[Congressional Record Volume 166, Number 119 (Monday, June 29, 2020)]
[House]
[Pages H2599-H2644]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                STATE HEALTH CARE PREMIUM REDUCTION ACT

  Mr. PALLONE. Madam Speaker, pursuant to House Resolution 1017, I call 
up the bill (H.R. 1425) to amend the Patient Protection and Affordable 
Care Act to provide for a Improve Health Insurance Affordability Fund 
to provide for certain reinsurance payments to lower premiums in the 
individual health insurance market, and ask for its immediate 
consideration.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Pursuant to House Resolution 1017, in lieu 
of the amendment in the nature of a substitute recommended by the 
Committee on Energy and Commerce printed in the bill, an amendment in 
the nature of a substitute consisting of the text of the Rules 
Committee Print 116-56, modified by the amendment printed in part B of 
House Report 116-436, is adopted, and the bill, as amended, is 
considered read.
  The text of the bill, as amended, is as follows:

                               H.R. 1425

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Patient Protection and 
     Affordable Care Enhancement Act''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents for this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

    TITLE I--LOWERING HEALTH CARE COSTS AND PROTECTING PEOPLE WITH 
                         PREEXISTING CONDITIONS

Sec. 101. Improving affordability by expanding premium assistance for 
              consumers.
Sec. 102. Improving affordability by reducing out-of-pocket and premium 
              costs for consumers.
Sec. 103. Expanding affordability for working families to fix the 
              family glitch.
Sec. 104. Tax credit reconciliation protections for individuals 
              receiving social security lump-sum payments.
Sec. 105. Preserving State option to implement health care 
              Marketplaces.
Sec. 106. Establishing a Health Insurance Affordability Fund.
Sec. 107. Rescinding the short-term limited duration insurance 
              regulation.
Sec. 108. Revoking section 1332 guidance.
Sec. 109. Requiring Marketplace outreach, educational activities, and 
              annual enrollment targets.
Sec. 110. Report on effects of website maintenance during open 
              enrollment.
Sec. 111. Promoting consumer outreach and education.
Sec. 112. Improving transparency and accountability in the Marketplace.
Sec. 113. Improving awareness of health coverage options.
Sec. 114. Promoting State innovations to expand coverage.
Sec. 115. Strengthening network adequacy.
Sec. 116. Protecting consumers from unreasonable rate hikes.
Sec. 117. Eligibility of DACA recipients for qualified health plans 
              offered through Exchanges.

TITLE II--ENCOURAGING MEDICAID EXPANSION AND STRENGTHENING THE MEDICAID 
                                PROGRAM

Sec. 201. Incentivizing Medicaid expansion.
Sec. 202. Providing 12-months of continuous eligibility for Medicaid 
              and CHIP.
Sec. 203. Mandatory 12-months of postpartum Medicaid eligibility.
Sec. 204. Reducing the administrative FMAP for nonexpansion States.
Sec. 205. Enhanced reporting requirements for nonexpansion states.
Sec. 206. Primary care pay increase.
Sec. 207. Permanent funding for CHIP.
Sec. 208. Permanent extension of CHIP enrollment and quality measures.
Sec. 209. State option to increase children's eligibility for Medicaid 
              and CHIP.
Sec. 210. Medicaid coverage for citizens of Freely Associated States.
Sec. 211. Extension of full Federal medical assistance percentage to 
              Indian health care providers.

     TITLE III--LOWERING PRICES THROUGH FAIR DRUG PRICE NEGOTIATION

Sec. 301. Establishing a Fair Drug Pricing Program.
Sec. 302. Drug manufacturer excise tax for noncompliance.
Sec. 303. Fair Price Negotiation Implementation Fund.

                  TITLE IV--PUBLIC HEALTH INVESTMENTS

Sec. 401. Supporting increased innovation.

    TITLE I--LOWERING HEALTH CARE COSTS AND PROTECTING PEOPLE WITH 
                         PREEXISTING CONDITIONS

     SEC. 101. IMPROVING AFFORDABILITY BY EXPANDING PREMIUM 
                   ASSISTANCE FOR CONSUMERS.

       (a) In General.--Section 36B(b)(3)(A) of the Internal 
     Revenue Code of 1986 is amended to read as follows:
       ``(A) Applicable percentage.--The applicable percentage for 
     any taxable year shall be the percentage such that the 
     applicable percentage for any taxpayer whose household income 
     is within an income tier specified in the following table 
     shall increase, on a sliding scale in a linear manner, from 
     the initial premium percentage to the final premium 
     percentage specified in such table for such income tier:


[[Page H2600]]



------------------------------------------------------------------------
  ``In the case of household  income
 (expressed as  a percent of poverty     The initial        The final
  line)  within the following income       premium           premium
                tier:                  percentage is--   percentage is--
------------------------------------------------------------------------
Up to 150.0 percent..................              0.0              0.0
150.0 percent up to 200.0 percent....              0.0              3.0
200.0 percent up to 250.0 percent....              3.0              4.0
250.0 percent up to 300.0 percent....              4.0              6.0
300.0 percent up to 400.0 percent....              6.0              8.5
400.0 percent and higher.............              8.5           8.5''.
------------------------------------------------------------------------

       (b) Conforming Amendment.--Section 36B(c)(1)(A) of the 
     Internal Revenue Code of 1986 is amended by striking ``but 
     does not exceed 400 percent''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2019.

     SEC. 102. IMPROVING AFFORDABILITY BY REDUCING OUT-OF-POCKET 
                   AND PREMIUM COSTS FOR CONSUMERS.

       Section 1302(c)(4) of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 18022(c)(4)) is amended by striking 
     ``calendar year)'' and inserting ``calendar year, based on 
     estimates and projections for the applicable calendar year of 
     the percentage (if any) by which the average per enrollee 
     premium for eligible employer-sponsored health plans (as 
     defined in section 5000A(f)(2) of the Internal Revenue Code 
     of 1986) exceeds such average per enrollee premium for the 
     preceding calendar year, as published in the National Health 
     Expenditure Accounts)''.

     SEC. 103. EXPANDING AFFORDABILITY FOR WORKING FAMILIES TO FIX 
                   THE FAMILY GLITCH.

       (a) In General.--Clause (i) of section 36B(c)(2)(C) of the 
     Internal Revenue Code of 1986 is amended to read as follows:
       ``(i) Coverage must be affordable.--

       ``(I) Employees.--An employee shall not be treated as 
     eligible for minimum essential coverage if such coverage 
     consists of an eligible employer-sponsored plan (as defined 
     in section 5000A(f)(2)) and the employee's required 
     contribution (within the meaning of section 5000A(e)(1)(B)) 
     with respect to the plan exceeds 9.5 percent of the 
     employee's household income.
       ``(II) Family members.--An individual who is eligible to 
     enroll in an eligible employer-sponsored plan (as defined in 
     section 5000A(f)(2)) by reason of a relationship the 
     individual bears to the employee shall not be treated as 
     eligible for minimum essential coverage by reason of such 
     eligibility to enroll if the employee's required contribution 
     (within the meaning of section 5000A(e)(1)(B), determined by 
     substituting `family' for `self-only') with respect to the 
     plan exceeds 9.5 percent of the employee's household 
     income.''.

       (b) Conforming Amendments.--
       (1) Clause (ii) of section 36B(c)(2)(C) of the Internal 
     Revenue Code of 1986 is amended by striking ``Except as 
     provided in clause (iii), an employee'' and inserting ``An 
     individual''.
       (2) Clause (iii) of section 36B(c)(2)(C) of such Code is 
     amended by striking ``the last sentence of clause (i)'' and 
     inserting ``clause (i)(II)''.
       (3) Clause (iv) of section 36B(c)(2)(C) of such Code is 
     amended by striking ``the 9.5 percent under clause (i)(II)'' 
     and inserting ``the 9.5 percent under clauses (i)(I) and 
     (i)(II)''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2021.

     SEC. 104. TAX CREDIT RECONCILIATION PROTECTIONS FOR 
                   INDIVIDUALS RECEIVING SOCIAL SECURITY LUMP-SUM 
                   PAYMENTS.

       (a) In General.--Section 36B(d)(2) of the Internal Revenue 
     Code of 1986 is amended by adding at the end the following 
     new subparagraph:
       ``(C) Exclusion of portion of lump-sum social security 
     benefits.--
       ``(i) In general.--The term `modified adjusted gross 
     income' shall not include so much of any lump-sum social 
     security benefit payment as is attributable to months ending 
     before the beginning of the taxable year.
       ``(ii) Lump-sum social security benefit payment.--For 
     purposes of this subparagraph, the term `lump-sum social 
     security benefit payment' means any payment of social 
     security benefits (as defined in section 86(d)(1)) which 
     constitutes more than 1 month of such benefits.
       ``(iii) Election to include excludable amount.--A taxpayer 
     may elect (at such time and in such manner as the Secretary 
     may provide) to have this subparagraph not apply for any 
     taxable year.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to taxable years beginning after December 31, 
     2019.

     SEC. 105. PRESERVING STATE OPTION TO IMPLEMENT HEALTH CARE 
                   MARKETPLACES.

       (a) In General.--Section 1311 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18031) is amended--
       (1) in subsection (a)--
       (A) in paragraph (4)(B), by striking ``under this 
     subsection'' and inserting ``under this paragraph or 
     paragraph (1)''; and
       (B) by adding at the end the following new paragraph:
       ``(6) Additional planning and establishment grants.--
       ``(A) In general.--There shall be appropriated to the 
     Secretary, out of any moneys in the Treasury not otherwise 
     appropriated, $200 million to award grants to eligible States 
     for the uses described in paragraph (3).
       ``(B) Duration and renewability.--A grant awarded under 
     subparagraph (A) shall be for a period of 2 years and may not 
     be renewed.
       ``(C) Limitation.--A grant may not be awarded under 
     subparagraph (A) after December 31, 2023.
       ``(D) Eligible state defined.--For purposes of this 
     paragraph, the term `eligible State' means a State that, as 
     of the date of the enactment of this paragraph, is not 
     operating an Exchange (other than an Exchange described in 
     section 155.200(f) of title 45, Code of Federal 
     Regulations).''; and
       (2) in subsection (d)(5)(A)--
       (A) by striking ``operations.--In establishing an Exchange 
     under this section'' and inserting ``operations.--
       ``(i) In general.--In establishing an Exchange under this 
     section (other than in establishing an Exchange pursuant to a 
     grant awarded under subsection (a)(6))''; and
       (B) by adding at the end the following:
       ``(ii) Additional planning and establishment grants.--In 
     establishing an Exchange pursuant to a grant awarded under 
     subsection (a)(6), the State shall ensure that such Exchange 
     is self-sustaining beginning on January 1, 2025, including 
     allowing the Exchange to charge assessments or user fees to 
     participating health insurance issuers, or to otherwise 
     generate funding, to support its operations.''.
       (b) Clarification Regarding Failure to Establish Exchange 
     or Implement Requirements.--Section 1321(c) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18041(c)) is 
     amended--
       (1) in paragraph (1), by striking ``If'' and inserting 
     ``Subject to paragraph (3), if''; and
       (2) by adding at the end the following new paragraph:
       ``(3) Clarification.--This subsection shall not apply in 
     the case of a State that elects to apply the requirements 
     described in subsection (a) and satisfies the requirement 
     described in subsection (b) on or after January 1, 2014.''.

     SEC. 106. ESTABLISHING A HEALTH INSURANCE AFFORDABILITY FUND.

       Subtitle D of title I of the Patient Protection and 
     Affordable Care Act is amended by inserting after part 5 (42 
     U.S.C. 18061 et seq.) the following new part:

         ``PART 6--IMPROVE HEALTH INSURANCE AFFORDABILITY FUND

     ``SEC. 1351. ESTABLISHMENT OF PROGRAM.

       ``There is hereby established the `Improve Health Insurance 
     Affordability Fund' to be administered by the Secretary of 
     Health and Human Services, acting through the Administrator 
     of the Centers for Medicare & Medicaid Services (in this 
     section referred to as the `Administrator'), to provide 
     funding, in accordance with this part, to the 50 States and 
     the District of Columbia (each referred to in this section as 
     a `State') beginning on January 1, 2022, for the purposes 
     described in section 1352.

     ``SEC. 1352. USE OF FUNDS.

       ``(a) In General.--A State shall use the funds allocated to 
     the State under this part for one of the following purposes:
       ``(1) To provide reinsurance payments to health insurance 
     issuers with respect to individuals enrolled under individual 
     health insurance coverage (other than through a plan 
     described in subsection (b)) offered by such issuers.
       ``(2) To provide assistance (other than through payments 
     described in paragraph (1)) to reduce out-of-pocket costs, 
     such as copayments, coinsurance, premiums, and deductibles, 
     of individuals enrolled under qualified health plans offered 
     on the individual market through an Exchange.
       ``(b) Exclusion of Certain Grandfathered and Transitional 
     Plans.--For purposes of subsection (a), a plan described in 
     this subsection is the following:
       ``(1) A grandfathered health plan (as defined in section 
     1251).
       ``(2) A plan (commonly referred to as a `transitional 
     plan') continued under the letter issued by the Centers for 
     Medicare & Medicaid Services on November 14, 2013, to the 
     State Insurance Commissioners outlining a transitional policy 
     for coverage in the individual and small group markets to 
     which section 1251 does not apply, and under the extension of 
     the transitional policy for such coverage set forth in the 
     Insurance Standards Bulletin Series guidance issued by the 
     Centers for Medicare & Medicaid Services on March 5, 2014, 
     February 29, 2016, February 13, 2017, April 9, 2018, March 
     25, 2019, and January 31, 2020, or under any subsequent 
     extensions thereof.
       ``(3) Student health insurance coverage (as defined in 
     section 147.145 of title 45, Code of Federal Regulations).

     ``SEC. 1353. STATE ELIGIBILITY AND APPROVAL; DEFAULT 
                   SAFEGUARD.

