[Congressional Record Volume 164, Number 125 (Wednesday, July 25, 2018)]
[House]
[Pages H7651-H7658]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
RESTORING ACCESS TO MEDICATION ACT OF 2018
Ms. JENKINS of Kansas. Mr. Speaker, pursuant to House Resolution
1012, I call up 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, and ask for its immediate consideration.
The Clerk read the title of the bill.
The SPEAKER pro tempore. Pursuant to House Resolution 1012, in lieu
of the amendment in the nature of a substitute recommended by the
Committee on Ways and Means printed in the bill, an amendment in the
nature of a substitute consisting of the text of Rules Committee Print
115-82 is adopted, and the bill, as amended, is considered read.
The text of the bill, as amended, is as follows:
H.R. 6199
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Restoring
Access to Medication and Modernizing Health Savings Accounts
Act of 2018''.
(b) Table of Contents.--The table of contents for this Act
is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. First dollar coverage flexibility for high deductible health
plans.
Sec. 3. Treatment of direct primary care service arrangements.
Sec. 4. Certain employment related services not treated as
disqualifying coverage for purposes of health savings
accounts.
Sec. 5. Contributions permitted if spouse has a health flexible
spending account.
Sec. 6. FSA and HRA terminations or conversions to fund HSAs.
Sec. 7. Inclusion of certain over-the-counter medical products as
qualified medical expenses.
Sec. 8. Certain amounts paid for physical activity, fitness, and
exercise treated as amounts paid for medical care.
SEC. 2. FIRST DOLLAR COVERAGE FLEXIBILITY FOR HIGH DEDUCTIBLE
HEALTH PLANS.
(a) In General.--Section 223(c)(2) of the Internal Revenue
Code of 1986 is amended by adding at the end the following
new subparagraph:
``(E) First dollar coverage flexibility.--
``(i) In general.--A plan shall not fail to be treated as a
high deductible health plan by reason of failing to have a
deductible for not more than $250 of specified services for
self-only coverage (twice such amount in the case of family
coverage) during a plan year.
``(ii) Specified services.--For purposes of this
subparagraph, the term `specified services' means, with
respect to a plan, services other than preventive care
(within the meaning of subparagraph (C)) identified under the
terms of the plan as being services to which clause (i)
applies.''.
(b) Inflation Adjustment.--Section 223(g)(1) of such Code
is amended--
(1) by striking ``and (c)(2)(A)'' each place it appears and
inserting ``, (c)(2)(A), and (c)(2)(E)'', and
(2) in subparagraph (B)--
(A) by striking ``such taxable year'' in the matter
preceding clause (i) and inserting ``the taxable year (plan
year in the case of the dollar amount in subsection
(c)(2)(E))'', and
(B) by striking ``clause (ii)'' and inserting ``clauses
(ii) and (iii)'' in clause (i), by striking ``and'' at the
end of clause (i), by striking the period at the end of
clause (ii) and inserting ``, and'', and by inserting after
clause (ii) the following new clause:
``(iii) in the case of the dollar amount in subsection
(c)(2)(E) for plan years beginning in calendar years after
2019, `calendar year 2018'.''.
(c) Effective Date.--The amendments made by this section
shall apply with respect to plan years beginning after
December 31, 2018.
SEC. 3. TREATMENT OF DIRECT PRIMARY CARE SERVICE
ARRANGEMENTS.
(a) In General.--Section 223(c)(1) of the Internal Revenue
Code of 1986 is amended by adding at the end the following
new subparagraph:
``(D) Treatment of direct primary care service
arrangements.--
``(i) In general.--A direct primary care service
arrangement shall not be treated as a health plan for
purposes of subparagraph (A)(ii).
``(ii) Direct primary care service arrangement.--For
purposes of this paragraph--
``(I) In general.--The term `direct primary care service
arrangement' means, with respect to any individual, an
arrangement under which such individual is provided medical
care (as defined in section 213(d)) consisting solely of
primary care services provided by primary care practitioners
(as defined in section 1833(x)(2)(A) of the Social Security
Act, determined without regard to clause (ii) thereof), if
the sole compensation for such care is a fixed periodic fee.
``(II) Limitation.--With respect to any individual for any
month, such term shall not include any arrangement if the
aggregate fees for all direct primary care service
arrangements (determined without regard to this subclause)
with respect to such individual for such month exceed $150
(twice such dollar amount in the case of an individual with
any direct primary care service arrangement (as so
determined) that covers more than one individual).
``(iii) Certain services specifically excluded from
treatment as primary care services.--For purposes of this
paragraph, the term `primary care services' shall not
include--
``(I) procedures that require the use of general
anesthesia,
``(II) prescription drugs (other than vaccines), and
``(III) laboratory services not typically administered in
an ambulatory primary care setting.
The Secretary, after consultation with the Secretary of
Health and Human Services, shall issue regulations or other
guidance regarding the application of this clause.''.
(b) Direct Primary Care Service Arrangement Fees Treated as
Medical Expenses.--Section 223(d)(2)(C) is amended by
striking ``or'' at the end of clause (iii), by striking the
period at the end of clause (iv) and inserting ``, or'', and
by adding at the end the following new clause:
``(v) any direct primary care service arrangement.''.
[[Page H7652]]
(c) Inflation Adjustment.--Section 223(g)(1) of such Code,
as amended by section 2(b), is amended--
(1) by inserting ``(c)(1)(D)(ii)(II),'' after ``(b)(2),''
each place it appears, and
(2) in subparagraph (B), by striking ``and (iii)'' and
inserting ``, (iii) and (iv)'' in clause (i), by striking
``and'' at the end of clause (ii), by striking the period at
the end of clause (iii) and inserting ``, and'', and by
inserting after clause (iii) the following new clause:
``(iv) in the case of the dollar amount in subsection
(c)(1)(D)(ii)(II) for taxable years beginning in calendar
years after 2019, `calendar year 2018'.''.
(d) Reporting of Direct Primary Care Service Arrangement
Fees on W-2.--Section 6051(a) of such Code is amended by
striking ``and'' at the end of paragraph (16), by striking
the period at the end of paragraph (17) and inserting ``,
and'', and by inserting after paragraph (17) the following
new paragraph:
``(18) in the case of a direct primary care service
arrangement (as defined in section 223(c)(1)(D)(ii)) which is
provided in connection with employment, the aggregate fees
for such arrangement for such employee.''.
