[Congressional Record Volume 164, Number 168 (Wednesday, October 10, 2018)]
[Senate]
[Pages S6738-S6747]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROVIDING FOR CONGRESSIONAL DISAPPROVAL UNDER CHAPTER 8 OF TITLE 5,
UNITED STATES CODE, OF THE RULE SUBMITTED BY THE SECRETARY OF THE
TREASURY, SECRETARY OF LABOR, AND SECRETARY OF HEALTH AND HUMAN
SERVICES RELATING TO ``SHORT-TERM, LIMITED DURATION INSURANCE''
Ms. BALDWIN. Mr. President, I move to proceed to Calendar No. 627,
S.J. Res. 63.
The PRESIDING OFFICER. The question is on agreeing to the motion.
The motion was agreed to.
The clerk will report the joint resolution by title.
The senior assistant legislative clerk read the joint resolution by
title:
A joint resolution (S.J. Res. 63) providing for
congressional disapproval under chapter 8 of title 5, United
States Code, of the rule submitted by the Secretary of the
Treasury, Secretary of Labor, and Secretary of Health and
Human Services relating to ``Short-Term, Limited Duration
Insurance.''
=========================== NOTE ===========================
On page S6738, October 10, 2018, in the first column, the
following appears: The clerk will report the joint resolution by
title. The senior assistant legislative clerk read the joint
resolution by title: A joint resolution (S.J. Res. 673) providing
for congressional disapproval under chapter 8 of title 5, United
States Code, of the rule submitted by the Secretary of the
Treasury, Secretary of Labor, and Secretary of Health and Human
Services relating to ``Short-Term, Limited Duration Insurance.''
The online Record has been corrected to read: The clerk will
report the joint resolution by title. The senior assistant
legislative clerk read the joint resolution by title: A joint
resolution (S.J. Res. 63) providing for congressional disapproval
under chapter 8 of title 5, United States Code, of the rule
submitted by the Secretary of the Treasury, Secretary of Labor,
and Secretary of Health and Human Services relating to ``Short-
Term, Limited Duration Insurance.''
========================= END NOTE =========================
The PRESIDING OFFICER. The Senator from Wisconsin.
Ms. BALDWIN. Mr. President, just over a year ago in this Chamber,
three brave Republican colleagues--Senator John McCain, Senator Susan
Collins, and Senator Lisa Murkowski--joined all Democrats in voting
against healthcare repeal legislation. They listened to the families of
their States.
I, too, voted against that repeal legislation because the people of
Wisconsin did not send me to Washington to take away their healthcare.
When congressional Republicans tried to pass repeal plans that would
allow insurance companies to charge more for preexisting conditions,
families across our country fought back.
When the Republican majority tried to charge older Americans an age
tax and make people pay more for less care, people let their voices be
heard and sent a loud message to Washington: Protect our care. They
sent us all a clear message that they want us to work across party
lines to protect the healthcare guarantees they depend on and to stand
up for those with preexisting health conditions. Yet defeating the
legislative efforts that would have made things worse for families
didn't end the threat to the American people.
The Trump administration has been trying to do what congressional
Republicans couldn't. They have been sabotaging our healthcare system
and rewriting the rules on guaranteed health protections and access to
affordable care that millions of Americans have today. This sabotage
has created instability in the healthcare market, contributing to
widespread premium spikes in 2018.
This administration ended the critical cost-sharing reduction
payments that made healthcare more affordable for almost 90,000
Wisconsinites. The Trump administration again slashed funding for
outreach efforts to help people sign up for healthcare.
Trusted navigator programs like those in Wisconsin have had their
funding cut by nearly 90 percent in the past 2 years. This will mean
fewer people in rural Wisconsin will receive the support they need to
obtain affordable coverage this year.
It doesn't stop there. The Trump administration has even joined
Wisconsin's Governor and Wisconsin's attorney general and other States
in going to court to support a lawsuit that would take away guaranteed
protections for people with preexisting conditions. If they succeed,
insurance companies will again be able to deny coverage or charge
higher premiums for the more than 130 million Americans with a
preexisting health condition. In fact, if the Affordable Care Act's
protections for people with preexisting conditions are struck down in
court, Wisconsin is among the States that has the most to lose.
According to the Kaiser Family Foundation, one out of every four
Wisconsinites has some sort of preexisting health condition, and they
simply cannot afford to have the healthcare they depend on threatened
with higher costs or coverage denials.
The Trump administration has expanded junk insurance plans. These
plans are cheap for a reason; they do not have to provide essential
health benefits like hospitalization, prescription drugs, and maternity
care.
According to the fine print of one of the plans sold in several
States, including my home State of Wisconsin--marketed by the Golden
Rule Company--the plan doesn't even have to cover hospital care on a
Friday or Saturday. It will be just your bad luck if you happen to get
sick and need healthcare on the weekend. The very first exclusion
states that it provides no benefits for a preexisting health condition.
The fine print also notes if you are pregnant, that will be considered
a preexisting health condition.
These junk insurance plans can deny healthcare coverage to people
with preexisting conditions when they need it the most, and that is why
I am leading this effort in the U.S. Senate to take action and stop
this sabotage.
This is personal to me. When I was 9 years old, I got sick. I was
really sick. I was in the hospital for 3 months. I eventually
recovered. When it came to health insurance, it was as if I had some
sort of scarlet letter. My grandparents, who raised me, couldn't find a
policy at any price that would cover me--not from any insurer--all
because I was a childhood branded with those words: ``preexisting
condition.''
This is also personal for Chelsey from Seymour, WI, whose daughter
was born with a congenital heart defect. Right now, Zoe is guaranteed
access to coverage without being denied or charged more because of her
preexisting condition.
Chelsey wrote me during that debate last year: ``I'm pleading to you
as a mother to fight for the kids in Wisconsin with pre-existing
conditions that are counting on you to protect that right.''
No parent or grandparent should have to lie awake at night wondering
if the healthcare they have today for themselves and their families
will be there tomorrow. With the expansion of these junk plans, that
fear could become a new reality for far too many families as healthy
people leave the market, increasing premiums for everyone.
Children like Zoe may not be able to find any plan that her parents
can afford or that will cover the care she needs. No family should be
forced to choose between helping a loved one get better or going
bankrupt.
Before the Affordable Care Act, too many families had to make that
choice. Before the healthcare law, I heard from Sue from Beloit, WI.
Sue's husband was diagnosed with lung cancer. They quickly found out
their insurance plan had a $13,000 limit on radiation and chemotherapy.
That covered about one round of chemotherapy. When they needed to
continue treatment, Sue and her family used all of their savings, and
then they maxed out all of their credit cards. When they were facing
insurmountable credit card debt, she told me: ``I had no choice but to
file bankruptcy.'' Sue's husband later died.
We can't go back to the days when insurance companies wrote the
rules, just as we cannot allow the Trump administration to rewrite the
rules on guaranteed healthcare protections that millions of Americans
depend on.
More than 20 of the leading healthcare organizations in America,
representing our Nation's physicians, patients, medical students, and
other health experts, are supporting this resolution to overturn the
Trump administration's expansion of junk insurance plans. They are
doing so because these junk plans will reduce access to quality
coverage for millions and increase costs.
These junk plans will charge people more for coverage based on their
preexisting conditions or deny them coverage outright. These junk plans
will leave cancer patients and survivors with higher premiums and fewer
insurance options. These junk plans will force premium increases on
older Americans.
I have heard my colleagues on the other side of the aisle say that
they are committed to protecting people with preexisting conditions.
Now is your chance to prove it. Anyone who says they support coverage
for people with
[[Page S6739]]
preexisting conditions should support this resolution to overturn the
Trump administration's expansion of these junk insurance plans.
This is an opportunity for Democrats and Republicans to come together
to protect people's access to quality, affordable healthcare when they
need it the most. Let us join in seizing the opportunity to do what is
right by the American people.
I yield.
The PRESIDING OFFICER. The Senator from Tennessee.
Mr. ALEXANDER. Mr. President, the resolution by the distinguished
Senator from Wisconsin is a resolution to say to the plumber who is
making $60,000 a year in Wisconsin or Tennessee: We want to keep your
insurance prices high. We don't want to reduce them by 70 percent, and
we want to keep 1.7 million people, according to the Urban Institute,
uninsured.
Let me say that again. If this resolution passes--if you vote yes--
you are saying to the plumber who makes $60,000 a year, who can't
afford to buy ObamaCare because his insurance premium is $20,000: We
are going to do everything we can to keep your insurance costs so high
that you can't afford it, and we are going to do everything we can to
keep 1.7 million Americans, according to the Urban Institute, from
having the option this short-term rule allows.
Let's see what we are talking about. We just heard eloquent comments
about preexisting conditions. This resolution has nothing to do with
preexisting conditions. It doesn't change one single word in the
Affordable Care Act, which guarantees that if you have a preexisting
condition, you have a right to buy ObamaCare, and you can't be charged
more because of it.