       ``(a) Encouraging State Options for Allocations.--
       ``(1) In general.--To be eligible for an allocation of 
     funds under this part for a year (beginning with 2022), a 
     State shall submit to the Administrator an application at 
     such time (but, in the case of allocations for 2022, not 
     later than 90 days after the date of the enactment of this 
     part and, in the case of allocations for a subsequent year, 
     not later than March 1 of the previous year) and in such form 
     and manner as specified by the Administrator containing--
       ``(A) a description of how the funds will be used; and

[[Page H2601]]

       ``(B) such other information as the Administrator may 
     require.
       ``(2) Automatic approval.--An application so submitted is 
     approved unless the Administrator notifies the State 
     submitting the application, not later than 60 days after the 
     date of the submission of such application, that the 
     application has been denied for not being in compliance with 
     any requirement of this part and of the reason for such 
     denial.
       ``(3) 5-year application approval.--If an application of a 
     State is approved for a purpose described in section 1352 for 
     a year, such application shall be treated as approved for 
     such purpose for each of the subsequent 4 years.
       ``(4) Revocation of approval.--The approval of an 
     application of a State, with respect to a purpose described 
     in section 1352, may be revoked if the State fails to use 
     funds provided to the State under this section for such 
     purpose or otherwise fails to comply with the requirements of 
     this section.
       ``(b) Default Federal Safeguard.--
       ``(1) 2022.--For 2022, in the case of a State that does not 
     submit an application under subsection (a) by the 90-day 
     submission date applicable to such year under subsection 
     (a)(1) and in the case of a State that does submit such an 
     application by such date that is not approved, the 
     Administrator, in consultation with the State insurance 
     commissioner, shall, from the amount calculated under 
     paragraph (4) for such year, carry out the purpose described 
     in paragraph (3) in such State for such year.
       ``(2) 2023 and subsequent years.--For 2023 or a subsequent 
     year, in the case of a State that does not have in effect an 
     approved application under this section for such year, the 
     Administrator, in consultation with the State insurance 
     commissioner, shall, from the amount calculated under 
     paragraph (4) for such year, carry out the purpose described 
     in paragraph (3) in such State for such year.
       ``(3) Specified use.--The amount described in paragraph 
     (4), with respect to 2022 or a subsequent year, shall be used 
     to carry out the purpose described in section 1352(a)(1) in 
     each State described in paragraph (1) or (2) for such year, 
     as applicable, by providing reinsurance payments to health 
     insurance issuers with respect to attachment range claims (as 
     defined in section 1354(b)(2)), using the dollar amounts 
     specified in subparagraph (B) of such section for such year) 
     in an amount equal to, subject to paragraph (5), the 
     percentage (specified for such year by the Secretary under 
     such subparagraph) of the amount of such claims.
       ``(4) Amount described.--The amount described in this 
     paragraph, with respect to 2022 or a subsequent year, is the 
     amount equal to the total sum of amounts that the Secretary 
     would otherwise estimate under section 1354(b)(2)(A)(i) for 
     such year for each State described in paragraph (1) or (2) 
     for such year, as applicable, if each such State were not so 
     described for such year.
       ``(5) Adjustment.--For purposes of this subsection, the 
     Secretary may apply a percentage under paragraph (3) with 
     respect to a year that is less than the percentage otherwise 
     specified in section 1354(b)(2)(B) for such year, if the cost 
     of paying the total eligible attachment range claims for 
     States described in this subsection for such year at such 
     percentage otherwise specified would exceed the amount 
     calculated under paragraph (4) for such year.

     ``SEC. 1354. ALLOCATIONS.

       ``(a) Appropriation.--For the purpose of providing 
     allocations for States under subsection (b) and payments 
     under section 1353(b) there is appropriated, out of any money 
     in the Treasury not otherwise appropriated, $10,000,000,000 
     for 2022 and each subsequent year.
       ``(b) Allocations.--
       ``(1) Payment.--
       ``(A) In general.--From amounts appropriated under 
     subsection (a) for a year, the Secretary shall, with respect 
     to a State not described in section 1353(b) for such year and 
     not later than the date specified under subparagraph (B) for 
     such year, allocate for such State the amount determined for 
     such State and year under paragraph (2).
       ``(B) Specified date.--For purposes of subparagraph (A), 
     the date specified in this subparagraph is--
       ``(i) for 2022, the date that is 45 days after the date of 
     the enactment of this part; and
       ``(ii) for 2023 or a subsequent year, January 1 of the 
     respective year.
       ``(C) Notifications of allocation amounts.--For 2023 and 
     each subsequent year, the Secretary shall notify each State 
     of the amount determined for such State under paragraph (2) 
     for such year by not later than January 1 of the previous 
     year.
       ``(2) Allocation amount determinations.--
       ``(A) In general.--For purposes of paragraph (1), the 
     amount determined under this paragraph for a year for a State 
     described in paragraph (1)(A) for such year is the amount 
     equal to--
       ``(i) the amount that the Secretary estimates would be 
     expended under this part for such year on attachment range 
     claims of individuals residing in such State if such State 
     used such funds only for the purpose described in paragraph 
     (1) of section 1352(a) at the dollar amounts and percentage 
     specified under subparagraph (B) for such year; minus
       ``(ii) the amount, if any, by which the Secretary 
     determines--

       ``(I) the estimated amount of premium tax credits under 
     section 36B of the Internal Revenue Code of 1986 that would 
     be attributable to individuals residing in such State for 
     such year without application of this part; exceeds
       ``(II) the estimated amount of premium tax credits under 
     section 36B of the Internal Revenue Code of 1986 that would 
     be attributable to individuals residing in such State for 
     such year if such State were a State described in section 
     1353(b) for such year.

     For purposes of the previous sentence and section 1353(b)(3), 
     the term `attachment range claims' means, with respect to an 
     individual, the claims for such individual that exceed a 
     dollar amount specified by the Secretary for a year, but do 
     not exceed a ceiling dollar amount specified by the Secretary 
     for such year, under subparagraph (B).
       ``(B) Specifications.--For purposes of subparagraph (A) and 
     section 1353(b)(3), the Secretary shall determine the dollar 
     amounts and the percentage to be specified under this 
     subparagraph for a year in a manner to ensure that the total 
     amount of expenditures under this part for such year is 
     estimated to equal the total amount appropriated for such 
     year under subsection (a) if such expenditures were used 
     solely for the purpose described in paragraph (1) of section 
     1352(a) for attachment range claims at the dollar amounts and 
     percentage so specified for such year.
       ``(3) Availability.--Funds allocated to a State under this 
     subsection for a year shall remain available through the end 
     of the subsequent year.''.

     SEC. 107. RESCINDING THE SHORT-TERM LIMITED DURATION 
                   INSURANCE REGULATION.

       (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.
       (b) Prohibition.--The Secretary of Health and Human 
     Services, the Secretary of the Treasury, and the Secretary of 
     Labor--
       (1) may not take any action to implement, enforce, or 
     otherwise give effect to the rule entitled ``Short-Term, 
     Limited Duration Insurance'' (83 Fed. Reg. 38212 (August 3, 
     2018));
       (2) shall apply any regulation revised by such rule as if 
     such rule had not been issued; and
       (3) may not promulgate any substantially similar rule.

     SEC. 108. REVOKING SECTION 1332 GUIDANCE.

       (a) Findings.--Congress finds the following:
       (1) On October 24, 2018, the administration published new 
     guidance to carry out section 1332 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18052) entitled ``State 
     Relief and Empowerment Waivers'' (83 Fed. Reg. 53575).
       (2) The new guidance encourages States to provide health 
     insurance coverage through insurance plans that may 
     discriminate against individuals with preexisting health 
     conditions, including the one in four Americans living with a 
     disability.
       (3) The implementation and enforcement of the new guidance 
     weakens protections for the millions of Americans living with 
     preexisting health conditions and jeopardizes Americans' 
     access to quality, affordable health insurance coverage.
       (b) Providing That Certain Guidance Related to Waivers for 
     State Innovation Under the Patient Protection and Affordable 
     Care Act Shall Have No Force or Effect.--Beginning July 1, 
     2020, the Secretary of Health and Human Services and the 
     Secretary of the Treasury may not take any action to 
     implement, enforce, or otherwise give effect to the guidance 
     entitled ``State Relief and Empowerment Waivers'' (83 Fed. 
     Reg. 53575 (October 24, 2018)), including any such action 
     that would result in individuals losing health insurance 
     coverage that includes the essential health benefits package 
     (as defined in subsection (a) of section 1302 of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18022(a)) 
     without regard to any waiver of any provision of such package 
     under a waiver under such section 1332), including the 
     maternity and newborn care essential health benefit described 
     in subsection (b)(1)(D) of such section, including any such 
     action that would result in a decrease in the number of such 
     individuals enrolled in coverage that is at least as 
     comprehensive as the coverage defined in section 1302(a) of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     18022(a)) compared to the number of such individuals who 
     would have been so enrolled in such coverage had such action 
     not been taken, including any such action that would, with 
     respect to individuals with substance use disorders, 
     including opioid use disorders, reduce the availability or 
     affordability of coverage that is at least as comprehensive 
     as the coverage defined in section 1302(a) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18022(a)) 
     compared to the availability or affordability, respectively, 
     of such coverage had such action not been taken, including 
     any such action that would result, with respect to vulnerable 
     populations (including low-income

[[Page H2602]]

     individuals, elderly individuals, and individuals with 
     serious health issues or who have a greater risk of 
     developing serious health issues), in a decrease in the 
     availability of coverage that is at least as comprehensive as 
     the coverage defined in section 1302(a) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18022(a)) with 
     coverage and cost sharing protections required under section 
     1332(b)(1)(B) of such Act (42 U.S.C. 18052(b)(1)(B)), 
     including any such action that would, with respect to 
     individuals with preexisting conditions, reduce the 
     affordability of coverage that is at least as comprehensive 
     as the coverage defined in section 1302(a) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18022(a)) 
     compared to the affordability of such coverage had such 
     action not been taken, including any such action that would 
     result in higher health insurance premiums for individuals 
     enrolled in health insurance coverage that is at least as 
     comprehensive as the coverage defined in section 1302(b) of 
     such Act (42 U.S.C. 18022(b)), and the Secretaries may not 
     promulgate any substantially similar guidance or rule. 
     Nothing in the previous sentence shall be construed to affect 
     the approval of waivers under section 1332 of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18052) that 
     establish reinsurance programs that are consistent with the 
     requirements under subsection (b)(1) of such section (42 
     U.S.C. 18052(b)(1)), lower health insurance premiums, and 
     protect health insurance coverage for people with preexisting 
     conditions.
       (c) GAO Report on Affect of State Innovation Waivers on 
     Coverage of Individuals and on Mental Health Health Care 
     Treatment.--Not later than 1 year after the date of the 
     enactment of this Act, the Comptroller General of the United 
     States shall submit to Congress a report on the number of 
     individuals expected to lose access to health insurance 
     coverage (as defined in section 2791 of the Public Health 
     Service Act (42 U.S.C. 300gg-91)) if subsection (b) were not 
     enacted and waivers under section 1332 of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18052) were 
     approved under the guidance described in such subsection (b). 
     Such report shall include an analysis of the expected effect 
     such waivers approved under such guidance would have on 
     mental health care treatment.

     SEC. 109. REQUIRING MARKETPLACE OUTREACH, EDUCATIONAL 
                   ACTIVITIES, AND ANNUAL ENROLLMENT TARGETS.

       (a) In General.--Section 1321(c) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18041(c)), as amended by 
     section 105(b), is further amended by adding at the end the 
     following new paragraphs:
       ``(4) Outreach and educational activities.--
       ``(A) In general.--In the case of an Exchange established 
     or operated by the Secretary within a State pursuant to this 
     subsection, the Secretary shall carry out outreach and 
     educational activities for purposes of informing individuals 
     about qualified health plans offered through the Exchange, 
     including by informing such individuals of the availability 
     of coverage under such plans and financial assistance for 
     coverage under such plans. Such outreach and educational 
     activities shall be provided in a manner that is culturally 
     and linguistically appropriate to the needs of the 
     populations being served by the Exchange (including hard-to-
     reach populations, such as racial and sexual minorities, 
     limited English proficient populations, individuals in rural 
     areas, veterans, and young adults) 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.
       ``(B) Limitation on use of funds.--No funds appropriated 
     under this paragraph shall be used for expenditures for 
     promoting non-ACA compliant health insurance coverage.
       ``(C) Non-ACA compliant health insurance coverage.--For 
     purposes of subparagraph (B):
       ``(i) The term `non-ACA compliant health insurance 
     coverage' means health insurance coverage, or a group health 
     plan, that is not a qualified health plan.
       ``(ii) Such term includes the following:

       ``(I) An association health plan.
       ``(II) Short-term limited duration insurance.

       ``(D) Funding.--Out of any funds in the Treasury not 
     otherwise appropriated, there are hereby appropriated for 
     fiscal year 2022 and each subsequent fiscal year, 
     $100,000,000 to carry out this paragraph. Funds appropriated 
     under this subparagraph shall remain available until 
     expended.
       ``(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.
       ``(5) Annual enrollment targets.--For plan year 2021 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.''.
       (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 (42 U.S.C. 18001 et seq.).

     SEC. 110. REPORT ON 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.

     SEC. 111. PROMOTING CONSUMER OUTREACH AND EDUCATION.

       (a) In General.--Section 1311(i) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18031(i)) is amended--
       (1) in paragraph (2), by adding at the end the following 
     new subparagraph:
       ``(C) Selection of recipients.--In the case of an Exchange 
     established and operated by the Secretary within a State 
     pursuant to section 1321(c), in awarding grants under 
     paragraph (1), the Exchange shall--
       ``(i) select entities to receive such grants based on an 
     entity's demonstrated capacity to carry out each of the 
     duties specified in paragraph (3);
       ``(ii) not take into account whether or not the entity has 
     demonstrated how the entity will provide information to 
     individuals relating to group health plans offered by a group 
     or association of employers described in section 2510.3-5(b) 
     of title 29, Code of Federal Regulations (or any successor 
     regulation), or short-term limited duration insurance (as 
     defined by the Secretary for purposes of section 2791(b)(5) 
     of the Public Health Service Act); and
       ``(iii) ensure that, each year, the Exchange awards such a 
     grant to--

       ``(I) at least one entity described in this paragraph that 
     is a community and consumer-focused nonprofit group; and
       ``(II) at least one entity described in subparagraph (B), 
     which may include another community and consumer-focused 
     nonprofit group in addition to any such group awarded a grant 
     pursuant to subclause (I).