(e) Effective Date.--The amendments made by this section
shall apply to months beginning after December 31, 2018, in
taxable years ending after such date.
SEC. 4. CERTAIN EMPLOYMENT RELATED SERVICES NOT TREATED AS
DISQUALIFYING COVERAGE FOR PURPOSES OF HEALTH
SAVINGS ACCOUNTS.
(a) In General.--Section 223(c)(1) of the Internal Revenue
Code of 1986, as amended by section 3(a), is amended by
adding at the end the following new subparagraph:
``(E) Special rule for qualified items and services.--
``(i) In general.--An individual shall not be treated as
covered under a health plan for purposes of subparagraph
(A)(ii) merely because the individual, in connection with the
employment of the individual or the individual's spouse,
receives (or is eligible to receive) qualified items and
services at--
``(I) a healthcare facility located at a facility owned or
leased by the employer of the individual (or of the
individual's spouse), or operated primarily for the benefit
of such employer's employees, or
``(II) a healthcare facility located within a supermarket,
pharmacy, or similar retail establishment.
``(ii) Qualified items and services defined.--For purposes
of this subparagraph, the term `qualified items and services'
means the following:
``(I) Physical examinations.
``(II) Immunizations, including injections of antigens
provided by employees.
``(III) Drugs other than a prescribed drug (as such term is
defined in section 213(d)(3)).
``(IV) Treatment for injuries occurring in the course of
employment.
``(V) Drug testing, if required as a condition of
employment.
``(VI) Hearing or vision screenings.
``(VII) Other similar items and services that do not
provide significant benefits in the nature of medical care.
``(iii) Aggregation.--For purposes of clause (i)(I), all
persons treated as a single employer under subsection (b),
(c), (m), or (o) of section 414 shall be treated as a single
employer.''.
(b) Effective Date.--The amendments made by this section
shall apply to months beginning after December 31, 2018, in
taxable years ending after such date.
SEC. 5. CONTRIBUTIONS PERMITTED IF SPOUSE HAS A HEALTH
FLEXIBLE SPENDING ACCOUNT.
(a) Contributions Permitted if Spouse Has a Health Flexible
Spending Account.--Section 223(c)(1)(B) of the Internal
Revenue Code of 1986 is amended by striking ``and'' at the
end of clause (ii), by striking the period at the end of
clause (iii) and inserting ``, and'', and by inserting after
clause (iii) the following new clause:
``(iv) coverage under a health flexible spending
arrangement of the spouse of the individual for any plan year
of such arrangement if the aggregate reimbursements under
such arrangement for such year do not exceed the aggregate
expenses which would be eligible for reimbursement under such
arrangement if such expenses were determined without regard
to any expenses paid or incurred with respect to such
individual.''.
(b) Effective Date.--The amendment made by this section
shall apply to plan years beginning after December 31, 2018.
SEC. 6. FSA AND HRA TERMINATIONS OR CONVERSIONS TO FUND HSAS.
(a) In General.--Section 106(e)(2) of the Internal Revenue
Code of 1986 is amended to read as follows:
``(2) Qualified hsa distribution.--For purposes of this
subsection--
``(A) In general.--The term `qualified HSA distribution'
means, with respect to any employee, a distribution from a
health flexible spending arrangement or health reimbursement
arrangement of such employee directly to a health savings
account of such employee if--
``(i) such distribution is made in connection with such
employee establishing coverage under a high deductible health
plan (as defined in section 223(c)(2)) after a significant
period of not having such coverage, and
``(ii) such arrangement is described in section
223(c)(1)(B)(iii) with respect to the portion of the plan
year after such distribution is made.
``(B) Dollar limitation.--The aggregate amount of
distributions from health flexible spending arrangements and
health reimbursement arrangements of any employee which may
be treated as qualified HSA distributions in connection with
an establishment of coverage described in subparagraph (A)(i)
shall not exceed the dollar amount in effect under section
125(i)(1) (twice such amount in the case of coverage which is
described in section 223(b)(2)(B)).''.
(b) Partial Reduction of Limitation on Deductible HSA
Contributions.--Section 223(b)(4) of such Code is amended by
striking ``and'' at the end of subparagraph (B), by striking
the period at the end of subparagraph (C) and inserting ``,
and'', and by inserting after subparagraph (C) the following
new subparagraph:
``(D) so much of any qualified HSA distribution (as defined
in section 106(e)(2)) made to a health savings account of
such individual during the taxable year as does not exceed
the aggregate increases in the balance of the arrangement
from which such distribution is made which occur during the
portion of the plan year which precedes such distribution
(other than any balance carried over to such plan year and
determined without regard to any decrease in such balance
during such portion of the plan year).''.
(c) Conversion to HSA-compatible Arrangement for Remainder
of Plan Year.--Section 223(c)(1)(B)(iii) of such Code, as
amended by section 5(a), is amended to read as follows:
``(iii) coverage under a health flexible spending
arrangement or health reimbursement arrangement for the
portion of the plan year after a qualified HSA distribution
(as defined in section 106(e)(2) determined without regard to
subparagraph (A)(ii) thereof) is made, if the terms of such
arrangement which apply for such portion of the plan year are
such that, if such terms applied for the entire plan year,
then such arrangement would not be taken into account under
subparagraph (A)(ii) of this paragraph for such plan year,
and''.
(d) Inclusion of Qualified HSA Distributions on W-2.--
(1) In general.--Section 6051(a) of such Code, as amended
by section 3(d), is amended by striking ``and'' at the end of
paragraph (17), by striking the period at the end of
paragraph (18) and inserting ``, and'', and by inserting
after paragraph (18) the following new paragraph:
``(19) the amount of any qualified HSA distribution (as
defined in section 106(e)(2)) with respect to such
employee.''.
(2) Conforming amendment.--Section 6051(a)(12) of such Code
is amended by inserting ``(other than any qualified HSA
distribution, as defined in section 106(e)(2))'' before the
comma at the end.
