[Congressional Record Volume 165, Number 4 (Wednesday, January 9, 2019)]
[Extensions of Remarks]
[Pages E26-E27]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   ADOPTING THE RULES OF THE HOUSE OF REPRESENTATIVES FOR THE 116TH 
                                CONGRESS

                                 ______
                                 

                               speech of

                        HON. SHEILA JACKSON LEE

                                of texas

                    in the house of representatives

                       Thursday, January 3, 2019

  Ms. JACKSON LEE. Mr. Speaker, in 2010, after a century of trying, 
under the leadership of Speaker Nancy Pelosi and our nation's 44th 
President, Barack Obama, the Affordable Care Act became the law of the 
land.
  Before the Affordable Care Act, untold millions of Americans lived 
with the reality that they did not have access to Affordable Care Act.
  Before the passage of the Affordable Care Act, 17.1 percent of 
Americans lacked health insurance; today nearly nine of ten (89.1 
percent) are insured, which is the highest rate since Gallup began 
tracking insurance coverage in 2008.
  Because of the Affordable Healthcare Act: insurance companies are 
banned from discriminating against anyone, including 17 million 
children, with a preexisting condition, or charging higher rates based 
on gender or health status; 6.6 million young-adults up to age 26 can 
stay on their parents' health insurance plans; 100 million Americans no 
longer have annual or life-time limits on healthcare coverage; 6.3 
million seniors in the ``donut hole'' have saved $6.1 billion on their 
prescription drugs; 3.2 million seniors now get free annual wellness 
visits under Medicare, and 360,000 Small Businesses are using the 
Health Care Tax Credit to help them provide health insurance to their 
workers; Pregnancy is no longer a pre-existing condition and women can 
no longer be charged a higher rate just because they are women.
  This bill was fiercely debated for over a year. It passed both houses 
of Congress and was signed by President Obama on March 23, 2010.
  The bill did many things--it improved access to quality care; made 
care more affordable, and improved the quality of the law.
  It also advanced several pillars that will undoubtedly advance 
healthcare in America.
  For example, the Affordable Care Act:
  Lowers the uninsured rate. Gallup recently estimated that the 
uninsured rate in Texas in 2015 was 22.3 percent, down from 27.0 
percent in 2013. In 2017, the number was at 16 percent.
  Prohibits coverage denials and reduced benefits, protecting as many 
as 10,694,840 Texans who have some type of pre-existing health 
condition, including 1,632,475 children.
  Eliminates lifetime and annual limits on insurance coverage and 
establishes annual limits on out-of-pocket spending on essential health 
benefits, benefiting 7,536,000 people in Texas, including 2,771,000 
women and 2,094,000 children.
  Allows states to expand Medicaid to all non-eligible adults with 
incomes under 133 percent of the federal poverty level. If Texas 
expands Medicaid, an additional 1,107,000 uninsured people would gain 
coverage.
  Establishes a system of state and federal Health Insurance Exchanges, 
or Marketplaces, to make it easier for individuals and small-business 
employees to purchase health plans at affordable prices. During the 
open enrollment period for 2016 coverage, 1,306,208 people in Texas 
selected a plan through the Marketplace, including approximately 
626,980 new consumers and 378,800 young adults. In Texas, 78 percent of 
Marketplace consumers could have selected a plan for $100 per month or 
less after tax credits for 2016 coverage.
  Created a temporary high-risk pool program to cover uninsured people 
with pre-existing conditions prior to 2014 reforms, which helped 10,336 
people in Texas.
  And, the ACA creates health plan disclosure requirements and simple, 
standardized summaries so 12,620,500 people in Texas can better 
understand coverage information and compare benefits.
  With respect to the affordability of care, the ACA made marked 
improvements in this sphere, too. For example, the ACA:
  Creates a tax credit that, during the most recent open enrollment 
period, has helped 1,093,573 Marketplace enrollees in Texas who 
otherwise might not be able to afford it sign up for health coverage 
through the Health Insurance Marketplace.
  Requires health insurers to provide consumers with rebates if the 
amount they spend on health benefits and quality of care, as opposed to 
advertising and marketing, is too low. Last year, 96,024 consumers in 
Texas received $14,119,897 in rebates. Since this requirement was put 
in place in 2011 more than $2.4 billion in total refunds have been paid 
to consumers nationwide through 2014.
  Eliminates out-of-pocket costs for preventive services like 
immunizations, certain cancer screenings, contraception, reproductive 
counseling, obesity screening, and behavioral assessments for children. 
This coverage is guaranteed for 10,278,005 people in Texas, including 
4,029,215 women.
  Eliminates out-of-pocket costs for 2,556,874 Medicare beneficiaries 
in Texas for preventive services like cancer screenings, bone-mass 
measurements, annual physicals, and smoking cessation.
  Phases out the ``donut hole'' coverage gap for 346,750 Medicare 
prescription drug beneficiaries in Texas, who have saved an average of 
$1,057 per beneficiary.
  Creates Accountable Care Organizations consisting of doctors and 
other health-care providers who come together to provide coordinated, 
high-quality care at lower costs to 564,161 Medicare beneficiaries in 
Texas.
  Phases out overpayments through the Medicare Advantage system, while 
requiring Medicare Advantage plans to spend at least 85 percent of 
Medicare revenue on patient care. Since 2009, Medicare Advantage 
enrollment has grown by 704,407 to 1,230,523 in Texas while premiums 
have dropped by 10 percent nationwide.
  And, the ACA also improved quality of care, too. For example, the 
ACA:
  Provides incentives to hospitals in Medicare to reduce hospital-
acquired infections and avoidable readmissions. Creates a collaborative 
health-safety learning network, the Partnership for Patients, which 
includes 121 hospitals in Texas, to promote best quality practices. 
Avoidable readmissions have fallen since 2010, saving 87,000 lives and 
$20 billion in health care costs, and the rate of one common deadly 
hospital acquired infection, central-line blood stream infections, fell 
by 50 percent from 2008 to 2014 nationwide.

