Congressional Record, Volume 164 Issue 125 (Wednesday, July 25, 2018)

[Congressional Record Volume 164, Number 125 (Wednesday, July 25, 2018)]
[House]
[Pages H7658-H7667]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

INCREASING ACCESS TO LOWER PREMIUM PLANS AND EXPANDING HEALTH SAVINGS
ACCOUNTS ACT OF 2018

Mr. ROSKAM. Mr. Speaker, pursuant to House Resolution 1011, I call up
the bill (H.R. 6311) to amend the Internal Revenue Code of 1986 and the
Patient Protection and Affordable Care Act to modify the definition of
qualified health plan for purposes of the health insurance premium tax
credit and to allow individuals purchasing health insurance in the
individual market to purchase a lower premium copper plan, and ask for
its immediate consideration.
The Clerk read the title of the bill.
The SPEAKER pro tempore. Pursuant to House Resolution 1011, in lieu
of the amendment in the nature of a substitute recommended by the
Committee on Ways and Means, an amendment in the nature of a substitute
consisting of the text of Rules Committee Print 115-83 is adopted, and
the bill, as amended, is considered read.
The text of the bill, as amended, is as follows:

H.R. 6311

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 ``Increasing
Access to Lower Premium Plans and Expanding 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. Carryforward of health flexible spending arrangement account
balances.
Sec. 3. Individuals entitled to part A of Medicare by reason of age
allowed to contribute to health savings accounts.
Sec. 4. Maximum contribution limit to health savings account increased
to amount of deductible and out-of-pocket limitation.
Sec. 5. Allow both spouses to make catch-up contributions to the same
health savings account.
Sec. 6. Special rule for certain medical expenses incurred before
establishment of health savings account.
Sec. 7. Allowance of bronze and catastrophic plans in connection with
health savings accounts.
Sec. 8. Allowing all individuals purchasing health insurance in the
individual market the option to purchase a lower premium
copper plan.
Sec. 9. Delay of reimposition of annual fee on health insurance
providers.

SEC. 2. CARRYFORWARD OF HEALTH FLEXIBLE SPENDING ARRANGEMENT
ACCOUNT BALANCES.

(a) In General.--Section 106 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
subsection:
``(h) Carryforward of Health Flexible Spending Arrangement
Account Balances.--A plan shall not fail to be treated as a
health flexible spending arrangement under this section or
section 105 merely because the lesser of--
``(1) such arrangement's account balance (or any portion
thereof) determined as of the end of any plan year, or
``(2) the product of the dollar limitation in effect under
section 125(i) for such plan year (determined without regard
to paragraph (2) thereof) multiplied by 3,
may be carried forward to the succeeding plan year.''.
(b) Coordination With Limitation on Salary Reduction
Contributions.--
(1) In general.--Section 125(i) of such Code is amended by
redesignating paragraph (2) as paragraph (3) and by inserting
after paragraph (1) the following new paragraph:
``(2) Coordination with carryforward of account balances.--
The dollar amount otherwise in effect under paragraph (1) for
any plan year shall be reduced (but not below zero) by the
excess (if any) of--
``(A) the amount of any account balance which is carried
forward to such plan year from the preceding plan year, over
``(B) twice the dollar limitation in effect under paragraph
(1) (determined without regard to this paragraph).''.
(2) Conforming amendments.--Section 125(i) of such Code is
amended by striking ``taxable year'' each place it appears in
paragraphs (1) and (3) (as redesignated by paragraph (1) of
this subsection) and inserting ``plan year''.
(c) Coordination With Cafeteria Plan Limitation on Deferred
Compensation.--Section 125(d)(2) of such Code is amended by
adding at the end the following new subparagraph:
``(E) Exception for health flexible spending
arrangements.--Subparagraph (A) shall not apply to a plan to
the extent of amounts in a health flexible spending
arrangement which may be carried forward as described in
section 106(h).''.
(d) Effective Date.--The amendments made by this section
shall apply to plan years beginning after December 31, 2018.

SEC. 3. INDIVIDUALS ENTITLED TO PART A OF MEDICARE BY REASON
OF AGE ALLOWED TO CONTRIBUTE TO HEALTH SAVINGS
ACCOUNTS.

(a) In General.--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 adding at the
end the following new clause:
``(iv) entitlement to hospital insurance benefits under
part A of title XVIII of the Social Security Act by reason of
section 226(a) of such Act.''.
(b) Conforming Amendment.--Section 223(b)(7) of such Code
is amended by inserting ``(other than an entitlement to
benefits described in subsection (c)(1)(B)(v))'' after
``Social Security Act''.
(c) 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. MAXIMUM CONTRIBUTION LIMIT TO HEALTH SAVINGS ACCOUNT
INCREASED TO AMOUNT OF DEDUCTIBLE AND OUT-OF-
POCKET LIMITATION.

(a) Self-Only Coverage.--Section 223(b)(2)(A) of the
Internal Revenue Code of 1986 is amended by striking
``$2,250'' and inserting ``the amount in effect under
subsection (c)(2)(A)(ii)(I)''.
(b) Family Coverage.--Section 223(b)(2)(B) of such Code is
amended by striking ``$4,500'' and inserting ``the amount in
effect under subsection (c)(2)(A)(ii)(II)''.
(c) Conforming Amendments.--Section 223(g)(1) of such Code
is amended--
(1) by striking ``subsections (b)(2) and'' both places it
appears and inserting ``subsection'', and
(2) in subparagraph (B), by striking ``determined by'' and
all that follows through `` `calendar year 2003'.'' and
inserting ``determined by substituting `calendar year 2003'
for `calendar year 2016' in subparagraph (A)(ii) thereof.''.
(d) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2018.

SEC. 5. ALLOW BOTH SPOUSES TO MAKE CATCH-UP CONTRIBUTIONS TO
THE SAME HEALTH SAVINGS ACCOUNT.

(a) In General.--Section 223(b)(5) of the Internal Revenue
Code of 1986 is amended to read as follows:
``(5) Special rule for married individuals with family
coverage.--
``(A) In general.--In the case of individuals who are
married to each other, if both spouses are eligible
individuals and either spouse has family coverage under a
high deductible health plan as of the first day of any
month--
``(i) the limitation under paragraph (1) shall be applied
by not taking into account any other high deductible health
plan coverage of either spouse (and if such spouses both have
family coverage under separate high deductible health plans,
only one such coverage shall be taken into account),
``(ii) such limitation (after application of clause (i))
shall be reduced by the aggregate amount paid to Archer MSAs
of such spouses for the taxable year, and
``(iii) such limitation (after application of clauses (i)
and (ii)) shall be divided equally between such spouses
unless they agree on a different division.
``(B) Treatment of additional contribution amounts.--If
both spouses referred to in subparagraph (A) have attained
age 55 before the close of the taxable year, the limitation
referred to in subparagraph (A)(iii) which is subject to
division between the spouses shall include the additional
contribution amounts determined under paragraph (3) for both
spouses. In any other case, any additional contribution
amount determined under paragraph (3) shall

[[Page H7659]]

not be taken into account under subparagraph (A)(iii) and
shall not be subject to division between the spouses.''.
(b) Effective Date.--The amendments made by this section
shall apply to taxable years beginning after December 31,
2018.

SEC. 6. SPECIAL RULE FOR CERTAIN MEDICAL EXPENSES INCURRED
BEFORE ESTABLISHMENT OF HEALTH SAVINGS ACCOUNT.

(a) In General.--Section 223(d)(2) of the Internal Revenue
Code of 1986 is amended by adding at the end the following
new subparagraph:
``(D) Treatment of certain medical expenses incurred before
establishment of account.--If a health savings account is
established during the 60-day period beginning on the date
that coverage of the account beneficiary under a high
deductible health plan begins, then, solely for purposes of
determining whether an amount paid is used for a qualified
medical expense, such account shall be treated as having been
established on the date that such coverage begins.''.
(b) Effective Date.--The amendment made by this section
shall apply with respect to coverage beginning after December
31, 2018.