(e) Effective Date.--The amendments made by this section
shall apply to distributions made after December 31, 2018, in
taxable years ending after such date.
SEC. 7. INCLUSION OF CERTAIN OVER-THE-COUNTER MEDICAL
PRODUCTS AS QUALIFIED MEDICAL EXPENSES.
(a) HSAs.--Section 223(d)(2) of the Internal Revenue Code
of 1986 is amended--
(1) by striking the last sentence of subparagraph (A) and
inserting the following: ``For purposes of this subparagraph,
amounts paid for menstrual care products shall be treated as
paid for medical care.'', and
(2) by adding at the end the following new subparagraph:
``(D) Menstrual care product.--For purposes of this
paragraph, the term `menstrual care product' means a tampon,
pad, liner, cup, sponge, or similar product used by women
with respect to menstruation or other genital-tract
secretions.''.
(b) Archer MSAs.--Section 220(d)(2)(A) of such Code is
amended by striking the last sentence and inserting the
following: ``For purposes of this subparagraph, amounts paid
for menstrual care products (as defined in section
223(d)(2)(D)) shall be treated as paid for medical care.''.
(c) Health Flexible Spending Arrangements and Health
Reimbursement Arrangements.--Section 106 of such Code is
amended by striking subsection (f) and inserting the
following new subsection:
``(f) Reimbursements for Menstrual Care Products.--For
purposes of this section and section 105, expenses incurred
for menstrual care products (as defined in section
223(d)(2)(D)) shall be treated as incurred for medical
care.''.
(d) Effective Dates.--
(1) Distributions from health savings accounts.--The
amendments made by subsections (a) and (b) shall apply to
amounts paid after December 31, 2018.
(2) Reimbursements.--The amendment made by subsection (c)
shall apply to expenses incurred after December 31, 2018.
SEC. 8. CERTAIN AMOUNTS PAID FOR PHYSICAL ACTIVITY, FITNESS,
AND EXERCISE TREATED AS AMOUNTS PAID FOR
MEDICAL CARE.
(a) In General.--Section 213(d)(1) of the Internal Revenue
Code of 1986 is amended by striking ``or'' at the end of
subparagraph (C), by striking the period at the end of
subparagraph (D) and inserting ``, or'', and by adding at the
end the following new subparagraph:
``(E) for qualified sports and fitness expenses.''.
(b) Qualified Sports and Fitness Expenses.--Section 213(d)
of such Code is amended by adding at the end the following
paragraph:
``(12) Qualified sports and fitness expenses.--
``(A) In general.--The term `qualified sports and fitness
expenses' means amounts paid for--
``(i) membership at a fitness facility,
``(ii) participation or instruction in a program of
qualified physical activity, or
``(iii) safety equipment for use in a program (including a
self-directed program) of qualified physical activity.
``(B) Limitations.--
``(i) Overall dollar limitation.--The aggregate amount
treated as qualified sports and
[[Page H7653]]
fitness expenses with respect to any taxpayer for any taxable
year shall not exceed $500 (twice such amount in the case of
a joint return or a head of household (as defined in section
2(b))).
``(ii) Dollar limitation on safety equipment.--The amount
treated as qualified sports and fitness expenses with respect
to any item of safety equipment described in subparagraph
(A)(iii) shall not exceed $250.
``(iii) Exclusion of exercise videos, etc.--Qualified
sports and fitness expenses shall not include videos, books,
or similar materials.
``(C) Qualified physical activity.--For purposes of this
paragraph--
``(i) In general.--Except as provided in clause (ii), the
term `qualified physical activity' means any physical
exercise or physical activity.
``(ii) Exclusions.--The Secretary, after consultation with
the Secretary of Health and Human Services, shall issue
guidance to determine for purposes of this paragraph what
does not constitute a qualified physical activity, including
golf, hunting, sailing, horseback riding, and other similar
activities.
``(D) Fitness facility defined.--For purposes of
subparagraph (A)(i), the term `fitness facility' means a
facility--
``(i) providing instruction in a program of qualified
physical activity or facilities for qualified physical
activity,
``(ii) which is not a private club owned and operated by
its members,
``(iii) whose health or fitness facility is not incidental
to its overall function and purpose, and
``(iv) which is fully compliant with applicable State and
Federal anti-discrimination laws.
``(E) Programs which include components other qualified
physical activity.--Rules similar to the rules of paragraph
(6) shall apply in the case of any program or facility that
includes qualified physical activity (or facilities
therefore) and also other components. For purposes of the
preceding sentence, travel and accommodations shall be
treated as an other component.
``(F) Inflation adjustment.--In the case of any taxable
year beginning in a calendar year after 2019, the $500 amount
in subparagraph (B)(i) and the $250 amount in subparagraph
(B)(ii) shall each be increased by an amount equal to--
``(i) such dollar amount, multiplied by
``(ii) the cost-of-living adjustment determined under
section 1(f)(3) for the calendar year in which such taxable
year begins, determined by substituting `calendar year 2018'
for `calendar year 2016' in subparagraph (A)(ii) thereof.
If any increase determined under the preceding sentence is
not a multiple of $10, such increase shall be rounded to the
next lowest multiple of $10.''.
(c) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2018.
The SPEAKER pro tempore. The bill, as amended, 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 gentlewoman from Kansas (Ms. Jenkins) and the gentleman from
Oregon (Mr. Blumenauer) each will control 30 minutes.
The Chair recognizes the gentlewoman from Kansas.
General Leave
Ms. JENKINS of Kansas. 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 materials on the bill under
consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman from Kansas?
There was no objection.
Ms. JENKINS of Kansas. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I am pleased to come to the floor today to speak in
support of the Restoring Access to Medication and Modernizing Health
Savings Account Act of 2018.
This legislation makes a variety of simple but much-need changes to
health savings accounts, or HSAs, rules to ensure that folks have more
access and choice when using their HSAs.
This bill contains five separate bipartisan pieces of legislation
that passed the Ways and Means Committee earlier this month. It
includes a bipartisan policy by Mr. Roskam and Mr. Thompson that would
allow HSA-eligible plans to offer a certain amount of first-dollar
coverage in their plan design without losing their HSA-eligibility.
