[Congressional Record Volume 165, Number 82 (Thursday, May 16, 2019)]
[House]
[Pages H3876-H3911]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 MARKETING AND OUTREACH RESTORATION TO EMPOWER HEALTH EDUCATION ACT OF 
                                  2019

  The Committee resumed its sitting.
  Mr. SHIMKUS. Mr. Chairman, I claim the time in opposition.
  The Acting CHAIR (Mr. Cox of California). The gentleman from Illinois 
is recognized for 5 minutes.
  Mr. SHIMKUS. Mr. Chairman, I reserve the balance of my time.
  Mr. WELCH. Mr. Chairman, I have no further speakers, so I reserve the 
balance of my time.
  Mr. SHIMKUS. Mr. Chairman, I believe I have the right to close.
  The Acting CHAIR. The gentleman from Vermont is recognized.
  Mr. WELCH. How much time is remaining, Mr. Chairman?
  The Acting CHAIR. The gentleman has 2 minutes remaining.
  Mr. WELCH. Mr. Chairman, as I mentioned earlier, we just have a 
difference of opinion. We think the Affordable Care Act is important to 
preserve and important to improve. My colleagues, when they have had an 
opportunity, have voted to repeal it.
  Failing to repeal it, what the Trump administration has done is chip 
away at it. We don't want the administration to be able to get rid of 
automatic reenrollment, which would likely result in the loss of 2 
million families having access to healthcare.
  There has been a number of other things that have happened: slashing 
funding, slashing funding for consumer outreach and enrollment 
education by 90 percent, cutting back the uninsured rate for 4 years, 
and 1.1 million Americans losing coverage last year.
  In the latest ACA marketplace final rule, the administration openly 
contemplated getting rid of this automatic reenrollment. This amendment 
protects the automatic reenrollment. It is going to protect continued 
access to care under the Affordable Care Act for 2 million Americans.
  Mr. Chairman, I yield back the balance of my time.
  Mr. SHIMKUS. Mr. Chairman, it is great being on the floor with a lot 
of my friends on the Energy and Commerce Committee and my colleagues 
across the aisle. Obviously, we have a fundamental disagreement.
  I know, in southern Illinois, one of the biggest questions I always 
got and concerns was that ObamaCare plans are too expensive, and the 
deductibles

[[Page H3877]]

are too high, so we can't use them. Hence, no one wanted to use them.
  Part of the change in the political landscape because of that was 
Republicans controlled the House. That is what happened politically. 
Here we are, and my colleagues and I have belabored this point all day, 
Mr. Chairman, about what we are trying to do. We are trying to lower 
the cost of prescription drugs, but we have to go back to this 
ObamaCare debate.
  Republicans control the Senate. They are not going to bring it up. 
The President is not going to sign the bill. It is instructional to 
have this debate. We understand it. We will eventually come back, and 
we will address these prescription drug bills. We will get there, but 
we have to go through this exercise. I understand that.
  The three bills that we could vote on and pass right now, probably on 
a suspension calendar and a voice vote, would be the three prescription 
drug bills that are part of this package. Those are the CREATES Act, 
the Protecting Consumers' Access to Generic Drugs Act, and the Bringing 
Low-cost Options and Competition while Keeping Incentives for New 
Generics Act, called the BLOCKING Act.
  That is what we could be doing today, that and some other things. We 
hope that what we will be addressing will make major changes in 
affordability, transparency, and the like.
  My colleagues also point out the numerous votes to repeal or replace 
parts of ObamaCare. I am proud to say I voted for all of them. The 
facts state that a lot of Democrats supported these, to fundamentally 
change provisions of ObamaCare.
  In fact, 30 of the bills my friends are citing were signed into law. 
Twenty-one of those bills were signed into law by President Obama. Of 
the 30 that were signed into law, Speaker Pelosi voted ``yes'' on 19 of 
them. These are part of the 60 bills that would repeal and replace, and 
we have 21, and 19 were voted for by Speaker Pelosi. Leader Hoyer voted 
``yes'' on 21 of them. My friend Chairman Pallone voted on 20 of them.
  Here are the examples that we want to lay out: repealing the 
unworkable and unsustainable CLASS Act, rescinding billions of dollars 
for the failed ObamaCare co-op program, delaying the Cadillac tax and 
medical device tax, cutting funding to the Independent Payment Advisory 
Board, providing regulatory and financial relief from ObamaCare's 
requirements for small business and independent contractors, requiring 
accurate income verification before disbursing subsidies to ObamaCare 
exchanges, and modifying eligibility for ObamaCare exchange subsidies.

  We can have this tit for tat, Mr. Chairman, and they will still want 
to defend ObamaCare. We will always say that the private market is 
better to provide lower cost and rapid response. It is an ideological 
fight.
  We will get through this debate. We will eventually come back and 
address these prescription drug issues that, as I mentioned, Mr. 
Chairman, we probably would pass on a voice vote once we return to 
this.
  I thank my colleagues. I have great respect for my colleague from 
Vermont. He is a very sincere and good friend. We look forward to 
debating this more in the future.
  Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Vermont (Mr. Welch).
  The amendment was agreed to.


             Amendment No. 4 Offered by Ms. Blunt Rochester

  The Acting CHAIR. It is now in order to consider amendment No. 4 
printed in House Report 116-61.
  Ms. BLUNT ROCHESTER. Mr. Chairman, 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 47, line 24, strike ``Section 1321(c)'' and insert:
       (a) In General.--Section 1321(c)
       Page 49, after line 18, insert the following:
       (b) Study and Report.--Not later than 30 days after the 
     date of the enactment of this Act, the Secretary of Health 
     and Human Services shall release to Congress all aggregated 
     documents relating to studies and data sets that were created 
     on or after January 1, 2014, and related to marketing and 
     outreach with respect to qualified health plans offered 
     through Exchanges under title I of the Patient Protection and 
     Affordable Care Act.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentlewoman 
from Delaware (Ms. Blunt Rochester) and a Member opposed each will 
control 5 minutes.
  The Chair recognizes the gentlewoman from Delaware.
  Ms. BLUNT ROCHESTER. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, this is a simple amendment designed to ensure that 
Congress is able to review the Department of Health and Human Services' 
own analysis of the ACA's marketing and outreach programs.
  In April of this year, I led a letter signed by 30 of my House 
colleagues on the Energy and Commerce Committee requesting HHS disclose 
any studies and data related to their marketing and outreach efforts 
for the ACA. HHS and CMS have had more than 50 days to respond to this 
request and provide crucial documents to the public and Congress. The 
lack of response confirms our concerns about transparency and 
commitment to implementing the current law.
  While estimates vary, it is clear that marketing and outreach efforts 
created by the ACA could significantly improve the lives of tens of 
thousands of Americans. Many of these Americans are simply unaware of 
the health insurance and financial assistance options available to 
them. HHS and CMS have the power and obligation to assist the public in 
understanding these options.
  My colleagues would agree that HHS and CMS also have the obligation 
to be good stewards of taxpayer dollars by doing this effectively. 
Because of this, earlier this morning, I sent a follow-up letter 
requesting that these documents be released without delay.
  The results of this study need to be made public so that Congress can 
enact effective policy that reaches our common goal of quality and 
affordable health insurance for all Americans.
  Simply put, public awareness of the ACA isn't as high as folks are 
made to believe, and the ACA's marketing and outreach program was an 
effective tool in helping Americans make informed decisions for their 
families.
  According to Joshua Peck, a former senior adviser at CMS who oversaw 
the marketing program, the private sector spends between $250 and 
$1,000 per enrollment. How much did it cost the Federal Government? 
Twenty-nine dollars.
  It costs government just $29 to enroll someone in the individual 
marketplace using TV ads. That is a good use of taxpayer dollars.
  A July 2018 Government Accountability Office report on ACA outreach 
and enrollment even cites the HHS' study, which looked at the most 
cost-effective forms of advertising for new and returning enrollees. 
The GAO found that the study named television ads as one of the best 
forms of advertising for enrolling Americans. Despite objective, fact-
based analysis, the administration eliminated these ads.
  Mr. Chairman, I support the underlying legislation, and I ask my 
colleagues to support my amendment and make clear that HHS should be 
transparent and release these studies.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SHIMKUS. Mr. Chairman, I claim the time in opposition.
  The Acting CHAIR. The gentleman from Illinois is recognized for 5 
minutes.
  Mr. SHIMKUS. Mr. Chairman, I reserve the balance of my time.
  Ms. BLUNT ROCHESTER. Mr. Chairman, in closing, I urge my colleagues 
to support this amendment and also support the underlying bill, and I 
yield back the balance of my time.
  Mr. SHIMKUS. Mr. Chairman, it is hard to sell a lemon, no matter how 
much you give in advertising. That is kind of the basis of our 
opposition to this amendment.
  Mr. Chair, as you heard me say in the last debate, in my 
congressional district, people didn't want to be forced to buy 
something that was too high, that was unaffordable, that the 
deductibles were too high, and that we in Washington mandated that they 
have to buy.
  Now we see a period where, in essence, people have a few more choices 
because of the waiver system, the 1332s. We see people flocking away 
from

[[Page H3878]]

ObamaCare plans to 1332 waivers within the States, which we think is a 
good deal.
  Part of the debate on this is: Let's pump more money in and maybe 
these people will stay in these failed ObamaCare plans. We reject that. 
We reject it based upon what we have done with Medicare Advantage and 
Medicare part D.
  The executive branch has said: Let's spend the same amount of money 
that we do for Medicare part D and Medicare Advantage, which have much 
higher enrollment than the ObamaCare exchanges.

                              {time}  1515

  So we think that is appropriate. We do think that, with $100 million 
or more to try to get people to buy a product and you see enrollment go 
down, that is not a good use of money.
  Mr. Chair, with that, we would ask for a ``no'' vote on the 
amendment, and I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Delaware (Ms. Blunt Rochester).
  The amendment was agreed to.


               Amendment No. 5 Offered by Mr. DeSaulnier

  The Acting CHAIR. It is now in order to consider amendment No. 5 
printed in House Report 116-61.
  Mr. DeSAULNIER. Mr. Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       At the end of title I, add the following:

  Subtitle D--Study on Role of Federal Assistance in Drug Development

     SEC. 131. STUDY ON ROLE OF FEDERAL ASSISTANCE IN DRUG 
                   DEVELOPMENT.

       (a) In General.--Not later than two years after the date of 
     the enactment of this Act, the Secretary of the Health and 
     Human Services shall enter into a contract with the National 
     Academy of Medicine to conduct a study on, and submit to 
     Congress a report on, the following:
       (1) The percentage of drugs developed in the United States 
     using at least some amount of Federal funding from any 
     Federal source.
       (2) The average cost incurred by a drug developer to 
     develop a drug.
       (3) The average amount of revenue and profits made by drug 
     developers from the sales of drugs.
       (4) The percentage of such revenue and profits that are 
     reinvested into research and development of new drugs.
       (5) The appropriate percentage, if any, of such revenue and 
     profits the Secretary, in consultation with the National 
     Academy of Medicine, recommends should be returned to Federal 
     entities for Federal funding used in the development of the 
     drugs involved.
       (b) Enforcement.--A drug developer shall, as a condition of 
     receipt of any Federal funding for the development of drugs, 
     comply with any request for the data necessary to perform the 
     study under subsection (a).
       (c) Confidentiality.--This section does not authorize the 
     disclosure of any trade secret, confidential commercial or 
     financial information, or other matter listed in section 
     552(b) of title 5, United States Code.
       (d) Definitions.--In this section:
       (1) The term ``drug'' has the meaning given such term in 
     section 201 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 321).
       (2) The term ``drug developer'' means an entity that 
     submitted, and received approval of, an application under 
     section 505 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355) or section 351 of the Public Health Service Act 
     (42 U.S.C. 262).

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from California (Mr. DeSaulnier) and a Member opposed each will control 
5 minutes.
  The Chair recognizes the gentleman from California.
  Mr. DeSAULNIER. Mr. Chairman, my amendment seeks to find information 
that will help with the high cost of prescription drugs in the United 
States, to help inform this institution and the American public.
  Mr. Chair, I have a form of noncurable blood cancer. In my pocket is 
a pill I take every day that keeps me alive. It costs $500 a day.
  Most of the research that developed this pill was at the Department 
of Defense and the National Institutes for Health. American taxpayers 
did the basic research.
  Earlier today, we had a long hearing in the Committee on Oversight of 
a similar situation where most of the development for an HIV lifesaving 
drug was developed at the University of California in San Francisco 
with NIH funding and no funding from the drug supplier that is now 
making billions of dollars.
  What my amendment does is direct the Academy of Medicine to get the 
information to differentiate what is basic taxpayer healthcare and how 
much that contributes to these billions of dollars of profits of 
pharmaceutical companies.
  It is not to say that these private investments are not good, but are 
they low risk and high reward or are they high risk and high reward? 
That is to say: Are the investors getting a really high risk based on 
what the taxpayers have done in investment?
  All this amendment does is direct the Academy of Medicine to come 
back with that information.
  We hear arguments from our Republican colleagues often that we need 
these investments in private-sector pharmaceutical companies. I don't 
disagree, but we need to know what portion of it is actually returning 
a reasonable rate of return. We want to attract those investments.
  Absent this kind of information, it is just a political opinion and 
argument. My amendment would get to that information that is so 
important to this debate.
  Mr. Chair, I reserve the balance of my time.
  Mr. SHIMKUS. Mr. Chairman, I claim the time in opposition.
  The Acting CHAIR. The gentleman from Illinois is recognized for 5 
minutes.
  Mr. SHIMKUS. Mr. Chair, I reserve the balance of my time.
  Mr. DeSAULNIER. Mr. Chair, I would hope that all the Members would 
support this amendment. It provides us valuable information by a source 
that we all value, the National Academy of Medicine, and it will get to 
this argument of my colleagues across the aisle.
  If their argument is right, then the public and the Congress will see 
it; it will be verified. If it is different--and I believe it is--we 
will start looking at the real value of private investment and the 
return on investment that is due the American public.
  Mr. Chair, I yield back the balance of my time.
  Mr. SHIMKUS. Mr. Chairman, I don't know my colleague very well, but I 
think it is instructive to our citizens as a whole that Members come 
from across this great land and have a lot of different issues. I think 
it is instructive that even Members of Congress can be fighting 
illnesses and need lifesaving medicine to do that.
  I don't think we are fundamentally opposed to the amendment. We don't 
think it does exactly what the author is claiming it will do.
  In this package, in this bill, it is not, obviously, going to go 
anywhere because the President is not going to sign this bill. It is 
not going to go through the Senate.
  Mr. Chair, I would encourage my colleague to come back and visit with 
us so that we start moving something that can get bipartisan agreement 
that I think would be very instructive in looking at this as an 
addition.
  Now, I am speaking for myself, not for the ranking member of the full 
committee, because the gentleman is right that we need to have 
information. And when government is helpful in creating the initial 
science that then goes over to the private sector, that then goes to 
creating blockbuster drugs, then we should know, kind of, the skin in 
the game, Mr. Chairman, and how much that is due to good Federal policy 
by not just legislators, but also our agencies that help push that 
research by NIH or the CDC or the National Cancer Institute.
  Had this bill been brought and the three prescription drug 
transparency lower cost options been brought to the floor, as I said 
before--and I am not going to restate this every amendment debate--but 
we probably would have had a voice vote and we could have gone out for 
dinner. But it is attached to the ObamaCare rescue mission, which we 
think the public has already rejected.
  So we will get through this process, but I would encourage my 
colleague to join with the chairman of the committee and Republicans in 
looking at what we can do on this provision in the future.
  Mr. Chair, I would ask my colleagues to vote ``no,'' and I yield back 
the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from California (Mr. DeSaulnier).

[[Page H3879]]

  The amendment was agreed to.


          Amendment No. 6 Offered by Mr. Harder of California

  The Acting CHAIR. It is now in order to consider amendment No. 6 
printed in House Report 116-61.
  Mr. HARDER of California. Mr. 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 46, beginning on line 17, amend clause (ii) to read as 
     follows:
       (ii) by striking the period and inserting a semicolon; and
       Page 46, line 20, strike ``clause'' and insert ``clauses''.
       Page 46, line 23, strike the period and the end quotes.
       Page 46, after line 23, insert the following:
       ``(iv) receive opioid specific education and training that 
     ensures the navigator can best educate individuals on 
     qualified health plans offered through an Exchange, 
     specifically coverage under such plans for opioid health care 
     treatment.''; and

  The Acting CHAIR. Pursuant to House Resolution 377, 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 today in support of my 
amendment to the Strengthening Health Care and Lowering Prescription 
Drug Costs Act.
  Families in my district, in the California Central Valley, need 
prescription drugs to go down in cost now, and they need access to care 
for every condition, including mental health and treatment for 
substance use disorders.
  That is exactly what my amendment is going to help with. The 
navigators that help folks understand healthcare through the exchanges 
are great, but they need additional tools to make sure folks struggling 
with opioid addiction get the coverage that they need. My amendment 
gives them just that.
  In most communities I visit, I hear from someone who has been touched 
by the opioid epidemic, and I am no exception. When I was in high 
school, I had a friend who was in a tough family situation, so I drove 
him to school every day for 2 years. He was one of the best golfers I 
ever met, had an amazing sense of humor. But, after graduating, he 
developed an addiction to opiates, and about 5 years ago we lost him to 
an overdose.
  Stories like my friend's are far too common. About 130 Americans die 
every single day from opiate overdose. Folks with substance use 
disorder deserve access to care just like everyone else, and every 
person in this country deserves prescription drugs that they can 
actually afford.
  It is for my friend and for our loved ones all across the country who 
have struggled with this that I urge my colleagues to vote for this 
amendment.
  Mr. Chair, I yield back the balance of my time.
  Mr. SHIMKUS. Mr. Chairman, I claim the time in opposition.
  The Acting CHAIR. The gentleman from Illinois is recognized for 5 
minutes.
  Mr. SHIMKUS. Mr. Chair, I would reserve the balance of my time unless 
my colleague yielded back.
  The Acting CHAIR. The gentleman has the only time remaining.
  Mr. SHIMKUS. Mr. Chairman, I yield myself such time as I may consume.
  Again, I appreciate my colleague coming down to the floor, especially 
when, in his opening statement, he says he wants drug costs to go down 
now.
  It is not going to happen now because it is in a package that is not 
going to be accepted by the Senate and the President is not going to 
sign.
  So, if we really want drug prices to go down now, we would have done 
what we did out of the full committee. We would have packaged this up 
with H.R. 965, the CREATES Act, which is a bipartisan agreement that is 
part of this bill, which would penalize branded drugmakers that 
withhold samples from generic manufacturers.
  We would have brought to the floor, either separately or in a 
package, H.R. 1499, the Protecting Consumer Access to Generic Drugs 
Act, bipartisan out of the committee. This would ban pay-for-delay 
agreements, which are a problem.
  And we would have brought up H.R. 938, the Bringing Low-cost Options 
and Competition while Keeping Incentives for New Generics, which is 
called the BLOCKING Act, which would limit the first-approved generic 
maker's ability to stall another rival's launch.
  I think we all want to get there. I think we will get there. We still 
are going to go through this process. But, make no mistake, this is not 
going to be signed into law that we can go down to the White House for 
a ceremony.
  Again, I would encourage my colleagues to work with the chairman of 
the Energy and Commerce Committee, my good friend Frank Pallone, and we 
can address this amendment and other processes and hopefully bring the 
bipartisan bill to the floor that would address a lot of other 
colleagues' concerns and really work on a bipartisan agreement that, 
then, by that bipartisan approach, the Senate would have to really look 
at seriously, and, hopefully, we would convince the President to sign 
the bill.
  I am just a simple man from southern Illinois, taught high school 
civics: two Chambers, President has got to sign the bill. Sometimes 
when we use all this time, it is for other purposes than really trying 
to have a bill become law.
  So, with that, I would ask my colleagues to vote ``no'' on the 
amendment, and I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from California (Mr. Harder).
  The question was taken; and the Acting Chair announced that the ayes 
appeared to have it.
  Mr. HARDER of California. Mr. 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 California 
will be postponed.


                 Amendment No. 7 Offered by Ms. Shalala

  The Acting CHAIR. It is now in order to consider amendment No. 7 
printed in House Report 116-61.
  Ms. SHALALA. Mr. Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add at the end of title II the following new section:

     SEC. 205. SENSE OF CONGRESS RELATING TO THE PRACTICE OF 
                   SILVER LOADING.

       It is the sense of Congress that the Secretary of Health 
     and Human Services should not take any action to prohibit or 
     otherwise restrict the practice commonly known as ``silver 
     loading'' (as described in the rule entitled ``Patient 
     Protection and Affordable Care Act; HHS Notice of Benefit and 
     Payment Parameters for 2020'' published on April 25, 2019 (84 
     Fed. Reg. 17533)).

  The Acting CHAIR. Pursuant to House Resolution 377, the gentlewoman 
from Florida (Ms. Shalala) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Florida.
  Ms. SHALALA. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chair, this amendment expresses a sense of Congress that the 
Secretary of Health and Human Services should not do anything that 
prohibits State insurance commissioners from allowing for so-called 
silver loading.
  Let me walk you through how we got to this point because, while 
silver loading has worked to keep costs on the exchanges lower for 
people who get subsidies, it has only been used because the 
administration was actively trying to kill the Affordable Care Act.
  In 2017, the administration decided to stop reimbursing health 
insurance companies for what are called cost-sharing reductions, CSRs. 
CSRs are payments that health insurance companies are required to make 
to help low- and moderate-income people afford healthcare.
  Under the Affordable Care Act, health insurance companies must help 
people have more affordable and, possibly, no copays or deductibles. 
The Federal Government was supposed to reimburse insurance providers 
for making these payments. However, in October of 2017, the 
administration stopped making these payments. This was a deliberate 
attempt to make health insurance on the exchange unaffordable and to 
undermine, weaken, and attack the Affordable Care Act.

                              {time}  1530

  In response to this, the States, bipartisan States, including my own, 
let insurance plans do what is now called ``silver loading.''

[[Page H3880]]

  State insurance regulators, in a desperate and a very creative 
attempt to stabilize the insurance markets, allowed insurance companies 
to build the unpaid CSR costs into their silver plans on the exchange.
  This was not the solution anyone wanted, but it is a solution that 
has worked and has created some stability and predictability in the 
insurance markets in the face of an administration that seeks chaos.
  Because the tax credits are benchmarked to the silver plans, silver 
loading has meant that most who receive subsidies did not see an 
increase in their health insurance premiums. In fact, new data shows 
that 2.6 million exchange consumers are now paying lower premiums as a 
result of silver loading.
  States that allowed for silver loading as a way to cope with the 
manufactured chaos that the administration tried to inflict on the 
market actually saw an increase in enrollment in the exchange.
  The administration has to stop trying to sabotage the Affordable Care 
Act. My amendment expresses that it is the sense of Congress that the 
Secretary of HHS shall not do anything to prohibit the use of silver 
loading to stabilize the health insurance marketplaces.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SHIMKUS. Mr. Chairman, I claim the time in opposition.
  The Acting CHAIR. The gentleman from Illinois is recognized for 5 
minutes.
  Mr. SHIMKUS. Mr. Chairman, I reserve the balance of my time.
  Ms. SHALALA. Mr. Chairman, I yield back the balance of my time.
  Mr. SHIMKUS. Mr. Chairman, obviously, I rise in opposition to this, 
and I understand my colleague from Florida's great expertise in this 
area and served in the previous administration.
  But when you have to subsidize a plan--there are a couple of 
problems. First of all, before ObamaCare came into being, or the 
Affordable Care Act--I am not trying to be disrespectful--insurance was 
regulated by States. The new law yanked that away from States to the 
point where they created a system of mandatory coverage that was 
unaffordable.
  So then part of the plan was, well, we need to subsidize these plans 
because, actuarially, they are not going to work without government 
intervention.
  Now, the Court case on this, we thought--and actually, I guess the 
Court case is still pending. Can the Federal Government force someone 
to buy something they don't want to buy? And we probably will hear 
another ruling on that. Initially, they said, yeah.
  The real debate shifted to: Does the Federal Government have the 
power to tax, versus do you have the power to force someone to buy 
something they don't want to buy?
  So the Supreme Court, in that ruling, said, since the Federal 
Government has the power to tax, this is really a tax; then, yeah, we 
can do this.
  So then we had the rollout. And the rollout, I think, in the public's 
eye, as a whole--first, due to the delay because of the computer 
system, the network couldn't manage it. And then, just the cost.
  As I said before, premiums way too high; deductibles too high; people 
forced to buy an insurance product that they could not use.
  People would go in and say, oh, I got coverage. Okay. But your 
coverage is you still got to pay the first $10,000 in deductible. And 
people say, what? That is not very good insurance.
  Well, that is what we created in this national healthcare delivery 
system.
  The public rendered judgment, as they do, through the political 
process. Republicans came back into control.
  Now, what we are trying to do is return to federalism. We have 
returned to States' regulation of insurance; provide more options to 
consumers. That is what is occurring now, so the higher cost or the 
costs are going down. In fact, I think there was a projection that 30 
percent--there was 30 percent increases until this last cycle, when 
there was a 3 percent increase. Why?
  Well, because, under the law, there are 1332 waivers which allow 
States to present another package; and you see our citizens, our 
constituents, voting with their feet to go to these State-based plans. 
That is a good thing.
  So we are trying--we don't want to turn the clock back again. So that 
is why I would ask my colleagues to vote ``no'' on the gentlewoman's 
amendment. Although brought well-intentioned and lovingly, I know.
  Mr. Chairman, I reject that. I ask for a ``no'' vote, and I yield 
back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Florida (Ms. Shalala).
  The amendment was agreed to.


                 Amendment No. 8 Offered by Mrs. Hayes

  The Acting CHAIR. It is now in order to consider amendment No. 8 
printed in House Report 116-61.
  Mrs. HAYES. Mr. 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 47, line 3, strike ``Grants under'' and insert 
     ``Subject to subparagraph (C), grants under''.
       Page 47, line 6, strike ``subparagraph'' and insert 
     ``subparagraphs''.
       Page 47, line 18, strike the end quotations and the second 
     period.
       Page 47, after line 18, insert the following:
       ``(C) State exchanges.--For the purposes of carrying out 
     this subsection, with respect to an Exchange operated by a 
     State pursuant to this section, there is authorized to be 
     appropriated $25,000,000 for fiscal year 2020 and each 
     subsequent fiscal year. Each State receiving a grant pursuant 
     to this subparagraph shall receive a grant in an amount that 
     is not less than $1,000,000.''.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentlewoman 
from Connecticut (Mrs. Hayes) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Connecticut.
  Mrs. HAYES. Mr. Chair, I yield myself such time as I may consume.
  It is fitting that H.R. 987, a bill that would protect the progress 
of the Affordable Care Act, should include language that would 
reinforce the Federal navigator program, which provides outreach, 
education and enrollment assistance to consumers looking to buy health 
insurance.
  This administration has slashed funding for Federal marketplace 
navigators in recent years, with some States facing cuts near 96 
percent, undermining the exchanges and hindering the ability of 
consumers to choose the insurance plan that works best for them.
  My background in education makes it hard for me to understand why we 
would ever want to eliminate tools to help educate the public about how 
to access healthcare. It is even harder for me to understand why we 
would want to limit this critical funding just to States that operate 
within the Federal marketplace.
  Residents in States like California, New York, Minnesota, and 
Connecticut deserve to have the same opportunity as people throughout 
the rest of the country to learn about their healthcare options, to 
learn how to sign up for coverage, and to learn how this coverage will 
work.
  And so my amendment would open navigator funds to State-run 
marketplaces, so that my home State of Connecticut, and the 11 other 
States that operate a State-based exchange, could benefit from this 
funding.
  The Affordable Care Act helped more than 20 million Americans sign up 
for health insurance. People of color experienced some of the largest 
gains in coverage under the Affordable Care Act, finally reducing 
longstanding racial disparities.
  But in recent years, my own State's exchange, Access Health CT 
Exchange, experienced a marked decrease in enrollment with communities 
of color; a worrisome sign that the progress that has been made in 
healthcare coverage with the passage of the Affordable Care Act may be 
slipping through our fingers.
  Cutting funding to the navigator and outreach programs represents 
underhanded attacks on the people that need healthcare the most. It is 
part of this administration's subtle strategy to roll back the 
protections of the Affordable Care Act by reducing healthcare access as 
a last-ditch effort.
  The simple fact is that brokers do not always serve these 
communities. There is an urgent need to reinforce and expand outreach 
programs to make sure that we are reaching people in all zip codes, of 
all demographics.
  State-based exchanges are already doing their part to be flexible, to 
invest

[[Page H3881]]

in outreach, and to partner with all communities. Access Health CT even 
expanded their open enrollment period this year after the Texas v. 
United States decision was unveiled in December. The exchange knew that 
it had to combat misinformation--that the Affordable Care Act was still 
intact, despite the Texas decision--and that people could still sign up 
for coverage.
  State-based exchanges need all the help they can get to support these 
efforts.
  Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I rise in opposition to the amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Mrs. HAYES. Mr. Chairman, how much time do I have?
  The Acting CHAIR. The gentlewoman has 2 minutes remaining.
  Mrs. HAYES. Mr. Chair, I want to point out that an estimated 90 
million Americans still have low health literacy. These people are 
disproportionately lower-income Americans, elderly Americans, and 
Americans with low English proficiency.
  There is a clear need and urgency for the Federal Government to help 
these people in States that operate State-based exchanges, and there is 
precedent for my amendment. My State exchange has received roughly $3 
million for the In-Person Assister program from the Federal Government.
  The bottom line is that the rules of the road have changed since 
changing the requirement to provide healthcare coverage to all 
Americans. There has never been a greater need to shore up programs 
that make certain working Americans, especially underserved 
populations, are protected and insured; that people in all communities 
know what their options are and know when and how to access these 
benefits.
  I strongly support H.R. 987. I think that my amendment will make it 
even better.
  I urge my colleagues to support this amendment.
  Mr. Chair, I yield the balance of my time to the gentleman from New 
Jersey (Mr. Pallone), the leader of this important bill.
  Mr. PALLONE. Mr. Chairman, I just think that the navigator program is 
so important, and all the outreach that we have in these bills is very 
important. I obviously support the gentlewoman's amendment because 
every effort to reach out and educate people about their options in the 
marketplace is so important.
  Mrs. HAYES. Mr. Chairman, I yield back the balance of my time.
  Mr. WALDEN. Mr. Chairman, I yield myself such time as I may consume.
  So let's talk about the navigator program. They enroll less than 1 
percent today, less than 1 percent.
  Wall Street Journal reported an investigation that one grantee took 
in $200,000 to enroll a grand total of 1 person; and they found the top 
10 most expensive navigators collected 2.77 million taxpayer dollars, 
2.77, Mr. Chairman.
  Do you know how many people they signed up? 314.
  They want to add $25 million more on top of the $62,500,000 in 
grants. We are talking about less than 1 percent.