SEC. 7. ALLOWANCE OF BRONZE AND CATASTROPHIC PLANS IN
CONNECTION WITH HEALTH SAVINGS ACCOUNTS.

(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) Bronze and catastrophic plans treated as high
deductible health plans.--
``(i) In general.--The term `high deductible health plan'
shall include any plan described in subsection (d)(1)(A) or
(e) of section 1302 of the Patient Protection and Affordable
Care Act.
``(ii) Certain rules not applicable.--Subparagraphs (C) and
(D) shall not apply with respect to any plan described in
clause (i).''.
(b) Effective Date.--The amendment made by this section
shall apply to months beginning after December 31, 2018, in
taxable years ending after such date.

SEC. 8. ALLOWING ALL INDIVIDUALS PURCHASING HEALTH INSURANCE
IN THE INDIVIDUAL MARKET THE OPTION TO PURCHASE
A LOWER PREMIUM COPPER PLAN.

(a) In General.--Section 1302(e) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18022(e)) is amended--
(1) in paragraph (1)--
(A) by redesignating clauses (i) and (ii) of subparagraph
(B) as subparagraphs (A) and (B), respectively, and adjusting
the margins accordingly;
(B) by striking ``plan year if--'' and all that follows
through ``the plan provides--'' and inserting ``plan year if
the plan provides--''; and
(C) in subparagraph (A), as redesignated by paragraph (1),
by striking ``clause (ii)'' and inserting ``subparagraph
(B)'';
(2) by striking paragraph (2); and
(3) by redesignating paragraph (3) as paragraph (2).
(b) Risk Pools.--Section 1312(c)(1) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18032(c)(1)) is
amended by inserting ``and enrollees in catastrophic plans
described in section 1302(e)'' after ``Exchange''.
(c) Conforming Amendment.--Section 1312(d)(3)(C) of the
Patient Protection and Affordable Care Act (42 U.S.C.
18032(d)(3)(C)) is amended by striking ``, except that in the
case of a catastrophic plan described in section 1302(e), a
qualified individual may enroll in the plan only if the
individual is eligible to enroll in the plan under section
1302(e)(2)''.
(d) Effective Date.--The amendments made by this section
shall apply to plan years beginning after December 31, 2018.

SEC. 9. DELAY OF REIMPOSITION OF ANNUAL FEE ON HEALTH
INSURANCE PROVIDERS.

(a) In General.--Section 9010(j)(3) of the Patient
Protection and Affordable Care Act is amended by striking
``December 31, 2019'' and inserting ``December 31, 2021''.
(b) Effective Date.--The amendment made by this section
shall apply to calendar years beginning 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 Illinois (Mr. Roskam) and the gentleman from
Michigan (Mr. Levin) each will control 30 minutes.
The Chair recognizes the gentleman from Illinois.

General Leave

Mr. ROSKAM. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
include extraneous material on the bill currently under consideration.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Illinois?
There was no objection.
Mr. ROSKAM. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I chair the Health Subcommittee at the Ways and Means
Committee, and I have had the opportunity, like many of my colleagues,
to hear from physicians, hospitals, and patient advocates. I have heard
a lot of stories about increased costs, which are exacerbating the
coverage and access challenges that we currently face.
There is a broad consensus that healthcare in the United States needs
to move towards a system that provides greater access to affordable
care. The question is: How do we get that done?
The ACA government-approved, government-mandated one-size-fits-all
insurance has dramatically decreased choice and increased premiums in
the individual market. We will hear a lot of debate about this today.
But here is what is happening close to home. Mr. Speaker, in my home
State, the Department of Health and Human Services released a report
that shows, between 2013 and 2017, the average monthly premium for
coverage in the individual market, in Illinois, increased 108 percent,
or by $3,228 a year.
I have five counties in my constituency. In two of those five
counties, there is only one insurer offering plans on the individual
exchange. That is not a choice. That is a government mandate. That is a
government monopoly.
It is time to drive a discussion around empowering individuals and
their families to make healthcare decisions for themselves based on
their needs and based on their budgets.
The policies that are included in H.R. 6311 expand access to
consumer-directed health plans with tax favored accounts, like health
savings accounts, HSAs. This bill increases choice, lowers premiums,
and let's more families save more money to pay for their healthcare
costs.
Now, my friends across the aisle will, without question, get up this
afternoon and say that this bill doesn't do anything to help people.
That instead of these policies, we should drop everything and work to
fix the very broken, flawed plan that is the ACA. Well, here is the
thing.
There are twice as many people who have an HSA than those who are
covered under the exchanges. Let me say that again. Twice as many
Americans are covered under HSAs than under the Affordable Care Act:
21.8 million people, Mr. Speaker, had a health savings account in 2017,
and there is only 10.6 million who are enrolled in the exchanges in
2018--2 to 1.
The bill makes smart changes to help families save more money pre-tax
for their healthcare. It changes the so-called use-it-or-lose-it nature
of flexible spending arrangements, FSAs, by allowing balances to roll
over to the next year. It doubles the amount of money people can put
into a health savings account so that they can save enough to cover
their exposure to out-of-pocket costs, and they are increasingly
vulnerable to these out-of-pocket costs.
Now, my friends on the other side may say they want to talk about and
distract from some of these commonsense solutions and say that somehow
some subpar insurance is being promoted. Well, even after canceling
millions of healthcare plans that people had and that people liked,
notwithstanding the President's promise that if you like your coverage,
you get to keep your coverage--you remember that, Mr. Speaker--
notwithstanding that, Democrats, God bless them, they still think they
know what type of healthcare is best for everyone. They haven't learned
yet that individuals and families are the best ones to make these
decisions, not politicians and not bureaucrats in Washington.
We think people should be able to purchase the type of coverage they
want and the type of coverage they can afford. One of the provisions in
this bill allows everyone to purchase a catastrophic plan, a plan that
was designed by ObamaCare. These plans offer the lowest premiums, and
we think everyone should have access to them.
Even better, because these plans have average deductibles of $6,000,
we think we should allow catastrophic and bronze plans to qualify for
an HSA as well. This means people can get a break in taxes for the
money that they save for their huge ObamaCare deductibles. This is real
savings to real people who are struggling under the current healthcare
law.

{time} 1645

It allows working seniors with HSA-eligible coverage who are enrolled
in Medicare part A to contribute to an HSA, which can provide an added
benefit for seniors and an incentive for them to stay on their
employer-sponsored plan over Medicare, if they choose. It makes perfect
sense.
It increases utility and flexibility through allowing both spouses to
make

[[Page H7660]]

catch-up contributions into the same HSA if they are over age 55.
Finally, it delays ObamaCare's health insurance tax for an additional
2 years, which would otherwise increase the cost of insurance premiums
through a nearly $27 billion excise tax. This is a flawed tax that gets
passed on to American families who are purchasing in the individual
market; it gets passed on to seniors in Medicare Advantage; it gets
passed on to small businesses; and it gets passed on in Medicaid
programs.
So I want to thank the Ways and Means Committee members who took that
effort seriously. I look forward to this afternoon's debate.
I want to thank Chairman Brady for his leadership in driving this
discussion, and I reserve the balance of my time.
House of Representatives,

Committee on Ways and Means,

Washington, DC, July 13, 2018.
Hon. Greg Walden,
Chairman, Committee on Energy and Commerce,
Washington, DC.
Dear Chairman Walden: I write to you regarding H.R. 6311,
to amend the Internal Revenue Code of 1986 and the Patient
Protection and Affordable Care Act to modify the definition
of the qualified health plan for purposes of the health
insurance premium tax credit and to allow individuals
purchasing health insurance in the individual market to
purchase a lower premium copper plan.
The Committee on Ways and Means ordered favorably reported
this bill which was also referred to the Committee on Energy
and Commerce. I ask that the Committee on Energy and Commerce
waive formal consideration of the bill so that it may proceed
expeditiously to the House Floor.
I acknowledge that by waiving formal consideration of the
bill, the Committee on Energy and Commerce is in no way
waiving its jurisdiction over the subject matter contained in
those provisions of the bills that fall within your Rule X
jurisdiction. I would support your effort to seek appointment
of an appropriate number of conferees on any House-Senate
conference involving this legislation.
I will include a copy of our letters in the Congressional
Record during consideration of this legislation on the House
floor.
Sincerely,
Kevin Brady,
Chairman.
____