Let me say that again. This rule, which the Senator from Wisconsin
seeks to overturn, not only keeps you from lowering your cost 70
percent, but it has nothing to do with preexisting conditions because
it doesn't change one single word of the Affordable Care Act guarantee
that if you have a preexisting condition you can buy insurance and you
can't be charged more. A rule can't change a law. It couldn't if it
tried. That is one thing.
The second thing is that the rule that the Senator from Wisconsin
seeks to overturn is the same rule that was in effect during all of
President Obama's term. President Obama's administration allowed 1 year
of short-term plans for people who couldn't afford insurance, couldn't
find it anywhere else, or who might be between jobs. Even after the
Affordable Care Act passed in 2010, President Obama and the Democratic
Congress thought it was a good enough idea to allow these short-term
plans to continue that they kept them in the law. The law supporting
these plans has nothing to do with the Affordable Care Act. It was
passed in the 1990s for the purpose of giving people who need a short-
term option, which might cost less because it has less coverage, the
chance to buy insurance.
States can regulate these plans. States may decide what protections
they should have. States may decide what the price should be, but,
typically, in 2016, the difference between the cost of an ObamaCare
plan was $393 a month for an unsubsidized ObamaCare plan and for a
short-term plan it was $124. In other words, the short-term plan, which
the Democrats and the Senator from Wisconsin seek to overturn, which
was in existence all during the Obama administration and was authorized
in the 1990s, would cut the plumber's insurance cost by 70 percent.
Now, why should we put up with that? Why should we put up with that?
The Urban Institute, not known as a conservative organization, has said
that up to 1.7 million Americans will take advantage of President
Trump's short-term plan, which was the same as the Obama short-term
plan, except that under the Trump rule, you may do it for as much as 3
years instead of just 1 year. It says that 1.7 million Americans will
take advantage of that. That is a lot of people.
Eighty-three percent of Americans who buy ObamaCare have a subsidy to
help them pay for it. It is the 17 percent who don't have a subsidy who
are most likely to be helped by this. Many simply can't afford a
$20,000 health insurance plan if they don't qualify for a subsidy, and
this says: We understand that. You can buy a different sort of plan if
your State permits it. You can pay less with less coverage and at least
you will have some insurance. At least you will have some insurance.
But our Democratic friends say: Oh, no, we don't want to do anything
that would lower the cost of health insurance.
Sometimes I think our Democratic friends have elevated to the level
of the status of the 67th book of the Bible the Affordable Care Act, or
ObamaCare. They will not even change parts of it that they agree with.
Earlier this year, Senator Murray and I, and then Senator Nelson and
Senator Collins, all worked together with many Senators in a great
bipartisan way to come up with a piece of legislation that would
temporarily help with the high prices of health insurance. Make no
mistake about it. In Tennessee, health insurance has gone up about 170
percent since ObamaCare was passed. That means the plumber or the
farmer or the person making 50, 60, or $70,000 a year can't afford to
pay the $20,000 premium they might be required to pay.
So we had this temporary Alexander-Murray-Collins-Nelson proposal. I
can still see Senator Collins standing on the floor offering it saying,
as she said: Oliver Wyman--the respected Oliver Wyman agency--says this
will lower insurance premiums by 40 percent over 3 years for people in
the individual market--people who don't get a subsidy, hardworking
people who can't afford health insurance.
What happened? Even though the Democratic leader said it contained
provisions that every single Democrat could support, the Democrats
pulled the rug out from under it at the last minute by insisting on a
radical version of abortion funding that they had not required since
1976, except in the ObamaCare law.
In other words, they deliberately kept health insurance prices 40
percent higher than they otherwise would have been. Was it to have an
issue in the Presidential election or in the election this year? I have
no idea, but I could think of no reason why not to do that.
Then, there is another example. Secretary of Labor Acosta has come up
with another very good idea that has been talked about a lot within
this body before: Why not give employees of smaller companies the right
to buy the same kind of insurance that employees of IBM or big
companies buy?
About half of all of us who have insurance get it on the job. We are
pretty happy with it. It has a lot of protections in it--not as many as
ObamaCare but, apparently, Democrats thought those protections were
sufficiently strong, including preexisting condition, and sufficiently
strong not to tamper with it. So the idea was this: Let's let the
people who work in the company with 10 or 15 or 20 employees in Alaska,
Tennessee, or Wisconsin have the same opportunity to buy insurance as
the employee of a big company has.
Democrats said absolutely not.
So we don't want to lower rates by 40 percent by a temporary proposal
supported by President Trump, Speaker Ryan, Senator McConnell, and let
the Democratic leaders say all Democrats could vote for that policy. We
don't want to let employees of smaller companies have the same options
that employees of big companies have that would lower their insurance
and give them more choices. And now we are being asked to say you can't
have a 70-percent reduction in your health insurance--the same kind of
proposal you had all during the Obama years. Let me say that again.
President Obama thought it was just fine to have short-term healthcare
plans for up to 1 year during the entire Obama administration. They
changed the rules 22 days before the end of his term and reduced it to
3 months that you could buy these plans, but that wasn't enforced until
April.
So let's keep it simple. If you needed insurance, if you lost your
job, if you couldn't afford insurance during the Obama years, if
ObamaCare got too expensive for you during the Obama years, you could
buy short-term insurance for up to 1 year if your State allowed it.
What the Democrats are saying is this: No, we are not even going to
do what President Obama would do. So we are going to keep your
insurance high today with a yes vote. We are going to
[[Page S6740]]
say to 1.7 million people who are uninsured: No, you can't buy this
insurance because we know more than you do.
Some people who might know more than we do is the National
Association of Insurance Commissioners. Senate Democrats wrote to them
asking them about these short-term plans and raising questions about
them.
Here is what the National Association of Insurance Commissioners, a
bipartisan organization, wrote back:
Short-term, limited duration insurance meets the needs of
consumers for whom other types of coverage may not be
appropriate, affordable, or available.
State Insurance Commissioners say short-term limited duration
insurance, the type that a ``yes'' vote today would ban--those are my
words--meets the needs of consumers for whom other types of coverage
may not be appropriate, affordable, or available.
I hope that across this country, as Americans look at this today, you
would ask the Senator from Wisconsin and her Democratic colleagues: Why
do you want to kill a rule that President Obama favored, that existed
all during ObamaCare while he was there, that gave people who might
lose their jobs or couldn't afford ObamaCare a chance to buy insurance
that might be 70-percent cheaper? Why would you want to keep 1.7
million Americans who don't have insurance, according to the Urban
Institute, from being able to afford this short-term rule? What do you
have against lower cost insurance that doesn't change one word of the
Affordable Care Act's protection guarantee of preexisting conditions?
In other words, with this rule, if you still want to buy ObamaCare
and need preexisting insurance protection, you have it. This could not
possibly change that because it is a rule, not a law.
I hope today that we vote no and that we affirm the Trump rule, which
is the Obama rule, which is the rule that supports the Wisconsin,
Oklahoma, and Alaska plumber who makes $60,000 a year, can't afford
$20,000-a-year ObamaCare, gets no government subsidy, and needs this in
order to insure his family.
I yield the floor.
Ms. BALDWIN. Mr. President, I ask unanimous consent that the
following documents concerning the rule submitted by the Secretary of
the Treasury, Secretary of Labor, and Secretary of Health and Human
Services relating to short-term, limited duration insurance be entered
into the Record: a letter to Congress from 113 health organizations
expressing concerns with the rule, a letter from the National
Association of Insurance Commissioners requesting a delay in
implementation of the rule, a short-term medical plan brochure from the
Golden Rule Insurance Company outlining the policy's coverage
exclusions, and a news article from 2014 illustrating the lack of
consumer protections in short-term limited duration plans.
There being no objection, the material was ordered to be printed in
the Record, as follows:
April 17, 2018.
Dear Speaker Ryan, Leader McConnell, Leader McCarthy,
Leader Schumer and Leader Pelosi: Our 113 organizations
represent millions of people with serious, acute, and chronic
diseases and disabilities, as well as their caregivers. These
individuals, and all Americans, need access to comprehensive,
affordable health coverage in order to meet their medical
needs.
We write to express our concerns about the impact the
proposed rule regarding short-term limited duration plans
(STLDs) (CMS-9924-P) will have both on the health insurance
marketplaces and the individuals we represent. While short
term plans can offer less expensive coverage, they are not
required to adhere to important standards, including the ten
essential health benefit categories, guaranteed issue, out-
of-pocket maximums, age-rating protections, and many other
critical consumer protections These policies are also allowed
to charge much higher premiums, deny coverage altogether for
consumers who cannot meet medical underwriting standards, and
impose lifetime and annual limits on services. If the
proposed rule put forward by the Administration is finalized
in its current form, it will limit access to quality and
affordable health insurance coverage for all Americans, and
disproportionately harm individuals with pre-existing
conditions and people with disabilities.