     In awarding such grants, an Exchange may consider an entity's 
     record with respect to waste, fraud, and abuse for purposes 
     of maintaining the integrity of such Exchange.'';
       (2) in paragraph (3)--
       (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;'';
       (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
       (E) by adding at the end the following flush left sentence:
     ``The duties specified in the preceding sentence may be 
     carried out by such a navigator at any time during a year.'';
       (3) in paragraph (4)(A)--
       (A) in the matter preceding clause (i), by striking 
     ``not'';
       (B) in clause (i)--
       (i) by inserting ``not'' before ``be''; and
       (ii) by striking ``; or'' and inserting a semicolon;
       (C) in clause (ii)--
       (i) by inserting ``not'' before ``receive''; and
       (ii) by striking the period and inserting a semicolon; and
       (D) by adding at the end the following new clauses:
       ``(iii) maintain physical presence in the State of the 
     Exchange so as to allow in-person assistance to consumers; 
     and
       ``(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
       (4) in paragraph (6)--
       (A) by striking ``Funding.--Grants under'' and inserting 
     ``Funding.--
       ``(A) State exchanges.--Grants under''; and
       (B) by adding at the end the following new subparagraph:
       ``(B) Federal exchanges.--For purposes of carrying out this 
     subsection, with respect to an Exchange established and 
     operated by the Secretary within a State pursuant to section 
     1321(c), the Secretary shall obligate $100,000,000 out of 
     amounts collected through the user fees on participating 
     health insurance issuers pursuant to section 156.50 of title 
     45, Code of Federal Regulations (or any successor 
     regulations), for fiscal year 2022 and each subsequent fiscal 
     year.

[[Page H2603]]

     Such amount for a fiscal year shall remain available until 
     expended.''.
       (b) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning on or after 
     January 1, 2021.

     SEC. 112. IMPROVING TRANSPARENCY AND ACCOUNTABILITY IN THE 
                   MARKETPLACE.

       (a) Open Enrollment Reports.--For plan year 2021 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 federally facilitated Exchange operated pursuant to 
     section 1321(c) of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18041(c)). 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 
     2021 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 Exchange described in 
     subsection (a) 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 plan year 2021, the Secretary shall 
     issue a report on advertising and outreach to consumers for 
     the open enrollment period for plan year 2021. 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.
       (b) Promoting Transparency and Accountability in the 
     Administration's Expenditures of Exchange User Fees.--For 
     plan year 2021 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.

     SEC. 113. IMPROVING AWARENESS OF HEALTH COVERAGE OPTIONS.

       (a) In General.--Not later than 90 days after the date of 
     the enactment of this Act, the Secretary of Labor, in 
     consultation with the Secretary of Health and Human Services, 
     shall update, and make publicly available in a prominent 
     location on the website of the Department of Labor, the model 
     Consolidated Omnibus Budget Reconciliation Act of 1985 
     (referred to in this section as ``COBRA'') continuation 
     coverage general notice and the model COBRA continuation 
     coverage election notice developed by the Secretary of Labor 
     for purposes of facilitating compliance of group health plans 
     with the notification requirements under section 606 of the 
     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1166). In updating each such notice, the Secretary of Labor 
     shall include information regarding any Exchange established 
     under title I of the Patient Protection and Affordable Care 
     Act (42 U.S.C. 18001 et seq.) through which a qualified 
     beneficiary may be eligible to enroll in a qualified health 
     plan, including--
       (1) the publicly accessible Internet website address for 
     such Exchange;
       (2) the publicly accessible Internet website address for 
     the Find Local Help directory maintained by the Department of 
     Health and Human Services on the healthcare.gov Internet 
     website (or a successor website);
       (3) a clear explanation that--
       (A) an individual who is eligible for continuation coverage 
     may also be eligible to enroll, with financial assistance, in 
     a qualified health plan offered through such Exchange, but, 
     in the case that such individual elects to enroll in such 
     continuation coverage and subsequently elects to terminate 
     such continuation coverage before the period of such 
     continuation coverage expires, such individual will not be 
     eligible to enroll in a qualified health plan offered through 
     such Exchange during a special enrollment period; and
       (B) an individual who elects to enroll in continuation 
     coverage will remain eligible to enroll in a qualified health 
     plan offered through such Exchange during an open enrollment 
     period and may be eligible for financial assistance with 
     respect to enrolling in such a qualified health plan;
       (4) information on consumer protections with respect to 
     enrolling in a qualified health plan offered through such 
     Exchange, including the requirement for such a qualified 
     health plan to provide coverage for essential health benefits 
     (as defined in section 1302(b) of such Act (42 U.S.C. 
     18022(b)) and the requirements applicable to such a qualified 
     health plan under part A of title XXVII of the Public Health 
     Service Act (42 U.S.C. 300gg et seq.); and
       (5) information on the availability of financial assistance 
     with respect to enrolling in a qualified health plan, 
     including the maximum income limit for eligibility for a 
     premium tax credit under section 36B of the Internal Revenue 
     Code of 1986.
       (b) Name of Notices.--In addition to updating the model 
     COBRA continuation coverage general notice and the model 
     COBRA continuation coverage election notice under paragraph 
     (1), the Secretary of Labor shall rename each such notice as 
     the ``model COBRA continuation coverage and Affordable Care 
     Act coverage general notice'' and the ``model COBRA 
     continuation coverage and Affordable Care Act coverage 
     election notice'', respectively.
       (c) Consumer Testing.--Prior to making publicly available 
     the model COBRA continuation coverage general notice and the 
     model COBRA continuation coverage election notice updated 
     under paragraph (1), the Secretary of Labor shall provide an 
     opportunity for consumer testing of each such notice, as so 
     updated, to ensure that each such notice is clear and 
     understandable to the average participant or beneficiary of a 
     group health plan.
       (d) Definitions.--In this subsection:
       (1) Continuation coverage.--The term ``continuation 
     coverage'', with respect to a group health plan, has the 
     meaning given such term in section 602 of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1162).
       (2) Group health plan.--The term ``group health plan'' has 
     the meaning given such term in section 607 of such Act (29 
     U.S.C. 1167).
       (3) Qualified beneficiary.--The term ``qualified 
     beneficiary'' has the meaning given such term in such section 
     607.
       (4) Qualified health plan.--The term ``qualified health 
     plan'' has the meaning given such term in section 1301 of the 
     Patient Protection and Affordable Care Act (42 U.S.C. 18021).

     SEC. 114. PROMOTING STATE INNOVATIONS TO EXPAND COVERAGE.

       (a) In General.--Subject to subsection (d), the Secretary 
     of Health and Human Services shall award grants to eligible 
     State agencies to enable such States to explore innovative 
     solutions to promote greater enrollment in health insurance 
     coverage in the individual and small group markets, including 
     activities described in subsection (c).
       (b) Eligibility.--For purposes of subsection (a), eligible 
     State agencies are Exchanges established by a State under 
     title I of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18001 et seq.) and State agencies with primary 
     responsibility over health and human services for the State 
     involved.
       (c) Use of Funds.--For purposes of subsection (a), the 
     activities described in this subsection are the following:
       (1) State efforts to streamline health insurance enrollment 
     procedures in order to reduce burdens on consumers and 
     facilitate greater enrollment in health insurance coverage in 
     the individual and small group markets, including automatic 
     enrollment and reenrollment of, or pre-populated applications 
     for, individuals without health insurance who are eligible 
     for tax credits under section 36B of the Internal Revenue 
     Code of 1986, with the ability to opt out of such enrollment.
       (2) State investment in technology to improve data sharing 
     and collection for the purposes of facilitating greater 
     enrollment in health insurance coverage in such markets.
       (3) Implementation of a State version of an individual 
     mandate to be enrolled in health insurance coverage.

[[Page H2604]]

       (4) Feasibility studies to develop comprehensive and 
     coherent State plan for increasing enrollment in the 
     individual and small group market.
       (d) Funding.--For purposes of carrying out this section, 
     there is hereby appropriated, out of any funds in the 
     Treasury not otherwise appropriated, $200,000,000 for each of 
     the fiscal years 2022 through 2024. Such amount shall remain 
     available until expended.

     SEC. 115. STRENGTHENING NETWORK ADEQUACY.

       (a) In General.--Section 1311(d) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18031(d)) is amended by 
     adding at the end the following new paragraph:
       ``(8) Network adequacy standards.--
       ``(A) Certain exchanges.--In the case of an Exchange 
     operated by the Secretary pursuant section 1321(c)(1) or an 
     Exchange described in section 155.200(f) of title 42, Code of 
     Federal Regulations (or a successor regulation), the Exchange 
     shall require each qualified health plan offered through such 
     Exchange to meet such quantitative network adequacy standards 
     as the Secretary may prescribe for purposes of this 
     subparagraph.
       ``(B) State exchanges.--In the case of an Exchange not 
     described in subparagraph (A), the Exchange shall establish 
     quantitative network adequacy standards with respect to 
     qualified health plans offered through such Exchange and 
     require such plans to meet such standards.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply with respect to plan years beginning on or after 
     January 1, 2022.

     SEC. 116. PROTECTING CONSUMERS FROM UNREASONABLE RATE HIKES.

       (a) Protection From Excessive, Unjustified, or Unfairly 
     Discriminatory Rates.--The first section 2794 of the Public 
     Health Service Act (42 U.S.C. 300gg-94), as added by section 
     1003 of the Patient Protection and Affordable Care Act 
     (Public Law 111-148), is amended by adding at the end the 
     following new subsection:
       ``(e) Protection From Excessive, Unjustified, or Unfairly 
     Discriminatory Rates.--
       ``(1) Authority of states.--Nothing in this section shall 
     be construed to prohibit a State from imposing requirements 
     (including requirements relating to rate review standards and 
     procedures and information reporting) on health insurance 
     issuers with respect to rates that are in addition to the 
     requirements of this section and are more protective of 
     consumers than such requirements.
       ``(2) Consultation in rate review process.--In carrying out 
     this section, the Secretary shall consult with the National 
     Association of Insurance Commissioners and consumer groups.
       ``(3) Determination of who conducts reviews for each 
     state.--The Secretary shall determine, after the date of 
     enactment of this section and periodically thereafter, the 
     following:
       ``(A) In which markets in each State the State insurance 
     commissioner or relevant State regulator shall undertake the 
     corrective actions under paragraph (4), based on the 
     Secretary's determination that the State regulator is 
     adequately undertaking and utilizing such actions in that 
     market.
       ``(B) In which markets in each State the Secretary shall 
     undertake the corrective actions under paragraph (4), in 
     cooperation with the relevant State insurance commissioner or 
     State regulator, based on the Secretary's determination that 
     the State is not adequately undertaking and utilizing such 
     actions in that market.
       ``(4) Corrective action for excessive, unjustified, or 
     unfairly discriminatory rates.--In accordance with the 
     process established under this section, the Secretary or the 
     relevant State insurance commissioner or State regulator 
     shall take corrective actions to ensure that any excessive, 
     unjustified, or unfairly discriminatory rates are corrected 
     prior to implementation, or as soon as possible thereafter, 
     through mechanisms such as--
       ``(A) denying rates;
       ``(B) modifying rates; or
       ``(C) requiring rebates to consumers.
       ``(5) Noncompliance.--Failure to comply with any corrective 
     action taken by the Secretary under this subsection may 
     result in the application of civil monetary penalties under 
     section 2723 and, if the Secretary determines appropriate, 
     make the plan involved ineligible for classification as a 
     qualified health plan.''.
       (b) Clarification of Regulatory Authority.--Such section is 
     further amended--
       (1) in subsection (a)--
       (A) in the heading, by striking ``Premium'' and inserting 
     ``Rate'';
       (B) in paragraph (1), by striking ``unreasonable increases 
     in premiums'' and inserting ``potentially excessive, 
     unjustified, or unfairly discriminatory rates, including 
     premiums,''; and
       (C) in paragraph (2)--
       (i) by striking ``an unreasonable premium increase'' and 
     inserting ``a potentially excessive, unjustified, or unfairly 
     discriminatory rate'';
       (ii) by striking ``the increase'' and inserting ``the 
     rate''; and
       (iii) by striking ``such increases'' and inserting ``such 
     rates''; and
       (2) in subsection (b)--
       (A) by striking ``premium increases'' each place it appears 
     and inserting ``rates''; and
       (B) in paragraph (2)(B), by striking ``premium'' and 
     inserting ``rate''.
       (c) Conforming Amendments.--Title XXVII of the Public 
     Health Service Act (42 U.S.C. 300gg et seq.) is amended--
       (1) in section 2723 (42 U.S.C. 300gg-22), as redesignated 
     by the Patient Protection and Affordable Care Act--
       (A) in subsection (a)--
       (i) in paragraph (1), by inserting ``and section 2794'' 
     after ``this part''; and
       (ii) in paragraph (2), by inserting ``or section 2794'' 
     after ``this part''; and
       (B) in subsection (b)--
       (i) in paragraph (1), by inserting ``and section 2794'' 
     after ``this part''; and
       (ii) in paragraph (2)--

       (I) in subparagraph (A), by inserting ``or section 2794 
     that is'' after ``this part''; and
       (II) in subparagraph (C)(ii), by inserting ``or section 
     2794'' after ``this part''; and

       (2) in section 2761 (42 U.S.C. 300gg-61)--
       (A) in subsection (a)--
       (i) in paragraph (1), by inserting ``and section 2794'' 
     after ``this part''; and
       (ii) in paragraph (2)--

       (I) by inserting ``or section 2794'' after ``set forth in 
     this part''; and
       (II) by inserting ``and section 2794'' after ``the 
     requirements of this part''; and

       (B) in subsection (b)--
       (i) by inserting ``and section 2794'' after ``this part''; 
     and
       (ii) by inserting ``and section 2794'' after ``part A''.
       (d) Applicability to Grandfathered Plans.--Section 
     1251(a)(4)(A) of the Patient Protection and Affordable Care 
     Act (Public Law 111-148), as added by section 2301 of the 
     Health Care and Education Reconciliation Act of 2010 (Public 
     Law 111-152), is amended by adding at the end the following:
       ``(v) Section 2794 (relating to reasonableness of rates 
     with respect to health insurance coverage).''.
       (e) Authorization of Appropriations.--There are authorized 
     to be appropriated to carry out this Act such sums as may be 
     necessary.
       (f) Effective Date.--The amendments made by this section 
     shall take effect on the date of enactment of this Act and 
     shall be implemented with respect to health plans beginning 
     not later than January 1, 2022.

     SEC. 117. ELIGIBILITY OF DACA RECIPIENTS FOR QUALIFIED HEALTH 
                   PLANS OFFERED THROUGH EXCHANGES.