House of Representatives,

Committee on Energy and Commerce,

Washington, DC, July 16, 2018.
Hon. Kevin Brady,
Chairman, Committee on Ways and Means,
Washington, DC.
Dear Chairman Brady: Thank you for your letters regarding
H.R. 4952, the ``Improving Seniors Access to Quality Benefits
Act,'' H.R. 6138, the ``Ambulatory Surgical Center (ACS)
Payment Transparency Act of 2018,'' and H.R. 6311, the ``To
amend the Internal Revenue Code of 1986 and the Patient
Protection and Affordable Care Act to modify the definition
of qualified health plan for purposes of the health insurance
premium tax credit and to allow individuals purchasing health
insurance in the individual market to purchase a lower
premium copper plan.''
The Committee on Energy and Commerce will forgo
consideration of both bills so that they may proceed
expeditiously to the House Floor.
I appreciate your assurance that by forgoing action on
these bills, the Committee is in no way waiving its
jurisdiction over the subject matter contained in the bills.
I also appreciate your offer of support for the appointment
of conferees from the Committee to any House-Senate
conference involving this legislation.
Sincerely,
Greg Walden,
Chairman.

Mr. LEVIN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I think we need to ask ourselves: What is this bill all
about? Why are we here today?
H.R. 6311 is the final of three bills regarding health savings
accounts and health taxes that we will be considering this week. I find
it sad we are not spending our time today addressing the most pressing
concerns of Americans struggling to make ends meet because of the
Republican sabotage of healthcare coverage.
Nothing in H.R. 6311, or any other bill we have considered this week,
undoes the ongoing harm caused by the actions of the Trump
administration or this Republican Congress.
For example, earlier this month, the administration created needless
confusion by refusing to make legally required risk adjustment payments
until, when there was major protest, it reversed course last night
under public pressure. But in June, the Justice Department refused to
defend protection for the 130 million Americans living with preexisting
health conditions.
Last fall, the President terminated cost-sharing reduction payments
for Americans earning 100 to 250 percent of the Federal poverty level.
The GOP tax bill gutted the individual responsibility requirement,
causing a 15 percent spike in premiums, according to CBO.
Recently, the administration again cut funding for navigator
organizations to just $10 million for the upcoming open enrollment
period. I saw at home what these navigator provisions meant to
nonprofit organizations that were reaching out to people who wanted
information and healthcare.
Cut, cut, cut is the administration's answer. And this Congress'
response to that administration action is zero, silence, silence,
silence.
These and so many other actions by Republicans have led to direct
increases in premiums and out-of-pocket costs for middle class
families.
Expanding HSAs and shifting more Americans into catastrophic
coverage, as H.R. 6311 does, will not meaningfully help middle class
families harmed by Republican sabotage of ACA. Instead, it will
primarily benefit wealthy Americans and large insurance companies.
According to data from the Joint Committee on Taxation, more than 80
percent of the tax benefit for health savings accounts goes to
individuals earning more than $100,000 annually. We pointed that out in
committee.
What was the response? Obfuscation, obfuscation. That is a fact and
analysis given to us by the Joint Committee on Taxation. So all these
crocodile tears for mainly middle class families, I think, are shown
for what they are.
Very few families with modest incomes can afford the high, out-of-
pocket expenses required in order to participate in a HSA. Doubling the
amount that individuals can contribute tax-free--tax-free--as this bill
does, will make no difference to the millions of working families who
don't have thousands of dollars available to contribute to an HSA in
the first place.
I suggest that everybody go home and talk to the general public.
In addition, a 2-year delay of the health insurance provider fee will
have only a minimal impact on premiums. Indeed, this provision will
mainly benefit insurance companies, while adding more than $25 billion
to the deficit.
Not only do the bills we have considered this week not address these
pressing issues, they also recklessly add to the deficit. Republicans
have failed to produce even $1 for the enormous cost of these bills. So
I said to the chairman of the committee that I once chaired, I was
sometimes asked that question: Will you pay for it? And I said yes.
I asked the chairman: Will you pay for this? At first, it was said:
Well, we don't have to do that in committee. So I said: Will you do it
on the floor, yes or no? He said no.
So here we are. Although we do not yet have a final analysis from the
Congressional Budget Office or the Joint Committee on Taxation, past
estimates of similar provisions have shown us this:
H.R. 184, which would repeal the medical device tax, will cost about
$20 billion over 10 years.
H.R. 6199, which would expand HSAs to include over-the-counter
medications and gym memberships, will cost roughly $20 billion.
And this bill, which expands HSAs and delays a tax on the health
insurance industry, would increase the deficit the most. This is, in a
few words, a Risky Roskam bill that would cost up to $50 billion, $50
billion.
When all is said and done, our actions this week could add up to $90
billion to our Nation's debt, increasing pressure to cut vital programs
like Medicare. This comes just months after a tax cut bill that would
add an additional $2 billion to the debt.
So, look, we need to come and ask ourselves: Why are we here?
These bills will not likely pass the Senate or become law, so here we
are. We are going to recess, adjourn tomorrow for 5 weeks or so. I
think the reality is that these bills, which will not likely pass the
Senate, will not ever become law.
I think it is likely that they have a different purpose, and I think
that was described in a recent article in The Hill. I read it because I
want the public to question what we do, and I quote:
``The bills on the House floor next week could give victories to the
bill

[[Page H7661]]

sponsors who are also vulnerable in November.'' The chairman of the
subcommittee, where I am ranking member, is facing, this article says,
``a tough reelection race in his suburban . . . district.''
``But overall, the measures slated for consideration are minor and
won't make a major dent in premiums, according to Joe Antos, a
healthcare expert at the right-leaning American Enterprise Institute.''
I want to quote that again: ``These measures slated for consideration
are minor and won't make a major dent in premiums, according to Joe
Antos, a healthcare expert at the right-leaning American Enterprise
Institute.''

So I think that is really what this is all about. It is a political
exercise. It is aimed to help people who are in a vulnerable political
position. But that is not a reason to bring up these bills today, when,
as I described earlier, there are so many issues relating to healthcare
coverage.
The Republicans have undertaken these last months under this
administration to do everything they can to sabotage healthcare for
Americans. As a result, 3 million people less have healthcare
insurance. But ACA works so well that 20 million people received
healthcare coverage they did not have.
So, this is kind of a sad moment. We are turning this place into a
campaign entity. We should not be doing that when it comes to
healthcare coverage. We tried, in recent times, to say to the
Republicans, if you want to improve ACA, we are ready. Never has there
been any offer to do that. Instead, it was repeal, repeal, repeal. I
won't say that 55 times, but that is how often it happened. More
recently, it was sabotage, sabotage, sabotage. That isn't what we
should be doing for what is so dear to Americans, healthcare coverage.
It is a sad day, as I said earlier, that, here we are, when so much
needs to be done, and this, essentially, is a political exercise.
I reserve the balance of my time.
Mr. ROSKAM. Mr. Speaker, I yield myself such time as I may consume.
The gentleman from Michigan asked the rhetorical question: Why are we
here?
I will tell you one reason why we are here. One reason why we are
here is I have an independent recollection of being in my car on
Michigan Avenue in Chicago, listening then to President Obama give a
speech to, I think it was the American Medical Association. I was
listening on the radio and he said, I think--I may be conflating here.
But he said: If you like your coverage, you can keep your coverage. If
you like your doctor, you get to keep your doctor.
I think, during the course of the healthcare discussion, the Obama
administration made this explicit promise to the American people: You
are going to save $2,500 per family. And it was going to be great. It
was going to solve all the problems. Yet, that didn't happen. That is
why we are here.
I have a constituency where two counties have one insurer. That is
why we are here.
Mr. Speaker, I yield 2 minutes to the gentleman from Minnesota (Mr.
Paulsen) to tell us why we are here.
Mr. PAULSEN. Mr. Speaker, just to follow up, there are too many
families that continue to suffocate under the high premiums and high
deductibles that we have from the Affordable Care Act.
In contrast to the top-down, one-size-fits-all approach of ObamaCare,
healthcare savings accounts put consumers in charge of their own
healthcare. It is no wonder they are gaining in popularity.
Today, nearly 22 million Americans have health savings accounts. That
is twice as many as was mentioned earlier, twice as many as the number
of people who are getting plans through the ObamaCare exchanges. That
is not even close. In Minnesota alone, more than a million, 1.2
million, people and families are eligible for HSA plans.
Now, the bill before us today supports the continued growth of
healthcare savings accounts and includes a couple of provisions that I
helped author, including allowing working seniors to contribute to an
HSA, increasing the limits that individuals and families can contribute
to their HSAs, and allowing married couples the opportunity to make
larger catch-up contributions to their own healthcare savings accounts.
Then it also creates a grace period to help pay for medical expenses
that someone may have incurred before they actually set up their
healthcare savings accounts.
These are all important improvements that will help provide value in
healthcare and help lower prices.
So let's let people purchase the type of coverage that they want and
that they can afford. I am really pleased that the bill before us makes
these very smart, strategic, calculated reforms, and I ask my
colleagues for their support.

