[Congressional Record Volume 165, Number 77 (Thursday, May 9, 2019)]
[House]
[Pages H3519-H3550]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
PROTECTING AMERICANS WITH PREEXISTING CONDITIONS ACT OF 2019
General Leave
Mr. PALLONE. Madam Speaker, I ask unanimous consent that all Members
have 5 legislative days in which to revise and extend their remarks and
include extraneous material on H.R. 986, the Protecting Americans with
Preexisting Conditions Act of 2019.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from New Jersey?
There was no objection.
The SPEAKER pro tempore. Pursuant to House Resolution 357 and rule
XVIII, the Chair declares the House in the Committee of the Whole House
on the state of the Union for the consideration of the bill, H.R. 986.
The Chair appoints the gentleman from Illinois (Mr. Garcia) to
preside over the Committee of the Whole.
{time} 1407
In the Committee of the Whole
Accordingly, the House resolved itself into the Committee of the
Whole House on the state of the Union for the consideration of the bill
(H.R. 986) to provide that certain guidance related to waivers for
State innovation under the Patient Protection and Affordable Care Act
shall have no force or effect, with Mr. Garcia of Illinois in the
chair.
The Clerk read the title of the bill.
The CHAIR. Pursuant to the rule, the bill is considered read the
first time.
General debate shall be confined to the bill and shall not exceed 1
hour equally divided and controlled by the chair and ranking minority
member of the Committee on Energy and Commerce.
The gentleman from New Jersey (Mr. Pallone) and the gentleman from
Oregon (Mr. Walden) each will control 30 minutes.
The Chair recognizes the gentleman from New Jersey.
Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, I rise to speak in favor of H.R. 986, the Protecting
Americans With Preexisting Conditions Act, introduced by Representative
Kuster from our committee.
This legislation should not be necessary but, unfortunately, the
Trump
[[Page H3520]]
administration continues to take actions that undermine the healthcare
of millions of Americans, including the more than 133 million people
with preexisting conditions.
Today, we are here because of the Trump administration's proposed
guidance last October that would allow States to expand and prop up
short-term junk insurance plans, even providing taxpayer subsidies for
those plans. In order to take this action, the administration blatantly
ignored the plain text of the Affordable Care Act and gutted standards
that States must meet in order to test insurance reforms.
I believe the administration's action is illegal, but, sadly, this
administration has never let the law get in the way of its goals. These
efforts will, without a doubt, seriously undermine the health coverage
of Americans with preexisting conditions.
A coalition of 24 national groups representing millions of Americans
with preexisting conditions, including the American Cancer Society
Cancer Action Network, the American Heart Association, and the American
Diabetes Association, wrote a letter in strong support of H.R. 986,
stating: ``The 1332 guidance substantially erodes the guardrails
governing coverage that people with preexisting conditions such as
cystic fibrosis, lung disease, cancer, cardiovascular disease,
diabetes, rare disorders, pregnant women, and many others rely on in
the individual marketplace.''
The patient organizations go on to say that ``these changes
fundamentally alter the nature of the section 1332 waiver program and
jeopardize adequate, affordable coverage for people with preexisting
conditions in the individual market. Halting the implementation of this
guidance will protect people with preexisting conditions.''
Mr. Chairman, by encouraging States to promote and expand short-term
insurance plans, the administration is giving insurers the green light
to directly discriminate against people with preexisting conditions; it
is giving the green light to these plans to charge people with
preexisting conditions more money; and it is giving these plans the
green light to refuse to cover any treatment that is related to
someone's preexisting condition.
The expansion of these junk plans will also undermine the insurance
market, leading to higher premiums for people with preexisting
conditions who need comprehensive coverage. This is not the way you
protect people with preexisting conditions.
The Trump administration's guidance also undermines the ACA's promise
of coverage of essential health benefits. The American people should
not have to worry about whether their insurance plan covers
prescription drugs, maternity and newborn care, mental health
and substance use disorder services.
This guidance is also bad news for older Americans who could be
charged a lot more for their insurance than what is allowed by the ACA.
In a nutshell, Mr. Chairman, this guidance is bad news for any
American who wants access to quality and affordable health coverage
that is there for them when they need it. Junk plans are just that--
they are junk.
People shouldn't have to read the fine print to see what is and is
not covered, and that is the hallmark of the Affordable Care Act. So
that is why we must rescind the guidance.
I want to commend my colleague, Ms. Kuster, for her great work on
this important bill.
I do want to emphasize that H.R. 986 would not do anything to
interfere with existing 1332 reinsurance waivers, which have bipartisan
support and began under the Obama administration. My Republican
colleagues continue to intentionally conflate these reinsurance waivers
with the Trump administration's new 1332 waiver guidance from October
of last year. H.R. 986 does not affect these reinsurance waivers.
I am disappointed that my Republican colleagues continue to make
these arguments, but the bad faith is not surprising, given their
terrible record on protecting people with preexisting conditions.
Mr. Chairman, this bill is necessary because of the ongoing assault
by the Trump administration on our healthcare system. I urge my
colleagues to join me in standing up for people with preexisting
conditions and standing up for people who want access to affordable and
quality healthcare.
Mr. Chairman, I reserve the balance of my time.
House of Representatives,
Committee on Ways and Means,
Washington, DC, May 8, 2019.
Hon. Frank Pallone,
Chairman, Committee on Energy and Commerce,
Washington, DC.
Dear Chairman Pallone: I am writing with respect to H.R.
986, Protecting Americans with Preexisting Conditions Act of
2019. As a result of you having consulted with us on
provisions that fall within our rule X jurisdiction, and in
recognition of the desire to expedite consideration of the
measure, the Committee on Ways and Means agrees to waive
formal consideration of H.R. 986.
The Committee on Ways and Means takes this action with the
mutual understanding that we do not waive any jurisdiction
over the subject matter contained in this or similar
legislation, and the Committee will be appropriately
consulted and involved as the bill or similar legislation
moves forward so that we may address any remaining issues
within our jurisdiction. The Committee also reserves the
right to seek appointment of an appropriate number of
conferees to any House-Senate conference involving this or
similar legislation.
Finally, I would appreciate your response to this letter
confirming this understanding, and would ask that a copy of
our exchange of letter on this matter be included in the
Congressional Record during floor consideration of H.R. 986.
Sincerely,
Richard E. Neal,
Chairman.
____
House of Representatives,
Committee on Energy and Commerce,
Washington, DC, May 9, 2019.
Hon. Richard E. Neal,
Chairman, Committee on Ways and Means,
House of Representatives, Washington, DC.
Dear Chairman Neal: Thank you for consulting with the
Committee on Energy and Commerce and agreeing to discharge
H.R. 986, Protecting Americans with Preexisting Conditions
Act of 2019 from further consideration, so that the bill may
proceed expeditiously to the House floor.
I agree that your forgoing further action on this measure
does not in any way diminish or alter the jurisdiction of
your committee or prejudice its jurisdictional prerogatives
on this measure or similar legislation in the future. I would
support your effort to seek appointment of an appropriate
number of conferees from your committee to any House-Senate
conference on this legislation.
I will ensure our letters on H.R. 986 are entered into the
Congressional Record during floor consideration of the bill.
I appreciate your cooperation regarding this legislation and
look forward to continuing to work together as this measure
moves through the legislative process.
Sincerely,
Frank Pallone, Jr.,
Chairman.
Mr. WALDEN. Mr. Chairman, I yield myself such time as I may consume.
Mr. Chairman, I rise today to call out the mischaracterization of
H.R. 986. The misleading title of this bill confirms the Democratic
majority's position to score political points instead of governing.
They claim their agenda is ``for the people.'' Well, this bill is ``for
the politics.''
So let me be clear. This bill has nothing to do with protecting
Americans with preexisting conditions. This bill has everything to do
with eliminating healthcare options that would be affordable for
Americans who can't afford health insurance today and choices for
States.
Section 1332 waivers were first enacted under ObamaCare to provide
States the opportunity to innovate and to provide their residents with
affordable health insurance options. The Trump administration has
simply updated the guidance for these 1332 ObamaCare waivers to make it
easier for a State's plan to be approved.
This guidance does not--I repeat, does not--permit the Secretary to
waive preexisting condition protections.
But, don't take my word for it alone. CMS Administrator Seema Verma
confirmed it yesterday, in writing. ``To be very clear, the 2018
guidance does nothing to erode PPACA's preexisting condition
provisions, which cannot be waived under section 1332,'' wrote
Administrator Verma.
{time} 1415
She went on to explain: ``Section 1332 does not permit States to
waive Public Health Service Act requirements such as guaranteed
availability and renewability of health insurance, the prohibition on
using health status to vary premiums, and the prohibition on
preexisting conditions exclusions. Furthermore, a section 1332 waiver
cannot
[[Page H3521]]
be approved that might otherwise undermine these requirements. This
administration stands committed to protecting people with preexisting
conditions.'' Seema Verma, she is the Administrator.
It is not just Administrator Verma. I want to quote from the Trump
administration statement of policy. ``If H.R. 986 were presented to the
President, his advisers would recommend that he veto it,'' wrote the
Trump administration in its ``Statement of Administration Policy.''
It goes on to say: ``The President has repeatedly made clear that
this administration will protect people with preexisting conditions.
The 2018 guidance in no way alters the guardrails in place for those
with preexisting conditions, and it would not allow the administration
to waive the requirements in place around preexisting conditions. The
title of this legislation gives the misleading impression that it will
enhance healthcare protections for Americans with preexisting
conditions.''
Put simply, Mr. Chair, this cynically titled messaging bill is all
about scoring political points and not legislating, which is what we
should be doing.
You see, if Democratic Members actually cared about protecting
individuals living with preexisting conditions, they would govern and
lock in these important safeguards. Since Democratic leaders chose to
put politics first, I offered an amendment to protect patients with
preexisting conditions, to lock that into law.
Mr. Chair, this amendment wasn't presented to the House for a vote.
In fact, it was never allowed out of the Rules Committee. That is a
shame because we could be voting on it today. I have tried to bring
that vote to the floor on numerous occasions, and I have been denied by
the Democratic majority.
My bill is simple. It provides guaranteed issue and renewability, a
ban on health status underwriting, and a ban on benefits exclusions,
real preexisting condition protections Democratic Members say they
support.
Guess what? It is titled the ``Pre-existing Conditions Protection
Act.'' How ironic, except my bill does what the title says.
Let's vote on that bill, Mr. Chair.
Here is what it comes down to. The status quo is not working for many
Americans. Healthcare costs are out of control. Patients and families
are struggling to pay ever-increasing premiums, deductibles, and out-
of-pocket costs.
There is work that we are doing. I just came from a meeting with the
President of the United States in the Roosevelt Room talking about
surprise billing. We are going to work together, Mr. Pallone and I and
others, to draft legislation to prevent that, to protect consumers.
We could do more here today than what this bill alleges to do.
Republicans want to work toward healthcare solutions that will decrease
costs, increase access, protect individuals with preexisting
conditions, make the healthcare system work better for families and for
patients, and actually be affordable.
We want to let our States innovate. These section 1332 waivers--
originally, again, put forward under President Obama--known as State
innovation waivers, they are working, Mr. Chair. Premiums have gone
down in seven States by an average of 20 percent, down 20 percent.
In my home State of Oregon, we have been a real innovator for decades
in the space of healthcare coverage and access and trying to get prices
down. Our premiums, under this 1332 waiver that Oregon has, have gone
down 6 percent in 2018, down 6 percent thanks to a State innovation
waiver.
These waivers could work. States want to innovate. They care about
their people and want to bring down costs. Instead of allowing more and
more States to innovate and lower their healthcare costs,
unfortunately, Democrats are of the mindset that Washington knows best,
not our States. States can't be trusted, apparently. They want to limit
the ability of States to innovate on behalf of their citizens.
This type of top-down, command-and-control, government-knows-best
approach is what leads to policies like the Democrats' ultimate goal of
a one-size-fits-all government takeover of healthcare.
A vote in support of their bill is a vote against innovation,
lowering costs, my colleagues' constituents, State legislatures,
Governors, State insurance commissioners, on and on and on. That is
what my colleagues are doing if they vote for this.
A vote against the bill is actually a vote for the people.
Mr. Chair, I encourage my colleagues to oppose this partisan gimmick,
and I reserve the balance of my time.
Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman
from New Hampshire (Ms. Kuster), the sponsor of the bill.
Ms. KUSTER of New Hampshire. Mr. Chair, I thank Chairman Pallone for
yielding, and I thank him for his guidance and leadership on the Energy
and Commerce Committee as we advanced critical legislation this week to
stabilize the Affordable Care Act and drive down prescription drug
costs for all Americans.
Mr. Chair, I rise today in support of my legislation, H.R. 986, the
Protecting Americans With Preexisting Conditions Act.
As a patient with a preexisting condition myself, I rise today to
stand with over 52 million Americans and over 200,000 Granite Staters
who live with preexisting conditions every single day. They could have
been denied access to healthcare prior to passage of the Affordable
Care Act, and many were.
While we recognize that we need to strengthen and stabilize the ACA,
we should equally accept the principle that nobody should be denied
coverage because of a preexisting condition.
When you think about it, asthma, allergies, Alzheimer's, cancer,
diabetes, just go right through the alphabet, having a child, even, any
of these are preexisting conditions. In my home State of New Hampshire
and across this country, opioid and alcohol addiction are preexisting
conditions.
Every week, and again here today, we have heard Republicans on the
House Energy and Commerce Committee say, ``Oh, of course we want to
protect Americans with preexisting conditions.'' Yet, at every step,
this administration is trying to sabotage the consumer protection
guardrails that are in the ACA, including fighting in court for the
total elimination of the Affordable Care Act with absolutely no
replacement.
The CHAIR. The time of the gentlewoman has expired.
Mr. PALLONE. Mr. Chair, I yield the gentlewoman an additional 30
seconds.
Ms. KUSTER of New Hampshire. Mr. Chair, an important piece of the
Affordable Care Act, section 1332, created the State innovation
waivers, which provide States with flexibility in implementing the ACA
as long as plans remain comprehensive, affordable, and accessible.
However, the Trump administration recently issued guidance encouraging
States to promote junk health plans through these waivers in order to
circumvent essential health benefits and protections for preexisting
conditions.
Mr. Chair, I urge my colleagues to vote ``yes'' on this bill.
Mr. WALDEN. Mr. Chair, I yield 2 minutes to the gentleman from
Michigan (Mr. Walberg), a very important member of our Energy and
Commerce Committee.
Mr. WALBERG. Mr. Chair, I thank the lead Republican for yielding.
Mr. Chair, I rise today in opposition to H.R. 986. I would give its
titled name, but it is yet another misleading effort that has nothing
to do with the title of the bill.
House Republicans fully support protections--and I will make it
clear--for patients with preexisting conditions.
I know that my Democratic colleagues and friends want to continue
using the mantra that works so well politically without fact, truth, or
reality during the election. We have gone beyond that now.
Republicans support protections for patients with preexisting
conditions. These patients deserve peace of mind and safeguards from
being treated unfairly. That has always been a priority of ours, and it
will continue to be, but that is not what the bill before us today
would do.
H.R. 986 can be summed up in 3 words: Washington knows best. The bill
eliminates flexibility at the State level, taking away options for
States
[[Page H3522]]
to innovate and bring down healthcare premiums.
The high and rising cost of healthcare is a significant concern for
patients and families in my district. We need to focus on solutions,
not politics. We need to focus on solutions to provide relief from
increasing costs, encourage choice and competition, expand access to
quality care, and maintain--and I will make it very clear here again--
important protections for patients with preexisting conditions.
We have the ideas to do that. We have the amendments that would put
that forward and make this bill something important to people with
preexisting conditions, but that is not being allowed today.
Let's stop playing political games with a bill title and a title like
this and, instead, focus on patient-centered solutions.
Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman
from Colorado (Ms. DeGette), who chairs our Oversight and
Investigations Subcommittee.
Ms. DeGETTE. Mr. Chair, I thank Chairman Pallone for yielding.
Mr. Chair, I rise in strong support of the Protecting Americans with
Preexisting Conditions Act.
Frankly, if my colleagues on the other side of the aisle were so firm
in their commitment to protecting Americans with preexisting
conditions, they would support this bill, because all it says is that
section 1332 will not stop the protections that we have under current
law.
The Trump administration guidance that allows States to undermine the
preexisting condition provisions of the ACA is, frankly, in clear
violation of congressional intent.
Let's be clear about something. When we say we are going to protect
people with preexisting conditions, we actually mean it. That is
exactly what this legislation does.
I would welcome support from my friends on the other side of the
aisle.
According to the Kaiser Family Foundation, over 750,000 people just
in my little State of Colorado would be at risk of losing their
healthcare coverage if it wasn't for the protections of the ACA.
The administration's repeated attempts to take these protections away
from people and deny them their right to obtain healthcare coverage is
the difference for many of them between life and death.
We are not going to let this happen. This Congress is going to make
sure that the goals of the ACA to give full healthcare coverage to
every American, including people with preexisting conditions, is going
to be preserved. We have come too far to turn back the clock now.
Mr. Chair, I am glad that we have this bill on the floor now. I thank
my colleague, Ms. Kuster, for sponsoring it, and I urge every Member of
this body to support it.
Mr. WALDEN. Mr. Chairman, I yield 2 minutes to the gentleman from
Georgia (Mr. Carter), our pharmacist on the Energy and Commerce
Committee.
Mr. CARTER of Georgia. Mr. Chair, I thank the gentleman for yielding.
Mr. Chair, I rise today in opposition to the so-called Protecting
Americans with Preexisting Conditions Act.
Mr. Chair, this is a misnomer. A misnomer is defined as a wrong or
inaccurate name or designation. That is what the title of this bill is.
It is wrong.
I join my colleagues on the Republican side in supporting protections
for people with preexisting conditions. In fact, it was one of the
first votes in Congress that we took this year, and it was defeated by
my colleagues across the aisle.
This bill, which is ironically, as I say, misnamed because it doesn't
protect preexisting conditions, would take steps to roll back State
efforts to innovate and lower premiums for Americans across the
country.
One issue I often hear about from my constituents is the cost of
healthcare coverage and the lack of options available under ObamaCare.
These waivers would allow for new strategies to address the high
premiums that so many people are facing.
In fact, of the States that created their own reinsurance programs,
they saw, on average, a nearly 20 percent drop in premiums, one State
seeing a drop as high as 43.4 percent.
As States continue to grapple with high insurance costs, they have
looked to these innovative waivers for opportunities to bring about new
ideas that help people, not remove options and opportunities.
We all know that there is an issue with affordability of insurance in
many areas. It should be known that this isn't as though it is just
more conservative States moving forward with these reinsurance
programs. States like New Jersey, where the chairman is from, and
Minnesota and Maryland have seen the benefits of this.
Mr. Chair, that is why I urge my colleagues to give States the
flexibility they need to reduce premiums and to vote ``no'' on this
legislation.
Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman
from Illinois (Ms. Schakowsky), who chairs our Consumer Protection and
Commerce Subcommittee.
{time} 1430
Ms. SCHAKOWSKY. Mr. Chairman, I believe that my colleagues on the
other side of the aisle are standing up and saying what they would like
to see, and that is to protect people with preexisting conditions. The
problem with what they are telling the American people is that what
they are proposing does not protect people with preexisting conditions.
I know when I first came to Congress as a woman, being a woman was a
preexisting condition. There were a lot of things that weren't covered
because we are women, until we passed the Affordable Care Act.
While the Republicans are talking about protecting such people, they
are supporting a lawsuit, right now, that, once again, would undo all
of the Affordable Care Act, sweeping out with them protections for
preexisting conditions.
But the other key word to listen to is flexibility. They are talking
about allowing up to 4 years of policies that States could enact that
do not cover the whole panoply of things that the Affordable Care Act
covers and could exclude even protection for preexisting conditions.
That is not flexibility. That is taking away benefits from people.
You can sign up for one of these, what we call, junk policies and you
are perfectly well, and then all of a sudden you have some kind of an
illness that, guess what, is not covered, and won't be covered, because
then you will have a preexisting condition.
The legislation Democrats have for you today would protect
preexisting conditions, no questions, period, end of story.
Mr. WALDEN. Mr. Chairman, I yield 2 minutes to the gentleman from
Texas (Mr. Arrington) to speak on this matter.
Mr. ARRINGTON. Mr. Chairman, I rise to shed light on a very deceptive
practice and the reason the American people refer to politics in
Washington as ``the swamp.'' That is giving bills names that, not only
have nothing to do with the legislation, but actually mislead the
American people to believe it is something that it is not.
This Democrat bill being considered today, entitled the Protecting
Americans with Preexisting Conditions Act, has absolutely nothing to do
with preexisting conditions and protecting people with preexisting
conditions.
This bill actually prevents a policy that allows States to have the
freedom and flexibility to provide for their citizens' healthcare
needs. Where they have exercised that flexibility, we have seen an
average of 20 percent in the reduction of healthcare costs.
There are laws on the books, Mr. Chairman, passed by Democrats and
Republicans alike, that prevent and punish people and companies who
participate in such false advertising. In fact, there is a good reason
the FTC has strong truth in advertising laws and strictly enforces them
against misleading and deceptive practices, because it hurts people, it
hurts consumers, and it actually, in this case, compromises the
American people's trust.
Mr. Chairman, the American people are sick and tired of political
games, they are tired of politicians and their duplicity, and they are
tired of their elected representatives deceiving them. That is what
this is.
Mr. Chairman, I encourage my colleagues to not vote for this bill
that takes the American people as fools and
[[Page H3523]]
preys on their fears, and I encourage both sides to stand in opposition
of this bill.
Mr. PALLONE. Mr. Chairman, I yield 1 minute to the gentleman from
Maryland (Mr. Hoyer), our majority leader.
Mr. HOYER. Mr. Chairman, I thank the chairman, Mr. Pallone, for the
extraordinary leadership he has shown on this issue and so many others,
and for his being an original drafter and sponsor of the Affordable
Care Act.
Sitting here, I was listening to speaker after speaker after speaker
tell me that this doesn't protect preexisting conditions. Of course, it
does. But those are people who not only didn't want to protect
preexisting conditions, they wanted to repeal the whole bill. They
wanted to kick 20 million people off health insurance. Give me a break.
Their crocodile tears are not, hopefully, deluding anybody. They are
against the Affordable Care Act. We get that. This administration has
done everything they can think of to undermine the Affordable Care Act,
which has an adverse effect on the ability of Americans to get health
insurance at a price they can afford.
Mr. Chairman, over the past few years, congressional Republicans and
the Trump administration have engaged in a dangerous campaign to
repeal, undermine, and dismantle the Affordable Care Act. Now,
depending upon how long they have been here, they may well have voted
over 60 times to repeal the Affordable Care Act. All of it. Preexisting
conditions and everything else.
Through executive actions and lawsuits, they have sabotaged the law
and fueled uncertainty in health insurance markets in the process. They
have a suit right now which wants to, effectively, repeal the entire
Affordable Care Act that the Attorney General of the United States and
the President of the United States are supporting.
Spare me these crocodile tears about how this bill doesn't protect
preexisting conditions. It does. But they don't care whether it does or
not.
They, the people, want to know that protections for those with
preexisting conditions won't disappear. That tens of millions of
Americans won't be made, effectively, uninsurable and lose their
coverage.
There are very few of us in this Chamber or in the gallery who don't
have some sort of preexisting condition. We, Democrats, are committed
to making sure that that will not preclude people from getting health
insurance.
In the first days of the Congress, we took action to do what the
Trump administration's Justice Department has refused to do: defend the
law in court. We are taking that action.
Instead, the Trump administration is seeking to overturn the entire
law, including the ban on denying coverage for those with preexisting
conditions.
Now, the Republicans did pass a bill, when they were in charge. They
sent it over to the Senate. They had a big--and I know other people
have talked about that--a big celebration at the White House, and the
President embraced the bill. Some 10 days later, he said: No, it is a
mean bill. The President of the United States embraced it, and, 10 days
later, it is a mean bill.
Overturning the law means the end of popular provisions, like a ban
on forcing women to pay more for the same coverage as men or allowing
those under age 26 to be covered under their parents' policy.
The administration's lawsuit would also bring back out-of-pocket
costs for preventive care and screenings. We want to encourage
preventive care. Why? It saves money and saves lives. Most egregiously,
it would kick 20 million Americans off health insurance coverage who
were able to get covered because of the Affordable Care Act.
Last month, the House passed a resolution written by Colin Allred,
our new Member from Texas, condemning that lawsuit which would repeal
the Affordable Care Act, and reiterating the importance of protecting
Americans' access to quality, affordable care.
Yesterday, the House took another step by passing bipartisan bills,
which Mr. Pallone brought to the floor, to help speed up the process of
bringing the cost of generic drugs down and not prescription costs up.
Today, we have a bill to overturn the Trump administration's guidance
that sabotages the Affordable Care Act by allowing substandard plans.
Are they cheaper? They are. But, in the end, they are much more
expensive because the coverage is minimal.
The effect of such a rule is to drive up prices for those with
preexisting conditions. That wasn't the intent of the Affordable Care
Act, which aimed to make coverage affordable for all Americans.
Next week, we will continue focusing on healthcare by considering
additional legislation to help Americans access quality, affordable
coverage.
I urge my colleagues on both sides. Some of them have said they want
to protect preexisting conditions. Some of them have said that. If they
believed it, then they need to vote for this bill. They need to do
something to protect those with preexisting conditions. Today's vote is
their opportunity to do so.
I thank Representative Kuster, who is on the floor with us today, for
introducing this legislation, and, again, Chairman Pallone for bringing
it to the floor.
House Democrats will continue, as we pledged to do in this last
campaign and as the people who voted for us are expecting us to do, to
protect the Affordable Care Act, protect their ability to get
insurance, notwithstanding a preexisting condition, protect their
families, protect them, and make America better.
Mr. WALDEN. Mr. Chairman, I yield myself such time as I may consume.
I want to make a couple of comments to my friend from Maryland, and he
is my friend. He is always quite poignant and eloquent in his remarks.
What we are debating here today is a bill that is misnamed that
doesn't do what it says it is going to do. What we do know is that 1332
waivers work. My State took advantage of that 1332 waiver and reduced
insurance premiums by 6 percent. The great State of Maryland--I was
just looking at some data, Mr. Chairman--has about 181,500 in the
enrollment year. They used a 1332 waiver. This year in the individual
market their costs for premiums in the individual market percent
decreased 43.4 percent.
Mr. HOYER. Will the gentleman yield? I would like to tell the
gentleman why that happened in Maryland.
Mr. WALDEN. Mr. Chair, I bet he would. But we know, overall, 19.9
percent across the country, because we are able to take some of this
money, put it together, and have a reinsurance program. Maine has done
it, Maryland has done it, and Oregon has done it. These are things that
work.
The complaint I get, Mr. Chairman, is people at home say, I may have
access to coverage now, but I can't afford the premium, or, if I can
afford the premium, I can't afford to get sick because the out-of-
pocket costs are so high. They are now falling off. Later in the
debate, I will share some data that has been published this week
showing people who literally walk away from healthcare because they
can't afford it. That should be our common mission and goal.
When it comes to protecting people with preexisting conditions, I
introduced legislation--and tried to get a vote on it every chance I
have had--that would lock into law preexisting condition protections,
regardless of what this Federal lawsuit's outcome is in Texas. We
should do that. That would be an easy vote. We could all vote for it.
But Democrats won't let us bring it to the floor.