This allows HSA plans to offer coverage for valuable services like
telehealth or primary care appointments without a deductible.
The bill permits patients with HSAs to access the innovative and
patient-centered direct primary care arrangements with HSA plans,
provisions championed by the bipartisan team of Mr. Paulsen and Mr.
Blumenauer.
The bill also allows coverage for certain medical services from a
retail or onsite clinic and permits contributions to an HSA if their
spouse has a health FSA, which is prohibited today.
Another commonsense provision in the bill allows rollovers from other
tax-advantaged health accounts to be able to fund HSAs. These proposals
were included in Mr. Kelly and Mr. Blumenauer's bipartisan legislation.
Additionally, this bill contains the PHIT Act, introduced in a
bipartisan manner by Mr. Jason Smith and Mr. Kind, that would allow
certain qualified fitness expenses to be eligible items that can be
paid for with tax-advantaged dollars, offsetting a portion of their
costs and promoting healthy activity.
Lastly, this legislation repeals the Affordable Care Act's
unnecessary barriers when it comes to using tax-advantaged health
accounts to purchase over-the-counter medicines, something that I have
been pleased to work on with my good friend Congressman Kind for the
last several years, and I am encouraged that the bipartisan duo of
Representatives Meng and Paulsen have also joined us in introducing the
underlying legislation.
In addition to expanding access for over-the-counter medication, the
bill also allows for feminine hygiene products to be considered a
qualified medical expense.
Since the passage of the Affordable Care Act, Americans have had to
seek prescriptions in order to use their health savings and flexible
spending accounts on safe and effective over-the-counter medicines.
This legislation would end the need for those prescriptions.
It doesn't make any sense to require the millions of American
families that use HSAs and FSAs to manage their healthcare needs to go
to the doctor in order to access over-the-counter medicines for things
like basic pain management and cold and allergy symptoms.
Nobody benefits from this nonsensical policy that requires consumers
to jump through unnecessary hoops and increases the burdens on the
healthcare system, all while providing no medical benefit. Over-the-
counter medicines are often the frontline treatment for many common
illnesses and for maintenance of chronic diseases, and they should be
treated as medically reimbursable healthcare therapies, just as
prescription medications.
Mr. Speaker, I am pleased the House is considering H.R. 6199, which
gives individuals and families more control over their healthcare
spending and increases their options when it comes to health savings
accounts.
Today marks a nice opportunity to pass bipartisan legislation to
simply make it easier for consumers to meet their basic medical needs.
These are commonsense, simple, bipartisan solutions, and I urge my
colleagues to support this legislation.
Mr. Speaker, I reserve the balance of my time.
Mr. BLUMENAUER. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I am pleased to be here with Ms. Jenkins, moving forward
on this legislation. It represents an opportunity for us to deal with a
series of, as she mentioned, bipartisan ideas, relatively simple, to
enhance service delivery.
I state from the outset that I am troubled that we were not able to
provide opportunities to pay for these. They carry a cost. In
committee, even though I thought they were a good idea, I voted against
some of them because they were rather expensive.
In the aggregate, these are things, moving forward, that will improve
healthcare, and I am hopeful that, as we move along the process, we can
find some ways to offset the costs involved.
Some of us have philosophical questions about the role of HSAs and
how it fits overall, but this legislation will make key consumer-
friendly improvements to our existing system. Direct primary care
medical homes are an important example of successful delivery reforms
that will become easier to access under this legislation.
DPC arrangements offer individuals access to comprehensive primary
care and prevention services in a medical home setting for a flat
monthly fee, as opposed to concierge services that some people have in
mind. Most of these practices typically charge a low monthly fee,
perhaps $50 to $100, in most cases, and they serve low- and
[[Page H7654]]
moderate-income patients. These fees support the delivery of high-
quality, coordinated care by providing better healthcare upfront in
primary care settings.
DPC practices reduce unnecessary hospital and specialty care, as well
as administrative expenses. This empowers the doctor-patient
relationship, enabling providers to resist financial incentives that
distort the decisionmaking process in primary care.
It also reduces the conveyor belt process, where people are typically
shuttled into the office in 8-minute increments. This is not the case
in direct primary care. It is not uncommon for appointments to last
half an hour or even an hour. So they build a better relationship with
patients, and they are able to better understand and address healthcare
needs.
By offering a high level of access to primary care, evidence shows
that direct primary care medical homes improve health outcomes and
reduce costs. Today, DPC medical homes serve individuals of all ages
and income in at least 47 States.
This legislation simplifies existing IRS regulations and clarifies
that direct primary care medical homes are qualified health expenses--
medical services--and not health plans.
I personally question the IRS ruling. We have debated with them, but
we have lost that. We fix it with this legislation.
{time} 1600
As more individuals and employers seek to utilize the direct primary
care delivery model, it is important that this outdated tax barrier not
get in the way of patients accessing this successful model.
The legislation will allow HSA plans to cover onsite employee
clinics. Think for a moment about the nursing stations that we have
here in the House of Representatives to provide that service. They can
offer physical exams, immunization, over-the-counter drugs, drug
testing, hearing and vision screening, and other minor primary care
preventive services to help employers assemble a benefits package for
their employees that is both practical and can give them a competitive
edge.
Allowing employees to access this basic healthcare service at work
means it doesn't disrupt the worksite. It is more convenient for them;
it is better for the employer.
Another key consumer change made by this bill is to recognize that
employees change jobs. This bill allows individuals to streamline the
conversion of a medical savings account, flexible savings account, or
HSA so they won't lose savings when they change jobs. These reasonable
changes will help consumers make the most of their employer-sponsored
coverage.
Now--make no mistake--while this legislation will certainly help some
consumers, it doesn't atone for the systematic sabotage that we have
seen of the Affordable Care Act by the administration and some of my
Republican colleagues. By zeroing out the mandate penalty, estimates
are that insurance premiums will rise 15 percent. None of these bills
before us today undo that premium hike that is visited upon our
constituents unnecessarily.
These premium increases are coming after Republicans gave insurance
companies billions in tax cuts in their tax bills. Republican attempts
to expand HSAs is no replacement for the Affordable Care Act's
financial assistance. Attempts to expand HSAs are a continuation of a
platform of shifting families into health plans which provide fewer
health benefits and higher out-of-pocket costs, while providing greater
tax benefits for those who need them least.