  Meanwhile, while they are talking about oh, we have got to educate 
people about all their options, then they put a gag rule in here that 
says, can't talk to you about short-term duration plans. Oh, no, we 
can't educate about that choice. No, you can't know about that. No, we 
are going to stop that. Oh, and you can't know about association health 
plan options either. It might be better for you and your family and 
actually be more affordable. No, no, no, because that is not our 
Federal decision here. They decide, and they don't want you to even 
know. So navigators can't talk about those things. That is gagged in 
this law.
  The amazing thing we never hear about is the good work of the Trump 
administration and the economy as it has taken off. And I say that in 
the context that we have seen the lowest unemployment rates for 
virtually every American and group of Americans; whether it is African 
Americans, Hispanic Americans, you name it, we are seeing, the lowest 
rates, in some cases, since they began keeping track of unemployment.
  So the economy is doing really well. Over 3 percent GDP growth the 
first quarter.
  So what has that meant for insurance?
  We have heard the constant, unrelenting attacks; you might as well 
use impeachment here at some point probably today.
  Look, the number of Americans in employer health coverage has 
increased by more than 2.5 million since President Trump took office. 
Two-and-one-half million more Americans aren't having to get their 
healthcare through the government and taxpayers. They are getting it 
through a job and their employer.
  In fact, today, there is a greater percentage of Americans in 
employer health coverage since Trump took office than any time since 
2000, any time since 2000.
  See, there is another way to provide healthcare and that is through a 
job.
  Now, I know those who support a full Federal takeover of everybody's 
health insurance don't like to hear that because, see, they don't think 
that employers should offer health insurance. They think only the 
government knows best. And so their Medicare for All plan, which would 
cause great delays in access to care, drive up costs, you would pay 
more; but it would take away your health insurance. If you get it from 
your employer, or if you get it from your union, or if you are a senior 
on Medicare and you have a Medicare advantage policy, that goes away 
too. Veterans with TRICARE? Democrats' Medicare for All program, that 
is gone, too.

                              {time}  1545

  It is kind of ironic to talk about how wonderful the Affordable Care 
Act is working for Americans, who, by the way, tell me: ``Look, I am 
getting stuck with the highest deductibles and premiums I have ever 
seen. I can't afford it.''
  We had an example from Grand Island, Nebraska, last week. A 60-year-
old couple makes $70,000 a year. They were paying $38,000 in premiums 
and $11,000 in deductibles.
  That is affordable insurance? I don't think so.
  That is why we think States should have the ability to experiment and 
regulate plans at the State level, as they did under ObamaCare.
  All that talk about junk plans and all that, by the way, those were 
approved under ObamaCare. Those were allowed under ObamaCare. Trump 
just allowed them to be there longer. But because he changed something, 
there is this automatic partisan response.
  I think we all ought to come together here. I have fought my entire 
legislative career in Oregon and here to make healthcare more 
affordable.
  The underlying drug bills, there is no light between us, none, 
between Republicans and Democrats. Those bills came out of committee 
unanimously.
  The only reason we are having this fight on the floor today is 
because somewhere along the way, the political operatives, Mr. 
Chairman, decided to bolt these two unrelated sets of bills together. 
They knew it would be kind of a poison pill and kind of fun to watch 
Republicans squirm on the floor. That is why we are here.
  The ObamaCare bills we are voting on today just dump more money into 
programs that investigations have shown are filled with fraud and 
abuse. How can you justify putting another $25 million into a program 
where the top 10 most expensive navigators collected $2.77 million and 
signed up a grand total of 314 people? Who in their right mind in 
private business, Mr. Chairman, would make that kind of investment?
  The Las Vegas Review-Journal said, after reading that, ``The 
navigator scheme is a make-work government jobs program rife with 
corruption and highly susceptible to scam artists.''
  Mr. Chairman, my time has expired. I yield back the balance of my 
time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Connecticut (Mrs. Hayes).
  The amendment was agreed to.


                 Amendment No. 9 Offered by Mrs. McBath

  The Acting CHAIR. It is now in order to consider amendment No. 9 
printed in House Report 116-61.
  Mrs. McBATH. Mr. Chair, I have an amendment at the desk.

[[Page H3882]]

  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:
       At the end of title I of the Rules Committee Print, add the 
     following:

                  Subtitle D--Pharmacy School Outreach

     SEC. 131. PHARMACY SCHOOL OUTREACH.

       The Secretary of Health and Human Services and the 
     Secretary of Education shall make every effort necessary to 
     ensure appropriate outreach to institutions of higher 
     education to ensure that students and faculty at schools of 
     pharmacy are provided with materials regarding generic drugs 
     and biosimilar biological products, including materials on--
       (1) how generic drugs and biosimilar biological products 
     are equivalent or similar to brand-name drugs;
       (2) the approval process at the Food and Drug 
     Administration for generic drugs and biosimilar biological 
     products;
       (3) how to make consumers aware of the availability of 
     generic drugs and biosimilar biological products;
       (4) requirements for substituting generic drugs and 
     biosimliar biological products in place of corresponding 
     drugs products; and
       (5) the impacts of generic drugs and biosimilar biological 
     products on consumer costs.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentlewoman 
from Georgia (Mrs. McBath) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Georgia.
  Mrs. McBATH. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chair, I am so proud to be voting today to stabilize healthcare 
for millions of Americans and to bring down the cost of prescription 
drugs.
  I came to Congress, like many of my fellow colleagues, to protect 
healthcare for my constituents with preexisting conditions and to make 
healthcare more affordable and accessible. I myself have a preexisting 
condition, having suffered breast cancer twice.
  My amendment today is focused on ensuring that our future pharmacists 
and those in the workforce are provided with materials regarding 
generic drugs and biosimilar biological products. Specifically, it 
would have the Secretary of Health and Human Services and the Secretary 
of Education make every effort necessary to ensure appropriate outreach 
to institutions of higher education to ensure that students and faculty 
at schools of pharmacy are provided with appropriate materials.
  This will allow for students and faculty to have material on how 
generic drugs and biosimilar biological products are equivalent or like 
brand-name drugs, the impact of these products on consumer costs, 
requirements for substituting these types of drugs with corresponding 
drug products, the impacts of these products on consumer costs, and 
more.
  Pharmacists spend a great deal of time with individuals when they 
come to the counter to fill an order. They provide guidance and educate 
patients on the prescriptions that they are taking. I have even met 
with my own local pharmacists many, many times to discuss my own 
prescriptions.
  They are very intelligent individuals who are relied on by their 
community daily. By instilling them with the information that they need 
to know to best help those whom they serve, we will all be better off.
  Mr. Chair, I urge all my colleagues to support this amendment and the 
underlying package.
  Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I rise in opposition to the amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
  Mrs. McBATH. Mr. Chair, I yield myself as much time as I might 
consume.
  Mr. Chair, I would like to say that, as a two-time breast cancer 
survivor myself, I have relied many, many times on the specific 
information and guidance that has been given to me by my own 
pharmacist.
  Our pharmacists should be allowed to be able to give resource 
information to help the patients that they serve. By tying their hands 
and not being able to give them the information that they need to 
really best serve their patients, we do them a great disservice.
  I truly believe that this information is very relevant. Giving 
pharmacists the ability they need to do their jobs is of great 
importance.
  Mr. Chair, I yield back the balance of my time.
  Mr. WALDEN. Mr. Chairman, I yield such time as he may consume to the 
gentleman from Georgia (Mr. Carter), America's only pharmacist in the 
U.S. House of Representatives and a distinguished gentleman from the 
Energy and Commerce Committee.
  Mr. CARTER of Georgia. Mr. Chair, I thank the ranking member for 
yielding and for the opportunity to speak on this bill.
  Mr. Chair, first of all, let me begin by thanking the gentlewoman 
from Georgia for proposing this amendment. Although I do find it 
unnecessary in a lot of ways, I have to admit that I applaud her, 
because educating our healthcare professionals and, therefore, 
educating the public about what is available is extremely important.
  I do have to tell you that I feel the pharmacy schools already do a 
good job of this, and this might be somewhat redundant. However, the 
underlying point is that more education is better even if it is 
overkill, if you will.
  Now, you ask me how I can say that. I have to say that I have to be 
consistent, and I have been consistent throughout that we need to 
educate the public.
  In fact, if we look back at the debate that we have had in the 
committee when we have been talking about the short-term plans, I made 
the point that we need to educate the public as to what is available. 
They need to know.
  Therefore, I would be inconsistent if I didn't agree with the lady 
that more education is better, because I have to tell you that these 
short-term plans--I believe that the other side refers to them as the 
junk plans. I have always said, if they are junk plans now, then they 
were junk plans during the Obama administration, because they were 
being offered then.
  But those short-term plans, we need to let people know about them. 
That is why I made an amendment in the committee to educate the public 
about the availability of these plans. Unfortunately, my colleagues on 
the other side of the aisle disagreed with that, feeling that, no, they 
don't need to know about it.
  Here we have an opportunity to let people know more, and I have to 
admit that I would be in favor of that. I thank the gentlewoman for 
offering this amendment. Where I might be a little bit ambivalent 
toward which way to go, I have to admit that consistency is important. 
Short-term plans, we need to let people know about them. I fought for 
that. So I don't think I would be consistent if I went against this.
  I thank the gentlewoman for offering this.
  Mr. WALDEN. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chairman, I appreciate the comments of my friend from Georgia, a 
distinguished member of the Energy and Commerce Committee.
  We really have come to rely upon Mr. Carter for his guidance, 
especially on areas related to pharmacies and trying to get the costs 
of prescription drugs down for consumers. We are all about that.

  We worked together in the last Congress to empower the FDA to get 
more generics to market sooner so we have more competition. That was a 
bipartisan bill.
  That is the way we operated in the last Congress, Mr. Chairman, as 
Republicans and Democrats. I led the committee, and we revamped 
everything at the FDA in generics, on medical device approvals, and on 
pharmaceuticals so we could benefit the patient first.
  We brought those bills to the floor unanimously. We didn't mess 
around with them and package them up with poison pills. We said: Let's 
go legislate, and let's get this done. And they did. They got done. 
They got into law, signed by President Trump.
  And guess what? Last year, the FDA approved more generics in one year 
than at any time in its history. So we did do things, led by 
Republicans in the House, the Republican leader of the Senate, and 
President Trump, joining with Democrats, just as we have attempted to 
do on the drug bills before us today.
  We are in full agreement. Stop the bad behaviors, get competition 
into the market, and bring down costs of drugs. But we also believe we 
should make sure Americans have choices that are

[[Page H3883]]

more affordable when it comes to their insurance.
  Democrats voted for ObamaCare. They blocked every amendment we had as 
Republicans at the time that was legislated. Remember, the former 
Speaker, now Speaker again, said you have to pass it so you can find 
out what is in it. It is kind of an odd way to legislate, but, anyway, 
here we are.
  By the way, the short-term plans they call junk plans on that side, 
Mr. Chairman, those short-term plans are the same ones we are debating 
today, except all President Trump did is say you can have them a little 
longer, because guess what? For some people, it is the only affordable 
health insurance they have access to in their States.
  They are regulated by the States. They are not unregulated. States 
can do all kinds of things. We should empower them to do things to make 
insurance more affordable.
  Unlike my friends on the other side, Mr. Chairman, they want to gag 
the navigators so they can't even tell them about alternatives that may 
actually benefit them and be more affordable.
  The plans that the other side of the aisle is railing against today, 
Mr. Chairman, are plans that are very much like the ones that were 
approved under President Obama and ObamaCare. It is just that President 
Trump said you can have them for longer if they work for you. But the 
States can come in and say, no, no.
  My State says just 3 months. That is it. Boom. Other States say 30 
days. Some States say none at all.
  Mr. Chairman, I am not going to oppose this amendment, and I yield 
back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Georgia (Mrs. McBath).
  The amendment was agreed to.


                Amendment No. 10 Offered by Ms. Scanlon

  The Acting CHAIR. It is now in order to consider amendment No. 10 
printed in House Report 116-61.
  Ms. SCANLON. Mr. Chairman, 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 50, insert after line 2, the following:

     SEC. 205. CONSUMER OUTREACH, EDUCATION, AND ASSISTANCE.

       (a) Open Enrollment Reports.--For plan year 2020 and each 
     subsequent year, the Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary''), in 
     coordination with the Secretary of the Treasury and the 
     Secretary of Labor, shall issue biweekly public reports 
     during the annual open enrollment period on the performance 
     of the Federal Exchange. Each such report shall include a 
     summary, including information on a State-by-State basis 
     where available, of--
       (1) the number of unique website visits;
       (2) the number of individuals who create an account;
       (3) the number of calls to the call center;
       (4) the average wait time for callers contacting the call 
     center;
       (5) the number of individuals who enroll in a qualified 
     health plan; and
       (6) the percentage of individuals who enroll in a qualified 
     health plan through each of--
       (A) the website;
       (B) the call center;
       (C) navigators;
       (D) agents and brokers;
       (E) the enrollment assistant program;
       (F) directly from issuers or web brokers; and
       (G) other means.
       (b) Open Enrollment After Action Report.--For plan year 
     2020 and each subsequent year, the Secretary, in coordination 
     with the Secretary of the Treasury and the Secretary of 
     Labor, shall publish an after action report not later than 3 
     months after the completion of the annual open enrollment 
     period regarding the performance of the Federal Exchange for 
     the applicable plan year. Each such report shall include a 
     summary, including information on a State-by-State basis 
     where available, of--
       (1) the open enrollment data reported under subsection (a) 
     for the entirety of the enrollment period; and
       (2) activities related to patient navigators described in 
     section 1311(i) of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18031(i)), including--
       (A) the performance objectives established by the Secretary 
     for such patient navigators;
       (B) the number of consumers enrolled by such a patient 
     navigator;
       (C) an assessment of how such patient navigators have met 
     established performance metrics, including a detailed list of 
     all patient navigators, funding received by patient 
     navigators, and whether established performance objectives of 
     patient navigators were met; and
       (D) with respect to the performance objectives described in 
     subparagraph (A)--
       (i) whether such objectives assess the full scope of 
     patient navigator responsibilities, including general 
     education, plan selection, and determination of eligibility 
     for tax credits, cost-sharing reductions, or other coverage;
       (ii) how the Secretary worked with patient navigators to 
     establish such objectives; and
       (iii) how the Secretary adjusted such objectives for case 
     complexity and other contextual factors.
       (c) Report on Advertising and Consumer Outreach.--Not later 
     than 3 months after the completion of the annual open 
     enrollment period for the 2020 plan year, the Secretary shall 
     issue a report on advertising and outreach to consumers for 
     the open enrollment period for the 2020 plan year. Such 
     report shall include a description of--
       (1) the division of spending on individual advertising 
     platforms, including television and radio advertisements and 
     digital media, to raise consumer awareness of open 
     enrollment;
       (2) the division of spending on individual outreach 
     platforms, including email and text messages, to raise 
     consumer awareness of open enrollment; and
       (3) whether the Secretary conducted targeted outreach to 
     specific demographic groups and geographic areas.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentlewoman 
from Pennsylvania (Ms. Scanlon) and a Member opposed each will control 
5 minutes.
  The Chair recognizes the gentlewoman from Pennsylvania.
  Ms. SCANLON. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chair, I rise today in support of an amendment to require greater 
accountability from the Department of Health and Human Services with 
respect to the Affordable Care Act.
  Time and time again, we have seen Republicans and the administration 
attempt to undermine the important work of the Affordable Care Act.
  In addition to attempting to strip away protections for preexisting 
conditions or reducing coverage for Medicaid recipients, the 
administration is trying to depress coverage by cutting consumer 
outreach and marketing for the ACA. Not only does sabotaging the 
enrollment process make it harder for the American people to get health 
coverage, but it also drives up costs.
  Unfortunately, this strategy has been working. We are currently at 
our highest uninsured rate in 4 years, with Affordable Care Act 
enrollment rates declining every year this President has been in 
office.
  Everyday Americans, like the folks in my district in southeastern 
Pennsylvania, can't afford more barriers to healthcare. When their 
choice is often between putting food on their table or going to the 
doctor, it is important that people have more information and access to 
the Affordable Care Act marketplaces, not less.
  My amendment would require greater transparency from the 
administration by requiring the Secretary of Health and Human Services 
to provide vital statistics on plan enrollment, outreach, and 
advertising, and the overall performance of the programs within the 
ACA.
  This information will allow Congress to perform better, quicker 
oversight on Health and Human Services' attempts to roll back 
information and outreach for potential Affordable Care Act enrollees.
  No longer will the administration be able to hide its lack of 
investment in ACA outreach and education or refuse to turn over data on 
how its say-nothing sabotage is hurting Americans.
  Mr. Chair, I encourage Members on both sides of the aisle to support 
this commonsense amendment, and I reserve the balance of my time.

                              {time}  1600

  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the 
gentlewoman's amendment.
  The Acting CHAIR (Mr. Aguilar). The gentleman from Oregon is 
recognized for 5 minutes.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Ms. SCANLON. Mr. Chairman, I would just, again, urge Members from 
both sides of the aisle to support this bill, and I yield back the 
balance of my time.
  Mr. WALDEN. Mr. Chairman, I thank the gentlewoman from Pennsylvania 
for her amendment. We are not going to object to the amendment. The 
exchanges already do a lot of this reporting, and more information is 
better than less.
  Now, I want to talk about these short-term, State-regulated, limited 
duration insurance policies because I think I have got a chart here, 
and we

[[Page H3884]]

will put it in the Record that there are 27 of our States, Mr. 
Chairman--27--that have decided that short-term plans are good for 
their people to be able to take advantage of. There are States from 
Alaska to Wyoming, from Kansas to Iowa, to Idaho and Pennsylvania where 
you can go up to 364 days.
  Now, there are 12 other States that have said, you know: We want to 
limit these to 6 months. That includes places like Colorado and Arizona 
and Nevada and Oklahoma, North Dakota.
  Then there are eight States, Mr. Chairman, that said: No, we want 3 
months. We think that is all we need in places like Oregon, Hawaii, or 
New Mexico.
  Then there are four States--California, Massachusetts, New Jersey, 
and New York--that said: No, we are just not going to allow any of 
these options in our State.
  Guess what. That is federalism. They get that right.
  Now, I know my friends on the other side of the aisle would like to 
take away that ability for these short-term duration, State-regulated 
plans and remove options from consumers, and I don't think that is the 
way to go. It is an honest disagreement here that we have, Mr. 
Chairman, between the parties.
  I have seen a lot of innovation come out of my home State of Oregon. 
I was meeting with one of our former Governors, John Kitzhaber, this 
morning, talking about the effect of the coordinated care 
organizations, and they have been able to actually bend the cost curve 
and improve access to delivery of care by having the flexibility, in 
some cases through waivers, to bring providers together, match them up 
with patients, and deliver care more efficiently and more effectively 
and with better outcomes. That should be what we are debating today: 
How do we get to better outcomes?
  We should also be debating how we get healthcare costs down, Mr. 
Chairman. We are doing a bit of that with the drug bills.
  It is unfortunate. It didn't have to be this way that they got made 
into partisan issues, because there is no partisan divide on those 
bills. It is the fact that, you know, bailing out some of these 
programs in ObamaCare that are so expensive.
  When it costs $2.40 per enrollee for agents and brokers to assist in 
enrollment and $767 if you spent $62.5 million in grants and they 
enrolled 81,000 individuals, it averages out, just a rough average, to 
over $700, why would we pour more money into the navigators that cost 
700 bucks and then say: Oh, by the way, these agents and brokers can't 
do anything to keep them out of this?
  The Trump administration actually expanded the authority for the 
agents and brokers to be involved, leveraging that private-sector help, 
and do you know what? They support 3,660,000 health plan enrollments. 
That is 42 percent of the plan enrollments in 2018 on the Federal 
platform exchanges--42 percent. Mr. Chairman, navigators do 1 percent. 
And my friends on the other side of the aisle want to keep dumping more 
and more money into the navigator program that, as I pointed out 
earlier, we found all kinds of wasteful spending in.
  So there is really an issue about spending. We know the results. We 
know there is a much better way to do this.
  So, Mr. Chairman, I am not going to oppose this particular amendment. 
It is fine, and more information is better than less.
  Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Pennsylvania (Ms. Scanlon).
  The amendment was agreed to.


                Amendment No. 11 Offered by Mr. Morelle

  The Acting CHAIR. It is now in order to consider amendment No. 11 
printed in House Report 116-61.
  Mr. MORELLE. Mr. Chairman, 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 47, after line 18, insert the following:
       (b) Study on Effects of Funding Cuts.--Not later than 1 
     year after the date of the enactment of this Act, the 
     Comptroller General of the United States shall study the 
     effects of funding cuts made for plan year 2019 with respect 
     to the navigator program (as described in section 1311(i) of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     18031(i))) and other education and outreach activities 
     carried out with respect to Exchanges established by the 
     Secretary of Health and Human Services pursuant to section 
     1321(c) of such Act. Such study shall describe the following:
       (1) How such funding cuts negatively impacted the ability 
     of entities under such program to conduct outreach activities 
     and fulfill duties required under such section 1311(i).
       (2) The overall effect on--
       (A) the number of individuals enrolled in health insurance 
     coverage offered in the individual market for plan year 2019; 
     and
       (B) the costs of health insurance coverage offered in the 
     individual market.
       Page 47, line 19, strike ``(B)'' and insert ``(C)''.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from New York (Mr. Morelle) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from New York.
  Mr. MORELLE. Mr. Chairman, I rise today to offer an amendment 
intended to detail the full harm done to our Nation by the White 
House's sabotage of the Affordable Care Act.
  Last summer, the Centers for Medicare and Medicaid Services announced 
a 70 percent cut, $26 million to the navigators program that provides 
in-person assistance to people who wish to sign up for insurance 
through the Affordable Care Act. In just 2 years, funding for this 
program has plummeted from $62.5 million to just $10 million.
  The President also cut digital TV and radio advertising by 90 
percent, reducing investment from $100,000,000 to $10 million. The 
failure to use Federal funding for these activities leaves it to the 
States to fill in the gaps and puts on them the burden for the 
continued success of State and Federal exchanges.
  My amendment directs the U.S. Government Accountability Office to 
conduct a study of these cuts to detail how reduced funding has harmed 
enrollment across the Nation and the resulting costs to our Nation's 
families.
  Funding for ACA outreach is essential to ensuring that Americans know 
their options and their healthcare benefits. Without public messaging 
campaigns, many people have been left confused about the open 
enrollment process, when they can begin signing up for coverage, and 
the deadline for enrolling before the new year.
  As we approach planning for the 2020 enrollment season, we need to 
fully understand the results of the cuts to outreach and advertising 
that were put in place in recent years. That is what my amendment seeks 
to do.
  I want to thank my colleague Congresswoman Wexton for joining me in 
these efforts, and I ask my colleagues to support this amendment.
  I thank the chair and the ranking member for their work, and I 
reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the 
gentleman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. I reserve the balance of my time.
  Mr. MORELLE. Mr. Chairman, I yield the remainder of my time to the 
gentlewoman from Virginia (Ms. Wexton), my colleague.
  Ms. WEXTON. Mr. Chairman, I thank the Representative for offering 
this amendment and for yielding.
  This amendment requests a GAO report on how funding cuts to the 
navigator program and to Affordable Care Act marketing and outreach 
have impacted health insurance enrollment and the cost of coverage on 
the individual markets.
  Navigator programs provide critical assistance to consumers by 
raising awareness about the availability of marketplace plans, 
assisting people as they apply for Federal subsidies, and providing 
impartial information about different marketplace plans. Importantly, 
these programs help otherwise hard-to-reach groups get health insurance 
coverage, including people living in rural and underserved communities.
  The Trump administration has made significant funding cuts to the 
navigator program, however, providing only $10 million in funding for 
the program for 2019, an 80 percent reduction over the past 2 years.

[[Page H3885]]

  Navigator funding in my home State of Virginia has been reduced by an 
astounding 76 percent between 2016 and 2018, down from approximately 
$2.2 million in 2016 to just $525,000 in 2018. To manage these cuts, 
programs have had to lay off staff, close offices, and limit their 
availability to help consumers.
  The administration's cuts hamper navigators' ability to do their 
jobs, leaving many consumers on their own during the enrollment 
process, and, as a result, people may not obtain coverage on the 
individual market, causing people who do get coverage to see their 
premiums increase.
  Constituents in my district and people throughout the U.S. rely on 
navigators to learn about coverage options and to enroll in the best 
possible healthcare plans for them. We need to know how the 
administration's drastic funding cuts have impacted the individual 
markets, and this amendment will allow us to do that.
  Mr. MORELLE. Mr. Chairman, I yield back the balance of my time.
  Mr. WALDEN. Mr. Chairman, it is interesting; the prior amendment that 
passed added $25 million more to this navigator program. For the plan 
year 2017, navigators received a total of $62.5 million in grants and 
yet only enrolled 81,426 individuals. That is less than 1 percent of 
the total enrollees.
  You see, the issue here isn't whether we should or shouldn't enroll 
more people. The issue is who is most efficient with the taxpayer or 
private-sector dollar to do that.
  We keep pouring more and more money into this navigator program and 
we know there is all this, well, I guess I am going to call it waste. I 
don't know if it is fraud.
  But holy smokes, as I have said before, one grantee, according to The 
Wall Street Journal, took in $200,000 and enrolled one person--one 
person. You want to have a Government Accountability Office report and 
investigation, let's look at the underlying program and how in the heck 
that could happen.
  And then they also found the top 10 expensive navigators collected 
$2.77 million and signed up 314.
  These aren't my numbers. These are The Wall Street Journal 
investigative reporters. You know, in the press, these are facts, which 
caused the Las Vegas Review-Journal to editorialize that: ``The 
navigator scheme is a make-work government jobs program rife with 
corruption and highly susceptible to scam artists. It's a slush fund 
for progressive constituent groups.''
  Not my words, that is the press. I have a journalism degree. I have a 
great respect for the press and what they write. I don't always agree 
with them.