Expanding access to these policies will likely cause
premiums in the individual insurance marketplace to increase
dramatically, as younger and healthier individuals choose to
enroll in cheap short-term plans. Allowing STLDs to
proliferate would force individuals, including those with
serious or chronic diseases and disabilities, into a smaller,
sicker market to obtain the coverage they need to manage
their health. Premiums for comprehensive plans that meet
federal standards would likely skyrocket, and plans would
likely exit the market. This will make insurance either
unavailable or unaffordable for those who rely on the
marketplace to get coverage
Our organizations are dedicated to identifying and
promoting improvements to our health insurance markets that
control costs, stabilize the market, and positively impact
coverage and care for millions of Americans. Expanding access
to STLDs will move us away from--not towards--achieving these
goals. As advocates for our communities, we implore you to
protect patients and consumers, including individuals with
pre-existing conditions and persons with disabilities, by
asking the Administration to withdraw this proposed rule
until it adequately protects patients and consumers, as well
as any rules that do not increase stability, improve
affordability, and secure access to quality coverage in our
insurance markets.
Sincerely,
AARP, Adrenal Insufficiency United, Adult Congenital Heart
Association, Adult Polyglucasan Body Disease Research
Foundation, Advocacy & Awareness for Immune Disorders
Association (AAIDA), Alliance for Aging Research, Alpha-1
Foundation, American Association of People with Disabilities,
American Association on Health & Disability, American Cancer
Society Cancer Action Network, American Diabetes Association,
American Heart Association, American Kidney Fund, American
Liver Foundation, American Lung Association, American
Multiple Endocrine Neoplasia Support, American Physical
Therapy Association, American Therapeutic Recreation
Association, Amyloidosis Support Groups.
Arthritis Foundation, Association of Oncology Social Work,
Autism Society, Autism Speaks, Autistic Self Advocacy
Network, Bazelon Center for Mental Health Law, Benign
Essential Blepharospasm Research Foundation, Brain Injury
Association of America, CancerCare, Caregiver Action Network,
Celiac Disease Foundation, Children's PKU Network, Consortium
of MS Centers, Crohn's & Colitis Foundation, Cutaneous
Lymphoma Foundation, Cystic Fibrosis Foundation, Disability
Rights Legal Center, Dystonia Advocacy Network, Dystonia
Medical Research Foundation, Easterseals.
Epilepsy Foundation, Family Voices, Fibrolamellar Cancer
Foundation, Fight Colorectal Cancer, FORCE: Facing Our Risk
of Cancer Empowered, GBS/CIDP Foundation International,
Global Colon Cancer Alliance, Hemophilia Federation of
America, Hyper IgM Foundation, Immune Deficiency Foundation,
Indian Organization for Rare Diseases, International Myeloma
Foundation, International Pemphigus and Pemphigoid
Foundation, International Waldenstrom's, Macroglobulinemia
Foundation, Interstitial Cystitis Association, Jack McGovern
Coats' Disease Foundation, Justice in Aging, LAL Solace,
Leukemia & Lymphoma Society.
Lung Transplant Foundation, Lupus Foundation of America,
Lutheran Services in America, Lymphangiomatosis & Gorham's
Disease Alliance, Lymphatic Education & Research Network, M-
CM Network, Malecare Cancer Support, March of Dimes, Mended
Little Hearts, Mental Health America, METAvivor, Muscular
Dystrophy Association, National Alliance on Mental Illness,
National Alopecia Areata Foundation, National Association for
Hearing and Speech Action, National Association of Councils
on Developmental Disabilities, National Association of State
Head Injury Administrators, National Comprehensive Cancer
Network, National Consumers League.
National Eosinophilia Myalgia Syndrome Network, National
Health Council, National Hemophilia Foundation, National LGBT
Cancer Project, National Multiple Sclerosis Society, National
Organization for Rare Disorders (NORD), National Patient
Advocate Foundation, National PKU Alliance, Inc., National
Spasmodic Dysphonia Association, NBIA Disorders Association,
NephCure Kidney International, Oncology Nursing Society,
Paralyzed Veterans of America, Parent Project Muscular
Dystrophy (PPMD), PKD Foundation, Platelet Disorder Support
Association, Prevent Cancer Foundation, PRP (Pityriasis Rubra
Pilaris) Alliance, Pulmonary Hypertension Association, Rare
and Undiagnosed Network (RUN).
Restless Legs Syndrome Foundation, Scleroderma Foundation,
Susan G. Komen, Tarlov Cyst Disease Foundation, TASH, The
American Liver Foundation, The APS Type 1 Foundation, Inc.,
The Desmoid Tumor Research Foundation, The Global Foundation
for Peroxisomal Disorders, The Guthy-Jackson Charitable
Foundation, The Lymphatic Malformation Institute, The Marfan
Foundation, United Ostomy Associations of America, US
Hereditary Angioedema Association, Vasculitis Foundation,
Worldwide Syringomyelia & Chiari Task Force.
[[Page S6741]]
____
National Association of Insurance Commissioners & The
Center for Insurance Policy and Research,
Washington, DC, April 23, 2018.
Re Short-Term, Limited-Duration Insurance CMS-9924-P.
Centers for Medicare & Medicaid Services, Department of
Health and Human Services,
Attention: CMS-9924-P,
Baltimore, MD.
To Whom It May Concern: Thank you for the opportunity to
comment on the proposed regulations on Short-Term, Limited
Duration Insurance published in the Federal Register on
February 21, 2018. These comments are submitted on behalf of
the members of the National Association of Insurance
Commissioners (NAIC), which represents the chief insurance
regulators in the 50 states, the District of Columbia, and
the 5 United States territories.
As state insurance regulators we have the primary
responsibility of regulating our insurance markets and
ensuring consumers are protected and the markets are
competitive. As we stated in our comments on the current
short-term, limited duration regulation, ``Federal
interference can, and often does, have unintended
consequences and may not be effective in addressing the
underlying issues.'' We argued that the arbitrary 3-month
limitation set by the Federal government could harm some
consumers and limit choices. Returning the Federal definition
to ``less than 12 months,'' as proposed, is consistent not
only with longstanding federal law but also with how this
term has been long defined by most states.
In the analysis of Economic Impact and Paperwork Burden
related to federalism, the proposed rule states:
Federal officials have discussed the issue of the term
length of short-term, limited duration insurance with State
regulatory officials. This proposed rule has no federalism
implications to the extent that current State law
requirements for short-term, limited duration insurance are
the same as or more restrictive than the Federal standard
proposed in this proposed rule. States may continue to apply
such State law requirements.
Consistent with this statement, any further requirements,
including but not limited to restrictions related to the
sale, design, rating or duration of these plans, must be left
to the States, which have the primary authority under our
federal system to regulate the business of insurance, so that
they can address the unique conditions and needs of their
respective insurance markets. It is critical that state
regulators maintain the flexibility to determine whether, and
under what conditions, these plans are appropriate for their
state. We urge continued state flexibility on this issue.
We also agree that educating consumers and ensuring that
they are aware of the limitations of these plans is
paramount. Some of these plans may provide significantly less
coverage and consumer protections than comprehensive plans.
We supported the disclosure requirements in the current
regulations and support the expansions in this proposed rule.
States have received several consumer complaints about
confusion and misinformation regarding their short-term or
excepted benefit plans. Because of the real risk that
consumers may confuse short-term policies with comprehensive
health insurance that complies with the Affordable Care Act
(ACA), it is important that they be made aware of any
limitations to these policies during the sales process. We
are pleased that the proposed rule retains these important
disclosure requirements and adds valuable additional
disclosures.
As drafted, this rulemaking does not address the impact of
Section 1557 of the ACA on the issuance of short-term,
limited duration plans. Specifically, it is unclear whether
or not these plans will be considered to be a ``health
program or activity'' under 45 C.F.R. Sec. 92.4 This
distinction is critical.
If these plans are not exempt from the definition of
``health plan or activity,'' the implication would be that
carriers could not offer these plans and also participate on
the Marketplace, Medicare, or Medicaid. In many states
throughout the country, carriers are deciding whether or not
to participate in the ACA-compliant marketplace, and if
clarifying language is not included carriers will be forced
to choose either to offer short-term, limited duration plans
or participate in the Exchange. We would ask for
clarification on this issue, and specifically advise that CMS
include language in the proposed definition of ``short-term,
limited duration insurance'' providing that such insurance is
``not a health program or activity as defined in 45 C.F.R.
Sec. 92.4.''
As to the issue of renewability, the members of the NAIC
concur that any decision over whether and when these plans
should be renewable should be left up to the States, not
dictated by the Federal government.
Finally, states are concerned about the timing of this
rule, and some states may want to modify existing laws and
regulations to protect consumers and state markets.
Therefore, we recommend that the final regulation allow
states, if they so choose, to begin enforcing the new rules
in 2020, thus giving them time to review their rules and seek
statutory or regulatory changes to facilitate a smooth
transition.
Thank you for this opportunity to comment. We are available
to discuss these or other issues as the Short-Term, Limited
Duration Proposed Rule is finalized.
Sincerely,
Julie Mix McPeak,
NAIC President, Commissioner, Tennessee Department of
Commerce & Insurance.