Mr. Chairman, I yield 2 minutes to the gentleman from Oklahoma (Mr.
Kevin Hern).
Mr. KEVIN HERN of Oklahoma. Mr. Chairman, let's be honest, we are not
here to solve a problem today. We are not here to change anything
today. This bill will do nothing to help people with preexisting
conditions.
Something not many people know about me is my family's history with
spina bifida.
I had an older sister, about 13 months older than me, who died 2
hours after birth because of spina bifida.
My older sister, who will turn 50 later this month, has lived her
entire life as a spina bifida survivor, spending the first 6 months of
her life enduring many surgeries. My mother knew that my sister was
going to be born with that very birth defect that took the life of her
first child. My sister had her first daughter, Kristen, who was born
with a devastating spina bifida condition. During the pregnancies, my
[[Page H3524]]
mother knew about my sister's birth defect and my sister knew of
Kristen's condition. In spite of that knowledge, their lives were not
aborted.
Kristen has a son who just turned 10. In spite of being in a
wheelchair for her entire life of 30 years, Kristen has been an awesome
mom to Daniel. Daniel will have an incredible story to tell about his
life because his great-grandmother and his grandmother did not seek
abortions to terminate the lives of their ``less than perfect''
children. He is alive today, and I am confident he will have an
incredible impact on those around him.
These aren't nameless, faceless people we are talking about. This is
my sister, my niece, and my family.
These preexisting conditions have had a massive impact on my life and
the lives of my family. These messaging bills are pointless. People
need help, not our talking points. Our goal should be success. We
should aim to write legislation that has a shot to become law and will
change people's lives for the better.
The aim of H.R. 986 is not to protect Americans with preexisting
conditions, but to interfere with the President's ability to govern.
These are real people and real problems that we are ignoring.
I believe that life is precious. Every life is worth protecting. We
have a lot of work to do and it is time to stop talking and act. That
is what we were elected to do here.
Mr. Chairman, the American people are tired of these political games.
{time} 1445
Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman
from California (Ms. Matsui).
Ms. MATSUI. Mr. Chairman, I rise today as a proud cosponsor of H.R.
986, the Protecting Americans with Preexisting Conditions Act, which
prohibits the Trump administration from promoting the sale of junk
insurance plans that do not fully protect Americans with preexisting
conditions. Today, we are taking a critical step to reverse a damaging
Trump administration policy.
With the Affordable Care Act, we sought to ensure that all people
covered in the same area are charged the same premium as everyone else,
regardless of their health status. Women cannot be denied coverage or
charged more simply because they are women, and more Americans now have
the freedom to start their own business or pursue work in the gig
economy without fear of losing coverage for preexisting conditions.
Coverage before the ACA was often tied to employer plans.
In California, we have taken a stance against the Trump
administration's sabotage of the ACA by protecting consumers from the
sale of junk plans, but not every State has followed our lead.
This legislation protects basic fairness and access to healthcare for
all Americans, not just those living in States that have sought
aggressive reforms, changes, and improvements to the law. We now have a
real opportunity to protect and build on the ACA's success, and I am
immensely pleased to be able to support such efforts on the floor
today.
Mr. WALDEN. Mr. Chairman, I yield 2 minutes to the gentleman from
Kansas (Mr. Marshall).
Mr. MARSHALL. Mr. Chairman, the lengths that my colleagues across the
aisle are willing to go to mislead the public and increase the
political divide over healthcare is shameful and embarrassing. H.R.
986, which I refuse to call by its name, makes a mockery of Americans
with preexisting conditions.
Mr. Chairman, I practiced obstetrics for over 25 years, and do you
know what the most common preexisting condition is? It is pregnancy.
I came to Congress to protect people with preexisting conditions and
to help patients. H.R. 986 just does the opposite. H.R. 986 prevents
innovation. It drives the cost of healthcare up and will cause fewer
people to have healthcare.
Let me be crystal clear about this, Mr. Chairman. This bill has
absolutely nothing to do with people with preexisting conditions. That
is why I am proud to join Congressman Walden and shed light on this
deceptive bill that the Democrats are pushing.
Under current law, States do not have the authority to waive
preexisting conditions using the section 1332 innovation waiver. It is
that simple.
Section 1332 waivers are working, and contrary to the Democrats'
claims, patients are raving about the 1332 waivers for reinsurance.
These waivers give States flexibility to provide Americans with
affordable healthcare options. And in the seven States using these
waivers, premiums have gone down by an average of 20 percent. They went
down 20 percent, with Maryland achieving a 43 percent premium
reduction.
So I stand here today to discuss the facts and not the fiction.
The 2018 guide from the President is making the process easier,
helping States pursue innovation strategies that will help more people
get coverage while delivering quality coverage people can actually
afford and use.
Most of us, including the President, are working towards a better
healthcare future for all Americans, where patients and families, not
bureaucrats in Washington, are in control of their own healthcare
decisions. I ask that my colleagues across the aisle stop the partisan
politics and come together to develop real healthcare policy solutions.
Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Vermont (Mr. Welch), a member of the committee.
Mr. WELCH. Mr. Chairman, I thank the gentleman for yielding.
Mr. Chairman, if we want to level with the American people, let's
acknowledge something: We have a difference of opinion on healthcare.
When we passed the Affordable Care Act, it provided, for the first
time, protections for people who have a preexisting condition.
Every single one of my colleagues on the Republican side voted
against that and then spent the next several years--69 times--voting to
get rid of the protection for preexisting conditions.
Then when they were in the majority, the first opportunity they had,
they passed a bill out of the House to take away the protection for
preexisting conditions.
And thank you to Senator John McCain for protecting the American
people.
Every single opportunity to stand up and protect people who are sick,
who lost their job but were sick and wanted to get insurance, you voted
``no''; we voted ``yes.''
You are talking now about waivers. I like waivers--we have benefited
in Vermont--but not this waiver. If you pass this waiver, you are going
to wave good-bye to the protection that we fought long and hard for for
preexisting conditions.
We fought for your families. We fought for our families. We fought
for all American families.
What kind of world is it if you are sick and you can't get
healthcare? That is what is at stake now. That should never be in
debate.
We will not back down on protecting people from preexisting
conditions. We will not back down on assaults on Medicare. We will not
back down on assaults on Medicaid.
Mr. Chairman, let us pass this bill and continue to protect
Americans' healthcare.
The CHAIR. Members are reminded to address their remarks to the
Chair.
Mr. WALDEN. Mr. Chairman, I would just say to my friend, the biggest
assault on Medicare is the Democrats' proposal to do Medicare for All.
We know it will cost $32 trillion, double personal and corporate
income taxes. I met with our hospitals yesterday: 40 percent reduction
in their payments. They are not sure how they would survive. They told
me most hospitals in America will go bankrupt under the Democrats'
proposal.
Mr. Chairman, I yield 2 minutes to the gentleman from New York (Mr.
Reed), a member of the powerful Ways and Means Committee.
Mr. REED. Mr. Chairman, I rise today in opposition to the bill before
us but, as the father of a type 1 diabetic, agree with the basis of the
law of the Affordable Care Act that says preexisting conditions must be
protected in every health insurance plan going forward. We should be
celebrating together that that reform is now the law of the land, and I
would hope my colleagues would take ``yes'' for an answer.
But what is being proposed today potentially jeopardizes that
protection,
[[Page H3525]]
because what you are proposing today is to take away the ability of the
States to comply with the law of the land to protect those preexisting
conditions in a way that allows the States to innovate, to drive health
insurance premiums down as the law protects those with preexisting
conditions.
This is not a political game. You are talking about real Americans.
You are talking about kids, like my son, who is a type 1 diabetic. And
if this law, as proposed, becomes the law of the land, you potentially
increase insurance premiums on millions of Americans because you take
away that innovation ability of the States to deliver the protections
of preexisting condition reform but lower premiums at the same time.
So I stand in strong objection to this political effort from my
colleagues on the other side of the aisle, and rather than engage in
politics, I join with the silent majority of Americans who say: You
know what? Enough is enough of politics. Get to the real work of the
people and lower healthcare costs for everyone.
Mr. WALDEN. Mr. Chairman, may I inquire as to how much time each side
has remaining.
The CHAIR. The gentleman from Oregon has 9 minutes remaining. The
gentleman from New Jersey has 16\1/2\ minutes remaining.
Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman
from New York (Ms. Clarke), the vice chair of the Energy and Commerce
Committee.
Ms. CLARKE of New York. Mr. Chairman, I thank our chairman for
yielding the time. I thank Congresswoman Kuster for her leadership.
As vice chair of the Committee on Energy and Commerce and cosponsor
of H.R. 986, I am proud to stand with my colleagues in support of the
Protecting Americans with Preexisting Conditions Act of 2019.
Healthcare is a right. In the 21st century, everyone must have the
right to the best quality and affordable healthcare insurance when they
need it most.
This human right must not be only limited to healthy individuals,
but, rather, the human right to healthcare must be available to every
American who has ever been ill at any time or is born with a
preexisting condition. No American should be penalized for a medical
condition that started before the individual's healthcare coverage
benefits went into effect.
Passage of the Protecting Americans with Preexisting Conditions Act
would rescind the 1332 guidance issued by the Trump administration,
which weakens coverage and undermines the Affordable Care Act's
protections for people with preexisting conditions.
Our friends on the other side of the aisle made more than 70 failed
attempts to replace and repeal the Affordable Care Act between 2011 and
2017.
Mr. Chair, we must do the right thing and enact legislation that
strengthens the standards of quality healthcare, affordability,
comprehensiveness, and coverage. Mr. Chairman, I urge my colleagues to
vote ``yes'' on H.R. 986.
Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman
from Michigan (Mrs. Dingell).
Mrs. DINGELL. Mr. Chairman, I rise today to speak in support of
protecting people with preexisting conditions.
Not that long ago, hardworking people who did everything right would
be denied insurance coverage just because they had diabetes or asthma
or they wanted to start a family.
We passed the ACA and ended discrimination against people with
preexisting conditions. Millions of Americans were able to sign up for
coverage for the first time in their lives, and millions who already
had coverage knew it wouldn't be taken away from them.
Remember the stories of people's insurance being canceled as they
were being rolled into operating rooms; that was the truth.
The ACA has done a lot of good. Could we work to improve it? Yes. And
I will work with any Republican or Democrat on those efforts. But when
this Congress and this administration attempt to roll back protections
for people with preexisting conditions, I will always stand against
those policies.
Mr. Chair, 2 years ago last week, House Republicans passed a bill to
rescind the whole ACA and take healthcare away from 20 million
Americans. Because Americans spoke up, that bill failed.
I am proud to cosponsor Representative Kuster's bill. Healthcare
should be affordable to every American.
Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman
from Virginia (Mr. Beyer).
Mr. BEYER. Mr. Chairman, I rise today to speak in support of H.R.
986, the Protecting Americans with Preexisting Conditions Act.
Frankly, Mr. Chairman, I am confused. I serve on the Ways and Means
Committee, and a few weeks ago, we had a long, lively hearing on the
need to preserve the preexisting conditions created by the ACA. I was
impressed that every member of the Ways and Means Committee, Democrat
and Republican, spoke passionately about this protection--every one.
We emerged from that hearing with a clear, bipartisan consensus that
we would never again condemn Americans who suffer from diabetes or
cancer or heart disease or epilepsy to unaffordable insurance and
perhaps an early death.
But today my Republican friends are ready to vote against the only
bill this year to keep the Trump administration from gutting the
preexisting exclusion. They argue that, no, this is not what CMS is
trying to do, yet this is exactly what would happen with short-term
insurance plans if the various States are given the opportunity to do
so. That is why virtually every organization that protects human health
supports this bill and is against the CMS action.
{time} 1500
States want waivers. States want to innovate. This bill won't keep
them from innovating or keep them from getting waivers. Remember what
States did before the Affordable Care Act when there was no prohibition
against higher costs for preexisting conditions or no insurance.
If what they say is, indeed, true, there is no harm voting ``yes''
for this bill. States will still be able to innovate, as long as they
don't violate the preexisting conditions exclusion.
Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman
from Texas (Ms. Jackson Lee).
Ms. JACKSON LEE. Mr. Chair, I thank the chairman very much for
yielding.
Just a second on memory lane, for those of us who were here for the
Affordable Care Act, dozens of our committees, including the Judiciary
Committee, heard the pain of people whose family members had died
because they had no access to healthcare and/or they had junk policies.
Mr. Chair, I rise today with the strongest of support for H.R. 986. I
thank my good friend, Ann Kuster, for her great leadership and indicate
that since the Affordable Care Act--and I know that we are now looking
at Medicare for All and many others. My view of it is yes, so that we
all can have access to healthcare.
It is, in fact, sure that this bill that we now have, which is being
attacked by the Trump administration in the Fifth Circuit right now
because of my attorney general attacking the Affordable Care Act, Texas
saw a national decrease of the uninsured from 14.8 to 8.8.
Now this legislation, which is to turn back the Trump guidance on the
issue of waivers, is vital because we have lower costs for health
insurance because of the ability for people to access and be taken care
of with the Affordable Care Act when they have preexisting conditions.
Sickle cell, triple negative breast cancer, and diabetes all plague
my constituency. Insulin costs are going through the roof. With this
guidance that Trump has put in place, it will be worse. It will be
compounded.
Rates will go up, and people suffering from preexisting conditions,
including pregnancy, will not get policies at a low cost. They will not
have comprehensive coverage that will include mental health. Certainly,
they will see a reverse of them being able to have coverage for
preexisting conditions.
[[Page H3526]]
That is the civil rights of healthcare. Preexisting conditions must
be protected.
I rise to enthusiastically support H.R. 986, and I demand that the
Trump administration stop taking away constitutional rights in
everything and denying people their right to good healthcare. Enough is
enough. Let us support this legislation.
Mr. Chair, I rise in strong support of H.R. 986, the ``Protecting
Americans With Pre-Existing Conditions Act of 2019,'' which blocks the
Trump Administration's efforts to give states the ability to weaken the
Affordable Care Act's critical protections for Americans with pre-
existing conditions.
On October 22, 2018, the Centers for Medicare & Medicaid Services
(CMS), HHS, and Treasury issued a guidance on Section 1332 of the ACA,
which authorizes states to waive certain requirements of the law and
experiment with health insurance reforms that could improve the well-
being and health of their residents.
The ACA has a clear statutory directive that states must maintain the
level of benefits, affordability, and coverage provided to state
residents by the ACA.
Section 1332 requires states to meet four statutory ``guardrails''
simultaneously and demonstrate that the proposed waiver will provide
comprehensive, affordable coverage to a comparable number of residents
as under the ACA, without increasing the federal deficit.
But in the 2018 guidance, HHS and Treasury revised the agencies'
interpretation of the statutory requirements, and significantly
loosened the standards that states must meet in order to receive waiver
approval, setting forth weaker requirements that must be met for the
affordability and comprehensiveness guardrails and adopted a new
definition of what classifies as coverage.
The 2018 guidance provided by the Trump Administration would allow
states to simply demonstrate that a comparable number of residents will
have access to comprehensive and affordable coverage, regardless of
whether they actually enroll in that coverage, thereby allowing the
Secretaries of HHS and Treasury to approve waivers that do not provide
coverage that is as affordable or as comprehensive as under the ACA.
The 2018 guidance also allows states to receive waiver approval for
proposals that direct the ACA's tax credit subsidies towards STLDI
plans and other types of health insurance plans that do not provide
protections for pre-existing conditions.
H.R. 986 revokes and rescinds the October 2018 Section 1332 guidance
and prohibits the Secretaries of HHS and Treasury from promulgating any
substantially similar guidance or rule.
These improper waivers leave consumers with less comprehensive plans
that do not cover needed services, such as prescription drugs,
maternity care and substance use disorder treatment.
Another way the ``Protecting Pre-Existing Conditions and Making
Health Care More Affordable Act of 2019,'' protects consumers is by
prohibiting insurance companies from selling junk health insurance
plans that do not provide coverage for essential medical treatments and
drugs or cover people with pre-existing medical conditions.
As a member of Congress who voted against each of the dozens of
Republican efforts to repeal the Affordable Care Act, I know first-hand
how important and critical access to affordable, high quality,
accessible health care available to everyone, including those with pre-
existing conditions, to the well-being of American families.
Because of the passage of the Affordable Care Act, the national
uninsured rate has been slashed from 14.8 in 2012 to 8.8 percent in
2018. Texas has long led the nation in rate of uninsured so the
comparable rates are 24.6 and 15 percent, respectively.
Mr. Chair, I distinctly recall a candidate for the highest public
office in the land saying ``Obamacare is a disaster'' and appealing for
voters to support him with this question: ``What have you got to
lose?''
The question deserves a response so I hope that person, who occupies
the Oval Office, is listening to my answer.
The Affordable Care Act, or ``Obamacare,'' has been an unmitigated
success to the more than 20 million Americans who for the first time
now have the security and peace of mind that comes with affordable,
accessible, high quality health care.
Mr. Chair, Tip O'Neill used to say that ``all politics is local'' so
let me share with you how Obamacare has dramatically changed lives for
the better for the people in my home state of Texas.
1.874 million Texans who have gained coverage since the ACA was
implemented could lose their coverage if the ACA is entirely or
partially repealed or invalidated.
1.1 million Texans who purchased high quality Marketplace coverage
now stand to lose their coverage if Texas v. United States, No. 4:18-
cv-00167-0 (N.D. Tex.), the lawsuit brought by Republican Governors,
and now whole-heartedly supported and aided by the Trump Administration
were to succeed.
508,000 kids in Texas who have gained coverage since the ACA was
implemented are also at risk of having their coverage rolled back.
205,000 young adult Texans who were able to stay on a parent's health
insurance plan thanks to the ACA now stand to lose coverage if the
Republican Congress eliminates the requirement that insurers allow
children to stay on their parents' plans until age 26.
646,415 Texans who received cost-sharing reductions to lower out-of-
pocket costs such as deductibles, co-pays, and coinsurance are now at
risk of having healthcare become unaffordable if the Republican
Congress eliminates costsharing reductions.
10.28 million Texans who now have private health insurance that
covers preventive services without any co-pays, coinsurance, or
deductibles stand to lose this access if the Republican Congress
eliminates ACA provisions requiring health insurers to cover important
preventive services without cost-sharing.
913,177 individuals Texans who received financial assistance to
purchase Marketplace coverage in 2016, averaging $271 per individual,
are at risk of having coverage become unaffordable if the Republican
Congress eliminates the premium tax credits.
1.1 million Texans could have insurance if all states adopted the
ACA's Medicaid expansion; these individuals will not be able to gain
coverage if the Republican Congress eliminates the Medicaid expansion.
Women in Texas who can now purchase insurance for the same price as
men are at risk of being charged more for insurance if the ACA's ban on
gender rating in the individual and small group markets is invalidated.
Before the ACA, women paid up to 56 percent more than men for their
health insurance.
Roughly 4.5 million Texans who have pre-existing health conditions
are at risk of having their coverage rescinded, being denied coverage,
or being charged significantly more for coverage if the ACA's ban on
pre-existing conditions is struck down.
346,750 Texas seniors who have saved an average of $1,057 each as a
result of closing the Medicare prescription drug ``donut hole'' gap in
coverage stand to lose this critical help going forward.
1.75 million Texas seniors who have received free preventive care
services thanks to ACA provisions requiring coverage of annual wellness
visits and eliminating cost-sharing for many recommended preventive
services covered by Medicare Part B, such as cancer screenings, are at
risk of losing access to these services if congressional Republicans go
forward with their plan to repeal the ACA.
The Affordable Care Act works and has made a life-affirming
difference in the lives of millions of Americans, in Texas and across
the country.
This is what happens when a visionary president cares enough to work
with a committed and empathetic Congress to address the real issues
facing the American people.
You want to know why the American people have Obamacare?
It is because Obama cared.
The same cannot be said about this Republican president and
congressional Republicans who have made careers of attacking and
undermining the Affordable Care Act's protections and benefits for the
American people.
I urge all Members to vote for H.R. 986 and send a powerful message
to the President and the American people that this House will not stand
idly by as this Administration tries to take away health care from more
than 130 million persons.
Instead, this House will resist by all constitutional and appropriate
means, including opposing this Administration in the courts and by
passing H.R. 986, the ``Protecting Pre-Existing Conditions and Making
Health Care More Affordable Act of 2019.''
Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from
Connecticut (Mr. Courtney).
Mr. COURTNEY. Mr. Chair, I thank the chairman for yielding.
Mr. Chair, after 2 years of the Trump administration trying and
failing in Congress to repeal the Affordable Care Act, they have gone
to plan B. Plan B is to use the administrative agencies, the Department
of Health and Human Services, and the court system as a way of trying
to accomplish what they could not accomplish through the House and the
Senate in the 115th Congress.
Today, we are dealing with one of those efforts, which was an order
that was issued in October of last year, issuing new guidelines for
State waivers from the Affordable Care Act, repealing the ObamaCare
guardrails that
[[Page H3527]]
made sure that patient protections would not be affected by such
waivers--for example, protecting people with preexisting conditions;
the elimination of lifetime caps on health insurance; and the
protections that were built in for essential health benefits that
defined real healthcare, not the cheap healthcare that was being sold
before the ACA was enacted.
An intervening event occurred since last October. We had an election.
It was the largest midterm turnout since 1914. We had a new majority
that was elected with a plurality of 10 million votes, larger than any
flip election in the past, any wave election in the past. The number
one issue from the voters was healthcare and protecting their patient
rights to affordable and comprehensive benefits.
Mr. Chair, we are here today debating an issue that the patient
groups that represent people with chronic illnesses, with expensive
illnesses like cancer, have stepped up across the board, saying vote
for this legislation to overturn the Trump order that they are trying
to get through but that they cannot get through the U.S. Congress. Vote
for this bill.
Mr. PALLONE. Mr. Chair, may I inquire how much time remains?
The CHAIR. The gentleman from New Jersey has 9 minutes remaining. The
gentleman from Oregon has 9 minutes remaining.
Mr. PALLONE. Mr. Chair, I yield myself such time as I may consume.
Mr. Chair, I wanted to mention this issue of reinsurance. Some of the
Republicans have brought up the fact that in the last few years under
the Obama administration, actually before President Trump, certain
States--I believe there are eight now, including my own--applied for
1332 waivers because they wanted to put in place reinsurance programs.
I want to assure everyone that those types of waivers that are
granted for reinsurance would continue and that this legislation in no
way impacts that. Keep in mind, we are not opposed to 1332 waivers.
But pursuant to the Affordable Care Act, which I helped draft, those
waivers, when granted, have to maintain affordability and
comprehensiveness of coverage and keep the same number of people
insured as under the ACA.
When my State and others have applied for waivers for reinsurance
programs, it is because the ACA reinsurance funding was discontinued at
some point under the original bill. Those States want to, among other
things, make sure that there is competitiveness in the marketplace by
providing some kind of reinsurance or risk protection so that more
insurers come into the marketplace in those States and create more
competition and lower prices.
When you ask the Federal Government for a reinsurance waiver, you are
still maintaining affordability, probably making things even more
affordable because of competition. You are still maintaining the
comprehensiveness of the coverage because you have to provide policies
that have all the essential benefits. You are keeping the same number
of people insured. In fact, what you are probably doing is having more
people insured.
The difference between that and the section 1332 guidance that the
Trump administration is now putting forth is that none of those things
are guaranteed under the waivers that the Trump administration is
proposing with their guidance.
For one thing, they are saying you can sell a junk plan that doesn't
have hospitalization, that doesn't have essential benefits, so you
violate the section 1332 provision.
You also end up having fewer people insured because the Trump
administration says you don't have to have the same number of people
covered. All you have to do is have access.
Lastly, affordability, sure, they will argue that somehow it is more
affordable because a junk plan doesn't cost as much, but that is sort
of a misnomer because the comprehensiveness of the coverage disappears.
I want everyone to understand, a State that applies to have
reinsurance as part of their program and gets a waiver, that is in no
way impacted by what we are proposing here today with Ms. Kuster's
bill. In fact, reinsurance reinforces the very things that the 1332
waivers are seeking to guarantee.
So that is a very false bit of information that my colleagues on the
other side are trying to put out here today. I wanted to explain that.
Mr. Chair, I reserve the balance of my time.
Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman
from Michigan (Ms. Slotkin).
Ms. SLOTKIN. Mr. Chair, I rise today in support of the Protecting
Americans with Preexisting Conditions Act.
For me, this issue is particularly personal. It is a major reason why
I ended up coming here to Congress.
I believe that the sabotage, the attempts at legislating out
protections for people with preexisting conditions, is something that
is just out of touch with the American people, certainly in Michigan's
Eighth Congressional District.
It is particularly personal to me because of my mom. My mom passed
away in 2011 from ovarian cancer. When she was diagnosed, she did not
have healthcare.
She had trouble with healthcare her entire life. She had breast
cancer as a young 31-year-old mom, so for the rest of her life, she had
a preexisting condition.
My parents divorced, and she lost her job. Because of that
preexisting condition, she could not afford health insurance. She went
5\1/2\ years without a checkup and no gynecological exam.
We finally got her health insurance, my brother and I. It was $1,000
a month, with a $10,000 deductible, her highest bill in Detroit.
In 2009, without us knowing, she let it lapse. Two months later, she
walked into an ER and was diagnosed with stage IV ovarian cancer.
I am sure my colleagues around the room know what it is like to have
a loved one get a terminal diagnosis. Your life as you know it
explodes.
That same week and that same month that our lives were exploding was
the same week and the same month we spent filling out the paperwork for
her to declare bankruptcy.
I think no matter whether you are a Republican, a Democrat, or an
independent, it is essential that we support people with preexisting
conditions, and I urge my colleagues to do so.
Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
Mr. PALLONE. Mr. Chair, I yield myself such time as I may consume. I
am still waiting for one of our other speakers.
Mr. Chair, I want to respond to my colleague, the ranking member,
whom I respect a great deal. He has several times today, as well as in
committee and as a representative at the Rules Committee, talked about
this amendment that he has on preexisting conditions.
First of all, the reality is that the ACA guarantees people coverage
with preexisting conditions. The problem here is not that we need to
restate that, but that the section 1332 guidance that the Trump
administration has proposed would undermine it.
On its surface, Mr. Walden's amendment appears to maintain
protections for preexisting conditions, but, again, that is not the
issue because he is not getting rid of the guidance that the Trump
administration has put forward under 1332.
What does that mean? It means that even with his amendment, the Trump
administration, under their guidance, would allow insuring companies to
not offer basic services such as hospitalization, maternity coverage,
mental health, and substance abuse disorders. Insurance companies would
no longer have to offer these benefits to people with preexisting
conditions who need those benefits.
Mr. Walden's amendment also does not include prohibitions on annual
and lifetime limits, which are critical protections for individuals
with preexisting conditions. These limits, which were commonplace prior
to the ACA, are a threat to the life and health of individuals with
serious medical conditions.
The Walden amendment would also allow insurance companies to charge
women more than men and put a significant financial burden on older
Americans.
We are not interested in these half measures that would leave
Americans worse off.
[[Page H3528]]
Mr. Chair, I yield such time as he may consume to the gentleman from
California (Mr. Harder).
Mr. HARDER of California. Mr. Chair, I rise today in support of my
amendment. My legislation would simply require the Federal Government
to issue an expert analysis of the impact of junk plans on mental
healthcare access. People deserve access to mental healthcare, and we
don't know how many people will lose that access if these junk plans
become used more widely.
That is exactly what my amendment would tell us.