  But, look, when you take these independent reviews and you look at 
what is happening there, CMS reported that 17 of those navigators 
enrolled fewer than 100 people at an average cost of $5,000 per 
enrollee--$5,000. $5,000. And my friends on the other side of the aisle 
want to shovel more money into that program. I think that is the height 
of fiscal irresponsibility.
  See, for $2.7 million, if we put that into community health centers, 
Mr. Chairman, do you know how many people we could cover? We could take 
care of 20,000 patients, according to one estimate--20,000.
  Health centers are really, really important to me and my 
constituents. We have 63 different places in my district, which is 
bigger than eight States east of the Mississippi, Mr. Chairman, where 
people get their healthcare in our communities. We have to reauthorize 
this year, by the end of September, our community health centers.
  Now, when I was chairman, we did that at a record level because they 
deliver record good healthcare. We have had no plan yet to figure out 
how to pay for that, but you are going dump $25 million more into this 
navigator program. Why don't we put it into actual healthcare?
  We reauthorized the Children's Health Insurance Program under 
Republicans and fully funded it for a decade. The longest that had ever 
been done was 5 years, and, unfortunately, most of my friends on the 
other side of the aisle voted repeatedly against doing that for a whole 
host of reasons, but they voted ``no.'' In Oregon, we have 122,700 
children and expectant moms that rely on CHIP, SCHIP, partnership with 
the State for their health insurance.
  So there are a lot of things we can invest in with the proceeds from 
the savings from the drug bills, but investing in the navigator 
program? $5,000 per enrollee?
  There are 100 navigators, that is all they did? One for 200,000, 
enrolled one person? I mean, come on. There has got to be a better way 
to not spend the taxpayers' money than that.
  And so I think you look at the incredible growth in men and women 
working in America, getting better paying jobs, bigger paychecks and 
healthcare, 2.5 million since President Trump took office, and 
Republicans put progrowth policies into the Tax Code, progrowth 
regulatory policies into the bureaucracy.
  Jobs are coming up. The biggest issue I run into with employers now 
is not overregulation; it is: Where do I find more people to work?
  So we need to look at job training. We need to work at available 
workforce. But this, this amendment, I think, is, frankly, from my 
perspective--with all due respect, GAO doesn't need to waste their time 
on this nor the taxpayer's money, and especially after $25 million more 
was just signed up in addition to--what?--$63 million, roughly, an 
enormous amount of money into a program that I think has a lot of 
problems. And the editorial writers at the Review-Journal said, 
``highly susceptible to scam artists,'' ``slush fund for progressive 
constituent groups.'' So I oppose the amendment.
  Mr. Chairman, I yield back the balance of my time.

                              {time}  1615

  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from New York (Mr. Morelle).
  The amendment was agreed to.


                 Amendment No. 12 Offered by Ms. Waters

  The Acting CHAIR. It is now in order to consider amendment No. 12 
printed in House Report 116-61.
  Ms. WATERS. Mr. Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       At the end of title I of the Rules Committee Print, add the 
     following new subtitle:

                          Subtitle D--Reports

     SEC. 131. EFFECTS OF INCREASES IN PRESCRIPTION DRUG PRICE.

       Not later than 1 year after the date of enactment of this 
     Act, the Secretary of Health and Human Services shall submit 
     a report to the Congress on the extent to which increases in 
     prescription drug prices may have caused Medicare 
     beneficiaries to forego recommended treatment, including 
     failing to fill prescriptions.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentlewoman 
from California (Ms. Waters) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from California.
  Ms. WATERS. Mr. Chairman, my amendment requires the Department of 
Health and Human Services to submit to Congress a report on the extent 
to which increases on prescription drug prices may have caused Medicare 
beneficiaries to forego recommended treatment, including failing to 
fill their prescriptions.
  Drug prices have increased significantly over the past year. The 
Center for American Progress reported that nearly 30 drug companies 
announced last year that price increases will take effect in January.
  Pfizer alone announced that it would raise the prices of 41 different 
drugs. Critical medications, including insulin and opioid addiction 
treatments, have already seen dramatic price increases this year.
  These price increases are taking a toll on patients. The Kaiser 
Family Foundation reported that among those currently taking 
prescription drugs, 24 percent of adults and 23 percent of seniors say 
it is difficult to afford their prescription drugs. This includes about 
one in ten respondents who say it is very difficult.
  The Kaiser Family Foundation also found that certain groups are much 
more likely to report difficulty affording medication, including those 
who are spending $100 or more a month on their prescriptions, that is 
58 percent; those who report being in fair or poor health, about 49 
percent; those who take four or more prescription drugs, 35 percent; 
and those with incomes less

[[Page H3886]]

than $40,000 per year, representing 35 percent.
  Furthermore, 29 percent of all adults report not taking their 
medicines as prescribed at some point in the past year because of the 
cost, and 8 percent say their condition got worse as a result of not 
taking their prescriptions as recommended.
  Needless to say, when Medicare beneficiaries cannot afford their 
medications, their health will suffer.
  My amendment requires HHS to study the impact of increases in 
prescription drug prices on Medicare beneficiaries and their health.
  Mr. Chairman, I urge my colleagues to support my amendment, and I 
reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the amendment, 
but I am not necessarily opposed to the amendment.
  The Acting CHAIR. Without objection, the gentleman from Oregon is 
recognized for 5 minutes.
  There was no objection.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Ms. WATERS. Mr. Chairman, we have had extensive discussions 
throughout this Congress about the plight of those who cannot afford 
prescription drugs.
  We know what the statistics are. We know the harm that is being 
caused to families, and we know that there are preventable deaths if, 
in fact, people could afford their prescription drugs.
  And so I would expect all of the Members of the House of 
Representatives, knowing this information, understanding all of the 
research that has been done, the data that has been collected, to 
simply support this amendment in order to save lives.
  Mr. Chairman, I yield back the balance of my time.
  Mr. WALDEN. Mr. Chairman, I support this amendment, and I yield back 
the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from California (Ms. Waters).
  The amendment was agreed to.


            Amendment No. 13 Offered by Ms. Johnson of Texas

  The Acting CHAIR. It is now in order to consider amendment No. 13 
printed in House Report 116-61.
  Ms. JOHNSON of Texas. Mr. Chairman, 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 46, beginning on line 17, amend clause (ii) to read as 
     follows:
       (ii) by striking the period and inserting a semicolon; and
       Page 46, line 20, strike ``clause'' and insert ``clauses''.
       Page 46, line 23, strike the period and the end quotes.
       Page 46, after line 23, insert the following:
       ``(iv) receive training on how to assist individuals with 
     enrolling for medical assistance under State plans under the 
     Medicaid program under title XIX of the Social Security Act 
     or for child health assistance under State child health plans 
     under title XXI of such Act.''; and

  The Acting CHAIR. Pursuant to House Resolution 377, the gentlewoman 
from Texas (Ms. Johnson) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Texas.
  Ms. JOHNSON of Texas. Mr. Chairman, I rise today to support this 
amendment. The amendment requires navigators to receive training on how 
to assist consumers with Medicaid and CHIP enrollment.
  This amendment has also been scored by the Congressional Budget 
Office to have no effect on direct spending or revenue.
  The health insurance navigator's program was created by the 
Affordable Care Act to assist individuals with selecting and enrolling 
in health insurance coverage plans.
  They were intended to carry out public education activities, provide 
information to prospective enrollees about insurance options and 
Federal assistance, and examine enrollees' eligibility for other 
Federal or State healthcare programs.
  Fundamentally, their responsibility was to help people make the best 
healthcare decisions for themselves and their families.
  Unfortunately, this essential program has been targeted in recent 
years, among others. The administration has slashed the open enrollment 
period in half, slashed funding for consumer outreach and enrollment 
education activities by 90 percent, and slashed funding for navigators 
by 84 percent.
  Because of this intentional sabotage, enrollment in the Federal 
marketplace has dropped each year under this Presidency.
  In my home State of Texas, we are, unfortunately, deeply familiar 
with the consequences of the lack of health insurance.
  Texas has the highest rate of uninsured people in the Nation, with 
4.7 million people lacking coverage and adequate access to healthcare.
  As representatives of Americans from all corners of the country, we 
have a responsibility to ensure that our constituents and communities 
are knowledgeable and can access the health insurance best suited for 
their individual health needs.
  By voting in favor of this amendment, Congress will ensure that 
navigators are fully equipped and informed to assist our families and 
children with their potential options within the Medicaid and CHIP 
programs.
  I appreciate my colleagues on the Committee on Energy and Commerce 
and their partnership in expanding training requirements for 
navigators, and in the Strengthening Healthcare and Lowering 
Prescription Drug Costs Act.
  Mr. Chairman, I urge my colleagues to support this amendment, and I 
reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the 
gentlewoman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Ms. JOHNSON of Texas. Mr. Chairman, I have no further statements, and 
I yield back the balance of my time.
  Mr. WALDEN. Mr. Chairman, I thank the gentlewoman for her amendment.
  I find it a bit interesting, though, that under the navigator 
program, on the one hand, my friends on the other side of the aisle 
say, Look, you can't talk about--in fact, you can't tell anybody about 
association health plans and those as options.
  You can't educate the public, the consumers about an opportunity to 
save money by having a state-regulated plan. No, not under the 
navigator. You can't do that.
  And yet, with this amendment, they want to expand that knowledge, so 
they can get training on the other government plans, Medicaid and CHIP 
enrollment. And that is not necessarily a bad thing. I am not saying 
that is a bad thing.
  But what I am saying is, why wouldn't we want full education? Why 
would we want, basically, a gag order here that prevents the navigators 
from telling the consumers, Here are some other options you may want to 
look at. Now, they have limitations; they are regulated by your State; 
you need to be fully informed--in fact, really informed, because some 
of them don't cover everything--as we have heard--because that was how 
it was designed under President Obama's plan, that there would be these 
options and they wouldn't be the fully covering plans, but they were 
okay because they would fill a gap.
  And those are the same plans we have heard a lot about today that 
States regulate. And I would go back to the fact that in some States it 
is 3 months.
  Well, in 27 States they go up to almost 1 year, including States such 
as Rhode Island and Tennessee, even Texas, Virginia, Georgia and Idaho.
  In 12 States, they go up to 6 months. In eight States, including 
mine, we said--in Oregon--just 3 months, that is all we are going to do 
in short-term duration plans.
  California, Massachusetts, New York, New Jersey, said no. Zero. We 
are not going to allow them.
  That is okay. That is federalism.
  But why, in the navigator program, would we say, You can't talk about 
things.
  I got a degree in journalism a long time ago at the University of 
Oregon, and I believe in the facts. And I believe marketplaces and 
consumers are better served when they have complete information to make 
choices.
  And I know that these insurance products are on the market. Some are 
fine, people like them.

[[Page H3887]]

  And I get these letters--I got one from Tom in Medford--that talked 
about how his premium, I think, went from 400-and-some dollars to $800 
in 1 year. And he is not sure what he is going to do. That was in 
October when the new numbers came out.
  And meanwhile, when we put all this reliance on these navigators. We 
know from the Wall Street Journal, one grantee took $200,000, enrolled 
one person.
  I guess, if you are the grantee, that is a pretty good deal. All you 
have to do is find one person to enroll, and you get 200 grand. To me, 
that sounds like a big waste of taxpayer dollars.

  The ten most expensive navigators collected $2.77 million, signed up 
314 people.
  Now, we heard about how the government needs to borrow and spend more 
than taxpayer dollars--or at least spend more taxpayer dollars--and do 
more education because the enrollment in the government plans has gone 
down by, I think, the figure is about $1 million or so. I guess, that 
is what is bandied about.
  What isn't mentioned, however, Mr. Chairman, is that under President 
Trump and the policies Republicans put into law, the economy took off. 
The economy took off. Thank goodness the economy took off.
  And 2.5 million Americans now get their insurance, more get their 
insurance through an employer.
  So, see, they got a job, they got a paycheck, they got insurance 
through their employer.
  And my guess is that accounts for some of that downturn. They don't 
have to come to the government to get their insurance. They are getting 
it through their employer.
  So you might have had like $1 million roll off on the exchanges, but 
you have got a 2.5 million pickup in the private insurance side. And I 
think that is pretty cool. I mean, that is important.
  And I know that my friends on the other side of the aisle with their 
national takeover of health insurance want to abolish ObamaCare and 
replace it with a single-payer system, which sounds sort of simple on 
its face, but we know that means you would have to double the personal 
income tax, double the corporate tax, and our doctors and hospitals, 
they would have to take like a 40-percent reduction.
  Mr. Chairman, I yield such time as he may consume to the gentleman 
from Texas (Mr. Burgess), my friend, the doctor, the former chairman of 
the Health Subcommittee, to make some comments.
  Mr. BURGESS. Mr. Chairman, I thank the ranking member for yielding.
  The fact is, there was a hearing on this one-size-fits-all government 
takeover, top-down, Soviet-style healthcare system that has been 
proposed by the other side of the aisle.
  And yet, that bill was not heard in the Committee on Energy and 
Commerce. It wasn't heard in the Ways and Means Committee. It was heard 
in the Rules Committee, the Speaker's committee.
  This is a high priority for the Speaker. This bill was heard in the 
Speaker's committee. That tells me that this is something that is 
highly likely to come forward. Unfortunately, it is just not a very 
good plan.
  And the gentleman is right, doctors would be required to take a 
significant reduction.
  The Acting CHAIR. The time of the gentleman from Oregon has expired.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Texas (Ms. Johnson).
  The amendment was agreed to.


                 Amendment No. 14 Offered by Mr. Lynch

  The Acting CHAIR. It is now in order to consider amendment No. 14 
printed in House Report 116-61.
  Mr. LYNCH. Mr. Chairman, I believe I have a couple of amendments at 
the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 42, beginning on line 6, strike ``December 31, 2022'' 
     and insert ``December 31, 2023''.
       Page 43, line 6, strike ``January 1, 2024'' and insert 
     ``January 1, 2025''.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from Massachusetts (Mr. Lynch) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Massachusetts.
  Mr. LYNCH. Mr. Chairman, my amendment would extend by 1 year the 
deadline by which States may apply for Federal grant assistance to set 
up State-based health insurance markets, moving the deadline from 
December 31, 2022, to December 31, 2023.

                              {time}  1630

  My amendment would also extend by 1 year the corresponding date by 
which the exchanges must be self-sustaining, from January 1, 2024, to 
January 1, 2025.
  Currently, 11 States and the District of Columbia have such health 
insurance exchanges. However, no health exchanges have been established 
since the ACA's original deadline of 2015.
  While I do support H.R. 987's language which provides an additional 
2-year window for States to establish their own insurance exchanges, 
given the complexity of the current debate with the possibility of 
single-payer healthcare out there and also Medicare for All, it is my 
hope and expectation that, by extending these application periods from 
2 to 3 years, more States will have the opportunity to weigh those 
outstanding options and explore the option to establish their own 
State-based exchanges.
  It was reported recently that the Governor of New Jersey, for 
example, has announced that his State would seek to establish its own 
State-based healthcare exchange for 2021. It is quite possible that 
other States that may have held off in setting up similar exchange 
marketplaces and are contemplating those other possibilities could also 
be reconsidering setting up an exchange, and that is the reason for my 
amendment. I believe that ensuring that States have the time to 
consider and plan for setting up such an exchange is the right thing to 
do.
  I would note that my amendment does not seek additional funding 
during that time period, so it will not increase the cost. It simply 
gives States additional time.
  I urge my colleagues to support my amendment as well as the 
underlying bill, and I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the 
gentleman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
  Mr. LYNCH. Mr. Chair, I think I have said enough. It is a technical 
amendment, and I yield back the balance of my time.
  Mr. WALDEN. Mr. Chairman, this section provides $200 million for 
States to establish State-based marketplaces. The Federal law provided 
States with the option of building their own State-based marketplace or 
utilizing the Federal marketplace.
  I know my own State blew through close to $300 million trying to 
create its own exchange. It was a terrible financial disaster, a total 
waste of money. They couldn't get it going. They finally closed the 
thing up, but not before they blew through hundreds of millions of 
dollars, and then they went to the Federal exchange.
  Every State except Alaska applied for these grants. Florida and 
Georgia were awarded planning grants but later returned their entire 
grants. Other States returned some of the grant money they received but 
also kept some.
  This would have been under the Obama administration when they were 
enacting ObamaCare. No funding was awarded after December 31, 2014, in 
accordance with the law.
  From the 2018 plan year, 34 States had federally facilitated 
marketplaces; 12 States had State-based marketplaces; and 5 States had 
State-based marketplaces using the Federal platform.
  The Committee on Energy and Commerce issued a majority staff report 
entitled: Implementing ObamaCare Review of CMS' Management of the 
State-Based Exchanges, September 13, 2016.
  I think it is important to share with my colleagues, among the 
report's key findings in 2016 were: CMS was not confident that the 
remaining State-based exchanges would be sustainable in the

[[Page H3888]]

long term, and as of September 2016, every State-based exchange still 
relies upon Federal establishment grant funds 20 months after the 
State-based exchanges were supposed to be self-sustaining by law.
  CMS eased the transition for these failed State-based exchanges so 
that they could join healthcare.gov by allowing them to keep the user 
fees collected by insurance carriers intended to pay for the use of 
healthcare.gov.
  Now, here we are, 5 years after the funding has expired considering a 
bill to reopen grants for States to establish State-based marketplaces. 
We have seen kind of a spotty record here. Maybe it is just a 
coincidence that $200 million is being made available now, because my 
friends on the other side set the agenda and they want to continue 
pushing out this idea.
  On Friday, Politico reported that New Jersey is proposing to create a 
State-based health exchange. Now, I think they have told us they 
actually don't need Federal money for that.
  But anyway, I don't think we are dealing with earmarks here; but 
earmarking money to help States create their own marketplaces is not 
what we should be about, and I am not sure we are. I don't think this 
is a Garden State giveaway, but it is kind of interesting.
  That is all I have got to say on this, Mr. Chairman, and I yield back 
the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Massachusetts (Mr. Lynch).
  The amendment was agreed to.


                 Amendment No. 15 Offered by Mr. Lynch

  The Acting CHAIR. It is now in order to consider amendment No. 15 
printed in House Report 116-61.
  Mr. LYNCH. Mr. Chairman, I have another amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 50, after line 2, insert the following section:

     SEC. 205. GAO REPORT.

       Not later than one year after the date of the enactment of 
     this Act, the Comptroller General of the United States shall 
     submit to Congress a study that analyzes the costs and 
     benefits of the establishment of State-administered health 
     insurance plans to be offered in the insurance market of such 
     States that choose to administer and offer such a plan.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from Massachusetts (Mr. Lynch) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Massachusetts.
  Mr. LYNCH. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, my amendment directs the Government Accountability 
Office to prepare a cost-benefit analysis of the establishment of a 
State-sponsored public health insurance option for States that may want 
to offer public options in their State's health insurance exchanges.
  A State-run public option would allow individual States to offer very 
basic, low-cost insurance plans without the high cost of commercial 
advertising and other overhead costs that can sometimes add as much as 
30 percent to the cost of some health insurance plans, or perhaps 
States could optimize the use of community health centers that we all 
love so much. Once these low-cost public option plans are on the 
market, private insurance companies would be forced to compete with 
that lower price by offering similar low-cost plans.
  State-sponsored public options could help address the lack of 
competition that is driving up the cost of healthcare in many States 
where one or two insurance companies are allowed to dominate the market 
due to the fact that the Affordable Care Act currently exempts 
insurance companies from antitrust laws.
  While State-run public options were a feature in the original 
version, the House version of the ACA, which I supported, Senate action 
deleted that from the final versions of the ACA which eventually passed 
and which I opposed.
  I believe that the information that the study will provide will be an 
important resource for States in regions looking to offer more 
healthcare options to their residents.
  Mr. Chairman, one of the loudest messages that came out of the last 
mid-term election was that, 9 years after the passage of the ACA, the 
American people still want us to fix their broken healthcare system.
  For many people, the Affordable Care Act is not affordable. But I 
believe it is fixable. Many fervent supporters of the ACA are also 
disappointed with the lack of success in reaching the goals of the ACA 
so that they are now supporting efforts to repeal the ACA in favor of 
single-payer or Medicare for All proposals.
  I believe there are some significant changes that could be made to 
the ACA to make it work. This study will be a simple way to provide our 
States with guidance that can help them determine whether a public 
option may be right for them.
  Mr. Chairman, I urge my colleagues to support both this amendment and 
the underlying bill, and I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the 
gentleman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
  Mr. LYNCH. Mr. Chair, I yield back the balance of my time.
  Mr. WALDEN. Mr. Chairman, I yield myself such time as I may consume.
  This amendment is pretty straightforward in asking the GAO to do this 
evaluation, and I think it is important to have cost-benefit analyses 
of State-administered health insurance plans for States that may want 
to offer a public option.
  Again, here we have a situation where States are experimenting, and 
our States are great laboratories for reform. The gentleman comes from 
a State where Republican Governors helped lead that effort, Governor 
Romney and others, and now Senator Romney from a different State.
  But my State did a lot of reform work as well, and we are all trying 
to figure out: How do we get healthcare to people in a timely way that 
is affordable? And we share that goal.
  Unfortunately, some of the promise of ObamaCare turned out not to be 
the case. People's insurance premiums did not go down $2,500. I still 
hear in my town meetings and in correspondence with my constituents 
that some were well-served, but I have a lot of them who were left 
behind, and they are out in the cold.
  At one of my townhalls, I had a middle age couple come up and say: We 
have decided we can't afford health insurance, so we have decided to go 
without.
  They looked at the premiums. They looked at the deductibles that are 
in these markets, and said: We can't pencil it out.
  None of us want that to be the case. That is why I think some of 
these options are really important to look at. And States can do that.
  And that is what President Trump tried to do is take what President 
Obama had agreed to with the short-term plans regulated by States to 
fill gaps to make health insurance options more available and health 
insurance more affordable. He just said: Well, if it is good for 3 
months, what is wrong with 364 days.
  So as a result, you have got 27 States that go up to nearly a year; 
12 are 6 months; 8 at 3 months; and 4 say, no, not in our State at all. 
So I think the report is probably going to give us some valuable 
information.
  Mr. Chairman, I guess I have actually convinced myself I am going to 
support this amendment despite my initial reservations, and I yield 
back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Massachusetts (Mr. Lynch).
  The amendment was agreed to.


                Amendment No. 16 Offered by Mr. Lipinski

  The Acting CHAIR. It is now in order to consider amendment No. 16 
printed in House Report 116-61.
  Mr. LIPINSKI. Mr. Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add at the end of title II the following new section:

[[Page H3889]]

  


     SEC. 205. REPORT ON THE EFFECTS OF WEBSITE MAINTENANCE DURING 
                   OPEN ENROLLMENT.

       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 examining whether the Department 
     of Health and Human Services has been conducting maintenance 
     on the website commonly referred to as ``Healthcare.gov'' 
     during annual open enrollment periods (as described in 
     section 1311(c)(6)(B) of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18031(c)(6)(B)) in such a 
     manner so as to minimize any disruption to the use of such 
     website resulting from such maintenance.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from Illinois (Mr. Lipinski) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Illinois.
  Mr. LIPINSKI. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, American families increasingly struggle with rising 
healthcare costs. That is why I am pleased to support the underlying 
bill which contains some commonsense provisions that will protect 
consumers, lower drug prices, and stabilize the individual insurance 
market, which will provide families with some needed relief.
  The amendment I am offering will further help Americans who purchased 
health insurance on healthcare.gov.
  Americans in 39 States without a State-based exchange depend on 
healthcare.gov to purchase insurance during open enrollment. This past 
year, over 8.4 million plan selections were made on this website.
  Over the past 2 years, the Department of Health and Human Services 
had announced maintenance outages on healthcare.gov for over 12 hours 
every Sunday during open enrollment. I am an engineer. I understand the 
complexity of this website and the heavy volume of users, which means 
that routine maintenance is necessary, even during open enrollment. 
However, I want to ensure that HHS is doing all it can to ensure this 
maintenance is conducted in a way that has the least impact on 
consumers.
  Families need ample time to choose health insurance plans. We must 
make sure that enrollment is not being negatively impacted by these 
outages. My amendment would require a GAO study to determine if 
healthcare.gov outages are having a negative impact on enrollment.
  HHS claims that maintenance is scheduled for times of low site 
traffic, but they have not provided data to support this claim. I know 
that when I am using the online exchange to purchase my insurance each 
year, I often will try to do it on a Sunday when I have free time. This 
may be an anomaly. We need to figure this out.
  What the GAO study would provide is clarity on the best time to 
schedule maintenance. This would help us to make sure HHS is doing 
right by Americans as they navigate the complex process of buying 
health insurance.
  Mr. Chairman, this is a simple, commonsense amendment. I urge a 
``yes'' vote on this amendment, and I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, it should come as no surprise that I seek 
time in opposition to the amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
  Mr. LIPINSKI. Mr. Chair, I yield myself the balance of my time.
  I think this is a commonsense amendment. I ask GAO to look at the 
study and say: Okay. What is the best time to take healthcare.gov 
offline to do maintenance?
  Let's do this the right way. As an engineer, that is the way I think. 
I think most companies would look at it this way.
  So I urge my colleagues to support this amendment, and I yield back 
the balance of my time.

                              {time}  1645

  Mr. WALDEN. Mr. Chairman, I thank the gentleman for bringing his 
amendment as well. He is a distinguished Member of our U.S. House of 
Representatives and an engineer, and we appreciate his intellectual 
horsepower on this issue.
  I was thinking, as he was talking about having the GAO have to do an 
audit to figure out the best time for routine maintenance to provide 
the least disruption to consumers, this is what happens when you have a 
government-run system. You have to have your independent auditors 
figure out how the system can keep current and not disrupt consumers.
  I was thinking that we don't have too many amendments that say let's 
have GAO audit Amazon's website to find out the best times to deal with 
consumers or your local whatever you go to for your hotels or your 
rental cars. Nobody is saying, hey, you have to have GAO, a government 
entity, figure out the best time or worst time to disrupt consumers on 
the Avis website or Enterprise or whatever. But we have to here, which 
is a government-run system with basically one website.
  We all know and we all lived through what happened with the initial 
rollout with this website, so, Mr. Chairman, to my friend from 
Illinois' point, it is important that we give the consumers the best 
possible experience when they are trying to sign up because we have all 
had to deal with it.
  In its initial days, man, it was a mess. I remember all those 
problems. We did hearings and oversight hearings in the Energy and 
Commerce Committee on it.
  Mr. Chairman, this is probably a good idea to do, and I yield back 
the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Illinois (Mr. Lipinski).
  The amendment was agreed to.


                 Amendment No. 17 Offered by Mr. Deutch

  The Acting CHAIR. It is now in order to consider amendment No. 17 
printed in House Report 116-61.
  Mr. DEUTCH. Mr. Chairman, 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 45, line 24, strike ``and''.
       In section 202(a)(2)--
       (1) redesignate subparagraph (B) as subparagraph (D); and
       (2) insert after subparagraph (A) the following new 
     subparagraphs:
       (B) in subparagraph (D), by striking ``and'' at the end;
       (C) in subparagraph (E), by striking the period at the end 
     and inserting ``; and''; and
       Page 46, line 1, strike ``following'' and insert 
     ``following:''
       Page 46, line 2, strike ``flush left sentence:'' and insert 
     the following:
       ``(F) conduct public education activities in plain language 
     to raise awareness of the requirements of and the protections 
     provided under--
       ``(i) the essential health benefits package (as defined in 
     section 1302(a)); and
       ``(ii) section 2726 of the Public Health Service Act 
     (relating to parity in mental health and substance use 
     disorder benefits).''

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from Florida (Mr. Deutch) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Florida.


         Modification to Amendment No. 17 Offered by Mr. Deutch

  Mr. DEUTCH. Mr. Chairman, I ask unanimous consent that my amendment 
be modified in the form I have placed at the desk.
  The Acting CHAIR. The Clerk will report the modification.
  The Clerk read as follows:

  Modification to Amendment No. 17 Printed in House Report No. 116-61

                    Offered by Mr. Deutch of Florida

       In lieu of the matter proposed to be inserted, insert the 
     following:
       Page 45, line 24, strike ``and''.
       In section 202(a)(2)--
       (1) redesignate subparagraph (B) as subparagraph (D); and
       (2) insert after subparagraph (A) the following new 
     subparagraphs:
       (B) in subparagraph (D), by striking ``and'' at the end;
       (C) in subparagraph (E), by striking the period at the end 
     and inserting ``; and''; and
       Page 45, line 24, strike ``and''.
       Page 45, after line 24, insert the following:
       (B) by inserting after subparagraph (E) the following:
       ``(F) conduct public education activities in plain language 
     to raise awareness of the requirements of and the protections 
     provided under--
       ``(i) the essential health benefits package (as defined in 
     section 1302(a)); and
       ``(ii) section 2726 of the Public Health Service Act 
     (relating to parity in mental health and substance use 
     disorder benefits).''; and
       Page 46, line 1, strike ``(b)'' and insert ``(c)''.