Raymond G. Farmer,
NAIC Vice President, Director, South Carolina Department of
Insurance.
Eric A. Cioppa,
NAIC President-Elect, Superintendent, Maine Bureau of
Insurance.
Gordon I. Ito,
NAIC Secretary-Treasurer, Commissioner, Insurance Division,
Hawaii Department of Commerce and Consumer Affairs.
____
UnitedHealthcare, Golden Rule Insurance Company
Short Term Medical Plans
STATES: AZ, FL, IA, IL, IN, MI, MS, NE, PA, TN, TX, WI, WV
This coverage is not required to comply with certain
federal market requirements for health insurance, principally
those contained in the Affordable Care Act. Be sure to check
your certificate carefully to make sure you are aware of any
exclusions or limitations regarding coverage of preexisting
conditions or health benefits (such as hospitalization,
emergency services, maternity care, preventive care,
prescription drugs, and mental health and substance use
disorder services). Your certificate might also have lifetime
and/or annual dollar limits on health benefits. If this
coverage expires or you lose eligibility for this coverage,
you might have to wait until an open enrollment period to get
other health insurance coverage. Also, this coverage is not
``minimum essential coverage.'' If you don't have minimum
essential coverage for any month in 2018, you may have to
make a payment when you file your tax return unless you
qualify for an exemption from the requirement that you have
health coverage for that month.
What's Not Covered (all plans)
This is only a general outline of the coverage provisions
and exclusions. It is not an insurance contract, nor part of
the insurance policy/certificate. You will find complete
coverage details in the policy/certificate Also see state
variations on pages 10-13.
general exclusions
Benefits will not be paid for services or supplies that are
not administered or ordered by a doctor and medically
necessary to the diagnosis or treatment of an illness or
injury, as defined in the policy.
No benefits are payable for expenses:
For non-emergency services or supplies received from a
provider who is not a network provider, except as
specifically provided for by the policy.
For a preexisting condition--A condition:
(1) for which medical advice, diagnosis, care, or treatment
was recommended or received within the 24 months immediately
preceding the date the covered person became insured under
the policy/certificate; or (2) that had manifested itself in
such a manner that would have caused an ordinarily prudent
person to seek medical advice, diagnosis, care, or treatment
within the 12 months immediately preceding the date the
covered person became insured under the policy/certificate.
A pregnancy existing on the effective date of coverage will
also be considered a preexisting condition.
Note: Even if you have had prior Golden Rule coverage and
your preexisting conditions were covered under that plan,
they will not be covered under this plan.
That would not have been charged if you did not have
insurance.
Incurred while your coverage is not in force.
Imposed on you by a provider (including a hospital) that
are actually the responsibility of the provider to pay.
For services performed by an immediate family member.
That are not identified and included as covered expenses
under the policy/certificate or are in excess of the eligible
expenses.
For services that are not covered expenses.
For services or supplies that are provided prior to the
effective date or after the termination date of the coverage.
For weight modification or surgical treatment of obesity,
including wiring of the teeth and all forms of intestinal
bypass surgery.
For breast reduction or augmentation.
For drugs, treatment, or procedures that promote
conception.
For sterilization or reversals of sterilization.
For fetal reduction surgery or abortion (unless life of
mother would be endangered).
For treatment of malocclusions, disorders of the
temporomandibular Joint (TMJ) or craniomandibular disorders.
For modification of the physical body in order to improve
psychological, mental, or emotional well-being, such as sex-
change surgery.
[[Page S6742]]
Not specifically provided for in the policy, including
telephone consultations, failure to keep an appointment,
television expenses, or telephone expenses.
For marriage, family, or child counseling.
For standby availability of a medical practitioner when no
treatment is rendered.
For hospital room and board and nursing services if
admitted on a Friday or Saturday, unless for an emergency, or
for medically necessary surgery that is scheduled for the
next day.
For dental expenses, including braces and oral surgery,
except as provided for in the policy/certificate.
For cosmetic treatment.
For reconstructive surgery unless incidental to or
following surgery or for a covered injury, or to correct a
birth defect in a child who has been a covered person since
childbirth until the surgery.
For diagnosis or treatment of learning disabilities,
attitudinal disorders, or disciplinary problems.
For diagnosis or treatment of nicotine addiction.
For charges related to, or in preparation for, tissue or
organ transplants, except as expressly provided for under
Transplant Services.
For high-dose chemotherapy prior to, in conjunction with,
or supported by ABMT/BMT, except as specifically provided
under the Transplant Expense Benefits provision.
For eye refractive surgery, when the primary purpose is to
correct nearsightedness, farsightedness, or astigmatism.
While confined for rehabilitation, custodial care,
educational care, nursing services, or while at a residential
treatment facility, except as provided for in the policy/
certificate.
For eyeglasses, contact lenses, hearing aids, eye
refraction, visual therapy, or any exam or fitting related to
these devices, except as provided for in the policy/
certificate.
Due to pregnancy (except complications), except as provided
in the policy/certificate.
For diagnostic testing while confined primarily for well-
baby care, except as provided in the policy/certificate.
For treatment of mental disorders or substance abuse
including court-ordered treatment for programs, except as
provided in the policy/certificate.
For preventive care or prophylactic care, including routine
physical examinations, premarital examinations, and
educational programs, except as provided in the policy/
certificate.
Incurred outside of the U.S., except for emergency
treatment.
Resulting from declared or undeclared war, intentionally
self-inflicted bodily harm (whether sane or insane); or
participation in a riot or felony (whether or not charged).
For or related to durable medical equipment or for its
fitting, implantation, adjustment or removal or for
complications therefrom, except as provided for in the
policy/certificate.
For outpatient prescription drugs, except as provided for
in the policy/certificate.
For surrogate parenting.
For treatments of hyperhidrosis (excessive sweating).
For alternative treatments, except as specifically covered
by the policy/certificate, including: acupressure,
acupuncture, aromatherapy, hypnotism, massage therapy,
rolfing, and other alternative treatments defined by the
Office of Alternative Medicine of the National Institutes of
Health.
Resulting from or during employment for wage or profit, if
covered or required to be covered by workers' compensation
insurance under state or federal law. If you entered into a
settlement that waives your right to recover future medical
benefits under a workers' compensation law or insurance plan,
this exclusion will still apply.
Resulting from intoxication, as defined by state law where
the illness or injury occurred, or while under the influence
of illegal narcotics or controlled substances, unless
administered or prescribed by a doctor.
For joint replacement, unless related to an injury covered
by the policy/certificate.
For non-emergency treatment of tonsils, adenoids,
hemorrhoids or hernia.
For injuries sustained during or due to participating,
instructing, demonstrating, guiding, or accompanying others
in any of the following: sports (professional, or semi-
professional, or intercollegiate except for intramural),
parachute jumping, hang-gliding, racing or speed testing any
motorized vehicle or conveyance, scuba/skin diving (when
diving 60 or more feet in depth), skydiving, bungee jumping,
or rodeo sports.
For injuries sustained during or due to participating,
instructing, demonstrating, guiding, or accompanying others
in any of the following if the covered person is paid to
participate or to instruct: operating or riding on a
motorcycle, racing or speed testing any non-motorized vehicle
or conveyance, horseback riding, rock or mountain climbing,
or skiing.
For injuries sustained while performing the duties of an
aircraft crew member, including giving or receiving training
on an aircraft.
For vocational or recreational therapy, vocational
rehabilitation, or occupational therapy, except as provided
for in the policy/certificate.
Resulting from experimental or investigational treatments,
or unproven services.
____
[From Bloomberg Businessweek, 2014-01-10]
The Trouble With Short-Term Health Plans in the Age of Obamacare
(By John Tozzi)
If you're shopping for health insurance, you may get a
pitch for something called a short-term medical plan. These
policies have been around forever and are aimed at recent
college grads, people between jobs, and new employees waiting
for group benefits to kick in. They're marketed by major
insurers including UnitedHealthcare Services, Humana, some
Blue Cross and Blue Shield carriers, and many smaller
companies.
Short-term plans have become more visible as some insurers
and brokers take advantage of the hoopla surrounding the
Affordable Care Act to market them as alternatives to the
policies available on the state and federal exchanges.
Although the plans look a little like those approved under
Obamacare, they provide less coverage and don't have to
adhere to the same rules. The companies are allowed to turn
away patients who are sick and refuse to cover preexisting
conditions. They don't have to pay for preventative care and
aren't required to renew a policy if a patient needs a lot of
medical care. ``If you get sick, it's not going to take care
of you,'' says Karen Pollitz, a senior fellow at the Kaiser
Family Foundation, a health researcher.
The short-term plans also don't satisfy the Obamacare
requirement that people have adequate coverage, so people who
buy them face the same tax penalties as the uninsured. Twenty
percent of short-term policyholders believed, wrongly, that
their coverage would be adequate under the ACA, according to
a survey published in September by EHealth, an online
brokerage that sells conventional and short-term policies. An
additional 64 percent said they weren't sure.
