In fact, one of these taxes, 
in order to pay for the Affordable Care Act, we are discussing right 
now, the medical device tax. It started out at 5 percent. In working 
with the industry, we came to a conclusion of 2.3 percent.
  So we went from $40 billion raised for the Affordable Care Act to $20 
billion, see, because we knew we had to pay for this. That is what 
healthcare is all about, and that is why you guys on the other side--
you people have not come up with an alternative, because you don't know 
how to pay for anything. So we paid for this.
  The Protect Medical Innovation Act. Well, when the Affordable Care 
Act was being crafted, the medical device industry--and by the way, the 
medical device industry is probably the most scrutinized industry in 
the United States. Most of those companies, the 7,000 in the United 
States--most of them--are good actors, but a lot of them were not.
  Ten years ago I stood on this floor, Mr. Speaker, and pointed out all 
the cases against the medical device companies who were bribing doctors 
in order for those doctors to recommend the device. That is a fact of 
life. I didn't make that up. That is not a political injection here. 
This is what happened.
  You could shove it off all you want. If I have to come back to the 
floor on another occasion and cite chapter and verse the court cases, 
you won't be so happy. That is not my purpose today.
  What I am saying is, they agreed to the deal. They knew that the 
increase in health coverage of millions more Americans would directly 
increase the demand for medical devices.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. NEAL. Mr. Speaker, I yield the gentleman an additional 2 minutes.
  Mr. PASCRELL. By the way, Mr. Ranking Member, many medical devices 
are sold to people old, like myself, who are on Medicare. You continue 
to cut Medicare, and you will be cutting off your nose to spite your 
face.
  Congress most recently passed a delay of the medical device tax as 
part of the continuing resolution. This extended the time that they 
wouldn't have to pay a dime to the health system through the end of 
next year, costing taxpayers $4 billion. Nothing to sneeze at.
  Additionally, this year, the industry has stood to benefit 
tremendously from the reduction in the corporate tax rate, down to 21 
percent. You didn't get that break, and I didn't get that break.
  There is nothing that will lead me to believe these benefits will 
trickle down to help patients afford the devices they need to survive 
or lower the price of those devices in the first place, regardless of 
who is paying for them, out of what plan.
  I'll go back to the point. We put the ACA together so that it would 
be paid for. That is why we had to come up with that money, and we did, 
so you couldn't repeal it. And what you are trying to do is choke it to 
death. You are trying to bleed it.
  What you are doing is forcing more and more people--you just went 
from 20 million down to 17 million because of the subsidies that you 
wouldn't put through that were in the law, because of the mandate 
that was originally in the law.

  And what is the alternative? Silence. Health issues are the biggest 
issue this year, Mr. Speaker. I am glad I am on the right side.
  The SPEAKER pro tempore. Members are reminded to address their 
remarks to the Chair.
  Mr. PAULSEN. Mr. Speaker, contrary to some of the claims we heard a 
little bit before about the bill doing nothing to help everyday, 
average Americans, I will just remind Members that this bill reverses a 
harmful tax that is hurting job growth and innovation across the 
country.
  Access to good-paying jobs and innovative medical products is 
critically important, and I would argue that that is really important 
for everyday Americans.
  I would agree, also, with what was said earlier. Americans need 
certainty. This is an industry that needs certainty if we are going to 
be able to invest in new innovations, new inventions, to keep patients 
at the forefront of lifesaving and life-improving technology, to make 
sure their healthcare is the model of the rest of the world.
  Mr. Speaker, I yield 3 minutes to the gentlewoman from Utah (Mrs. 
Love), who has been a strong voice for innovation, not only in her 
State but within our conference here in the House of Representatives, 
in repealing the device tax.
  Mrs. LOVE. Mr. Speaker, this is about the medical technology industry 
and a manufacturing success story, one of the last expanding 
manufacturing enterprises in the United States. While the U.S. is the 
current worldwide leader in medical technology innovation, that 
leadership is being threatened.
  I am speaking to you today about the medical device tax. This 
industry has a huge presence in Utah, and this unfair tax would have a 
negative effect on my district and the country as a whole.