  Mr. DEUTCH (during the reading). Mr. Chair, I ask unanimous consent 
to dispense with the reading.

[[Page H3890]]

  The Acting CHAIR. Is there objection to the request of the gentleman 
from Florida?
  Mr. WALDEN. Mr. Chairman, I reserve the right to object.
  The Acting CHAIR. The gentleman from Oregon is recognized on his 
reservation.
  Mr. WALDEN. Mr. Chairman, I know there were a lot of amendments that 
came through the system. I am trying to figure out what the issue is 
here, but I know we offered 16 amendments and got one. The Democrats 
got 25 amendments and had one technical amendment through the Rules 
Committee.
  Could the Parliamentarian or somebody explain what the problem is 
here and why we have to correct it here on the floor?
  That is my question.
  Mr. DEUTCH. Will the gentleman yield?
  Mr. WALDEN. Mr. Chairman, I yield to the gentleman from Florida.
  Mr. DEUTCH. Mr. Chairman, the amendment is a technical amendment to 
address a drafting error so that it is conforming and so there will be 
no problems going forward.
  Mr. WALDEN. Mr. Chair, I withdraw my reservation.
  The Acting CHAIR. The reservation is withdrawn.
  Without objection, the reading of the modification is dispensed with.
  There was no objection.
  The Acting CHAIR. Is there objection to the original request of the 
gentleman from Florida?
  There was no objection.
  The Acting CHAIR. The amendment is modified.
  The gentleman from Florida is recognized for 5 minutes.
  Mr. DEUTCH. Mr. Chairman, I yield myself such time as I may consume.
  I thank my Florida colleague, Representative Castor, for her 
leadership in protecting access to high-quality healthcare in our State 
and across the country and for her authorship of the ENROLL Act to help 
more Americans shop for and sign up for health plans on healthcare.gov.
  My amendment requires navigators to provide information in plain 
language about the 10 essential health benefits that are a part of 
every healthcare.gov plan: outpatient hospital care; emergency care; 
hospitalization; pregnancy, maternity, and newborn care; mental health 
and substance use disorder services; prescription medicines; 
rehabilitative services; labs; preventive care; and pediatric care, 
including dental and vision services.
  It also requires navigators to help consumers understand their 
protections under the Mental Health Parity Act. According to a survey 
commissioned by the American Psychological Association, only 4 percent 
of Americans were familiar with the mental health parity law as of 
2014, and just 7 percent were aware of mental health parity more 
broadly. Those numbers didn't change from the time of passage of the 
Affordable Care Act in 2010 through the first years of enrollment in 
2014.
  Mental health parity means insurance companies can't discriminate 
against Americans battling addiction in the opioid crisis. Parity means 
insurance companies can't make it harder to get care for deadly eating 
disorders than it is to get care for deadly cancer. Parity means we 
treat mental healthcare like healthcare because that is exactly what it 
is.
  The Affordable Care Act's protections have saved lives and the 
financial security of millions of Americans, including one family who 
told me the story of their battle to treat their 19-year-old daughter's 
eating disorder. Here is what they said:

       Our daughter was a sophomore in college when she was 
     diagnosed with an eating disorder. She had to take several 
     leaves of absence from her studies to seek treatment. This 
     would not have been financially possible without the benefits 
     of the ACA. Had she left school for treatment before the 
     passage of the ACA, she would have been dropped from our 
     family insurance. But because of the ACA, she could continue 
     under our coverage.
       It was this ongoing treatment that has allowed our daughter 
     to regain her health enough to graduate from college and 
     maintain full-time employment.

  While it is clear that parity has made improvements, we still have so 
much more to do.
  This week, I heard from another family in my district about their 
daughter's struggle to get coverage and treatment. In the cycle of 
denials and arbitrarily reduced levels of care, her family was able to 
use the parity law to fight for their daughter's life in the courts.
  But that is not enough. Parity protections have opened doors to 
better mental health and addiction treatment for so many Americans. As 
we observe Mental Health Awareness Month, it is important to 
acknowledge how far we have to go.
  My amendment will help more Americans understand the benefits and 
protections available to them and help them get the care they need.
  Mr. Chairman, I urge my colleagues to support it, and I reserve the 
balance of my time.
  Mr. WALDEN. Mr. Chairman, I rise in opposition to the gentleman's 
amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Mr. DEUTCH. Mr. Chairman, this is an important amendment so that 
every American understands that mental health is health and that we 
need to care as much about the health of our bodies from our shoulders 
up as we do from our shoulders down. That is what people need to be 
made aware of so they have the ability to fight for that access to 
mental healthcare.
  Mr. Chairman, I yield back the balance of my time.
  Mr. WALDEN. Mr. Chairman, I appreciate the gentleman's commitment, 
especially on mental health and substance abuse. He has done a lot of 
work in this area.
  I know, Mr. Chairman, when we in the last Congress worked together in 
a bipartisan way, we passed 60 different bills related to the deadly 
scourge of opioid addiction and overdose. The prior Congress to that I 
believe is when we rewrote America's mental health laws for the first 
time in decades.

  We all have friends, family, and people in our communities who need 
help, especially with mental health and, as we know, substance use 
disorder. We did a lot of good work, I would say. We have to make sure, 
to the gentleman's point, that the efforts we have put forward, the 
programs we have initiated, and the funding we put behind these 
programs actually get to the people who need the help.
  Mr. Chairman, I yield such time as he may consume to the gentleman 
from Texas (Mr. Burgess), who was chairman of our subcommittee when we 
were in the majority and now is the top Republican of the Health 
Subcommittee, to talk a little bit about these issues.
  Mr. BURGESS. Mr. Chairman, I thank the gentleman for yielding.
  Mr. Chairman, I think the kindest thing I can say about this 
amendment is it should not be necessary.
  Just a brief review of the history of mental health parity as it 
relates to our healthcare system, of course, those of us who were here 
in Congress the day after the Lehman Brothers bankruptcy was declared 
in September 2008 will recall that Patrick Kennedy's bill dealing with 
mental health parity was used as the vehicle to provide the Troubled 
Asset Relief Program, which followed in the wake of the Lehman Brothers 
bankruptcy.
  So mental health parity was actually written into law in 2008, signed 
by George W. Bush. That was 2 years prior to the passage of the 
Affordable Care Act.
  So the Affordable Care Act comes along. The essential health benefits 
were eventually disclosed in the Affordable Care Act in November 2012, 
about a week after election day, if I recall correctly.
  The mental health parity rules were not written by the Department of 
Health and Human Services until probably 2 years after that, but they 
were written under Secretary Sebelius. As a consequence, those have 
been the rules of the road ever since.
  I guess what I don't quite understand is why the navigator system 
constructed under the Affordable Care Act was not constructed in a way 
that would have allowed this information to be part of the package of 
information that is disclosed by the navigators.
  Perhaps had we had a hearing in the Energy and Commerce Committee 
dealing with this, it might have been instructive when we did the 10-
year reauthorization of the State Children's

[[Page H3891]]

Health Insurance Program a little over a year ago. The parity language 
was, in fact, included at the request of a Democratic member of the 
Energy and Commerce Committee. The parity language was included in the 
rewriting of the reauthorization of the State Children's Health 
Insurance Program.
  But my recollection was, in the navigator program, this should have 
been part of the basic information offered by the navigators.
  I guess, to sum up, I do not understand why it would now take an act 
of Congress to get them to do what they were required to do upon the 
signing of the passage of the Affordable Care Act.
  Mr. WALDEN. Mr. Chairman, I would just conclude that I appreciate the 
gentleman's comments.
  As I look at a bunch of amendments coming up, to my colleague from 
Texas (Mr. Burgess), there are a whole bunch of these that they are 
saying, oh, we have to order the navigators do this, do this, and do 
that.
  You wonder what their current training is that we have to pass laws 
telling them to learn about these things and then go talk to people.
  This is part of my argument that we are pumping a lot of money into a 
program that we know there has been--I don't know if I can say fraud, 
but if you got $200,000 to enroll one person or $2.7 million to enroll 
314, some of the Nation's leading editorial writers have had some 
pretty strong words to say about corruption and scam artists and that 
sort of thing.
  We are having to pass laws that tell them, oh, by the way, talk about 
mental health, talk about substance abuse, talk about referrals to 
community-based organizations, the navigator system, vulnerable 
populations, all these things. Holy smokes, what don't they know and 
what is left out?
  We should have a hearing on this issue in the committee as well as 
the Medicare for All proposal.
  Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR (Mr. Lynch). The question is on the amendment, as 
modified, offered by the gentleman from Florida (Mr. Deutch).
  The amendment, as modified, was agreed to.


           Amendment No. 18 Offered by Mr. Brown of Maryland

  The Acting CHAIR. It is now in order to consider amendment No. 18 
printed in House Report 116-61.
  Mr. BROWN of Maryland. Mr. Chairman, 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 48, line 21, strike the period and insert ``and shall 
     be provided to populations residing in high health disparity 
     areas (as defined in subparagraph (E)) served by the 
     Exchange, in addition to other populations served by the 
     Exchange.''.
       Page 49, line 18, strike the end quotes and the second 
     period and insert the following:
       ``(E) High health disparity area defined.--For purposes of 
     subparagraph (A), the term `high health disparity area' means 
     a contiguous geographic area that--
       ``(i) is located in one census tract or ZIP code;
       ``(ii) has measurable and documented racial, ethnic, or 
     geographic health disparities;
       ``(iii) has a low-income population, as demonstrated by--

       ``(I) average income below 138 percent of the Federal 
     poverty line; or
       ``(II) a rate of participation in the special supplemental 
     nutrition program under section 17 of the Child Nutrition Act 
     of 1966 (42 U.S.C. 1786) that is higher than the national 
     average rate of participation in such program;

       ``(iv) has poor health outcomes, as demonstrated by--

       ``(I) lower life expectancy than the national average; or
       ``(II) a higher percentage of instances of low birth weight 
     than the national average; and

       ``(v) is part of a Metropolitan Statistical Area identified 
     by the Office of Management and Budget.''.

  The Acting CHAIR. Pursuant to House Resolution 377, 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. Chairman, I yield myself 3\1/2\ minutes.
  Mr. Chairman, I rise in support of my amendment and the underlying 
legislative effort that would lower the cost of prescription drugs, 
crack down on junk insurance plans being encouraged by the Trump 
administration, and reverse the administration's irresponsible sabotage 
of the Affordable Care Act.
  Specifically, my amendment would require the HHS Secretary to conduct 
educational outreach to communities with high health disparities and 
would thereby expand outreach efforts to increase coverage among 
African Americans, Latinos, Native Americans, low-income families, and 
rural communities.
  Our effort to help more Americans get access to affordable healthcare 
comes just as we are seeing the impact of the Trump administration's 
effort to undermine our healthcare system.
  This week, we learned that more than 1 million Americans lost their 
health insurance in the past year, and the number of Americans in high-
deductible plans reached an all-time high.
  Black and Latino Americans and families living at or near the poverty 
line are particularly impacted by President Trump's sabotage. These 
communities are the most at risk of being uninsured, and these 
communities have always faced the greatest barriers to obtaining care 
and have reported the poorest health outcomes.

                              {time}  1700

  Before the Trump administration, we saw large gains in coverage for 
low-income individuals and people of color under the Affordable Care 
Act.
  Finally having that health insurance made a key difference in 
determining when people got care, where they got their care, and, 
ultimately, how healthy they could be. However, this progress has been 
rapidly reversed over the last 2 years.
  My amendment would ensure that we aren't leaving behind those with 
predictably poor health outcomes, like those with lower life expectancy 
or children born with lower birthweight.
  Families in high-disparity areas suffer from low levels of 
healthcare, literacy, language barriers, and limited awareness of the 
Affordable Care Act's coverage options.
  In this uncertain environment, in our complicated healthcare system, 
in this constant fight for access to healthcare in this country, 
knowledge is half the battle.
  I strongly encourage my colleagues to support this amendment. Help 
all Americans attain the knowledge they need and win their healthcare 
battles.
  Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek the time in opposition to the 
gentleman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Mr. BROWN of Maryland. Mr. Chairman, I yield 1 minute to the 
gentleman from Illinois (Mr. Krishnamoorthi).
  Mr. KRISHNAMOORTHI. Mr. Chairman, I rise today in support of 
amendment No. 18 to H.R. 987.
  I want to thank Congressman Brown for his partnership on this 
amendment, which will ensure that we conduct thorough outreach to 
inform consumers in areas with high health disparities about their 
insurance options.
  The underlying legislation restores assistance to help Americans 
enroll in affordable, high-quality health insurance, and this amendment 
makes sure those efforts include a particular focus on low-income areas 
most in need not only of health insurance, but also of improved health 
outcomes.
  In addition to reversing the Trump administration's sabotage of the 
Affordable Care Act, this bill is a huge step forward in our efforts to 
lower the cost of prescription drugs.
  For families in my district and across the country, the high cost of 
prescription drugs is more than a health issue; it is an economic 
issue. Increasing competition and improving access to safe, lower cost 
generics can save American families thousands of dollars each year at 
the pharmacy counter.
  Mr. Chair, working families are counting on this body to help 
strengthen access to high-quality health insurance. For this reason, 
Mr. Chair, I urge my colleagues to support this amendment.
  Mr. BROWN of Maryland. Mr. Chair, may I inquire as to how much time 
is remaining.
  The Acting CHAIR. The gentleman from Maryland has 1\1/2\ minutes 
remaining.

[[Page H3892]]

  

  Mr. BROWN of Maryland. Mr. Chair, I yield such time as she may 
consume to the gentlewoman from California (Ms. Barragan).
  Ms. BARRAGAN. Mr. Chair, I am proud to join my colleague, Congressman 
Brown, in cosponsoring his amendment, implementing outreach and 
educational activities in areas with high health disparities.
  I know about this all too well. I represent one of these districts, a 
district that is a majority minority. It is 88 percent Latino and 
African American, combined. These are the types of districts where you 
have higher health disparities happening, where Latinos and African 
Americans have more diabetes than anybody else.
  My district also happens to be 357 out of 435. That is where we land 
as far as income of all the congressional districts in Congress, where 
people need this information. They need the outreach so that they know 
what kind of access they have to healthcare so that they have those 
options.
  Providing opportunities to underserved communities to learn about 
their healthcare coverage options will result in more people signing up 
for affordable care. More people will get treated when they become 
sick, and more people will be able to live healthy and productive 
lives.
  Mr. Chair, I urge my colleagues to support this amendment.
  Mr. BROWN of Maryland. Mr. Chairman, I yield back the balance of my 
time.
  Mr. WALDEN. Mr. Chairman, let me just say a couple of things. One, I 
represent a very rural district in Oregon. It is two-thirds of the 
landmass of the State. We suffer a lot of these same issues: low 
income, high levels of poverty, and the need for basic services.
  Mr. Chairman, that is why I worry a lot about making sure our 
community health centers get funded. I think you know this. They run 
out of funding in just a matter of months. The National Health Service 
Corps, same thing. By the end of September, I think they run out of 
money. I have a number of Indian reservations. Native Americans. Their 
Special Diabetes Program runs out of money. The teaching health centers 
run out of money.
  Yes, today we are pouring money into a program that some of our 
Nation's leading editorial writers have called susceptible to scam 
artists and corruption and that spends $2.7 million to sign up 314 
people. That doesn't seem like a very good expenditure to me. I would 
rather put that money into our community health centers and into some 
of these other proven programs that work.
  I think it is fine to do outreach, certainly, and to expand 
education. I do wish it were more fulsome. I wish there weren't a gag 
restriction on our navigators so that they can't talk about other 
insurance alternatives that our States have pioneered and regulate, 
that even the Obama administration approved these short-term plans; yet 
derided today, these were approved, in many cases, under the last 
administration.

  This one said: If they work good for 3 months, let's see if States 
want them for 6 or 9 or pretty close to 12.
  That is what the President did.
  President Trump, too, if you think about the economy--all we ever 
hear on the other side is kind of all the negative. It is sort of 
Debbie Downer day here.
  Actually, the economy is doing really well, and, as a result, people 
are getting jobs. When they are getting jobs, they are getting bigger 
paychecks. They are also getting insurance. And 2.5 million people now 
have insurance who didn't have it before, through their employer, 
during the Trump administration.
  I realize they are not going to go bragging on the Trump 
administration, my friends to the left, but I do think it is important 
to get the facts out there because facts matter, and I believe in 
facts.
  Mr. Chair, 2.5 million more people now have insurance who didn't have 
it before, and they have it through their employer. That is the 
direction we should go: jobs, income, insurance through your employer.
  Then what we really should focus on--and I think there is bipartisan 
support for this--is how do we get at the costs for healthcare.
  By the way, who knows what anything costs, right? We are paying more 
and more out of pocket through our deductibles and our copays, yet what 
does an MRI cost here versus there versus there?
  I was at the White House with the President on Thursday, Mr. Chair, 
and he is going after surprise billing. My friend from New Jersey and I 
are joined on this effort to pass bipartisan legislation so that the 
consumer doesn't get stuck with a bill because somebody showed up to 
care for him at a hospital that, it turns out, wasn't in their plan. 
They played by the rules, the consumer did.
  We had one example there of a doctor whose daughter got care and then 
was asked to do a urine test because of some medication. They wanted to 
do just a quick test. The doctor said: Hey, will you do it? She did it 
on the way out.
  It turned out the lab, I think it was, was not in the network of her 
insurance plan. She didn't know that. She just followed the doctor's 
orders. Do you know what that bill was? Over $17,000.
  He brought a copy of the bill. I don't have it here, but he brought 
it to the White House.
  And President Trump is full-throat ready to solve this. Just as he 
and his administration--I don't think we have ever had a President, not 
in my lifetime, that has leaned in more to get prescription drug prices 
down for consumers.
  That is what is going on there in the real world. And the President 
and Secretary Azar and the team at CMS, they are leading on this now.
  There are things you might like or dislike in terms of their 
proposals, but we have never had a President and an administration do 
more to try and drive out the unnecessary costs that consumers are 
being forced to pay.
  That is where they are making the decision of whether they can afford 
to actually take the drugs from the pharmacist and go home or leave 
them on the counter.
  So we have got a lot of issues, and some of them we are going to work 
out. I just so regret that we are here today with these for funding the 
navigator program with another $25 million on top of the 68 so they can 
spend $2.7 million and sign up 314 people. We can do that much more 
efficiently. We have proven that.
  CMS says that others can do it for much less money, much less money. 
Not $767 per enrollee, but $2.40. Who wouldn't take that deal, $2.40 
per enrollee or $767?
  So I just think there is a better way to operate. This amendment is 
fine in the end, I guess, and so I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Maryland (Mr. Brown).
  The amendment was agreed to.


                 Amendment No. 19 Offered by Mr. Gomez

  The Acting CHAIR. It is now in order to consider amendment No. 19 
printed in House Report 116-61.
  Mr. GOMEZ. Mr. 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 45, line 24, strike ``and''.
       Page 45, after line 24, insert the following new 
     subparagraphs:
       (B) in subparagraph (D), by striking ``and'' at the end;
       (C) in subparagraph (E), by striking the period at the end 
     and inserting ``; and'';
       (D) by inserting after subparagraph (E) the following new 
     subparagraph:
       ``(F) provide referrals to community-based organizations 
     that address social needs related to health outcomes.''; and
       Page 46, line 1, strike ``(b)'' and insert ``(e)''.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from California (Mr. Gomez) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from California.
  Mr. GOMEZ. Mr. Chair, I believe that the American people are well 
aware that this administration, the Trump administration, has taken 
steps to sabotage the Affordable Care Act, and now my party, the 
Democrats, are taking major steps to reverse it. But, as we do so, we 
should also address health equity.
  My amendment will ensure that the ACA navigators can and should refer

[[Page H3893]]

Americans to community-based organizations that also address social 
needs tied to health outcomes.
  Social factors like your ZIP Code, income, race, ethnicity, and 
language ability all play a major role in one's health. A good example 
in the communities I represent is housing and homelessness. Without 
adequate housing, it is hard to address people's healthcare needs.
  At a recent roundtable I had with hospitals, community health 
centers, and other medical professionals, they made clear that 
homelessness profoundly impacts people's and their patients' health. 
Hospitals like L.A. County-USC are looking at homelessness as a health 
risk factor.
  What does that mean? That means, when you get checked into L.A. 
County-USC, they not only determine do you have a family history of 
preexisting conditions like heart disease and hypertension, have you 
suffered from alcoholism, they not only consider that, but now they put 
on the board, right above the patient, ``Homeless.''
  The reason why is that you might be able to take care of their 
underlying healthcare condition, but, if they end up back on the street 
days later, then their health outcomes will be negatively impacted.
  So organizations in our communities that are not necessarily 
healthcare related can play a critical role in addressing healthcare 
outcomes.
  Navigators must understand what our constituents are facing. They can 
meet people where they are and are well positioned to refer them to 
organizations that can improve that individual's long-term healthcare 
outcome and also reduce costs.
  We know that the Trump administration is undermining ObamaCare, and 
we need to reverse it with this legislation. Yet, at the same time, we 
must improve health equity to ensure all Americans have meaningful 
access to care. My amendment would do just that: improve health equity, 
lower costs, and help Americans from all backgrounds get and stay 
healthy.
  Mr. Chair, I yield back the balance of my time.
  Mr. WALDEN. Mr. Chair, I seek the time in opposition to the 
gentleman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chair, I will try and make this fairly quick.
  I actually am going to oppose this amendment for this reason. Here we 
are going through trying to say to the health navigators, in amendment 
after amendment: Your job is to enroll people in health insurance. That 
is your job. And, by the way, we are going to have to pass a law that 
tells you to be sure and include a discussion about mental health, be 
sure and include and get educated on substance use disorder benefits.
  One after another, we are going through and putting in the statute 
all the things that ought to be, A, common sense and, B, ought to be 
part of an overall educational program for the navigators.
  And now recognizing, well, first of all, they are very expensive; 
second, there has been at least some level of questionable activity in 
the use of the taxpayer dollars; and, third, they don't know what they 
are doing, so we have got to instruct them via statute; now we are 
going to say: By the way, go do all these other things, too, that have 
nothing to do directly with enrolling people in the Affordable Care 
Act.
  So you are going to say, on the one hand: We don't think you are 
getting it right; we have got to give you more money. Now we are going 
to give you new duties that are kind of loosely described, if you ask 
me, to provide referrals to community-based organizations and address 
social needs related to health outcomes.
  That is all going to be in law now? Really?
  I think this whole program, the more I sit and listen to all the 
amendments that need to be put into law to change it--this was an 
ObamaCare creation, so I guess we are--I don't know. I wouldn't say you 
are sabotaging ObamaCare with this, but, certainly, you are changing 
ObamaCare and the navigators.
  We are looking at the costs, and, gosh, there is a lot we could do.

                              {time}  1715

  I think the gentleman has 40 health centers in his district. And I 
assume he knows that I have got about 63 locations; and I assume the 
gentleman knows the money for those health centers runs out at the end 
of the fiscal year, and we have got to find a way to pay for that. I 
would rather put the money into that than into this program.
  So, Mr. Chairman, I am going to oppose this amendment, and I yield 
back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from California (Mr. Gomez).
  The amendment was agreed to.


                Amendment No. 20 Offered by Ms. Escobar

  The Acting CHAIR. It is now in order to consider amendment No. 20 
printed in House Report 116-61.
  Ms. ESCOBAR. Mr. Chairman, 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 45, strike lines 20 through 24 and insert the 
     following:
       (A) by amending subparagraph (C) to read as follows:
       ``(C) facilitate enrollment, including with respect to 
     individuals with English proficiency individuals and 
     individuals with chronic illnesses, in qualified health 
     plans, State medicaid plans under title XIX of the Social 
     Security Act, and State child health plans under title XXI of 
     such Act; and''.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentlewoman 
from Texas (Ms. Escobar) and a Member opposed each will control 5 
minutes.


 =========================== NOTE =========================== 

  
  May 16, 2019, on page H3893, the following appeared: The Acting 
CHAIR. Pursuant to House Resolution 43, the gentlewoman from Texas 
(Ms. ESCOBAR) and a Member opposed each will control 5 minutes.
  
  The online version has been corrected to read: The Acting CHAIR. 
Pursuant to House Resolution 377, the gentlewoman from Texas (Ms. 
ESCOBAR) and a Member opposed each will control 5 minutes.


 ========================= END NOTE ========================= 


  The Chair recognizes the gentlewoman from Texas.


        Modification to Amendment No. 20 Offered by Ms. Escobar

  Ms. ESCOBAR. Mr. Chairman, I ask unanimous consent that my amendment 
be modified in the form that I have placed at the desk.
  The Acting CHAIR. The Clerk will report the modification.
  The Clerk read as follows:

  Modification to Amendment No. 20 printed in House Report No. 116-61

                    Offered by Ms. Escobar of Texas

       In lieu of the matter proposed to be inserted, insert the 
     following:
       Page 45, strike lines 20 through 24 and insert the 
     following:
       (A) by amending subparagraph (C) to read as follows:
       ``(C) facilitate enrollment, including with respect to 
     individuals with limited English proficiency and individuals 
     with chronic illnesses, in qualified health plans, State 
     medicaid plans under title XIX of the Social Security Act, 
     and State child health plans under title XXI of such Act; 
     and''.

  Ms. ESCOBAR (during the reading). Mr. Chair, I ask unanimous consent 
to dispense with the reading.
  The Acting CHAIR. Is there objection to the request of the 
gentlewoman from Texas?
  Mr. WALDEN. Mr. Chairman, reserving the right to object.
  The Acting CHAIR. The gentleman from Oregon is recognized on his 
reservation.
  Mr. WALDEN. Mr. Chairman, I guess this is the second time we have had 
to edit amendments on the House floor, if I understand what is 
happening.
  There were a lot of amendments offered in the Rules Committee. We 
were promised by the Democrats at the beginning of this legislative 
session that this would be an open House where our amendments would be 
considered. I know 92 percent of the amendments the Democrats have 
allowed to come to the floor have been Democrat amendments. Imagine 
that.
  We had 16 Republican amendments on this bill alone. We got one 
amendment. Democrats got 25, and two of them we have had to edit here 
on the floor. And then we had one that was a bipartisan, just technical 
change amendment.
  I sure hope we are not going to see that for the rest of this 
Congress under Democratic control, that we are shut out of the 
amendment process.
  When Republicans were in charge and had the Rules Committee, 45 
percent, something like that, of the amendments were minority 
amendments, Democrat amendments. We opened the floor to that, and now 
it has been shut down.
  Mr. Chairman, I won't object to this change. It needs to be done.
  Mr. Chairman, I withdraw my objection.