       (a) In General.--Section 1312(f)(3) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18032(f)(3)) is 
     amended--
       (1) by striking ``or an alien lawfully present in the 
     United States'' and inserting ``, an alien lawfully present 
     in the United States, or a DACA recipient''; and
       (2) by adding at the end the following: ``For purposes of 
     the previous sentence, the term `DACA recipient' means an 
     individual who was granted deferred action pursuant to the 
     Deferred Action for Childhood Arrivals Program announced in 
     the memorandum of the Secretary of Homeland Security dated 
     June 15, 2012, and for whom such grant remains valid.''.
       (b) Application of Reduced Cost-sharing.--Section 
     1402(e)(2) of the Patient Protection and Affordable Care Act 
     (42 U.S.C. 18071(e)(2)) is amended by adding at the end the 
     following: ``A DACA recipient (as defined in section 
     1312(f)(3)) shall be treated as lawfully present for purposes 
     of this section.''
       (c) Eligibility for Advance Payments.--Section 1412(d) of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     18082(d)) is amended by adding at the end the following: 
     ``For purposes of the previous sentence, a DACA recipient (as 
     defined in section 1312(f)(3)) shall be treated as lawfully 
     present in the United States.''.
       (d) Verification of Eligibility.--Section 1411(c)(2)(B) of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     18081(c)(2)(B)) is amended--
       (1) in clause (i)(I), by inserting ``or a DACA recipient 
     (as defined in section 1312(f)(3))'' after ``an alien 
     lawfully present in the United States''; and
       (2) in clause (ii), by inserting ``or a DACA recipient (as 
     defined in section 1312(f)(3))'' after ``an alien lawfully 
     present in the United States''.
       (e) Application of Tax Credit for Coverage Under a 
     Qualified Health Plan.--Section 36B(e)(2) of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following: ``A DACA recipient (as defined in section 
     1312(f)(3) of the Patient Protection and Affordable Care Act) 
     shall be treated as lawfully present for purposes of this 
     section.''.
       (f) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 2021.

TITLE II--ENCOURAGING MEDICAID EXPANSION AND STRENGTHENING THE MEDICAID 
                                PROGRAM

     SEC. 201. INCENTIVIZING MEDICAID EXPANSION.

       (a) In General.--Section 1905(y)(1) of the Social Security 
     Act (42 U.S.C. 1396d(y)(1)) is amended--
       (1) in subparagraph (A), by striking ``2014, 2015, and 
     2016'' and inserting ``each of the first 3 consecutive 12-
     month periods in which the State provides medical assistance 
     to newly eligible individuals'';
       (2) in subparagraph (B), by striking ``2017'' and inserting 
     ``the fourth consecutive 12-month period in which the State 
     provides medical assistance to newly eligible individuals'';
       (3) in subparagraph (C), by striking ``2018'' and inserting 
     ``the fifth consecutive 12-month period in which the State 
     provides medical assistance to newly eligible individuals'';
       (4) in subparagraph (D), by striking ``2019'' and inserting 
     ``the sixth consecutive 12-month period in which the State 
     provides medical assistance to newly eligible individuals''; 
     and
       (5) in subparagraph (E), by striking ``2020 and each year 
     thereafter'' and inserting ``the seventh consecutive 12-month 
     period in which the State provides medical assistance to 
     newly eligible individuals and each such period thereafter''.
       (b) Effective Date.--Beginning on January 1, 2022, the 
     amendments made by subsection (a) shall take effect as if 
     included in the enactment of the Patient Protection and 
     Affordable Care Act (Public Law 111-148).

[[Page H2605]]

  


     SEC. 202. PROVIDING 12-MONTHS OF CONTINUOUS ELIGIBILITY FOR 
                   MEDICAID AND CHIP.

       (a) Requirement of 12-Month Continuous Enrollment Under 
     Medicaid.--Section 1902(e)(12) of the Social Security Act (42 
     U.S.C. 1396a(e)(12)) is amended to read as follows:
       ``(12) 12-month continuous enrollment.--Notwithstanding any 
     other provision of this title, a State plan approved under 
     this title (or under any waiver of such plan approved 
     pursuant to section 1115 or section 1915), shall provide that 
     an individual who is determined to be eligible for benefits 
     under such plan (or waiver) shall remain eligible and 
     enrolled for such benefits through the end of the month in 
     which the 12-month period (beginning on the date of 
     determination of eligibility) ends.''.
       (b) Requirement of 12-Month Continuous Enrollment Under 
     CHIP.--
       (1) In general.--Section 2102(b) of the Social Security Act 
     (42 U.S.C. 1397bb(b)) is amended by adding at the end the 
     following new paragraph:
       ``(6) Requirement for 12-month continuous enrollment.--
     Notwithstanding any other provision of this title, a State 
     child health plan that provides child health assistance under 
     this title through a means other than described in section 
     2101(a)(2), shall provide that an individual who is 
     determined to be eligible for benefits under such plan shall 
     remain eligible and enrolled for such benefits through the 
     end of the month in which the 12-month period (beginning on 
     the date of determination of eligibility) ends.''.
       (2) Conforming amendment.--Section 2105(a)(4)(A) of the 
     Social Security Act (42 U.S.C. 1397ee(a)(4)(A)) is amended--
       (A) by striking ``has elected the option of'' and inserting 
     ``is in compliance with the requirement for''; and
       (B) by striking ``applying such policy under its State 
     child health plan under this title'' and inserting ``in 
     compliance with section 2102(b)''.
       (c) Effective Date.--
       (1) In general.--Except as provided in paragraph (2) or 
     (3), the amendments made by subsections (a) and (b) shall 
     apply to determinations (and redeterminations) of eligibility 
     made on or after the date that is 12 months after the last 
     day of the emergency period described in section 
     1135(g)(1)(B) of the Social Security Act (42 U.S.C. 1320b-
     5(g)(1)(B)).
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX or State child 
     health plan under title XXI of the Social Security Act (42 
     U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) which the 
     Secretary of Health and Human Services determines requires 
     State legislation (other than legislation appropriating 
     funds) in order for the respective plan to meet the 
     additional requirement imposed by the amendment made by 
     subsection (a) or (b), respectively, the respective plan 
     shall not be regarded as failing to comply with the 
     requirements of such title solely on the basis of its failure 
     to meet such applicable additional requirement before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of the 
     session is considered to be a separate regular session of the 
     State legislature.
       (3) Option to implement 12-month continuous eligibility 
     prior to effective date.--A State may elect through a State 
     plan amendment under title XIX or XXI of the Social Security 
     Act (42 U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) to 
     apply the amendment made by subsection (a) or (b), 
     respectively, on any date prior to the date specified in 
     paragraph (1), but not sooner than the date of the enactment 
     of this Act.

     SEC. 203. MANDATORY 12-MONTHS OF POSTPARTUM MEDICAID 
                   ELIGIBILITY.

       (a) Extending Continuous Medicaid and CHIP Coverage for 
     Pregnant and Postpartum Women.--
       (1) Medicaid.--Title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.) is amended--
       (A) in section 1902(l)(1)(A), by striking ``60-day period'' 
     and inserting ``365-day period'';
       (B) in section 1902(e)(6), by striking ``60-day period'' 
     and inserting ``365-day period'';
       (C) in section 1903(v)(4)(A)(i), by striking ``60-day 
     period'' and inserting ``365-day period''; and
       (D) in section 1905(a), in the 4th sentence in the matter 
     following paragraph (30), by striking ``60-day period'' and 
     inserting ``365-day period''.
       (2) CHIP.--Section 2112 of the Social Security Act (42 
     U.S.C. 1397ll) is amended by striking ``60-day period'' each 
     place it appears and inserting ``365-day period''.
       (b) Requiring Full Benefits for Pregnant and Postpartum 
     Women.--
       (1) Medicaid.--
       (A) In general.--Paragraph (5) of section 1902(e) of the 
     Social Security Act (24 U.S.C. 1396a(e)) is amended to read 
     as follows:
       ``(5) Any woman who is eligible for medical assistance 
     under the State plan or a waiver of such plan and who is, or 
     who while so eligible becomes, pregnant, shall continue to be 
     eligible under the plan or waiver for medical assistance 
     through the end of the month in which the 365-day period 
     (beginning on the last day of her pregnancy) ends, regardless 
     of the basis for the woman's eligibility for medical 
     assistance, including if the woman's eligibility for medical 
     assistance is on the basis of being pregnant.''.
       (B) Conforming amendment.--Section 1902(a)(10) of the 
     Social Security Act (42 U.S.C. 1396a(a)(10)) is amended in 
     the matter following subparagraph (G) by striking ``(VII) the 
     medical assistance'' and all that follows through 
     ``complicate pregnancy,''.
       (2) CHIP.--Section 2107(e)(1) of the Social Security Act 
     (42 U.S.C. 1397gg(e)(1)) is amended--
       (A) by redesignating subparagraphs (H) through (S) as 
     subparagraphs (I) through (T), respectively; and
       (B) by inserting after subparagraph (G), the following:
       ``(H) Section 1902(e)(5) (requiring 365-day continuous 
     coverage for pregnant and postpartum women).''.
       (c) Maintenance of Effort.--
       (1) Medicaid.--Section 1902 of the Social Security Act (42 
     U.S.C. 1396a) is amended--
       (A) in paragraph (74), by striking ``subsection (gg); and'' 
     and inserting ``subsections (gg) and (qq);''; and
       (B) by adding at the end the following new subsection:
       ``(qq) Maintenance of Effort Related to Low-Income Pregnant 
     Women.--For calendar quarters beginning on or after the 
     effective date described in section 203(d) of the Patient 
     Protection and Affordable Care Enhancement Act, and before 
     January 1, 2023, no Federal payment shall be made to a State 
     under section 1903(a) for amounts expended under a State plan 
     under this title or a waiver of such plan if the State--
       ``(1) has in effect under such plan eligibility standards, 
     methodologies, or procedures for individuals described in 
     subsection (l)(1) who are eligible for medical assistance 
     under the State plan or waiver under subsection 
     (a)(10)(A)(ii)(IX) that are more restrictive than the 
     eligibility standards, methodologies, or procedures, 
     respectively, for such individuals under such plan or waiver 
     that are in effect on the date of the enactment of this 
     subsection; or
       ``(2) provides medical assistance to individuals described 
     in subsection (l)(1) who are eligible for medical assistance 
     under such plan or waiver under subsection (a)(10)(A)(ii)(IX) 
     at a level that is less than the level at which the State 
     provides such assistance to such individuals under such plan 
     or waiver on the date of the enactment of this subsection.''.
       (2) CHIP.--Section 2112 of the Social Security Act (42 
     U.S.C. 1397ll), as amended by subsection (b), is further 
     amended by adding at the end the following subsection:
       ``(g) Maintenance of Effort.--For calendar quarters 
     beginning on or after the effective date described in section 
     203(d) of the Patient Protection and Affordable Care 
     Enhancement Act, and before January 1, 2023, no payment may 
     be made under section 2105(a) with respect to a State child 
     health plan if the State--
       ``(1) has in effect under such plan eligibility standards, 
     methodologies, or procedures for targeted low-income pregnant 
     women that are more restrictive than the eligibility 
     standards, methodologies, or procedures, respectively, under 
     such plan that are in effect on the date of the enactment of 
     this subsection; or
       ``(2) provides pregnancy-related assistance to targeted 
     low-income pregnant women under such plan at a level that is 
     less than the level at which the State provides such 
     assistance to such women under such plan on the date of the 
     enactment of this subsection.''.
       (d) Effective Date.--
       (1) In general.--Except as provided under paragraph (2), 
     the amendments made by subsections (a) and (b) shall take 
     effect on (and the effective date described in this 
     subsection shall be) the first day of the calendar quarter 
     during which the last day of the emergency period described 
     in section 1135(g)(1)(B) of the Social Security Act (42 
     U.S.C. 1320b-5(g)(1)(B)) occurs.
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX or State child 
     health plan under title XXI of the Social Security Act (42 
     U.S.C. 1396 et seq.; 42 U.S.C. 1397aa et seq.) which the 
     Secretary of Health and Human Services determines requires 
     State legislation (other than legislation appropriating 
     funds) in order for the respective plan to meet the 
     additional requirement imposed by the amendments made by 
     subsection (a) or (b), respectively, the respective plan 
     shall not be regarded as failing to comply with the 
     requirements of such title solely on the basis of its failure 
     to meet such applicable additional requirement before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of the 
     session is considered to be a separate regular session of the 
     State legislature.

     SEC. 204. REDUCING THE ADMINISTRATIVE FMAP FOR NONEXPANSION 
                   STATES.

       Section 1903 of the Social Security Act (42 U.S.C. 1396b) 
     is amended--
       (1) in subsection (a)(7), by inserting ``subsection (bb) 
     and'' before ``section 1919(g)(3)(B)''; and
       (2) by adding at the end the following new subsection:
       ``(bb) Reduction of Federal Payments for Certain 
     Administrative Costs of Nonexpansion States.--
       ``(1) In general.--In the case of a State that does not 
     provide under the State plan of such State (or waiver of such 
     plan) for making medical assistance available in accordance 
     with section 1902(k)(1) to all individuals described in 
     section 1902(a)(10)(i)(VIII) for a calendar quarter beginning 
     on or after October 1, 2022, the Secretary may reduce the 
     percentage specified in subsection (a)(7) for amounts 
     described in such subsection expended during such quarter by 
     such State by the number of percentage points specified in 
     paragraph (2) for such quarter.
       ``(2) Amount of reduction.--For purposes of paragraph (1), 
     the number of percentage points specified in this paragraph 
     for a calendar quarter is the following:

[[Page H2606]]

       ``(A) For the calendar quarter beginning on October 1, 
     2022, 0.5.
       ``(B) For a calendar quarter beginning on or after January 
     1, 2023, and ending before July 1, 2027, the number of 
     percentage points specified under this paragraph for the 
     previous quarter, plus 0.5.
       ``(C) For a calendar quarter beginning on or after July 1, 
     2027, 10.
       ``(3) Definition.--For purposes of this subsection, the 
     term `State' means a State that is one of the 50 States or 
     the District of Columbia.''.

     SEC. 205. ENHANCED REPORTING REQUIREMENTS FOR NONEXPANSION 
                   STATES.