{time} 1700

Mr. LEVIN. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I have heard the so-called fact that more people have
HSAs than those who are covered by ObamaCare. That simply is not true.
ObamaCare includes expanded Medicaid. So if you want to talk about
more than in the exchanges, we can discuss that and argue it, but don't
come here and minimize the impact of ACA.
We worked hard on it. We meet so many people who have benefited from
what we Democrats did, and the public, more and more, is expressing
that. You were on the wrong side of history, and you are now on the
wrong side of public opinion.
Mr. Speaker, I yield 2 minutes, or more if he would like, to the
gentleman from New York (Mr. Higgins), an active member of our
committee.
Mr. HIGGINS of New York. Mr. Speaker, health savings accounts, while
they may help people manage their healthcare costs marginally, the sad
truth is this legislation will do nothing--nothing--to lower healthcare
costs and to improve healthcare quality.
The legislation also does nothing--nothing--to protect people with
preexisting conditions, and 40 percent of Americans between the ages of
50 and 64\1/2\ have preexisting conditions.
The legislation before us will increase the deficit by tens of
billions of dollars and will threaten the long-term viability of
Medicare and Social Security.
Mr. Speaker, because of recent actions by the Trump Justice
Department and House Republicans, millions of Americans between the
ages of 50 and 64\1/2\ who buy their health insurance on the individual
market are about to get clobbered with double-digit multiyear health
insurance premium increases, and this Congress is doing nothing--
nothing--to help. This population needs the protection of Medicare now.
Medicare at 50 would allow people to buy Medicare as their health
insurance. Medicare is Affordable Care Act compliant, with essential
benefits, has high patient satisfaction ratings, has full access to
primary care and physician specialists, and always, always covers
preexisting conditions. Medicare at 50 also is thousands of dollars
cheaper when compared with the gold plan on the individual market.
Mr. Speaker, Medicare is the best public option that already exists,
and the best public option that already exists should be available to
millions of Americans ages 50 to 64\1/2\.
Mr. ROSKAM. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Indiana (Mrs. Walorski).
Mrs. WALORSKI. Mr. Speaker, I rise in support of H.R. 6311, the
Increasing Access to Lower Premium Plans and Expanding Health Savings
Accounts Act.
This important bill contains a 2-year delay of the health insurance
tax, or HIT. Like the medical device tax, which the House voted
yesterday to repeal, the HIT is yet another damaging tax from
ObamaCare. It raises premiums for families, for small businesses, for
seniors, and for the disabled enrolled in Medicare Advantage. In fact,
the HIT could raise annual premiums for the typical Medicare Advantage
couple by $500 if it returns in 2020.
I am a proud original cosponsor, with Representatives Noem, Sinema,
and Bera, of H.R. 5963, which delays the HIT for 2 years, and I am
thrilled this bill we are voting for today includes it.
I look forward to the day when we can finally repeal this tax that
falls on the backs of seniors, the disabled, small businesses, and
hardworking families, but until then, I urge my colleagues to support
delaying it.

[[Page H7662]]

Mr. LEVIN. Mr. Speaker, I yield 3 minutes to the gentlewoman from
California (Ms. Judy Chu), who is so active and there all the time.
Ms. JUDY CHU of California. Mr. Speaker, I rise today in strong
opposition to H.R. 6311, which, contrary to its name, would do very
little to help Americans access quality healthcare coverage. Instead,
it would force families to accept low-quality, catastrophic health
plans, or junk coverage, that does not meet healthcare needs and leaves
ordinary Americans to foot the bill when something goes wrong.
What does a catastrophic and high-deductible plan mean? Well, it is a
disaster for many.
Recent studies have shown that 40 percent of Americans cannot afford
even a $400 emergency expense, let alone the thousands of dollars
necessary for a medical emergency, which could happen to any of us, but
that is the plan Republicans are offering. Americans would get a plan
that is substandard. No one wants to have health coverage that doesn't
actually cover much at all.
What is more, these catastrophic and high-deductible health plans are
especially harmful to women. Since 50 percent of the pregnancies in the
United States are unplanned, many parents in these plans will not have
saved enough to cover these high deductibles or unexpected costs.
Furthermore, most pregnancies last 9 months and, thus, span more than
one plan year. That means during the course of a single pregnancy, a
mother in one of these plans would have to hit her deductible twice.
Maternity care services without complications can average around
$10,000 per pregnancy. What would happen in a pregnancy with
complications?
The Affordable Care Act was passed so that we could move away from
junk plans that offered nothing in terms of coverage and left people
with thousands of dollars in medical debt. This bill is just another
attempt to undermine the ACA, and we cannot go back.
Mr. ROSKAM. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, every time today we hear the phrase ``junk coverage,''
think ObamaCare. And I am not trying to be facetious, because there is
nothing in this bill that makes any change to any coverage. I could
only assume that the gentlewoman from California (Ms. Judy Chu) is
referring to the catastrophic coverage that was part of the ACA.
All we are doing today is saying, with that coverage, they ought not
be alone. They ought not just be out on an ice floe all by themselves.
People who have that type of catastrophic coverage that our friends,
when they were in the majority, created, those people should simply
have access to a health savings account.