[[Page H3894]]

  The Acting CHAIR. The reservation is withdrawn.
  Without objection, the reading of the modification is dispensed with.
  There was no objection.
  The Acting CHAIR. Is there objection to the original request of the 
gentlewoman from Texas?
  There was no objection.
  The Acting CHAIR. The amendment is modified.
  The Chair recognizes the gentlewoman from Texas.
  Ms. ESCOBAR. Mr. Chairman, I yield myself such time as I may consume.
  I rise today to offer an amendment to H.R. 987, the Strengthening 
Health Care and Lowering Prescription Drug Costs Act.
  The navigator program is crucial to communities like El Paso, where 
we have one of the highest uninsured rates in the State of Texas.
  Navigators provide free assistance to my constituents as they 
maneuver through the marketplace to find a healthcare plan that is 
right for them. When funded adequately, these programs help decrease 
the uninsured population across the country.
  However, the Trump administration has sought to cut funding for the 
navigator program in its plan to systematically undermine the 
Affordable Care Act.
  By slashing the program's funding by 84 percent over the last 2 
years, the total funds allotted for it now stands at $10 million.
  To exemplify these draconian cuts, consider this:
  In 2017, there were nine navigator programs funded in Texas and two 
operating in El Paso County.
  In 2018, the number of navigator programs in Texas dropped to just 
two, with only one now operating in El Paso County. This presents a 
challenge to States and districts like mine that have seen their 
populations increase over the past decade.
  The Center for Medicare and Medicaid Services has coupled these deep 
cuts with a rule overturning a requirement for navigator programs to 
train their assisters to help individuals with chronic illnesses and 
limited English proficiency.
  While the Trump administration claims this will give navigators more 
flexibility to tailor their training for the populations they serve, it 
is really another attempt to scale back what has proven to be a 
successful program.
  By cutting funds and reversing this requirement, navigator programs 
will be forced to choose between extra training for their assisters or 
hiring more of them to cover counties now lacking operational programs.
  Navigator programs that do not provide proper training could result 
in their assisters being underprepared when a consumer from a 
vulnerable population comes to them for assistance. Enrolling in the 
marketplace can be complex for anyone, especially for those whose 
primary language is not English.
  While H.R. 987 restores funding to the navigator program, we must 
ensure these programs continue to train their assisters to help 
underserved populations.
  My amendment does just that by requiring Navigators to provide 
training for their assisters to serve vulnerable populations, including 
individuals with chronic illnesses and limited English proficiency.
  In my home county of El Paso, there are almost 25,000 uninsured 
individuals who are not English proficient. This amendment will ensure 
navigator programs are able to help all El Pasoans find suitable 
healthcare plans.
  Simply put, Mr. Chair, access to affordable healthcare is a right, 
and my amendment ensures we make every attempt to leave no one behind.
  I urge my colleagues to support this amendment, and I thank 
Representatives Torres and Porter for their cosponsorship.
  Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the 
gentlewoman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Ms. ESCOBAR. Mr. Chairman, I yield back the balance of my time.
  Mr. WALDEN. Mr. Chairman, I know it has been a long day here on the 
floor, and we are covering a lot of ground. We have got a few more 
amendments to go.
  Again, I think as we go through these amendments, and the gentlewoman 
is spot on, we have got to make sure people are trying to help people 
get access to insurance; can speak the language, can assist in each one 
of our districts.
  But it is kind of an indictment to the existing program, if you think 
about it, that you have got to come here and legislate this. To me, 
whether it is about mental health, or substance abuse, or this, or the 
one before, this should be commonsense management of a program, and it 
tells me we have got a problem with the underlying navigator program.
  We know that it is very, very expensive. We know that they enroll 
less than 1 percent, less than 1 percent. Everything we are arguing 
about this afternoon with all the amendments on the navigator program, 
both, are shining the light on the shortcomings of the program itself, 
which I think the administration has pointed to and said, This thing 
isn't working very well, and it is at the least very expensive; $767 
per enrollee, it appears. In the private sector they do it for much, 
much, much, much less.
  So it is not that this amendment is bad or misguided. I don't think 
it is. But I think, once again, it is like a bright light on the 
underlying program that must be fraught with all kinds of problems, 
because we have got 16--no, wait. We have got 25 amendments from my 
friends on the other side of the aisle, most of which are to tell the 
navigator how to do a better job and to put in Federal statute how to, 
basically have common sense.
  I have never thought, by the way, you could legislate common sense. I 
don't know what my colleagues think of that. I never thought you could.
  But I do know we need to fund community health centers, and the 
National Health Service Corps, and special diabetes programs, and 
teaching hospitals. And we have got this issue of the--this will be one 
that will be interesting.
  If you don't want to change ObamaCare, are you going to let the 
Cadillac tax hit insurance plans of union workers and people working in 
business?
  Or are you going to put off the big cuts that are coming right at our 
hospitals?
  I had my hospitals in the other day, and they are saying, Boy, I sure 
hope you are going to turn off those DSH cuts that are headed our way. 
We did that last Congress. I helped lead the effort on that.
  But that is actually called for in the underlying ObamaCare which, by 
the way, a disproportionate share of hospitals are those in our rural 
areas, in many cases, have a high portion of Medicaid, and they were 
supposed to, as part of the grand bargain with the Obama administration 
and Democrats, take these cuts. And now they are coming back to us 
saying, We can't afford to take these cuts.
  So I don't know if you will describe that as sabotaging ObamaCare, 
but I will bet you are going to join us in trying to hold off those DSH 
cuts that are coming at our community hospitals.
  So it just strikes me, again, that this navigator program must be a 
mini-disaster in the making if everybody has to come to the floor with 
an amendment to tell them how to do their job, and to reach out and 
serve the people this whole thing was intended to serve.
  So it is not that I am opposed to the amendment. I just think the 
underlying program is pretty darn expensive. But you have heard me say 
that before today, Mr. Chairman, a time or two.
  I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment, as modified, 
offered by the gentlewoman from Texas (Ms. Escobar).
  The amendment, as modified, was agreed to.


                 Amendment No. 21 Offered by Ms. Wexton

  The Acting CHAIR. It is now in order to consider amendment No. 21 
printed in House Report 116-61.
  Ms. WEXTON. Mr. Chairman, 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 204, strike ``The Secretary'' and insert the 
     following:

[[Page H3895]]

       (b) Prohibition.--The Secretary
       In section 204, insert after the header the following new 
     subsection:
       (a) Findings.--Congress finds the following:
       (1) On August 3, 2018, the Administration issued a final 
     rule entitled ``short-term, limited-duration insurance'' (83 
     Fed. Reg. 38212).
       (2) The final rule dramatically expands the sale and 
     marketing of insurance that--
       (A) may discriminate against individuals living with 
     preexisting health conditions, including children with 
     complex medical needs and disabilities and their families;
       (B) lacks important financial protections provided by the 
     Patient Protection and Affordable Care Act (Public Law 111-
     148), including the prohibition of annual and lifetime 
     coverage limits and annual out-of-pocket limits, that may 
     increase the cost of treatment and cause financial hardship 
     to those requiring medical care, including children with 
     complex medical needs and disabilities and their families; 
     and
       (C) excludes coverage of essential health benefits 
     including hospitalization, prescription drugs, and other 
     lifesaving care.
       (3) The implementation and enforcement of the final rule 
     weakens critical protections for up to 130 million Americans 
     living with preexisting health conditions and may place a 
     large financial burden on those who enroll in short-term 
     limited-duration insurance, which jeopardizes Americans' 
     access to quality, affordable health insurance.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentlewoman 
from Virginia (Ms. Wexton) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Virginia.
  Ms. WEXTON. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, my amendment includes findings about how short-term, 
limited-duration insurance weakens protections for the millions of 
Americans living with preexisting health conditions, including children 
with complex medical needs and disabilities.
  Last year, the Trump administration greatly expanded the sale and 
marketing of short-term, limited-duration insurance, also known as junk 
insurance, plans. And these plans are junk because they don't provide 
critical protections laid out by the Affordable Care Act.
  As my amendment points out, these plans lack important financial 
protections, may discriminate against individuals living with 
preexisting conditions, and may exclude coverage of essential health 
benefits such as prescription drugs and hospitalization.
  The protections afforded by the Affordable Care Act are literally 
lifesaving for children with complex medical needs and disabilities. 
These children require specialized treatment and medical care that 
depends on medications, therapies, and equipment such as ventilators, 
oxygen tanks, feeding tubes, and specialized wheelchairs. The ACA's 
essential health benefits ensure plans cover this care and treatment 
that these children may need.
  Children with complex medical needs often require extended hospitals 
stays with medical care costing into the millions of dollars. Families 
who purchase junk plans and whose children subsequently encounter 
medical difficulties may soon find that these insurance plans are 
effectively worthless, failing to cover the healthcare their children 
need, and terminating their coverage if it becomes too expensive. These 
children could also be subject to lifetime coverage caps that they 
would exceed before they are old enough even to go to preschool.
  The Trump administration's actions don't only harm families 
purchasing junk plans. As more people participate in these junk plans, 
the families who remain in comprehensive ACA-compliant plans would also 
see the cost of their insurance premiums increase.
  No family should face uncertainty about whether or not their children 
will have access to lifesaving care when they need it most.
  My amendment includes findings that highlight just how harmful these 
junk plans are for the up to 130 million Americans living with 
preexisting health conditions, and how they jeopardize Americans' 
access to quality, affordable health insurance.
  Mr. Chairman, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the 
gentlewoman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.

                              {time}  1730

  Ms. WEXTON. Mr. Chairman, junk plans provide inadequate medical 
coverage and circumvent crucial consumer protections afforded by the 
Affordable Care Act and are harmful to those living with preexisting 
conditions.
  We have a responsibility to guarantee affordable quality health 
insurance for every American.
  Mr. Chair, I hope my colleagues agree, and I urge them to support 
this amendment. I thank my colleagues, and I yield back the balance of 
my time.
  Mr. WALDEN. Mr. Chair, I yield myself such time as I might consume.
  Mr. Chairman, I note that the gentlewoman's amendment--and it is a 
serious amendment, we appreciate it being offered. But in her State of 
Virginia, the State of Virginia said it is okay to offer these plans up 
to 364 days duration, short-term, limited-duration insurance policies. 
These fill a gap that are regulated by her State.
  These kinds of plans, Mr. Chairman, were first approved by the Obama 
administration, because they must have recognized that there would be a 
need for a short-term plan to fill a gap here and there, and obviously 
a lot of Americans have taken advantage of those plans.
  Now, because of that, the Trump administration said, well, maybe if 
they are good for 3 months, we should let States decide up to a year, 
and then they could go up to a couple of years, I guess. Four states 
have already said no way, no how; three have said 8 months, that is as 
long as you can go; 12 have said that you can go to 6 months; and 27 
States, including the State of Virginia, the Commonwealth of Virginia, 
has said 364 days.
  Now, look, the important thing here, and I think we would have to 
agree on this if this were the amendment, there should be full and 
complete disclosure of what these plans cover or do not cover, full and 
complete, completely transparent, because the last thing any of us 
wants is someone with a preexisting condition or some other issue or 
complex medical situation, like the gentlewoman described, from getting 
a plan that basically they are told covers those things when it 
doesn't.
  Now, it is interesting, I know Dr. Burgess is not only a 
distinguished member of the Energy and Commerce Committee, but one of 
the rare individuals in our body that also serves on the Rules 
Committee.
  If memory serves me right, Dr. Burgess, I believe one of our 
colleagues, the chair of the Energy and Commerce Subcommittee on 
Health, had an amendment in the Rules Committee that would require full 
disclosure and transparency, right?
  Mr. BURGESS. Will the gentleman yield?
  Mr. WALDEN. I yield to the gentleman from Texas.
  Mr. BURGESS. Mr. Chair, the gentleman is correct. And, in fact, if 
the gentleman will recall, that in our committee work on these bills 
dealing with the Affordable Care Act, the chairwoman of the 
Subcommittee on Health actually had this as a stand-alone bill.
  It was not considered when we did the markup on the other four bills. 
For some reason, it fell off the list that day. I don't know why. I 
wasn't consulted, and I wasn't advised. But it was offered as one of 
the amendments up in the Rules Committee, again, by a Democratic member 
of the Energy and Commerce Committee, the chairwoman of the 
Subcommittee on Health, but the amendment was not made in order.
  And, again, I don't know why. I was not part of the discussion of the 
majority that decided which amendments were going to come to the floor.
  It was perhaps a little surprising, because a majority of the 
amendments that were made in order were Democratic amendments. And, 
again, this was a Democratic amendment.
  I think the ranking member of the full committee and I agree, that 
this is precisely the type of situation where you would want the 
purchaser to have complete knowledge of what they were buying. And the 
State Commissioner of Insurance, I know in my State in Texas, is very 
clear about that. On the website of the State of Texas, you need to 
know what you are buying.
  This would be one of those cases where that disclosure, in fact, 
would be extremely helpful to the family that is

[[Page H3896]]

trying to make a decision. Because, look, why is someone looking at 
buying a limited-duration plan? They are looking at buying a limited-
duration plan because they can't afford what is being sold on 
healthcare.gov or there perhaps is some temporary situation, a job 
transition or something that they are trying to cover.
  The fact of the matter remains that the child described in the 
previous discussion would likely be better covered in one of the plans 
sold at healthcare.gov, but if, for whatever reason, the family decided 
that they wanted to investigate a less expensive plan and a limited-
duration plan, that is certainly their right to do so. Probably not the 
best advice for them to buy that limited-duration plan, but certainly 
they should be free to do so, but they should also receive the 
information.
  Mr. WALDEN. Mr. Chair, back to the issue of the gentlewoman's 
amendment, the chair of the Subcommittee on Health, her amendment, the 
short summary here says:

       Require short-term, limited-duration insurance plans to 
     prominently carry a disclosure the plan provides coverage for 
     limited medical conditions and benefits.

  That amendment was not made in order. It should have been made in 
order, because then we could get to the other question here, which I 
think we all agree on, is that there needs to be complete transparency 
of these things, because they don't cover everything. We all buy lots 
of insurance products for cars, houses, life insurance, disability, and 
all these things, and I want it to be easy to understand, full 
disclosure.
  Mr. Chair, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Virginia (Ms. Wexton).
  The question was taken; and the Acting Chair announced that the ayes 
appeared to have it.
  Ms. WEXTON. Mr. 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 Virginia 
will be postponed.


                 Amendment No. 22 Offered by Mr. Pappas

  The Acting CHAIR. It is now in order to consider amendment No. 22 
printed in House Report 116-61.
  Mr. PAPPAS. Mr. 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 47, line 23, insert after ``activities'' the 
     following: ``and annual enrollment targets'' (and update the 
     table of contents accordingly).
       Page 48, line 2, strike ``paragraph'' and insert 
     ``paragraphs''.
       Page 49, line 18, strike the closing quotation mark and 
     second period and insert the following:
       ``(5) Annual enrollment targets.--For plan year 2020 and 
     each subsequent plan year, in the case of an Exchange 
     established or operated by the Secretary within a State 
     pursuant to this subsection, the Secretary shall establish 
     annual enrollment targets for such Exchange for such year.''.

  The Acting CHAIR. Pursuant to House Resolution 377, 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. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chair, I want to thank my colleagues for introducing this 
legislation that works to improve our healthcare system and lower the 
skyrocketing costs of prescription drugs. This bill will bring much 
needed relief to the millions of Americans who are struggling to afford 
the care that they need.
  The people from my home State of New Hampshire know that we must move 
beyond a political debate over the ACA to bipartisan action that will 
improve coverage and lower costs.
  Just last week, I was proud to vote to protect Americans with 
preexisting conditions and introduce an amendment to safeguard coverage 
for those suffering from substance use disorder.
  The amendment I am offering today strengthens this legislation and 
the ACA by ensuring the administration is actively working to expand 
Americans' access to care.
  Specifically, my amendment requires the Department of Health and 
Human Services to set enrollment targets, goals that can be tracked and 
pursued with smart investments of resources.
  This commonsense practice was employed by the previous 
administration, yet the Trump administration has failed to do so.
  While they should be promoting enrollment for affordable coverage, 
Health and Human Services has slashed the advertisement and outreach 
budget by 90 percent and it cut in-person enrollment assistance funding 
nearly in half.
  These actions have very real consequences. Recent reports indicate 
that more than 1.1 million Americans lost healthcare coverage in 2018.
  In my State of New Hampshire, more than 10,000 individuals lost 
coverage over the past 3 years.
  These cuts have hindered organizations such as the Bi-State Primary 
Care Association in New Hampshire.
  The organization is responsible for helping nearly 110,000 
underserved Granite Staters navigate the complexities of our healthcare 
system and find coverage in the enrollment period, which lasts only 6 
weeks.
  In the words of Executive Director Tess Kuenning:

       The loss in funding means a loss of a trusted impartial 
     adviser educating and providing information so people can 
     make an informed decision about health insurance coverage.

  Without collecting and monitoring enrollment numbers, it is 
impossible to hold the department accountable or track how they are 
deploying resources to support enrollment.
  In fact, the nonpartisan GAO slammed the administration for refusing 
to set targets and having no way to evaluate overall performance.
  As a small business owner, I can't fathom how leaders can work 
towards success without clearly defined goals. How do you measure 
progress? How do you know how to best utilize your resources? How do 
you know if you need to make a course correction?
  The American people deserve to know their government is working to 
expand access to care, not seeking to limit it.
  In the greatest Nation on Earth, no American should miss the 
opportunity to have healthcare, economic security, quality of life, and 
the peace of mind that comes with it.
  Mr. Chair, I urge the adoption of this amendment, and I reserve the 
balance of my time.
  Mr. WALDEN. Mr. Chairman, I rise in opposition to the amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
  Mr. PAPPAS. Mr. Chairman, I urge adoption of this amendment, and I 
yield back the balance of my time.
  Mr. WALDEN. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chairman, while I appreciate the gentleman's amendment, and I am 
all about setting targets and holding people accountable for their 
goals, it turns out the navigators already tried that, and it didn't 
work very well. So I don't know that having Secretary Azar set a goal 
for each of the exchanges and all is going to work any better.
  Navigators enrolled less than 1 percent of total enrollees. And 
according to one report, in fact, the navigator's program had an 
enrollment goal of 2,000, but, well, he kind of fell short. He only 
enrolled one person. So that is a bit of a problem.
  I think goals are a good thing, but I don't know that that is going 
to help here. We know how many people get enrolled. We know information 
around this.
  I don't know. Once again, here we are trying to micromanage a program 
that clearly has a lot of flaws, or we wouldn't be putting all these 
things into statute.
  I mean, I don't think we are giving these amendments to 25 Democrats 
just because they are freshmen. I think they have substantive issues 
they are trying to bring to the floor here. But it seems to me that 
this is really odd to micromanage a program to this level, and so I am 
going to end up opposing this amendment.
  Mr. Chairman, 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).

[[Page H3897]]

  The amendment was agreed to.


           Amendment No. 23 Offered by Mr. Cox of California

  The Acting CHAIR. It is now in order to consider amendment No. 23 
printed in House Report 116-61.
  Mr. COX of California. Mr. 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 47, after line 18, insert the following:
       (b) Promote Transparency and Accountability in the 
     Administration's Expenditures of Exchange User Fees.--For 
     plan year 2020 and each subsequent plan year, not later than 
     the date that is 3 months after the end of such plan year, 
     the Secretary of Health and Human Services shall submit to 
     the appropriate committees of Congress and make available to 
     the public an annual report on the expenditures by the 
     Department of Health and Human Services of user fees 
     collected pursuant to section 156.50 of title 45, Code of 
     Federal Regulations (or any successor regulations). Each such 
     report for a plan year shall include a detailed accounting of 
     the amount of such user fees collected during such plan year 
     and of the amount of such expenditures used during such plan 
     year for the federally facilitated Exchange operated pursuant 
     to section 1321(c) of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 18041(c)) on outreach and enrollment 
     activities, navigators, maintenance of Healthcare.gov, and 
     operation of call centers.
       Page 47, line 19, strike ``(b)'' and insert ``(c)''.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from California (Mr. Cox) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from California.
  Mr. COX of California. Mr. Chair, I am honored to be here today to 
introduce my amendment to H.R. 987, the Strengthening Health Care and 
Lowering Prescription Drug Costs Act.
  My amendment promotes transparency and accountability to how the 
Trump administration is spending Affordable Care Act, ACA, user fees.
  For nearly 2 years now, the Trump administration and Republicans in 
Congress have tried and failed to repeal the ACA. Had they been 
successful, 23 million hardworking Americans would have lost their 
health insurance and be left with nothing, no health security for 
themselves, their children, or their families.
  When those efforts didn't pan out, the Trump administration and our 
friends across the aisle turned their attention to sabotaging the ACA, 
dismantling the law piece by piece.
  First on the chopping block, they shorted the ACA enrollment periods 
by over half, from 92 days to 45. Less time to make a decision means 
less participation.
  Next up was cutting funding for consumer education and outreach, not 
just a small cut, but a reduction of 90 percent from $100 million to 
just $10 million.
  The goals are clear: let's keep public healthcare options a secret 
and let's make it as difficult as possible to insure yourself and your 
family.
  Funding for vital navigator programs was slashed by 40 percent. This 
was a move the Government Accountability Office, the GAO, has self-
described as ``problematic.'' But it is much more than problematic; it 
is detrimental.
  It is clear their goal is and always has been to drive ACA enrollment 
down to zero.
  Last year, the administration began allowing insurance companies to 
provide junk insurance plans, plans that, for one, don't protect 
consumers with preexisting conditions.
  Now the administration is pushing the ACA navigators to promote these 
junk plans, advertising these plans as somehow comparable to qualified 
ACA plans that provide full protections.
  Obviously, consumers are going to be confused by this.
  The GAO found that the drastic reduction in outreach and advertising, 
``Likely detracted from the 2018 enrollment.''
  That is not likely. That is a fact.
  This is unacceptable, and it works directly against the intent of the 
law, which is to get more people healthcare coverage.
  For some reason, this administration thinks that having uninsured 
Americans is a good thing.
  My Democratic colleagues, the American public, and I believe 
differently.
  In my home State of California, we saw the value of investing in ACA 
consumer education outreach. The way to get people covered and reduce 
uninsured rates is to educate consumers about their healthcare coverage 
options and make sure they know that healthcare insurance is affordable 
and within reach.
  Having strong consumer outreach and enrollment activities can, in 
fact, lower premiums. This is exactly what we found in California.
  Our State program covering California estimates that its outreach 
activities lowered premiums by up to 8 percent for all consumers.

                              {time}  1745

  This is basic economics. More participants equal lower costs for 
everyone. That 8 percent reduction amounts to some $576 million in my 
State alone. That, my friends, is a great investment.
  There is a clear intent by this administration and the Republican 
Members to undermine the Affordable Care Act by drastically reducing 
vital funding for a fully functioning marketplace. And who does that 
hurt? Everyone.
  This administration intends to jam the spokes on the progress the ACA 
has made to increase the number of people with healthcare coverage. 
Congress and the American people deserve answers to these attempts to 
subvert the ACA.
  First, we need to know what the administration has been spending ACA 
user fees on if they are not using these funds for education and 
outreach. We need to know why you are still charging States a 3\1/2\ 
percent user fee to access a Federal platform if those fees aren't 
being used for the purposes they were collected. And, naturally, we 
need to know why there was a recent 50 percent increase in user fees 
for State-based marketplaces. Talk about a tax rate hike.
  My amendment seeks answers. It requires an annual report to be 
submitted to Congress that includes a detailed breakdown on spending 
for, one, outreach and enrollment; two, the navigator program; and, 
three, the maintenance of healthcare.gov and the call centers.
  No one should be denied or dropped healthcare coverage because they 
are a senior, pregnant, or get sick. Healthcare is a right, not a 
privilege, and everyone deserves access to quality, affordable care. It 
is critical now, more than ever, for us to receive answers on how the 
ACA user fees have been spent over the last 2 years by this 
administration.
  I urge my colleagues to support my amendment, and I yield back the 
balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the 
gentleman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chairman, it is amazing to me that 17 navigators, 
according to CMS, during the grant year 2016 to 2017, 17 of these 
navigators that my friends on the other side of the aisle are such big 
fans of enrolled fewer than 100 people at an average cost of $5,000 per 
enrollee. That doesn't seem to be very cost efficient to me.
  As I have said before, today, The Wall Street Journal investigation 
found one grantee got 200 grand and enrolled one person. This is a 
great program.
  You can't understand why the Trump administration wants to cut back 
and put some boundaries around? I can't imagine why you would embrace 
that. I just don't get it.
  The top 10 most expensive navigators collected $2.77 million, and 
they signed up 314 people. Let that one sink in. I mean, if you all 
want to embrace that, that is up to you. Not the way I would do 
business.
  The Las Vegas Review-Journal editorialized: ``The navigator scheme is 
a make-work government jobs program rife with corruption and highly 
susceptible to scam artists. It's a slush fund for progressive 
constituent groups.''
  That is a respected newspaper. The journalist is writing this, Wall 
Street Journal's investigation.
  We figure out $62.5 million in grants enrolled 81,426 individuals. 
That is less than 1 percent. That is your navigators, Mr. Chairman, 
that some are so enthralled with; that is their body of work: $62.5 
million, 1 percent.
  Now, if you just run a simple calculation, that means about $767 was 
spent

[[Page H3898]]

per individual that was enrolled. That is a lot of money.
  By contrast, agents and brokers assisted with 42 percent of the 
federally facilitated exchange enrollment for plan year 2018, which 
cost the FFE only $2.40, $2.40 per enrollee to provide training and 
technical assistance.
  So we have before us this opportunity to either fund a program that 
appears to be susceptible to scam, according to one paper: One person 
gets enrolled, and one person gets paid $200,000 to enroll that one 
person. That is the outcome. That doesn't seem to make a lot of sense 
to me.
  So I would say to my colleague from California that where we really 
need the transparency and accountability is on the navigators 
themselves. That is where we ought to be investigating.
  And on the short-term duration plans, it is unfortunate that Ms. 
Eshoo's amendment was not made in order, because I agree that we need 
more transparency on those plans so people know what they are buying. I 
don't want anybody to get a plan that doesn't cover what they need. I 
don't think any of us do.
  So, Mr. Chairman, I oppose the gentleman's amendment, and unless any 
other Member requests time, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from California (Mr. Cox).
  The amendment was agreed to.


           Amendment No. 24 Offered by Mr. Cox of California

  The Acting CHAIR. It is now in order to consider amendment No. 24 
printed in House Report 116-61.
  Mr. COX of California. Mr. Chairman, 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 48, line 20, after ``populations,'' insert 
     ``individuals residing in areas where the unemployment rates 
     exceeds the national average unemployment rate,''.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from California (Mr. Cox) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from California.
  Mr. COX of California. Mr. Chair, I am honored to be here today to 
introduce my amendment to H.R. 987, The Strengthening Health Care and 
Lowering Prescription Drug Costs Act.
  My amendment would ensure that communities with high unemployment 
numbers are prioritized in the navigator outreach program.
  The Affordable Care Act created navigator programs to provide 
outreach, education, and enrollment assistance to consumers shopping 
for healthcare coverage. Robust marketing and outreach programs through 
the navigator program have been very successful throughout the country 
and have demonstrated meaningful benefits to our consumers.
  In my home State of California, we have been making these necessary 
investments to ensure people throughout our State get the information 
they need to obtain coverage, and it works. Our State-based 
marketplace, Covered California, estimates that its investment in the 
marketing and outreach in 2015 and 2016 increased enrollment, which 
reduced premiums by up to 8 percent for all of our enrolled members. 
That is savings to all enrolled members of some $576 million. Based on 
a small budget of some $56 million, that is a great investment. That is 
a 1,000 percent return on investment. That is a great deal by anyone's 
measure.
  That is the goal: to reduce the number of uninsured Americans. We all 
know that, when we have insurance, we stay healthy, and this 
strengthens our overall healthcare system, our communities, and our 
Nation.
  That is why the navigator program is so important, and the Trump 
administration's 84 percent cut to the program since 2016 is just 
unacceptable. It is imperative that funding be restored to navigator 
programs.
  Navigator programs help those without employer-sponsored insurance 
through small companies, sole proprietors, contractors, and every one 
of those entrepreneurs who are staking their claim to the American 
Dream.
  The fact is many people who are eligible for financial assistance 
through the ACA, which would help them obtain coverage, don't even know 
they can get help, and this administration wants to keep them in the 
dark. Some 40 percent of consumers today don't even know there are 
options available.
  My congressional district has an unemployment rate of almost 17 
percent, and this is made up of rural communities that face unique 
challenges and barriers with respect to education, communication, and 
transportation. This makes it very difficult for my constituents to 
receive information on their healthcare insurance options.
  This is so similar to many of our rural communities across our 
Nation. For many of those communities, the navigator program is the 
only way they can access this vital information.
  Everyone should have health insurance and know their healthcare 
options. Healthcare is a right, not a privilege, and your ZIP Code 
should not dictate your ability to obtain health insurance.
  My amendment would help distressed communities like those in my 
district and so many more across our Nation that may not have the 
resources to access the full healthcare options. By fully funding the 
navigator program and by focusing our efforts on areas that have high 
unemployment, we can get more people covered. And that is the goal.
  Here in America, the building blocks for success are a quality 
education, dedication to hard work, and good health. A healthy 
workforce is vital for America's success. We must fund the navigator 
program to help educate those who are difficult to reach geographically 
or who have limited access to ACA resources.
  This is a critical and necessary investment that will build stronger, 
healthier, and more productive communities and an America that 
demonstrates that its best investments are its people.
  With that, I urge my colleagues to support my amendment, and I 
reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, 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. Mr. Chairman, I reserve the balance of my time.
  Mr. COX of California. Mr. Chairman, I yield back the balance of my 
time.
  Mr. WALDEN. Mr. Chairman, let me just make a couple of points.
  First of all, of course we want navigators to work in areas where 
there is high unemployment. My district, over the years, has had some 
of the highest unemployment in the State of Oregon.
  Then I go down the list of future amendments here, and it is like, 
oh, we have got another one coming up that ensures rural areas are 
included in the navigator outreach. Well, that is a good idea.
  And then there is another one that ensures that State healthcare 
exchange outreach activities also target our veteran population. Yes, 
that is a good idea.
  Why are we having to put all this in statute? Who the heck is running 
this program, and why is it such a mess that it requires amendment 
after amendment after amendment? My point is: Where does this stop?
  Of course we want them to work with veterans. Of course we want them 
to work with seniors and the young. Are we going to go to age segments 
here, 18 to 29, 31 to--I mean, come on. Really? We are going to put all 
this in statute?
  How do they not have common sense? Who are these navigators that we 
have to direct them from the floor of the House into statute? Oh, by 
the way, be sure and work in an unemployed area. Be sure to mention 
that there are services for mental health and substance abuse. Oh, 
don't forget this, that, and the other thing.
  I mean, I think we only ran out of amendments because we ran out of 
ideas of things to put into the statute, but that is no way to run a 
program.
  And if it costs $767 for everyone they sign up for the government to 
run its navigator program but the private sector can do it for $2.40, 
that is not a very economical way. You don't make it up in volume.
  And of course we want people to get access to insurance and 
information. I was in the radio business for 20 years. Our job was to 
get information out to consumers, so I am all about that.