                              {time}  1615

  In Utah, this industry has created more than 10,300 jobs and 
contributes over $5 billion to the State's economy.
  Recently, Congress has been focused on reducing taxes to make the 
United States a more attractive place to do business, but the medical 
technology industry would get a significant tax increase. Even with the 
recent tax changes, industry gains would be neutralized by this tax.
  Under the 2.3 percent excise tax, medical device manufacturers would 
be required to pay the IRS an estimated average of $194 million per 
month in medical device tax payments. In Utah, BD's total impact of the 
device tax is about $90 million on an annualized basis. For Edwards 
Lifesciences, this would be a $30 million expense.
  In a competitive global economy, this tax threatens the industry that 
directly employs 400,000 Americans, generates $25 billion in payroll, 
and invests nearly $10 billion in research and development annually.
  American companies represent 38 percent of the global market, and the 
suspended tax looms over our Nation's ability to innovate and to stay 
competitive. As companies look to make cuts to offset the tax, research 
and development is often the first one to go. This tradeoff undermines 
the future of the industry and puts discovery of new breakthrough 
medical technologies at risk. In other words, it is putting the 
livelihoods of people and their health at risk.
  According to figures from the U.S. Department of Commerce, the United 
States medical technology industry lost nearly 29,000 jobs while the 
medical device tax was in effect. When the medical device tax was 
suspended, most medical device companies reinvested most of their 
savings into their innovative strategies and improving United States 
facilities. But long-term investment has been postponed because of the 
threat that it might come back.
  Mr. Speaker, it has been said that, by repealing the medical device 
tax, we are going to be taking money out of Medicare. That is 
absolutely ridiculous. As a matter of fact, there was a $700 billion 
cut to Medicare to pay for the Affordable Care Act.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mr. PAULSEN. Mr. Speaker, I yield an additional 1 minute to the 
gentlewoman from Utah.
  Mrs. LOVE. Mr. Speaker, Utah's Merit Medical was planning on spending 
$1.5 million for salary increases and 401(k) benefits for hourly 
workers, but they can't, unless this tax is repealed.

[[Page H7122]]