People who are struggling with depression, anxiety, schizophrenia, or
substance use disorder deserve coverage. We are talking about real
people in our communities who need help, and they should get it.
That is especially true because of the stigma surrounding mental
health issues. If you tell your friends that you have cancer, they tell
you to get help. If you tell your friends you have depression, they
tell you to tough it out or go to the gym.
Without access to mental healthcare, a lot of people end up self-
medicating. That is why we have to make sure that they are covered with
real insurance, not junk plans.
{time} 1515
These plans are a scam.
I heard a horror story from a woman in Stanislaus County about her
family's experience with a junk plan before the Affordable Care Act.
Her daughter went off to school and got cheap, university-sponsored
insurance.
After a couple of years, she had a mental health issue present, but
she was completely denied coverage for the treatment that she needed.
Even though she paid premiums for years, she wasn't covered, and her
family had to pay thousands of dollars out of pocket. Years later, they
are still paying it off today, more than 10 years after her mental
health episode.
That is a common story because only about half of these plans cover
mental healthcare, and only about one-third cover substance use
disorder, and that is a huge problem in the Central Valley, especially
for young people.
It is in people's twenties that they start showing signs of a lot of
mental health problems, and this often coincides with the development
of substance use disorders. People who turn 26 have to get off their
parents' insurance. They pick the cheapest thing they can find.
If we don't pass this amendment, millions of people who have similar
stories will be denied coverage for mental health issues when they need
it most.
That is a scam. That is what my amendment demands.
Mr. WALDEN. Mr. Chairman, how much time remains on each side?
The CHAIR. The gentleman from Oregon has 9 minutes remaining. The
gentleman from New Jersey has 1 minute remaining.
Mr. WALDEN. Mr. Chairman, I yield myself the balance of my time.
Mr. Chairman, let me address a few issues. First of all, my friend my
New Jersey--and he is my friend--referenced my amendment.
It is unfortunate that we can't debate my amendment on the floor,
because the Democrats who control the Rules Committee wouldn't allow my
amendment to be considered, nor would they allow us to bring a bill to
the floor that I have authored that has more than 100 cosponsors that
would make sure that preexisting conditions are protected in case the
court decision in Texas goes against the ACA and wipes out those
protections.
This would be an insurance policy in public law for people with a
preexisting condition. We can do that today. If it has some
shortcomings, then let's have a markup on this bill and work that out.
I care deeply about preexisting condition protection. I fought for it
as a legislator. I helped create the high-risk pools in Oregon back in
the late eighties and early nineties. I have supported it every step of
the way.
Let me again quote from the Department of Health and Human Services.
We asked them, and they wrote back to me, about protection for
preexisting conditions. Seema Verma, the Administrator, said in her
letter to me: ``To be very clear, the 2018 guidance does nothing to
erode PPACA's preexisting condition provisions, which cannot be waived
under section 1332.''
So they cannot do that. They cannot waive those protections under
1332.
``Section 1332 does not permit States to waive Public Health Service
Act requirements, such as guaranteed availability and renewability of
health insurance, the prohibition on using health status to vary
premiums, and the prohibition on preexisting conditions exclusions.
Furthermore, a section 1332 waiver cannot be approved that might
otherwise undermine these requirements. This administration stands
committed to protecting people with preexisting conditions.''
That is the head of CMS. It is her agency that approves 1332 waivers.
There have been no waivers so far approved under this guidance, and
that is what she tells us in writing, period, because of the
information that is being sent around.
We do know that seven States have taken advantage of the prior 1332
process, and it has yielded more affordable insurance premiums for
American citizens.
Now, I find it curious. My State has been very progressive in these
areas. When I was in the State legislature, I helped try to expand
access to affordable healthcare. We had to come to Washington to get a
waiver for the Oregon health plan and Medicaid, and we looked at all
kinds of different ways to get access to affordable healthcare, and I
have never let up on that.
I believe strongly in helping people with preexisting conditions.
Like my colleagues on the other side of the aisle, my wife and I had a
son who did not survive because of a heart condition. We dealt with all
of these issues leading up to his birth and eventual death. So I am
fully committed to protecting people with preexisting conditions.
What we are arguing about here is: Is health insurance affordable for
Americans and are there better ways, using States as laboratories, to
innovate and bring down costs of care and costs of insurance, because
more of us are paying more out of our pocket than at any time in our
history.
There was a very interesting story which I will put in the Record for
everyone to read, data from the Kaiser Foundation this week that ran in
a publication called Axios. I just want to share some of what they
found about what is really going on if you get outside of the beltway
here in Washington and talk to real people.
They evaluated people who had coverage under their employer, in this
case, and had a chronic condition of some sort. It is not a small
group.
About half of Americans who have employer coverage--so that is half
of 158 million--report that 6 in 10 in that group report they or a
family member skipped or postponed medical care or prescription drugs
they needed because of the costs, or, in some cases, they tried a home
remedy.
High deductibles make things worse. Among those with chronic
conditions whose deductibles were at least $3,000 for an individual or
$5,000 for a family, three-quarters, Mr. Chairman, 75 percent, report
skipping or postponing some type of care; and about half, 49 percent,
say they or a family member had problems paying medical bills or
difficulty affording their premiums, deductibles, or copays in the last
year.
So what States--including mine, including New Jersey, including
Maryland, and including Maine and Alaska--did was say: Hey, Washington,
D.C., give us just a little flexibility here. Let us come with up with
plans that may be more affordable.
They did that under the prior rules, and rates went down, on average,
19.9 percent--some States more, some less.
Now, what happens when people can't afford to use their own
insurance? Because that is happening with these deductibles and with
these high levels, let alone the premiums.
The ripple effect on family budgets, according to the story in Axios,
is a substantial share of people reported taking measures such as
increasing credit card debt, 28 percent; using up most of their
savings, 26 percent; getting an extra job, 19 percent; borrowing money
from family or friends, 14 percent.
This is what we are trying to argue could be better taken care of.
This is the issue that is being ignored by a Washington one size fits
all.
So we protect people with preexisting conditions, 1332 waivers--that
law
[[Page H3529]]
stays in effect--but we want to give States a little more flexibility
to go after this to bring down the cost.
Now, my friend from New Jersey and I, Mr. Chairman, are working
together on some of these drug reforms so we can get drug costs down.
I was at the White House today with the President on surprise
billing, and I think we are going to work together on that issue, Mr.
Chairman, so that no American consumer who follows the rules gets stuck
with a surprise bill. What are you supposed to do, wake up in the
middle of the operation and say: Hey, is everybody in this room still
on my plan? If you play by the rules, you shouldn't get stuck unfairly
with a surprise bill. We are going to find a solution.
My State came up with a way to do that already and other States have
other ideas, but we are going to protect consumers there as well. We
are going to drive down the cost of drugs, and we should continue to go
after this issue of the high cost of healthcare because that is what
Americans in my 20 townhalls--and I don't think anybody in the House
has done more.
I have done 20 townhalls this year. In almost every one of them, they
are asking: How do you get the costs down?
Mr. Chairman, 1332 waivers gave my State the opportunity to get costs
down, and we should not impede that process.
We are going to debate a lot about these policies going forward, and
if there are junk plans, then let's expose them for what they are, and
let's pass Ms. Eshoo's bill from, I think, last Congress, which
required more transparency and accountability so you don't have fraud
and deception. Count me all in on that.
There is a lot more we can do to drive down costs.
My legislation--again, Democrats refused to bring up in committee or
have on the floor--would make sure, regardless of any lawsuit, people
with preexisting conditions can continue to get covered. So
irrespective of the court decisions, they would get covered.
If my bill were allowed to be voted on in the House, I guarantee you,
we might have some issues we need to work out. I am happy to do that.
If it passed, it would become law. This President is firmly committed
to protecting people with preexisting conditions, so we should do that.
We should also have a hearing on the Medicare for All bill that some
on the other side are promoting. I have asked for that.
I know there was one in the Rules Committee, but Energy and Commerce
is the committee of jurisdiction for most of that. We have not seen
that hearing yet. I hope, in the future, we will, because we should
know the impact of wiping out Medicare Advantage plans and Medigap
plans.
I have been told TRICARE would go away, all private insurance would
go away, and it would be a one-size-fits-all, government-run system. I
am worried about the delay in access to care. I am worried about the
access to the great, new innovative drugs and procedures that we would
lose in America.
So, Mr. Chairman, I must oppose this underlying legislation. I remain
committed to protecting people with preexisting conditions, as do my
colleagues on the Republican side. Then we ought to focus together, Mr.
Chairman, as a Congress to do the best thing for our constituents,
which is to bring the greatest leverage possible to reduce unnecessary
costs in the healthcare system in America.
Mr. Chairman, I ask my colleagues to oppose this bill, and I yield
back the balance of my time.
Mr. PALLONE. Mr. Chairman, I yield myself the balance of my time.
Mr. Chairman, the problem is that nothing that my colleague on the
Republican side says about his amendment and nothing that is in Seema
Verma's letter will help a person with preexisting conditions.
The bottom line is this 1332 guidance that the Trump administration
has put forward allows junk plans to be sold so that people with
preexisting conditions will not get the coverage they need. They can be
charged more. They are not guaranteed that things like recisions and
lifetime limits don't go back into place.
So the problem that we face is we can't allow people with preexisting
conditions to suffer and not get coverage because they are going to be
charged more or because they are not going to get the coverage they
need by buying a junk plan.
If you really care about that and you want to make sure that people
with preexisting conditions really are guaranteed good coverage and can
afford their coverage, then you have to vote for Ms. Kuster's bill.
That is all we are saying here.
I am not saying that my colleague on the other side is not well
meaning, but nothing he has said will protect the people with
preexisting conditions from the problems with the Trump guidance. So I
would ask my colleagues to support this bill.
Mr. Chairman, I include in the Record two letters from various
nonprofit health organizations supporting the bill.
May 8, 2019.
Hon. Greg Walden,
Ranking Member,
House Energy & Commerce Committee,
Washington, DC.
Dear Ranking Member Walden: Our 35 organizations,
representing the interests of the millions of patients and
consumers who live with serious, acute, and chronic
conditions, have worked together for many months to ensure
that patient voices are reflected in the ongoing
Congressional debate regarding the accessibility of health
coverage for all Americans and families. In March 2017, we
identified three overarching principles to guide and measure
any work to further reform and improve the nation's health
insurance system. Our core principles are that health care
must be adequate, affordable, and accessible. Together, our
organizations understand what individuals and families need
to prevent disease, manage health, and cure illness. As the
116th Congress progresses, we welcome the opportunity to work
with members on both sides of the aisle on solutions that
will preserve coverage for individuals who are currently
covered, extend coverage to those who remain uninsured, and
lower costs and improve quality for all.
Prior to the Affordable Care Act (ACA), individuals who
were in the most need of health insurance coverage--including
older and sicker Americans and people living with pre-
existing conditions--often found it difficult, if not
impossible, to obtain health insurance that provided the
coverage they needed. Many individuals were denied coverage
due to their pre-existing conditions or were charged
outrageous premiums and/or were left with inadequate benefit
packages.
Without access to comprehensive health coverage they could
afford, many patients with serious and chronic conditions
were often forced to delay or forego necessary health care.
Before the patient protections provided under the ACA, more
than half of heart patients reported difficulty paying for
their care and of those patients more than 40 percent said
they had delayed care or had not filled prescriptions.
Uninsured patients with diabetes were six times as likely to
forgo necessary medical care than those with coverage.
Uninsured patients were less likely to be screened for cancer
and more likely to be diagnosed with later stage disease
which is harder to survive and more costly to treat.
Individuals and families with pre-existing conditions rely
on critical protections in current law to help them access
comprehensive, affordable health coverage that meets their
medical needs. Unfortunately, the arguments of the plaintiffs
and the recent change of opinion by the Department of Justice
in the Texas v. U.S. case continue to represent a serious
threat to these protections. We are troubled by the argument
made by the plaintiffs and DOJ that the court must invalidate
the entire ACA due to Congress' repeal of the individual
mandate, as many provisions of the ACA directly protect
people with pre-existing conditions.
Our organizations appreciate that members of Congress share
our concerns about the potential impact of Texas v. U.S. on
people with pre-existing conditions. Several bills have been
introduced in response to this case, from H. Res. 14, which
authorized the Speaker, on behalf of the House of
Representatives, to intervene in the case of Texas v. United
States, to S. 1125, the Protect Act, and H.R. 692, the Pre-
existing Conditions Protection Act of 2019.
Some of these bills--including S. 1125 and H.R. 692--
attempt to provide protection to people with pre-existing
conditions should the ACA be invalidated. We recognize and
appreciate the sponsors' efforts, and know that in many
cases, in response to stakeholder feedback, sponsors have
revised previous drafts of these bills to offer additional
protections for consumers, including those with pre-existing
conditions. However, we remain concerned that the policies
outlined in these bills fall far short of the comprehensive
protections and coverage expansion included in current law.
As you are aware, current law requires issuers to comply
with a set of provisions that work together to promote
adequate, affordable, and accessible coverage for people with
pre-existing conditions. A holistic approach that includes--
but is not limited to--community rating, guaranteed issue,
essential health benefits, cost-sharing limits, a
[[Page H3530]]
prohibition of lifetime and annual limits, allowing young
people to stay on their parents' insurance to age 26, the ban
on pre-existing condition exclusions, and other important
provisions protect people with serious health care needs from
discriminatory coverage practices and promote access to
affordable coverage. Medicaid expansion also brought coverage
to millions of Americans who were previously uninsured, many
of whom went without vital care. These policies are
inextricably linked and repealing any of them threatens
access to critical care for people with life-threatening,
disabling, chronic, or serious health care needs.
We hope that you will keep these critical patient
protections and the interlocking functions of current law
that safeguard coverage for consumers, patients, and
individuals with pre-existing conditions at the front of your
mind during the 116th Congress. We are grateful that Congress
is committed to exploring both immediate and long-term
approaches that can be taken to shore up and strengthen the
individual insurance market and we remain ready and willing
to work with Congress to achieve that goal and provide all
Americans with the health care they need and deserve. If you
have any questions about this letter, please contact Katie
Berge, Federal Government Relations Manager for the American
Heart Association.
Sincerely,
United Way Worldwide, COPD Foundation, Hemophilia
Federation of America, Susan G. Komen, Family Voices,
American Heart Association, National Health Council, Epilepsy
Foundation, March of Dimes, ALS Association, National
Hemophilia Foundation, National Coalition for Cancer
Survivorship, Alpha-1 Foundation, American Liver Foundation,
National Multiple Sclerosis Society, WomenHeart: The National
Coalition for Women with Heart Disease, American Cancer
Society Cancer Action Network.
Muscular Dystrophy Association, National Patient Advocate
Foundation, Leukemia & Lymphoma Society, Lutheran Services in
America, National Kidney Foundation, American Lung
Association, Cystic Fibrosis Foundation, American Diabetes
Association, National Psoriasis Foundation, National Alliance
on Mental Illness, Adult Congenital Heart Association,
Arthritis Foundation, Chronic Disease Coalition, Immune
Deficiency Foundation, Cancer Support Community, National
Organization for Rare Disorders, Pulmonary Hypertension
Association, Juvenile Diabetes Research Foundation.
____
May 8, 2019.
Re Letter of Support from 23 Patient and Consumer Advocacy
Organizations for H.R. 986.
Hon. Ann McLane Kuster,
House of Representatives,
Washington, DC.
Dear Representative Kuster: Our 24 organizations,
representing the interests of the millions of patients and
consumers who live with serious, acute, and chronic
conditions, have worked together for many months to ensure
that patient voices are reflected in the ongoing
Congressional debate regarding the accessibility of health
coverage for all Americans and families. Today, we write in
strong support of your legislation to protect people with
pre-existing conditions who receive coverage in the
individual marketplace. The Protecting Americans with
Preexisting Conditions Act of 2019, H.R. 986, would require
the Administration to rescind its Section 1332 State Relief
and Empowerment Waivers Guidance, released on October 22,
2018 (1332 guidance). We are concerned about the impact that
this guidance could have on the people we represent and
applaud your introduction of this bill.
In March 2017, we identified three overarching principles
to guide and measure any work to further reform and improve
the nation's health insurance system. Our core principles are
that health insurance coverage must be adequate, affordable,
and accessible. Together, our organizations understand what
individuals and families need to prevent disease, manage
health, and cure illness. Our organizations are deeply
concerned about how the new 1332 guidance will affect the
individual marketplace's stability in states that choose to
pursue some of the policies allowed under this guidance,
including those that promote short term plans and other
substandard coverage. We are pleased that this legislation
represents a significant and meaningful step towards
protecting all Americans from coverage that does not cover
what they need to promote their health and well-being.
As you know, the 1332 guidance substantially erodes the
guardrails governing coverage that people with pre-existing
conditions such as cystic fibrosis, lung disease, cancer,
cardiovascular disease, diabetes, rare disorders, pregnant
women, and many others rely on in the individual marketplace.
Of particular concern, the new guidance would allow states to
let individuals use advanced premium tax credits to purchase
non-compliant short-term, limited duration insurance plans--
which could further draw younger, healthier people out of the
risk pool for comprehensive insurance and drive up premiums
for those who need comprehensive coverage. The guidance also
eliminates protections for vulnerable populations, such as
individuals with low incomes and those with chronic and
serious health issues, by removing the requirement to
safeguard those populations under any waiver. We are deeply
concerned by this as these changes fundamentally alter the
nature of the Section 1332 waiver program and jeopardize
adequate, affordable coverage for people with pre-existing
conditions in the individual market. Halting the
implementation of this guidance will protect people with pre-
existing conditions from the repercussions of these market
destabilizing actions.
H.R. 986 represents a significant step towards protecting
patients and consumers. Yet, we also recognize that there is
much more that needs to be done to improve upon our current
system of care, including making coverage more accessible and
affordable. Up until this year, health insurance enrollment
has steadily increased, and, with it, the promise of a more
diverse risk pool and greater protection for people with
serious health care needs. However, the recent
reinterpretation of the guidelines is jeopardizing
enrollment. Shortened enrollment periods, fewer resources for
outreach and education and less funding for consumer
navigators not only creates confusion for consumers but
directly impacts the number of individuals who enroll in
Marketplace coverage. Without Congressional action, these
trends will make it harder for many to access coverage and
will further contribute to the destabilization of insurance
markets and result in higher premiums for many enrollees.
Making high-quality coverage and care more affordable is
also a high priority for the people that we represent.
Passage of legislation that expands access to and the level
of advance premium tax credits, fixes the family glitch,
creates a nationwide reinsurance program, and reduces
systemic health care costs could significantly ease the cost
burden for people of all income levels who rely on the
individual marketplace for coverage. We urge Congress to
support legislation that maintains the quality of coverage
while expanding access and affordability.
Again, thank you for your leadership on this critical issue
for people with pre-existing conditions. We support your
efforts to halt the implementation of the 2018 guidance,
ensuring the guidance from 2015 remains intact and promoting
stability in the individual marketplace. We urge members of
Congress to vote for H.R. 986.
Sincerely,
Hemophilia Federation of America, National Health Council,
Cystic Fibrosis Foundation, Epilepsy Foundation, March of
Dimes, National Coalition for Cancer Survivorship, American
Heart Association, Alpha-1 Foundation, American Liver
Foundation, Susan G. Komen, National Hemophilia Foundation,
WomenHeart: The National Coalition for Women with Heart
Disease.
National Multiple Sclerosis Society, Muscular Dystrophy
Association, Lutheran Services in America, American Lung
Association, National Alliance on Mental Illness, National
Patient Advocate Foundation, Arthritis Foundation, Leukemia &
Lymphoma Society, American Cancer Society Cancer Action
Network, National Organization for Rare Disorders, Pulmonary
Hypertension Association, Cancer Support Community.
Mr. PALLONE. Mr. Chair, I yield back the balance of my time.
Ms. JOHNSON of Texas. Mr. Chair, I want to voice my support for H.R.
986, the Protecting Americans with Preexisting Conditions Act of 2019.
This legislation will rescind the administration's October 2018
Section 1332 waiver guidance, which is an essential step to protect
pre-existing conditions and prevent the loss of comprehensive coverage
plans. We will ensure that our constituents will be able to access the
essential health benefits guaranteed under the Patient Protection and
Affordable Care Act.
As representatives of Americans from all corners of our country, we
have a responsibility to protect the most vulnerable in our
communities. We must ensure that our constituents, many with pre-
existing conditions, are not placed at risk of losing their health
insurance coverage or fall victim to plans which fail to offer
essential health benefits.
As the first registered nurse elected to the United States Congress,
I am proud to safeguard the healthcare of my constituents and all
Americans through my support of the Protecting Americans with
Preexisting Conditions Act of 2019.
I urge my colleagues to support this legislation.
Ms. CASTOR of Florida. Mr. Chair, I rise today to stand up for my
neighbors--including those with preexisting conditions--by supporting
H.R. 986, the Protecting Americans with Preexisting Conditions Act.
Health care in American should be affordable and accessible to all.
Passage of the Affordable Care Act in 2010 ensured that our neighbors
with a preexisting condition, like asthma, heart disease or cancer,
would no longer be denied insurance.
It is unfortunate that the President and Republicans in Congress have
made it their mission to sabotage the affordable health care of
hardworking families, including gutting protections for people with
preexisting conditions and take away affordable, quality health care
from millions of Americans. I am cosponsoring the Protecting Americans
with Preexisting Conditions Act to safeguard Americans from the Trump
administration's efforts to undo the affordability and
comprehensiveness of our
[[Page H3531]]
health care. H.R. 986 will overturn the Trump administration's
expansion of Section 1332 waivers that were originally included in the
Affordable Care Act to give states flexibility to experiment with
insurance reforms that could improve the health and well-being of
citizens. Unfortunately, the administration would instead use those
waivers to weaken standards put in place to protect the health of
Americans--especially our neighbors with preexisting conditions.
H.R. 986 would end the administration's push of Americans into sub-
par and deceptive junk plans that many times exclude coverage for
preexisting conditions. These plans do not provide basic benefits or
financial protection standard and would return patients to the days
when they would discover only when they get sick or God forbid get a
cancer diagnosis that their plan imposes unreasonable limits on
coverage and excludes vital benefits. They discriminate based on age,
health status and gender.
Democrats will not allow the Trump administration and Congressional
Republicans to drive premiums higher in the individual market and rip
coverage away from those that need it the most. I want to thank my
colleague Rep. Kuster for helping lead this charge and I urge my
colleagues to support H.R. 986 and support our neighbors with
preexisting conditions.
The CHAIR. All time for general debate has expired.
Pursuant to the rule, the bill shall be considered for amendment
under the 5-minute rule, and shall be considered as read.
The text of the bill is as follows:
H.R. 986
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Protecting Americans with
Preexisting Conditions Act of 2019''.
SEC. 2. PROVIDING THAT CERTAIN GUIDANCE RELATED TO WAIVERS
FOR STATE INNOVATION UNDER THE PATIENT
PROTECTION AND AFFORDABLE CARE ACT SHALL HAVE
NO FORCE OR EFFECT.
Beginning April 1, 2019, the Secretary of Health and Human
Services and the Secretary of the Treasury may not take any
action to implement, enforce, or otherwise give effect to the
guidance entitled ``State Relief and Empowerment Waivers''
(83 Fed. Reg. 53575 (October 24, 2018)), and the Secretaries
may not promulgate any substantially similar guidance or
rule.
The CHAIR. No amendment to the bill shall be in order except those
printed in part A of House Report 116-51. Each such amendment may be
offered only in the order printed in the report, by a Member designated
in the report, shall be considered read, shall be debatable for the
time specified in the report, equally divided and controlled by the
proponent and an opponent, shall not be subject to amendment, and shall
not be subject to a demand for division of the question.
Amendment No. 1 Offered by Mr. Langevin
The CHAIR. It is now in order to consider amendment No. 1 printed in
part A of House Report 116-51.
Mr. LANGEVIN. Mr. Chairman, I have an amendment at the desk.
The CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 3, insert after line 5 the following:
SEC. 2. FINDINGS.
Congress finds the following:
(1) On October 24, 2018, the administration published new
guidance to carry out section 1332 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18052) entitled ``State
Relief and Empowerment Waivers'' (83 Fed. Reg. 53575).
(2) The new guidance encourages States to provide health
insurance coverage through insurance plans that may
discriminate against individuals with preexisting health
conditions, including the one in four Americans living with a
disability.
(3) The implementation and enforcement of the new guidance
weakens protections for the millions of Americans living with
preexisting health conditions and jeopardizes Americans'
access to quality, affordable health insurance coverage.
Page 3, line 6, redesignate section 2 as section 3.
The CHAIR. Pursuant to House Resolution 357, the gentleman from Rhode
Island (Mr. Langevin) and a Member opposed each will control 5 minutes.
The Chair recognizes the gentleman from Rhode Island.
Mr. LANGEVIN. Mr. Chairman, I yield myself such time as I may
consume.
Mr. Chairman, Americans with disabilities have always faced
significant barriers to healthcare. A decade ago, an insurer could
charge a family an exorbitant amount to cover a child, merely because
the child had asthma. An insurer could tell an amputee that they would
cover her medical equipment except for treatment related to her
amputated limb. Or an insurer could flat-out deny coverage to the
victim of an accidental shooting at the age of 16 simply because he had
a spinal cord injury.
Essentially, insurers could legally discriminate against individuals
with disabilities and face no consequences. That is absolutely
outrageous, Mr. Chairman.
Then Congress finally passed the Affordable Care Act and started to
bring those barriers down. For the first time, people with preexisting
health conditions, including the one in four Americans living with a
disability, no longer had to worry about whether they would be denied
comprehensive health insurance.
{time} 1530
Coverage of essential health benefits meant a mother with a traumatic
brain injury could obtain rehabilitative services and learn how to
walk, a man with Parkinson's could access medication to control his
tremors, or a child with a vision impairment could visit an eye doctor
to prevent further vision loss.
This access to healthcare is vital because, when Americans with
disabilities are healthy, they can stay active with their families,
pursue fulfilling careers, and engage in their communities.
Unfortunately, the Trump administration is, once again, working to
raise barriers to health coverage instead of working to eliminate them.
The administration's October 2018 guidance encourages States to allow
insurers to offer short-term, limited-duration plans that do not have
to provide coverage of preexisting conditions or essential health
benefits.
This means insurers offering these junk plans can discriminate
against disabled individuals by charging astronomical prices, excluding
necessary treatments from coverage, or denying an individual health
insurance altogether.
This is outrageous. If you are having deja vu, it is because this is
exactly what was happening to Americans with disabilities before the
passage of the Affordable Care Act.
The amendment that I am offering today makes clear exactly what
people with disabilities have to lose if States act on the
administration's guidance.
I have spent my near two decades in Congress championing efforts to
eliminate barriers to access and integration for people with
disabilities and helping my fellow Americans understand their great
potential.
But, fundamentally, none of that matters if people with disabilities
are not healthy because insurers deny them coverage to treat their
conditions.
The damage from the administration's guidance would be borne
disproportionately by the disabled community, my community, and my
amendment makes that clear.
Whether someone is born with a disability, develops a disability, or
becomes disabled due to an accident, that disability--I assure you--
happened by chance, not by choice.
Even the healthiest 30-year-old today could be in a car accident
tonight and wake up with a lifelong disability tomorrow; and, if that
30-year-old had one of these junk plans, much of the cost of that care
would fall on his or her own shoulders, and they would be on their own.