HSAs and high-deductible healthcare plans shift costs to consumers
without bending the cost curve or addressing underlying costs of
medical care in the United States. I think we can and should do better.
For instance, the President has promised action on lowering
prescription drug costs. These bills today do nothing to lower the cost
of drugs consumers buy, and seek to move more people into plans that
provide only catastrophic coverage, exposing more people to pay the
full freight of drug price hikes.
Now, we have legislation before our committees that could move
forward to do something about this, and I am saddened, despite Trump's
talking about it, that we have really not taken action to do so. And we
could, on a bipartisan basis, if we were enabled to do so.
The collection of bills on the floor this week will reduce Federal
revenues by about $90 billion and will do nothing to reduce the number
of uninsured people that will increase as a result of policy changes my
Republican friends have done in this Congress. Their sabotage efforts
under the Trump administration have caused millions of people to lose
coverage, and millions more will do so in the future.
Now we are seeing, in the budget proposal, my Republican friends
proposing to cut Medicare and Medicaid by nearly $1 trillion to try and
pay for the deficits that have been exaggerated by tax cuts they have
enacted. The bills that we will be considering, especially the next
one, will only add fuel to that fire.
So, I am pleased that we have got some bipartisan pieces that we can
move forward. I am hopeful that we don't abandon a sense of fiscal
responsibility to be able to work together to pay for them, and I hope
that we can encourage some of my friends on the other side of the aisle
to dial back the assault on the Affordable Care Act, especially by the
administration, so that we don't destabilize the system further, drive
up costs, and increase the number of uninsured.
Mr. Speaker, I reserve the balance of my time.
Ms. JENKINS of Kansas. Mr. Speaker, I yield 3 minutes to the
gentleman from South Carolina (Mr. Rice), a distinguished member of the
House Ways and Means Committee.
Mr. RICE of South Carolina. Mr. Speaker, I am proud to stand before
you today to discuss two bills that expand choice and offer lower cost.
And lower cost and choice are what are needed in healthcare.
Back home in South Carolina, the average premium before ObamaCare, in
2013, in the individual market, was $233. In 2017--which the premiums
were set before the President took office--before the ``assault'' on
ObamaCare that my colleague was speaking of, the premium reached $512.
That is a $279-per-month increase in 4 years, a 120 percent increase
from 2013 to 2017.
Before ObamaCare, 85 percent of the people in the country were
covered by health insurance. At the peak, under the Affordable Care
Act, 91 percent were covered. So we covered 6 percent more people, and
that is a good thing. But what was the cost of that? To cover 6 percent
more of our population, the other 85 percent, who were already covered,
either by Medicare, Medicaid, or private insurance, had to pay another
120 percent on their premiums in South Carolina, 105 percent
nationwide. And the premiums are going to go up double digits again
this year.
We need lower cost, and we need choice. In South Carolina, all of the
insurance companies have pulled out of the exchanges except for one. In
fact, 40 percent of the counties in the country have only one choice
for health insurance. That is no choice at all. It is either health
insurance or nothing. You select from that one company, or you get
nothing. We need lower cost, and we need choice.
These bills today, by allowing more liberal contributions to health
savings accounts, by allowing easier access to health savings accounts,
by allowing health savings accounts to be used for more purposes--like
private family care or for nonprescription drugs, over-the-counter
drugs--they are serving the exact causes, the exact purposes, that I
hear the most complaints about back home.
My folks back home are saying: How can I afford these insurance
policies? With the high deductibles that are being forced on us by
these insurance companies, even if I have the insurance policy, I
cannot afford to use it.
Mr. Speaker, I am proud to stand before you today to recommend these
bills.
Mr. BLUMENAUER. Mr. Speaker, I yield 4 minutes to the gentleman from
Wisconsin (Mr. Kind), a senior member of the Committee on Ways and
Means, author of several of these reform provisions, and a champion of
value over volume in healthcare, as well as fiscal restraint.
Mr. KIND. Mr. Speaker, I thank my friend and colleague from Oregon
for yielding me this time. I agree with my colleague.
[[Page H7655]]
Mr. Speaker, I rise in opposition to this legislation, not because of
the policy initiatives underlying these bills, but because of how
fiscally irresponsible it is being done.
This week, out of the Ways and Means Committee, we have 10 bills to
be debated and voted on on the House floor, at a total cost of roughly
$90 billion. There was no effort made to try to find an offset or a
pay-for in order to maintain some fiscal discipline in this place. That
is problematic, because we keep digging the hole deeper.
But my name is on a few of these bills. Yesterday we had the repeal
of the medical device tax, legislation that I had authored with my
friend from Minnesota, Erik Paulsen. But that came at a cost of $20
billion. No offset. No pay-for. Just borrow more money from China and
let future generations wrestle with it.
But it made sense policy-wise to try to repeal that in a fiscally
responsible manner, because we were taxing these manufacturers whether
they were making a profit or not. In fact, the pre-revenue companies
were getting hit by the same tax. Policy-wise, it didn't make a lot of
sense.
Today, I was happy to introduce legislation from our friend and
colleague, Ms. Jenkins, on the Restoring Access to Medication Act. This
will make it easier for patients to purchase over-the-counter medicine
with their HSA and FSA account money without having to first run to
their doctor to get a prescription. Just for the sake of efficiency and
the cost savings, policy-wise, that makes sense; but the legislation
comes with a cost, and there was no effort to pay for that.
Also part of this package is legislation I have introduced with our
colleague, Mr. Smith, called the Personal Health Investment Today Act,
or the PHIT Act. This would allow HSA and FSA dollars to be used for
physical exercise, for gym memberships, so that we are investing in the
front end of wellness and keeping people healthy in their lives rather
than the hundreds of billions of dollars we spend at the back end
dealing with chronic disease management.
Policy-wise that makes sense, but the legislation, again, comes with
a cost. No attempt to pay for it. I think that is fiscally
irresponsible.