  Merit Medical is also planning a $60 million R&D facility, but it is 
now on hold because of the tax. In Utah, with the last suspension, BD 
increased R&D spending from 6 percent to 6.5 percent in sales.
  If this tax does not get repealed, the industry is forced to start 
making payments. Investments will be the tradeoff, and innovation will 
be stifled. This means less jobs for Americans, a less competitive 
America in the medical device industry, and, potentially, an increase 
in the medical cost for our constituents so that this industry can pay 
for the tax.
  It is time to make sure that we put money back into the hands of 
Americans, American businesses, and out of the hands of government.
  Mr. NEAL. Mr. Speaker, I yield myself 1 minute.
  Mr. Speaker, anybody who doesn't understand what $2.3 trillion of tax 
cuts and further tax cuts of this measure mean as a threat to Medicare 
and Social Security and Medicaid down the road, that is a short-term 
view of where we are headed financially in America.
  Mr. Speaker, I yield 3 minutes to the gentleman from California (Mr. 
Correa).
  Mr. CORREA. Mr. Speaker, first of all, I want to say I represent the 
Golden State of California, and I am proud to say that California was 
the first State in the Union to implement, to accept the Affordable 
Care Act a number of years ago, and when we did so, we knew it was a 
work in progress. After all, Medicare continues to be a work in 
progress after 60 years. One of those areas we knew we had to change 
was the medical device tax.
  In California, there are over 1,000 medical technology companies, 
many of which are small to medium, that employ more than 70,000 
Californians. Many of those live and work in my district, and these are 
good-paying middle class jobs.
  The research and development of groundbreaking medical technology 
helps improve patient care and treatments not only for Americans, but 
for folks throughout the world.
  In recognition of the medical tax device's negative impact on 
innovation and investment, Congress delayed its implementation on two 
separate occasions. Unfortunately, the temporary suspension of this tax 
is scheduled to expire at the end of this year. If reinstated, this tax 
will impede future investments and domestic innovation and restrain 
hiring and job growth.
  Since research and development in this area of technology takes a 
number of years, the uncertainty about the future of this tax will 
delay essential research and development and growth in many areas of 
the State of California. That is why repealing the medical tax device 
permanently will encourage economic growth and hiring in Orange County 
and in my area.
  The medical device industry represents jobs not only for the next 
generation, but for the next 20 to 30 years in this country. Mr. 
Speaker, therefore, I urge passage of H.R. 184.
  Mr. PAULSEN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I thank the gentleman for sharing his perspective from 
California. I think of Minnesota and California and Massachusetts and 
some other States that have a propensity of strong ecosystems of 
medical technology, and those jobs, we know, are very, very important. 
We want to see those continue.
  I just want to mention, Mr. Speaker, what we don't want to go back 
to, because these are the stories we were hearing prior to our 
suspension, why we need to permanently repeal this tax.
  I remember speaking to a company in Plymouth, Minnesota. They were 
pretty clear. They said: Instead of 10 projects, we are only going to 
have 6 projects funded with this tax in place. That means too few 
engineers, too few technicians while that device tax was in effect.
  I talked to another company that was actually in Texas. They had laid 
off an employee that had been employed for 22 years, and then they had 
laid off 25 people, deferring the hiring of another 15 employees 
because of that tax being put in place.
  Another medical company in Shoreview, Minnesota, told me they had to 
borrow $100,000 a month from the bank just to pay the device tax 
because the tax was on sales and revenue, not on profits. That is a 
high-risk tragedy, Mr. Speaker, in order to keep these companies alive.
  There is a company in New York that was trying to finance a new 
cancer therapy using gamma radiation, and they struggled to raise the 
necessary funds that were necessary to complete the project because the 
medical device tax was discouraging investment in lifesaving 
innovation.
  And then, Mr. Speaker, I remember having a conversation with an 
employee, someone from my district, and he came up to me and said: Mr. 
Paulsen, I have been employed at this medical device company for 21 
years, a strong medical device manufacturer, but because of the tax, I 
have lost my job. Now his family struggled at his new job because his 
wages were $40,000 less than where he was before he was laid off, all 
because of that device tax. His vacation time was cut in half, and his 
healthcare costs also went up.
  Mr. Speaker, I reserve the balance of my time.
  Mr. NEAL. Mr. Speaker, I reserve the balance of my time, but I am 
prepared to close.
  Mr. PAULSEN. Mr. Speaker, I yield myself such time as I may consume 
while we wait for one additional speaker.
  Mr. Speaker, let me just remind folks where we are right now. Think 
back to 2013, 2014 when this tax was first put in place. We heard 
earlier from one of our colleagues who had said: Do you know what? The 
medical device industry was a part of putting together the Affordable 
Care Act, and they agreed to this.
  Actually, that is a myth. It is not true. I have talked to numerous 
medical device manufacturers, small, medium, and large, as well as the 
associations, that said they had no part in agreeing to that. In fact, 
when this dollar amount came up as a part of the Affordable Care Act, 
they backed into it. There was some dollar amount assigned, and that is 
how he backed into a 2.3 percent excise tax.
  And, again, just a reminder, an excise tax is a tax on your sales and 
revenue, not on your profits. For companies that take 8 to 10 years to 
become profitable in the first place, that is a high hurdle when you 
are trying to attract new capital, new investors in order to take the 
risk that this new technology is going to be successful.
  You have already got to go through the FDA. You have got to go 
through a rigorous process, go through a gold standard, and then you 
have to make sure that you are going to potentially have CMS offer a 
reimbursement policy for your devices.
  So there is a whole host of, or a multitude of, risk factors that go 
in already when companies are thinking of starting up to actually be a 
part of this strong ecosystem of providing medical technology and 
lifesaving innovation that goes out to help our patients.
  The good news is, if we keep this industry strong in America, if we 
can repeal this tax permanently, we will not only be improving 
healthcare outcomes around the world; we will be keeping those jobs 
here. We will be keeping the headquarters here in the United States.
  So it is not just some of the tax reforms you pass, Mr. Speaker. It 
is about giving more certainty and more predictability by repealing a 
tax that never should have been put in place in the first place.
  And I think with strong bipartisan support, both on a vote today in 
the House and potentially once again in the Senate--I think the last 
time we had a vote leading up to President Obama signing a temporary 
suspension of the device tax, we had enough votes in the House to 
override a Presidential veto. That is what got the attention of the 
Senate. That is what got the attention of the President at that time, 
and we actually made it the law of the land, 2-year suspension. We 
renewed another 2-year suspension.
  But now is the time, Mr. Speaker, to actually make this permanent, to 
put ourselves in a position to make this repeal permanent, to put 
ourselves in a position where we can guarantee that American innovation 
is going to be strong and steadfast for years and decades to come. We 
can keep this American success story alive.
  We have got a host of other challenges, I know, as we look towards 
the medical device industry. We have a hearing going on right now on 
trade,

[[Page H7123]]

for instance. We don't need to do anything else with potential tariffs 
or quotas in different areas that put additional uncertainty on this 
industry, on these high-paying, high-quality jobs. So this is one 
initial effort that we can make today on the House floor, with a strong 
bipartisan vote, to make sure a permanent repeal is also the law of the 
land.
  Mr. Speaker, I am looking around for my colleague from Indiana, who I 
think is on the way right now.
  Mr. Speaker, I reserve the balance of my time.