I had hoped that, 9 years after the passage of the Affordable Care
Act, I would no longer have to come here and defend the idea that
quality, affordable healthcare is a right and not a privilege. But,
once again, here we are.
Mr. Chairman, I support my friend Congresswoman Kuster's underlying
legislation, and I ask my colleagues to support my amendment to make
clear the damage the Trump administration's guidance would cause to
people with disabilities.
Mr. Chairman, I reserve the balance of my time.
Mr. WALDEN. Mr. Chairman, I claim the time in opposition to the
amendment.
The CHAIR. The gentleman from Oregon is recognized for 5 minutes.
Mr. WALDEN. Mr. Chairman, I would just say that section 1332 does not
permit States to waive preexisting condition protections, period. And I
would,
[[Page H3532]]
again, cite the guidance from the CMS director, Ms. Seema Verma, where
she states that. And that will be in the Record.
Again, I think what we are trying to do here is give States more
flexibility to bring down the cost of health insurance, while following
these guidelines as outlined.
As I mentioned earlier in the debate, high deductibles are pricing
people out of coverage, and by that, I mean they are walking away from
getting the care that they need because they can't pay for it; or they
are driving up their credit card debt, wiping out their savings, they
are having to take another job, they are borrowing money from others.
So, what the Trump administration is trying to do is build on what
the Obama administration created, 1332 waivers, that have, frankly,
been very successful in many, many States.
Mr. Chairman, I reserve the balance of my time.
Mr. LANGEVIN. Mr. Chairman, I just want to, in reference to the
gentleman from Oregon's comments, state that the plans under the Obama
administration were supposed to be very short in duration, for a 3-
month period, while individuals sought more comprehensive, appropriate
health coverage according to their needs.
It wasn't supposed to be a replacement for a good quality, affordable
healthcare plan that would cover preexisting conditions and essential
health benefits to identify problems early on, a potential lifelong or
a very serious illness with long-term health consequences that could
potentially even lead to losing one's life.
They took what was supposed to be a stopgap, and now they are trying
to make that a permanent plan. That is just wrong.
The CHAIR. The time of the gentleman from Rhode Island has expired.
Mr. WALDEN. Mr. Chairman, I yield back the balance of my time.
The CHAIR. The question is on the amendment offered by the gentleman
from Rhode Island (Mr. Langevin).
The amendment was agreed to.
Amendment No. 2 Offered by Mr. Brown of Maryland
The CHAIR. It is now in order to consider amendment No. 2 printed in
part A of House Report 116-51.
Mr. BROWN of Maryland. Mr. Chair, I have an amendment at the desk.
The CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 3, line 17, insert after the period the following new
sentence: ``Nothing in the previous sentence shall be
construed to affect the approval of waivers under section
1332 of the Patient Protection and Affordable Care Act (42
U.S.C. 18052) that establish reinsurance programs that are
consistent with the requirements under subsection (b)(1) of
such section (42 U.S.C. 18052(b)(1)), lower health insurance
premiums, and protect health insurance coverage for people
with preexisting conditions.''.
The CHAIR. Pursuant to House Resolution 357, the gentleman from
Maryland (Mr. Brown) and a Member opposed each will control 5 minutes.
The Chair recognizes the gentleman from Maryland.
Mr. BROWN of Maryland. Mr. Chair, I yield myself such time as I may
consume.
Mr. Chair, I rise in support of the underlying bill that will
preserve protections for hundreds of thousands of Marylanders and
Americans who, like me, have a preexisting condition.
And I rise in support, of course, of my amendment to protect States
which are acting to strengthen their insurance marketplaces, lower
premiums, and expand access to high-quality care by preserving their
reinsurance programs that they have established.
For more than 2 years, the President, in concert with Republicans in
Congress, have tried every trick in the book to undermine the
Affordable Care Act. They tried repealing it, taking it to the courts,
and now want to allow States to gut protections for those the
Affordable Care Act helped most.
These attacks jeopardize healthcare for Americans with chronic
conditions like asthma, high blood pressure, and diabetes and threaten
to bankrupt thousands of families with a loved one who has fallen ill
due to no fault of their own.
It is not just bad policy. It is fundamentally cruel.
That is why, in the face of this onslaught by the Trump
administration to make the Affordable Care Act less effective, we must
provide States with every tool in the toolbox to keep premiums down,
while preventing the Trump administration from giving States the power
to gut essential protections.
I firmly believe that States should have the power and flexibility to
innovate and find healthcare solutions that work best for them. The
Affordable Care Act always envisioned a critical role for States.
States design their own exchanges, shape their Medicaid programs, and
take the lead in enforcing patient protections and reviewing rate
increases.
These waivers took on new importance after President Trump and the
Republican Congress failed to repeal ObamaCare and, instead, sought to
undermine the Affordable Care Act by eliminating the requirement to
obtain health insurance, ending cost-sharing payments for low-income
individuals, passing regulations that encouraged short-term and junk
insurance, and defunding advertising and outreach during open
enrollment.
This sabotage has caused more families to pay higher premiums and
made fewer people able to get the high-quality care they deserve.
States acted to counteract these efforts by establishing reinsurance
programs and applying for State innovation waivers.
Reinsurance programs protect insurers from very high, unpredictable
medical expenses incurred by their Members.
Alaska, Minnesota, Oregon, Maine, Wisconsin, New Jersey, and my own
State of Maryland have all received Federal approval to establish
reinsurance programs.
These are the very programs my amendment seeks to protect. These
programs work and meet the shared goal of making health insurance
affordable and accessible to all Americans, including those with
preexisting conditions.
Reinsurance programs have been able to cut premiums by 20 percent, on
average, and save the Federal Government nearly $1 billion.
Maryland saw the biggest savings, lowering individual premiums by
more than 43 percent. These lower premiums will help entice younger and
healthier individuals to get insurance, making healthcare more
affordable for everyone.
While we have a President in the White House and Republicans in
Congress who have made healthcare prohibitively expensive and stripped
protections for those who need it most, it is imperative that this
Congress protect our partners at the State level who are working with
us to protect healthcare for all Americans.
My amendment will protect these innovative reinsurance programs and
encourage more States to adopt them.
Mr. Chair, I reserve the balance of my time.
Mr. WALDEN. Mr. Chairman, I claim the time in opposition to the
gentleman's amendment.
The CHAIR. The gentleman from Oregon is recognized for 5 minutes.
Mr. WALDEN. Mr. Chairman, I am not necessarily opposed to his
amendment, but I do think it is important to talk about the issues that
really matter when it comes to affordable healthcare.
Again, when we talked about giving States the authority to innovate
and to protect their citizens, we are for that. I come from a State
that pioneered the Oregon Health Plan.
I was there. I created a select committee when I was the Republican
majority leader of the Oregon House, when we finally got the waiver
from the Federal Government after a couple of years to actually
implement the Oregon Health Plan. It was very creative about how to
hold down healthcare costs and expand coverage and do all those things.
We have worked on a lot of different issues over the years.
What we did with the President today, I think, is really important
and, that is, looked at this issue of surprise billing: If you follow
all the rules, you go to a hospital that is in your network, and let's
say some provider gets sick in the night and they substitute somebody
else who doesn't turn out to be in your network and then, weeks later,
you get an astronomical bill through no fault of your own.
There was a parent down there whose daughter had had, I think, some
sort of
[[Page H3533]]
surgery, and the physician, on the way out, said: Oh, by the way, I
want you to do just a little urine test here. We are going to run an
analysis.
So she did, left, and, a period of time later, got a bill for
$17,000.
Her dad is a doctor and said: How did this happen?
Well, it turned out whoever did the test was not in the network of
her insurance. She didn't know.
What are you going to do? You have had whatever surgery she had, and
on the way out the doctor says: Hey, by the way, give us a little
sample. I just want to run a test because I have got you on this drug,
and I want to make sure it is all working right.
Then a $17,000 bill arrives a couple of months later.
They were there with the President today in the Roosevelt Room at
this bipartisan event. And her dad negotiated. He couldn't say what
level, but it was certainly not what the insurer would have paid.
Do you know what the insurer would have paid for that, in network? A
hundred bucks. He said you can probably get the test done now for $25.
A $17,000 bill arrives.
This is what is happening to Americans who have insurance, and that
is why we have got to deal with the surprise billing issue. It is why
we have to squeeze the juice out of the middle of the healthcare
delivery system.
We do all these great innovations. And Republicans led the effort on
the 21st Century Cures Act.
We met with Dr. Francis Collins yesterday, the extraordinary leader
of NIH; the longest-serving President-appointed--under Obama--NIH
director in the history of our country.
Because of what we put forward to dramatically increase investment in
NIH--Republicans led that effort, Fred Upton, but joined with Diana
DeGette, a Democrat out of Colorado, and a bunch of us--they are now
finding cures.
Dr. Collins said yesterday they have identified now 6,500 genetic
diseases where they now can figure out, I'll say, the misspelling of
the DNA code.
Some of my colleagues may have seen on ``60 Minutes'' Dr. Collins
talking about that they think they found a cure for sickle cell anemia.
They found a misspelling--one letter misspelled in that big chain of
DNA--that they were able to go in with our new technology--some of it
is a result of what we have done collaboratively here--and change,
alter, that letter.
And they have these people now that there is no evidence of sickle
cell in their blood platelets.
There are 6,500 diseases that they now know the misspelling. Now they
have got to figure out how to train your body, using immuno technology,
to have your own cells turned on in a little different way and go after
these diseases.
These are remarkable advances in lifesaving medicines and treatments.
{time} 1545
We, I think, as a country, have to figure out how we pay for that, if
each one of these is individualized.
Our system is antiquated and doesn't deal with this effectively. We
are going to have to figure that out because a lifesaving cure isn't
going to cure a life if people can't afford to get the medicine.
We also need to drill down on telehealth and telemedicine.
One of our colleagues today was talking about mental health services.
My district is bigger than any State east of the Mississippi, unless
you have to count Lake Michigan with Michigan, which, of course, you
do. So telehealth really matters, and we are getting great results for
our veterans and for our citizens using telehealth. But our providers
don't often get paid for the service they provide over telehealth. Why?
That is something we have to address.
You go one thing after another after another here, where we should be
spending our valuable legislative time solving the problems that real
Americans run into every day of the week: How do I pay the bill? You
tell me I have insurance, and I do, and I pay a record--I don't know
whose premium under ObamaCare went down $2,500 a month, but I will talk
about this more.
Mr. Chair, I yield back the balance of my time.
Mr. BROWN of Maryland. Mr. Chair, I join my colleague, the gentleman
from Oregon, in acknowledging the great work that is happening in the
States of Oregon, New Jersey, and Maryland in establishing these
reinsurance programs. It is my amendment that seeks to protect these
very strong programs, so I urge my colleagues to support this
amendment.
Mr. Chair, I yield back the balance of my time.
The CHAIR. The question is on the amendment offered by the gentleman
from Maryland (Mr. Brown).
The question was taken; and the Chair announced that the ayes
appeared to have it.
Mr. BROWN of Maryland. Mr. Chair, I demand a recorded vote.
The CHAIR. Pursuant to clause 6 of rule XVIII, further proceedings on
the amendment offered by the gentleman from Maryland will be postponed.
Amendment No. 3 Offered by Ms. Pressley
The CHAIR. It is now in order to consider amendment No. 3 printed in
part A of House Report 116-51.
Ms. PRESSLEY. Mr. Chair, I have an amendment at the desk.
The CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
In section 2, insert ``, including any such action that
would result in individuals losing health insurance coverage
that includes the essential health benefits package (as
defined in subsection (a) of section 1302 of the Patient
Protection and Affordable Care Act (42 U.S.C. 18022(a))
without regard to any waiver of any provision of such package
under a waiver under such section 1332), including the
maternity and newborn care essential health benefit described
in subsection (b)(1)(D) of such section'' after ``(October
24, 2018))''.
The CHAIR. Pursuant to House Resolution 357, the gentlewoman from
Massachusetts (Ms. Pressley) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentlewoman from Massachusetts.
Ms. PRESSLEY. Mr. Chair, I rise today in support of my amendment to
H.R. 986, the Protecting Patients with Preexisting Conditions Act.
Quality, affordable healthcare is a fundamental human right, period.
No one should have to face financial ruin while they are fighting for
their life.
When people are using GoFundMe pages to pay their medical bills, when
parents are burying their children who ration their insulin to pay
their student loans, we know that we are in the midst of a moral
crisis. Yet, we must contend with an administration that is determined
to roll back these rights and protections.
Each of us has loved ones whose lives are put in conditional jeopardy
when we erode protections for preexisting conditions. These efforts put
lives at risk, and we are here today to fight back.
In my district, the Massachusetts Seventh, half the residents are
living with preexisting conditions. Families are struggling with some
of the highest per capita healthcare costs in the Nation, even as they
live in the shadow of some of the best healthcare institutions in the
world.
In my district, travel 3 miles from Back Bay to Roxbury, and life
expectancy drops 30 years--30.
Since its implementation, the ACA has provided critical protections
for the nearly 3 million residents of Massachusetts living with
preexisting conditions.
Our families, our neighbors, our communities are depending on us to
uphold the lifesaving protections for people with preexisting
conditions. We can do that today by passing H.R. 986.
Mr. Chair, my amendment to H.R. 986 affirms that women's healthcare
isn't optional. It is an essential benefit every plan must cover. At a
time when more than 67 million American women and girls are living with
a preexisting condition, we cannot--no, we will not go backward.
At a time when life expectancy is declining because of gun violence,
opioid use, and a maternal mortality crisis, we cannot afford to
compromise on these essential services.
Before the ACA, Mr. Chair, typical insurance plans considered
maternity care a luxury benefit, and women consistently paid more for
primary care than men. In fact, women who have given birth, had a C-
section, or were living with HIV or a previous breast cancer diagnosis
could be considered to
[[Page H3534]]
have preexisting conditions and denied coverage.
Thanks to the ACA, many women who were previously uninsured gained
health coverage, including vital access to preventative care.
This administration's cruel and dangerous guidance would weaken these
provisions and allow insurers to sell skimpy plans that can exclude
coverage like maternity care and pediatric services.
The ACA is our floor, not our ceiling. We must continue to fight for
universal healthcare. We must continue to push for a healthcare system
that meets the needs of the people we represent, a healthcare system
that sees all people, hears all people, and cares for all people in a
way that promotes safety, dignity, and respect. I urge my colleagues to
support this amendment.
Mr. Chair, I reserve the balance of my time.
Mr. WALDEN. Mr. Chair, I claim the time in opposition, although I am
not necessarily opposed to the gentlewoman's amendment.
The CHAIR. Without objection, the gentleman from Oregon is recognized
for 5 minutes.
There was no objection.
Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
Ms. PRESSLEY. Mr. Chair, I yield back the balance of my time.
Mr. WALDEN. Mr. Chair, I appreciate the gentlewoman's comments and
her amendment. I don't intend to oppose her amendment, but I do want to
pick up on something she said that is really important.
The gentlewoman mentioned opioids. In the last Congress, when I
chaired the Energy and Commerce Committee, I helped lead the bipartisan
effort to produce 60 pieces of legislation dealing with the opioid
crisis, to help those who were addicted get the assistance they need,
to get resources into our communities to help medical advancements to
find non-opioid-related medical treatments, and to stop fentanyl from
coming into our country.
I didn't get the opportunity, but I hope the President and his team
will continue to raise this issue with the Chinese leadership when they
come because a lot of this illicit fentanyl is being produced in China
and then coming to the United States.
Dr. Burgess, who was our chair of the Subcommittee on Health and is
now the top Republican, I think went up to the chairman's district in
New Jersey and viewed one of the international mail processing
facilities. At least, it was in New Jersey. I don't know its precise
location.
Together we said, working with the Trump administration's FDA
Commissioner, we have to do more at these mail processing facilities to
stop fentanyl from coming in.
By the way, fentanyl is like 100 times more potent than morphine. If
you had a salt shaker and put out, I don't know, 10, 15 grains of salt
and ingested that, if it was fentanyl, it would kill you.
We said let's put more resources toward stopping illegal fentanyl
from coming into the United States, and we are doing that now. We are
beefing that up.
It comes in through Mexico as well. It is both China and Mexico. It
is creating pockets of death in our communities. Especially in some of
our urban areas, we have seen where it gets mixed in with heroin to
give even a higher high or whatever. Then you see groups of people who
take this, not knowing it has been jacked up with fentanyl, and you
have a whole group that dies.
The most insidious discussion or incident I heard about was a parent
who I got to know a little bit, whose daughter, he told me, self-
medicated occasionally with heroin, and she died in college.
When they did the autopsy, they figured out she had been given 100
percent fentanyl. It wasn't a mix with heroin, Mr. Chair.
The tragedy of that was, he felt that her supplier knew she was an
occasional user so had low tolerance and, basically, probably killed
her to prove to his other buyers that he had the most potent stuff on
the street.
A colleague of ours, Mr. Katko, who was a prosecutor before he came
to the Congress, he and I were having a discussion on this matter. He
said he prosecuted a case just like that. That is how evil this stuff
is.
As we look at the whole panoply of issues about healthcare, mental
health services, addiction services, stopping these things from coming
in, we can find a lot of common ground.
Republicans supported protections for preexisting conditions before
the ACA, during the ACA, after the ACA today. We did. Same with putting
kids on your policies at 26. We agreed with those principles.
But the ObamaCare act was rammed through this House and the Senate,
and we weren't even allowed to bring any of the 90-some amendments we
offered to the floor. We were completely shut out of that process. It
was a horrible process, and it shouldn't be repeated.
I hear a lot about how we voted to repeal it a bazillion times. Well,
you know what? If you go through and dissect those votes, there were a
whole bunch of Democrats that voted with us. The President at the time,
President Obama, signed some of that legislation because even he
admitted there were problems in the ACA.
Going forward, I hope we can address the big problem in America,
which is high-cost insurance, high deductibles, but, moreover, the high
cost of healthcare itself because it is pretty hard to go home and
explain why things cost what they do today.
We have to get around the high cost issue. The access issue, that is
where earlier I talked about telehealth and telemedicine. There is a
lot of work we will do together.
Unfortunately, this is a mislabeled bill today. The laws governing
1332 waivers prohibit what the majority is concerned about. But I don't
have opposition to this amendment.
Mr. Chairman, I yield back the balance of my time.
The CHAIR. The question is on the amendment offered by the
gentlewoman from Massachusetts (Ms. Pressley).
The amendment was agreed to.
Amendment No. 4 Offered by Mr. Harder of California
The CHAIR. It is now in order to consider amendment No. 4 printed in
part A of House Report 116-51.
Mr. HARDER of California. Mr. Chairman, I have an amendment at the
desk.
The CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Add at the end the following:
SEC. 3. GAO REPORT ON AFFECT OF STATE INNOVATION WAIVERS ON
COVERAGE OF INDIVIDUALS AND ON MENTAL HEALTH
HEALTH CARE TREATMENT.
Not later than 1 year after the date of the enactment of
this Act, the Comptroller General of the United States shall
submit to Congress a report on the number of individuals
expected to lose access to health insurance coverage (as
defined in section 2791 of the Public Health Service Act (42
U.S.C. 300gg-91)) if section 2 were not enacted and waivers
under section 1332 of the Patient Protection and Affordable
Care Act (42 U.S.C. 18052) were approved under the guidance
described in such section 2. Such report shall include an
analysis of the expected effect such waivers approved under
such guidance would have on mental health care treatment.
The CHAIR. Pursuant to House Resolution 357, the gentleman from
California (Mr. Harder) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentleman from California.
Mr. HARDER of California. Mr. Chair, I rise in support of my
amendment.
As I stated in my previous remarks, my amendment would simply require
the Federal Government to issue an expert analysis of the impact of
junk plans on mental health access.
People deserve access to mental healthcare, and we need to know how
many people will lose that access if these junk plans become used more
widely.
Mr. Chair, I reserve the balance of my time.
Mr. WALDEN. Mr. Chair, I claim the time in opposition to the
gentleman's amendment.
The CHAIR. The gentleman from Oregon is recognized for 5 minutes.
Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
Mr. HARDER of California. Mr. Chair, I yield back the balance of my
time.
Mr. WALDEN. Mr. Chair, I appreciate the gentleman's amendment.
Look, we all care deeply about getting mental health services into
our community. In fact, under Republican leadership on the Energy and
Commerce Committee a few years ago, we
[[Page H3535]]
rewrote America's mental health laws for the first time since John
Kennedy signed the last bill into law before he was tragically
assassinated in Texas. It was a lot of work, but it was bipartisan
work.
Not only did we look at those mental health laws that were on the
books, because what happens around here is somebody comes up with a new
idea, so you put a new program in place, and you give an authorization.
Maybe it gets funded, maybe it doesn't. A year goes by. Somebody has a
new idea. Put another one on the books. Nobody ever goes back and looks
at what worked and what didn't.
So our colleague, Dr. Murphy, at the time, who is a psychologist and
a terrific leader in this area, really drove this review and said,
look, we have to help kids with mental illness, and we need to help
adults.
We could deal with a lot of the violence in America if you got people
care. It is not that everybody with mental illness goes violent, but we
do know that mental health services help people in every way and that
the programs we had--we had a lot of them--weren't funded, weren't
funded properly, or didn't work. Some worked better than others.
We had this comprehensive review in the Energy and Commerce Committee
of these different programs the Federal Government has. Then we said,
going forward--kind of what you are trying to do with this GAO report
in a little different way--let's measure the efficacy of the programs
we do have.
{time} 1600
Let's find out what is working in our communities, and then let's get
aid into our communities directly. Let's cut out the middle bureaucracy
and get assistance, financial assistance into our communities.
So we passed that. That is now the law of the land. And I think last
year we were able to get money into that, finally, and I hope we can do
more going forward, because we know that--I am being a little sarcastic
here, but it is an extraordinary finding. Guess what? Your brain and
your physical body are connected. Who knew, right? And we have all
known that.
So I supported the effort to get the same treatment under insurance
for mental health as physical health because they are completely
connected. So going forward, we have got to make sure that that bond is
strengthened, not weakened, and that people continue to get help for
mental health.
I am a big believer in that. I know it works. It is fascinating to
see, with the whole genome project, now they can do a genetic test and
figure out which mental health drug will work in your body or my body.
We didn't know that before, and now they can figure out which one will
actually work for you or me or whomever.
I hope we have lifted the stigma on people needing mental health
services. We are just a big bag of chemicals, and things get out of
balance. So I hope that we have lifted that as we did, I believe, on
addiction.
There are a lot of people, and over time people evolve their views
and get better understandings, and I think over time we realized that
people with drug addictions--especially this came out through our
opioids work--weren't necessarily criminals. They weren't to be shunned
from society.
What we learned in the course of our work on opioids was, when I
talked to parents whose kids had a high school football injury or
something and the doctor gave them a painkiller, all of a sudden, this
stuff is so addictive, a few treatments and they are hooked, and then
they need more and more and more and more.
I always remember my friend Mr. Rush from the Chicago area, when we
were talking about treatment for opioids, said: That is great you are
doing that. When the people I represented had issues in terms of crack
cocaine and all, you just called them druggies and you put them in
prison.
That affected what we wrote and how we legislated, and we moved away
from calling it treatment for opioids to people with substance abuse
because we realized we needed to think broader as a country and as a
Congress, and we did that and we changed the law. All that now is law
to deal with opioids and mental health services.
So, Mr. Chairman, I don't have an objection to this amendment, but
there is a lot we have done and a lot more we need to do, and I will
talk about some of the things we need to do going forward.
Mr. Chairman, I yield back the balance of my time.
The CHAIR. The question is on the amendment offered by the gentleman
from California (Mr. Harder).
The amendment was agreed to.
Amendment No. 5 Offered by Mr. Walden
The CHAIR. It is now in order to consider amendment No. 5 printed in
part A of House Report 116-51.
Mr. WALDEN. Mr. Chairman, I have an amendment at the desk. I believe
it is No. 5, printed in House Report 116-51.
The CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Beginning on page 3, line 4, strike ``Protecting Americans
with Preexisting Conditions Act of 2019'' and insert ``This
Bill Actually Has Nothing to do with Protecting Americans
with Preexisting Conditions Act''.
The CHAIR. Pursuant to House Resolution 357, the gentleman from
Oregon (Mr. Walden) and a Member opposed each will control 5 minutes.
The Chair recognizes the gentleman from Oregon.
Mr. WALDEN. Mr. Chairman, I would just say, in terms of this
amendment, it is just trying to make the point that the bill we have
before us today is not as described or labeled. In our opinion, it is
more about politics and gotcha politics than it is about the underlying
issue.
We know from the Department of Health and Human Services, they have
made it clear in the letter from the Director who would approve these
waivers that she believes that the underlying law protects people with
preexisting conditions and all the other things I talked about earlier,
that they can't waive that law--they cannot.
So I would enter into the Record again, Mr. Chairman, as part of my
remarks, her comments about the guidance, the 2018 guidance, and where
she says it does not erode ObamaCare's preexisting condition
provisions. She is the one in charge of this. That is what she is
saying.
But I want to talk about something else she says in this letter about
premiums and the costs to people getting their insurance. She says:
``Under the PPACA''--or ObamaCare or the Affordable Care Act, however
you want to describe it--``we have seen dramatically higher premiums
and decreased options for millions of consumers, in large part due to
the law's overly prescriptive mandates and excessive Federal Government
takeover of areas traditionally left under State oversight.''
She points out: ``In 2019, the average monthly premium for a
benchmark plan for a family of four on HealthCare.gov is now over
$1,500, which can easily exceed a family's mortgage.''
Continuing with her letter to me, she said: ``There are many areas of
the country with far higher monthly premiums. For example, a of 60-
year-old couple living in Grand Island, Nebraska, making $70,000 a
year, will need to pay over $3,000 per month for the lowest cost silver
plan available. That is almost $38,000 per year for a plan with an
$11,100 deductible.''
Now, think about that, Mr. Chair. This is a couple that is making
$70,000 a year. They are 60 years old. They live in Nebraska, and
$3,000 a month in premiums, over $3,000, and an $11,000 deductible.
That is over $48,000, and they only make $70,000 a year.
This is happening in America today. Heck, it is happening in Nebraska
right now. So what we are saying is people are walking away.
She goes on to say: ``For millions of Americans, coverage this
expensive is not a realistic option, and many choose to go without
coverage at all. In fact, after average premiums rose by 21 percent,
1.3 million unsubsidized people walked away from the market in 2017.''
Those are the people we need to be helping. There is a lot more we
need to be doing. I will put the rest of this in the Record. But I
think everybody knows we are just trying make a point with this
amendment.
Mr. Chair, I ask unanimous consent to withdraw my amendment.
The CHAIR. Is there objection to the request of the gentleman from
Oregon?
Mr. PALLONE. Mr. Chair, I object.
[[Page H3536]]
The CHAIR. Objection is heard.
Mr. PALLONE. Mr. Chair, I claim the time in opposition to the
amendment.
The CHAIR. The gentleman from New Jersey will suspend.
The gentleman from Oregon is recognized.
Mr. WALDEN. Mr. Chairman, just to clarify, from a parliamentary
standpoint, I was just going to withdraw the amendment, but if the
gentleman wants to speak on it, I can ask unanimous consent to withdraw
it after he speaks.
Mr. Chairman, I reserve the balance of my time.
Mr. PALLONE. Mr. Chairman, I claim the time in opposition to the
gentleman from Oregon's amendment.
The CHAIR. The gentleman from New Jersey is recognized for 5 minutes.