There's plenty of cause for the confusion. Assurant, one of
the larger sellers of the temporary medical plans, says on
its website that ``these plans do not meet minimum essential
coverage requirements'' and customers may face tax penalties.
But insurance agency Liberty Medicare in Wynnewood, Pa.,
called short-term plans ``a viable alternative to Obamacare
plans'' in a recent blog post, although the company also
noted that ``their benefits are not as broad as Obamacare
benefits.'' Even if the policies exclude preexisting
conditions, says president Gregory Lazarev, for ``healthy
people who are not entitled to subsidies, it makes perfect
sense to go and buy a short-term plan.''
20 Percent of short-term policy holders wrongly believe
their plan meets Obamacare standards.
``There definitely are some companies out there that are
aggressively marketing these and [similar] policies,''
Pollitz says. One making expansive claims is Health Insurance
Innovations, which connects consumers with short-term
policies from third-party insurers. The Tampa company, which
raised $65 million in an initial offering about a year ago,
is expecting a boost from the ACA, even though its plans
don't meet the law's requirements for adequate coverage. ``We
want to be ready to take full advantage of this unprecedented
degree of market expansion,'' Chief Executive Officer Michael
Kosloske said in a November earnings call. In an interview,
Kosloske says: ``Our benefits are the same or better than
what you're going to find, for example, on the exchanges.''
A sample policy sold by Kosloske's company suggests
otherwise. Unlike ACA plans, it doesn't cover immunizations
and routine physicals, outpatient prescription drugs,
preexisting conditions, pregnancy or childbirth, sports
injuries, substance abuse treatment, allergies, or kidney
disease. It also comes with a $2 million lifetime limit on
benefits, a provision banned under Obamacare rules.
Buying the stripped-down, short-term policy could save a
30-year-old Florida man $1,123 in premiums over a year,
compared with a typical bronze-level HMO plan from Humana. If
he earns $46,000 a year, he'd have to pay about 41 percent of
the savings in tax penalties for not having coverage
authorized by the ACA. The penalty rate will double in 2015.
If the hypothetical consumer earns $23,000 or less, federal
subsidies would make up the difference between the price of
the bronze plan and the short-term policy.
Kosloske points out that the bronze plan has exclusions,
too, and a limited network--it doesn't pay anything if you
see a doctor outside the plan. In the plan his company sells,
``covered benefits are paid the same way whether in or
outside the broad and highly accessible provider network,''
he says. Pollitz advises consumers to stay away from short-
term plans. ``It may cover your claims until your term of
coverage runs out,'' she says. But for anyone who gets sick
and hopes to renew, ``it's junk.''
The bottom line: Consumers buying cheaper, short-term
health plans get limited benefits and still have to pay
Obamacare penalties.
The PRESIDING OFFICER (Mr. Sullivan). The time of the majority has
expired.
Mr. INHOFE. Mr. President, I ask unanimous consent that I be
acknowledged to speak for 10 minutes.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
S. 3021
Mr. INHOFE. Mr. President, I don't think that is necessary because I
think I was scheduled to do that anyway.
What we are going to be addressing here in just a few minutes is a
very significant piece of legislation. We do a
[[Page S6743]]
lot of things around here that some people think are important, but
this is something that really is important. It is something that has a
long history behind it.
America's water infrastructure bill, known as the WRDA bill, was
started about 20 years ago, and we made a commitment at that time that
we would actually have a WRDA bill every 2 years. We didn't do that up
until 2014. In 2014, we had gone since 2007 since we had had one, and
this needs to be done to keep our water infrastructure going and the
things that we are supposed to be doing. So we did it in 2014 and 2016,
and now we will do the 2018 bill. That is what we are supposed to be
doing.
It is a great way to keep up the productive momentum that we have
seen in Congress leading up to the midterm election and delivering on
President Trump's promises.
The WRDA bill is another great example of what can happen when we
work with our friends across the aisle on issues that affect every
State of our Nation.
I was privileged to chair the Environment and Public Works Committee
during that timeframe, when we went back to every other year, and it is
something that has worked very well. People can depend on the resources
being there when the time comes. So I think right now it is a bill that
is sponsored by ourselves, along with the ranking members and the
Senators of that committee, the EPW Committee, and the Transportation
Subcommittee.
I want to take a moment to thank the members I just mentioned and
their staffs. The staffs are the ones who do the heavy lifting because
without our willingness to work together on this legislation, we
wouldn't be able to discuss it here on the floor today, and I
appreciate that dedication. It is going to happen today.
There are a lot of provisions in the bill that advance our Nation's
infrastructure priorities. In addition, the State of Oklahoma would
benefit in many ways as well.
One of the big secrets around the world and around America is that
Oklahoma is actually navigable. We have a navigation way that goes from
the Mississippi River all the way up to my hometown of Tulsa, with the
Port of Catoosa.
I can remember many years ago, when I was in the State legislature,
and some people came to me who were World War II veterans--one of the
groups that was doing a very good job--and they said: We would like to
be able to show and to demonstrate that we are navigable in Oklahoma.
If you will get us a submarine, we will take it all the way up to
Oklahoma.
So I went down to Orange, TX, and found the USS Batfish. This is a
World War II submarine. They were able to do it without any help at
all--without any help from government. They had to get on there, and
they had to reduce it to get under bridges and lift it up in shallow
places. All of my adversaries were saying: We will sink Inhofe and his
submarine. But we did it, and it is there today.
So we do have the McClellan-Kerr Arkansas River Navigation System. We
have some items in there under this to protect that resource from what
they call the Three Rivers report, which provides a permanent solution
for the situation we are experiencing near the mouth of the system,
where the White River and the Arkansas River are trying to merge. If
left alone, they would merge. That would destroy everything that goes
up from that area in Arkansas. It includes language for Bartlesville to
navigate the murky waters of water supply contracts and to change those
contracts with everyone to get away from the idea that the Army Corps
of Engineers is going to be able to do something that would be
prohibitive cost-wise to the communities like Bartlesville, OK.
We support our Nation's economic competitiveness by increasing access
to water storage and supply, providing protection from dangerous flood
waters, deepening the nationally significant ports, and maintaining
navigability in the inland waterways.
Since hurricane season is upon us, we have recently seen the cruel
aftermath of these storms and the flooding that followed Hurricane
Harvey, Irma, Florence, and now Michael. Right now they are preparing
down there to evacuate as we speak. It could become a mandatory
evacuation. This is something that is happening. Events like this show
why it is utterly critical to maintain flood control and be able to
protect against the floodwaters as much as possible.
That is what this bill we will be considering in a few minutes is all
about. It will also further address the need for repairing our aging
drinking water, wastewater and irrigation systems, improving conditions
all across the United States in homes, farms, and businesses.
We have reauthorized WIFIA and authorized a new tool by including
Senator Boozman's SRF WIN Act, of which I am a very proud cosponsor.
These provisions, along with technical assistance for our small and
rural systems, will provide more help to our communities struggling to
finance and upgrade our hidden infrastructure needs.
Maintaining critical infrastructure is one of the most important
constitutionally required duties we have as Members of Congress. I
sometimes have to remind people who often disregard a document called
the Constitution that this is what we are supposed to be doing and what
we are carrying out with the bill we are about to pass in the next few
minutes.
I look forward to passing this legislation and sending it to the
President to sign into law. It is another win for America.
I have to say, the committee has done so well. People are criticizing
the Senate all the time, saying nothing is being done. Our Environment
and Public Works Committee gets things done--the FAST Act, the chemical
act, the last WRDA bill, and now the 2018 WRDA bill. It is what we are
supposed to be doing here, and it is a very significant vote.
I yield the floor.
I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mrs. MURRAY. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
S.J. Res. 63
Mrs. MURRAY. Mr. President, I come to the floor to support Senator
Baldwin's resolution to overturn President Trump's junk plans rule.
Since day one, President Trump has been relentless in his efforts to
sabotage healthcare for people in our Nation. He has worked to drive up
the costs, given power back to big insurance companies, and despite his
recent campaign promise to fight for people with preexisting
conditions, almost every single step he has taken has been in the
opposite direction.
President Trump's awful junk plan rule, which went into effect last
week, is the latest example. His decision to expand junk insurance
plans actually gives insurance companies more power to sell plans that
ignore protections for people with preexisting conditions. It gives
insurance companies more power to discriminate based on age or on sex.
It gives insurance companies even more power to avoid covering
important medical needs like emergency care, mental health care,
prescription drugs, or even maternity care. This rule also lets
insurance companies spend less money on patients directly and more
money on excessive administrative costs and executive bonuses. This new
rule shows how empty President Trump's promises are when it comes to
preexisting conditions.
It is not just President Trump. A lot of Republicans are claiming to
stand for protections for preexisting conditions. However, when you
compare how Democrats are fighting for these protections and how some
Republicans are undermining them, the difference is as clear as night
and day.