       Section 1903 of the Social Security Act (42 U.S.C. 1396b), 
     as amended by section 204, is further amended--
       (1) in subsection (a)(7), by striking ``subsection (bb)'' 
     and inserting ``subsections (bb) and (cc)''; and
       (2) by adding at the end the following new subsection:
       ``(cc) Reduction of Federal Payments for Certain 
     Administrative Costs of Nonexpansion States That Do Not 
     Satisfy Reporting Requirements.--
       ``(1) In general.--
       ``(A) Reduction.--In the case of a nonexpansion State, with 
     respect to a fiscal year (beginning with fiscal year 2023) 
     that does not satisfy the reporting requirement under 
     paragraph (2) for such fiscal year, the percentage specified 
     in subsection (a)(7) for amounts described in such subsection 
     expended by such State during a calendar quarter described in 
     paragraph (4) with respect to such fiscal year, subject to 
     subparagraph (B), shall be reduced by the number of 
     percentage points specified in paragraph (4) for the 
     respective calendar quarter.
       ``(B) Exception.--In the case of a nonexpansion State that 
     is subject to a reduction under subparagraph (A) for the 
     calendar quarter described in paragraph (4)(A) with respect 
     to a fiscal year, if the State satisfies the criteria 
     described in subparagraphs (A), (B), and (C) of paragraph (2) 
     (without regard to the dates specified in such subparagraph 
     (A) and (C)) before the beginning of a subsequent calendar 
     quarter described in paragraph (4) with respect to such 
     fiscal year, then such State shall not be subject to a 
     reduction under subparagraph (A) for such subsequent calendar 
     quarter.
       ``(2) Reporting requirement.--For purposes of paragraph 
     (1), a nonexpansion State satisfies the reporting requirement 
     under this paragraph for a fiscal year, if the nonexpansion 
     State--
       ``(A) by not later than January 1 of such year, posts on 
     the public website of the State agency administering the 
     State plan, the information described in paragraph (3) with 
     respect to such State for the previous year;
       ``(B) provides for at least a 30-day period for notice and 
     comment on such information; and
       ``(C) by not later than March 1 of such year, submits to 
     the Secretary a complete report including such information, 
     comments submitted pursuant to subparagraph (B), and a 
     response by the State to each such comment.
       ``(3) Information described.--The information described in 
     this paragraph, with respect to a State and year, is the 
     following:
       ``(A) The the estimated number of individuals who were 
     uninsured for at least 6 months, shown by age-groups of 0 to 
     18 years of age and of 19 years of age to 64 years of age, as 
     well as a detailed description of the basis for the 
     estimates.
       ``(B) The estimated number of the individuals estimated 
     under subparagraph (A) in the State who would be eligible for 
     medical assistance under the State plan if the State were to 
     make medical assistance under the State plan available in 
     accordance with section 1902(k)(1) to all individuals 
     described in section 1902(a)(10)(i)(VIII), and a detailed 
     description of the basis for the estimates.
       ``(C) A comprehensive listing of State income eligibility 
     criteria for all mandatory and optional Medicaid eligibility 
     groups for which the State plan provides medical assistance 
     (other than with respect to individuals described in clause 
     (i)(II), (ii)(VI), or (ii)(XXII) of section 1902(a)(10)(A)).
       ``(D) The total amount of hospital uncompensated-care costs 
     and a breakdown of the source of such costs, as well as a 
     breakdown for rural and non-rural hospitals.
       ``(4) Percentage described.--For purposes of paragraph (1), 
     a calendar quarter described in this paragraph, with respect 
     to a fiscal year, and the percentage points described in this 
     paragraph for such quarter, with respect to a State, are--
       ``(A) for the calendar quarter beginning on the April 1 
     occurring during such fiscal year, 0.5 percentage points;
       ``(B) for the calendar quarter beginning on the July 1 
     occurring during such fiscal year, 1.0 percentage point; and
       ``(C) for the calendar quarter beginning on the October 1 
     occurring during the subsequent fiscal year, 1.5 percentage 
     points.
       ``(5) Payment in case of reporting state.--The expenses 
     incurred by a non-expansion State, with respect to any 
     calendar quarter with respect to a fiscal year (beginning 
     with 2021), for carrying out subparagraphs (A) through (C) of 
     paragraph (2) shall, for purposes of section 1903(a)(7), be 
     considered to be expenses necessary for the proper and 
     efficient administration of the State plan under this title.
       ``(6) Nonexpanion state defined.--For purposes of this 
     subsection, the term `nonexpansion State' means, with respect 
     to a fiscal year, a State that as of the first quarter of 
     such fiscal year does not provide under the State plan of 
     such State (or waiver of such plan) for making medical 
     assistance available in accordance with section 1902(k)(1) to 
     all individuals described in section 1902(a)(10)(i)(VIII).''.

     SEC. 206. PRIMARY CARE PAY INCREASE.

       (a) Renewal of Payment Floor; Additional Providers.--
       (1) In general.--Section 1902(a)(13) of the Social Security 
     Act (42 U.S.C. 1396a(a)(13)) is amended by striking 
     subparagraph (C) and inserting the following:
       ``(C) payment for primary care services (as defined in 
     subsection (jj)) at a rate that is not less than 100 percent 
     of the payment rate that applies to such services and 
     physician under part B of title XVIII (or, if greater, the 
     payment rate that would be applicable under such part if the 
     conversion factor under section 1848(d) for the year involved 
     were the conversion factor under such section for 2009), and 
     that is not less than the rate that would otherwise apply to 
     such services under this title if the rate were determined 
     without regard to this subparagraph, and that are--
       ``(i) furnished during 2013 and 2014, by a physician with a 
     primary specialty designation of family medicine, general 
     internal medicine, or pediatric medicine; or
       ``(ii) furnished during the period that begins on the first 
     day of the first month that begins one year after the date of 
     enactment of the Patient Protection and Affordable Care 
     Enhancement Act and ends September 30, 2024--

       ``(I) by a physician with a primary specialty designation 
     of family medicine, general internal medicine, or pediatric 
     medicine, but only if the physician self-attests that the 
     physician is Board certified in family medicine, general 
     internal medicine, or pediatric medicine;
       ``(II) by a physician with a primary specialty designation 
     of obstetrics and gynecology, but only if the physician self-
     attests that the physician is Board certified in obstetrics 
     and gynecology;
       ``(III) by an advanced practice clinician, as defined by 
     the Secretary, that works under the supervision of--

       ``(aa) a physician that satisfies the criteria specified in 
     subclause (I) or (II); or
       ``(bb) a nurse practitioner or a physician assistant (as 
     such terms are defined in section 1861(aa)(5)(A)) who is 
     working in accordance with State law, or a certified nurse-
     midwife (as defined in section 1861(gg)) who is working in 
     accordance with State law;

       ``(IV) by a rural health clinic, Federally-qualified health 
     center, or other health clinic that receives reimbursement on 
     a fee schedule applicable to a physician, a nurse 
     practitioner or a physician assistant (as such terms are 
     defined in section 1861(aa)(5)(A)) who is working in 
     accordance with State law, or a certified nurse-midwife (as 
     defined in section 1861(gg)) who is working in accordance 
     with State law, for services furnished by a physician, nurse 
     practitioner, physician assistant, or certified nurse-
     midwife, or services furnished by an advanced practice 
     clinician supervised by a physician described in subclause 
     (I)(aa) or (II)(aa), another advanced practice clinician, or 
     a certified nurse-midwife; or
       ``(V) by a nurse practitioner or a physician assistant (as 
     such terms are defined in section 1861(aa)(5)(A)) who is 
     working in accordance with State law, or a certified nurse-
     midwife (as defined in section 1861(gg)) who is working in 
     accordance with State law, in accordance with procedures that 
     ensure that the portion of the payment for such services that 
     the nurse practitioner, physician assistant, or certified 
     nurse-midwife is paid is not less than the amount that the 
     nurse practitioner, physician assistant, or certified nurse-
     midwife would be paid if the services were provided under 
     part B of title XVIII;''.

       (2) Conforming amendments.--Section 1905(dd) of the Social 
     Security Act (42 U.S.C. 1396d(dd)) is amended--
       (A) by striking ``Notwithstanding'' and inserting the 
     following:
       ``(1) In general.--Notwithstanding'';
       (B) by inserting ``or furnished during the additional 
     period specified in paragraph (2),'' after ``2015,''; and
       (C) by adding at the end the following:
       ``(2) Additional period.--For purposes of paragraph (1), 
     the additional period specified in this paragraph is the 
     period that begins on the first day of the first month that 
     begins one year after the date of enactment of the Patient 
     Protection and Affordable Care Enhancement Act.''.
       (b) Improved Targeting of Primary Care.--Section 1902(jj) 
     of the Social Security Act (42 U.S.C. 1396a(jj)) is amended--
       (1) by redesignating paragraphs (1) and (2) as 
     subparagraphs (A) and (B), respectively and realigning the 
     left margins accordingly;
       (2) by striking ``For purposes of'' and inserting the 
     following:
       ``(1) In general.--For purposes of''; and
       (3) by adding at the end the following:
       ``(2) Exclusions.--Such term does not include any services 
     described in subparagraph (A) or (B) of paragraph (1) if such 
     services are provided in an emergency department of a 
     hospital.''.
       (c) Ensuring Payment by Managed Care Entities.--
       (1) In general.--Section 1903(m)(2)(A) of the Social 
     Security Act (42 U.S.C. 1396b(m)(2)(A)) is amended--
       (A) in clause (xii), by striking ``and'' after the 
     semicolon;
       (B) by realigning the left margin of clause (xiii) so as to 
     align with the left margin of clause (xii) and by striking 
     the period at the end of clause (xiii) and inserting ``; 
     and''; and
       (C) by inserting after clause (xiii) the following:
       ``(xiv) such contract provides that (I) payments to 
     providers specified in section 1902(a)(13)(C) for primary 
     care services defined in section 1902(jj) that are furnished 
     during a year or period specified in section 1902(a)(13)(C)

[[Page H2607]]

     and section 1905(dd) are at least equal to the amounts set 
     forth and required by the Secretary by regulation, (II) the 
     entity shall, upon request, provide documentation to the 
     State, sufficient to enable the State and the Secretary to 
     ensure compliance with subclause (I), and (III) the Secretary 
     shall approve payments described in subclause (I) that are 
     furnished through an agreed upon capitation, partial 
     capitation, or other value-based payment arrangement if the 
     capitation, partial capitation, or other value-based payment 
     arrangement is based on a reasonable methodology and the 
     entity provides documentation to the State sufficient to 
     enable the State and the Secretary to ensure compliance with 
     subclause (I).''.
       (2) Conforming amendment.--Section 1932(f) of the Social 
     Security Act (42 U.S.C. 1396u-2(f)) is amended by inserting 
     ``and clause (xiv) of section 1903(m)(2)(A)'' before the 
     period.

     SEC. 207. PERMANENT FUNDING FOR CHIP.

       (a) In General.--Section 2104(a) of the Social Security Act 
     (42 U.S.C. 1397dd(a)) is amended--
       (1) in paragraph (26), by inserting at the end ``and'';
       (2) by amending paragraph (27) to read as follows:
       ``(27) for each fiscal year beginning with fiscal year 
     2024, such sums as are necessary to fund allotments to States 
     under subsections (c) and (m).''; and
       (3) by striking paragraph (28).
       (b) In General.--Section 2104(a)(28) of the Social Security 
     Act (42 U.S.C. 1397dd(a)(28)) is amended to read as follows:
       ``(28) for fiscal year 2027 and each subsequent year, such 
     sums as are necessary to fund allotments to States under 
     subsections (c) and (m).''.
       (c) Allotments.--
       (1) In general.--Section 2104(m) of the Social Security Act 
     (42 U.S.C. 1397dd(m)) is amended--
       (A) in paragraph (2)(B)(i), by striking ``,, 2023, and 
     2027'' and inserting ``and 2023'';
       (B) in paragraph (7)--
       (i) in subparagraph (A), by striking ``and ending with 
     fiscal year 2027,''; and
       (ii) in the flush left matter at the end, by striking ``or 
     fiscal year 2026'' and inserting ``fiscal year 2026, or a 
     subsequent even-numbered fiscal year'';
       (C) in paragraph (9)--
       (i) by striking ``(10), or (11)'' and inserting ``or 
     (10)''; and
       (ii) by striking ``2023, or 2027,'' and inserting ``or 
     2023''; and
       (D) by striking paragraph (11).
       (2) Conforming amendment.--Section 50101(b)(2) of the 
     Bipartisan Budget Act of 2018 (Public Law 115-123) is 
     repealed.

     SEC. 208. PERMANENT EXTENSION OF CHIP ENROLLMENT AND QUALITY 
                   MEASURES.