At the time when we worked on and passed the Affordable Care Act,
President Obama had one major request, that all of it had to be paid
for, all of it had to be offset. We worked hard to accomplish it, and,
in fact, we did, and then some. We did not add one nickel to our budget
deficit or to future budget debt forecasts because of how we dealt with
that in a fiscally responsible manner.
All we are asking is that our colleagues on the other side who are in
charge now and running this place try to practice some semblance of
that fiscal discipline that we showed with the passage of the
Affordable Care Act.
We ought to be working together, finding out what is working with the
healthcare system and fixing what isn't.
What is not working is the elimination of cost-sharing reduction
payments that help health insurance providers spread the risk in the
health insurance exchanges. That is one of the reasons why premiums are
being driven up right now.
What is not working is refusing to provide funding to the navigators,
who help people make the choices with the health plans that they have
available, or undercutting funding for any education outreach with
patients, or the elimination of the individual responsibility component
so that young and healthy people don't get to sit around and wait until
they get sick or injured and then go out and acquire health insurance.
That is not how insurance markets work.
What also doesn't work is an administration that is trying to
undermine the protections that are in place under the Affordable Care
Act for people with preexisting conditions. There is a lawsuit pending
right now. This administration should be defending that preexisting
condition exclusion, and they are refusing to do so. That will
implicate millions of lives throughout our country.
There is a lot that we can and should be working on together to
improve the healthcare system, to reduce healthcare costs for all
Americans. This approach, this piecemeal approach, while policy-wise
there is a lot of justification and explanation for what is happening,
is being done in a very fiscally irresponsible manner, just piling on
the debt.
The SPEAKER pro tempore (Mr. Bost). The time of the gentleman has
expired.
Mr. BLUMENAUER. Mr. Speaker, I yield the gentleman from Wisconsin 1
additional minute.
Mr. KIND. Mr. Speaker, this comes, by the way, on the heels, in this
session of Congress, of the passage of a major tax cut last year that
will add over $2 trillion to our national debt over the next 10 years
because, again, there was no attempt to pay for it. It comes on the
heels of the passage of a 2-year budget that will increase spending by
over half a trillion dollars, none of it paid for, none of it offset.
Just yesterday, President Trump just announced a $12 billion subsidy
bailout program for our family farmers because of the adverse effects
that they are feeling due to his tariffs. And that is going to be
borrowed money from China, again, to pay our farmers because they can't
now sell their product--guess where--into the Chinese market.
How crazy is this? I hope we are not in an era now where budget
deficits and debt only matters when there is a Democrat in the White
House. Over the last year and a half, that certainly seems to be the
case in this Congress.
Ms. JENKINS of Kansas. Mr. Speaker, I appreciate my friend's point of
view on the other side of the aisle. Mr. Kind and I have worked really
hard on this legislation for many years. I want to, for the Record,
just remind folks that this bill is simply allowing people to keep more
of their hard-earned money.
Letting people keep their own money is not government spending that
needs to be offset. Each of these bills contained in this package were
authored with our Democratic colleagues without an offset. Each of
these bills went through committee, with bipartisan support, without an
offset. It is ironic that Democrats want to, all of a sudden, claim to
be fiscally conservative.
This is the same Democratic Party that passed the stimulus in 2009.
Remember, that bill added nearly $800 billion to the deficit.
Mr. Speaker, I yield 3 minutes to the gentleman from Pennsylvania
(Mr. Kelly), a real leader on these issues on the House Committee on
Ways and Means.
Mr. KELLY of Pennsylvania. Mr. Speaker, I thank the gentlewoman for
including my bill, H.R. 6305, the Bipartisan HSA Improvement Act of
2018, in H.R. 6199, the Restoring Access to Medication and Modernizing
Health Savings Accounts Act.
{time} 1615
This important legislation expands access to and enhances the utility
of health savings accounts, also known as HSAs.
My legislation gives employers more flexibility to offer quality
healthcare in the setting that is best for them, like onsite or retail
clinics. Employers around the country are offering innovative ways to
deliver healthcare to their associates, and this provision makes sure
that individual health savings accounts can utilize these same
services.
It also fixes the spouse penalty by allowing individuals to make
health savings account contributions if a spouse has a flexible
spending account, while preventing double-dipping in tax benefits.
Lastly, it makes it easier for people to save for their healthcare by
streamlining the conversion of other tax-preferred accounts to health
savings accounts.
Ultimately, this bill modernizes healthcare delivery and gives
employers the freedom to innovate and improve their employees' health.
I am also very pleased to see that the PHIT Act was included in this
package. I strongly support adding more of an emphasis on exercise and
wellness to build a healthy American population.
We spend an incredible amount of money on healthcare but very little
on maintenance, like exercise and wellness, before we get sick. The
PHIT Act will better incentivize healthy lifestyles.
Mr. Speaker, we are trying to improve healthcare for all Americans.
[[Page H7656]]
This means giving consumers a choice in their healthcare by
incentivizing wellness and exercise. This is a preemptive effort to
build a healthier, stronger America and the freedom to design insurance
products that work best for them.
If you want to keep healthcare costs down, let's just make sure
people are healthier. That is the best way to do it.
And do you know what? I really like this debate because we talk about
how the deficit has grown. And for my colleagues on the other side, I
wasn't here at the time, but I watched the deficit grow in the
beginning of the Obama administration from $9 trillion to $20 trillion,
and I am glad that, finally, somebody has awakened to the fact that we
are working with huge deficits.
Now, this bill was passed by the Ways and Means Committee in a
bipartisan fashion, and I want to thank my friend Earl Blumenauer for
working on this issue.
This issue is extremely important for the 175 million Americans who
get their health insurance from their employer. I strongly urge my
colleagues on both sides of the aisle to vote in favor of H.R. 6199.
Mr. BLUMENAUER. Mr. Speaker, I yield myself 1 minute just to respond
briefly.
Mr. Speaker, I was here in 2009. The very month President Obama took
office, there were 700,000 jobs lost. There was great fear that we were
going to have a complete collapse of the auto industry. There was a
whole range of things that we were in an emergency situation on, and
the worst economic crisis since the Great Depression.
As it was, a major portion of that bill was tax cuts to try and
stimulate the economy. I do point out that as we move forward, our
healthcare bill was entirely paid for, and that is what we need to get
back to.