Mr. PALLONE. Mr. Chairman, it disturbs me, I guess, that my colleague
on the other side, whom I greatly respect, keeps mentioning this letter
from Seema Verma, the CMS Administrator.
Nothing that she says in her letter is in any way going to change the
guidance that she and the Trump administration have put forward that
would undermine people with preexisting conditions' ability to get good
insurance if this guidance is allowed to continue and States get
waivers pursuant to the guidance, because of, again, the issue of
affordability.
You see, the problem is that the 1332 waivers, the way they are set
out in the ACA, have certain guardrails, if you will, to prevent
waivers that would allow for junk insurance and other policies that
would undermine people with preexisting conditions from getting good
insurance.
Those guardrails say that any kind of waiver has to guarantee
affordability, has to guarantee comprehensive coverage, the essential
benefits package, robust coverage, and also not reduce the number of
people who are insured.
This guidance that Seema Verma and the Trump administration have put
forward does exactly the opposite, because it allows insurance to be
sold, if a State seeks to do so, that would eliminate, for example,
hospitalization or eliminate mental health coverage or eliminate
coverage for maternity care.
Now, if you are someone with preexisting conditions and they
eliminate coverage for your preexisting condition, that relates to your
preexisting condition, you might as well not even have insurance, and
that is why we say it is junk. It lets a waiver be granted that would
allow the insurance companies of that State to charge more based on
age, based on sex. I mean, the list goes on.
So Seema Verma can send out all the letters she wants, but it doesn't
mean anything.
I like to say, you know, one of the things that disturbs me most,
also, is we on the Democratic side, myself and some of the other
chairmen of some of the other committees, sent a letter and a request,
because it has been pointed out repeatedly that Seema Verma has been
putting out contracts up to $4 million a year to basically promote
herself, and that is being investigated right now as we speak.
So, again, I don't like to say bad things about people, but the
bottom line is she is in no position to be telling us what is in this
guidance. This guidance is going to hurt people with preexisting
conditions, and there is no way that she is going to get around it.
Mr. Chair, I reserve the balance of my time.
Mr. WALDEN. Mr. Chairman, I would just suggest that it was Seema
Verma who is the head of CMS who issued the guidance, so I think she is
in a position to have a say about what she believes the guidance allows
or doesn't.
To be clear, to quote her letter again: ``The 2018 guidance does
nothing to erode the PPACA's preexisting condition provisions.'' That
is what she is saying.
So I think that letter is important. She put it in writing. She has
said that repeatedly, and so I take her at her word. I do. I include
her letter in the Record.
Centers for Medicare &
Medicaid Services,
Washington, DC, May 7, 2019.
Hon. Greg Walden,
Ranking Member, House Committee on Energy and Commerce, House
of Representatives, Washington, DC.
Dear Representative Walden: Thank you for your continued
interest in new state flexibility available under guidance
recently issued interpreting section 1332 of the Patient
Protection and Affordable Care Act (PPACA) (the 2018
guidance). Working within the limitations of the PPACA, this
2018 guidance is an important element of the Administration's
actions to expand options and lower costs for patients around
the country. I wanted to take this opportunity to set the
record straight and reaffirm this Administration's commitment
to lowering healthcare costs, increasing consumer choices,
and protecting our most vulnerable citizens, including those
who have pre-existing conditions.
To be very clear, the 2018 guidance does nothing to erode
the PPACA's pre-existing condition provisions, which cannot
be waived under section 1332. Section 1332 does not permit
states to waive Public Health Service Act requirements such
as guaranteed availability and renewability of health
insurance, the prohibition on using health status to vary
premiums, and the prohibition on pre-existing conditions
exclusions. Furthermore, a section 1332 waiver cannot be
approved that might otherwise undermine these requirements.
This Administration stands committed to protecting people
with pre-existing conditions.
Under the PPACA, we have seen dramatically higher premiums
and decreased options for millions of consumers, in large
part due to the law's overly prescriptive mandates and
excessive Federal government takeover of areas traditionally
under state oversight. In 2019, the average monthly premium
for a benchmark plan for a family of four on HealthCare.gov
is now over $1,500, which can easily exceed a family's
mortgage. There are many areas of the country with far higher
monthly premiums. For example, a 60-year-old couple living in
Grand Island, Nebraska, making $70,000 a year, will need to
pay over $3,000 per month for the lowest cost silver plan
available. That's almost $38,000 per year for a plan with an
$11,100 deductible. That's over half their income.
For millions of Americans, coverage this expensive is not a
realistic option, and many choose to go without coverage at
all. In fact, after average premiums rose by 21 percent, 1.3
million unsubsidized people walked away from the market in
2017, the last year the prior administration oversaw open
enrollment. While these higher premiums force some people to
go uninsured, coverage is generally not optional for people
with a pre-existing condition and so, without a subsidy,
someone with a pre-existing condition must face the full
burden of the PPACA's skyhigh premiums. This Administration
has not forgotten the people facing this hardship.
Section 1332 of the PPACA provides the discretion to
approve a section 1332 state waiver plan if the following
four statutory guardrails are met: affordability,
comprehensiveness, coverage, and federal deficit neutrality.
Section 1332 allows states to develop new healthcare programs
and solutions that would be not permissible without a section
1332 waiver.
Unfortunately, guidance issued under the prior
Administration in December 2015 (the 2015 guidance) regarding
section 1332 waivers had the effect of significantly
restricting the innovation states could pursue. The prior
Administration imposed a one-size-fits-all approach to these
waivers, making it difficult for states to address the
specific needs of their residents.
In October, the Administration issued guidance under
section 1332 of the PPACA to provide states with significant
opportunities to chart a different course for their markets
through expanded flexibility. Section 1332 and the 2018
guidance ensure that consumers who wish to retain coverage
similar to that provided under the PPACA can do so, but they
empower states to take steps to stabilize their markets and
allow more affordable coverage options that may be more
attractive to individuals and families priced out of the
current market, including people with pre-existing
conditions.
Over the past two years, this Administration has approved
seven section 1332 waivers authorizing reinsurance programs
to help fund claims for people with high healthcare costs.
These reinsurance programs provide much needed premium relief
for people in the market and, in particular, for people with
pre-existing conditions without other coverage options. These
section 1332 waivers were all approved under the prior, more
restrictive 2015 guidance. I believe, given the expanded
flexibility discussed in the 2018 guidance, states will be
able to develop additional healthcare programs and solutions
that work for their residents.
As you know, some have criticized the state flexibility
offered under the 2018 guidance, claiming that states will
pursue section 1332 waivers that undermine their own
individual market risk pools and make coverage more expensive
for their own residents with pre-existing conditions. Again,
I want to make clear that a section 1332 waiver cannot
undermine coverage for people with pre-existing conditions.
Moreover, any section 1332 waiver will need to carefully
account for any impact on the individual market risk pool and
guarantee that access to coverage is at least as
comprehensive and affordable as would exist without the
waiver.
So, if a state seeks to pursue the use of more affordable
options, such as catastrophic plans or short-term limited
duration plans, under a section 1332 state waiver plan, the
state must ensure access to coverage that is overall as
affordable and comprehensive for people who remain in the
individual market risk pool.
[[Page H3537]]
Thank you again for your shared interest in bringing down
healthcare costs and protecting our fellow Americans with
pre-existing conditions. We remain focused on improving our
nation's health care system by empowering states to innovate
and develop new solutions to expand access to affordable and
high value coverage options, and we look forward to working
with you to achieve these goals. Should you have questions,
please contact the CMS Office of Legislation.
Sincerely,
Seema Verma.
Mr. WALDEN. Now, Mr. Chair, I was willing to withdraw the amendment.
That takes unanimous consent, and I just would attempt to do that
again. I don't know if my colleague cares about that or not.
Mr. PALLONE. Mr. Chair, I have no objection.
Mr. WALDEN. Mr. Chairman, so we can move on to the other amendments,
I ask unanimous consent to withdraw the amendment.
The CHAIR. Is there objection to the request of the gentleman from
Oregon?
There was no objection.
The CHAIR. The amendment is withdrawn.
The Chair understands that amendment No. 6 will not be offered.
Amendment No. 7 Offered by Mr. Holding
The CHAIR. It is now in order to consider amendment No. 7 printed in
part A of House Report 116-51.
Mr. HOLDING. Mr. Chairman, I have an amendment at the desk.
The CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 3, beginning on line 4, strike ``Protecting Americans
with Preexisting Conditions Act of 2019'' and insert ``Insert
Politically Punchy Title That Doesn't Reflect the Bill
Substance Act''.
The CHAIR. Pursuant to House Resolution 357, the gentleman from North
Carolina (Mr. Holding) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentleman from North Carolina.
Mr. HOLDING. Mr. Chairman, I believe my amendment speaks for itself.
My friends on the other side of the aisle are playing political games
with their bill trying to convince the American people that it would
accomplish something that it would not. I have offered a title that
accurately reflects the political grandstanding that my Democrat
friends are effecting today.
Mr. Chair, I reserve the balance of my time.
Mr. PALLONE. Mr. Chairman, I claim the time in opposition to the
amendment.
The CHAIR. The gentleman from New Jersey is recognized for 5 minutes.
Mr. PALLONE. Mr. Chairman, just to back up what I said previously
about the implications for this Trump administration and Seema Verma's
guidance that they put forward with regard to 1332, I want to read a
section from a letter that was sent by 23 patient and consumer advocacy
organizations in support of H.R. 986, the bill that is before us. These
organizations include the Heart Association, the Lung Association, the
Epilepsy Foundation, et cetera. This goes back to the guardrails.
As I said, under 1332, in the ACA, there are guardrails that say that
any waivers have to guarantee affordability, have to guarantee
comprehensiveness of coverage, and have to, at the same time, not
reduce the number of people with insurance.
Nothing that Seema Verma or anything on the other side that is being
said is suggesting in any way that, under this guidance, those
principles wouldn't be violated. In fact, they would be violated.
So this is what these 23 patient and consumer advocacy organizations
say about the Trump guidance waiver: ``This gross misinterpretation of
the guardrails will have real consequences for patients, steering
people into substandard coverage, such as short-term, limited-duration
plans and association health plans, which often do not cover the full
range of benefits and services that patients rely on to manage their
conditions.
``Further, policies that could be implemented under this new
interpretation could fundamentally alter the risk pool for a State's
individual marketplace, making comprehensive coverage unaffordable for
patients who rely on it and jeopardizing the stability of the State's
marketplace. The resulting lack of access to care could have
devastating short- and long-term consequences for the millions of
patients we represent.''
{time} 1615
The bottom line is this is going to dramatically hurt people with
preexisting conditions if they try to buy insurance that will cover the
maladies that they want to cover, and they need to have covered.
Again, I don't understand, Mr. Holding and, previously, Mr. Walden
have these amendments that really have nothing substantive to say. All
they do is talk about changing the title because they are trying to
ridicule what Democrats are trying to do here, which is to guarantee
that people with preexisting conditions are protected.
I don't want to get upset, but I think that it is kind of
inappropriate, when here we are trying to guarantee people with
preexisting conditions are protected--even Republicans on the other
side are saying that is important to them--and, instead of having a
serious debate about this, they put forward amendments that change the
title to ridicule what we are trying to do. It is just unfortunate that
we are at that point now, but that is where we are.
Madam Chairman, I reserve the balance of my time.
Mr. HOLDING. Madam Chair, I yield to the gentleman from Oregon (Mr.
Walden).
Mr. WALDEN. Madam Chair, I thank the gentleman for yielding.
Madam Chair, I just want to say that I, too, wish we were debating my
legislation that I tried to offer the first of the Congress and was
refused the opportunity to bring it to the floor. That would lock into
statute preexisting protections for people who have preexisting
conditions.
This court case is pending. We could get a ruling tomorrow. Somewhere
in the last couple of months, Congress could have acted to put in
statute a separate law that would be there, irrespective of the
decision of the judge, or judges as it goes through its process, that
could wipe out all of the ACA and could wipe out preexisting condition
protections. We could do that, except their Committee on Rules put
these amendments in order to debate on the floor, but not the amendment
that actually protects people with preexisting conditions. So it is not
my fault--we don't control of the Rules Committee--that my serious
amendment about protecting people with preexisting conditions was not
made in order. I don't control the Rules Committee. The Speaker does,
and others.
When we talk about affordability, remember the example that Seema
Verma points out, in Grand Island, Nebraska, a couple making $60,000 a
year, 60 years old, $38,000 for the plan, and $11,000 deductible. How
is that affordable? It is not.
I want our States to innovate. Do you know what, if a State doesn't
want to innovate, it doesn't have to. And if they violate the rules,
they are not going to get their waiver.
But what we do know is that when States have innovated, like mine,
like the gentlemen from Wisconsin and Alaska, they have seen reductions
in premiums and full-throated coverage. I want innovation. I don't want
to price people out of the market.
Mr. HOLDING. Madam Chair, this bill before us today makes no
structural changes to improve access to or delivery of care. It would
limit healthcare choices and stifle State level innovation that has
proven to lower premiums. This bill does not help those with
preexisting conditions, but it does attempt to confuse them and
encourage more political dysfunction to the detriment of the American
people.
Madam Chair, I yield back the balance of my time.
Mr. PALLONE. Madam Chair, my colleagues on the other side started out
this debate on these amendments by basically saying they wanted to
substitute the title rather than talking about the substance. Now, my
colleague, the ranking member, starts talking about the lawsuit that
would--I think he is talking about the lawsuit that would repeal the
Affordable Care Act.
Again, my colleagues on the other side are not looking to protect
people with preexisting conditions, they are not looking to protect
anybody, because now they are saying that it is a
[[Page H3538]]
good idea to repeal the Affordable Care Act. So we are back to the
basic debate about whether or not we should have the Affordable Care
Act, which until President Trump came along and started sabotaging the
bill, 97 percent of Americans had health insurance, an all-time high in
the history of this country.
So, okay, that is fine. Now we are going to say that they want to
repeal the Affordable Care Act once again. This is what this is all
about on their side of the aisle: repeal the act, move to court to try
to get the courts to declare the act unconstitutional, no effort to
worry about the millions and millions of Americans who have gotten
coverage because of the Affordable Care Act.
I really don't know what else I can say at this point, but at least
they revealed their true motive, which is simply to repeal the whole
bill.
Once again, I guess there is not much to say here, other than to say
that I would urge my colleagues to reject this amendment. Let's get
back to talking about the substance of the bill that is before us,
which would guarantee that there are protections for people with
preexisting conditions.
Madam Chair, I yield back the balance of my time.
The Acting CHAIR (Ms. Underwood). The question is on the amendment
offered by the gentleman from North Carolina (Mr. Holding).
The question was taken; and the Acting Chair announced that the noes
appeared to have it.
Mr. PALLONE. Madam Chair, I demand a recorded vote.
The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further
proceedings on the amendment offered by the gentleman from North
Carolina will be postponed.
Amendment No. 8 Offered by Ms. Porter
The Acting CHAIR. It is now in order to consider amendment No. 8
printed in part A of House Report 116-51.
Ms. PORTER. Madam Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
In section 2, insert ``, including any such action that
would result in a decrease in the number of such individuals
enrolled in coverage that is at least as comprehensive as the
coverage defined in section 1302(a) of the Patient Protection
and Affordable Care Act (42 U.S.C. 18022(a)) compared to the
number of such individuals who would have been so enrolled in
such coverage had such action not been taken'' after
``(October 24, 2018))''.
The Acting CHAIR. Pursuant to House Resolution 357, the gentlewoman
from California (Ms. Porter) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentlewoman from California.
Ms. PORTER. Madam Chair, I rise today to offer an amendment to the
Protecting Americans with Preexisting Conditions Act.
This bill would prevent the Trump administration from allowing States
to use waivers to provide junk health plans that reduce coverage and
decrease cost sharing provisions.
In the Affordable Care Act, section 1332 waivers were created to
provide States flexibility to implement innovative plans that would
expand coverage, reduce costs, and provide more comprehensive benefits.
Our States can be incubators for opportunity and these waivers allow
them the opportunity to improve access to affordable, quality services
in groundbreaking ways. But, last year, the Trump administration
released guidance that would allow States to use these waivers to take
care away from the individuals who need it most, and that is
unacceptable.
Because of the Affordable Care Act, 3,826,000 Californians have
gained health coverage. In my home district, the 45th District of
California, more than 338,000 people have a preexisting condition, many
of whom gained coverage or received more affordable coverage because of
new protections established under the Affordable Care Act.
This Sunday is Mother's Day. Having given birth, being a mother, is a
preexisting condition, a factor that used to contribute to higher
insurance costs for most of the women we will celebrate this weekend.
We can't go back to the days when being a woman was enough to let an
insurance company charge you more for basic healthcare.
My amendment will prohibit the administration from issuing any
waivers that would let States craft healthcare plans that would reduce
the number of individuals enrolled in comprehensive plans that are
compliant with our country's current healthcare laws.
This bill preserves waivers that provide States with flexibility.
This bill encourages States to provide innovative plans. But what this
bill does is make sure that those waivers can be used for their
original intent: expanding care and decreasing costs.
Madam Chair, I urge my colleagues to support my amendment, and I
reserve the balance of my time.
Mr. WALDEN. Madam Chair, I seek time in opposition to the
gentlewoman's amendment.
The Acting CHAIR. The gentleman from Oregon is recognized for 5
minutes.
Mr. WALDEN. Madam Chair, I would like to point out a couple of
things.
One, I have introduced legislation to protect people with preexisting
conditions. I did that because I knew this lawsuit is pending. We can
argue about the ACA and the lawsuit and all that, but the long and
short of it is that if the court rules the ACA gets thrown out as
unconstitutional, which may happen, people with preexisting conditions
would be exposed, and I don't want that to happen. That is why I
introduced legislation.
I would be honored if we could take that up in the Energy and
Commerce Committee that I used to chair and put it on the House floor.
I tried to bring it here as an amendment and it was denied by the
Democrat majority, so we can't even have a debate here about it. If it
is not everything it should be, then I am happy to work with people to
try and make it as durable and robust as it needs to be. So that is
one.
When we talk about insurance--and there is kind of silence on the
other side--2.5 million Americans since President Trump have gotten
healthcare insurance through their employer. We have one of the most
robust economies most Americans have ever seen: 3.2 percent, I think,
GDP growth the first quarter. Some have said, you need fairy dust to do
that. Well, that is not true. You need good economic policy. We have
that in America: the lowest unemployment for African Americans,
Hispanic Americans, all Americans. Incredible numbers, incredible
growth. As a result, people are getting off government subsidized
healthcare, or fully funded healthcare, onto private health insurance,
which Democrats want to wipe out. One hundred and fifty-eight million
Americans get their health insurance through their employer or through
their union.
And when it comes to the Affordable Care Act, that is what put in
place the big cuts that are coming to our hospitals, the DSH cuts, that
I held off as chairman of the Energy and Commerce Committee. We passed
legislation to prevent the DSH cuts from hitting our disproportionate
share of hospitals, those that deal with more lower income folks. We
are going to have to do that again. Because ObamaCare says you got to
hit your hospital with a big cost increase, if you will, or take away a
subsidy.
The Cadillac tax. I met with building trade folks in my State. These
people bargained away, potentially, wages for better benefits. And then
along comes ObamaCare, the Affordable Care Act, that says: Oh, by the
way, if you have got too generous a plan, according to the government,
you are going to have to pay a 40 percent tax on that plan. And, by the
way, it was never indexed for inflation. And guess what, healthcare
costs continue to go up and premiums go up.
More and more Americans' health insurance is going to fall into this
so-called Cadillac tax. There will be a 40 percent tax on those plans.
The working men and women, who are part of a union or in the private
sector and who have good, generous healthcare benefits, the Federal
Government, the Democrat-driven plan that is totally partisan passed,
it says, we are going to whack you with a 40 percent tax. How fair is
that, Madam Chair? I don't think it is. We have kept that tax from
taking effect as Republicans. We will see what this Congress does.
But, moreover, we fully funded our community health centers. We,
under Republicans, funded the children's health insurance program, a
Republican creation, for a decade. I led that
[[Page H3539]]
effort. Most Democrats consistently voted against funding children's
health insurance time and time again. It had never been funded for more
than 5 years ever in its history. One hundred and twenty-two thousand,
seven hundred Oregonian kids and pregnant moms get their health
insurance through CHIP. It is a marvelous program. Republicans led the
effort, because I did it. We first tried to get 5, then 6, and then
eventually we got 10 years funded. That is locked into law.
We need to go back and fund our community health centers. I told
people that if I were chairman, my palms would be getting a little
sweaty now at the list of things we need to get done--I am looking at
my friends.
In Oregon, in my district, I think we had 63 delivery sites and 12
community health centers. We fully funded those centers at a record
level in the last Congress, because I believe fully in that network of
the delivery of healthcare. It is extraordinarily important. We should
be doing that today, but we are not.
We have got the National Health Service Corps, special diabetes
programs for Indians, special diabetes programs for type I diabetes,
teaching health centers, personal responsibility education programs,
sexual risk avoidance education grants, and family-to-family health
information centers. We have demo programs, increased access to dental
healthcare services, and delay in authority to terminate contracts for
Medicare Advantage plans. We have protection for recipients of HCBS
against spousal impoverishment. We have demonstration of approved
community behavioral health clinics, Medicaid funding for territories,
delay in effective date for Medicaid amendments related to beneficiary
liability settlements, DSH allotment, and money follows the person. All
those expire at the end of this fiscal year. We have real work we need
to get done, Madam Chair.
Madam Chair, I yield back the balance of my time.
{time} 1630
Ms. PORTER. Madam Chair, I yield 1 minute to the distinguished
gentlewoman from California (Ms. Pelosi).
Ms. PELOSI. Madam Chair, I thank the gentlewoman for yielding, and I
thank her for the constructive amendment and for her exceptional
leadership as a leading Member of an outstanding freshman class.
I also thank Congressman Pallone, chairman of the full committee, for
giving us the opportunity to bring to the floor historic legislation
that will make a tremendous difference in the lives of the American
people.
Today, with the Protecting Americans with Preexisting Conditions Act,
Democrats are honoring their promises to the American people.
Madam Chair, our Democratic majority ran on the promise to protect
American families' quality, affordable healthcare.
We have now voted three times to oppose the GOP healthcare lawsuit,
but every time, with every vote, House Republicans reveal their
inconsistency and complicity with the administration's assault on
people with preexisting conditions and every American's healthcare.
It was interesting to listen to the distinguished ranking member of
the committee express his views when the fact is that, 2 years ago,
House Republicans voted to gut protections for people with preexisting
conditions and take away millions of families' healthcare, and they
then threw a party to celebrate.
They went down to the White House and celebrated: We have taken away
the preexisting conditions benefit.
The American people resoundingly rejected the Republicans' attack on
their healthcare and their financial security, yet the GOP is plowing
full steam ahead with their monstrous campaign to sabotage the
Affordable Care Act and take away healthcare.
Just last week, the administration doubled down on its demands that
the courts throw out every protection and benefit provided by the
Affordable Care Act.
Again, over and over, we have had bills on the floor to invite the
Republicans to join us in rejecting that Republican attack.
Overwhelmingly, they have rejected that.
Today, again, we can celebrate that we are protecting Americans with
preexisting conditions and honoring that promise we made to the
American people, as I said.
The bill reverses a dangerous part of the Trump administration's
reckless sabotage campaign, blocking cynical guidance to States. Here
is what they do: dismantle protections for people with preexisting
conditions and push families into junk plans that discriminate against
people with preexisting conditions and do not cover essential benefits.
In fact, you are paying for nothing.
The Trump guidance puts lives on the line, not only sabotaging the
healthcare law but the health of millions of Americans who rely on it.
Nearly 30 national groups representing people with preexisting
conditions have spoken out, including the American Cancer Society,
Cancer Action Network, American Heart Association, American Diabetes
Association, American Lung Association, National Alliance on Mental
Illness, Susan G. Komen, and many more.
They write, ``This dangerous action could take us back to the days
when people with preexisting conditions were openly discriminated
against and blatantly denied access to lifesaving care.''
These organizations, I want Ranking Member Walden to hear because he
seemed to have been distracted, all these organizations for cancer,
diabetes, heart, lung, mental health, all of that, they write, ``This
dangerous action could take us back to the days when people with
preexisting conditions were openly discriminated against and blatantly
denied access to lifesaving care.''
We thank all the groups and families--including the sick little
children, the Little Lobbyists--for their courage to speak out and show
that this is a fight not just about legislation but about lives.
Nothing is more eloquent than the stories that they tell, and many have
told their stories here.
They had 10,000 events around the country to stop the Republicans'
sabotage on healthcare, much of it from people with preexisting
conditions, especially children born with preexisting conditions.
This bill that we have today is just the beginning. In the coming
weeks, House Democrats will bring forth more bold legislation to reduce
the price of prescription drugs, to empower States to build better
exchanges, and to block junk plans and reverse the GOP's enrollment
sabotage.
Senator McConnell said that he is the grim reaper. He wears that as a
badge of honor.
He is the grim reaper. He is going to kill any House legislation for
the people, saying that he will bury our bills in the Senate graveyard,
effectively. That is really not a very hopeful political agenda, the
grim reaper.
I have news for him. Legislation to protect the preexisting condition
benefit and many of the other pieces of this agenda are alive and well
among the American people, and they will make their voices heard.
The American people want action, and the special interest GOP Senate
needs to stop standing in their way, Leader McConnell.
I urge a strong vote for this legislation for the people.
I commend the gentlewoman for her very important amendment. She said
being a mom was a preexisting condition. As the mother of five, it is 6
years to the day when I talked to the insurance company about my bad
back.
They said: Why would we even insure you? You are a poor risk, having
had children.
I said: That is funny you say that. I thought it was a show of
strength on my part to have five children. Are you calling that
something that would be a barrier to my getting insurance?
I want to emphasize, as we approach Mother's Day, how important this
particular amendment is to help moms and their families.
Madam Chair, I urge a ``yes'' vote on Congresswoman Porter's
important Mother's Day amendment.
Ms. PORTER. Madam Chair, I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentlewoman from California (Ms. Porter).
The amendment was agreed to.
Amendment No. 9 Offered by Mr. Pappas
The Acting CHAIR. It is now in order to consider amendment No. 9
printed in part A of House Report 116-51.
[[Page H3540]]
Mr. PAPPAS. Madam Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
In section 2, insert ``, including any such action that
would, with respect to individuals with substance use
disorders, including opioid use disorders, reduce the
availability or affordability of coverage that is at least as
comprehensive as the coverage defined in section 1302(a) of
the Patient Protection and Affordable Care Act (42 U.S.C.
18022(a)) compared to the availability or affordability,
respectively, of such coverage had such action not been
taken'' after ``(October 24, 2018))''.
The Acting CHAIR. Pursuant to House Resolution 357, the gentleman
from New Hampshire (Mr. Pappas) and a Member opposed each will control
5 minutes.
The Chair recognizes the gentleman from New Hampshire.
Mr. PAPPAS. Madam Chair, I yield myself such time as I may consume.
Madam Chair, I thank my colleague from New Hampshire, Representative
Kuster, for offering this legislation that will safeguard healthcare
protections for the 130 million Americans with preexisting conditions.
The amendment I am offering today would ensure that we don't take any
steps backward in our fight against this Nation's opioid epidemic.
For people in my home State of New Hampshire, the Affordable Care Act
is a lifesaving law. It is the best tool we have to combat the opioid
crisis. As I travel around my district, I hear heartbreaking stories of
those lost and those still fighting hard.