       (a) Pediatric Quality Measures Program.--Section 
     1139A(i)(1) of the Social Security Act (42 U.S.C. 1320b-
     9a(i)(1)) is amended--
       (1) in subparagraph (C), by striking at the end ``and'';
       (2) in subparagraph (D), by striking the period at the end 
     and insert a semicolon; and
       (3) by adding at the end the following new subparagraphs:
       ``(E) for fiscal year 2028, $15,000,000 for the purpose of 
     carrying out this section (other than subsections (e), (f), 
     and (g)); and
       ``(F) for a subsequent fiscal year, the amount appropriated 
     under this paragraph for the previous fiscal year, increased 
     by the percentage increase in the consumer price index for 
     all urban consumers (all items; United States city average) 
     over such previous fiscal year, for the purpose of carrying 
     out this section (other than subsections (e), (f), and 
     (g)).''.
       (b) Express Lane Eligibility Option.--Section 1902(e)(13) 
     of the Social Security Act (42 U.S.C. 1396a(e)(13)) is 
     amended by striking subparagraph (I).
       (c) Assurance of Affordability Standard for Children and 
     Families.--
       (1) In general.--Section 2105(d)(3) of the Social Security 
     Act (42 U.S.C. 1397ee(d)(3)) is amended--
       (A) in the paragraph heading, by striking ``through 
     september 30, 2027''; and
       (B) in subparagraph (A), in the matter preceding clause 
     (i)--
       (i) by striking ``During the period that begins on the date 
     of enactment of the Patient Protection and Affordable Care 
     Act and ends on September 30, 2027'' and inserting 
     ``Beginning on the date of the enactment of the Patient 
     Protection and Affordable Care Act'';
       (ii) by striking ``During the period that begins on October 
     1, 2019, and ends on September 30, 2027'' and inserting 
     ``Beginning on October 1, 2019''; and
       (iii) by striking ``The preceding sentences shall not be 
     construed as preventing a State during any such periods 
     from'' and inserting ``The preceding sentences shall not be 
     construed as preventing a State from''.
       (2) Conforming amendments.--Section 1902(gg)(2) of the 
     Social Security Act (42 U.S.C. 1396a(gg)(2)) is amended--
       (A) in the paragraph heading, by striking ``through 
     september 30, 2027''; and
       (B) by striking ``through September 30'' and all that 
     follows through ``ends on September 30, 2027'' and inserting 
     ``(but beginning on October 1, 2019,''.
       (d) Qualifying States Option.--Section 2105(g)(4) of the 
     Social Security Act (42 U.S.C. 1397ee(g)(4)) is amended--
       (1) in the paragraph heading, by striking ``for fiscal 
     years 2009 through 2027'' and inserting ``after fiscal year 
     2008''; and
       (2) in subparagraph (A), by striking ``for any of fiscal 
     years 2009 through 2027'' and inserting ``for any fiscal year 
     after fiscal year 2008''.
       (e) Outreach and Enrollment Program.--Section 2113 of the 
     Social Security Act (42 U.S.C. 1397mm) is amended--
       (1) in subsection (a)--
       (A) in paragraph (1), by striking ``during the period of 
     fiscal years 2009 through 2027'' and inserting ``, beginning 
     with fiscal year 2009,'';
       (B) in paragraph (2)--
       (i) by striking ``10 percent of such amounts'' and 
     inserting ``10 percent of such amounts for the period or the 
     fiscal year for which such amounts are appropriated''; and
       (ii) by striking ``during such period'' and inserting ``, 
     during such period or such fiscal year,''; and
       (C) in paragraph (3), by striking ``For the period of 
     fiscal years 2024 through 2027, an amount equal to 10 percent 
     of such amounts'' and inserting ``Beginning with fiscal year 
     2024, an amount equal to 10 percent of such amounts for the 
     period or the fiscal year for which such amounts are 
     appropriated''; and
       (2) in subsection (g)--
       (A) by striking ``2017,,'' and inserting ``2017,'';
       (B) by striking ``and $48,000,000'' and inserting 
     ``$48,000,000''; and
       (C) by inserting after ``through 2027'' the following: ``, 
     $12,000,000 for fiscal year 2028, and, for each fiscal year 
     after fiscal year 2028, the amount appropriated under this 
     subsection for the previous fiscal year, increased by the 
     percentage increase in the consumer price index for all urban 
     consumers (all items; United States city average) over such 
     previous fiscal year''.
       (f) Child Enrollment Contingency Fund.--Section 2104(n) of 
     the Social Security Act (42 U.S.C. 1397dd(n)) is amended--
       (1) in paragraph (2)--
       (A) in subparagraph (A)(ii)--
       (i) by striking ``and 2024 through 2026'' and inserting 
     ``beginning with fiscal year 2024''; and
       (ii) by striking ``2023, and 2027'' and inserting ``, and 
     2023''; and
       (B) in subparagraph (B)--
       (i) by striking ``2024 through 2026'' and inserting 
     ``beginning with fiscal year 2024''; and
       (ii) by striking ``2023, and 2027'' and inserting ``, and 
     2023''; and
       (2) in paragraph (3)(A)--
       (A) by striking ``fiscal years 2024 through 2026'' and 
     inserting ``beginning with fiscal year 2024''; and
       (B) by striking ``2023, or 2027'' and inserting ``, or 
     2023''.

     SEC. 209. STATE OPTION TO INCREASE CHILDREN'S ELIGIBILITY FOR 
                   MEDICAID AND CHIP.

       Section 2110(b)(1)(B)(ii) of the Social Security Act (42 
     U.S.C. 1397jj(b)(1)(B)(ii)) is amended--
       (1) in subclause (II), by striking ``or'' at the end;
       (2) in subclause (III), by striking ``and'' at the end and 
     inserting ``or''; and
       (3) by inserting after subclause (III) the following new 
     subclause:

       ``(IV) at the option of the State, whose family income 
     exceeds the maximum income level otherwise established for 
     children under the State child health plan as of the date of 
     the enactment of this subclause; and''.

     SEC. 210. MEDICAID COVERAGE FOR CITIZENS OF FREELY ASSOCIATED 
                   STATES.

       (a) In General.--Section 402(b)(2) of the Personal 
     Responsibility and Work Opportunity Reconciliation Act of 
     1996 (8 U.S.C. 1612(b)(2)) is amended by adding at the end 
     the following new subparagraph:
       ``(G) Medicaid exception for citizens of freely associated 
     states.--With respect to eligibility for benefits for the 
     designated Federal program defined in paragraph (3)(C) 
     (relating to the Medicaid program), section 401(a) and 
     paragraph (1) shall not apply to any individual who lawfully 
     resides in 1 of the 50 States or the District of Columbia in 
     accordance with the Compacts of Free Association between the 
     Government of the United States and the Governments of the 
     Federated States of Micronesia, the Republic of the Marshall 
     Islands, and the Republic of Palau and shall not apply, at 
     the option of the Governor of Puerto Rico, the Virgin 
     Islands, Guam, the Northern Mariana Islands, or American 
     Samoa as communicated to the Secretary of Health and Human 
     Services in writing, to any individual who lawfully resides 
     in the respective territory in accordance with such 
     Compacts.''.
       (b) Exception to 5-Year Limited Eligibility.--Section 
     403(d) of such Act (8 U.S.C. 1613(d)) is amended--
       (1) in paragraph (1), by striking ``or'' at the end;
       (2) in paragraph (2), by striking the period at the end and 
     inserting ``; or''; and
       (3) by adding at the end the following new paragraph:
       ``(3) an individual described in section 402(b)(2)(G), but 
     only with respect to the designated Federal program defined 
     in section 402(b)(3)(C).''.
       (c) Definition of Qualified Alien.--Section 431(b) of such 
     Act (8 U.S.C. 1641(b)) is amended--
       (1) in paragraph (6), by striking ``; or'' at the end and 
     inserting a comma;
       (2) in paragraph (7), by striking the period at the end and 
     inserting ``, or''; and
       (3) by adding at the end the following new paragraph:
       ``(8) an individual who lawfully resides in the United 
     States in accordance with a Compact of Free Association 
     referred to in section 402(b)(2)(G), but only with respect to 
     the designated Federal program defined in section 
     402(b)(3)(C) (relating to the Medicaid program).''.
       (d) Application to State Plans.--Section 1902(a)(10)(A)(i) 
     of the Social Security Act (42 U.S.C. 1396a(a)(10)(A)(i)) is 
     amended by inserting after subclause (IX) the following:

       ``(X) who are described in section 402(b)(2)(G) of the 
     Personal Responsibility and Work Opportunity Reconciliation 
     Act of 1996 and eligible for benefits under this title by 
     reason of application of such section;''.

       (e) Conforming Amendments.--Section 1108 of the Social 
     Security Act (42 U.S.C. 1308) is amended--

[[Page H2608]]

       (1) in subsection (f), in the matter preceding paragraph 
     (1), by striking ``subsections (g) and (h) and section 
     1935(e)(1)(B)'' and inserting ``subsections (g), (h), and (i) 
     and section 1935(e)(1)(B)''; and
       (2) by adding at the end the following:
       ``(i) Exclusion of Medical Assistance Expenditures for 
     Citizens of Freely Associated States.--Expenditures for 
     medical assistance provided to an individual described in 
     section 431(b)(8) of the Personal Responsibility and Work 
     Opportunity Reconciliation Act of 1996 (8 U.S.C. 1641(b)(8)) 
     shall not be taken into account for purposes of applying 
     payment limits under subsections (f) and (g).''.
       (f) Effective Date.--The amendments made by this section 
     shall apply to benefits for items and services furnished on 
     or after the date of the enactment of this Act.

     SEC. 211. EXTENSION OF FULL FEDERAL MEDICAL ASSISTANCE 
                   PERCENTAGE TO INDIAN HEALTH CARE PROVIDERS.

       (a) In General.--Section 1905 of the Social Security Act 
     (42 U.S.C. 1396d) is amended--
       (1) in subsection (a), by amending paragraph (9) to read as 
     follows:
       ``(9) clinic services furnished by or under the direction 
     of a physician, without regard to whether the clinic itself 
     is administered by a physician, including--
       ``(A) such services furnished outside the clinic by clinic 
     personnel to an eligible individual who does not reside in a 
     permanent dwelling or does not have a fixed home or mailing 
     address; and
       ``(B) such services provided outside the clinic on the 
     basis of a referral from a clinic administered by an Indian 
     Health Program (as defined in paragraph (12) of section 4 of 
     the Indian Health Care Improvement Act, or an Urban Indian 
     Organization as defined in paragraph (29) of section 4 of 
     such Act that has a grant or contract with the Indian Health 
     Service under title V of such Act;''.
       (2) in subsection (b), by inserting after ``(as defined in 
     section 4 of the Indian Health Care Improvement Act)'' the 
     following: ``; the Federal medical assistance percentage 
     shall also be 100 per centum with respect to amounts expended 
     as medical assistance for services which are received through 
     an Urban Indian organization (as defined in section 4 of the 
     Indian Health Care Improvement Act) that has a grant or 
     contract with the Indian Health Service under title V of such 
     Act''.
       (b) Extension of Full Federal Medical Assistance Percentage 
     to Services Furnished by Native Hawaiian Health Care 
     Systems.--
       (1) In general.--Beginning on the date of enactment of this 
     Act--
       (A) for purposes of section 1905(a)(9) of the Social 
     Security Act (42 U.S.C. 1396d(a)(9)), services described in 
     subsection (b) that are furnished in any location shall be 
     deemed to be clinic services; and
       (B) notwithstanding section 1905(b) of the Social Security 
     Act (42 U.S.C. 1396d(b)), the Federal medical assistance 
     percentage with respect to amounts expended as medical 
     assistance for such services shall be 100 percent.
       (2) Services described.--The services described in this 
     subsection are services for which payment is available under 
     the State plan under title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.) of Hawaii (or any waiver of such plan) 
     that--
       (A) are furnished on or after the date of enactment of this 
     Act;
       (B) are furnished to an individual who--
       (i) is a Native Hawaiian; and
       (ii) is eligible for medical assistance under such plan; 
     and
       (C) are furnished by an Indian health care provider (as 
     such term is defined in section 1932(h)(4)(A) of the Social 
     Security Act (42 U.S.C. 1396u-2(h)(4)(A)) or a Native 
     Hawaiian health care system (without regard to whether such 
     services are furnished through an Indian Health Service 
     facility).

     TITLE III--LOWERING PRICES THROUGH FAIR DRUG PRICE NEGOTIATION

     SEC. 301. ESTABLISHING A FAIR DRUG PRICING PROGRAM.

       (a) Program To Lower Prices for Certain High-Priced Single 
     Source Drugs.--Title XI of the Social Security Act (42 U.S.C. 
     1301 et seq.) is amended by adding at the end the following 
     new part:

 ``PART E--FAIR PRICE NEGOTIATION PROGRAM TO LOWER PRICES FOR CERTAIN 
                    HIGH-PRICED SINGLE SOURCE DRUGS

     ``SEC. 1191. ESTABLISHMENT OF PROGRAM.

       ``(a) In General.--The Secretary shall establish a Fair 
     Price Negotiation Program (in this part referred to as the 
     `program'). Under the program, with respect to each price 
     applicability period, the Secretary shall--
       ``(1) publish a list of selected drugs in accordance with 
     section 1192;
       ``(2) enter into agreements with manufacturers of selected 
     drugs with respect to such period, in accordance with section 
     1193;
       ``(3) negotiate and, if applicable, renegotiate maximum 
     fair prices for such selected drugs, in accordance with 
     section 1194; and
       ``(4) carry out the administrative duties described in 
     section 1196.
       ``(b) Definitions Relating to Timing.--For purposes of this 
     part:
       ``(1) Initial price applicability year.--The term `initial 
     price applicability year' means a plan year (beginning with 
     plan year 2023) or, if agreed to in an agreement under 
     section 1193 by the Secretary and manufacturer involved, a 
     period of more than one plan year (beginning on or after 
     January 1, 2023).
       ``(2) Price applicability period.--The term `price 
     applicability period' means, with respect to a drug, the 
     period beginning with the initial price applicability year 
     with respect to which such drug is a selected drug and ending 
     with the last plan year during which the drug is a selected 
     drug.
       ``(3) Selected drug publication date.--The term `selected 
     drug publication date' means, with respect to each initial 
     price applicability year, April 15 of the plan year that 
     begins 2 years prior to such year.
       ``(4) Voluntary negotiation period.--The term `voluntary 
     negotiation period' means, with respect to an initial price 
     applicability year with respect to a selected drug, the 
     period--
       ``(A) beginning on the sooner of--
       ``(i) the date on which the manufacturer of the drug and 
     the Secretary enter into an agreement under section 1193 with 
     respect to such drug; or
       ``(ii) June 15 following the selected drug publication date 
     with respect to such selected drug; and
       ``(B) ending on March 31 of the year that begins one year 
     prior to the initial price applicability year.
       ``(c) Other Definitions.--For purposes of this part:
       ``(1) Fair price eligible individual.--The term `fair price 
     eligible individual' means, with respect to a selected drug--
       ``(A) in the case such drug is furnished or dispensed to 
     the individual at a pharmacy or by a mail order service--
       ``(i) an individual who is enrolled under a prescription 
     drug plan under part D of title XVIII or an MA-PD plan under 
     part C of such title if coverage is provided under such plan 
     for such selected drug; and
       ``(ii) an individual who is enrolled under a group health 
     plan or health insurance coverage offered in the group or 
     individual market (as such terms are defined in section 2791 
     of the Public Health Service Act) with respect to which there 
     is in effect an agreement with the Secretary under section 
     1197 with respect to such selected drug as so furnished or 
     dispensed; and
       ``(B) in the case such drug is furnished or administered to 
     the individual by a hospital, physician, or other provider of 
     services or supplier--
       ``(i) an individual who is entitled to benefits under part 
     A of title XVIII or enrolled under part B of such title if 
     such selected drug is covered under the respective part; and
       ``(ii) an individual who is enrolled under a group health 
     plan or health insurance coverage offered in the group or 
     individual market (as such terms are defined in section 2791 
     of the Public Health Service Act) with respect to which there 
     is in effect an agreement with the Secretary under section 
     1197 with respect to such selected drug as so furnished or 
     administered.
       ``(2) Maximum fair price.--The term `maximum fair price' 
     means, with respect to a plan year during a price 
     applicability period and with respect to a selected drug (as 
     defined in section 1192(c)) with respect to such period, the 
     price published pursuant to section 1195 in the Federal 
     Register for such drug and year.
       ``(3) Average international market price defined.--
       ``(A) In general.--The terms `average international market 
     price' and `AIM price' mean, with respect to a drug, the 
     average price (which shall be the net average price, if 
     practicable, and volume-weighted, if practicable) for a unit 
     (as defined in paragraph (4)) of the drug for sales of such 
     drug (calculated across different dosage forms and strengths 
     of the drug and not based on the specific formulation or 
     package size or package type), as computed (as of the date of 
     publication of such drug as a selected drug under section 
     1192(a)) in all countries described in clause (ii) of 
     subparagraph (B) that are applicable countries (as described 
     in clause (i) of such subparagraph) with respect to such 
     drug.
       ``(B) Applicable countries.--
       ``(i) In general.--For purposes of subparagraph (A), a 
     country described in clause (ii) is an applicable country 
     described in this clause with respect to a drug if there is 
     available an average price for any unit for the drug for 
     sales of such drug in such country.
       ``(ii) Countries described.--For purposes of this 
     paragraph, the following are countries described in this 
     clause:

       ``(I) Australia.
       ``(II) Canada.
       ``(III) France.
       ``(IV) Germany.
       ``(V) Japan.
       ``(VI) The United Kingdom.