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore. Members are directed to remove their 
conversations from the floor.
  Mr. NEAL. Mr. Speaker, I yield myself as much time as I may consume.
  Mr. Speaker, I want to address the reference that my friend from 
Minnesota offered a moment ago when he referred to the device tax as 
mythology.
  I negotiated that agreement with the industry. They asked for the 
following: that it be applied to foreign competition. We said yes. This 
was done in Speaker Pelosi's office with the industry.

  They suggested at the time that the 5 percent tax be cut to 2.3 
percent. We went along with that. Even though the United States Senate 
had sent over a revenue package of $40 billion, we cut it by $20 
billion.
  So that wasn't mythology. It was the way the institution once worked, 
how we negotiate, go back and forth, discuss, and then come to rational 
conclusions that might help and acknowledge the 20 million more 
Americans who have coverage now under the Affordable Care Act--20 
million Americans.
  I want to say something at this point, Mr. Speaker, if I may.
  In the State of Massachusetts, do you know what we are really proud 
of on this day? One hundred percent of the children in Massachusetts 
are covered with health insurance, and 97 percent of the adults in our 
State are covered with health insurance. It is a remarkable statistic, 
and it is based, in some measure, on the negotiations we had with 
respective industries to get this legislation over the goal line.
  So I know exactly what happened here, and I understand fully what 
negotiations mean. But we rejected the $40 billion price tag that came 
from the U.S. Senate, cut it in half and said to the industry: This is, 
we hope and expect, your share of making sure that 20 million more 
Americans have health insurance.
  That is what this issue is about: accessibility, earlier stages of 
prevention, getting people into health insurance earlier in life. That 
is precisely what we did with the Affordable Care Act.
  And let me just say this, if I may, as well. Let me talk about the 
mandate, while they are waiting for their next speaker to arrive. Here 
is what makes the mandate and its importance.
  Why should the rest of us in America pay $1,000 a year in our health 
insurance plans because there are those who don't want to buy health 
insurance and end up in the emergency rooms of America, and they thumb 
their noses at us on the way out because of uncompensated care and they 
don't pay the bill?
  So do you know what would be great, Mr. Speaker? If we all knew the 
day that our house was going to burn down, then--do you know what?--the 
day before, we would buy homeowners insurance.

                              {time}  1630

  If we all knew the day that we were going to get in that accident, we 
would buy automobile insurance. But the truth is that insurance spreads 
risk, and we all know we don't know when those things might occur, so 
we buy insurance in advance.
  So, today, 20 million more Americans have insurance because of what 
we did with the Affordable Care Act. This idea that you can continually 
sabotage it and take it apart piece by piece makes no sense.
  On this particular issue with the device revenue, I can tell you and 
I can state to you, under oath, Mr. Speaker, what we did to negotiate 
this contribution to making America's healthcare more effective and 
better for all members of the American family, the understanding being 
that, at the end of life, if you have earlier intervention with 
healthcare, the end of life might be a heck of a lot more pleasant 
along the way.
  Mr. Speaker, I reserve the balance of my time.
  Mr. PAULSEN. Mr. Speaker, I yield 2 minutes to the gentlewoman from 
Indiana (Mrs. Walorski), who has been a champion of not only repealing 
this tax, but fighting hard for the medical device industry in her home 
State.
  Mrs. WALORSKI. Mr. Speaker, I rise today in support of H.R. 184, the 
Protect Medical Innovation Act.
  Mr. Speaker, this legislation will permanently repeal the job-killing 
medical device tax. Hoosiers are proud to be leaders in medical 
innovation with more than 300 medical device manufacturers in our State 
that support nearly 55,000 jobs. These are high-paying jobs, with 
workers in the industry earning about $50,000 per year, on average.
  However, after ObamaCare's medical device tax took effect, the 
industry lost almost 29,000 good-paying jobs nationwide from 2012 to 
2015, according to Department of Commerce data. That is why Congress 
took bipartisan action in 2015 to suspend the tax for 2 years, and did 
so again earlier this year. But if it goes back into effect after 2019, 
it will impede new discoveries and stifle medical innovation while 
destroying good jobs.
  Right now, our economy is booming because of historic tax cuts and 
regulatory reforms, and we need to keep that momentum going. It is time 
to end the medical device tax once and for all. Permanently repealing 
this job-killing tax will protect American workers and help patients 
access the lifesaving medical technology they need.
  Mr. Speaker, the medical device tax would have a devastating impact 
on Hoosier workers and people from across the country who depend on 
these products. The Protect Medical Innovation Act will boost American 
innovation and manufacturing, and it will encourage medical research 
and development that make a real difference in people's lives.
  Mr. Speaker, I urge my colleagues to support this vital piece of 
legislation.
  Mr. NEAL. Mr. Speaker, I yield myself the remainder of my time.
  Mr. Speaker, I am delighted that the gentlewoman from Indiana, my 
friend, just mentioned the tax cut, so let me just point this out. We 
have gone from a rate of 35 percent in the corporate world to 21 
percent, a 14 point cut in the corporate tax rate, and we are being 
asked to do this on top of it.
  Now, Medicare purchases most of the medical devices in America--
taxpayer supported. It is an earned benefit. But here is the other 
important part of it that I think bears some noting today. It is a 
terrific industry. It is not in dispute. It is an important industry in 
America.
  But when the gentlewoman says: ``Well, the economy is booming because 
of these tax cuts,'' a reminder, a fact, not from my Twitter account, 
but stated on the House floor: The American economy has been growing 
for 94 straight months.
  The idea that this all happened 500 days ago doesn't stand up 
underneath the magnifying glass of critical analysis. The stock market 
has been going up since March of 2009.
  So when I look at the corporate cut--astounding, by the way--
remember, President Obama said we should have a corporate rate of 28 
percent and the chairman of the Ways and Means Committee, a good friend 
of mine, a Republican, he said, no, we should have 25 percent.
  So what did the other side do? Let's see, the difference between 28 
and 25? Aha, it is 21. I mean, I haven't figured that out yet.
  So, day after day, we roll through here with another tax cut 
proposal, and we watch the deficits and the debt go to $20 trillion. 
Whatever happened to the Republican idea of fiscal rectitude, which 
year after year they lectured us on?
  We negotiated this agreement over the device tax, Mr. Speaker, 
guaranteed. It was accepted by the industry. Again, we applied it to 
foreign competition. They would be taxed at the same rate. Medicare 
would remain the largest vendor, the largest purchaser of medical 
devices.
  This is a step backward on America's healthcare plan. If they would 
just give the Affordable Care Act a chance to