What is not to love about that?
So when you hear ``junk coverage,'' just be dismissive of that. It is
a talking point, and it is not particularly persuasive. Who is
persuasive is the gentleman from Nebraska.
Mr. Speaker, I yield 2 minutes to the gentleman from Nebraska (Mr.
Smith).
Mr. SMITH of Nebraska. Mr. Speaker, I rise today in support of H.R.
6311, the Increasing Access to Lower Premium Plans and Expanding Health
Savings Accounts Act.
This bill gives all Americans the option to purchase a catastrophic
plan if they so choose, which, under current law, is restricted to a
limited population. This bill will increase health insurance plan and
pricing options as we continue our work to address the underlying
problems of ObamaCare.
Nebraskans continue to tell me that they are desperate for more
options to buy health insurance for their families. We are down to only
one insurer in Nebraska, in Nebraska's exchange; and with premiums for
a family, which can exceed $30,000 before even factoring in four- and
five-figure deductibles, families need more options, Nebraskans need
more options.
The way to create access to healthcare for more people is by
understanding better the buyer-seller relationship.
If you want to reduce costs through increasing participation, whoever
is doing the selling must create products the consumer is willing to
buy. The more barriers are wedged between the buyer and seller, the
more transparency and competition will decrease and the more healthcare
costs for consumers will increase.
It is obvious that ObamaCare policies, which have restricted choice
through one-size-fits-all requirements for insurance products, continue
to fail, and this bill will help give Nebraskans and all Americans the
choices they need and deserve.
Mr. Speaker, I thank Mr. Roskam for bringing us this bill, and I urge
support for it.
Mr. LEVIN. Mr. Speaker, I yield 5 minutes to the gentleman from Texas
(Mr. Doggett), a true fighter.
Mr. DOGGETT. Mr. Speaker, TrumpCare, that is what we are talking
about today.
What is TrumpCare? Well, it is not much care. In fact, it is mainly
indifference from people that don't really care or understand the
plight of thousands of families across this country working to make
ends meet, and suddenly somebody has an accident on the way home from
work or suddenly a child is diagnosed with some dreaded disease, and
they face, without access to affordable health insurance, a
catastrophe.
We know that there are a significant number of American families that
have said they couldn't meet a $400 or $500 emergency. Think about what
happens to them when they face a $4,000 or a $40,000 healthcare bill.
That is what the Affordable Care Act has been all about.
So today we see the chapter in the TrumpCare story that Mr. Roskam
and his colleagues are offering for Trump and all of his cohorts. And
what is it? It is the 5 percent solution, because we know that health
savings accounts have been used by exactly 5 percent of those who earn
less than $100,000.
So, as usual, the Trump approach is let's do more for the few, and to
heck with the many, the many people who are out there for whom health
savings accounts provide little or no protection.
Now, of course, it is a valuable tax shelter for some people who are
a little bit more prosperous in our society, and that is fine, but I
believe we need to make healthcare accessible to more people.
And then there is the additional problem that Mr. Roskam and his
colleagues have decided to pay for their package of bills, $100 billion
of bills, by borrowing just a little bit more. After all the trillions
of dollars that they have borrowed from the Saudis and the Chinese and
people here at home, wherever they can find somebody who will take
their IOU, they want to borrow a little more money, $100 billion,
almost, to finance this package of bills to help that 5 percent of the
families who earn less than $100,000.
I offered an amendment, recognizing that it wouldn't correct all the
flaws of TrumpCare, but that it would address one central problem, and
that is the problem of preexisting conditions.
What is a preexisting condition? Well, it is whatever an insurance
company wants to point to to deny you coverage before the Affordable
Care Act.
I do think that our Republican colleagues are afflicted with a very
serious preexisting condition. It is called amnesia. They have
forgotten what healthcare was like for families before the Affordable
Care Act came into existence and prohibited these preexisting
conditions not only for those who went to the marketplace, but across
the board, to prevent preexisting conditions from being used against
someone to deny them coverage or to limit the coverage that they got.
The kind of people whom I came in contact with as we worked on the
Affordable Care Act who were determined to have preexisting conditions
were a victim of domestic violence, someone who was born with a
disability, and someone who had an accident or an illness and found
themselves with some lingering effects of that. They would either be
denied coverage altogether, or they would find in the fine print of
their insurance policy significant limitations on that insurance. The
insurance would cover them for everything except what they needed
insurance for.
Now, after the Republican attempt--and not just one, but 60 or 70
attempts--to repeal the Affordable Care Act failed in the United States
Senate, thanks to the courage of a few there and of the many across
this country who said, ``We don't want it repealed,''

[[Page H7663]]

now that it has failed, they have devoted the last year to doing
everything in the book to try to sabotage the Affordable Care Act.
They won't stabilize health insurance markets. They won't focus on
reducing premiums. They won't focus on strengthening and correcting any
of the shortcomings within the Affordable Care Act, like the need to
rein in the prescription drug price gouging.
So instead of expanding accessible coverage, what they do is to
expand a healthcare tax shelter for a few people.
Having done so much harm, they tell us today that they are not
advocating junk insurance. Well, let's talk about junk insurance,
because I think they are right in the junkyard on it.
President Trump's administration is out there telling the courts that
they cannot defend the protections in the Affordable Care Act.
The SPEAKER pro tempore (Mr. Mitchell). The time of the gentleman has
expired.
Mr. LEVIN. Mr. Speaker, I yield an additional 2 minutes to the
gentleman from Texas.
Mr. DOGGETT. Mr. Speaker, they can't defend, and they refuse to
defend, the preexisting conditions provisions that protect, in Texas,
it is almost half of the population who are said to have some type of
preexisting condition.

{time} 1715

So the administration won't protect those with preexisting
conditions. They are hoping to erode that protection. And when I
offered a one-paragraph amendment, Republicans refused it without any
decent explanation in our committee to ensure that the preexisting
condition provision was in any policy that would be purchased under
this plan.
So what you will be left with, as my colleague from California
explained, are junk insurance plans. They are the kind that promise
great coverage, but down in the fine print of the policy, you don't
have coverage when you need it. They are skinny insurance plans that
aren't about the size of the person, but the size of the coverage, that
it doesn't cover very much. And those kinds of plans are the kind that
we will end up having.
We have a saboteur-in-chief, not only when it comes to our military
alliances and our friends abroad but, with this President, with
reference to healthcare. These bare-bones, junk insurance policies will
not get the job done.
I think of the many people whom I represent in central Texas, and I
am sure they are not unlike people in the suburbs of Chicago.
They are people like Colleen, who is a bookkeeper. She adopted her
son through the foster care system when he was 18 months old. Unknown
to her, he had a preexisting condition; and she learned that she had a
preexisting condition. And as she said: ``The Affordable Care Act made
my family possible.''
I think of people like Theresa in San Antonio, who says that, before
the Affordable Care Act, she found herself repeatedly digging out of
medical debt because of a preexisting condition.
I think of a constituent who called me during the debate of the
Affordable Care Act because her sister could not get coverage for
cancer.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. LEVIN. Mr. Speaker, I yield an additional 30 seconds to the
gentleman from Texas.
Mr. DOGGETT. Mr. Speaker, her sister could not get coverage. Though
she had substantial chemotherapy coverage, it was not enough to cover
the full amount of the treatment that she needed.
We cannot go back. These folks would drag us back along with the
chief saboteur of healthcare in this country. We don't want to return
to the fine print restrictions, to the clever caveats. We need
comprehensive coverage.
The Affordable Care Act can be made better, and I believe we are
going to have a Congress that will do just that if we defeat this
effort.
Mr. ROSKAM. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, let's talk about the 5 percent solution. So, if you are
in the 5 percent, you need a solution. Five percent of this country is
millions of people who are in HSAs.
And the characterization of something as a tax shelter, as the
gentleman from Texas just characterized, is a completely loaded and
pejorative term.
So where do we go for some level of clarity? Let's go to the Joint
Committee on Taxation, and the question that was posed to them was:
Show us the tax returns of people who take advantage or who are in a
health savings account.
In 2015, 71 percent of returns reported an income of $200,000 or
less. Are those rich people? I don't think so. And, in addition, 28
percent reported income of $75,000 or less.
So the hyperbole, the overstatement, the mischaracterization, I think
is ``rich.''
And did you notice something, Mr. Speaker? I laid out the President's
promise: You like your coverage, you get to keep your coverage. You
like your doctor, you get to keep your doctor. And we are going to save
$2,500 per year per family.
There has been silence on the other side of the aisle, and I predict
that that won't be answered all afternoon. Do you want to know why?
Because there is no answer.
For real answers, I yield 3 minutes to the gentleman from Tennessee
(Mr. Roe).
Mr. ROE of Tennessee. Mr. Speaker, I rise today in support of H.R.
6311. This bill makes a number of welcome changes to our broken
healthcare system to put patients back in charge of their healthcare.
I have been a physician in rural east Tennessee for over 30 years.
Mr. Speaker, we heard about how the tax bill had caused these premiums
to go up. Let me tell you what has happened in the State of Tennessee.
Since the ACA took place, the number of options went down and the
premiums have gone up, on average, 175 percent.
Let me say this: In the hospital where I practiced, a university
hospital, the majority of people with uncollectible debt are people
with insurance.
Let me say that again. The majority of uncollectible debt are people
with insurance.
Why? Because the out-of-pockets and copays are so high that they
can't afford it. And that is one of the reasons we need this bill.
And let me say, also, that a year ago I was facing a major operation,
Mr. Speaker, a cancer operation. I had the ACA insurance. I looked at
what my out-of-pocket was, what my copays were, what my premiums were,
and what my employer, the taxpayers of this country, paid for me. I
would have been better off if I had just written a check for the cost
of that cancer operation that I had. I had an insurance card. I didn't
have insurance coverage. That is what I had with the ACA so-called
insurance.
Now that the mandate is gone--I want to say this--we heard: Oh,
goodness, the sky is falling because premiums are going to go up. In
Tennessee, our premiums actually went down 10 percent from the major
insurer in the State, Blue Cross, and for that we are eternally
grateful in my State.
What we want, now that the mandate has gone, this bill will help
create a more affordable copper plan option which will allow the tax
credit recipients to use their credit to pay for coverage. This is
something we should look at to expand. In fact, Senator Alexander and
Congressman Duncan have introduced legislation which would allow
consumers to purchase an off-market plan when there are limited
options.
In my district, in the First District of Tennessee, almost as many
people, within a few hundred, paid the penalty tax, whatever Justice
Roberts wanted to call it, as actually got a subsidy. Almost as many
people paid it. So what good is it?
All of these changes are long overdue. Americans have dealt with the
crushing costs associated with ObamaCare, and we are trying to give
them as much relief as possible. By passing this bill today, we will
return control to patients to determine what level of coverage is best
for them and their families rather than the government making an
arbitrary decision for them.
If we had a system of healthcare in this country where it was patient
centered and market driven, these changes would be unnecessary.
Instead, we still have a top-down, government-knows-