Mr. Speaker, I yield 3 minutes to the gentleman from Illinois (Mr.
Danny K. Davis), a champion of healthcare, dealing with disparities in
the healthcare system, a champion for balance and vision, and I
appreciate him being here.
Mr. DANNY K. DAVIS of Illinois. Mr. Speaker, I thank my colleague who
demonstrates with regularity the intensification of real care for the
people.
Today, we take up another bill that does nothing to make up for the
long-term Republican sabotage of the Affordable Care Act. Tens of
millions of working families also see their healthcare costs skyrocket
due to the repeated Republican efforts to undermine the healthcare
system.
Tens of millions of Americans with preexisting conditions will still
fear the loss of guaranteed health protections with the horrible choice
of loss of health insurance or untenable premiums.
The Republicans' sabotage will cost a typical family of four in my
congressional district $2,250 more in insurance premiums in 2019. The
Republicans' sabotage will cost a typical 55-year-old couple in my
congressional district $3,570 more in 2019.
The 2019 premium hikes follow an average 37 percent increase in 2018.
These premium hikes are especially disturbing when contrasted with the
billions in tax cuts the Republicans gave to insurance companies in
their tax law.
H.R. 6199 makes a small change to health savings accounts used
exclusively by the wealthy. Many of my constituents have trouble paying
for basic living costs like heat, food, and housing. They ask me
regularly for a few hundred dollars to help their kids stay in college.
The vast majority of my constituents can't set aside tens of
thousands of dollars to pay for their medical care out of pocket in a
health savings account. This legislation does nothing to increase
coverage, improve affordability, or change the skyrocketing costs of
healthcare.
I urge my colleagues to reject this bill, and I urge my Republican
colleagues to bring up meaningful legislation to improve coverage and
lower costs to help the tens of millions of Americans in need.
Ms. JENKINS of Kansas. Mr. Speaker, I yield 3 minutes to the
gentleman from Kansas (Mr. Estes), my friend and colleague.
Mr. ESTES of Kansas. Mr. Speaker, I rise to speak in support of two
bills being considered today as part of our overall goal to improve
healthcare for families across the country.
Currently, ObamaCare is broken. As I mentioned in an opinion piece,
from 2010 to 2016, health insurance premiums increased by nearly $4,400
per family.
This year, health insurance costs rose about 30 percent and are
expected to go up an additional 10 to 20 percent in 2019.
These skyrocketing costs are not due to some sabotage, as some folks
have suggested. Instead, they are a product of a system that was
designed and destined to fail.
Today, we all recognize that ObamaCare has failed to provide
insurance for all Americans. Rather than create more government-run
healthcare, we need competition and free market solutions like health
savings accounts to put patients in control of their own healthcare.
That is why I am proud to support H.R. 6199, the Restoring Access to
Medication Act of 2018, sponsored by Representative Lynn Jenkins and
Representative Grace Meng.
H.R. 6199 repeals provisions of the Affordable Care Act that restrict
health savings accounts, medical savings accounts, health flexible
spending arrangements, and health reimbursement arrangements to only be
used for prescription drugs or insulin. Removing these restrictions
will allow people to use such accounts for over-the-counter drugs.
I am also proud to support H.R. 6311, the Increasing Access to Lower
Premium Plans and Expanding Health Savings Accounts Act of 2018,
sponsored by Representatives Peter Roskam and Michael Burgess.
H.R. 6311 provides relief from ObamaCare's rising premiums and
limited choices by allowing the premium tax credit to be used for plans
offered outside of ObamaCare exchanges. The bill also expands access to
the lowest premium plans for people purchasing coverage in the
individual market and allows the premium tax credit to be used to
offset the cost of such plans. These measures increase competition for
consumers and seek to drive down the cost of health insurance.
I want to thank the Ways and Means Committee for bringing forward
thoughtful healthcare solutions that will help American families. I
urge my colleagues to support both bills.
Mr. BLUMENAUER. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, I take modest exception to the notion that somehow the
Affordable Care Act failed. It represents the largest expansion of
healthcare that we have seen in decades. It is so popular and important
that, when my Republican friends attempted to repeal it, something they
have been working on for 7 years, it blew up in their face. Even
President Trump said their bill was mean. And it continues, even though
they are working to dismantle it bolt by bolt.
I would hope that we will return to sanity to be able to work to be
able to move forward on things like some of the elements in this bill
here today that we agree upon that could move us forward rather than
the continued battle over the notion that the Affordable Care Act is
something that needs to be destroyed. The American people deserve
better.
Mr. Speaker, I reserve the balance of my time.
Ms. JENKINS of Kansas. Mr. Speaker, I yield 2 minutes to the
gentleman from Illinois (Mr. Roskam), who has provided great leadership
in this area.
Mr. ROSKAM. Mr. Speaker, I am pleased to see the inclusion of the
Promoting High-Value Health Care Through Flexibility for Deductible
Health Plans in this bill today. This is legislation that is bipartisan
that I introduced, along with the Congressman from California (Mr.
Thompson), that gives consumers the choice and flexibility that they
need to be engaged in their healthcare.
In a nutshell, the bill allows plans to offer coverage for high-
value, low-cost services like telehealth, chronic disease management
such as diabetic testing strips, or primary care visits below the
deductible. In a nutshell, what we are trying to do is give patients
more choices, more capacity to be more demonstrative about navigating
through their own healthcare needs.
This is a good bipartisan approach. I thank the gentlewoman for
including it, and I thank her for the time. I urge its passage.
[[Page H7657]]
Mr. BLUMENAUER. Mr. Speaker, I reserve the balance of my time.
Ms. JENKINS of Kansas. Mr. Speaker, I yield 2 minutes to the
gentleman from Minnesota (Mr. Paulsen), who has worked tirelessly in
this area.
Mr. PAULSEN. Mr. Speaker, I thank the chairwoman for yielding.
Mr. Speaker, as an advocate for giving consumers more choice in
healthcare and lowering costs, I support this bill, which also gives
more flexibility for those who have healthcare savings accounts, as
well as some of the other provisions that were already just previously
mentioned.