I also hear from constituents who, on a regular basis, can't fathom
where they would be without coverage for their substance use disorder.
I am here today on behalf of constituents like Phil Spagnuolo from
Laconia. As Phil fought to recover from substance use disorder, he took
comfort in knowing that he could rely on coverage that was affordable
and accessible to him in the midst of the greatest medical challenge of
his life.
Thanks to the Affordable Care Act, Phil has gone from jail to
treatment and recovery to serving as a leader in the recovery
community, coaching and advocating for those grappling with addiction.
New Hampshire is incredibly proud of his story and his example, and
it is all made possible because of the ACA and its basic protections.
The collective impact of substance use disorder coverage has expanded
treatment and recovery opportunities in New Hampshire and across the
country.
Unfortunately, far too many still do not access this kind of
lifesaving care. We still lose 130 Americans each and every day in
their battle with opioid addiction.
The scope of this crisis is simply immense. No region, no community,
no family has been spared.
Despite the alarming statistics, the administration issued guidance
that would allow insurance companies to discriminate against Americans
with preexisting conditions, including the 19.7 million Americans like
Phil with a history of substance use.
That is why I am offering this amendment today, to strengthen the
underlying legislation and prohibit any further actions to reduce the
availability or affordability of coverage for those battling substance
use disorder.
We should be working together to open the doors to those most in
need, not shutting them because of politics.
I urge the adoption of this amendment, and I reserve the balance of
my time, Madam Chair.
Mr. WALDEN. Madam Chair, I seek time in opposition to the amendment.
The Acting CHAIR. The gentleman from Oregon is recognized for 5
minutes.
Mr. WALDEN. Madam Chair, I reserve the balance of my time.
Mr. PAPPAS. Madam Chair, I am willing to close if the gentleman from
Oregon is, and I reserve the balance of my time.
Mr. WALDEN. Actually, I believe I get to close, don't I?
The Acting CHAIR. The gentleman from Oregon has the right to close.
Mr. WALDEN. That is what I thought.
Madam Chair, I reserve the balance of my time.
Mr. PAPPAS. Madam Chair, this is a critical issue. This is an
important piece of legislation. I, for one, don't trust this
administration to get it right.
They have tried every trick in the book they can to repeal the
Affordable Care Act outright legislatively and to undermine it
administratively. They have gone to the courts to take away critical
protections from Americans who need them most. I, for one, am not going
to stand for it.
The people of New Hampshire and of this country, we are ensuring that
we get this right for them. It is very critical for those suffering
from substance use disorder that we ensure those important protections
remain on the books so that people can access care.
There is no more important tool in our toolbox than ensuring that
people have health insurance to take care of their substance use
disorder. That is why I brought forward this amendment today.
Madam Chair, I yield back the balance of my time.
Mr. WALDEN. Madam Chair, I yield myself such time as I may consume.
Section 1332 already requires that the State plan will provide
coverage that is at least as comprehensive as the essential health
benefits, including mental health and substance use disorder services.
That is already required, including behavioral health treatment, and
would provide coverage to at least a comparable number of its
residents. That is already in the 1332 requirements.
I appreciate the gentleman's passion for dealing with the opioid
epidemic. I led the effort that brought together Republicans and
Democrats. We passed 60 different pieces of legislation. I think 57 of
them, by the time we were done working together, passed unanimously in
this House.
We bundled them up into H.R. 6 because we all know the Senate can't
handle 57 or 60 different pieces of legislation, but they could handle
one. The work we did here and the work they did there ended up in, I
would argue, the Nation's most comprehensive legislation to address a
drug problem our country has ever had. And that is our law.
The President of the United States, who was just disparaged here on
the House floor, helped lead this effort because he passionately cares
about the issue of addiction. He lost a brother, I believe, to
alcoholism.
He was a leader, and his team were leaders, in this effort we put
together on opioids. He invited Republicans and Democrats to the White
House for the bill signing. Mrs. Trump helped organize all of that.
This legislation is comprehensive on opioids. It wasn't part of the
ACA. You see, we can work together and improve underlying laws. We can
address major problems facing the country when majorities want to do
that. We did it last Congress under my leadership, and it was
Republicans and Democrats. We didn't start out agreeing on some of
these matters, but we ended up there, with just a couple of exceptions.
I sent my friend, Madam Chair, the chairman of the Energy and
Commerce Committee today, a comprehensive list of kind of what we
learned in the final phase of our investigation into how America ended
up in the place it was with opioids. There are some additional
recommendations that I hope and assume we will get to out of that
investigative report that we concluded at the end of the year.
Hopefully, we will get there.
I believe we need to do oversight on the legislation we passed. I
have always felt that about bills we passed. We need to go take a
second look.
{time} 1645
What is working? What is not? We are not going to get it right the
first time, and we always know there is more to do, and we need to do
more on what was H.R. 6 in the last Congress, our opioids legislation.
Madam Chair, I am not opposed to the gentleman's amendment, and you
have to say you are in order to get the time, I guess, but I am not.
I am fully committed to making sure that people with substance abuse
disorders continue to get the help they need in our communities. That
is what our whole legislative thrust was about last Congress and will
remain there. As I say, section 1332 already requires that in these
plans.
Again, remember what we are talking about here is States coming to
the Federal Government saying: We have a
[[Page H3541]]
better idea to fill a gap, so people have affordable insurance. That is
what a waiver is under 1332. And, I guess, I have more confidence in my
State than others must have in theirs, but I think from my own
experience, Republicans and Democrats work together in Oregon to get
health insurance out, and coverage out, and expand access to care. I
have always continued to try to do that.
I have faith that my State would do this. These plans we will hear
more about next week, but they are regulated by State insurance
commissioners. I am not in the school that says all of those people are
bad and we are the only ones with a great idea. I want innovation. I
want it from the States, and I want to drive down costs of healthcare
while improving access and delivery of services.
So I am not opposed to the gentleman's amendment. I do hope we can
address these issues of fully funding our community health centers, our
National Health Service Corps, and these diabetes programs which we
reauthorized and funded in the last Congress, and which we need to do
again. They are called the Special Diabetes Program for Indians and
Special Diabetes Program for type 1 diabetes.
We have got to get after that, too, Madam Chair. We have to find the
money to do it. It is not easy. I know we have a lot of other things. I
just wish we were doing those sorts of the things today because these
programs expire in September, and we don't have that many legislative
days left.
Hopefully, we can move on to the things I know we can agree on and
find solutions for, and that we do it sooner rather than later.
Madam Chair, I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentleman from New Hampshire (Mr. Pappas).
The amendment was agreed to.
Amendment No. 10 Offered by Mr. Rouda
The Acting CHAIR. It is now in order to consider amendment No. 10
printed in part A of House Report 116-51.
Mr. ROUDA. Madam Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
In section 2, insert ``, including any such action that
would result, with respect to vulnerable populations
(including low-income individuals, elderly individuals, and
individuals with serious health issues or who have a greater
risk of developing serious health issues), in a decrease in
the availability of coverage that is at least as
comprehensive as the coverage defined in section 1302(a) of
the Patient Protection and Affordable Care Act (42 U.S.C.
18022(a)) with coverage and cost sharing protections required
under section 1332(b)(1)(B) of such Act (42 U.S.C.
18052(b)(1)(B))'' after ``(October 24, 2018))''.
The Acting CHAIR. Pursuant to House Resolution 357, the gentleman
from California (Mr. Rouda) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentleman from California.
Mr. ROUDA. Madam Chairwoman, 9 years ago our Nation took a monumental
step forward to address the needs of millions of Americans with a
preexisting condition. Before the passage of the Affordable Care Act,
individuals across the country were denied coverage or charged higher
premiums due to their medical history.
While I came to Washington to protect our healthcare, the Trump
administration has continued its assault on the Affordable Care Act. In
this case, the administration is trying to use an ACA provision
designed to give States the ability to test new insurance reforms that
could improve the wellbeing of their residents, but, instead, that
provision is being used to undermine protections for people with
preexisting conditions and the coverage of essential health benefits,
all in an effort to prop up junk, short-term insurance plans.
Today, we will stand up to that assault on America's healthcare by
passing H.R. 986, to nullify these efforts. We must be clear that any
future administrative actions by this administration or any other
administration should not harm the vulnerable populations that the
Affordable Care Act was designed to protect.
To that end, my amendment would prohibit any future rule or guidance
from diminishing the Affordable Care Act that would result in reduction
in the availability, affordability, and comprehensiveness for people
with preexisting conditions, the elderly and low-income individuals.
My amendment would affirm these critical guardrails that protect the
care of so many Americans across our country and help strengthen and
uphold the principles of this landmark law.
I would like to thank Chairman Pallone, Chairman Neal, and their
respective staff for their assistance with this amendment.
I ask my colleagues to join me in supporting this amendment to ensure
that this and future administrations do not undermine the healthcare of
vulnerable populations.
Madam Chair, I reserve the balance of my time.
Mr. WALDEN. Madam Chairwoman, I seek time in opposition to the
gentleman's amendment.
The Acting CHAIR. The gentleman from Oregon is recognized for 5
minutes.
Mr. WALDEN. Madam Chair, I am not opposed to the gentleman's
amendment, but I am happy to speak on it.
Again, section 1332 already requires that the State plan, the one
they submit, will provide coverage that is at least as comprehensive as
the essential health benefits, including mental health and substance
use disorder services, including behavioral health treatment, and will
provide coverage to at least a comparable number of its residents.
Madam Chair, I reserve the balance of my time.
Mr. ROUDA. Madam Chairwoman, we are at a crossroads in our country.
When we look at the global stage, there are approximately 200
countries, of which 40 are industrialized, developed countries. Of
those 40 industrialized, developed countries, 39 of them have universal
healthcare. Only one does not, the wealthiest, greatest country in the
history of the world. That is why we have tens of millions of
individuals in our country without insurance.
We know that preexisting conditions have to be covered because when
we look at the fact that this country spends 18.5 percent of its GDP on
healthcare, almost double what these other industrialized, developed
countries spend, you would think the United States of America has the
healthiest people in the world.
Madam Chairwoman, that is not the case. I am sad to report that most
critical criteria when looking at Americans' healthcare, we are in the
bottom quartile, even though we spend 18.5 percent of our GDP. We know
that the inability to pay healthcare costs is a leading cause of
involuntary bankruptcy and homelessness.
Preexisting conditions is the underlying reason for those two things.
That is why we must make sure that we protect affordable healthcare in
the United States through the act, and make sure that preexisting
conditions are covered today and tomorrow for future generations.
Madam Chair, I yield back the balance of my time.
Mr. WALDEN. Madam Chairwoman, I yield myself such time as I may
consume.
Madam Chair, I just want to go back to what is going on in America's
healthcare costs and look at some of what is going on elsewhere around
the world.
First of all, I would draw the Member's attention to the Kaiser
Foundation report that Axios reported on about people who have health
insurance and still can't afford to use it. They talked about just over
half of those with employer coverage have some sort of chronic disease,
so they have health insurance. But the deductibles which are at $3,000
to $5,000 are so high that three-quarters of the people reported
skipping or postponing some type of care. Half, 49 percent, said that a
family member had a problem paying medical bills or difficulty
affording their premiums, deductibles, or copays in the last year.
What we are trying to do is help those people in the individual
market, and we would love to help those people in the market that
employer-provided health insurance is in as well, and put downward
pressure on pricing, and go after the cost of healthcare from one end
to the other.
[[Page H3542]]
Now, the gentleman from California, I believe, has talked about going
to a, I guess, government-run, single-payer system. I have got two
veterans that work virtually full time helping veterans in Oregon's
Second District get access to a similar sort of system. You know of it
as the VA. Think about the problems we have with that government-run,
single, sort of, payer-operated system.
If you get in, I have veterans saying: It is great. I have got
coverage. But it is people who have to wait 6 months to get eyeglasses
at one point, or they can't get in to get their surgery done. And we
are working with thousands of veterans that have to come to
their Member of Congress to be able to get access to the healthcare
they were promised when they put on the Nation's uniform.
We have that system in place, and it has incredible problems in wait
time, so I had to create the Choice Program and everything else.
Then I was intrigued by a story about a woman in Nova Scotia who is
33 years old. She is under one of those systems my friend wants for us,
I guess. After three trips to the emergency room, they just never would
believe her and her problem and see her, and she couldn't get access to
doctors. When she finally did, her anal cancer had progressed to stage
III.
Now, at 33, she is in menopause, she writes. She had a Facebook post
recently wanting to meet with the Premier to explain how broken their
healthcare system is.
We all know stories about Canadians who come across the border who
can afford to get their healthcare done here because they can get it
done sooner. We all know of stories in other countries where they have
global budgets, and when they run out, you are done. I have had people
tell me the little secret is: Get sick before June because they are
going to run out and you won't get in. That is what is going on around
the world.
And I think, in many measures, when people are especially sick, if
they have the money, they come to the United States for care. They go
to MD Anderson Cancer Center, and they go to the Mayo Clinic.
Those are the folks who come to America. What I want is the MD
Andersons and the Mayo Clinics, and the Oregon and Health & Science
Universities to be affordable and available to all Americans.
We had a hearing today--I think it was pretty good--on drug pricing,
following up on what I did 2 years ago looking at the manufacturers,
the PBMs, the distributors, and the insurers. Everybody wants a piece
of this. Everybody is getting a chunk. The result is, we have a
healthcare system that costs too much. So let's go figure that out.
That is what innovation is about, and that is what our States can do
in their wonderful laboratories. Some of them will do really good
things, and some of them will make mistakes and learn from it. We
should pick the best from among the States. That is what we are looking
for here in these 1332 waivers is some flexibility for our States to
innovate.
I believe our States and my colleagues--and by the way, Oregon is
completely Democrat controlled--but they care about citizens of the
State of Oregon, and so does the insurance commissioner, and they are
only going to ask for permission for a plan that will be better than
what the Federal Government is trying to jam down their throat in a
one-size-fits-all.
So I don't object to the gentleman's amendment. I think we can do
better by harnessing great innovation. We do it in medicine, and we do
it everywhere else. We have competitive insurance products for a lot of
other things we buy, and I would like to see more options, more choice,
more transparency in healthcare, and more consumer involvement.
Madam Chairwoman, I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentleman from California (Mr. Rouda).
The amendment was agreed to.
Amendment No. 11 Offered by Mr. Malinowski
The Acting CHAIR. It is now in order to consider amendment No. 11
printed in part A of House Report 116-51.
Mr. MALINOWSKI. Madam Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
In section 2, insert ``, including any such action that
would, with respect to individuals with preexisting
conditions, reduce the affordability of coverage that is at
least as comprehensive as the coverage defined in section
1302(a) of the Patient Protection and Affordable Care Act (42
U.S.C. 18022(a)) compared to the affordability of such
coverage had such action not been taken'' after ``(October
24, 2018))''.
The Acting CHAIR. Pursuant to House Resolution 357, the gentleman
from New Jersey (Mr. Malinowski) and a Member opposed each will control
5 minutes.
The Chair recognizes the gentleman from New Jersey.
Mr. MALINOWSKI. Madam Chairwoman, there are many problems in our
healthcare system. We have heard about a number of them today, but we
are here for one simple, specific reason, because of the guidance that
the administration issued last year that allows States to expand the
availability and duration of junk, short-term insurance plans.
Now, the administration and its defenders will not say this because
it has become politically impossible to do so, but these plans are
cheaper precisely because they deny coverage to people with preexisting
conditions and for, what any reasonable person would agree are
essential benefits, like maternity care and prescription drugs.
That is what they mean when they use the euphemism ``flexibility.''
Will these plans take hold? Here is what happens, in plain language, if
you have a preexisting condition. You have a choice. Either stay in
your ACA plan and see your premiums rise as healthy people move to
cheaper, junk insurance, or you sign up for a junk plan yourself and
risk getting gouged when the services you need aren't covered.
You end up with a two-tiered healthcare system in America: one for
healthy people, and one for sick people. Now, the underlying bill
rescinds that guidance. The amendment I have submitted would prohibit
the administration from taking any other action that would reduce the
affordability of comprehensive coverage for Americans with preexisting
conditions.
{time} 1700
Now, this would not in any way prevent States from using section 1332
waivers to make healthcare better and more affordable. Many States, as
we have heard, have done so in ways that have lowered health insurance
premiums without, in any way, undermining protections for people with
preexisting conditions.
Yes, section 1332 has a clear directive that States must maintain the
benefits, affordability, and coverage provided by the ACA, but it is
clear that the administration has disregarded these standards and could
do so again to remove protections for vulnerable groups, to promote
expansion of health plans that are not compliant with the ACA, and to
take other steps that would increase costs, especially for women and
older adults.
This amendment, along with the overall bill, makes sure that we keep
our promise to the American people. It makes clear that, when we say we
are going to protect everyone with a preexisting condition, that is not
an empty slogan that means whatever we want it to mean. Those words
mean something, that every American deserves quality health insurance,
and no American should be forced to pay more for good coverage because
of a preexisting health problem.
Madam Chair, that is what H.R. 986 and my amendment guarantee. I urge
my colleagues to support both, and I reserve the balance of my time.
Mr. WALDEN. Madam Chair, I claim the time in opposition to the
gentleman's amendment.
The Acting CHAIR. The gentleman from Oregon is recognized for 5
minutes.
Mr. WALDEN. Madam Chair, I reserve the balance of my time.
Mr. MALINOWSKI. Madam Chair, I will close by saying there is no
question whatsoever what the administration intends to do. They have
been trying from day one, from January 2017, to repeal the Affordable
Care Act and its essential protections for the American people.
The only thing that has changed is that it has become politically
impossible for anyone in America to say that
[[Page H3543]]
you are opposed to protecting people with preexisting conditions, and
so a war against healthcare protections is being covered up by a war
against the English language.
Everyone says, ``We are for preexisting conditions,'' yet every
single step the administration and its supporters take is designed to
weaken those protections. This amendment and the underlying bill say
that you can't do that anymore. They guarantee, going forward, that the
ACA's protections are respected and that any experimentation by the
States will have to be consistent with those protections.
Madam Chair, I urge my colleagues' support for the amendment and the
bill, and I yield back the balance of my time.
Mr. WALDEN. Madam Chair, I yield myself such time as I may consume.
Madam Chair, I do not oppose this amendment because this amendment
does not do anything the law already, I think, requires.
Section 1332 does not permit States to waive preexisting condition
protections. Section 1332 already requires that the State plan will
provide coverage that is at least as comprehensive as the essential
health benefits and will provide coverage and cost-sharing protections
against excessive out-of-pocket spending. That is what the underlying
law already does.
We have the assurance from the CMS Administrator saying, once again,
to be clear: ``The 2018 guidance does nothing to erode the PPACA's
preexisting condition provisions, which cannot be waived under section
1332.''
She is the one who makes the decision.
By the way, I would just point out that no State has come to the
Trump administration under this new authority that we are aware of and
said: ``Please approve our plan.''
Junk plans--and we will hear more about that term of art. By the way,
those junk plans were allowed for under the Obama administration and
under the ACA. At that time, they were only allowed for 3 months. There
seemed to be a lot of interest in a variety of options for citizens to
take advantage of that covered their needs.
So the Trump administration said, well, if they are good for 3
months, what if we extend them to 12 months or just at 12 months? That
is what they did. They were junk plans under Trump; they were wonderful
options under Obama. It is the same set of plans.
You can always go on the exchange, and you can always find other
coverage that fits your need. We are trying to not have just one plan
that nobody can afford. That is what you are seeing in this situation
that Ms. Seema Verma put forward, Madam Chair, the head of the CMS, the
Administrator for the Centers for Medicare and Medicaid Services.
She uses, as an example, this situation in Grand Island, Nebraska. It
is not Oregon; it is Nebraska. A $70,000-a-year, 60-year-old couple are
paying $38,000 a year for their insurance with an $11,100 deductible.
Now, how is that affordable? Does anybody in here think that is a great
idea?
That is what you are saying: Don't innovate. We have got it covered.
The ACA has it covered. There is no need for innovation here, nothing
to see. The plan works great.
Then we know, from the Kaiser Foundation study, people are saying: I
can't afford it. So I will jack up my credit card, and I will wipe out
my savings.
All this is going on. The ACA did not solve every problem. It
expanded coverage. You can't help but do that, spend that much money.
States like mine took full advantage of it. But we are left with these
pockets and problems in America that I think States could assist us in
if we gave them expanded authority under 1332 waivers to say: Hey,
guess what, Washington? We have a better idea here. Here it is. Take a
look at it, and make sure it fits the Federal guidelines and law, but
let us innovate.
Oregon did that. Under the prior 1332 approval process, insurance
rates went down 6 percent; Wisconsin down 10.6; New Jersey, 15;
Maryland, 43; Maine, 9.4; Minnesota, 20; Alaska, 34.7. Using this sort
of ``Mother May I'' approval, that is what you have to do.
I remember when Oregon did the Oregon health plan. I was in the State
legislature then, and we had to plead and beg with the administration
at the time to get approval to try and experiment on Medicaid coverage
to expand coverage and improve access to care. We couldn't do it
without Mother Washington, Father Washington, or Brother Washington,
whoever, back here, saying: Yeah, okay. We will let you try that.
We should be in partnerships with our States.
By the way, States can pass a law and say: We are not going down this
path. They have every right to do it. New Jersey has done it, and
California has done it: None of these short-term duration plans, we are
not going to be a part of that.
Every State has that right. But there are a lot of States that look
at their citizens and say: $38,000 a year for your insurance and
$11,000 for your deductible; you are making $70,000; you are 60 years
old. That is not working real well either. So maybe we can find a
product that would work for you and help you out.
So we are talking about a range of options and choices. America has
always done well and markets do better when we have more choices. That
is what we are talking about here.
The gentleman's amendment I don't object to at all. I think it is the
underlying law as described by the head of the Department who would
have to approve all these 1332 waivers.
Madam Chair, I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentleman from New Jersey (Mr. Malinowski).
The question was taken; and the Acting Chair announced that the ayes
appeared to have it.
Mr. MALINOWSKI. Madam Chair, I demand a recorded vote.
The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further
proceedings on the amendment offered by the gentleman from New Jersey
will be postponed.
Amendment No. 12 Offered by Ms. Wild
The Acting CHAIR. It is now in order to consider amendment No. 12
printed in part A of House Report 116-51.
Ms. WILD. Madam Chair, I have an amendment at the desk.
The Acting CHAIR. The Clerk will designate the amendment.
The text of the amendment is as follows:
Page 3, line 16, insert after ``2018)),'' the following:
``including any such action that would result in higher
health insurance premiums for individuals enrolled in health
insurance coverage that is at least as comprehensive as the
coverage defined in section 1302(b) of such Act (42 U.S.C.
18022(b)),''.
The Acting CHAIR. Pursuant to House Resolution 357, the gentlewoman
from Pennsylvania (Ms. Wild) and a Member opposed each will control 5
minutes.
The Chair recognizes the gentlewoman from Pennsylvania.
Ms. WILD. Madam Chair, I rise today to offer an amendment to H.R.
986, the Protecting Americans with Preexisting Conditions Act of 2019.
My amendment would put an end to the rising cost of premiums. It is
an amendment that should be met with overwhelming bipartisan support
and without opposition.
Specifically, my amendment would prohibit the administration from
taking any further action that would result in higher premiums for
Americans who need comprehensive coverage.
This administration has unilaterally made healthcare more expensive
and less accessible for the American people by taking actions that run
contrary to the spirit and purpose of the ACA. That has resulted in
higher premiums and reduced enrollment.
In 2017, the administration stopped cost-sharing payments that helped
reduce out-of-pocket costs for low-income Americans. This action alone
increased premiums by 20 percent and raised costs for families not
receiving subsidies.
In 2018, the administration issued new section 1332 guidance that
allows States to raise healthcare costs for people with preexisting
conditions. This 2018 guidance also gave a green light to insurance
companies to expand junk plans that don't cover essential health
benefits. We know that pulling people out of the pool only makes
insurance premiums more expensive for those with preexisting
conditions.
Also, in 2018, the administration slashed funding for consumer
enrollment assistance and outreach. Their
[[Page H3544]]
goal: reduced healthcare enrollment; the result: higher premiums.
Just last month, the administration finalized a rule that would
increase limits on total out-of-pocket costs for millions. The
administration moved forward with this even though the rule itself
noted that all commenters on this topic expressed opposition to or
concerns about the proposed change.
This past Monday, the administration released a notice seeking
comment on a proposal that would reduce eligibility for Medicaid and
cut premium tax credits for millions.
It is time to say ``no'' to future attempts to sabotage working
Americans' healthcare.
Madam Chair, I reserve the balance of my time.
Mr. WALDEN. Madam Chair, I claim the time in opposition to the
gentlewoman's amendment.
The Acting CHAIR. The gentleman from Oregon is recognized for 5
minutes.
Mr. WALDEN. Madam Chair, I reserve the balance of my time.
Ms. WILD. Madam Chairman, my amendment is about fairness. Patients
should not face increased premiums at the whim of appointed government
officials, especially for essential health benefits like emergency
services, maternity, newborn, pediatric care, mental health and
substance abuse treatment, prescription drugs, laboratory services, and
preventive and wellness services for chronic disease management.
From malicious lawsuits aimed at striking down the ACA in its
entirety and, along with it, the protections for preexisting conditions
to ending the practice of public advertisement of enrollment period and
educating the people about the complexities of health insurance, it has
become clear that Congress must reclaim its legislative authority and
ensure that this administration faithfully executes the spirit of this
law.
The ACA is the law. The Constitution gives Congress the power to make
laws and requires the executive branch to faithfully execute the laws
that Congress passes.
We all heard Republicans on the campaign trail last year say that
they would protect coverage for preexisting conditions and help drive
down our premiums. This is their chance to fulfill those campaign
promises with concrete action.
Action, not words, is what the American people demand, and it is what
they deserve. Let's make that commitment a reality by adopting this
amendment, passing this bill, and pushing the Senate to take it up so
that we can get it signed into law.
In closing, Madam Chair, this is about standing up for the dignity of
working families in the most basic and fundamental sense. It is about
saying that every child, woman, man, and family in this country
deserves the same certainty of being able to afford high-quality
healthcare.
Our people deserve better. We need to stop the political
gamesmanship, and we need to focus on people across our country who
need good, affordable healthcare right now.
This is also our chance to remind this administration and future
administrations that Congress makes the laws, and the executive branch
doesn't get to fool around with the implementation just to see it fail
for political reasons.
Madam Chair, I yield back the balance of my time.
Mr. WALDEN. Madam Chair, I yield myself such time as I may consume.
Madam Chair, let's talk about this amendment.
I have talked earlier about all the things that need to be
reauthorized--community health centers, special diabetes programs, all
of that which I know the committee is aware of and I hope we begin
marking. I wish we were dealing with that today.
I heard from the gentlewoman about Republicans and preexisting
conditions and ``Where is your plan?'' It is sitting up in the Rules
Committee because your party would not allow my amendment to do that
and to be brought to the floor for debate today. I don't control the
Rules Committee. It is 2 to 1 by the majority. It is just the way it
works around here, and I respect that.
But you allowed my amendments that were more in jest about the false
nature of the title of the bill to be debated but not the substantive
amendment I offered which does protect people with preexisting
conditions in case the lawsuit were to prevail and ObamaCare is thrown
out. But, no, we couldn't have that debate.
I have asked for my bill to be considered in the committee of
jurisdiction. That hasn't happened either.