[[Page H7664]]

best approach to healthcare that continues to cost folks all across the
country more than they can afford.
I support the provisions in this bill because I have worked very hard
to get to it.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. ROSKAM. Mr. Speaker, I yield the gentleman an additional 30
seconds.
Mr. ROE of Tennessee. Mr. Speaker, I will finish by saying that the
current system under ObamaCare is unsustainable, and we must increase
affordable options or the system will collapse.
Finally, I will put it this way: We need to put patients and
doctors--no insurance companies and bureaucrats--in charge of
healthcare decisions in this country. That is what a health savings
account does, and I encourage all of my colleagues to support this.
Mr. LEVIN. Mr. Speaker, how much time do I have remaining?
The SPEAKER pro tempore. The gentleman from Michigan has 6\1/2\
minutes remaining. The gentleman from Illinois has 14 minutes
remaining.
Mr. LEVIN. Mr. Speaker, I reserve the balance of my time.
Mr. ROSKAM. Mr. Speaker, I yield 3 minutes to the gentleman from Ohio
(Mr. Stivers).
Mr. STIVERS. Mr. Speaker, I want to thank the gentleman from Illinois
for yielding me time.
Mr. Speaker, I rise today to support H.R. 6311, and more
specifically, I rise to support bipartisan language to make flexible
spending accounts flexible.
While 44 percent of Americans have access to flexible spending
accounts, flexible spending accounts have not been flexible. There are
two problems:
Under ObamaCare, flexible spending account contributions were capped
at $2,650. And while the average American spends more than $5,700 in
out-of-pocket healthcare costs, it is just not enough.
The second problem is flexible spending account rules make people use
it or lose it at the end of the year, and they can't roll over their
money. They have to spend it on things they don't need or they have to
lose that money.
Our bipartisan solution solves those problems by doing two things:
First, it increases the limit on FSA accounts by a multiple of three
to $7,950. And I did the math for the ranking member. That total would
be, over 3 years, if you wanted to save $50 a week, you could
accumulate $7,950. Obviously, that would be if you weren't using it, so
it would probably take longer than that to accumulate that kind of
money. But, again, that is well over the average of $5,700 of out-of-
pocket expenses that the average American has.
And, by the way, while flexible spending accounts are accessible to
people, one of the reasons people like them is they make out-of-pocket
expenses more affordable for individuals because those contributions
are pretax dollars.
The second thing our bipartisan language does is it allows the
balance to be rolled over at the end of the year up to that $7,950
limit. The rollover provision keeps people from losing their money or
making healthcare expenses that are wasteful at the end of the year.
Mr. Speaker, I urge my colleagues to support the flexible spending
account language and the underlying bill.
Mr. LEVIN. Mr. Speaker, I yield 2 minutes to the gentlewoman from
Michigan (Mrs. Lawrence), my colleague.
Mrs. LAWRENCE. Mr. Speaker, I rise to speak against H.R. 6311.
This bill does no favor for the average working American. This is yet
another bill to sabotage the Affordable Care Act and make healthcare
more expensive for those who need it the most.
Expanding these health savings accounts, which are simply investment
accounts, doesn't cover basic healthcare. It does not help the average
American who needs true healthcare.
This Republican legislation will not help my constituents in
Michigan. It does not serve the need of access to healthcare for
America's most vulnerable. The bill does not serve seniors either. It
hurts them by drawing Medicare recipients into high-cost care.
In Michigan, 92 percent of Medicare beneficiaries make under $50,000,
and 14 percent are Black seniors who live below the poverty line. We
know seniors can't afford this.
We also know this bill will drain more money from Medicare by adding
$60 billion to the deficit.
We need affordable care for everyone, not unaffordable health plans
for a few. This bill would destabilize and destroy affordable
healthcare.
Mr. ROSKAM. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, there is nothing in this bill that is destructive at
all. The entire structure of the bill is invitational. The bill
presumes the status quo in terms of the Affordable Care Act, and it
allows people to get in sync with the Affordable Care Act, and it
allows them to save money in a tax-free manner.
I am really surprised at the hyperbole, the overstatement, and the
over characterization. Nobody has answered either, Mr. Speaker, if you
will notice, my admonition about the characterization of junk
insurance. To attribute that claim, which we have heard from a couple
of speakers this afternoon, against this bill is to attribute that
claim and that criticism against the ACA, because the underlying bill
matches exactly what the ACA purports, that is, catastrophic coverage.
It simply says, if you have that coverage and your deductibles take
your breath away, good news; you can save on a tax-free basis.
So I think, with all due respect to the talking point writers and all
due respect to the critics of this bill, I think the entire debate
would be uplifted somewhat if we were debating the actual bill that is
before us instead of tweets and news feeds and so forth.
Mr. Speaker, I reserve the balance of my time.
Mr. LEVIN. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, as I close, I think back some years ago when we were
working on ACA. It was one of our proudest achievements. The
Republicans, from day one, were determined to destroy it. ACA can be
made better, but destruction is not improvement.
This bill, when you put it together, is not only unpaid for, but
would be a step to try to undermine the basic thrust of the ACA, to
replace these basic provisions with something much less.
In a word, the Republicans are on the wrong side of history, and the
clock is ticking.

{time} 1730

These bills, when you put them all together, essentially say, these
are another way to undercut ACA. This is a very, very weak--and I think
worse than a weak set of alternatives. They have never been able to
come up with a comprehensive bill, and this effort is the opposite. As
we have mentioned, relatively few people with lower income can access
these. So many of the people who access HSAs are people who can afford
it.
We can make it better. But don't come here when you have had no
alternative to say that this is something that could replace ACA. You
don't pay for it. You are reckless. This, as I said earlier, is a
reckless bill of the chairman of our subcommittee.
So I urge my colleagues to reject this and to not be fooled. We
Democrats come to the floor with a sense of being on the right side of
history. What is happening in this country is that more and more of the
public acknowledge it. Compared to when we first started, I remember
going back home, there was so much opposition, so much misguided. But
when people--20 million--for the first time, in most cases, had
healthcare, the clock began to tick in the direction of universal care.
You are trying to turn back the clock, you Republicans, but it is
ticking more and more towards universality. That is what is happening
in this country. And this is becoming part of the bedrock, the
foundations of care and of provisions for the benefit of the American
people as Social Security was, as Medicare was, and as Medicaid was.
You are going to pay the price for your blind opposition. The public
is more and more aware, as their eyes have been opened and as their
health has been protected, what this has meant to millions of families
in this country--millions. I run into it every day I go home, people
who come and say: Without healthcare coverage,