       ``(4) Unit.--The term `unit' means, with respect to a drug, 
     the lowest identifiable quantity (such as a capsule or 
     tablet, milligram of molecules, or grams) of the drug that is 
     dispensed.

     ``SEC. 1192. SELECTION OF NEGOTIATION-ELIGIBLE DRUGS AS 
                   SELECTED DRUGS.

       ``(a) In General.--Not later than the selected drug 
     publication date with respect to an initial price 
     applicability year, subject to subsection (h), the Secretary 
     shall select and publish in the Federal Register a list of--
       ``(1)(A) with respect to an initial price applicability 
     year during 2023, at least 25 negotiation-eligible drugs 
     described in subparagraphs (A) and (B), but not subparagraph 
     (C), of subsection (d)(1) (or, with respect to an initial 
     price applicability year during such period beginning after 
     2023, the maximum number (if such number is less than 25) of 
     such negotiation-eligible drugs for the year) with respect to 
     such year; and
       ``(B) with respect to an initial price applicability year 
     during 2024 or a subsequent year, at least 50 negotiation-
     eligible drugs described in subparagraphs (A) and (B), but 
     not subparagraph (C), of subsection (d)(1) (or, with respect 
     to an initial price applicability year during such period, 
     the maximum number (if such number is less than 50) of such 
     negotiation-eligible drugs for the year) with respect to such 
     year;
       ``(2) all negotiation-eligible drugs described in 
     subparagraph (C) of such subsection with respect to such 
     year; and
       ``(3) all new-entrant negotiation-eligible drugs (as 
     defined in subsection (g)(1)) with respect to such year.

[[Page H2609]]

     Each drug published on the list pursuant to the previous 
     sentence shall be subject to the negotiation process under 
     section 1194 for the voluntary negotiation period with 
     respect to such initial price applicability year (and the 
     renegotiation process under such section as applicable for 
     any subsequent year during the applicable price applicability 
     period). In applying this subsection, any negotiation-
     eligible drug that is selected under this subsection for an 
     initial price applicability year shall not count toward the 
     required minimum amount of drugs to be selected under 
     paragraph (1) for any subsequent year, including such a drug 
     so selected that is subject to renegotiation under section 
     1194.
       ``(b) Selection of Drugs.--In carrying out subsection 
     (a)(1) the Secretary shall select for inclusion on the 
     published list described in subsection (a) with respect to a 
     price applicability period, the negotiation-eligible drugs 
     that the Secretary projects will result in the greatest 
     savings to the Federal Government or fair price eligible 
     individuals during the price applicability period. In making 
     this projection of savings for drugs for which there is an 
     AIM price for a price applicability period, the savings shall 
     be projected across different dosage forms and strengths of 
     the drugs and not based on the specific formulation or 
     package size or package type of the drugs, taking into 
     consideration both the volume of drugs for which payment is 
     made, to the extent such data is available, and the amount by 
     which the net price for the drugs exceeds the AIM price for 
     the drugs.
       ``(c) Selected Drug.--For purposes of this part, each drug 
     included on the list published under subsection (a) with 
     respect to an initial price applicability year shall be 
     referred to as a `selected drug' with respect to such year 
     and each subsequent plan year beginning before the first plan 
     year beginning after the date on which the Secretary 
     determines two or more drug products--
       ``(1) are approved or licensed (as applicable)--
       ``(A) under section 505(j) of the Federal Food, Drug, and 
     Cosmetic Act using such drug as the listed drug; or
       ``(B) under section 351(k) of the Public Health Service Act 
     using such drug as the reference product; and
       ``(2) continue to be marketed.
       ``(d) Negotiation-Eligible Drug.--
       ``(1) In general.--For purposes of this part, the term 
     `negotiation-eligible drug' means, with respect to the 
     selected drug publication date with respect to an initial 
     price applicability year, a qualifying single source drug, as 
     defined in subsection (e), that meets any of the following 
     criteria:
       ``(A) Covered part d drugs.--The drug is among the 125 
     covered part D drugs (as defined in section 1860D-2(e)) for 
     which there was an estimated greatest net spending under 
     parts C and D of title XVIII, as determined by the Secretary, 
     during the most recent plan year prior to such drug 
     publication date for which data are available.
       ``(B) Other drugs.--The drug is among the 125 drugs for 
     which there was an estimated greatest net spending in the 
     United States (including the 50 States, the District of 
     Columbia, and the territories of the United States), as 
     determined by the Secretary, during the most recent plan year 
     prior to such drug publication date for which data are 
     available.
       ``(C) Insulin.--The drug is a qualifying single source drug 
     described in subsection (e)(3).
       ``(2) Clarification.--In determining whether a qualifying 
     single source drug satisfies any of the criteria described in 
     paragraph (1), the Secretary shall, to the extent 
     practicable, use data that is aggregated across dosage forms 
     and strengths of the drug and not based on the specific 
     formulation or package size or package type of the drug.
       ``(3) Publication.--Not later than the selected drug 
     publication date with respect to an initial price 
     applicability year, the Secretary shall publish in the 
     Federal Register a list of negotiation-eligible drugs with 
     respect to such selected drug publication date.
       ``(e) Qualifying Single Source Drug.--For purposes of this 
     part, the term `qualifying single source drug' means any of 
     the following:
       ``(1) Drug products.--A drug that--
       ``(A) is approved under section 505(c) of the Federal Food, 
     Drug, and Cosmetic Act and continues to be marketed pursuant 
     to such approval; and
       ``(B) is not the listed drug for any drug that is approved 
     and continues to be marketed under section 505(j) of such 
     Act.
       ``(2) Biological products.--A biological product that--
       ``(A) is licensed under section 351(a) of the Public Health 
     Service Act, including any product that has been deemed to be 
     licensed under section 351 of such Act pursuant to section 
     7002(e)(4) of the Biologics Price Competition and Innovation 
     Act of 2009, and continues to be marketed under section 351 
     of such Act; and
       ``(B) is not the reference product for any biological 
     product that is licensed and continues to be marketed under 
     section 351(k) of such Act.
       ``(3) Insulin product.--Notwithstanding paragraphs (1) and 
     (2), any insulin product that is approved under subsection 
     (c) or (j) of section 505 of the Federal Food, Drug, and 
     Cosmetic Act or licensed under subsection (a) or (k) of 
     section 351 of the Public Health Service Act and continues to 
     be marketed under such section 505 or 351, including any 
     insulin product that has been deemed to be licensed under 
     section 351(a) of the Public Health Service Act pursuant to 
     section 7002(e)(4) of the Biologics Price Competition and 
     Innovation Act of 2009 and continues to be marketed pursuant 
     to such licensure.
     For purposes of applying paragraphs (1) and (2), a drug or 
     biological product that is marketed by the same sponsor or 
     manufacturer (or an affiliate thereof or a cross-licensed 
     producer or distributor) as the listed drug or reference 
     product described in such respective paragraph shall not be 
     taken into consideration.
       ``(f) Information on International Drug Prices.--For 
     purposes of determining which negotiation-eligible drugs to 
     select under subsection (a) and, in the case of such drugs 
     that are selected drugs, to determine the maximum fair price 
     for such a drug and whether such maximum fair price should be 
     renegotiated under section 1194, the Secretary shall use data 
     relating to the AIM price with respect to such drug as 
     available or provided to the Secretary and shall on an 
     ongoing basis request from manufacturers of selected drugs 
     information on the AIM price of such a drug.
       ``(g) New-entrant Negotiation-eligible Drugs.--
       ``(1) In general.--For purposes of this part, the term 
     `new-entrant negotiation-eligible drug' means, with respect 
     to the selected drug publication date with respect to an 
     initial price applicability year, a qualifying single source 
     drug--
       ``(A) that is first approved or licensed, as described in 
     paragraph (1), (2), or (3) of subsection (e), as applicable, 
     during the year preceding such selected drug publication 
     date; and
       ``(B) that the Secretary determines under paragraph (2) is 
     likely to be included as a negotiation-eligible drug with 
     respect to the subsequent selected drug publication date.
       ``(2) Determination.--In the case of a qualifying single 
     source drug that meets the criteria described in subparagraph 
     (A) of paragraph (1), with respect to an initial price 
     applicability year, if the wholesale acquisition cost at 
     which such drug is first marketed in the United States is 
     equal to or greater than the median household income (as 
     determined according to the most recent data collected by the 
     United States Census Bureau), the Secretary shall determine 
     before the selected drug publication date with respect to the 
     initial price applicability year, if the drug is likely to be 
     included as a negotiation-eligible drug with respect to the 
     subsequent selected drug publication date, based on the 
     projected spending under title XVIII or in the United States 
     on such drug. For purposes of this paragraph the term `United 
     States' includes the 50 States, the District of Columbia, and 
     the territories of the United States.
       ``(h) Conflict of Interest.--
       ``(1) In general.--In the case the Inspector General of the 
     Department of Health and Human Services determines the 
     Secretary has a conflict, with respect to a matter described 
     in paragraph (2), the individual described in paragraph (3) 
     shall carry out the duties of the Secretary under this part, 
     with respect to a negotiation-eligible drug, that would 
     otherwise be such a conflict.
       ``(2) Matter described.--A matter described in this 
     paragraph is--
       ``(A) a financial interest (as described in section 
     2635.402 of title 5, Code of Federal Regulations (except for 
     an interest described in subsection (b)(2)(iv) of such 
     section)) on the date of the selected drug publication date, 
     with respect the price applicability year (as applicable);
       ``(B) a personal or business relationship (as described in 
     section 2635.502 of such title) on the date of the selected 
     drug publication date, with respect the price applicability 
     year;
       ``(C) employment by a manufacturer of a negotiation-
     eligible drug during the preceding 10-year period beginning 
     on the date of the selected drug publication date, with 
     respect to each price applicability year; and
       ``(D) any other matter the General Counsel determines 
     appropriate.
       ``(3) Individual described.--An individual described in 
     this paragraph is--
       ``(A) the highest-ranking officer or employee of the 
     Department of Health and Human Services (as determined by the 
     organizational chart of the Department) that does not have a 
     conflict under this subsection; and
       ``(B) is nominated by the President and confirmed by the 
     Senate with respect to the position.

     ``SEC. 1193. MANUFACTURER AGREEMENTS.

       ``(a) In General.--For purposes of section 1191(a)(2), the 
     Secretary shall enter into agreements with manufacturers of 
     selected drugs with respect to a price applicability period, 
     by not later than June 15 following the selected drug 
     publication date with respect to such selected drug, under 
     which--
       ``(1) during the voluntary negotiation period for the 
     initial price applicability year for the selected drug, the 
     Secretary and manufacturer, in accordance with section 1194, 
     negotiate to determine (and, by not later than the last date 
     of such period and in accordance with subsection (c), agree 
     to) a maximum fair price for such selected drug of the 
     manufacturer in order to provide access to such price--
       ``(A) to fair price eligible individuals who with respect 
     to such drug are described in subparagraph (A) of section 
     1191(c)(1) and are furnished or dispensed such drug during, 
     subject to subparagraph (2), the price applicability period; 
     and
       ``(B) to hospitals, physicians, and other providers of 
     services and suppliers with respect to fair price eligible 
     individuals who with respect to such drug are described in 
     subparagraph (B) of such section and are furnished or 
     administered such drug during, subject to subparagraph (2), 
     the price applicability period;
       ``(2) the Secretary and the manufacturer shall, in 
     accordance with a process and during a period specified by 
     the Secretary pursuant to rulemaking, renegotiate (and, by 
     not later than the last date of such period and in accordance 
     with subsection (c), agree to) the maximum fair price for 
     such drug if the Secretary determines that there is a 
     material change in any of the factors described in section 
     1194(d) relating to the drug, including changes in the AIM 
     price for such drug, in order to provide access to such 
     maximum fair price (as so renegotiated)--

[[Page H2610]]