[[Page H7124]]

work, instead of these deliberate efforts day after day to sabotage it, 
we could move on with the business of the country.
  Mr. Speaker, I gladly yield back the balance of my time.
  Mr. PAULSEN. Mr. Speaker, as I close, let me remind my colleague, 
because he had mentioned eliminating the individual mandate as a part 
of the tax reform that was enacted recently, according to the IRS, 79 
percent of the 6.6 million people who paid the penalty in 2015 had 
incomes below $50,000. These are middle class people.
  Mr. NEAL. Will the gentleman yield?
  Mr. PAULSEN. I yield to the gentleman from Massachusetts.
  Mr. NEAL. Mr. Speaker, what did the Republican majority do to the 
cost subsidies for those people?
  Mr. PAULSEN. Mr. Speaker, reclaiming my time, on the individual 
mandate, 6.6 million people who paid the penalty had incomes below 
$50,000. These are middle class people who had to pay the fine instead 
of buying overpriced ObamaCare coverage that they could not afford. 
Now, starting in 2019, they are not going to have to do that anymore. 
Republicans think that is a good thing.

  Let me close back on the bill, though, Mr. Speaker.
  The good news is that both Republicans and Democrats here today agree 
and understand that the medical device excise tax does more harm than 
good, and it has to be repealed. We heard testimony and speakers today 
on both sides of the aisle. We will have a strong, bipartisan vote to 
repeal this tax permanently.
  We have already had a suspension twice. But we need to give this 
industry certainty so that we can make sure that this American success 
story not only survives, but thrives.
  It is about high-paying jobs with net exports around the world. This 
makes sure that patients not only in the United States are going to 
have access to new medical technology devices, for baby boomers, 
seniors, and those getting up in their elder years with new devices. 
This is really critical for the innovation that is going to help to 
make sure that we are protecting patients around the world, keeping 
headquarters here, keeping jobs here, and improving healthcare 
outcomes.
  Today, we have an opportunity to help. It is helping those small 
startups that are part of the very ecosystem that has made this 
industry so strong in the United States that provides these jobs, and 
making sure that entrepreneurs, doctors, engineers, and folks who come 
up with an idea in the backyard or in the garage can see their idea 
come to fruition.
  So let's remove this threat to innovation. Let's remove this job-
killing tax once and for all. There are 277 cosponsors in the House. 
How many bills actually get that many cosponsors of Democrats and 
Republicans? Let's continue to show the American public that what we 
are doing here in Washington on this issue is results oriented, is 
solution oriented, and we are sensitive, and we understand that.
  Mr. Speaker, I ask everyone to vote for the passage of H.R. 184, and 
I yield back the balance of my time.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 1011, the previous question is ordered 
on the bill, as amended.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. PAULSEN. 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.

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