[[Page H7665]]

where would I be? Not only financially, but where would I be and what
is so dear to me, my health and the health of our families and the
health of our kids?
I urge we Democrats to stand up tall and say to the American public:
The ACA was a major historic step in the right direction. The
Republicans continue to try to destroy it. History is showing that,
once again, they were moving in the wrong discretion.
Mr. Speaker, I urge that we reject this bill and move proudly
forward. We put together this step. We are going to continue to move
forward.
Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. Members are reminded to direct their remarks
to the Chair.
Mr. ROSKAM. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I served on the Ways and Means Committee when the ACA
was passed, and I recall then-minority ranking member Dave Camp from
Michigan, who went on to become the chairman later, offered an
alternative to the ACA.
He inquired of then-chairman Rangel: When are we going to get to the
Republican alternative? When are we going to get to the Republican
alternative?
I remember this because I was sitting--I think I had the same seat
that Mr. Higgins from New York has--down in front on the left side of
the dais.
Charlie Rangel evoked an old gospel song. He said: Soon and very
soon, which is why I remember.
Now, soon and very soon never came for that amendment. Soon and very
soon never came for the Republican alternative to be considered in the
Ways and Means Committee.
Now what we are dealing with is the reality of the Affordable Care
Act. Mr. Speaker, what we are proposing is to say: Look, we have got
some suggestions; we think we can make this better.
Is this reckless? I think not. I fundamentally reject that. When you
accept the entire premise of the current structure of the Affordable
Care Act, and you take something that pre-existed within the Affordable
Care Act, that is health savings accounts, and you attach it and you
expand it, where is the defensiveness?
This is what is amazing to me about this debate. This is why our
country is stuck. Our friends on the other side of the aisle have
created the Affordable Care Act, and it is orthodoxy. To take it on and
to try to make improvements--they say they want improvements.
They say: Oh, let's work together.
All afternoon with Ms. Jenkins here on the House floor, she was
managing time of bills that were bipartisan in nature, bipartisan as
they went through the committee, but you got none of that veneer of
bipartisanship as they were discussed on the floor. They were perceived
as a direct attack at what? Orthodoxy.
So notwithstanding the invitation to work on both sides of the aisle,
the other side is making it very clear that they are unwilling to take
the structure of the ACA, to take favorable tax treatment and help more
people save their own money and spare themselves the results of a law
that our friends on the other side of the aisle said that you could
keep your doctor, you could keep your coverage, and you would save
$2,500 per person--and, again, I reiterate, Mr. Speaker, did you notice
there was no answer to that charge this afternoon?
I laid it out twice and now a third time; and absolute silence.
Why? Because they oversold. Now when they have got friends on this
side of the aisle who are saying: Look, we can improve this. Let's work
here. No, we don't like the ACA, but we can work through some of these
things, then, all of a sudden, it is stiff-arm. Then, all of a sudden,
it is insincere. Then, all of a sudden, it is political.
This is good work, this is serious work, and it is work that is
designed to bring relief to people who are suffering, who have no
interest in the nature of a donkeys-and-elephants debate on the House
floor. Most people's eyes glaze over.
Most people say they want remedies. This is a remedy that makes
sense. This is a remedy in sync with the ACA in some ways. The
responses we have heard from the other side I don't think are
persuasive.
Mr. Speaker, I urge the passage of H.R. 6311, 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.

Motion to Recommit

Ms. FRANKEL of Florida. Mr. Speaker, I have a motion to recommit at
the desk.
The SPEAKER pro tempore. Is the gentlewoman opposed to the bill?
Ms. FRANKEL of Florida. I am opposed in its current form.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Ms. Frankel of Florida moves to recommit the bill H.R. 6311
to the Committee on Ways and Means with instructions to
report the same back to the House forthwith with the
following amendment:
At the end, add the following:

SEC. 10. RESTORATION OF MEDICARE TRUST FUND SOLVENCY.

Notwithstanding any other provision of this Act, no
amendment made by this Act shall take effect until the annual
reports of the Board of the Trustees of the Federal Hospital
Insurance Trust Fund established under section 1817 of the
Social Security Act and the Federal Supplementary Medical
Insurance Trust Fund established under section 1841 of the
Social Security Act indicate the reduction of solvency of
such trust funds by reason of Public Law 115-97 (and the
amendments made thereby) have been reversed.

Ms. FRANKEL of Florida (during the reading). Mr. Speaker, I ask
unanimous consent to dispense with the reading.
The SPEAKER pro tempore. Is there objection to the request of the
gentlewoman?
There was no objection.
The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman is
recognized for 5 minutes in support of her motion.
Ms. FRANKEL of Florida. Mr. Speaker, this is the final amendment to
the bill which will not kill the bill or send it back to committee. If
adopted, the bill will immediately proceed to final passage, as
amended.
Mr. Speaker, my motion will make this bill much better. It is going
to delay this legislation from going into effect until we clean up one
of the messes caused by the Republican tax scam, the big giveaway to
the richest few in this country at the expense of most Americans.
Now, listen to this. The 2018 Medicare trustee report predicts that
the Medicare trust fund will be depleted in 2026--3 years earlier than
predicted in last year's report.
Now, Mr. Speaker, why is this? Not a big surprise. The $2.3 trillion
Republican tax cut for the benefit of corporations and billionaires has
shortchanged the longevity of the fund that pays for the healthcare of
58 million seniors. It is called Medicare, a program that celebrates
its 53rd year anniversary this month, a system that seniors have spent
a lifetime paying into.
Just ask Eve in my hometown of West Palm Beach who relies on skilled
nursing care, like the 1.8 million Eves in this country; or Irving in
Delray, who had his prostate removed. Like Irving, 6.6 Americans rely
on Medicare to pay for their hospital visits every year.
Medicare helps to keep our grandmothers and grandfathers healthy and
repair them when they are sick. It allows men and women who raised
families and built their country to retire in dignity without paying
every last dollar for their needed well-care visit, their blood
pressure medicine, or their hip replacement.
Mr. Speaker, I urge my colleagues to do the right thing for the folks
whom we love and who love us, take the time to fix this legislation,
and put the money back into the Medicare trust fund, that was cruelly--
I say cruelly--stolen by the Republican tax scam, the giveaway to the
richest 1 percent and the big corporate interests.
Let's keep Medicaid alive and well. Please support this motion to
recommit.
Mr. Speaker, I yield back the balance of my time.
Mr. ROSKAM. Mr. Speaker, I claim the time in opposition.
The SPEAKER pro tempore. The gentleman from Illinois is recognized
for 5 minutes.

[[Page H7666]]

Mr. ROSKAM. Mr. Speaker, I urge us to reject this motion to recommit.
The hospital insurance trust fund isn't going to be insolvent purely
because we are freeing Americans from the individual mandate. This
crisis has been going on for decades.
Mr. Speaker, I urge a ``no'' vote, and I yield back the balance of my
time.
The SPEAKER pro tempore. Without objection, the previous question is
ordered on the motion to recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Ms. FRANKEL of Florida. Mr. Speaker, on that I demand the yeas and
nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule
XX, this 15-minute vote on the motion to recommit will be followed by
5-minute votes on:
Passage of H.R. 6311, if ordered; and
Passage of H.R. 6199.
The vote was taken by electronic device, and there were--yeas 187,
nays 229, not voting 12, as follows:

[Roll No. 375]