I want to highlight my support for one of the provisions in this bill
that will allow people to use their healthcare savings account to pay
for direct primary care and those arrangements.
The concept of direct primary care is simple, and it is supported by
a lot of family doctors, a lot of primary care doctors. People pay a
monthly fee to see their physician in this area anytime they choose,
over the phone, through telemedicine, or in person, and then they get a
whole host of services. It is really important for strengthening the
doctor-patient relationship, and it means that more people will have
access to primary care services instead of just going to the emergency
room in order to get care.
But, unfortunately, the IRS has stated that direct primary care
arrangements are essentially health insurance, and they categorize them
in this way so you cannot use your HSAs and those funds to pay for
direct primary care. That is why Congressman Blumenauer and I authored
legislation to fix this and to allow HSAs, health savings accounts, to
be used for direct primary care, and I am pleased that it is included
in this bill.
Another important reform will allow employers to offer direct primary
care arrangements to employees that have an HSA, also. This will let
more people have access to direct primary care through their healthcare
savings accounts, allowing family practice doctors like Dr. Julie
Anderson in Minnesota to expand their practice without having to worry
about the headache of filling out mountains of paperwork and excessive
insurance forms, because direct primary care let's the doctor work
directly with the patient and you don't have to go through extensive
billing services and insurance.
Healthcare savings accounts, Mr. Speaker, have already been proven to
help lower healthcare costs; and expanding them, giving consumers more
flexibility and more choices, will mean families are also going to be
better off.
So let's allow healthcare savings accounts to be used for direct
primary care and support the underlying bill.
Mr. BLUMENAUER. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, I appreciate the opportunity for us to have this
discussion. It has been fun working with the gentleman from Minnesota
(Mr. Paulsen) on this notion of direct primary care. It is a simple
notion that runs athwart IRS regulations. I still don't fully
understand why these should be classified as ``health plan'' rather
than ``payment for service.''
But, nonetheless, we were able to work together on a bipartisan basis
to move this forward. It is not expensive. The score is less than $2
billion out of $90 billion that we are tossing around here, and I
personally believe that it will result in substantial savings in order
to provide more efficient coverage.
But I must say that I am a little troubled by the continuing assault
on what we are doing with the fiscal future of this country.
{time} 1630
We just saw the latest reports that because of what my Republican
friends have done with the budget and with the tax bill, we have
doubled the deficit this year. It is doubled.
Now, there were complaints from my friend from Kansas about deficit
spending when President Obama took office. Remember, he was only
President for one-third of that month and lost 700,000 jobs. The
economy was in free fall. Absolutely we took steps: cutting taxes and
moving in areas to try and strengthen parts of the economy that was
posing huge problems for people across the board. And this was broadly
supported by people in business. Economic experts actually agree that
probably we didn't do enough, and that slowed the economic recovery.
But the economy has recovered.
We have seen 9 consecutive years of private sector job growth. That
is what Trump inherited: over 7 years of job growth. The economy was
strong. It wasn't in free fall. Yet, in that strong position, we are
doubling the deficit this year. We are looking at trillion dollar
deficits as far as the eye can see.
And we just had the President announce that he wants to spend $12
billion more, not because we are in economic free fall, but because his
ruinous trade policies have resulted in losses to the farming sector.
They are going to provide extra government bailout, not because farmers
want it, but because they are being injured by these ruinous trade
policies.
There was a time when most of my Republican friends would rise up in
opposition. It is certain that if these were offered by Bill Clinton or
Barack Obama, they would be screaming at the top of their lungs. Most
of them are strangely silent now, but it is another $12 billion to try
to fix a problem that Trump has created by starting trade wars with our
friends, trying to punish China, and, in fact, we are punishing our
allies. And somehow auto imports are national security.
This is embarrassing that we are in this situation. But it is not
just embarrassing, it is dangerous. We are weakening ourselves
economically, while we pick fights with our allies, like Canada and the
European Union.
Mr. Speaker, on top of all of this, we are going to advance
legislation today that have some nuggets of positive things. I have
worked with my colleagues on some of them. There are important
advances, but they are coming at a price of $90 billion added to the
deficit, without even an attempt to work with us to offset. I think we
could have offset the direct primary care piece that we are talking
about here. It is relatively small potatoes compared to $90 billion,
and compared to $12 billion for tariff relief for a trade war we didn't
need.
Mr. Speaker, I enjoy the conversation about some of these items. I
think it is important to spotlight them. But I am hopeful that we are
able to return to fiscal stability, not having bailouts for farmers
that they don't want and wouldn't need if we had a rational tariff
policy. I am hopeful that we are not going to have a parade of other
things that undermine the Affordable Care Act and add unnecessary costs
to the deficit.
Mr. Speaker, I yield back the balance of my time.
Ms. JENKINS of Kansas. Mr. Speaker, I yield myself the remainder of
my time.
Mr. Speaker, we have heard my friends on the other side of the aisle
suggest here, this afternoon, this bill might, in some way, hurt people
with preexisting conditions. However, we know that is simply not true.
This bill doesn't touch preexisting conditions. It doesn't raise costs
or premiums on families. And it doesn't take away anyone's choice of a
healthcare plan.
Millions of Americans use tax-advantage healthcare accounts to save
and pay for healthcare expenses. In fact, there are twice as many
Americans with an HSA than those who get coverage on the Affordable
Care Act's exchanges. Almost 22 million people had an HSA in 2017, and
there is only about 10 million people enrolled on the exchanges in
2018. Forty-four percent of all civilian workers had access to a health
flexible spending arrangement in 2017.
The provisions in this bill allow more things to be paid for out of
these accounts, like over-the-counter drugs, feminine products, and
fitness activities. This means people are paying less because they are
able to use pre-tax dollars or take a deduction for their contribution.
As a reminder, the policies in the bill are all bipartisan. We have
worked together to write and advance them.
This bill helps middle class families afford their healthcare
expenses, and I hope my colleagues will continue to support this
legislation.
Mr. Speaker, I yield back the balance of my time
The SPEAKER pro tempore. All time for debate has expired.
Pursuant to House Resolution 1012, the previous question is ordered
on the bill, as amended.
[[Page H7658]]
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. BLUMENAUER. 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.
____________________