When President Trump tried to pass his TrumpCare bill and undermine
preexisting condition protection, Democrats stood with families across
the country and fought tirelessly to stop that awful bill. However,
most of our Republican colleagues championed it. When President Trump's
Justice Department chose to abandon these protections in court against
the Republican-led lawsuit to strike them down, Democrats rallied
around the bill to let the Senate join the lawsuit and defend
protections for preexisting conditions. Not a single Republican joined
in that
[[Page S6744]]
effort. Now President Trump is undermining these protections through
the junk plan rule, and Democrats are again on the floor leading the
charge against him with the resolution that is before us today.
Where are those Republican colleagues who have claimed to care so
much about this issue but have done so little to fight for it? So far
they have offered empty promises and even gimmicks, like a bill they
claim protects people with preexisting conditions but actually allows
insurance companies to discriminate based on age and sex.
If Republicans are serious about standing up for people with
preexisting conditions, they will join us to pass this bill and fight
for them. I am not holding my breath, but I am not giving up. Democrats
are going to keep fighting for people across the country, for people
with preexisting conditions. We are going to keep fighting for cancer
patients and survivors, people living with diabetes and arthritis and
other chronic diseases, and we are going to keep fighting for women who
are pregnant or seniors who are facing the challenges of old age and
for so many other families who might not be able to get the care they
need without these important protections for people with preexisting
conditions.
Finally, I thank Ms. Baldwin for her leadership on this very
important effort. I know this fight is personal for her, like it is for
so many families across the country. I am grateful for her leading the
charge.
Thank you.
I yield the floor.
Mrs. FEINSTEIN. Mr. President, I rise today in support of S.J. Res.
63, a resolution of disapproval on the Trump administration's final
rule allowing the expansion of short-term junk health insurance plans.
My home State of California recently passed a law prohibiting these
short-term plans to protect consumers because these plans do not offer
real coverage and are allowed to only take healthy consumers.
One hundred thirty million non-elderly Americans have a preexisting
condition, including 16 million in California. Among the most important
provisions in the Affordable Care Act are the consumer protection
requirements for health insurance plans that ensure preexisting
conditions no longer dictate access to health coverage and essential
benefits that ensure coverage is meaningful and comprehensive.
It does a cancer patient little good to have health insurance that
doesn't cover chemotherapy, just as coverage without maternal care is
meaningless to an expectant mother. In fact, before the Affordable Care
Act was passed, three out of four plans on the individual market did
not cover labor and delivery.
An analysis by Kaiser Family Foundation just this last April found
that of the more than 600 short-term plans offered through two major
insurance websites, eHealth and Agile Health Insurance, across 45
States, none included maternity care. It gets worse: 71 percent offered
no prescription drug coverage, and 43 percent of these plans didn't
cover mental healthcare services.
To be frank, these plans are junk insurance. The major protections in
the Affordable Care Act are basically tossed out the window, and we are
reminded of why health reform was needed so badly in the first place.
These plans can include annual and lifetime limits on care, meaning
that, if you need an expensive medical treatment, you may be out of
luck, even after paying your premiums. Women can once again be charged
more than men for the same plan.
Insurance companies don't have to comply with medical loss ratio
rules that limit administrative costs. In fact, short-term plans
covering 80 percent of the market in 2016 only spent half of premium
dollars on actual medical care.
Short-term plans have traditionally been used by some consumers for
what the name implies, to bridge short gaps between long-term coverage
for a matter of months. The final rule changes this to years. Given the
severe shortfalls these plans have and significant consumer risk, they
are simply not meant to be a substitute for real health insurance.
I urge my colleagues to support this resolution to protect consumers
and look forward to working together to improve health coverage, not
make it worse.
Mr. CARDIN. Mr. President, today I wish to discuss American's access
to healthcare and the patient protections that are currently being
threatened by the Trump administration, specifically expanding the
availability of junk health insurance, also known as short-term limited
duration plans.
Short-term limited duration insurance is a type of health insurance
that was designed to fill temporary gaps in coverage, such as when an
individual is transitioning from one plan or coverage to another plan
or coverage.
The Obama administration limited these plans to 3 months to ensure
they would be used only as a backstop for those who truly need
temporary, limited duration coverage.
A major flaw of this insurance is that it is exempt from certain
consumer protections provided through the Affordable Care Act.
Because of the Affordable Care Act, health insurance companies are
required to offer essential health benefits such as emergency services,
maternity care, mental health and substance use disorder services, and
preventative services. Additionally, insurance companies are no longer
allowed to place annual or lifetime dollar limits on coverage and
cannot refuse to cover someone or charge someone more just because they
have a preexisting condition.
Among the most common preexisting conditions are high blood pressure,
behavioral health disorders, high cholesterol, asthma/chronic lung
disease, heart conditions, diabetes, and cancer.
In 2017, HHS released a report stating that as many as 133 million
non-elderly Americans have a preexisting condition. The Maryland Health
Benefit Exchange estimates that there are approximately 2.5 million
non-elderly Marylanders with a preexisting condition, 320,000 of which
are children.
Expanding access to short-term limited duration plans is another in a
long line of GOP healthcare sabotage efforts since President Trump took
office. Short-term plans are allowed to have annual or lifetime dollar
limits on coverage, and do not have to provide coverage of essential
health benefits or provide coverage to those with preexisting
conditions. These plans will lead to increased health insurance
premiums for people buying insurance on the ACA marketplace. Healthy
individuals may be deceived to leave the marketplace and buy these junk
plans instead.
Short-term plans will impose an ``age tax'' on seniors because they
are allowed to charge seniors more for coverage. Currently, the ACA
limits how much more plans are allowed to charge seniors.
Short-term plans are junk insurance, plain and simple. People believe
they have coverage, but when they get sick and need medical care, they
suddenly realize the plan that they paid for won't allow them to
receive the care they require.
These actions by the Trump administration to expand access to short-
term plans is wrong. Not only do these actions directly threatens the
133 million Americans with preexisting conditions, but also any
American who wishes to have strong, affordable, and comprehensive
coverage.
S. 3021
Mrs. FEINSTEIN. Mr. President, I rise today to speak in support of
the pending bill, America's Water Infrastructure Act.
I congratulate Chairman Barrasso and Ranking Member Carper of the
Environment and Public Works Committee for completing this vitally
important bill on time. It is critical that we reauthorize Army Corps
projects and other water financing authorities every 2 years, as they
have done.
The bill before us authorizes construction of 12 new water resource
development projects and 65 studies.
America's Water Infrastructure Act also includes a number of
provisions that will benefit California.
The bill includes a provision I authored that will require EPA and
the Bureau of Reclamation to enter into an agreement within a year. The
agreement must specify how the two agencies will jointly administer a
Treasury-rate loan program for storage, water recycling, groundwater
recharge, and other water supply projects.
[[Page S6745]]
This provision builds off EPA's success using Treasury-rate loans to
fund projects under the Water Infrastructure Finance and Innovation
Act, WIFIA. The idea is to extend these Treasury-rate loans to water
supply projects.
There are three significant ways WIFIA loans will lower costs for
local agencies wanting to build storage, water recycling, groundwater
recharge, or other water supply projects:
No. 1, they will pay only 3.2 percent interest rate on their loans
based on today's rates, versus 4 percent or greater rates for municipal
bond financing;
No. 2, the districts would not need to start paying interest until 5
years after substantial completion of the project; and No. 3, loans are
for 35 rather than 30 years, lowering annual debt service costs.
The combination of these benefits could reduce the costs of building
a project by as much as 25 percent. For example, if a consortium of
water districts takes out a loan to build Sites Reservoir, they would
pay only $512/acre-foot instead of $682/acre-foot, a 25 percent saving.
These water district savings of up to 25 percent are a highly cost-
effective use of taxpayer dollars because they can be obtained by
appropriations of only 1-1.5 percent of the cost of the loan, as
validated by OMB.
OMB has approved loans of $5 billion backed only by appropriations of
only 1 percent of that amount, or $50 million for WIFIA, because there
is a virtually nonexistent default rate for water projects.
Only four in a thousand water infrastructure projects default, based
on a study conducted by Fitch credit rating agency.
Moreover, WIFIA loans include substantial taxpayer protections.
Private sector loans have to cover at least 51 percent of the project
cost, and the Federal loans would have senior status in the event of
any default. These provisions protect the taxpayer in the event of any
default.
The provision in the bill before us is a compromise, different in
some significant ways from the provision I included in the Senate bill.
Like the Senate bill, the bill before us requires EPA and the Bureau of
Reclamation to enter into an agreement within a year on how they would
jointly administer a Treasury-rate loan program for water supply
projects.
However, the House was unwilling to allow the Bureau of Reclamation
to recommend water supply projects for loans within EPA's existing
WIFIA authority. As a result, additional legislation will be needed to
authorize Reclamation loans for water supply projects once EPA and
Reclamation reach their agreement.
While further legislation will be needed, the legislation before us
today provides an important step forward. EPA has developed expertise
in processing and administering water supply loans, so it is more
efficient if Reclamation can recommend the loans and EPA can administer
them. Without the legislation before us, EPA and Reclamation would not
reach an agreement on how they would jointly administer these water
supply loans.