I have also asked for the Democrats' one-size-fits-all takeover of
healthcare, Medicare for All, however you want to describe it, that we
have a hearing in Energy and Commerce. That hasn't happened either. We
are the committee of jurisdiction.
You talk about working people. It is ObamaCare that puts a 40 percent
tax on union plans and employer plans that exceed a certain level of
costs, and they don't index it. Now, I don't know where the gentlewoman
is on the Cadillac tax, but I want to repeal it. I never voted for it.
{time} 1715
So, if they want to enshrine the Affordable Care Act in its entirety
and make no changes, then I guess they are for a 40 percent tax on the
kind of insurance plans that my building tradespeople negotiated to
get--and other unions--instead of getting wage increases.
We have delayed that.
And when we look at the cuts in the Affordable Care Act coming at our
hospitals in rural areas that serve lower-income areas, the DSH
payments, we put off those cuts to our hospitals--last cycle--under
Republican leadership. And we are going to face that question in this
Congress under Democrat leadership.
So, a vote to delay those DSH cuts again--if one does that--is voting
to repeal or delay part of ObamaCare.
I hear 60, 70 votes to do these things to ObamaCare--repeal the CLASS
Act, which was a long-term health insurance program that was destined
for failure, and even President Obama signed its repeal.
I can go through a whole list of things that got repealed. We are the
only ones who ever get tagged with voting to repeal.
As far as our commitment to preexisting conditions protection: It is
real, it is robust, and it was always in everything we did.
Yeah, I know what the political rhetoric was. I have run campaigns. I
have been around that. I know how you can nuance around. But we always
protected people with preexisting conditions--always, period, hard
stop. Protected people with preexisting conditions, in what came out of
my committee and came across this House floor, they were always
covered--always.
So I hear the political rhetoric, but I know the facts. See, I am an
old journalism major, and I believe in facts.
The facts of the matter are that 1332 waivers have given our States
an opportunity to give our citizens an affordable health insurance
plan, not one that I guess they will defend--$38,000 a year in
premiums, $11,000 a year in deductibles, copays, out-of-pocket costs.
How is that working for anybody?
And shouldn't that 60-year-old couple in Nebraska have a chance to
have a better plan option? Nope, guess not. Washington is going to
decide it all for you. Write your check: 38 grand. That is for the
premiums. And $11,000 in out-of-pocket costs, your deductibles. Then
maybe you can get something covered, right?
Well, what is left? We know from this Kaiser study I have cited
earlier that was in Axios: People wipe out their savings. They put it
on their credit cards. They borrow from their friends. Or they simply
don't get coverage.
That is the world they want to freeze-frame and leave in place. That
is not what the Republicans are for. We want innovation. We want
choice. We believe in our States having the opportunity to innovate and
do it even better, not to go back to the old ways. No. That is not what
we are for. I know that is what Democrats want to label us as being
for, but it is not true.
And we have proven results in opioids; Community Health Centers; the
longest funding for Children's Health Insurance Program in the history
of the United States of America, under Republican leadership--10 years.
We are the ones, Republicans, who led the effort to invest in medical
research at unprecedented rates under
[[Page H3545]]
what Fred Upton put forward and what Newt Gingrich put forward.
Mr. WALDEN. Madam Chair, I yield back the balance of my time.
The Acting CHAIR. The question is on the amendment offered by the
gentlewoman from Pennsylvania (Ms. Wild).
The question was taken; and the Acting Chair announced that the ayes
appeared to have it.
Ms. WILD. Madam Chair, I demand a recorded vote.
The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further
proceedings on the amendment offered by the gentlewoman from
Pennsylvania will be postponed.
Announcement by the Acting Chair
The Acting CHAIR. Pursuant to clause 6 of rule XVIII, proceedings
will now resume on those amendments printed in part A of House Report
116-51 on which further proceedings were postponed, in the following
order:
Amendment No. 2 by Mr. Brown of Maryland.
Amendment No. 7 by Mr. Holding of North Carolina.
Amendment No. 11 by Mr. Malinowski of New Jersey.
Amendment No. 12 by Ms. Wild of Pennsylvania.
The Chair will reduce to 2 minutes the minimum time for any
electronic vote after the first vote in this series.
Amendment No. 2 Offered by Mr. Brown of Maryland
The Acting CHAIR. The unfinished business is the demand for a
recorded vote on the amendment offered by the gentleman from Maryland
(Mr. Brown) on which further proceedings were postponed and on which
the ayes prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The Acting CHAIR. A recorded vote has been demanded.
A recorded vote was ordered.
The vote was taken by electronic device, and there were--ayes 351,
noes 70, not voting 16, as follows:
[Roll No. 191]
AYES--351
Adams
Aguilar
Allred
Amodei
Armstrong
Arrington
Axne
Bacon
Baird
Balderson
Barr
Barragan
Beatty
Bera
Bergman
Beyer
Bilirakis
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Bost
Boyle, Brendan F.
Brady
Brindisi
Brooks (IN)
Brown (MD)
Brownley (CA)
Buchanan
Bucshon
Burgess
Bustos
Butterfield
Calvert
Carbajal
Carson (IN)
Cartwright
Case
Casten (IL)
Castor (FL)
Castro (TX)
Chabot
Chu, Judy
Cicilline
Cisneros
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Cole
Collins (NY)
Conaway
Connolly
Cooper
Correa
Costa
Courtney
Cox (CA)
Craig
Crawford
Crenshaw
Crist
Crow
Cuellar
Cunningham
Curtis
Davids (KS)
Davis (CA)
Davis, Danny K.
Davis, Rodney
Dean
DeFazio
DeGette
DeLauro
DelBene
Delgado
Demings
DeSaulnier
Deutch
Diaz-Balart
Dingell
Doggett
Doyle, Michael F.
Dunn
Engel
Escobar
Eshoo
Espaillat
Evans
Finkenauer
Fitzpatrick
Fleischmann
Fletcher
Flores
Fortenberry
Foster
Foxx (NC)
Frankel
Fudge
Gabbard
Gallagher
Gallego
Garamendi
Garcia (IL)
Garcia (TX)
Gianforte
Gibbs
Golden
Gomez
Gonzalez (OH)
Gonzalez (TX)
Gonzalez-Colon (PR)
Gottheimer
Graves (LA)
Graves (MO)
Green (TX)
Griffith
Grijalva
Grothman
Guest
Guthrie
Haaland
Hagedorn
Harder (CA)
Hartzler
Hastings
Hayes
Heck
Herrera Beutler
Higgins (NY)
Hill (AR)
Hill (CA)
Himes
Holding
Hollingsworth
Horn, Kendra S.
Horsford
Houlahan
Hoyer
Hudson
Huffman
Hunter
Hurd (TX)
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson (OH)
Johnson (SD)
Johnson (TX)
Joyce (OH)
Joyce (PA)
Kaptur
Katko
Keating
Kelly (IL)
Kelly (PA)
Kennedy
Khanna
Kildee
Kilmer
Kim
Kind
King (IA)
King (NY)
Kinzinger
Kirkpatrick
Krishnamoorthi
Kuster (NH)
Kustoff (TN)
LaHood
LaMalfa
Lamb
Langevin
Larsen (WA)
Larson (CT)
Latta
Lawrence
Lawson (FL)
Lee (CA)
Lee (NV)
Lesko
Levin (CA)
Levin (MI)
Lewis
Lieu, Ted
Lipinski
Loebsack
Lofgren
Long
Lowenthal
Lowey
Lucas
Luetkemeyer
Lujan
Luria
Lynch
Malinowski
Maloney, Carolyn B.
Maloney, Sean
Marchant
Marshall
Matsui
McAdams
McBath
McCarthy
McCaul
McCollum
McEachin
McGovern
McHenry
McKinley
McNerney
Meeks
Meng
Meuser
Miller
Moolenaar
Moore
Morelle
Moulton
Mucarsel-Powell
Mullin
Murphy
Nadler
Napolitano
Neal
Neguse
Newhouse
Norcross
Norton
Nunes
O'Halleran
Ocasio-Cortez
Omar
Pallone
Panetta
Pappas
Pascrell
Payne
Perlmutter
Peters
Peterson
Phillips
Plaskett
Pocan
Porter
Pressley
Price (NC)
Quigley
Radewagen
Raskin
Reed
Reschenthaler
Rice (NY)
Rice (SC)
Rodgers (WA)
Roe, David P.
Rogers (KY)
Rose (NY)
Rose, John W.
Rouda
Rouzer
Roybal-Allard
Ruiz
Ruppersberger
Rush
Rutherford
Sablan
Sanchez
Sarbanes
Scanlon
Schakowsky
Schiff
Schneider
Schrader
Schrier
Schweikert
Scott (VA)
Scott, Austin
Scott, David
Sensenbrenner
Serrano
Sewell (AL)
Shalala
Sherman
Sherrill
Shimkus
Simpson
Sires
Slotkin
Smith (MO)
Smith (NJ)
Smith (WA)
Smucker
Soto
Spanberger
Spano
Speier
Stanton
Stauber
Stefanik
Steil
Stevens
Stivers
Suozzi
Takano
Taylor
Thompson (CA)
Thompson (MS)
Thompson (PA)
Thornberry
Timmons
Tipton
Titus
Tlaib
Tonko
Torres (CA)
Torres Small (NM)
Trahan
Trone
Turner
Underwood
Upton
Van Drew
Vargas
Veasey
Vela
Velazquez
Visclosky
Wagner
Walberg
Walden
Wasserman Schultz
Waters
Watkins
Watson Coleman
Webster (FL)
Welch
Westerman
Wexton
Wild
Wilson (FL)
Wilson (SC)
Wittman
Womack
Yarmuth
Young
Zeldin
NOES--70
Aderholt
Allen
Amash
Babin
Banks
Biggs
Brooks (AL)
Buck
Budd
Burchett
Byrne
Carter (GA)
Carter (TX)
Cheney
Cline
Cloud
Collins (GA)
Comer
Cook
Davidson (OH)
DesJarlais
Duffy
Duncan
Estes
Ferguson
Fulcher
Gaetz
Gohmert
Gooden
Gosar
Granger
Graves (GA)
Green (TN)
Harris
Hern, Kevin
Hice (GA)
Higgins (LA)
Huizenga
Johnson (LA)
Jordan
Kelly (MS)
Lamborn
Loudermilk
Massie
Mast
McClintock
Meadows
Mitchell
Mooney (WV)
Norman
Palazzo
Palmer
Pence
Perry
Posey
Ratcliffe
Riggleman
Roby
Rogers (AL)
Roy
Scalise
Smith (NE)
Steube
Stewart
Walorski
Weber (TX)
Williams
Woodall
Wright
Yoho
NOT VOTING--16
Abraham
Bass
Bishop (UT)
Cardenas
Cummings
Emmer
Olson
Pingree
Richmond
Rooney (FL)
Ryan
San Nicolas
Swalwell (CA)
Walker
Waltz
Wenstrup
{time} 1744
Messrs. KELLY of Mississippi, SMITH of Nebraska, MAST, and CARTER of
Georgia changed their vote from ``aye'' to ``no.''
Messrs. BUCSHON, BAIRD, WEBSTER of Florida, BACON, FLEISCHMANN, LONG,
and KELLY of Pennsylvania changed their vote from ``no'' to ``aye.''
So the amendment was agreed to.
The result of the vote was announced as above recorded.
Amendment No. 7 Offered by Mr. Holding
The Acting CHAIR. The unfinished business is the demand for a
recorded vote on the amendment offered by the gentleman from North
Carolina (Mr. Holding) on which further proceedings were postponed and
on which the noes prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The Acting CHAIR. A recorded vote has been demanded.
A recorded vote was ordered.
The Acting CHAIR. This will be a 2-minute vote.
The vote was taken by electronic device, and there were--ayes 184,
noes 237, not voting 16, as follows:
[Roll No. 192]
AYES--184
Aderholt
Allen
Amodei
Armstrong
Arrington
Babin
Bacon
Baird
Balderson
Banks
Barr
Bergman
Biggs
Bilirakis
Bost
Brady
Brooks (AL)
Brooks (IN)
Buchanan
Buck
Bucshon
Budd
Burchett
Burgess
Byrne
Calvert
Carter (GA)
Carter (TX)
Chabot
Cheney
Cloud
Cole
Collins (GA)
Collins (NY)
Comer
Conaway
Cook
Crawford
Crenshaw
Curtis
Davidson (OH)
Davis, Rodney
DesJarlais
Diaz-Balart
Duffy
Duncan
Dunn
Estes
Ferguson
Fleischmann
Flores
[[Page H3546]]
Fortenberry
Foxx (NC)
Fulcher
Gaetz
Gallagher
Gianforte
Gibbs
Gohmert
Gonzalez (OH)
Gonzalez-Colon (PR)
Gooden
Gosar
Granger
Graves (GA)
Graves (LA)
Graves (MO)
Green (TN)
Griffith
Grothman
Guthrie
Hagedorn
Harris
Hartzler
Hern, Kevin
Herrera Beutler
Hice (GA)
Hill (AR)
Holding
Hollingsworth
Hudson
Huizenga
Hunter
Hurd (TX)
Johnson (LA)
Johnson (OH)
Johnson (SD)
Jordan
Joyce (OH)
Joyce (PA)
Katko
Kelly (MS)
Kelly (PA)
King (IA)
King (NY)
Kinzinger
Kustoff (TN)
LaHood
LaMalfa
Lamborn
Latta
Lesko
Long
Loudermilk
Lucas
Luetkemeyer
Marchant
Marshall
Massie
Mast
McCarthy
McCaul
McClintock
McHenry
McKinley
Meadows
Meuser
Miller
Mitchell
Moolenaar
Mooney (WV)
Mullin
Newhouse
Norman
Nunes
Palazzo
Palmer
Pence
Perry
Posey
Radewagen
Ratcliffe
Reed
Reschenthaler
Rice (SC)
Riggleman
Roby
Rodgers (WA)
Roe, David P.
Rogers (AL)
Rogers (KY)
Rose, John W.
Rouzer
Rutherford
Scalise
Schweikert
Scott, Austin
Sensenbrenner
Shimkus
Simpson
Smith (MO)
Smith (NE)
Smucker
Spano
Stauber
Stefanik
Steil
Steube
Stewart
Stivers
Thompson (PA)
Thornberry
Timmons
Tipton
Turner
Upton
Wagner
Walberg
Walden
Walorski
Waltz
Watkins
Weber (TX)
Webster (FL)
Westerman
Williams
Wilson (SC)
Wittman
Womack
Woodall
Wright
Yoho
Young
Zeldin
NOES--237
Adams
Aguilar
Allred
Amash
Axne
Barragan
Beatty
Bera
Beyer
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brindisi
Brown (MD)
Brownley (CA)
Bustos
Butterfield
Carbajal
Carson (IN)
Cartwright
Case
Casten (IL)
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Cisneros
Clark (MA)
Clarke (NY)
Clay
Cleaver
Cline
Clyburn
Cohen
Connolly
Cooper
Correa
Costa
Courtney
Cox (CA)
Craig
Crist
Crow
Cuellar
Cunningham
Davids (KS)
Davis (CA)
Davis, Danny K.
Dean
DeFazio
DeGette
DeLauro
DelBene
Delgado
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Engel
Escobar
Eshoo
Espaillat
Evans
Finkenauer
Fitzpatrick
Fletcher
Foster
Frankel
Fudge
Gallego
Garamendi
Garcia (IL)
Garcia (TX)
Golden
Gomez
Gonzalez (TX)
Gottheimer
Green (TX)
Grijalva
Guest
Haaland
Harder (CA)
Hastings
Hayes
Heck
Higgins (LA)
Higgins (NY)
Hill (CA)
Himes
Horn, Kendra S.
Horsford
Houlahan
Hoyer
Huffman
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson (TX)
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kildee
Kilmer
Kim
Kind
Kirkpatrick
Krishnamoorthi
Kuster (NH)
Lamb
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee (CA)
Lee (NV)
Levin (CA)
Levin (MI)
Lewis
Lieu, Ted
Lipinski
Loebsack
Lofgren
Lowenthal
Lowey
Lujan
Luria
Lynch
Malinowski
Maloney, Carolyn B.
Maloney, Sean
Matsui
McAdams
McBath
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moore
Morelle
Moulton
Mucarsel-Powell
Murphy
Nadler
Napolitano
Neal
Neguse
Norcross
Norton
O'Halleran
Ocasio-Cortez
Omar
Pallone
Panetta
Pappas
Pascrell
Payne
Perlmutter
Peters
Peterson
Phillips
Pingree
Plaskett
Pocan
Porter
Pressley
Price (NC)
Quigley
Raskin
Rice (NY)
Rose (NY)
Rouda
Roy
Roybal-Allard
Ruiz
Ruppersberger
Rush
Sablan
Sanchez
Sarbanes
Scanlon
Schakowsky
Schiff
Schneider
Schrader
Schrier
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shalala
Sherman
Sherrill
Sires
Slotkin
Smith (WA)
Soto
Spanberger
Speier
Stanton
Stevens
Suozzi
Takano
Taylor
Thompson (CA)
Thompson (MS)
Titus
Tlaib
Tonko
Torres (CA)
Torres Small (NM)
Trahan
Trone
Underwood
Van Drew
Vargas
Veasey
Vela
Velazquez
Visclosky
Wasserman Schultz
Waters
Watson Coleman
Welch
Wexton
Wild
Wilson (FL)
Yarmuth
NOT VOTING--16
Abraham
Bass
Bishop (UT)
Cardenas
Cummings
Emmer
Gabbard
Olson
Richmond
Rooney (FL)
Ryan
San Nicolas
Smith (NJ)
Swalwell (CA)
Walker
Wenstrup
Announcement by the Acting Chair
The Acting CHAIR (during the vote). There is 1 minute remaining.
{time} 1749
Messrs. RUSH, ROUDA, PHILLIPS, and Ms. MUCARSEL-POWELL changed their
vote from ``aye'' to ``no.''
So the amendment was rejected.
The result of the vote was announced as above recorded.
Amendment No. 11 Offered by Mr. Malinowski
The Acting CHAIR. The unfinished business is the demand for a
recorded vote on the amendment offered by the gentleman from New Jersey
(Mr. Malinowski) on which further proceedings were postponed and on
which the ayes prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The Acting CHAIR. A recorded vote has been demanded.
A recorded vote was ordered.
The Acting CHAIR. This will be a 2-minute vote.
The vote was taken by electronic device, and there were--ayes 302,
noes 117, not voting 18, as follows:
[Roll No. 193]
AYES--302
Adams
Aguilar
Allred
Armstrong
Arrington
Axne
Bacon
Balderson
Barragan
Beatty
Bera
Beyer
Bilirakis
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Bost
Boyle, Brendan F.
Brindisi
Brooks (IN)
Brown (MD)
Brownley (CA)
Buchanan
Bucshon
Burgess
Bustos
Butterfield
Calvert
Carbajal
Carson (IN)
Carter (TX)
Cartwright
Case
Casten (IL)
Castor (FL)
Castro (TX)
Chabot
Chu, Judy
Cicilline
Cisneros
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Cole
Collins (NY)
Comer
Connolly
Cook
Cooper
Correa
Costa
Courtney
Cox (CA)
Craig
Crenshaw
Crist
Crow
Cuellar
Cunningham
Davids (KS)
Davis (CA)
Davis, Danny K.
Davis, Rodney
Dean
DeFazio
DeGette
DeLauro
DelBene
Delgado
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Engel
Escobar
Eshoo
Espaillat
Evans
Finkenauer
Fitzpatrick
Fletcher
Flores
Fortenberry
Foster
Frankel
Fudge
Gallagher
Gallego
Garamendi
Garcia (IL)
Garcia (TX)
Gianforte
Gibbs
Golden
Gomez
Gonzalez (OH)
Gonzalez (TX)
Gonzalez-Colon (PR)
Gottheimer
Graves (LA)
Graves (MO)
Green (TX)
Griffith
Grothman
Guest
Guthrie
Haaland
Hagedorn
Harder (CA)
Hartzler
Hastings
Hayes
Heck
Herrera Beutler
Higgins (NY)
Hill (CA)
Himes
Horn, Kendra S.
Horsford
Houlahan
Hoyer
Huffman
Hurd (TX)
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson (OH)
Johnson (TX)
Joyce (OH)
Joyce (PA)
Kaptur
Katko
Keating
Kelly (IL)
Kennedy
Khanna
Kildee
Kilmer
Kim
Kind
King (NY)
Kinzinger
Kirkpatrick
Krishnamoorthi
Kuster (NH)
Lamb
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee (CA)
Lee (NV)
Levin (CA)
Levin (MI)
Lewis
Lieu, Ted
Lipinski
Loebsack
Lofgren
Long
Lowenthal
Lowey
Luetkemeyer
Lujan
Luria
Lynch
Malinowski
Maloney, Carolyn B.
Maloney, Sean
Marshall
Matsui
McAdams
McBath
McCaul
McCollum
McEachin
McGovern
McHenry
McKinley
McNerney
Meeks
Meng
Moolenaar
Moore
Morelle
Moulton
Mucarsel-Powell
Murphy
Nadler
Napolitano
Neal
Neguse
Newhouse
Norcross
Norton
O'Halleran
Ocasio-Cortez
Omar
Pallone
Panetta
Pappas
Pascrell
Payne
Perlmutter
Peters
Peterson
Phillips
Pingree
Plaskett
Pocan
Porter
Pressley
Price (NC)
Quigley
Radewagen
Raskin
Reed
Rice (NY)
Rice (SC)
Rodgers (WA)
Rose (NY)
Rouda
Roybal-Allard
Ruiz
Ruppersberger
Rush
Sablan
Sanchez
Sarbanes
Scanlon
Schiff
Schneider
Schrader
Schrier
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shalala
Sherman
Sherrill
Shimkus
Sires
Slotkin
Smith (NJ)
Smith (WA)
Smucker
Soto
Spanberger
Spano
Speier
Stanton
Stauber
Stefanik
Steil
Stevens
Stivers
Suozzi
Takano
Taylor
Thompson (CA)
Thompson (MS)
Thompson (PA)
Tipton
Titus
Tlaib
Tonko
Torres (CA)
Torres Small (NM)
Trahan
Trone
Turner
Underwood
Upton
Van Drew
Vargas
Veasey
Vela
Velazquez
Visclosky
Wagner
Walden
Waltz
Wasserman Schultz
Waters
Watkins
Watson Coleman
Welch
Wexton
Wild
Wilson (FL)
Yarmuth
Young
Zeldin
NOES--117
Aderholt
Allen
Amash
Amodei
Babin
Baird
Banks
Barr
Bergman
Biggs
Brady
Brooks (AL)
Buck
Budd
Burchett
Byrne
Carter (GA)
Cheney
Cline
Cloud
Collins (GA)
Conaway
Crawford
Curtis
Davidson (OH)
DesJarlais
Diaz-Balart
Duffy
Duncan
Dunn
[[Page H3547]]
Estes
Ferguson
Fleischmann
Foxx (NC)
Fulcher
Gaetz
Gohmert
Gooden
Gosar
Granger
Graves (GA)
Green (TN)
Harris
Hern, Kevin
Hice (GA)
Higgins (LA)
Hill (AR)
Holding
Hollingsworth
Hudson
Huizenga
Hunter
Johnson (LA)
Johnson (SD)
Jordan
Kelly (MS)
Kelly (PA)
King (IA)
Kustoff (TN)
LaHood
LaMalfa
Lamborn
Latta
Lesko
Loudermilk
Lucas
Marchant
Massie
Mast
McCarthy
McClintock
Meadows
Meuser
Miller
Mitchell
Mooney (WV)
Mullin
Norman
Nunes
Palazzo
Palmer
Pence
Perry
Posey
Ratcliffe
Reschenthaler
Riggleman
Roby
Roe, David P.
Rogers (AL)
Rogers (KY)
Rouzer
Roy
Rutherford
Scalise
Schweikert
Scott, Austin
Sensenbrenner
Simpson
Smith (MO)
Smith (NE)
Steube
Stewart
Thornberry
Timmons
Walberg
Walorski
Weber (TX)
Webster (FL)
Westerman
Williams
Wilson (SC)
Wittman
Womack
Woodall
Wright
Yoho
NOT VOTING--18
Abraham
Bass
Bishop (UT)
Cardenas
Cummings
Emmer
Gabbard
Grijalva
Olson
Richmond
Rooney (FL)
Rose, John W.
Ryan
San Nicolas
Schakowsky
Swalwell (CA)
Walker
Wenstrup
Announcement by the Acting Chair
The Acting CHAIR (during the vote). There is 1 minute remaining.
{time} 1754
Messrs. STEWART and CURTIS changed their vote from ``aye'' to ``no.''
Mr. BUCHANAN changed his vote from ``no'' to ``aye.''
So the amendment was agreed to.
The result of the vote was announced as above recorded.
Amendment No. 12 Offered by Ms. Wild
The Acting CHAIR. The unfinished business is the demand for a
recorded vote on the amendment offered by the gentlewoman from
Pennsylvania (Ms. Wild) on which further proceedings were postponed and
on which the ayes prevailed by voice vote.
The Clerk will redesignate the amendment.
The Clerk redesignated the amendment.
Recorded Vote
The Acting CHAIR. A recorded vote has been demanded.
A recorded vote was ordered.
The Acting CHAIR. This will be a 2-minute vote.
The vote was taken by electronic device, and there were--ayes 308,
noes 112, not voting 17, as follows:
[Roll No. 194]
AYES--308
Adams
Aguilar
Allred
Armstrong
Arrington
Axne
Bacon
Barragan
Beatty
Bera
Beyer
Bilirakis
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Bost
Boyle, Brendan F.
Brindisi
Brooks (IN)
Brown (MD)
Brownley (CA)
Buchanan
Burgess
Bustos
Butterfield
Calvert
Carbajal
Carson (IN)
Carter (TX)
Cartwright
Case
Casten (IL)
Castor (FL)
Castro (TX)
Chabot
Chu, Judy
Cicilline
Cisneros
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Cole
Collins (NY)
Comer
Connolly
Cook
Cooper
Correa
Costa
Courtney
Cox (CA)
Craig
Crenshaw
Crist
Crow
Cuellar
Cunningham
Davids (KS)
Davis (CA)
Davis, Danny K.
Davis, Rodney
Dean
DeFazio
DeGette
DeLauro
DelBene
Delgado
Demings
DeSaulnier
Deutch
Diaz-Balart
Dingell
Doggett
Doyle, Michael F.
Engel
Escobar
Eshoo
Espaillat
Evans
Finkenauer
Fitzpatrick
Fletcher
Flores
Fortenberry
Foster
Frankel
Fudge
Gallagher
Gallego
Garamendi
Garcia (IL)
Garcia (TX)
Gianforte
Golden
Gomez
Gonzalez (OH)
Gonzalez (TX)
Gonzalez-Colon (PR)
Gottheimer
Graves (LA)
Graves (MO)
Green (TX)
Griffith
Grijalva
Grothman
Guthrie
Haaland
Hagedorn
Harder (CA)
Hartzler
Hastings
Hayes
Heck
Herrera Beutler
Higgins (NY)
Hill (CA)
Himes
Holding
Horn, Kendra S.