[[Page H3899]]

  It is just amazing, though, when you see the inefficiency of a 
Federal system versus the efficiency of a private-sector initiative.
  And here we just passed an amendment, $25 million more into this 
program, and yet we know in some cases there is enormous cost, and 
there appears to be, you know--I don't know--malfeasance. I don't know 
what it is.
  But if the top 10 most expensive navigators collected $2.77 million 
to sign up 314 people, I think we are in the wrong business. We ought 
to go be navigators at that rate. That is a pretty good rate of return 
for them, but not for the people and the taxpayers.
  Mr. Chairman, I yield 1 minute to the distinguished gentleman from 
California (Mr. McCarthy), the Republican leader of the United States 
House of Representatives.
  Mr. McCARTHY. Mr. Chairman, I want to spend 1 minute and thank my 
friend, Congressman Walden. I know the work that he puts in when it 
comes to healthcare for America.
  Mr. Chairman, I know of a bill that Mr. Walden has in to protect 
preexisting conditions. We have asked many times to mark it up or bring 
it to the floor--no, not brought. It is talked about a lot, Mr. 
Chairman, but no bill to bring it here.
  I know your care when it comes to not just healthcare, but the type 
of treatment one is able to get, the quality of care out there, 
because, Mr. Chairman, there are people out there who will run health 
facilities for the seniors but don't do a very good job. The quality is 
not there.

                              {time}  1800

  People have lost their own healthcare within there. People have been 
fined by the way they have treated individuals and seniors. People have 
lost eyes just because the treatment had been poor.
  Mr. Chairman, we are here today on this floor because we all know 
that drug prices are too high. That is why the Energy and Commerce 
Committee worked tirelessly to pass three healthcare bills unanimously 
to address that.
  Now, how often is that said on this floor? Not very often. It was a 
moment that I heard from almost every member on that committee, a 
moment of pride.
  We could have legislation passed in a bipartisan fashion today. We 
could take it from that committee and bring it to the floor, and we 
would have the exact same thing happen. We could have the Republicans 
and the Democrats coming together to lower the price of drugs.
  You know who wins? All of America.
  Sadly, however, these good faith efforts have been unnecessarily 
thrown into a partisan and senseless attempt to bail out pieces of the 
Affordable Care Act.
  Now, I don't say that--but I guess I just did, Mr. Chairman. I knew 
it because I happen to be a Member of Congress. I watched it because I 
watched the committee work together, find common ground in a place 
where it is really difficult.
  But when I looked at The Washington Post, it was very interesting. 
This is what they said. They actually put it best. Democrats are 
putting a ``political pothole''--yeah, that is what they said--a 
``political pothole'' in the way of real drug pricing reform.
  You know, if you ever spend time back in your district or across this 
country, I would promise you one of the top three issues you will get 
is the price of drugs. I think everybody in this body was looking 
forward to this day, prior to the Democrats playing with political 
potholes.
  Make no mistake, the drug pricing component of H.R. 987 is very 
strong. The three drug pricing bills in this legislation get to the 
heart of the problem, the lack of competition in the generic drug 
market. Increased competition for generic drugs would lead to lower 
prices and make medication more accessible. Two things, I think, 
anybody in America would desire.
  Just think for a moment. You would get more competition, more choice, 
and lower prices.
  We were so close. We got out of committee. The Members on both sides 
said yes. The only step you had left: Go to the Rules Committee and 
come to the floor.
  But as you pass through that committee to get to the Rules Committee 
and get to the floor, I guess it had to go through leadership. 
Leadership made a choice: Politics before people.
  These reforms would have removed barriers to generic drugs entering 
the market, making healthcare more affordable for patients. It is a 
real change.
  That would have been a positive moment we all could have celebrated. 
But you know what is going to happen here? It is going to be a partisan 
vote and a bill that goes nowhere.
  It is going to be a pothole that most people will say elected 
officials are supposed to fix, not create. It is the opposite of what 
elected officials are supposed to do. They are supposed to fill in the 
potholes, not dig them.
  But if you read The Washington Post, they will tell you exactly who 
created them--the Democrats.
  There are a lot of things that happen on this floor that at times are 
reckless, irresponsible, and just downright embarrassing. Mr. Chairman, 
this is one of them. Why at a time when both sides say they want to 
lower the prices of drugs and give people more options?
  It goes to the core of the individual, of their own health. Well, it 
goes to the core of what the Democrats want to do. They don't want to 
make law. They love playing politics.
  You know what happens when they play politics? Not only do keep drug 
prices high, but they break another promise.
  I happen to have been in this body, Mr. Chairman, when I heard those 
words, that if you like your healthcare, you could keep it.
  I thought those millions of Americans who lost their healthcare that 
time, that that would be the end. But no, Mr. Chairman, the Democrats 
took the majority again. I thought that was enough.
  Had you taken enough health policies away from millions of Americans? 
The answer was no. They had a few more to go. Mr. Chairman, 1.5 
million, the Congressional Budget Office says.
  So think, tomorrow when Americans wake up, there was a moment the 
prices could be lower. But, no. Would they ever think that not only are 
you not going to lower them, but you are going to take my healthcare 
away?
  That is exactly what is going to happen here today. That is the 
poison pill they added to the bills.
  Mr. Chairman, 1.5 million Americans will lose their plans. Now, if 
you listen to the other side, they say, no, no, it is net neutral. You 
know what it is? The CBO says, no, it goes down to 500,000.
  I have heard them use the Congressional Budget Office thousands of 
times, Mr. Chairman, on the floor. I haven't heard them use it today.
  Mr. Chairman, if you read books about politicians, if you read ``The 
Prince'' and you read Machiavelli, it is interesting, the ends justify 
the means. That is what it says. You see, it is about control. It is 
really about who can control what you can have.
  There was a moment there that you would have greater options and 
lower prices. No, we will tell you what you need and what you can have.
  There was a moment there that you would have even greater options 
when it came to healthcare. No, that is not going to be. We are going 
to take that away from you. And you know what? It is going to cost you 
more when we do it.
  Mr. Chairman, I would say I would be shocked that this was going to 
happen. I can't say I am shocked anymore because, Mr. Chairman, on one 
side of the aisle in this Chamber, half of the entire majority party 
has cosponsored a bill, Medicare for none.

  Not only are they taking more than 1.5 million Americans' plans away 
today, but they also have a plan to take more than 150 million 
Americans' plans away. They are going to bankrupt Medicare. They are 
going to deny you if you have private healthcare now.
  But that is okay. The ends justify the means. Why? Because they have 
control.
  That is exactly what happened here, Mr. Chairman. You had a committee 
that worked in a bipartisan manner. It is really irresponsible that the 
Rules Committee or the leadership would undercut their own chair of 
that committee to put a poison pill on three bills that came out in a 
bipartisan manner, with an idea that they would work in good faith, 
with an idea that they would put people before politics.

[[Page H3900]]

  When you study history, and they talk about elected officials, they 
will tell you even from the most local places you get elected, the jobs 
you are going to have are filling in potholes. I never heard someone 
say your job as elected officials is to create potholes, but that is 
what we witnessed today.
  It is a sad day for this House. We could do so much better. We did in 
committee.
  Is it just, Mr. Chairman, that the majority doesn't want to solve a 
problem? Because, Mr. Chairman, I have searched. They have been in 
power for quite some time, and I have not found one problem they have 
solved yet. I found a few potholes they created. I think we have enough 
problems.
  When we have that moment that we can come together inside of a 
committee, could we just keep it a little longer so it can get to the 
floor?
  Mr. Chairman, there will be an option. There will be an amendment in 
this body that gives you an opportunity. If you were in that Committee 
on Energy and Commerce and you voted on these bills without the poison 
pill, it will be your moment of truth. It will tell a lot to America, 
Mr. Chairman, whether you serve your constituents or you serve your 
leadership.
  That is what we will be watching. That is what America will be 
wondering. That is what we all hope will happen.
  Mr. WALDEN. Mr. Chairman, may I inquire as to how much time I have 
remaining?
  The Acting CHAIR (Mr. Aguilar). The gentleman has 1\1/2\ minutes 
remaining.
  Mr. WALDEN. Mr. Chairman, again, I thank the Republican leader of the 
U.S. House for not only his leadership on this issue but on so many 
others, and for giving us clarity on what is really going on here.
  It is unfortunate. As The Washington Post and other news media 
organizations reported, it didn't have to be this way. It didn't have 
to be this way.
  We did pass the three drug reform bills unanimously out of the 
committee. I was a big supporter of them. Every Republican was. I think 
every Republican on the floor will be if they get a chance to vote for 
those.
  In the past, when I was chairman of the committee, we moved over 143 
bills out of the committee. Ninety-three percent of them had bipartisan 
votes on the House floor. Fifty-seven became law. One of those 57 
contained about 60 different opioid bills we rolled into just one.
  I agree with the leader. This is going to delay passage in the Senate 
because they are going to have to sort this out, rip it apart. The 
added spending and the navigator piece probably don't survive. But it 
didn't have to be that way.
  I found that if you have big bipartisan support out of the House, you 
are likely to get quicker action in the Senate, and it goes down to the 
President.
  If you want to do something quickly about high-cost drugs and stop 
bad behavior that denies access for new generics, then you want to move 
quickly, not slowly. You want to move in a bipartisan way, not a 
partisan way. Unfortunately, that is not our way today.
  Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from California (Mr. Cox).
  The amendment was agreed to.
  The Acting CHAIR. The Chair is advised that amendment No. 25 will not 
be offered.


       Amendment No. 26 Offered by Ms. Kendra S. Horn of Oklahoma

  The Acting CHAIR. It is now in order to consider amendment No. 26 
printed in House Report 116-61.
  Ms. KENDRA S. HORN of Oklahoma. Mr. 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 48, line 20, after ``populations,'' insert 
     ``individuals in rural areas,''.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentlewoman 
from Oklahoma (Ms. Kendra S. Horn) and a Member opposed each will 
control 5 minutes.
  The Chair recognizes the gentlewoman from Oklahoma.
  Ms. KENDRA S. HORN of Oklahoma. Mr. Chair, I yield myself such time 
as I may consume.
  Mr. Chair, I am pleased today to offer an amendment that ensures that 
rural areas are included in navigator outreach under H.R. 987, the 
Strengthening Health Care and Lowering Prescription Drug Costs Act.
  This amendment ensures that the navigators who help people understand 
their options under the Affordable Care Act also help our rural 
communities.
  The overall bill places federally funded grants in communities across 
the country to pay navigators who play a vital role in helping 
Americans understand their health coverage options in the marketplace. 
It helps them know what they qualify for.
  Without question, access to healthcare is one of our Nation's most 
critical issues. This is true across the country, whether in major 
metropolitan areas, big cities, small towns, on the coasts, or in the 
heartland. But specific problems look different from place to place, 
and our rural communities are undoubtedly struggling.
  One of the worst outcomes in rural communities of lack of access to 
healthcare is hospital closures.
  Sadly, Oklahoma is no stranger to them. We have already lost six 
hospitals since 2010, and many more are teetering on the edge.
  Simply put, hospitals can't stay open when their patients don't have 
coverage and the hospitals aren't able to pay their bills.
  Right now, Oklahoma has the second highest uninsured rate in the 
Nation, and our rural areas often bear the brunt of the coverage gap. 
They simply don't have enough patients with coverage to offset the ones 
without it.
  The Washington Post just wrote a story about a 15-bed hospital in my 
home State in a town called Fairfax. Fairfax Community Hospital is so 
close to closing that their computer software won't operate because the 
licensing fees haven't been paid.
  Their air-conditioning is also shut down. Imagine that, as it gets 
hotter and hotter in the Oklahoma summertime.
  I want to share an excerpt of the story because these matters are 
about real lives. It is not about numbers. These are about people who 
are suffering because they don't have access to care.

                              {time}  1815

  It starts with CEO Tina Steele talking to the employees who are 
crammed in a crowded office and sweating.
  ``So how desperate are we?'' One employee asked. ``How much money do 
we have in the bank?''
  ``Somewhere around $12,000,'' Steele said.
  ``And how long will that last us?''
  ``Under normal circumstances?'' Steele asked. She looked down at a 
chart on her desk and ran calculations in her head. ``Probably a few 
hours. Maybe a day at most.''
  The only reason the hospital had been able to stay open at all was 
because about 30 employees continued showing up to work without pay. 
There was no other hospital within 30 miles of the two-lane roads and 
prairie in sprawling Osage County, which meant Fairfax Community was 
the only lifeline in that part of the county that increasingly needed 
rescuing.
  ``If we aren't open, where do these people go?'' asked a physician 
assistant, thinking about the dozens of patients he treated each month 
in the ER, including some in critical condition after drug overdoses, 
falls from horses, oil field disasters, and car crashes.
  ``They'll go to the cemetery,'' another employee said. ``If we're not 
here, these people don't have time. They'll die along with this 
hospital.''
  Like I said, there are similar stories in other hospitals that have 
played out six times across Oklahoma, and in many other places. 
According to some estimates, there are 102 hospitals that have closed 
nationwide, and we, as Americans, can't let our neighbors die simply 
because they live in small towns. We must solve this rural health 
crisis.
  Navigators are a part of this solution. This amendment makes sure 
that we help people living in small towns across Oklahoma and the 
country stay healthy and understand their options so that they can take 
care of themselves and their families.
  I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the amendment.

[[Page H3901]]

  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
  Ms. KENDRA S. HORN of Oklahoma. Mr. Chair, adding on to this, the 
inclusion of rural communities with navigators serving them is 
critical, because from 2016 to 2018, Oklahoma lost 78 percent of its 
navigator funding. The very communities that are in the most need, 
where people have the least access to services and understanding, 
including broadband, so that they can access the services they need, 
are the very ones that are suffering most.
  These closures and the lack of access not only have an effect in the 
communities that directly impact them, but ripple across my State and 
this Nation.
  The Acting CHAIR. The time of the gentlewoman has expired.
  Mr. WALDEN. Mr. Chairman, I am outraged to find out that these 
navigators are not reaching out to people in rural areas. What we have 
learned today on the House floor is that apparently this program 
doesn't reach people in rural areas. That is why the gentlewoman from 
Oklahoma has this amendment, apparently. These navigators, what the 
heck do they do?
  We have had amendments to say you have got to have navigators reach 
out to people on Medicaid. You have got to have navigators reach out to 
people on the Children's Health Insurance Program. We have to tell them 
that? What have they been doing?
  We are going to have an amendment coming up saying, Navigators, we 
are going to put into Federal law that you have to reach out to the 
veterans' community. They don't do that today? Are you serious?
  And we are going to have navigators that have to be educated. When 
you are reaching out, you better talk about mental health services and 
substance abuse. Have they been ignoring that all along? I guess so.
  Because my friends on the other side of the aisle have been bringing 
amendment after amendment to correct these obvious omissions and 
problems with the navigator program. What has been going on in the 
navigator program?
  This is outrageous to learn that rural areas--and I represent an area 
that would stretch from the Atlantic Ocean to Ohio, 69,000 square 
miles--and you are talking about rural. I am going to find out why the 
heck those navigators aren't talking to people in my district, and why 
we have to put in law that they have to now.
  How many years has this been going on under ObamaCare, and at what 
cost to taxpayers? And you are going to give them another $25 million. 
Who are they talking to? Are they talking to people in suburban areas 
only, or urban areas only?
  But if they are not talking about Medicaid and CHIP, and apparently 
not to veterans, who are they counseling and what are they telling 
them? What a disaster of a program. We ought to halt right now and 
figure out who are these people and what are they getting paid to do.
  We know they cost $767 for every enrollee, compared to $2.40 in the 
private sector. So we are paying them a lot. We know that 
investigations have shown that one grantee took $200,000 and enrolled 
one person, and, apparently, that person was not a veteran, not on 
Medicaid, not in a rural area, and not on CHIP. Who knows. Right?
  I appreciate the gentlewoman's amendment, but I am astonished to 
learn of the fact that we have to put it in law that they have to talk 
to people in rural areas. This demands investigation to figure out what 
in the heck is going on.
  Now, let's talk about what else is facing us. What really takes care 
of people in rural areas are our community health centers, 27 million 
people, 1 in 12 in every State. The District of Columbia and the 
territories rely on community health centers for their care, and of the 
patients treated at these centers, one in three are living in poverty; 
one in five are rural residents; and one in nine are children.

  If you want to put the taxpayer money to good purpose, it would be to 
fund our community health centers, like Republicans led the way on last 
time at record levels because we know they deliver for people in rural 
areas. They deliver for people in urban areas. They deliver quality 
care.
  That is where our money should go, not into a program like this, 
apparently, that we have to have these amendments from Democrat 
Members. I think we had 25 amendments from Democrat Members telling 
navigators we are going to go to rural areas, we are going to go to 
veterans. Who are they serving today? It is a mess.
  Mr. Chairman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Oklahoma (Ms. Kendra S. Horn).
  The amendment was agreed to.


               Amendment No. 27 Offered by Mr. Cunningham

  The Acting CHAIR. It is now in order to consider amendment No. 27 
printed in House Report 116-61.
  Mr. CUNNINGHAM. Mr. Chairman, 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 48, line 20, after ``populations,'' insert 
     ``veterans,''.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from South Carolina (Mr. Cunningham) and a Member opposed each will 
control 5 minutes.
  The Chair recognizes the gentleman from South Carolina.
  Mr. CUNNINGHAM. Mr. Chair, I rise today in support of my 
straightforward, commonsense amendment which will ensure that our 
Nation's veterans have access to quality, affordable health insurance 
coverage.
  While people often think that everyone who has served in the military 
immediately has access to VA healthcare, this is not the case. In fact, 
only three out of five veterans under the age of 65 are eligible for 
healthcare through the VA, and only a quarter of those who are eligible 
for VA healthcare rely on the VA as their sole source of insurance.
  Younger veterans who served for 24 consecutive months are eligible 
for VA coverage for 5 years after their discharge, and veterans over 
the age of 65 qualify for Medicare. This leaves a potential gap in 
coverage for many veterans who have recently served after their 5-year 
period and before they become eligible for Medicare.
  That is why it is imperative that the healthcare exchange outreach 
and educational strategies be designed in a way to reach our Nation's 
veterans.
  As a Member of the House Committee on Veterans' Affairs, I am 
committed to ensuring every veteran has access to high-quality 
healthcare regardless of where they receive that care.
  Studies show that when Americans are informed about the correct time 
to sign up for healthcare, and the options to make that coverage 
affordable, they choose to get insured.
  My amendment is simply asking that we make our Nation's veterans 
aware of the healthcare options available to them. This is particularly 
important to the Lowcountry, because my district has one of the highest 
concentrations of veterans in the entire country.
  It has the highest concentrations in the entire State of South 
Carolina, and I want to make sure that each of them are aware of their 
coverage options so that they can make the best choice for themselves 
and for their families.
  Mr. Chair, I want to ask my colleagues on both sides of the aisle to 
join me in supporting my amendment as well as the underlying 
legislation.
  I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I seek time in opposition to the 
gentleman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Mr. Chairman, as I said in the last amendment debate, it 
is astonishing to me that apparently these navigators aren't serving 
people in rural areas, and now I find out that they are apparently not 
serving our veteran population effectively as well.
  I am going to reserve the balance of my time.
  Mr. CUNNINGHAM. Mr. Chairman, in closing, I would like to thank 
Chairman Pallone and Chairman Scott for their work in constructing this 
important legislation which will lower drug prices, stabilize the 
insurance market, and decrease premiums for hardworking families across 
this country.
  I also want to thank Chairman McGovern and my colleagues on the

[[Page H3902]]

Rules Committee for allowing my amendment to come to the floor. I urge 
all of my colleagues on both sides of the aisle to vote in favor of 
this commonsense amendment as well as the underlying legislation.
  I yield back the balance of my time.
  Mr. WALDEN. Mr. Chairman, I thank the gentleman for his service to 
the country and all of our veterans, men and women, who wear our 
uniform and deserve our undying appreciation and thanks.
  But it is astonishing, once again, it is appalling that these 
navigators apparently aren't serving our veterans. We have to come to 
the floor with amendments to Federal law to order them to take care of 
our veterans. What kind of program is this?
  We know it is expensive. We know some in the news media, some of the 
editorial writers in our country said it is open to fraud and--let me 
read it.
  An editorial paper out West said, ``In reality, the navigator scheme 
is a make-work government jobs program rife with corruption and highly 
susceptible to scam artists. It's a slush fund for progressive 
constituent groups.''
  That is how one editorial came out. I am sure there are good people 
in there somewhere doing good work, but we know that according to CMS, 
17 navigators enrolled less than 100 people at an average cost of 
$5,000 per enrollee. What kind of program is this? We know it is 
expensive.
  One grantee took in $200,000 and enrolled one person. The top ten 
most expensive collected $2.77 million and signed up 314 people. So it 
is inefficient, but at least it is really expensive. What a waste.
  I am sure they enroll people, but only 1 percent of those enrolled in 
the exchange are helped by navigators. And then today, we find out that 
we have to tell them what to do, which makes you wonder, what have they 
been doing? Because we have had amendments to say, you have got to have 
them educate people about Medicaid, or CHIP, or veterans, rural areas, 
mental health, substance abuse--one thing after another. I think we 
ought to investigate them and the whole program stem to stern.
  If there is waste and fraud, we ought to go after it. If there is all 
of this expense, we ought to knock it down. And if they are not serving 
people--I am glad we had the rural amendment. Do we need one for urban, 
and suburban, and semi-frontier counties? It makes me wonder who they 
do serve. We know it is expensive.
  Obviously, we are going to tell them to serve the veterans. You know 
that makes sense.
  I am glad your amendment got made in order. We had 16 Republican 
amendments. They only made one in order. There were 25 Democratic 
amendments made in order. Two of those we had to edit on the floor, and 
one technical amendment.

  It seems an odd way to run the House. We were promised in the opening 
days by the chairman of the Rules Committee that it was all going to be 
different. Boy, he was right. It is just a different way.
  I think that our Member on the Rules Committee could probably tell us 
92 percent of the amendments that have been allowed on the House floor 
have been from Democrats. When Republicans were in the majority, 45 
percent of the amendments came from Democrats. We tried to have an open 
process. Now we are being shut out, and that is unfortunate.
  So, Mr. Chairman, we have had a long day here. I think we all care 
deeply about making sure people have access to affordable healthcare. 
Republicans believe we need to reform how our systems work. We need to 
drive down the cost of drugs, and nobody has led more on this in my 
history around here than the President of the United States, Donald 
Trump.
  From day one, he has told the drug companies: You need to get your 
prices down. I was with him in the White House when he said that in 
about February of 2017, and he has never relented. And he is a partner 
in this progress to go after surprise billing, to go after high drug 
costs. He is leading through his administration, and he will sign the 
drug bills that we worked out in committee.
  The travesty is the pothole created by the Democrat politicos that 
said we have got to link the drug bills we all have agreement on that 
the President would sign, to bills that we know are bailing out 
ObamaCare. And worse, we are now funding huge money, and even more 
authorized today, into a program that apparently wasn't taking care of 
veterans, nor people in rural areas.

                              {time}  1830

  It is astonishing. So, Mr. Chairman, this amendment is fine. It makes 
sense. It is just outrageous we have to put in Federal law that these 
navigators have to actually help veterans because they ought to be 
doing that day in and day out. Veterans are the ones who give us our 
freedom. We need to investigate the navigators.
  Mr. Chairman, I yield back balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from South Carolina (Mr. Cunningham).
  The amendment was agreed to.


                    Announcement by the Acting Chair

  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, proceedings 
will now resume on those amendments printed in House Report 116-61 on 
which further proceedings were postponed, in the following order:
  Amendment No. 2 by Mr. McKinley of West Virginia.
  Amendment No. 6 by Mr. Harder of California.
  Amendment No. 21 by Ms. Wexton of Virginia.
  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. McKinley

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentleman from West 
Virginia (Mr. McKinley) 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 vote was taken by electronic device, and there were--ayes 189, 
noes 230, not voting 18, as follows:

                             [Roll No. 210]

                               AYES--189

     Aderholt
     Allen
     Amash
     Amodei
     Armstrong
     Arrington
     Babin
     Bacon
     Baird
     Balderson
     Banks
     Barr
     Bergman
     Biggs
     Bilirakis
     Bishop (UT)
     Bost
     Brady
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Budd
     Burchett
     Burgess
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Cline
     Cloud
     Cole
     Collins (NY)
     Comer
     Conaway
     Cook
     Crawford
     Crenshaw
     Curtis
     Davidson (OH)
     Davis, Rodney
     DesJarlais
     Diaz-Balart
     Duffy
     Duncan
     Dunn
     Emmer
     Estes
     Ferguson
     Fleischmann
     Flores
     Fortenberry
     Foxx (NC)
     Fulcher
     Gaetz
     Gallagher
     Gianforte
     Gibbs
     Gohmert
     Golden
     Gonzalez (OH)
     Gonzalez-Colon (PR)
     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 (SD)
     Jordan
     Joyce (OH)
     Joyce (PA)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Kustoff (TN)
     LaHood
     LaMalfa
     Lamb
     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
     Nunes
     Olson
     Palazzo
     Palmer
     Pence
     Perry
     Posey
     Ratcliffe
     Reed
     Reschenthaler
     Rice (SC)
     Riggleman
     Roby
     Rodgers (WA)
     Roe, David P.
     Rogers (AL)
     Rogers (KY)
     Rooney (FL)
     Rose, John W.
     Rouzer
     Roy
     Rutherford
     Scalise
     Schweikert
     Scott, Austin
     Sensenbrenner
     Shimkus
     Simpson
     Smith (MO)
     Smith (NE)
     Spano
     Stauber
     Stefanik
     Steil
     Steube
     Stewart
     Stivers
     Taylor
     Thompson (PA)
     Thornberry
     Timmons
     Tipton
     Turner
     Upton
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Waltz
     Watkins
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Wright
     Yoho
     Young
     Zeldin

                               NOES--230

     Adams
     Aguilar
     Allred
     Axne
     Barragan
     Bass
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.