Now that we know that Reclamation and EPA will reach this agreement
within a year, Congress can shortly thereafter move legislation with
both agencies' support to extend the successful and cost-effective
WIFIA loan program to water supply projects. I look forward to working
with my colleagues on this additional legislation.
I am also pleased that this bill authorizes construction and studies
and provides other needed modifications for many important water
infrastructure projects in California.
One such project that received a construction authorization is the
Lower San Joaquin River project, which provides critical flood control
to the Stockton metropolitan area.
Additionally, this bill doubles Federal funding for the Harbor South
Bay water recycling project, authorizing up to $70 million in Federal
funds.
This increase in Federal funding will meaningfully expand this
project's capability to provide recycled water to surrounding
communities. I am pleased to see Army Corps funding utilized for water
recycling, which is truly a key for sustainability and water security
in drought-prone California.
Other key California projects in this bill include authorization for
a flood risk management, navigation, and ecosystem restoration project
in the San Diego River and directing the Army Corps to expedite flood
risk management, water conservation and ecosystem restoration studies
at the Coyote Valley Dam, Lower Cache Creek, Lower San Joaquin River,
South San Francisco, Tijuana River, Westminster-East Garden Grove, and
San Luis Rey River.
Lastly, I would like to mention the two other very important
provisions for California as well as the Nation that I strongly
support.
This bill increases funding for the Army Corps' dam rehabilitation
program for structures built before 1940 from $10 million to $40
million until fiscal year 2026. The United States is facing many
challenges due to aging infrastructure, and in California, we saw the
serious ramifications of that with the Oroville Dam disaster.
Additionally, this legislation reauthorizes and expands the Drinking
Water State Revolving Loan Fund for the first time in 22 years to
address aging or damaged drinking water infrastructure in communities
across the country.
For all these reasons, I support the America's Water Infrastructure
Act before us today. Thank you.
Mrs. MURRAY. I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. CARPER. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. CARPER. Mr. President, I don't know what it is like in Alaska,
Wyoming, or Tennessee these days, but a lot of times, when I am going
home or back and forth, people are saying to me: I wouldn't want your
job for all the tea in China.
I say: Well, I actually feel lucky to do this job. They ask: What do
you like about it? I say: I like helping people. They say: Really? And
they ask for examples.
Today is a good example. One of the best ways to help people is to
make sure they have a job. There are a lot of different ways we provide
that nurturing environment for job creation and preservation, and one
of those ways is in the area of infrastructure. Sometimes an overlooked
part of our infrastructure is the one we address directly in the Water
Resources Development Act before us today.
Our water infrastructure is actually the forgotten leg on the
infrastructure stool. We rightly worry about the infrastructure we can
see: our bridges, highways, airports, and railroads, but our Nation's
water infrastructure: our pipes, shipping channels, flood control
structures, and the infrastructure we don't see, as we have learned, is
in desperate need of investment.
Our Nation's drinking water systems, dams, reservoirs, levees,
shipping lanes, and ports support and promote economic growth and job
creation. These systems provide water for everything from families to
agriculture to small businesses. This is infrastructure that Americans
rely on every day, and it keeps our economy moving.
America's Water Infrastructure Act of 2018, the legislation that we
will soon be voting on, makes water a priority from coast to coast. As
my good friend, the chairman of our committee, John Barrasso, has said,
America needs comprehensive water infrastructure legislation that will
create jobs, keep communities safe, and make the Army Corps of
Engineers and the EPA more accessible to stakeholders.
The legislation before the Senate today has received endorsement from
industry, from environmental protection groups, and from everything in
between. The U.S. Conference of Mayors, the National League of Cities,
and the National Association of Counties say that this bill drives
investment in navigation, flood protection, and ecosystem restoration
in communities and that it protects public health and safety and our
natural resources. It is critical in helping our communities to build,
maintain, and improve this critical infrastructure while growing our
national and local economies.
[[Page S6746]]
I am here to applaud and thank, once again, our chairman, our staffs,
and everyone who has worked on this from Alaska to Wyoming.
Mr. President, I ask unanimous consent that a list of congressional
staff who deserve recognition for their work on S. 3021 be printed in
the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Thanks to the staff who worked tirelessly on this bill
throughout the year, including the staff of Chairman John
Barrasso: Richard Russell, Brian Clifford, Elizabeth Olsen,
Andy Harding, Pauline Thorndike, Craig Thomas; Ranking Member
Tom Carper: Mary Frances Repko, John Kane, Christina
Baysinger, Skylar Bayer, Ashley Morgan, Avery Mulligan,
Andrew Rogers; Subcommittee Chairman Jim Inhofe: Jennie
Wright; Subcommittee Ranking Member Benjamin L. Cardin: Mae
Stevens; Chairman Bill Shuster: Ian Bennitt, Victor
Sarmiento, Elizabeth Fox, Jon Pawlow, Geoff Gosselin, Peter
Como, Chris Vieson; Ranking Member Peter A. DeFazio: Ryan
Seiger, Michael Brain, Kathy Dedrick, David Napoliello;
Chairman Greg Walden: Jerry Couri; and Ranking Member Frank
Pallone: Jackie Cohen, Jean Fruci, Rick Kessler, Tuley
Wright.
Mr. CARPER. I yield my time.
The PRESIDING OFFICER. The Senator from Wyoming.
Mr. BARRASSO. Mr. President, I ask unanimous consent to complete my
brief statement before the rollcall is taken.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
Mr. BARRASSO. Mr. President, it is time to vote on America's Water
Infrastructure Act.
I thank my friend and colleague from Delaware, the senior Senator,
Mr. Carper, for his great contributions to this piece of legislation.
It is an important bill that has broad bipartisan, bicameral support.
There are 95 groups that have endorsed it. They represent a broad
cross-section of stakeholders from a wide variety of backgrounds. From
the Sierra Club to the American Petroleum Institute to the U.S. Chamber
of Commerce, they all agree that this important infrastructure
legislation is good for our country, good for our communities, good for
our economy, and good for our environment. The Wyoming Wool Growers
Association, the Arkansas Rural Water Association, and the Milwaukee
Metropolitan Sewerage District have all united in praise for a bill
that will help all 50 States.
The water infrastructure bill passed our committee 21 to nothing, and
it passed the House with a unanimous voice vote. It is time to send it
to the President for his signature. I would just ask our Members to
join us in supporting this important bipartisan infrastructure bill.
Mr. President, along with Ranking Member Carper, I ask unanimous
consent to have an explanatory statement to accompany S. 3021,
America's Water Infrastructure Act, printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Senate Explanatory Statement to Accompany S. 3021, America's Water
Infrastructure Act of 2018
The following explanatory statement from the Senate
supplements and provides additional views on the Managers'
Joint Explanatory Statement accompanying S. 3021: America's
Water Infrastructure Act of 2018 (AWIA), that was submitted
as part of the Congressional Record during consideration in
the House of Representatives on September 13, 2018.
section 1144
Section 1144 on Levee Safety Initiative Reauthorization
extends by five years the authorization of appropriations for
the National Levee Safety Program, which includes the
committee on levee safety, inventory and inspection of
levees, and levee safety initiative. The Senate Managers urge
the Army Corps of Engineers (the Corps) to improve the
current levels of levee safety program transparency and local
levee sponsor involvement.
By law and policy, local levee sponsors assure the day-to-
day performance of levee systems. As such, local sponsors
typically maintain abundant familiarity with localized flood
and levee system conditions as well as local risk management
and communication needs. For the levee safety program to be
successful in achieving cost-beneficial flood damage
reduction, the Corps must to the maximum extent practicable
involve local sponsor expertise and rely on scientifically
sound and technically rigorous analysis. The Senate Managers
are aware of internal guidance drafted by the Corps to direct
its district offices to engage public sponsors as
participants in all levee safety program activities. The
Corps is encouraged to execute this directive fully so that
local sponsors and affected citizens derive maximum benefit
from the levee safety program.
The Senate Managers arc additionally concerned about the
agency's decision to formulate and publicize Levee Safety
Action Classification (LSAC) assignments for levee systems in
the absence of site-specific solutions and corresponding cost
estimates. It is difficult to perform effective risk
characterization and communication about levee systems in the
absence of identified corrective actions and their associated
costs and benefits. The levee safety program must improve
flood protection by driving requisite cooperation with local
sponsors, transparency, objectivity, rigorous technical
justification, and development of actual solutions that focus
on the imperative of identifying cost-beneficial, engineered
solutions. The Corps noted in a March 2018 Levee Portfolio
Report that, ``there may be reluctance to share risk
information with the public when an immediate and viable risk
management solution has not been identified.'' The Senate
Managers urge the Corps to immediately rectify this shortfall
by cooperating with local levee sponsors to produce viable
levee system corrective actions and corresponding cost
estimates along with LSAC assignments. Given the scope and
potential impact of these levee system risk assessments,
which could involve levee accreditation status by FEMA under
the National Flood Insurance Program, the Corps should also
seek out external peer review of the reliability and
usefulness of the overall LSAC process.
section 1170
Section 1170 contains a drafting error that was identified
following the passage of S. 3021 as amended by the House of
Representatives. The Senate Managers intend to initiate
legislation to make a technical correction in the language of
this section to replace the words ``Arizona River Basin''
with ``Arkansas River Basin'' to ensure the work is conducted
in the Arkansas River Basin, located in Colorado and three
other States. Further, the Senate Managers ask that the Corps
prepare to implement this section as so modified pending the
correction.
section 1229
Section 1229 directs the Secretary to do a report on the
status of a water supply contract for Wright Patman Lake,
Texas. In addition to that provision, the Senate Managers
believe that the Secretary should implement the Department of
the Army, Civil Works Contract No. 29-68-A-0130, at Wright
Patman Lake, Texas, in an expeditious manner and in
accordance with all applicable Federal and State water laws.