Horsford
Houlahan
Hoyer
Hudson
Huffman
Hunter
Hurd (TX)
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson (OH)
Johnson (TX)
Joyce (OH)
Joyce (PA)
Kaptur
Katko
Keating
Kelly (IL)
Kennedy
Khanna
Kildee
Kilmer
Kim
Kind
King (NY)
Kinzinger
Kirkpatrick
Krishnamoorthi
Kuster (NH)
Lamb
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee (CA)
Lee (NV)
Levin (CA)
Levin (MI)
Lewis
Lieu, Ted
Lipinski
Loebsack
Lofgren
Long
Lowenthal
Lowey
Luetkemeyer
Lujan
Luria
Lynch
Malinowski
Maloney, Carolyn B.
Maloney, Sean
Marshall
Matsui
McAdams
McBath
McCaul
McCollum
McEachin
McGovern
McHenry
McKinley
McNerney
Meeks
Meng
Mitchell
Moolenaar
Moore
Morelle
Moulton
Mucarsel-Powell
Murphy
Nadler
Napolitano
Neal
Neguse
Newhouse
Norcross
Norton
O'Halleran
Ocasio-Cortez
Omar
Pallone
Palmer
Panetta
Pappas
Pascrell
Payne
Perlmutter
Peters
Peterson
Phillips
Pingree
Plaskett
Pocan
Porter
Pressley
Price (NC)
Quigley
Radewagen
Raskin
Reed
Rice (NY)
Rice (SC)
Rodgers (WA)
Rose (NY)
Rouda
Rouzer
Roybal-Allard
Ruiz
Ruppersberger
Rush
Sablan
Sanchez
Sarbanes
Scanlon
Schakowsky
Schiff
Schneider
Schrader
Schrier
Scott (VA)
Scott, Austin
Scott, David
Sensenbrenner
Serrano
Sewell (AL)
Shalala
Sherman
Sherrill
Shimkus
Sires
Slotkin
Smith (NJ)
Smith (WA)
Smucker
Soto
Spanberger
Spano
Speier
Stanton
Stefanik
Steil
Stevens
Stivers
Suozzi
Takano
Taylor
Thompson (CA)
Thompson (MS)
Thompson (PA)
Titus
Tlaib
Tonko
Torres (CA)
Torres Small (NM)
Trahan
Trone
Turner
Underwood
Upton
Van Drew
Vargas
Veasey
Vela
Velazquez
Visclosky
Wagner
Walden
Waltz
Wasserman Schultz
Waters
Watkins
Watson Coleman
Welch
Wexton
Wild
Wilson (FL)
Wilson (SC)
Yarmuth
Young
Zeldin
NOES--112
Aderholt
Allen
Amash
Amodei
Babin
Baird
Balderson
Banks
Barr
Bergman
Biggs
Brady
Brooks (AL)
Buck
Bucshon
Budd
Burchett
Byrne
Carter (GA)
Cheney
Cline
Cloud
Collins (GA)
Conaway
Crawford
Curtis
Davidson (OH)
DesJarlais
Duffy
Duncan
Dunn
Estes
Ferguson
Fleischmann
Foxx (NC)
Fulcher
Gaetz
Gibbs
Gohmert
Gooden
Gosar
Granger
Graves (GA)
Green (TN)
Guest
Harris
Hern, Kevin
Hice (GA)
Higgins (LA)
Hill (AR)
Hollingsworth
Huizenga
Johnson (LA)
Johnson (SD)
Jordan
Kelly (MS)
Kelly (PA)
King (IA)
Kustoff (TN)
LaHood
LaMalfa
Lamborn
Latta
Lesko
Loudermilk
Lucas
Marchant
Massie
Mast
McCarthy
McClintock
Meadows
Meuser
Miller
Mooney (WV)
Mullin
Norman
Palazzo
Pence
Perry
Posey
Reschenthaler
Riggleman
Roby
Roe, David P.
Rogers (AL)
Rogers (KY)
Rose, John W.
Roy
Rutherford
Scalise
Schweikert
Simpson
Smith (MO)
Smith (NE)
Stauber
Steube
Stewart
Thornberry
Timmons
Tipton
Walberg
Walorski
Weber (TX)
Webster (FL)
Westerman
Williams
Wittman
Womack
Woodall
Wright
Yoho
NOT VOTING--17
Abraham
Bass
Bishop (UT)
Cardenas
Cummings
Emmer
Gabbard
Nunes
Olson
Ratcliffe
Richmond
Rooney (FL)
Ryan
San Nicolas
Swalwell (CA)
Walker
Wenstrup
Announcement by the Acting Chair
The Acting CHAIR (Ms. Kendra S. Horn of Oklahoma) (during the vote).
There is 1 minute remaining.
{time} 1801
So the amendment was agreed to.
The result of the vote was announced as above recorded.
The Acting CHAIR. There being no further amendments, under the rule,
the Committee rises.
Accordingly, the Committee rose; and the Speaker pro tempore (Ms.
Underwood) having assumed the chair, Ms. Kendra S. Horn of Oklahoma,
Acting Chair of the Committee of the Whole House on the state of the
Union, reported that that Committee, having had under consideration the
bill (H.R. 986) to provide that certain guidance related to waivers for
State innovation under the Patient Protection and Affordable Care Act
shall have no force or effect, and, pursuant to House Resolution 357,
she reported the bill back to the House with sundry amendments adopted
in the Committee of the Whole.
The SPEAKER pro tempore. Under the rule, the previous question is
ordered.
Is a separate vote demanded on any amendment reported from the
Committee of the Whole? If not, the Chair will put them en gros.
The amendments were agreed to.
The SPEAKER pro tempore. The question is on the engrossment and third
reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
Motion to Recommit
Mr. WALDEN. Madam Speaker, I have a motion to recommit at the desk.
[[Page H3548]]
The SPEAKER pro tempore. Is the gentleman opposed to the bill?
Mr. WALDEN. Oh, yes, I am, Madam Speaker, in its current form.
The SPEAKER pro tempore. The Clerk will report the motion to
recommit.
The Clerk read as follows:
Mr. Walden moves to recommit the bill H.R. 986 to the
Committee on Energy and Commerce with instructions to report
the same back to the House forthwith with the following
amendments:
Page 3, strike lines 3 through 5, and insert the following:
SECTION 1. FINDINGS.
Congress finds the following:
(1) On October 24, 2018, the Administration published new
guidance to carry out section 1332 of the Patient Protection
and Affordable Care Act (42 U.S.C. 18052) entitled ``State
Relief and Empowerment Waivers'' (83 Fed. Reg. 53575).
(2) The new guidance does not amend such section 1332 and
does not permit the Secretary of Health and Human Services to
waive protections for individuals with preexisting
conditions, including guaranteed availability and
renewability of health insurance, the prohibition on using
health status to vary premiums, and the prohibition on
preexisting conditions exclusions.
(3) Moreover, this guidance stipulates that any section
1332 waiver will need to carefully account for any impact on
the individual market risk pool and guarantee that access to
coverage is at least as comprehensive and affordable as would
exist without the waiver.
Page 3, line 17, insert before the period the following:
``, including if such substantially similar guidance or rule
would allow a State to waive such requirements as guaranteed
availability and renewability of health insurance, the
prohibition on using health status to vary premiums, or the
prohibition on preexisting conditions exclusions''.
The SPEAKER pro tempore. The gentleman from Oregon is recognized for
5 minutes.
Mr. WALDEN. Madam Speaker, this bill is blatantly political in its
title. The misleading title of the bill confirms the Democratic
majority's passion to score political points instead of governing.
Madam Speaker, they claim the agenda is ``for the people.'' This bill
is ``for the politics'' and the TV ads.
This motion to recommit is simple, Madam Speaker. First, it strikes
the Democrats' misleading title, and it includes findings to make clear
that, under current law, Health and Human Services cannot waive
protections for individuals with preexisting conditions, period. They
are protected.
Second, Madam Speaker, the motion to recommit would prohibit the
Secretaries of HHS and Treasury from reissuing substantially similar
guidance, including guidance that allows the State to waive guaranteed
availability and renewability of health insurance, the prohibition on
using health status to vary premiums, and the prohibition on
preexisting conditions exclusions.
Madam Speaker, the Trump administration guidance does not amend
section 1332. It does not permit the Secretary of Health and Human
Services to waive protections for individuals with preexisting
conditions, like guaranteed availability and renewability of health
insurance, like the prohibition on using health status to vary
premiums, and the prohibition on preexisting conditions exclusions.
Moreover, the President's guidance stipulates that any section 1332
waiver will need to carefully account for any impact on the individual
market risk pool and guarantee--guarantee--that access to coverage is
at least as comprehensive and as affordable as would exist without the
waiver.
Now, this is fully explained, Madam Speaker, in the letter I have
here from the head of CMS, Seema Verma, and I want to quote directly
from it because I think it is important for our Members to understand
the facts of the matter here, because facts matter.
``To be very clear, the 2018 guidance does nothing to erode,'' I am
going to say ObamaCare or the Affordable Care Act's ``preexisting
condition provisions''--nothing--``which cannot be waived under section
1332. Section 1332 does not permit States to waive Public Health
Service Act requirements such as guaranteed availability and
renewability of health insurance, the prohibition on using health
status to vary premiums, and the prohibition on preexisting conditions
exclusions.''
Now why are we here? Why are we having this discussion? Because
people at home can't afford the health insurance they are being
peddled, and we want States to be able to innovate and cut costs for
consumers. That is why we are here. That is what we are for.
Democrats don't want that. Democrats are opposed to letting States
innovate, apparently. And let's look at what happens.
Madam Speaker, according to Health and Human Services Administrator
Seema Verma, Grand Island, Nebraska, a 60-year-old couple making
$70,000 a year is paying about $38,000 for their insurance premiums,
and that plan, under ObamaCare, gets them an $11,100 deductible.
$38,000 in premiums, $11,000 in deductibles, and they call that
coverage. I call that unaffordable.
Now, meanwhile, we have seven States that have used the authority
under the last administration. See, ObamaCare allows this 1332; Trump
expands it. They have been able to drive down premiums by 19.9 percent.
My State, it is 6 percent; other States have been more. Alaska, New
Jersey, other States have taken advantage of this.
Republicans and Democrats agree we will always protect people with
preexisting conditions. We will always do that. They can run their ads;
they can deceive people; they can mislead people, Madam Speaker; but we
will always fight to protect people with preexisting conditions--
always. Our plan last year did it. Our plan this year does it.
I will tell you what, Madam Speaker. We would have a vote today on
the House floor to do that, to actually enshrine in statute,
irrespective of the lawsuit, protections for Americans with preexisting
conditions, except the Democrats and the Rules Committee refuse to
allow that amendment to be considered on the House floor. They would
not do that, because it was my amendment; it is my bill.
I have been pleading to have this bill considered so we can lock into
statute protections for Americans' preexisting conditions. They want
the argument. They want the politics. They don't want the policy.
We are for innovation; we are for lower premiums; we are for more
consumer choice; and we are for driving down the cost of healthcare in
America so people have coverage they can afford, Madam Chair. That is
what our motion to recommit will do, and I urge our support.
Madam Speaker, I yield back the balance of my time.
Ms. SLOTKIN. Madam Speaker, I claim the time in opposition.
The SPEAKER pro tempore. The gentlewoman from Michigan is recognized
for 5 minutes.
Ms. SLOTKIN. Madam Speaker, I rise because this motion to recommit is
simply another attempt to take away protections for people with
preexisting conditions.
Madam Speaker, at face value, the amendment appears to maintain
protections for people with preexisting conditions, but make no
mistake, no matter the language included in this MTR, the goal of the
1332 guidance expands and promotes junk plans that discriminate against
people with preexisting conditions. These plans also make comprehensive
coverage for people with preexisting conditions more expensive.
It is not enough to say, my colleagues, that you protect preexisting
conditions. It is what happens on the ground that matters.
{time} 1815
If my colleagues are serious about protecting Americans with
preexisting conditions, I urge them to oppose this amendment, support
the underlying bill, and join us in doing what the American public has
made very clear they want.
While Members of the other party may claim they are ready to work to
protect individuals, their actions tell a different story.
Madam Speaker, 2 years ago, exactly this week, most House Republicans
voted overwhelmingly for a bill that would have gutted the ACA and
weakened protections for people with preexisting conditions.
My colleagues--including you, sir--stood on the White House lawn and
celebrated that bill and would have made it more difficult for people
with preexisting conditions.
A few courageous Republicans, who I applaud--including the late
Senator John McCain--joined Democratic Members and Senators in
preventing this bill from becoming law.
[[Page H3549]]
You can boo John McCain if you want.
Since then, the administration has tried every play in the book to
undercut, sabotage, skirt protections in the ACA, including protections
for people with preexisting conditions.
We currently have an open suit from your side that is meant to
invalidate the entirety of the ACA, including protections for people
with preexisting conditions.
I stand in opposition to this motion because the issue of protecting
people with preexisting conditions is deeply personal to me, as it is
to so many people in this room and in our districts.
My mom passed away in 2011 from ovarian cancer, and when she was
diagnosed, she did not have healthcare. She had struggled to afford
healthcare her entire life.
She had breast cancer as a 31-year old mom, leaving her with a
preexisting condition for the rest of her life. When she lost her job
in 2002, she lost her insurance, and it was impossible to find coverage
that she could afford. She went 5\1/2\ years with no insurance, no
checkup, no gynecological exam, no one saying ``you should get
tested.''
In 2008, we finally helped her get insurance. Because of her
preexisting condition, it was $1,000 a month and a $10,000 deductible.
She let it lapse and walked into an ER a few months later and was
diagnosed with stage IV ovarian cancer.
Now, I am sure my colleagues on the other side of the aisle know
exactly what it is like to have a loved one get a terminal diagnosis.
Your life as you know it explodes.
And that same week and that same month that my life was exploding,
was the same week and the same month that I spent filing the paperwork
for my mom to declare bankruptcy. So, no one should be gouged because
they happen to be born with a preexisting condition.
We have evolved as a country, as a Nation, to see that, and I urge my
colleagues to evolve as well.
Madam Speaker, in my district protecting people with preexisting
conditions is not a Democratic or Republican issue. It is what people
of all political backgrounds are demanding of us as their
representatives.
That is our mission. That is our mandate. And to ignore the interest
of our constituents at this point, is dereliction of duty, plain and
simple.
I urge my colleagues to join me in opposing this amendment that would
hurt people like my mom. To my colleagues across the aisle, do the
right thing. Put people before politics. Vote against this amendment.
Madam Speaker, I yield back the balance of my time.
The SPEAKER pro tempore. Members are reminded to address their
remarks to the Chair.
Without objection, the previous question is ordered on the motion to
recommit.
There was no objection.
The SPEAKER pro tempore. The question is on the motion to recommit.
The question was taken; and the Speaker pro tempore announced that
the noes appeared to have it.
Recorded Vote
Mr. WALDEN. Madam Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, the Chair
will reduce to 5 minutes the minimum time for any electronic vote on
the question of passage. This is a 5-minute vote.
The vote was taken by electronic device, and there were--ayes 182,
noes 231, not voting 18, as follows:
[Roll No. 195]
AYES--182
Aderholt
Allen
Amodei
Armstrong
Arrington
Babin
Bacon
Baird
Balderson
Banks
Barr
Bergman
Biggs
Bilirakis
Bost
Brady
Brooks (AL)
Brooks (IN)
Buchanan
Buck
Bucshon
Budd
Burchett
Burgess
Byrne
Calvert
Carter (GA)
Carter (TX)
Chabot
Cheney
Cline
Cloud
Cole
Collins (GA)
Collins (NY)
Comer
Conaway
Cook
Crawford
Crenshaw
Curtis
Davidson (OH)
Davis, Rodney
DesJarlais
Diaz-Balart
Duffy
Duncan
Dunn
Estes
Ferguson
Fitzpatrick
Fleischmann
Flores
Fortenberry
Foxx (NC)
Fulcher
Gaetz
Gallagher
Gianforte
Gibbs
Gohmert
Gonzalez (OH)
Gooden
Gosar
Granger
Graves (GA)
Graves (LA)
Graves (MO)
Green (TN)
Griffith
Grothman
Guest
Guthrie
Hagedorn
Harris
Hartzler
Hern, Kevin
Herrera Beutler
Hice (GA)
Higgins (LA)
Hill (AR)
Holding
Hudson
Huizenga
Hunter
Hurd (TX)
Johnson (LA)
Johnson (OH)
Johnson (SD)
Jordan
Joyce (OH)
Joyce (PA)
Katko
Kelly (MS)
Kelly (PA)
King (IA)
King (NY)
Kinzinger
Kustoff (TN)
LaHood
LaMalfa
Lamborn
Latta
Lesko
Long
Loudermilk
Lucas
Luetkemeyer
Marchant
Marshall
Mast
McCarthy
McCaul
McClintock
McHenry
McKinley
Meadows
Meuser
Miller
Mitchell
Moolenaar
Mooney (WV)
Mullin
Newhouse
Norman
Palazzo
Palmer
Pence
Posey
Reed
Reschenthaler
Rice (SC)
Riggleman
Roby
Roe, David P.
Rogers (AL)
Rogers (KY)
Rose, John W.
Rouzer
Rutherford
Scalise
Schweikert
Scott, Austin
Sensenbrenner
Shimkus
Simpson
Smith (MO)
Smith (NE)
Smith (NJ)
Smucker
Spano
Stauber
Stefanik
Steil
Steube
Stewart
Stivers
Taylor
Thompson (PA)
Thornberry
Timmons
Tipton
Turner
Upton
Wagner
Walberg
Walden
Walorski
Waltz
Watkins
Weber (TX)
Webster (FL)
Westerman
Williams
Wilson (SC)
Wittman
Womack
Woodall
Wright
Yoho
Young
Zeldin
NOES--231
Adams
Aguilar
Allred
Amash
Axne
Barragan
Beatty
Bera
Beyer
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brindisi
Brown (MD)
Brownley (CA)
Bustos
Butterfield
Carbajal
Carson (IN)
Cartwright
Case
Casten (IL)
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Cisneros
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly
Cooper
Correa
Costa
Courtney
Cox (CA)
Craig
Crist
Crow
Cuellar
Cunningham
Davids (KS)
Davis (CA)
Davis, Danny K.
Dean
DeFazio
DeGette
DeLauro
DelBene
Delgado
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Engel
Escobar
Eshoo
Espaillat
Evans
Finkenauer
Fletcher
Foster
Frankel
Fudge
Gallego
Garamendi
Garcia (IL)
Garcia (TX)
Golden
Gomez
Gonzalez (TX)
Gottheimer
Green (TX)
Grijalva
Haaland
Harder (CA)
Hastings
Hayes
Heck
Higgins (NY)
Hill (CA)
Himes
Hollingsworth
Horn, Kendra S.
Horsford
Houlahan
Hoyer
Huffman
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson (TX)
Kaptur
Keating
Kelly (IL)
Kennedy
Khanna
Kildee
Kilmer
Kim
Kind
Kirkpatrick
Krishnamoorthi
Kuster (NH)
Lamb
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee (CA)
Lee (NV)
Levin (CA)
Levin (MI)
Lewis
Lieu, Ted
Lipinski
Loebsack
Lofgren
Lowenthal
Lowey
Lujan
Luria
Lynch
Malinowski
Maloney, Carolyn B.
Maloney, Sean
Massie
Matsui
McAdams
McBath
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moore
Morelle
Moulton
Mucarsel-Powell
Murphy
Nadler
Napolitano
Neal
Neguse
Norcross
O'Halleran
Ocasio-Cortez
Omar
Pallone
Panetta
Pappas
Pascrell
Payne
Perlmutter
Peters
Peterson
Phillips
Pingree
Pocan
Porter
Pressley
Price (NC)
Quigley
Raskin
Rice (NY)
Rose (NY)
Rouda
Roy
Roybal-Allard
Ruiz
Ruppersberger
Rush
Sanchez
Sarbanes
Scanlon
Schakowsky
Schiff
Schneider
Schrader
Schrier
Scott (VA)
Scott, David
Serrano
Sewell (AL)
Shalala
Sherman
Sherrill
Sires
Slotkin
Smith (WA)
Soto
Spanberger
Speier
Stanton
Stevens
Suozzi
Takano
Thompson (CA)
Thompson (MS)
Titus
Tlaib
Tonko
Torres (CA)
Torres Small (NM)
Trahan
Trone
Underwood
Van Drew
Vargas
Veasey
Vela
Velazquez
Visclosky
Wasserman Schultz
Waters
Watson Coleman
Welch
Wexton
Wild
Wilson (FL)
Yarmuth
NOT VOTING--18
Abraham
Bass
Bishop (UT)
Cardenas
Cummings
Emmer
Gabbard
Nunes
Olson
Perry
Ratcliffe
Richmond
Rodgers (WA)
Rooney (FL)
Ryan
Swalwell (CA)
Walker
Wenstrup
{time} 1825
So the motion to recommit was rejected.
The result of the vote was announced as above recorded.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Recorded Vote
Mr. PALLONE. Madam Speaker, I demand a recorded vote.
A recorded vote was ordered.
The SPEAKER pro tempore. This is a 5-minute vote.
[[Page H3550]]
The vote was taken by electronic device, and there were--ayes 230,
noes 183, answered ``present'' 1, not voting 17, as follows:
[Roll No. 196]
AYES--230
Adams
Aguilar
Allred
Axne
Barragan
Beatty
Bera
Beyer
Bishop (GA)
Blumenauer
Blunt Rochester
Bonamici
Boyle, Brendan F.
Brindisi
Brown (MD)
Brownley (CA)
Bustos
Butterfield
Carbajal
Carson (IN)
Cartwright
Case
Casten (IL)
Castor (FL)
Castro (TX)
Chu, Judy
Cicilline
Cisneros
Clark (MA)
Clarke (NY)
Clay
Cleaver
Clyburn
Cohen
Connolly
Cooper
Correa
Costa
Courtney
Cox (CA)
Craig
Crist
Crow
Cuellar
Cunningham
Davids (KS)
Davis (CA)
Davis, Danny K.
Dean
DeFazio
DeGette
DeLauro
DelBene
Delgado
Demings
DeSaulnier
Deutch
Dingell
Doggett
Doyle, Michael F.
Engel
Escobar
Eshoo
Espaillat
Evans
Finkenauer
Fitzpatrick
Fletcher
Foster
Frankel
Fudge
Gallego
Garamendi
Garcia (IL)
Garcia (TX)
Golden
Gomez
Gonzalez (TX)
Gottheimer
Green (TX)
Grijalva
Haaland
Harder (CA)
Hastings
Hayes
Heck
Higgins (NY)
Hill (CA)
Himes
Horn, Kendra S.
Horsford
Houlahan
Hoyer
Huffman
Jackson Lee
Jayapal
Jeffries
Johnson (GA)
Johnson (TX)
Kaptur
Katko
Keating
Kelly (IL)
Kennedy
Khanna
Kildee
Kilmer
Kim
Kind
Kirkpatrick
Krishnamoorthi
Kuster (NH)
Lamb
Langevin
Larsen (WA)
Larson (CT)
Lawrence
Lawson (FL)
Lee (CA)
Lee (NV)
Levin (CA)
Levin (MI)
Lewis
Lieu, Ted
Lipinski
Loebsack
Lofgren
Lowenthal
Lowey
Lujan
Luria
Lynch
Malinowski
Maloney, Carolyn B.
Maloney, Sean
Matsui
McAdams
McBath
McCollum
McEachin
McGovern
McNerney
Meeks
Meng
Moore
Morelle
Moulton
Mucarsel-Powell
Murphy
Nadler
Napolitano
Neal
Neguse
Norcross
O'Halleran
Ocasio-Cortez
Omar
Pallone
Panetta
Pappas
Pascrell
Payne
Perlmutter
Peters
Peterson
Phillips
Pingree
Pocan
Porter
Pressley
Price (NC)
Quigley
Raskin
Rice (NY)
Rose (NY)
Rouda
Roybal-Allard
Ruiz
Ruppersberger
Sanchez
Sarbanes
Scanlon
Schakowsky
Schiff
Schneider
Schrader
Schrier
Scott (VA)
Scott, David
Sensenbrenner
Serrano
Sewell (AL)
Shalala
Sherman
Sherrill
Sires
Slotkin
Smith (NJ)
Smith (WA)
Soto
Spanberger
Speier
Stanton
Stevens
Suozzi
Takano
Thompson (CA)
Thompson (MS)
Titus
Tlaib
Tonko
Torres (CA)
Torres Small (NM)
Trahan
Trone
Underwood
Van Drew
Vargas
Veasey
Vela
Velazquez
Visclosky
Wasserman Schultz
Waters
Watson Coleman
Welch
Wexton
Wild
Wilson (FL)
Yarmuth
NOES--183
Aderholt
Allen
Amash
Amodei
Armstrong
Arrington
Babin
Bacon
Baird
Balderson
Banks
Barr
Bergman
Biggs
Bilirakis
Bost
Brady
Brooks (AL)
Brooks (IN)
Buchanan
Buck
Bucshon
Budd
Burchett
Burgess
Byrne
Calvert
Carter (GA)
Carter (TX)
Chabot
Cheney
Cline
Cloud
Cole
Collins (GA)
Collins (NY)
Comer
Conaway
Cook
Crawford
Crenshaw
Curtis
Davidson (OH)
Davis, Rodney
DesJarlais
Diaz-Balart
Duffy
Duncan
Dunn
Estes
Ferguson
Fleischmann
Fortenberry
Foxx (NC)
Fulcher
Gaetz
Gallagher
Gianforte
Gibbs
Gohmert
Gonzalez (OH)
Gooden
Gosar
Granger
Graves (GA)
Graves (LA)
Graves (MO)
Green (TN)
Griffith
Grothman
Guest
Guthrie
Hagedorn
Harris
Hartzler
Hern, Kevin
Herrera Beutler
Hice (GA)
Higgins (LA)
Hill (AR)
Holding
Hollingsworth
Hudson
Huizenga
Hunter
Hurd (TX)
Johnson (LA)
Johnson (OH)
Johnson (SD)
Jordan
Joyce (OH)
Joyce (PA)
Kelly (MS)
Kelly (PA)
King (IA)
King (NY)
Kinzinger
Kustoff (TN)
LaHood
LaMalfa
Lamborn
Latta
Lesko
Long
Loudermilk
Lucas
Luetkemeyer
Marchant
Marshall
Massie
Mast
McCarthy
McCaul
McClintock
McHenry
McKinley
Meadows
Meuser
Miller
Mitchell
Moolenaar
Mooney (WV)
Mullin
Newhouse
Norman
Palazzo
Palmer
Pence
Perry
Posey
Reed
Reschenthaler
Rice (SC)
Riggleman
Roby
Rodgers (WA)
Roe, David P.
Rogers (AL)
Rogers (KY)
Rose, John W.
Rouzer
Roy
Rutherford
Scalise
Schweikert
Scott, Austin
Shimkus
Simpson
Smith (MO)
Smith (NE)
Smucker
Spano
Stauber
Stefanik
Steil
Steube
Stewart
Stivers
Taylor
Thompson (PA)
Thornberry
Timmons
Tipton
Turner
Upton
Wagner
Walberg
Walden
Walorski
Waltz
Watkins
Weber (TX)
Webster (FL)
Westerman
Williams
Wilson (SC)
Wittman
Womack
Woodall
Wright
Yoho
Young
Zeldin
ANSWERED ``PRESENT''--1
Flores
NOT VOTING--17
Abraham
Bass
Bishop (UT)
Cardenas
Cummings
Emmer
Gabbard
Nunes
Olson
Ratcliffe
Richmond
Rooney (FL)
Rush
Ryan
Swalwell (CA)
Walker
Wenstrup
{time} 1834
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
____________________