[[Page H3903]]


     Brindisi
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Carbajal
     Cardenas
     Carson (IN)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Cohen
     Connolly
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crist
     Crow
     Cuellar
     Cummings
     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
     Gabbard
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     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
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kildee
     Kilmer
     Kim
     Kind
     Kirkpatrick
     Krishnamoorthi
     Kuster (NH)
     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.
     Matsui
     McAdams
     McBath
     McCollum
     McEachin
     McGovern
     McNerney
     Meng
     Moore
     Morelle
     Mucarsel-Powell
     Murphy
     Nadler
     Napolitano
     Neal
     Neguse
     Norcross
     Norton
     O'Halleran
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Perlmutter
     Peters
     Peterson
     Phillips
     Pingree
     Pocan
     Porter
     Pressley
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Richmond
     Rouda
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Sablan
     San Nicolas
     Sanchez
     Sarbanes
     Scanlon
     Schakowsky
     Schiff
     Schneider
     Schrader
     Schrier
     Scott (VA)
     Scott, David
     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

                             NOT VOTING--18

     Abraham
     Bucshon
     Byrne
     Clyburn
     Collins (GA)
     Johnson (LA)
     Johnson (OH)
     Maloney, Sean
     Massie
     Meeks
     Moulton
     Plaskett
     Radewagen
     Rose (NY)
     Ryan
     Smucker
     Swalwell (CA)
     Weber (TX)

                              {time}  1855

  Ms. PORTER, Messrs. BRINDISI, GREEN of Texas, McADAMS, McEACHIN, 
Mses. JAYAPAL, BASS, and SCHAKOWSKY changed their vote from ``aye'' to 
``no.''
  Messrs. YOHO, BABIN, KING of Iowa, NORMAN, STEWART, ROGERS of 
Alabama, GROTHMAN, WALBERG, RUTHERFORD, and KATKO changed their vote 
from ``no'' to ``aye.''
  So the amendment was rejected.
  The result of the vote was announced as above recorded.


          Amendment No. 6 Offered by Mr. Harder of California

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentleman from California 
(Mr. Harder) 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 243, 
noes 174, not voting 20, as follows:

                             [Roll No. 211]

                               AYES--243

     Adams
     Aguilar
     Allred
     Axne
     Bacon
     Barragan
     Bass
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brindisi
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Carbajal
     Cardenas
     Carson (IN)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Cohen
     Connolly
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crist
     Crow
     Cuellar
     Cummings
     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
     Fortenberry
     Foster
     Frankel
     Fudge
     Gabbard
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     Golden
     Gomez
     Gonzalez (TX)
     Gonzalez-Colon (PR)
     Gottheimer
     Green (TX)
     Grijalva
     Haaland
     Harder (CA)
     Hastings
     Hayes
     Heck
     Higgins (NY)
     Hill (CA)
     Himes
     Hollingsworth
     Horn, Kendra S.
     Horsford
     Houlahan
     Hoyer
     Huffman
     Hurd (TX)
     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
     Meng
     Moore
     Morelle
     Mucarsel-Powell
     Murphy
     Nadler
     Napolitano
     Neal
     Neguse
     Norcross
     Norton
     O'Halleran
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Perlmutter
     Peters
     Peterson
     Phillips
     Pingree
     Pocan
     Porter
     Pressley
     Price (NC)
     Quigley
     Raskin
     Reed
     Rice (NY)
     Richmond
     Rouda
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Sablan
     San Nicolas
     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
     Steil
     Stevens
     Suozzi
     Takano
     Thompson (CA)
     Thompson (MS)
     Titus
     Tlaib
     Tonko
     Torres (CA)
     Torres Small (NM)
     Trahan
     Trone
     Underwood
     Upton
     Van Drew
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Wasserman Schultz
     Waters
     Watson Coleman
     Welch
     Wexton
     Wild
     Wilson (FL)
     Yarmuth

                               NOES--174

     Aderholt
     Allen
     Amash
     Amodei
     Armstrong
     Babin
     Baird
     Balderson
     Banks
     Barr
     Bergman
     Biggs
     Bilirakis
     Bishop (UT)
     Bost
     Brady
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Budd
     Burchett
     Burgess
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Cline
     Cloud
     Cole
     Collins (NY)
     Comer
     Conaway
     Cook
     Crawford
     Crenshaw
     Curtis
     Davidson (OH)
     Davis, Rodney
     DesJarlais
     Diaz-Balart
     Duncan
     Dunn
     Emmer
     Estes
     Ferguson
     Fleischmann
     Flores
     Foxx (NC)
     Fulcher
     Gaetz
     Gallagher
     Gianforte
     Gibbs
     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
     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
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     Meadows
     Meuser
     Miller
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Newhouse
     Norman
     Nunes
     Olson
     Palazzo
     Palmer
     Pence
     Perry
     Posey
     Ratcliffe
     Reschenthaler
     Rice (SC)
     Riggleman
     Roby
     Rodgers (WA)
     Roe, David P.
     Rogers (AL)
     Rogers (KY)
     Rooney (FL)
     Rose, John W.
     Rouzer
     Roy
     Rutherford
     Scalise
     Schweikert
     Scott, Austin
     Shimkus
     Simpson
     Smith (MO)
     Smith (NE)
     Spano
     Stauber
     Stefanik
     Steube
     Stewart
     Stivers
     Taylor
     Thompson (PA)
     Thornberry
     Timmons
     Tipton
     Turner
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Waltz
     Watkins
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Wright
     Yoho
     Young
     Zeldin

                             NOT VOTING--20

     Abraham
     Arrington
     Bucshon
     Byrne
     Clyburn
     Collins (GA)
     Duffy
     Gohmert
     Johnson (LA)
     Johnson (OH)
     Massie
     Meeks
     Moulton
     Plaskett
     Radewagen
     Rose (NY)
     Ryan
     Smucker
     Swalwell (CA)
     Weber (TX)


                    Announcement by the Acting Chair

  The Acting CHAIR (during the vote). There is 1 minute remaining.

                              {time}  1900

  So the amendment was agreed to.
  The result of the vote was announced as above recorded.

[[Page H3904]]

  



                 Amendment No. 21 Offered by Ms. Wexton

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentlewoman from Virginia 
(Ms. Wexton) 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 232, 
noes 185, not voting 20, as follows:

                             [Roll No. 212]

                               AYES--232

     Adams
     Aguilar
     Allred
     Axne
     Barragan
     Bass
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brindisi
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Carbajal
     Cardenas
     Carson (IN)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Cohen
     Connolly
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crist
     Crow
     Cuellar
     Cummings
     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
     Gabbard
     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
     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
     Meng
     Moore
     Morelle
     Mucarsel-Powell
     Murphy
     Nadler
     Napolitano
     Neal
     Neguse
     Norcross
     Norton
     O'Halleran
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Perlmutter
     Peters
     Peterson
     Phillips
     Pingree
     Pocan
     Porter
     Pressley
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Richmond
     Rouda
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Sablan
     San Nicolas
     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

                               NOES--185

     Aderholt
     Allen
     Amash
     Amodei
     Armstrong
     Arrington
     Babin
     Bacon
     Baird
     Balderson
     Banks
     Barr
     Bergman
     Biggs
     Bilirakis
     Bishop (UT)
     Bost
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Budd
     Burchett
     Burgess
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Cline
     Cloud
     Cole
     Collins (NY)
     Comer
     Conaway
     Cook
     Crawford
     Crenshaw
     Curtis
     Davidson (OH)
     Davis, Rodney
     DesJarlais
     Diaz-Balart
     Duffy
     Duncan
     Dunn
     Emmer
     Estes
     Ferguson
     Fleischmann
     Flores
     Fortenberry
     Foxx (NC)
     Fulcher
     Gaetz
     Gallagher
     Gianforte
     Gibbs
     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 (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
     Nunes
     Olson
     Palazzo
     Palmer
     Pence
     Perry
     Posey
     Ratcliffe
     Reed
     Reschenthaler
     Rice (SC)
     Riggleman
     Roby
     Rodgers (WA)
     Roe, David P.
     Rogers (AL)
     Rogers (KY)
     Rooney (FL)
     Rose, John W.
     Rouzer
     Roy
     Rutherford
     Scalise
     Schweikert
     Scott, Austin
     Sensenbrenner
     Shimkus
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Spano
     Stauber
     Stefanik
     Steil
     Steube
     Stewart
     Stivers
     Taylor
     Thompson (PA)
     Thornberry
     Timmons
     Tipton
     Turner
     Upton
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Waltz
     Watkins
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Wright
     Yoho
     Young
     Zeldin

                             NOT VOTING--20

     Abraham
     Brady
     Bucshon
     Byrne
     Clyburn
     Collins (GA)
     Gohmert
     Gonzalez-Colon (PR)
     Johnson (LA)
     Johnson (OH)
     Massie
     Meeks
     Moulton
     Plaskett
     Radewagen
     Rose (NY)
     Ryan
     Smucker
     Swalwell (CA)
     Weber (TX)

                              {time}  1908

  So the amendment was agreed to.
  The result of the vote was announced as above recorded.
  The Acting CHAIR (Mr. Hastings). There being no further amendments, 
under the rule, the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Aguilar) having assumed the chair, Mr. Hastings, 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. 987) to 
amend the Patient Protection and Affordable Care Act to provide for 
Federal Exchange outreach and educational activities, and, pursuant to 
House Resolution 377, he reported the bill, as amended by that 
resolution, back to the House with sundry further 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. Mr. Speaker, I have a motion to recommit at the desk.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. WALDEN. Oh, my gosh, Mr. Speaker, in its current form, 
absolutely, yes, sir.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Walden of Oregon moves to recommit the bill H.R. 987 to 
     the Committee on Energy and Commerce with instructions to 
     report the same back to the House forthwith with the 
     following amendment:
       Strike title I and insert the following:

               TITLE I--LOWERING PRESCRIPTION DRUG COSTS

     SEC. 100. SHORT TITLE.

       This title may be cited as the ``CREATES Act''.

  Subtitle A--Bringing Low-cost Options and Competition While Keeping 
                      Incentives for New Generics

     SEC. 101. CHANGE CONDITIONS OF FIRST GENERIC EXCLUSIVITY TO 
                   SPUR ACCESS AND COMPETITION.

       Section 505(j)(5)(B)(iv) of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355(j)(5)(B)(iv)) is amended--
       (1) in subclause (I), by striking ``180 days after'' and 
     all that follows through the period at the end and inserting 
     the following: ``180 days after the earlier of--

       ``(aa) the date of the first commercial marketing of the 
     drug (including the commercial marketing of the listed drug) 
     by any first applicant; or
       ``(bb) the applicable date specified in subclause (III).''; 
     and

       (2) by adding at the end the following new subclause:
       ``(III) Applicable date.--The applicable date specified in 
     this subclause, with respect to an application for a drug 
     described in subclause (I), is the date on which each of the 
     following conditions is first met:

       ``(aa) The approval of such an application could be made 
     effective, but for the eligibility of a first applicant for 
     180-day exclusivity under this clause.
       ``(bb) At least 30 months have passed since the date of 
     submission of an application for the drug by at least one 
     first applicant.
       ``(cc) Approval of an application for the drug submitted by 
     at least one first applicant is not precluded under clause 
     (iii).

[[Page H3905]]

       ``(dd) No application for the drug submitted by any first 
     applicant is approved at the time the conditions under items 
     (aa), (bb), and (cc) are all met, regardless of whether such 
     an application is subsequently approved.''.

        Subtitle B--Protecting Consumer Access to Generic Drugs

     SEC. 111. UNLAWFUL AGREEMENTS.

       (a) Agreements Prohibited.--Subject to subsections (b) and 
     (c), it shall be unlawful for an NDA or BLA holder and a 
     subsequent filer (or for two subsequent filers) to enter 
     into, or carry out, an agreement resolving or settling a 
     covered patent infringement claim on a final or interim basis 
     if under such agreement--
       (1) a subsequent filer directly or indirectly receives from 
     such holder (or in the case of such an agreement between two 
     subsequent filers, the other subsequent filer) anything of 
     value, including a license; and
       (2) the subsequent filer agrees to limit or forego research 
     on, or development, manufacturing, marketing, or sales, for 
     any period of time, of the covered product that is the 
     subject of the application described in subparagraph (A) or 
     (B) of subsection (g)(8).
       (b) Exclusion.--It shall not be unlawful under subsection 
     (a) if a party to an agreement described in such subsection 
     demonstrates by clear and convincing evidence that the value 
     described in subsection (a)(1) is compensation solely for 
     other goods or services that the subsequent filer has 
     promised to provide.
       (c) Limitation.--Nothing in this section shall prohibit an 
     agreement resolving or settling a covered patent infringement 
     claim in which the consideration granted by the NDA or BLA 
     holder to the subsequent filer (or from one subsequent filer 
     to another) as part of the resolution or settlement includes 
     only one or more of the following:
       (1) The right to market the covered product that is the 
     subject of the application described in subparagraph (A) or 
     (B) of subsection (g)(8) in the United States before the 
     expiration of--
       (A) any patent that is the basis of the covered patent 
     infringement claim; or
       (B) any patent right or other statutory exclusivity that 
     would prevent the marketing of such covered product.
       (2) A payment for reasonable litigation expenses not to 
     exceed $7,500,000 in the aggregate.
       (3) A covenant not to sue on any claim that such covered 
     product infringes a patent.
       (d) Enforcement by Federal Trade Commission.--
       (1) General application.--The requirements of this section 
     apply, according to their terms, to an NDA or BLA holder or 
     subsequent filer that is--
       (A) a person, partnership, or corporation over which the 
     Commission has authority pursuant to section 5(a)(2) of the 
     Federal Trade Commission Act (15 U.S.C. 45(a)(2)); or
       (B) a person, partnership, or corporation over which the 
     Commission would have authority pursuant to such section but 
     for the fact that such person, partnership, or corporation is 
     not organized to carry on business for its own profit or that 
     of its members.
       (2) Unfair or deceptive acts or practices enforcement 
     authority.--
       (A) In general.--A violation of this section shall be 
     treated as an unfair or deceptive act or practice in 
     violation of section 5(a)(1) of the Federal Trade Commission 
     Act (15 U.S.C. 45(a)(1)).
       (B) Powers of commission.--Except as provided in 
     subparagraph (C) and paragraphs (1)(B) and (3)--
       (i) the Commission shall enforce this section in the same 
     manner, by the same means, and with the same jurisdiction, 
     powers, and duties as though all applicable terms and 
     provisions of the Federal Trade Commission Act (15 U.S.C. 41 
     et seq.) were incorporated into and made a part of this 
     section; and
       (ii) any NDA or BLA holder or subsequent filer that 
     violates this section shall be subject to the penalties and 
     entitled to the privileges and immunities provided in the 
     Federal Trade Commission Act.
       (C) Judicial review.--In the case of a cease and desist 
     order issued by the Commission under section 5 of the Federal 
     Trade Commission Act (15 U.S.C. 45) for violation of this 
     section, a party to such order may obtain judicial review of 
     such order as provided in such section 5, except that--
       (i) such review may only be obtained in--

       (I) the United States Court of Appeals for the District of 
     Columbia Circuit;
       (II) the United States Court of Appeals for the circuit in 
     which the ultimate parent entity, as defined in section 
     801.1(a)(3) of title 16, Code of Federal Regulations, or any 
     successor thereto, of the NDA or BLA holder (if any such 
     holder is a party to such order) is incorporated as of the 
     date that the application described in subparagraph (A) or 
     (B) of subsection (g)(8) or an approved application that is 
     deemed to be a license for a biological product under section 
     351(k) of the Public Health Service Act (42 U.S.C. 262(k)) 
     pursuant to section 7002(e)(4) of the Biologics Price 
     Competition and Innovation Act of 2009 (Public Law 111-148; 
     124 Stat. 817) is submitted to the Commissioner of Food and 
     Drugs; or
       (III) the United States Court of Appeals for the circuit in 
     which the ultimate parent entity, as so defined, of any 
     subsequent filer that is a party to such order is 
     incorporated as of the date that the application described in 
     subparagraph (A) or (B) of subsection (g)(8) is submitted to 
     the Commissioner of Food and Drugs; and

       (ii) the petition for review shall be filed in the court 
     not later than 30 days after such order is served on the 
     party seeking review.
       (3) Additional enforcement authority.--
       (A) Civil penalty.--The Commission may commence a civil 
     action to recover a civil penalty in a district court of the 
     United States against any NDA or BLA holder or subsequent 
     filer that violates this section.
       (B) Special rule for recovery of penalty if cease and 
     desist order issued.--
       (i) In general.--If the Commission has issued a cease and 
     desist order in a proceeding under section 5 of the Federal 
     Trade Commission Act (15 U.S.C. 45) for violation of this 
     section--

       (I) the Commission may commence a civil action under 
     subparagraph (A) to recover a civil penalty against any party 
     to such order at any time before the expiration of the 1-year 
     period beginning on the date on which such order becomes 
     final under section 5(g) of such Act (15 U.S.C. 45(g)); and
       (II) in such civil action, the findings of the Commission 
     as to the material facts in such proceeding shall be 
     conclusive, unless--

       (aa) the terms of such order expressly provide that the 
     Commission's findings shall not be conclusive; or
       (bb) such order became final by reason of section 5(g)(1) 
     of such Act (15 U.S.C. 45(g)(1)), in which case such findings 
     shall be conclusive if supported by evidence.
       (ii) Relationship to penalty for violation of an order.--
     The penalty provided in clause (i) for violation of this 
     section is separate from and in addition to any penalty that 
     may be incurred for violation of an order of the Commission 
     under section 5(l) of the Federal Trade Commission Act (15 
     U.S.C. 45(l)).
       (C) Amount of penalty.--
       (i) In general.--The amount of a civil penalty imposed in a 
     civil action under subparagraph (A) on a party to an 
     agreement described in subsection (a) shall be sufficient to 
     deter violations of this section, but in no event greater 
     than--

       (I) if such party is the NDA or BLA holder (or, in the case 
     of an agreement between two subsequent filers, the subsequent 
     filer who gave the value described in subsection (a)(1)), the 
     greater of--

       (aa) 3 times the value received by such NDA or BLA holder 
     (or by such subsequent filer) that is reasonably attributable 
     to the violation of this section; or
       (bb) 3 times the value given to the subsequent filer (or to 
     the other subsequent filer) reasonably attributable to the 
     violation of this section; and

       (II) if such party is the subsequent filer (or, in the case 
     of an agreement between two subsequent filers, the subsequent 
     filer who received the value described in subsection (a)(1)), 
     3 times the value received by such subsequent filer that is 
     reasonably attributable to the violation of this section.

       (ii) Factors for consideration.--In determining such 
     amount, the court shall take into account--

       (I) the nature, circumstances, extent, and gravity of the 
     violation;
       (II) with respect to the violator, the degree of 
     culpability, any history of violations, the ability to pay, 
     any effect on the ability to continue doing business, profits 
     earned by the NDA or BLA holder (or, in the case of an 
     agreement between two subsequent filers, the subsequent filer 
     who gave the value described in subsection (a)(1)), 
     compensation received by the subsequent filer (or, in the 
     case of an agreement between two subsequent filers, the 
     subsequent filer who received the value described in 
     subsection (a)(1)), and the amount of commerce affected; and
       (III) other matters that justice requires.

       (D) Injunctions and other equitable relief.--In a civil 
     action under subparagraph (A), the United States district 
     courts are empowered to grant mandatory injunctions and such 
     other and further equitable relief as they deem appropriate.
       (4) Remedies in addition.--Remedies provided in this 
     subsection are in addition to, and not in lieu of, any other 
     remedy provided by Federal law.
       (5) Preservation of authority of commission.--Nothing in 
     this section shall be construed to affect any authority of 
     the Commission under any other provision of law.
       (e) Federal Trade Commission Rulemaking.--The Commission 
     may, in its discretion, by rule promulgated under section 553 
     of title 5, United States Code, exempt from this section 
     certain agreements described in subsection (a) if the 
     Commission finds such agreements to be in furtherance of 
     market competition and for the benefit of consumers.
       (f) Antitrust Laws.--Nothing in this section shall modify, 
     impair, limit, or supersede the applicability of the 
     antitrust laws as defined in subsection (a) of the first 
     section of the Clayton Act (15 U.S.C. 12(a)), and of section 
     5 of the Federal Trade Commission Act (15 U.S.C. 45) to the 
     extent that such section 5 applies to unfair methods of 
     competition. Nothing in this section shall modify, impair, 
     limit, or supersede the right of a subsequent filer to assert 
     claims or counterclaims against any person, under the 
     antitrust laws or other laws relating to unfair competition.
       (g) Definitions.--In this section:
       (1) Agreement resolving or settling a covered patent 
     infringement claim.--The term ``agreement resolving or 
     settling a covered patent infringement claim'' means any 
     agreement that--

[[Page H3906]]

       (A) resolves or settles a covered patent infringement 
     claim; or
       (B) is contingent upon, provides for a contingent condition 
     for, or is otherwise related to the resolution or settlement 
     of a covered patent infringement claim.
       (2) Commission.--The term ``Commission'' means the Federal 
     Trade Commission.
       (3) Covered patent infringement claim.--The term ``covered 
     patent infringement claim'' means an allegation made by the 
     NDA or BLA holder to a subsequent filer (or, in the case of 
     an agreement between two subsequent filers, by one subsequent 
     filer to another), whether or not included in a complaint 
     filed with a court of law, that--
       (A) the submission of the application described in 
     subparagraph (A) or (B) of paragraph (9), or the manufacture, 
     use, offering for sale, sale, or importation into the United 
     States of a covered product that is the subject of such an 
     application--
       (i) in the case of an agreement between an NDA or BLA 
     holder and a subsequent filer, infringes any patent owned by, 
     or exclusively licensed to, the NDA or BLA holder of the 
     covered product; or
       (ii) in the case of an agreement between two subsequent 
     filers, infringes any patent owned by the subsequent filer; 
     or
       (B) in the case of an agreement between an NDA or BLA 
     holder and a subsequent filer, the covered product to be 
     manufactured under such application uses a covered product as 
     claimed in a published patent application.
       (4) Covered product.--The term ``covered product'' means a 
     drug (as defined in section 201(g) of the Federal Food, Drug, 
     and Cosmetic Act (21 U.S.C. 321(g))), including a biological 
     product (as defined in section 351(i) of the Public Health 
     Service Act (42 U.S.C. 262(i)).
       (5) NDA or bla holder.--The term ``NDA or BLA holder'' 
     means--
       (A) the holder of--
       (i) an approved new drug application filed under section 
     505(b)(1) of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355(b)(1)) for a covered product; or
       (ii) a biologics license application filed under section 
     351(a) of the Public Health Service Act (42 U.S.C. 262(a)) 
     with respect to a biological product;
       (B) a person owning or controlling enforcement of the 
     patent on--
       (i) the list published under section 505(j)(7) of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(j)(7)) in 
     connection with the application described in subparagraph 
     (A)(i); or
       (ii) any list published under section 351 of the Public 
     Health Service Act (42 U.S.C. 262) comprised of patents 
     associated with biologics license applications filed under 
     section 351(a) of such Act (42 U.S.C. 262(a)); or
       (C) the predecessors, subsidiaries, divisions, groups, and 
     affiliates controlled by, controlling, or under common 
     control with any entity described in subparagraph (A) or (B) 
     (such control to be presumed by direct or indirect share 
     ownership of 50 percent or greater), as well as the 
     licensees, licensors, successors, and assigns of each of the 
     entities.
       (6) Patent.--The term ``patent'' means a patent issued by 
     the United States Patent and Trademark Office.
       (7) Statutory exclusivity.--The term ``statutory 
     exclusivity'' means those prohibitions on the submission or 
     approval of drug applications under clauses (ii) through (iv) 
     of section 505(c)(3)(E) (5- and 3-year exclusivity), clauses 
     (ii) through (iv) of section 505(j)(5)(F) (5-year and 3-year 
     exclusivity), section 505(j)(5)(B)(iv) (180-day exclusivity), 
     section 527 (orphan drug exclusivity), section 505A 
     (pediatric exclusivity), or section 505E (qualified 
     infectious disease product exclusivity) of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355(c)(3)(E), 
     355(j)(5)(B)(iv), 355(j)(5)(F), 360cc, 355a, 355f), or 
     prohibitions on the submission or licensing of biologics 
     license applications under section 351(k)(6) (interchangeable 
     biological product exclusivity) or section 351(k)(7) 
     (biological product reference product exclusivity) of the 
     Public Health Service Act (42 U.S.C. 262(k)(6), (7)).
       (8) Subsequent filer.--The term ``subsequent filer'' 
     means--
       (A) in the case of a drug, a party that owns or controls an 
     abbreviated new drug application submitted pursuant to 
     section 505(j) of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 355(j)) or a new drug application submitted 
     pursuant to section 505(b)(2) of the Federal Food, Drug, and 
     Cosmetic Act (21U.S.C. 355(b)(2)) and filed under section 
     505(b)(1) of such Act (21 U.S.C. 355(b)(1)) or has the 
     exclusive rights to distribute the covered product that is 
     the subject of such application; or
       (B) in the case of a biological product, a party that owns 
     or controls an application filed with the Food and Drug 
     Administration under section 351(k) of the Public Health 
     Service Act (42 U.S.C. 262(k)) or has the exclusive rights to 
     distribute the biological product that is the subject of such 
     application.
       (h) Effective Date.--This section applies with respect to 
     agreements described in subsection (a) entered into on or 
     after the date of the enactment of this Act.

     SEC. 112. NOTICE AND CERTIFICATION OF AGREEMENTS.

       (a) Notice of All Agreements.--Section 1111(7) of the 
     Medicare Prescription Drug, Improvement, and Modernization 
     Act of 2003 (21 U.S.C. 355 note) is amended by inserting ``or 
     the owner of a patent for which a claim of infringement could 
     reasonably be asserted against any person for making, using, 
     offering to sell, selling, or importing into the United 
     States a biological product that is the subject of a 
     biosimilar biological product application'' before the period 
     at the end.
       (b) Certification of Agreements.--Section 1112 of such Act 
     (21 U.S.C. 355 note) is amended by adding at the end the 
     following:
       ``(d) Certification.--The Chief Executive Officer or the 
     company official responsible for negotiating any agreement 
     under subsection (a) or (b) that is required to be filed 
     under subsection (c) shall, within 30 days of such filing, 
     execute and file with the Assistant Attorney General and the 
     Commission a certification as follows: `I declare that the 
     following is true, correct, and complete to the best of my 
     knowledge: The materials filed with the Federal Trade 
     Commission and the Department of Justice under section 1112 
     of the Medicare Prescription Drug, Improvement, and 
     Modernization Act of 2003, with respect to the agreement 
     referenced in this certification--
       `` `(1) represent the complete, final, and exclusive 
     agreement between the parties;
       `` `(2) include any ancillary agreements that are 
     contingent upon, provide a contingent condition for, were 
     entered into within 30 days of, or are otherwise related to, 
     the referenced agreement; and
       `` `(3) include written descriptions of any oral 
     agreements, representations, commitments, or promises between 
     the parties that are responsive to subsection (a) or (b) of 
     such section 1112 and have not been reduced to writing.'.''.

     SEC. 113. FORFEITURE OF 180-DAY EXCLUSIVITY PERIOD.

       Section 505(j)(5)(D)(i)(V) of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355(j)(5)(D)(i)(V)) is amended by 
     inserting ``section 111 of the Lowering Prescription Drug 
     Costs and Extending Community Health Centers and Other Public 
     Health Priorities Act or'' after ``that the agreement has 
     violated''.

     SEC. 114. COMMISSION LITIGATION AUTHORITY.

       Section 16(a)(2) of the Federal Trade Commission Act (15 
     U.S.C. 56(a)(2)) is amended--
       (1) in subparagraph (D), by striking ``or'' after the 
     semicolon;
       (2) in subparagraph (E), by inserting ``or'' after the 
     semicolon; and
       (3) by inserting after subparagraph (E) the following:
       ``(F) under section 111(d)(3)(A) of the Lowering 
     Prescription Drug Costs and Extending Community Health 
     Centers and Other Public Health Priorities Act;''.

     SEC. 115. STATUTE OF LIMITATIONS.

       (a) In General.--Except as provided in subsection (b), the 
     Commission shall commence any administrative proceeding or 
     civil action to enforce section 111 of this Act not later 
     than 6 years after the date on which the parties to the 
     agreement file the Notice of Agreement as provided by section 
     1112(c)(2) and (d) of the Medicare Prescription Drug, 
     Improvement, and Modernization Act of 2003 (21 U.S.C. 355 
     note).
       (b) Civil Action After Issuance of Cease and Desist 
     Order.--If the Commission has issued a cease and desist order 
     under section 5 of the Federal Trade Commission Act (15 
     U.S.C. 45) for violation of section 111 of this Act and the 
     proceeding for the issuance of such order was commenced 
     within the period required by subsection (a) of this section, 
     such subsection does not prohibit the commencement, after 
     such period, of a civil action under section 111(d)(3)(A) 
     against a party to such order or a civil action under 
     subsection (l) of such section 5 for violation of such order.

 Subtitle C--Creating and Restoring Equal Access to Equivalent Samples

     SEC. 121. ACTIONS FOR DELAYS OF GENERIC DRUGS AND BIOSIMILAR 
                   BIOLOGICAL PRODUCTS.