This includes the acceptance and expenditure of funds
contributed by a non-Federal interest for any study required
by law to implement the contract.
section 1318
Section 1318 directs the Secretary of the Army to align the
schedules of and ensure coordination between the Argentine,
East Bottoms, Fairfax-Jersey Creek, and North Kansas Levees
Units, Missouri River and Tributaries at Kansas Cities,
Missouri and Kansas, project and the project for flood risk
management in Armourdale and Central Industrial District
Levee Units, Missouri River and Tributaries at Kansas Cities,
Missouri arid Kansas. It is the Senate Managers' intent that
these two flood control projects be considered to be a single
project for budgeting purposes despite separate
authorizations, and for the purposes of the Supplemental
Appropriations in the Bipartisan Budget Act of 2018, P.L.
115-123, it is an ongoing construction project.
section 2010
Section 2010 provides new authority to permit a State to
require the owner or operator of certain public water systems
to assess its options for consolidation, transfer of
ownership, or other activities in order to get that system
into compliance. The Senate Managers believe there is no
requirement for systems to adhere to the results of these
assessments.
section 4103
Section 4103 provides technical assistance for treatment
works in the Clean Water Act (CWA). It is the Senate
Managers' view that, when determining which qualified and
experienced nonprofit organizations will provide on-site
training and technical assistance, the EPA should consult
with the relevant State and the publicly owned treatment
works to determine the forms of training and technical
assistance they believe will be most effective and
beneficial.
Additional Views of the Senate Managers on Water Resource Issues and
the Development of S. 3021
EPA's ``Water Transfer Rule,'' 40 CFR Sec. 122.3(i),
excludes discharges from ``an activity that conveys or
connects waters of the United States without subjecting the
transferred water to intervening industrial, municipal, or
commercial use'' from the National Pollutant Discharge
Elimination System (NPDES) wastewater permitting requirements
of the Clean Water Act, 33 USC Sec. 1342. The Second Circuit
Court of Appeals held that EPA's interpretation of CWA is
reasonable and EPA is entitled to Chevron deference in
Catskill Mountain Chapter of Trout Unlimited v. EPA, 846 F.3d
492 (2nd Cir., 2017); cert denied, 138 S. CT. 1164-1165 (Feb.
26, 2018). The Supreme Court's denial of certiorari resolves
the question of whether EPA's Rule complies with the CWA.
[[Page S6747]]
The Senate Managers encourage the Secretary to conduct a
study on impediments to the U.S. Army Corps of Engineers'
Water Infrastructure Finance and Innovation Act (33 U.S.C.
3901 et seq.) (WIFIA) program implementation. In the study,
the Secretary should examine obstacles to the implementation
of the Corps WIFIA program and to identify all projects that
the Secretary determines are potentially viable to receive
assistance. Additionally, the study should describe any
amendments to the Act or other legislative or regulatory
changes that would improve the Secretary's ability to
implement the Corps' WIFIA program. The report should be
submitted to the Committee on Environment and Public Works of
the Senate and the Committee on Transportation and
Infrastructure of the House of Representatives no later than
one year after enactment of AWIA 2018.
Water resources projects have historically not been able to
be completed after construction commences due to the use of
benefit-cost analyses in the budgeting of water resources
development projects. During construction, costs accrue while
benefits are not yet realized, which lowers the benefit-cost
ratio stalling projects. The Senate Managers continue to be
concerned with this matter, and ask that the Corps provide
recommendations to Congress on how to address this concern
within 180 days of enactment of this Act.
Several Chief's Reports were neither completed nor received
by Congress before negotiations closed on AWIA, and the bill
was passed by the United States House of Representatives. The
final bill did not include these projects for that reason.
The Senate Managers believe that the Corps should expedite
the completion of these reports in an expedient manner so
these projects can be included in the next Water Resources
Development Act.
The Senate Managers believe that the Secretary should
expedite the expected Chief's Report for the Souris River
Basin, Minot, North Dakota, flood risk management project
that was authorized by section 209 of the Flood Control Act
of 1966 (80 Stat. 1423).
The Senate Managers believe that the Secretary should
expedite the expected Chief's Report for the Delta Islands
and Levees, California, ecosystem restoration project. It was
authorized by a June 1, 1948, Committee on Public Works of
the Senate resolution; the resolution adopted by the
Committee on Public Works of the House of Representatives on
May 8, 1948; and House Report 108-357 accompanying the Energy
and Water Development Appropriations Act, 2004 (Public Law
108-137; 117 Stat. 1827).
The Senate Managers believe that the Secretary should
expedite the expected Chief's Report for the Anacostia
Watershed, Prince George's County, Maryland, for flood
control, navigation, and ecosystem restoration. The project
was authorized by a resolution adopted by the Committee on
Public Works and Transportation of the House of
Representatives on. September 8, 1988.
The Senate Managers believe that the Secretary should
expedite the expected Chiefs Report for the Hashamomuck Cove,
New York, project for coastal storm risk management, which
was authorized in title X of division A of the Disaster
Relief Appropriations Act, 2013 (Public Law 113-2; 127 Stat.
23).
The Senate Managers encourage the Secretary to expedite the
completion of the post authorization change report (PACR) for
the Howard A. Hanson Dam, Washington project for water supply
and ecosystem restoration. This project was authorized by
section 204 of the Flood Control Act of 1950 (64 Stat. 180)
and modified by section 101(b)(15) of WRDA 1999.
The Senate Managers encourage the Secretary to expedite the
completion of the PACR for the Port Pierce, Florida, shore
protection and harbor mitigation project. The project was
authorized by section 301 of the River and Harbor Act of 1965
(79 Stat. 1092), section 102 of the River and Harbor Act of
1968 (82 Stat. 732), and section 506(a)(2) of the Water
Resources Development Act of 1996 (110 Stat. 3757), and
modified by section 313 of the Water Resources Development
Act of 1999 (113 Stat. 301).
The Senate Managers encourage the Secretary to expedite the
completion of the PACR for the Port of Iberia navigation
project, authorized by section 1001(25) of WRDA 2007 (121
Stat. 1053; 128 Stat. 1351).
The Senate Managers encourage the Secretary to expedite the
completion of PACR for the Wrightsville Beach, North
Carolina, hurricane and storm damage risk reduction project.
It was authorized by section 203 of the Flood Control Act of
1962 (76 Stat. 1182) and section 501 of WRDA 1986 (100 Stat.
4135).
The Senate Managers also encourage the Secretary to
expedite the completion of the PACR for the Carolina Beach,
North Carolina, hurricane and storm damage risk reduction
that was authorized by section 203 of the Flood Control Act
of 1962 (76 Stat. 1182).
The Senate Managers note that a number of environmental
infrastructure projects were unable to be included in the
final text of AWIA due to the statutory requirements of the
project vetting process established in WRDA 2014. As noted in
the Joint Managers Statement on September 13, 2018, AWIA
amends the WRDA 2014 project vetting process to allow for the
consideration of environmental infrastructure projects
prospectively. Although the requirements of WRDA 2014 limited
the consideration of environmental infrastructure projects
during the development of S. 3021, the Senate Managers
encourage the Corps to vet such projects using the updated
review process and resubmit them for inclusion in the next
water resources authorization.
Though not authorized in S. 3021, the Senate Managers have
also agreed to request and support a National Academies study
on the Rio Grande River Basin. Such study should examine the
Rio Grande River Basin as a holistic system to better
understand how the Corps should manage this river system in
the face of extreme weather events to better meet water needs
of the region. The National Academies should conduct an
evaluation of the capacity, operation and state of existing
basin reservoirs; look for opportunities to promote water
conservation through operation, regulation or physical
improvements of the reservoirs; and examine the impacts of
reservoir operation and management on species and habitats to
the region. The study is expected to provide recommendations
for future management scenarios and recommendations in
accordance with the Rio Grande Compact to assist in
establishing more flexible operation procedures to meet the
water needs of the Rio Grande River Basin. The Corps is
encouraged to initiate this study with the National Academies
as soon as practicable.
Mr. BARRASSO. I yield the floor.
____________________