  Yet, for some reason, Republicans filed countless legal challenges to 
this law.
  On two separate occasions, the United States Supreme Court has ruled 
on the validity of the Affordable Care Act.
  In 2012, it pushed back on a challenge arguing that the ACA is 
unconstitutional.
  In 2015, the Supreme Court pushed back on a statutory challenge to 
the ACA.
  In both instances, the United States Supreme Court upheld the 
Affordable Care Act and did so with a Supreme Court Justice appointed 
by a Republican President
  Following these two endorsements of the law by the Supreme Court, the 
law appeared safe.
  Until last month, when a sole federal district judge In Texas 
invalidated the Affordable Care Act based on perverse logic.
  The genesis of this entire litigation is has been problematic.
  Texas v. United States as an action filed in Texas by our state 
attorney general, who is currently under criminal indictment.
  The matter was then joined by state attorneys general, who now pledge 
to fight the House's vigorous appeal of this matter.

[[Page E27]]

  That judge's ruling indicated that when Republicans in Congress, as 
part of the GOP tax scam, repealed the individual mandate of the 
Affordable Care Act--that part of the law that required all to have 
proof of health insurance or pay a penalty--they in effect invalidated 
the whole law, rendering it unconstitutional.
  This is absurd. First, it ignores the fact that the Affordable Care 
Act has twice been upheld by the Supreme Court.
  Second, despite the fact that the Supreme Court has twice ruled on 
the ACA, it has never endorsed the perverse reasoning underlying this 
district court's ruling.
  To be clear, in NFIB v. Sebellius, 567 U.S. 519 (2012), the Supreme 
Court held that the penalty for failing to buy health insurance was a 
constitutional exercise of the Congress's tax and spending power, not 
that it must be, or that the provision of the law at issue from the tax 
is otherwise unconstitutional in the absence of it.
  It follows that a district court invalidating a law as 
unconstitutional based on this provision, without giving to the 
Congress the opportunity to fix the infirmity, smacks of the type of 
judicial activism which the American political right often laments, 
especially when the Supreme Court has twice ruled on the law's 
constitutionality.
  The ruling was met by cheers and applause by the President and 
Congressional Republicans, whose singular policy mission over the last 
eight years has been to end the Affordable Care Act, and in the process 
take away the health care that millions of individuals receive through 
it.
  Let me first state that the Affordable Care Act, which House 
Republicans derisively call Obamacare, is still the law of the land.
  The ruling issued by a federal district court judge in the Northern 
District of Texas is wrong on the facts, the law, and will not stand.
  Unfortunately, the present administration occupying the White House 
is a sworn opponent of the Affordable Care Act, and the provisions it 
contains, like protecting people with preexisting conditions and 
ensuring that young adults can stay on their parents' healthcare plans 
until Age 26.
  That is why, with respect to Texas v. United States, Democrats offer 
H. Res. 6, which would: permit the Speaker, on behalf of the House of 
Representatives, in consultation with the Bipartisan Legal Advisory 
Group, to intervene, otherwise appear, or take any other steps in any 
other cases involving the Patient Protection and Affordable Care Act, 
to protect the institutional interests of the House and to defend such 
act and the amendments made by such Act to other provisions of law, and 
any amendments to such provisions, including the provisions ensuring 
affordable health coverage for those with preexisting conditions.
  The title directs the Office of General Counsel of the House of 
Representatives to represent the House in any such litigation and 
authorizes the Office of General Counsel to employ the services of 
outside counsel, including pro bono counsel, or other outside experts.
  This is not an unprecedented action and in fact is contemplated by 
federal authority.
  Rule 24 Federal Rules of Civil Procedure prescribe permissive 
intervention in a federal action by a government entity to vindicate a 
real interest.
  The need to protect the healthcare interests of tens of millions of 
Americans--which was made possible, in part, by an act of this body, is 
a real interest as contemplated by Rule 24.
  And this approach has bipartisan history.
  As recently as 2011, when the Obama Administration refused to uphold 
the validity of the discriminatory Defense of Marriage Act, which I did 
not support, House Republicans invoked Title III to hire outside 
counsel in defense of an ultimately unconstitutional bill--the first 
time the Supreme Court had ever ruled on the law's validity.
  In contrast, in this case, the Affordable Care Act has withstood many 
legal challenges by the Supreme Court and has emerged from them intact.
  The need to intervene in this case is informed by the millions of 
Americans whose peace of mind about their healthcare security is in 
doubt, including the countless Texans in my home state.
  I urge my colleagues to approve H. Res. 6, and authorize intervention 
in this case, to vindicate the healthcare interests of tens of 
millions.

                          ____________________