       (a) Definitions.--In this section--
       (1) the term ``commercially reasonable, market-based 
     terms'' means--
       (A) a nondiscriminatory price for the sale of the covered 
     product at or below, but not greater than, the most recent 
     wholesale acquisition cost for the drug, as defined in 
     section 1847A(c)(6)(B) of the Social Security Act (42 U.S.C. 
     1395w-3a(c)(6)(B));
       (B) a schedule for delivery that results in the transfer of 
     the covered product to the eligible product developer 
     consistent with the timing under subsection (b)(2)(A)(iv); 
     and
       (C) no additional conditions are imposed on the sale of the 
     covered product;
       (2) the term ``covered product''--
       (A) means--
       (i) any drug approved under subsection (c) or (j) of 
     section 505 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355) or biological product licensed under subsection 
     (a) or (k) of section 351 of the Public Health Service Act 
     (42 U.S.C. 262);
       (ii) any combination of a drug or biological product 
     described in clause (i); or
       (iii) when reasonably necessary to support approval of an 
     application under section 505 of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355), or section 351 of the Public 
     Health Service Act (42 U.S.C. 262), as applicable, or 
     otherwise meet the requirements for approval under either 
     such section, any product, including any device, that is 
     marketed or intended for use with such a drug or biological 
     product; and
       (B) does not include any drug or biological product that 
     appears on the drug shortage list in effect under section 
     506E of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
     356e), unless--

[[Page H3907]]

       (i) the drug or biological product has been on the drug 
     shortage list in effect under such section 506E continuously 
     for more than 6 months; or
       (ii) the Secretary determines that inclusion of the drug or 
     biological product as a covered product is likely to 
     contribute to alleviating or preventing a shortage.
       (3) the term ``device'' has the meaning given the term in 
     section 201 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 321);
       (4) the term ``eligible product developer'' means a person 
     that seeks to develop a product for approval pursuant to an 
     application for approval under subsection (b)(2) or (j) of 
     section 505 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355) or for licensing pursuant to an application under 
     section 351(k) of the Public Health Service Act (42 U.S.C. 
     262(k));
       (5) the term ``license holder'' means the holder of an 
     application approved under subsection (c) or (j) of section 
     505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
     355) or the holder of a license under subsection (a) or (k) 
     of section 351 of the Public Health Service Act (42 U.S.C. 
     262) for a covered product;
       (6) the term ``REMS'' means a risk evaluation and 
     mitigation strategy under section 505-1 of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355-1);
       (7) the term ``REMS with ETASU'' means a REMS that contains 
     elements to assure safe use under section 505-1(f) of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(f));
       (8) the term ``Secretary'' means the Secretary of Health 
     and Human Services;
       (9) the term ``single, shared system of elements to assure 
     safe use'' means a single, shared system of elements to 
     assure safe use under section 505-1(f) of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355-1(f)); and
       (10) the term ``sufficient quantities'' means an amount of 
     a covered product that the eligible product developer 
     determines allows it to--
       (A) conduct testing to support an application under--
       (i) subsection (b)(2) or (j) of section 505 of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 355); or
       (ii) section 351(k) of the Public Health Service Act (42 
     U.S.C. 262(k)); and
       (B) fulfill any regulatory requirements relating to 
     approval of such an application.
       (b) Civil Action for Failure To Provide Sufficient 
     Quantities of a Covered Product.--
       (1) In general.--An eligible product developer may bring a 
     civil action against the license holder for a covered product 
     seeking relief under this subsection in an appropriate 
     district court of the United States alleging that the license 
     holder has declined to provide sufficient quantities of the 
     covered product to the eligible product developer on 
     commercially reasonable, market-based terms.
       (2) Elements.--
       (A) In general.--To prevail in a civil action brought under 
     paragraph (1), an eligible product developer shall prove, by 
     a preponderance of the evidence--
       (i) that--

       (I) the covered product is not subject to a REMS with 
     ETASU; or
       (II) if the covered product is subject to a REMS with 
     ETASU--

       (aa) the eligible product developer has obtained a covered 
     product authorization from the Secretary in accordance with 
     subparagraph (B); and
       (bb) the eligible product developer has provided a copy of 
     the covered product authorization to the license holder;
       (ii) that, as of the date on which the civil action is 
     filed, the product developer has not obtained sufficient 
     quantities of the covered product on commercially reasonable, 
     market-based terms;
       (iii) that the eligible product developer has submitted a 
     written request to purchase sufficient quantities of the 
     covered product to the license holder and such request--

       (I) was sent to a named corporate officer of the license 
     holder;
       (II) was made by certified or registered mail with return 
     receipt requested;
       (III) specified an individual as the point of contact for 
     the license holder to direct communications related to the 
     sale of the covered product to the eligible product developer 
     and a means for electronic and written communications with 
     that individual; and
       (IV) specified an address to which the covered product was 
     to be shipped upon reaching an agreement to transfer the 
     covered product; and

       (iv) that the license holder has not delivered to the 
     eligible product developer sufficient quantities of the 
     covered product on commercially reasonable, market-based 
     terms--

       (I) for a covered product that is not subject to a REMS 
     with ETASU, by the date that is 31 days after the date on 
     which the license holder received the request for the covered 
     product; and
       (II) for a covered product that is subject to a REMS with 
     ETASU, by 31 days after the later of--

       (aa) the date on which the license holder received the 
     request for the covered product; or
       (bb) the date on which the license holder received a copy 
     of the covered product authorization issued by the Secretary 
     in accordance with subparagraph (B).
       (B) Authorization for covered product subject to a rems 
     with etasu.--
       (i) Request.--An eligible product developer may submit to 
     the Secretary a written request for the eligible product 
     developer to be authorized to obtain sufficient quantities of 
     an individual covered product subject to a REMS with ETASU.
       (ii) Authorization.--Not later than 120 days after the date 
     on which a request under clause (i) is received, the 
     Secretary shall, by written notice, authorize the eligible 
     product developer to obtain sufficient quantities of an 
     individual covered product subject to a REMS with ETASU for 
     purposes of--

       (I) development and testing that does not involve human 
     clinical trials, if the eligible product developer has agreed 
     to comply with any conditions the Secretary determines 
     necessary; or
       (II) development and testing that involves human clinical 
     trials, if the eligible product developer has--

       (aa)(AA) submitted protocols, informed consent documents, 
     and informational materials for testing that include 
     protections that provide safety protections comparable to 
     those provided by the REMS for the covered product; or
       (BB) otherwise satisfied the Secretary that such 
     protections will be provided; and
       (bb) met any other requirements the Secretary may 
     establish.
       (iii) Notice.--A covered product authorization issued under 
     this subparagraph shall state that the provision of the 
     covered product by the license holder under the terms of the 
     authorization will not be a violation of the REMS for the 
     covered product.
       (3) Affirmative defense.--In a civil action brought under 
     paragraph (1), it shall be an affirmative defense, on which 
     the defendant has the burden of persuasion by a preponderance 
     of the evidence--
       (A) that, on the date on which the eligible product 
     developer requested to purchase sufficient quantities of the 
     covered product from the license holder--
       (i) neither the license holder nor any of its agents, 
     wholesalers, or distributors was engaged in the manufacturing 
     or commercial marketing of the covered product; and
       (ii) neither the license holder nor any of its agents, 
     wholesalers, or distributors otherwise had access to 
     inventory of the covered product to supply to the eligible 
     product developer on commercially reasonable, market-based 
     terms;
       (B) that--
       (i) the license holder sells the covered product through 
     agents, distributors, or wholesalers;
       (ii) the license holder has placed no restrictions, 
     explicit or implicit, on its agents, distributors, or 
     wholesalers to sell covered products to eligible product 
     developers; and
       (iii) the covered product can be purchased by the eligible 
     product developer in sufficient quantities on commercially 
     reasonable, market-based terms from the agents, distributors, 
     or wholesalers of the license holder; or
       (C) that the license holder made an offer to the individual 
     specified pursuant to paragraph (2)(A)(iii)(III), by a means 
     of communication (electronic, written, or both) specified 
     pursuant to such paragraph, to sell sufficient quantities of 
     the covered product to the eligible product developer at 
     commercially reasonable market-based terms--
       (i) for a covered product that is not subject to a REMS 
     with ETASU, by the date that is 14 days after the date on 
     which the license holder received the request for the covered 
     product, and the eligible product developer did not accept 
     such offer by the date that is 7 days after the date on which 
     the eligible product developer received such offer from the 
     license holder; or
       (ii) for a covered product that is subject to a REMS with 
     ETASU, by the date that is 20 days after the date on which 
     the license holder received the request for the covered 
     product, and the eligible product developer did not accept 
     such offer by the date that is 10 days after the date on 
     which the eligible product developer received such offer from 
     the license holder.
       (4) Remedies.--
       (A) In general.--If an eligible product developer prevails 
     in a civil action brought under paragraph (1), the court 
     shall--
       (i) order the license holder to provide to the eligible 
     product developer without delay sufficient quantities of the 
     covered product on commercially reasonable, market-based 
     terms;
       (ii) award to the eligible product developer reasonable 
     attorney's fees and costs of the civil action; and
       (iii) award to the eligible product developer a monetary 
     amount sufficient to deter the license holder from failing to 
     provide eligible product developers with sufficient 
     quantities of a covered product on commercially reasonable, 
     market-based terms, if the court finds, by a preponderance of 
     the evidence--

       (I) that the license holder delayed providing sufficient 
     quantities of the covered product to the eligible product 
     developer without a legitimate business justification; or
       (II) that the license holder failed to comply with an order 
     issued under clause (i).

       (B) Maximum monetary amount.--A monetary amount awarded 
     under subparagraph (A)(iii) shall not be greater than the 
     revenue that the license holder earned on the covered product 
     during the period--
       (i) beginning on--

[[Page H3908]]

       (I) for a covered product that is not subject to a REMS 
     with ETASU, the date that is 31 days after the date on which 
     the license holder received the request; or
       (II) for a covered product that is subject to a REMS with 
     ETASU, the date that is 31 days after the later of--

       (aa) the date on which the license holder received the 
     request; or
       (bb) the date on which the license holder received a copy 
     of the covered product authorization issued by the Secretary 
     in accordance with paragraph (2)(B); and
       (ii) ending on the date on which the eligible product 
     developer received sufficient quantities of the covered 
     product.
       (C) Avoidance of delay.--The court may issue an order under 
     subparagraph (A)(i) before conducting further proceedings 
     that may be necessary to determine whether the eligible 
     product developer is entitled to an award under clause (ii) 
     or (iii) of subparagraph (A), or the amount of any such 
     award.
       (c) Limitation of Liability.--A license holder for a 
     covered product shall not be liable for any claim under 
     Federal, State, or local law arising out of the failure of an 
     eligible product developer to follow adequate safeguards to 
     assure safe use of the covered product during development or 
     testing activities described in this section, including 
     transportation, handling, use, or disposal of the covered 
     product by the eligible product developer.
       (d) No Violation of REMS.--Section 505-1 of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 355-1) is amended by 
     adding at the end the following new subsection:
       ``(l) Provision of Samples Not a Violation of Strategy.--
     The provision of samples of a covered product to an eligible 
     product developer (as those terms are defined in section 
     121(a) of the Lowering Prescription Drug Costs and Extending 
     Community Health Centers and Other Public Health Priorities 
     Act) shall not be considered a violation of the requirements 
     of any risk evaluation and mitigation strategy that may be in 
     place under this section for such drug.''.
       (e) Rule of Construction.--
       (1) Definition.--In this subsection, the term ``antitrust 
     laws''--
       (A) has the meaning given the term in subsection (a) of the 
     first section of the Clayton Act (15 U.S.C. 12); and
       (B) includes section 5 of the Federal Trade Commission Act 
     (15 U.S.C. 45) to the extent that such section applies to 
     unfair methods of competition.
       (2) Antitrust laws.--Nothing in this section shall be 
     construed to limit the operation of any provision of the 
     antitrust laws.

     SEC. 122. REMS APPROVAL PROCESS FOR SUBSEQUENT FILERS.

       Section 505-1 of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 355-1), as amended by section 121, is further 
     amended--
       (1) in subsection (g)(4)(B)--
       (A) in clause (i) by striking ``or'' after the semicolon;
       (B) in clause (ii) by striking the period at the end and 
     inserting ``; or''; and
       (C) by adding at the end the following:
       ``(iii) accommodate different, comparable aspects of the 
     elements to assure safe use for a drug that is the subject of 
     an application under section 505(j), and the applicable 
     listed drug.'';
       (2) in subsection (i)(1), by striking subparagraph (C) and 
     inserting the following:
       ``(C)(i) Elements to assure safe use, if required under 
     subsection (f) for the listed drug, which, subject to clause 
     (ii), for a drug that is the subject of an application under 
     section 505(j) may use--
       ``(I) a single, shared system with the listed drug under 
     subsection (f); or
       ``(II) a different, comparable aspect of the elements to 
     assure safe use under subsection (f).
       ``(ii) The Secretary may require a drug that is the subject 
     of an application under section 505(j) and the listed drug to 
     use a single, shared system under subsection (f), if the 
     Secretary determines that no different, comparable aspect of 
     the elements to assure safe use could satisfy the 
     requirements of subsection (f).'';
       (3) in subsection (i), by adding at the end the following:
       ``(3) Shared rems.--If the Secretary approves, in 
     accordance with paragraph (1)(C)(i)(II), a different, 
     comparable aspect of the elements to assure safe use under 
     subsection (f) for a drug that is the subject of an 
     abbreviated new drug application under section 505(j), the 
     Secretary may require that such different comparable aspect 
     of the elements to assure safe use can be used with respect 
     to any other drug that is the subject of an application under 
     section 505(j) or 505(b) that references the same listed 
     drug.''; and
       (4) by adding at the end the following:
       ``(m) Separate REMS.--When used in this section, the terms 
     `different, comparable aspect of the elements to assure safe 
     use' or `different, comparable approved risk evaluation and 
     mitigation strategies' means a risk evaluation and mitigation 
     strategy for a drug that is the subject of an application 
     under section 505(j) that uses different methods or 
     operational means than the strategy required under subsection 
     (a) for the applicable listed drug, or other application 
     under section 505(j) with the same such listed drug, but 
     achieves the same level of safety as such strategy.''.

     SEC. 123. RULE OF CONSTRUCTION.

       (a) In General.--Nothing in this subtitle, the amendments 
     made by this subtitle, or in section 505-1 of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 355-1), shall be 
     construed as--
       (1) prohibiting a license holder from providing an eligible 
     product developer access to a covered product in the absence 
     of an authorization under this subtitle; or
       (2) in any way negating the applicability of a REMS with 
     ETASU, as otherwise required under such section 505-1, with 
     respect to such covered product.
       (b) Definitions.--In this section, the terms ``covered 
     product'', ``eligible product developer'', ``license 
     holder'', and ``REMS with ETASU'' have the meanings given 
     such terms in section 121(a).

       Strike title II and insert the following:

             TITLE II--SUPPORTING PEDIATRIC CANCER RESEARCH

     SEC. 201. FINDING; SENSE OF CONGRESS.

       According to the Congressional Budget Office, the 
     bipartisan provisions of title I of this Act decrease Federal 
     spending by over $4,000,000,000. It is the sense of Congress 
     that these savings should be redirected to the National 
     Institutes of Health Innovation Account to be made available 
     to support pediatric cancer research as provided by the 
     amendments made by section 202.

     SEC. 202. PEDIATRIC CANCER RESEARCH.

       Section 1001(b) of the 21st Century Cures Act (Public Law 
     114-255) is amended--
       (1) in paragraph (3), by amending subparagraph (A) to read 
     as follows:
       ``(A) Authorization of appropriations.--For each of the 
     fiscal years 2017 through 2026, there is authorized to be 
     appropriated from the Account to the Director of NIH, for the 
     purpose of carrying out the NIH Innovation Projects, an 
     amount not to exceed the total amount transferred to the 
     Account under paragraph (2)(A), plus $4,963,000,000 for the 
     period of fiscal years 2020 through 2024, to remain available 
     until expended.''; and
       (2) in paragraph (4), by adding at the end the following 
     new subparagraph:
       ``(E) For pediatric cancer research, not to exceed a total 
     of $4,963,000,000 for the period of fiscal years 2020 through 
     2024.''.

  Mr. WALDEN (during the reading). Mr. Speaker, I ask unanimous consent 
to dispense with the reading.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Oregon?
  There was no objection.
  The SPEAKER pro tempore. The gentleman from Oregon is recognized for 
5 minutes.
  Mr. WALDEN. Mr. Speaker, Republicans and Democrats worked together on 
provisions to bring generic drugs to market faster and to stop abusive 
practices. We did that on the Energy and Commerce Committee, and we 
brought this House multiple bills to achieve that goal, and we did it 
unanimously.
  We believe our bipartisan work will increase competition and 
ultimately help lower the cost of prescription drugs.
  These policies passed unanimously out of the Energy and Commerce 
Committee. They help consumers, and they have the added benefit of 
helping the Federal Government by producing $4 billion in savings.
  Unfortunately, our friends on the other side of the aisle, Democrats, 
decided to pair these bipartisan bills to lower drug costs with what 
they knew were very partisan bills that I, frankly, think waste 
taxpayer money in many cases.
  We ought to be working together on this, not descending ``into 
partisan politics on a seemingly bipartisan issue.'' Those are the 
words of STAT News as reported today.
  The fact is, when we do work together, we can achieve real results. 
In the last Congress, we reauthorized the Food and Drug Administration, 
and we gave that agency the tools and resources to get generic drugs 
into market faster.
  It is already working. Our work produced, with the FDA's efforts, a 
record number of generic drugs coming to market, driving competition, 
and giving consumers more choices.
  We did the same thing in the prior Congress when Fred Upton and Diana 
DeGette led the effort on 21st Century Cures so we could invest in 
medical research. That was bipartisan.
  Unfortunately, today you have partisan bills coupled with bipartisan 
bills, a poison pill, if you will. And the Democrats have decided to 
use the money, in part generated by our work on generic drugs, to fund 
more navigators.
  Let me just talk briefly about navigators.
  They cost you an average of $767 every time they sign up an 
individual. In the private sector, it is $2.40. And they just added 
another $25 million to that.
  The Wall Street Journal reported one grantee took in $200,000 to 
enroll a grand total of one person.

[[Page H3909]]

  The top 10 most expensive navigators collected $2.77 million in 
contracts from the Federal Government. They signed up 314 people. That 
is how they spent the money.
  One newspaper editorialized: ``The navigator scheme is a make-work 
government jobs program rife with corruption and highly susceptible to 
scam artists.''
  Today on the House floor, you will have a choice with this motion to 
recommit, and the choice is to spend it that way and add more money 
into that navigator program, that, by the way, we just approved a bunch 
of amendments to tell navigators to go work with people in rural areas, 
to work with people on CHIP, veterans. Apparently, they weren't working 
with any of those folks.
  So the motion to recommit says this: same drug bills that we passed 
out of committee, so you will be able to vote ``yes'' on those, and 
then the money that is generated, rather than going to this flawed 
navigator program will go to the NIH innovation fund to support 
childhood cancer research. That is your choice.
  By using the savings from the drug pricing provisions to pay for 
childhood cancer research, this amendment makes clear the bipartisan 
drug pricing offsets should be used to pay for bipartisan healthcare 
priorities.
  So, if you support lowering the cost of prescription drugs and you 
support the work of the NIH and its efforts to save countless lives of 
children with cancer, then you vote ``yes'' on the motion to recommit.
  Mr. Speaker, I yield back the balance of my time.
  Mrs. McBATH. Mr. Speaker, I rise in opposition to the motion to 
recommit.
  The SPEAKER pro tempore. The gentlewoman from Georgia is recognized 
for 5 minutes.
  Mrs. McBATH. Mr. Speaker, healthcare is an issue that is deeply 
personal to me. I, myself, like millions of Americans, live with a 
preexisting condition.
  As a two-time breast cancer survivor, I understand what it is like to 
have your life turned upside down by a diagnosis. Treatment was 
exhausting, both physically and emotionally. I did it all while raising 
my family and working full-time. I was terrified.
  Despite being lucky in having health insurance through my job, I was 
still worried about my financial security. I was concerned about making 
it to my radiation treatments every single day, sometimes for weeks, 
and then back to work and then back home to raise my son, Jordan.
  I had to do it, just like millions of Americans out there who share a 
similar story like mine. I truly don't know what I would have done or 
what would have happened if I had lost that healthcare insurance.
  Over 300,000 Georgians in my State, in my district have a preexisting 
condition. Over 45,000 of those people are children under the age of 
17.
  My colleagues here are worried about the health and well-being of 
their constituents, and we have heard countless heart-wrenching stories 
from Americans across the Nation--our neighbors, our friends, and our 
loved ones.
  Americans are simply worried about their healthcare. I am worried 
about their healthcare. They are tired of these games.
  Let's stop playing politics with the health and well-being of the 
American people. It just needs to stop.
  Last year, the Trump administration allowed the expanded sale of junk 
insurance plans, many of which do not cover maternity care, mental and 
behavioral health, or coverage to treat preexisting conditions.
  Under these plans, women can be charged more than men; insurance 
companies can cancel coverage as soon as an enrollee gets sick. People 
enrolled in these plans might seek care for themselves or for a family 
member only to be left out in the cold without coverage.
  No matter what the White House or my colleagues on the other side of 
the aisle cook it up to, the American people have said time and time 
again that they oppose plans that rip healthcare coverage away from 
those with preexisting conditions.

  While the motion does attempt to fund vital public health services 
and programs that have long garnered bipartisan support, the funding 
levels fail to provide greater investments to these programs. I know 
that we can work together to fund these programs, but keeping the 
administration's junk plan rule on the books would harm public health 
and not help it.
  We don't have to make these false choices. This underlying bill 
combines key pieces of legislation that lower drug costs, strengthen 
healthcare, reverse the sabotage, and rescind the administration's junk 
plan rule.
  We are making it easier for American families to assess and sign up 
for affordable healthcare.
  We are making sure that plans cover essential health benefits, like 
maternity care and treatment for substance use disorder.
  We are making sure that patients do not face annual or lifetime caps.
  We are making sure that patients are not discriminated against based 
on their preexisting conditions, like myself.
  This is what we are elected to do for the American people.
  Republicans plan to support protections for preexisting conditions, 
but they have failed to condemn the administration's decision asking 
the courts to invalidate the entire ACA. They have failed to call on 
the President to reverse course. They have refused to join us in 
condemning the administration's refusal to defend the law of the land.
  If our colleagues on the other side of the aisle are serious about 
protecting preexisting conditions, they will support the underlying 
bill and defeat this MTR.
  Action, not words, is what the American people demand, and it is what 
they deserve. Democrats are committed to putting consumers first.
  We will fight relentlessly to protect individuals with preexisting 
conditions and expand coverage to more Americans.
  We will make sure no one--absolutely no one--has to choose between a 
prescription drug or their mortgage. That is unconscionable.
  Mr. Speaker, I urge my colleagues to join us in standing for ensuring 
Americans have access to affordable healthcare and prescription drugs. 
I stand in opposition to this MTR. I urge my colleagues to join me in 
opposing the political ploy that would hurt American families, those 
with preexisting conditions, and those who are trying to afford their 
healthcare and prescription drugs.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. WALDEN. Mr. 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 188, 
noes 228, not voting 15, as follows:

                             [Roll No. 213]

                               AYES--188

     Aderholt
     Allen
     Amash
     Amodei
     Armstrong
     Arrington
     Babin
     Bacon
     Baird
     Balderson
     Banks
     Barr
     Bergman
     Biggs
     Bilirakis
     Bishop (UT)
     Bost
     Brady
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Budd
     Burchett
     Burgess
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Cline
     Cloud
     Cole
     Collins (NY)
     Comer
     Conaway
     Cook
     Crawford
     Crenshaw
     Curtis
     Davidson (OH)
     Davis, Rodney
     DesJarlais
     Diaz-Balart
     Duffy
     Duncan
     Dunn
     Emmer
     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
     Hollingsworth
     Hudson
     Huizenga
     Hunter
     Hurd (TX)
     Johnson (SD)
     Jordan
     Joyce (OH)
     Joyce (PA)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Kustoff (TN)
     LaHood

[[Page H3910]]


     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
     Nunes
     Olson
     Palazzo
     Palmer
     Pence
     Perry
     Posey
     Ratcliffe
     Reed
     Reschenthaler
     Rice (SC)
     Riggleman
     Roby
     Rodgers (WA)
     Roe, David P.
     Rogers (AL)
     Rogers (KY)
     Rooney (FL)
     Rose, John W.
     Rouzer
     Roy
     Rutherford
     Scalise
     Schweikert
     Scott, Austin
     Sensenbrenner
     Shimkus
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Spano
     Stauber
     Stefanik
     Steil
     Steube
     Stewart
     Stivers
     Taylor
     Thompson (PA)
     Thornberry
     Timmons
     Tipton
     Turner
     Upton
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Waltz
     Watkins
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Wright
     Yoho
     Young
     Zeldin

                               NOES--228

     Adams
     Aguilar
     Allred
     Axne
     Barragan
     Bass
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brindisi
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Carbajal
     Cardenas
     Carson (IN)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Cohen
     Connolly
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crist
     Crow
     Cuellar
     Cummings
     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
     Gabbard
     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
     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
     Meng
     Moore
     Morelle
     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)
     Richmond
     Rouda
     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--15

     Abraham
     Bucshon
     Byrne
     Clyburn
     Collins (GA)
     Johnson (LA)
     Johnson (OH)
     Massie
     Meeks
     Moulton
     Rose (NY)
     Ryan
     Smucker
     Swalwell (CA)
     Weber (TX)

                              {time}  1928

  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. WALDEN. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This is a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 234, 
noes 183, not voting 15, as follows:

                             [Roll No. 214]

                               AYES--234

     Adams
     Aguilar
     Allred
     Axne
     Barragan
     Bass
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brindisi
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Carbajal
     Cardenas
     Carson (IN)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Cohen
     Connolly
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crist
     Crow
     Cuellar
     Cummings
     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
     Gabbard
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     Golden
     Gomez
     Gonzalez (TX)
     Gottheimer
     Green (TX)
     Grijalva
     Haaland
     Harder (CA)
     Hastings
     Hayes
     Heck
     Herrera Beutler
     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
     Meng
     Moore
     Morelle
     Mucarsel-Powell
     Murphy
     Nadler
     Napolitano
     Neal
     Neguse
     Norcross
     O'Halleran
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Pelosi
     Perlmutter
     Peters
     Peterson
     Phillips
     Pingree
     Pocan
     Porter
     Pressley
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Richmond
     Rouda
     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 (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
     Upton
     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
     Bishop (UT)
     Bost
     Brady
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Budd
     Burchett
     Burgess
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Cline
     Cloud
     Cole
     Collins (NY)
     Comer
     Conaway
     Cook
     Crawford
     Crenshaw
     Curtis
     Davidson (OH)
     Davis, Rodney
     DesJarlais
     Diaz-Balart
     Duffy
     Duncan
     Dunn
     Emmer
     Estes
     Ferguson
     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
     Hice (GA)
     Higgins (LA)
     Hill (AR)
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hunter
     Hurd (TX)
     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
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     Meadows
     Meuser
     Miller
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Newhouse
     Norman
     Nunes
     Olson
     Palazzo
     Palmer
     Pence
     Perry
     Posey
     Ratcliffe
     Reed
     Reschenthaler
     Rice (SC)
     Riggleman
     Roby
     Rodgers (WA)
     Roe, David P.
     Rogers (AL)
     Rogers (KY)
     Rooney (FL)
     Rose, John W.
     Rouzer
     Roy
     Rutherford
     Scalise
     Schweikert
     Scott, Austin
     Sensenbrenner
     Shimkus
     Simpson
     Smith (MO)
     Smith (NE)
     Spano
     Stauber
     Stefanik
     Steil
     Steube
     Stewart
     Stivers
     Taylor
     Thompson (PA)
     Thornberry
     Timmons
     Tipton
     Turner
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Waltz
     Watkins
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Wright
     Yoho
     Young
     Zeldin

                             NOT VOTING--15

     Abraham
     Bucshon
     Byrne
     Clyburn
     Collins (GA)
     Johnson (LA)
     Johnson (OH)
     Massie
     Meeks
     Moulton
     Rose (NY)
     Ryan
     Smucker
     Swalwell (CA)
     Weber (TX)

[[Page H3911]]


  


                              {time}  1938

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

                          ____________________