YEAS--187

Adams
Aguilar
Barragan
Beatty
Bera
Beyer
Bishop (GA)
Blum
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brady (PA)
Brown (MD)
Brownley (CA)
Bustos
Butterfield
Capuano
Carbajal
Cardenas
Carson (IN)
Cartwright
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly
Cooper
Correa
Costa
Courtney
Crist
Crowley
Cuellar
Cummings
Davis (CA)
Davis, Danny
DeFazio
DeGette
Delaney
DeLauro
DelBene
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Engel
Eshoo
Espaillat
Esty (CT)
Evans
Foster
Frankel (FL)
Fudge
Gabbard
Gallego
Garamendi
Gomez
Gonzalez (TX)
Gottheimer
Green, Al
Green, Gene
Grijalva
Gutierrez
Hastings
Heck
Higgins (NY)
Himes
Hoyer
Huffman
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson, E. B.
Jones
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kihuen
Kildee
Kilmer
Kind
Krishnamoorthi
Kuster (NH)
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee
Levin
Lewis (GA)
Lieu, Ted
Lipinski
Loebsack
Lofgren
Lowenthal
Lowey
Lujan Grisham, M.
Lujan, Ben Ray
Lynch
Maloney, Carolyn B.
Matsui
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moore
Moulton
Murphy (FL)
Nadler
Napolitano
Neal
Nolan
Norcross
O'Halleran
O'Rourke
Pallone
Panetta
Pascrell
Payne
Pelosi
Perlmutter
Peters
Peterson
Pingree
Pocan
Polis
Price (NC)
Quigley
Raskin
Rice (NY)
Richmond
Rosen
Roybal-Allard
Ruiz
Ruppersberger
Rush
Ryan (OH)
Sanchez
Sarbanes
Schakowsky
Schiff
Schneider
Schrader
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shea-Porter
Sherman
Sires
Smith (WA)
Soto
Suozzi
Swalwell (CA)
Takano
Thompson (CA)
Thompson (MS)
Titus
Tonko
Torres
Tsongas
Vargas
Veasey
Vela
Velazquez
Visclosky
Wasserman Schultz
Waters, Maxine
Watson Coleman
Welch
Wilson (FL)
Yarmuth

NAYS--229

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

NOT VOTING--12

Bass
Black
Blackburn
Cramer
Dunn
Ellison
Frelinghuysen
Hanabusa
Maloney, Sean
Palazzo
Speier
Walz

{time} 1807

Messrs. REED, KINZINGER, MacARTHUR, RUSSELL, BRAT, BISHOP of Utah,
and RICE of South Carolina changed their vote from ``yea'' to ``nay.''
Mr. SOTO, Mses. JAYAPAL and BROWNLEY of California, Mrs. NAPOLITANO,
Messrs. O'HALLERAN and GOTTHEIMER changed their vote from ``nay'' to
``yea.''
So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
Stated against:
Mr. DUNN. Mr. Speaker, I was unavoidably detained. Had I been
present, I would have voted ``nay'' on rollcall No. 375.
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.

Recorded Vote

Mr. LEVIN. Mr. Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. This is a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 242,
noes 176, not voting 10, as follows:

[Roll No. 376]

AYES--242

Abraham
Aderholt
Allen
Amash
Amodei
Arrington
Babin
Bacon
Banks (IN)
Barletta
Barr
Barton
Bera
Bergman
Biggs
Bilirakis
Bishop (MI)
Bishop (UT)
Blum
Bost
Brady (TX)
Brat
Brooks (AL)
Brooks (IN)
Buchanan
Buck
Bucshon
Budd
Burgess
Bustos
Byrne
Calvert
Carter (GA)
Carter (TX)
Chabot
Cheney
Cloud
Coffman
Cole
Collins (GA)
Collins (NY)
Comer
Comstock
Conaway
Cook
Costello (PA)
Crawford
Cuellar
Culberson
Curbelo (FL)
Curtis
Davidson
Davis, Rodney
Denham
DeSantis
DesJarlais
Diaz-Balart
Donovan
Duffy
Duncan (SC)
Duncan (TN)
Dunn
Emmer
Estes (KS)
Faso
Ferguson
Fitzpatrick
Fleischmann
Flores
Fortenberry
Foxx
Frelinghuysen
Gaetz
Gallagher
Garrett
Gianforte
Gibbs
Gohmert
Gonzalez (TX)
Goodlatte
Gosar
Gottheimer
Gowdy
Granger
Graves (GA)
Graves (LA)
Graves (MO)
Griffith
Grothman
Guthrie
Handel
Harper
Harris
Hartzler
Hensarling
Herrera Beutler
Hice, Jody B.
Higgins (LA)
Hill
Holding
Hollingsworth
Hudson
Huizenga
Hultgren
Hunter
Hurd
Issa
Jenkins (KS)
Jenkins (WV)
Johnson (LA)
Johnson (OH)
Johnson, Sam
Jordan
Joyce (OH)
Katko
Kelly (MS)
Kelly (PA)
King (IA)
King (NY)
Kinzinger
Knight
Kuster (NH)
Kustoff (TN)
Labrador
LaHood
LaMalfa
Lamb
Lamborn
Lance
Latta
Lesko
Lewis (MN)
LoBiondo
Long
Loudermilk
Love
Lucas
Luetkemeyer
MacArthur
Marchant
Marino
Marshall
Massie
Mast
McCarthy
McCaul
McClintock
McHenry
McKinley
McMorris Rodgers
McSally
Meadows
Messer
Mitchell
Moolenaar
Mooney (WV)
Mullin
Murphy (FL)
Newhouse
Noem
Norman
Nunes
O'Halleran
Olson
Palmer
Paulsen
Pearce
Perry
Peterson
Pittenger

[[Page H7667]]

Poe (TX)
Poliquin
Posey
Ratcliffe
Reed
Reichert
Renacci
Rice (SC)
Roby
Roe (TN)
Rogers (AL)
Rogers (KY)
Rohrabacher
Rokita
Rooney, Francis
Rooney, Thomas J.
Ros-Lehtinen
Rosen
Roskam
Ross
Rothfus
Rouzer
Royce (CA)
Russell
Rutherford
Sanford
Scalise
Schweikert
Scott, Austin
Sensenbrenner
Sessions
Shimkus
Shuster
Simpson
Sinema
Smith (MO)
Smith (NE)
Smith (NJ)
Smith (TX)
Smucker
Stefanik
Stewart
Stivers
Taylor
Tenney
Thompson (PA)
Thornberry
Tipton
Trott
Turner
Upton
Valadao
Wagner
Walberg
Walden
Walker
Walorski
Walters, Mimi
Weber (TX)
Webster (FL)
Wenstrup
Westerman
Williams
Wilson (SC)
Wittman
Womack
Woodall
Yoder
Yoho
Young (AK)
Young (IA)
Zeldin

NOES--176

Adams
Aguilar
Barragan
Beatty
Beyer
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brady (PA)
Brown (MD)
Brownley (CA)
Butterfield
Capuano
Carbajal
Cardenas
Carson (IN)
Cartwright
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly
Cooper
Correa
Costa
Courtney
Crist
Crowley
Cummings
Davis (CA)
Davis, Danny
DeFazio
DeGette
Delaney
DeLauro
DelBene
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Engel
Eshoo
Espaillat
Esty (CT)
Evans
Foster
Frankel (FL)
Fudge
Gabbard
Gallego
Garamendi
Gomez
Green, Al
Green, Gene
Grijalva
Gutierrez
Hastings
Heck
Higgins (NY)
Himes
Hoyer
Huffman
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson, E. B.
Jones
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kihuen
Kildee
Kilmer
Kind
Krishnamoorthi
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee
Levin
Lewis (GA)
Lieu, Ted
Lipinski
Loebsack
Lofgren
Lowenthal
Lowey
Lujan Grisham, M.
Lujan, Ben Ray
Lynch
Maloney, Carolyn B.
Matsui
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moore
Moulton
Nadler
Napolitano
Neal
Nolan
Norcross
O'Rourke
Pallone
Panetta
Pascrell
Payne
Pelosi
Perlmutter
Peters
Pingree
Pocan
Polis
Price (NC)
Quigley
Raskin
Rice (NY)
Richmond
Roybal-Allard
Ruiz
Ruppersberger
Rush
Ryan (OH)
Sanchez
Sarbanes
Schakowsky
Schiff
Schneider
Schrader
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shea-Porter
Sherman
Sires
Smith (WA)
Soto
Suozzi
Swalwell (CA)
Takano
Thompson (CA)
Thompson (MS)
Titus
Tonko
Torres
Tsongas
Vargas
Veasey
Vela
Velazquez
Visclosky
Wasserman Schultz
Waters, Maxine
Watson Coleman
Welch
Wilson (FL)
Yarmuth

NOT VOTING--10

Bass
Black
Blackburn
Cramer
Ellison
Hanabusa
Maloney, Sean
Palazzo
Speier
Walz

{time} 1813

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

____________________