       ``(A) to fair price eligible individuals who with respect 
     to such drug are described in subparagraph (A) of section 
     1191(c)(1) and are furnished or dispensed such drug during 
     any year during the price applicability period (beginning 
     after such renegotiation) with respect to such selected drug; 
     and
       ``(B) to hospitals, physicians, and other providers of 
     services and suppliers with respect to fair price eligible 
     individuals who with respect to such drug are described in 
     subparagraph (B) of such section and are furnished or 
     administered such drug during any year described in 
     subparagraph (A);
       ``(3) the maximum fair price (including as renegotiated 
     pursuant to paragraph (2)), with respect to such a selected 
     drug, shall be provided to fair price eligible individuals, 
     who with respect to such drug are described in subparagraph 
     (A) of section 1191(c)(1), at the pharmacy or by a mail order 
     service at the point-of-sale of such drug;
       ``(4) the manufacturer, subject to subsection (d), submits 
     to the Secretary, in a form and manner specified by the 
     Secretary--
       ``(A) for the voluntary negotiation period for the price 
     applicability period (and, if applicable, before any period 
     of renegotiation specified pursuant to paragraph (2)) with 
     respect to such drug all information that the Secretary 
     requires to carry out the negotiation (or renegotiation 
     process) under this part, including information described in 
     section 1192(f) and section 1194(d)(1); and
       ``(B) on an ongoing basis, information on changes in prices 
     for such drug that would affect the AIM price for such drug 
     or otherwise provide a basis for renegotiation of the maximum 
     fair price for such drug pursuant to paragraph (2);
       ``(5) the manufacturer agrees that in the case the selected 
     drug of a manufacturer is a drug described in subsection (c), 
     the manufacturer will, in accordance with such subsection, 
     make any payment required under such subsection with respect 
     to such drug; and
       ``(6) the manufacturer complies with requirements imposed 
     by the Secretary for purposes of administering the program, 
     including with respect to the duties described in section 
     1196.
       ``(b) Agreement in Effect Until Drug Is No Longer a 
     Selected Drug.--An agreement entered into under this section 
     shall be effective, with respect to a drug, until such drug 
     is no longer considered a selected drug under section 
     1192(c).
       ``(c) Special Rule for Certain Selected Drugs Without AIM 
     Price.--
       ``(1) In general.--In the case of a selected drug for which 
     there is no AIM price available with respect to the initial 
     price applicability year for such drug and for which an AIM 
     price becomes available beginning with respect to a 
     subsequent plan year during the price applicability period 
     for such drug, if the Secretary determines that the amount 
     described in paragraph (2)(A) for a unit of such drug is 
     greater than the amount described in paragraph (2)(B) for a 
     unit of such drug, then by not later than one year after the 
     date of such determination, the manufacturer of such selected 
     drug shall pay to the Treasury an amount equal to the product 
     of--
       ``(A) the difference between such amount described in 
     paragraph (2)(A) for a unit of such drug and such amount 
     described in paragraph (2)(B) for a unit of such drug; and
       ``(B) the number of units of such drug sold in the United 
     States, including the 50 States, the District of Columbia, 
     and the territories of the United States, during the period 
     described in paragraph (2)(B).
       ``(2) Amounts described.--
       ``(A) Weighted average price before aim price available.--
     For purposes of paragraph (1), the amount described in this 
     subparagraph for a selected drug described in such paragraph, 
     is the amount equal to the weighted average manufacturer 
     price (as defined in section 1927(k)(1)) for such dosage 
     strength and form for the drug during the period beginning 
     with the first plan year for which the drug is included on 
     the list of negotiation-eligible drugs published under 
     section 1192(d) and ending with the last plan year during the 
     price applicability period for such drug with respect to 
     which there is no AIM price available for such drug.
       ``(B) Amount multiplier after aim price available.--For 
     purposes of paragraph (1), the amount described in this 
     subparagraph for a selected drug described in such paragraph, 
     is the amount equal to 200 percent of the AIM price for such 
     drug with respect to the first plan year during the price 
     applicability period for such drug with respect to which 
     there is an AIM price available for such drug.
       ``(d) Confidentiality of Information.--Information 
     submitted to the Secretary under this part by a manufacturer 
     of a selected drug that is proprietary information of such 
     manufacturer (as determined by the Secretary) may be used 
     only by the Secretary or disclosed to and used by the 
     Comptroller General of the United States or the Medicare 
     Payment Advisory Commission for purposes of carrying out this 
     part.
       ``(e) Regulations.--
       ``(1) In general.--The Secretary shall, pursuant to 
     rulemaking, specify, in accordance with paragraph (2), the 
     information that must be submitted under subsection (a)(4).
       ``(2) Information specified.--Information described in 
     paragraph (1), with respect to a selected drug, shall include 
     information on sales of the drug (by the manufacturer of the 
     drug or by another entity under license or other agreement 
     with the manufacturer, with respect to the sales of such 
     drug, regardless of the name under which the drug is sold) in 
     any foreign country that is part of the AIM price. The 
     Secretary shall verify, to the extent practicable, such sales 
     from appropriate officials of the government of the foreign 
     country involved.
       ``(f) Compliance With Requirements for Administration of 
     Program.--Each manufacturer with an agreement in effect under 
     this section shall comply with requirements imposed by the 
     Secretary or a third party with a contract under section 
     1196(c)(1), as applicable, for purposes of administering the 
     program.

     ``SEC. 1194. NEGOTIATION AND RENEGOTIATION PROCESS.

       ``(a) In General.--For purposes of this part, under an 
     agreement under section 1193 between the Secretary and a 
     manufacturer of a selected drug, with respect to the period 
     for which such agreement is in effect and in accordance with 
     subsections (b) and (c), the Secretary and the manufacturer--
       ``(1) shall during the voluntary negotiation period with 
     respect to the initial price applicability year for such 
     drug, in accordance with this section, negotiate a maximum 
     fair price for such drug for the purpose described in section 
     1193(a)(1); and
       ``(2) as applicable pursuant to section 1193(a)(2) and in 
     accordance with the process specified pursuant to such 
     section, renegotiate such maximum fair price for such drug 
     for the purpose described in such section.
       ``(b) Negotiating Methodology and Objective.--
       ``(1) In general.--The Secretary shall develop and use a 
     consistent methodology for negotiations under subsection (a) 
     that, in accordance with paragraph (2) and subject to 
     paragraph (3), achieves the lowest maximum fair price for 
     each selected drug while appropriately rewarding innovation.
       ``(2) Prioritizing factors.--In considering the factors 
     described in subsection (d) in negotiating (and, as 
     applicable, renegotiating) the maximum fair price for a 
     selected drug, the Secretary shall, to the extent 
     practicable, consider all of the available factors listed but 
     shall prioritize the following factors:
       ``(A) Research and development costs.--The factor described 
     in paragraph (1)(A) of subsection (d).
       ``(B) Market data.--The factor described in paragraph 
     (1)(B) of such subsection.
       ``(C) Unit costs of production and distribution.--The 
     factor described in paragraph (1)(C) of such subsection.
       ``(D) Comparison to existing therapeutic alternatives.--The 
     factor described in paragraph (2)(A) of such subsection.
       ``(3) Requirement.--
       ``(A) In general.--In negotiating the maximum fair price of 
     a selected drug, with respect to an initial price 
     applicability year for the selected drug, and, as applicable, 
     in renegotiating the maximum fair price for such drug, with 
     respect to a subsequent year during the price applicability 
     period for such drug, in the case that the manufacturer of 
     the selected drug offers under the negotiation or 
     renegotiation, as applicable, a price for such drug that is 
     not more than the target price described in subparagraph (B) 
     for such drug for the respective year, the Secretary shall 
     agree under such negotiation or renegotiation, respectively, 
     to such offered price as the maximum fair price.
       ``(B) Target price.--
       ``(i) In general.--Subject to clause (ii), the target price 
     described in this subparagraph for a selected drug with 
     respect to a year, is the average price (which shall be the 
     net average price, if practicable, and volume-weighted, if 
     practicable) for a unit of such drug for sales of such drug, 
     as computed (across different dosage forms and strengths of 
     the drug and not based on the specific formulation or package 
     size or package type of the drug) in the applicable country 
     described in section 1191(c)(3)(B) with respect to such drug 
     that, with respect to such year, has the lowest average price 
     for such drug as compared to the average prices (as so 
     computed) of such drug with respect to such year in the other 
     applicable countries described in such section with respect 
     to such drug.
       ``(ii) Selected drugs without aim price.--In applying this 
     paragraph in the case of negotiating the maximum fair price 
     of a selected drug for which there is no AIM price available 
     with respect to the initial price applicability year for such 
     drug, or, as applicable, renegotiating the maximum fair price 
     for such drug with respect to a subsequent year during the 
     price applicability period for such drug before the first 
     plan year for which there is an AIM price available for such 
     drug, the target price described in this subparagraph for 
     such drug and respective year is the amount that is 80 
     percent of the average manufacturer price (as defined in 
     section 1927(k)(1)) for such drug and year.
       ``(4) Annual report.--After the completion of each 
     voluntary negotiation period, the Secretary shall submit to 
     Congress a report on the maximum fair prices negotiated (or, 
     as applicable, renegotiated) for such period. Such report 
     shall include information on how such prices so negotiated 
     (or renegotiated) meet the requirements of this part, 
     including the requirements of this subsection.
       ``(c) Limitation.--
       ``(1) In general.--Subject to paragraph (2), the maximum 
     fair price negotiated (including as renegotiated) under this 
     section for a selected drug, with respect to each plan year 
     during a price applicability period for such drug, shall not 
     exceed 120 percent of the AIM price applicable to such drug 
     with respect to such year.
       ``(2) Selected drugs without aim price.--In the case of a 
     selected drug for which there is no AIM price available with 
     respect to the initial price applicability year for such 
     drug, for each plan year during the price applicability 
     period before the first plan year for which there is an AIM 
     price available for such drug, the maximum fair price 
     negotiated (including as renegotiated) under this section for 
     the selected drug shall not exceed the amount equal to 85 
     percent of the average manufacturer price for the drug with 
     respect to such year.

[[Page H2611]]

       ``(d) Considerations.--For purposes of negotiating and, as 
     applicable, renegotiating (including for purposes of 
     determining whether to renegotiate) the maximum fair price of 
     a selected drug under this part with the manufacturer of the 
     drug, the Secretary, consistent with subsection (b)(2), shall 
     take into consideration the factors described in paragraphs 
     (1), (2), (3), and (5), and may take into consideration the 
     factor described in paragraph (4):
       ``(1) Manufacturer-specific information.--The following 
     information, including as submitted by the manufacturer:
       ``(A) Research and development costs of the manufacturer 
     for the drug and the extent to which the manufacturer has 
     recouped research and development costs.
       ``(B) Market data for the drug, including the distribution 
     of sales across different programs and purchasers and 
     projected future revenues for the drug.
       ``(C) Unit costs of production and distribution of the 
     drug.
       ``(D) Prior Federal financial support for novel therapeutic 
     discovery and development with respect to the drug.
       ``(E) Data on patents and on existing and pending 
     exclusivity for the drug.
       ``(F) National sales data for the drug.
       ``(G) Information on clinical trials for the drug in the 
     United States or in applicable countries described in section 
     1191(c)(3)(B).
       ``(2) Information on alternative products.--The following 
     information:
       ``(A) The extent to which the drug represents a therapeutic 
     advance as compared to existing therapeutic alternatives and, 
     to the extent such information is available, the costs of 
     such existing therapeutic alternatives.
       ``(B) Information on approval by the Food and Drug 
     Administration of alternative drug products.
       ``(C) Information on comparative effectiveness analysis for 
     such products, taking into consideration the effects of such 
     products on specific populations, such as individuals with 
     disabilities, the elderly, terminally ill, children, and 
     other patient populations.
     In considering information described in subparagraph (C), the 
     Secretary shall not use evidence or findings from comparative 
     clinical effectiveness research in a manner that treats 
     extending the life of an elderly, disabled, or terminally ill 
     individual as of lower value than extending the life of an 
     individual who is younger, nondisabled, or not terminally 
     ill. Nothing in the previous sentence shall affect the 
     application or consideration of an AIM price for a selected 
     drug.
       ``(3) Foreign sales information.--To the extent available 
     on a timely basis, including as provided by a manufacturer of 
     the selected drug or otherwise, information on sales of the 
     selected drug in each of the countries described in section 
     1191(c)(3)(B).
       ``(4) VA drug pricing information.--Information disclosed 
     to the Secretary pursuant to subsection (f).
       ``(5) Additional information.--Information submitted to the 
     Secretary, in accordance with a process specified by the 
     Secretary, by other parties that are affected by the 
     establishment of a maximum fair price for the selected drug.
       ``(e) Request for Information.--For purposes of negotiating 
     and, as applicable, renegotiating (including for purposes of 
     determining whether to renegotiate) the maximum fair price of 
     a selected drug under this part with the manufacturer of the 
     drug, with respect to a price applicability period, and other 
     relevant data for purposes of this section--
       ``(1) the Secretary shall, not later than the selected drug 
     publication date with respect to the initial price 
     applicability year of such period, request drug pricing 
     information from the manufacturer of such selected drug, 
     including information described in subsection (d)(1); and
       ``(2) by not later than October 1 following the selected 
     drug publication date, the manufacturer of such selected drug 
     shall submit to the Secretary such requested information in 
     such form and manner as the Secretary may require.
     The Secretary shall request, from the manufacturer or others, 
     such additional information as may be needed to carry out the 
     negotiation and renegotiation process under this section.
       ``(f) Disclosure of Information.--For purposes of this 
     part, the Secretary of Veterans Affairs may disclose to the 
     Secretary of Health and Human Services the price of any 
     negotiation-eligible drug that is purchased pursuant to 
     section 8126 of title 38, United States Code.

     ``SEC. 1195. PUBLICATION OF MAXIMUM FAIR PRICES.

       ``(a) In General.--With respect to an initial price 
     applicability year and selected drug with respect to such 
     year, not later than April 1 of the plan year prior to such 
     initial price applicability year, the Secretary shall publish 
     in the Federal Register the maximum fair price for such drug 
     negotiated under this part with the manufacturer of such 
     drug.
       ``(b) Updates.--
       ``(1) Subsequent year maximum fair prices.--For a selected 
     drug, for each plan year subsequent to the initial price 
     applicability year for such drug with respect to which an 
     agreement for such drug is in effect under section 1193, the 
     Secretary shall publish in the Federal Register--
       ``(A) subject to subparagraph (B), the amount equal to the 
     maximum fair price published for such drug for the previous 
     year, increased by the annual percentage increase in the 
     consumer price index for all urban consumers (all items; U.S. 
     city average) as of September of such previous year; or
       ``(B) in the case the maximum fair price for such drug was 
     renegotiated, for the first year for which such price as so 
     renegotiated applies, such renegotiated maximum fair price.
       ``(2) Prices negotiated after deadline.--In the case of a 
     selected drug with respect to an initial price applicability 
     year for which the maximum fair price is determined under 
     this part after the date of publication under this section, 
     the Secretary shall publish such maximum fair price in the 
     Federal Register by not later than 30 days after the date 
     such maximum price is so determined.

     ``SEC. 1196. ADMINISTRATIVE DUTIES; COORDINATION PROVISIONS.

       ``(a) Administrative Duties.--
       ``(1) In general.--For purposes of section 1191, the 
     administrative duties described in this section are the 
     following:
       ``(A) The establishment of procedures (including through 
     agreements with manufacturers under this part, contracts with 
     prescription drug plans under part D of title XVIII and MA-PD 
     plans under part C of such title, and agreements under 
     section 1197 with group health plans and health insurance 
     issuers of health insurance coverage offered in the 
     individual or group market) under which the maximum fair 
     price for a selected drug is provided to fair price eligible 
     individuals, who with respect to such drug are described in 
     subparagraph (A) of section 1191(c)(1), at pharmacies or by 
     mail order service at the point-of-sale of the drug for the 
     applicable price period for such drug and providing that such 
     maximum fair price is used for determining cost-sharing under 
     such plans or coverage for the selected drug.
       ``(B) The establishment of procedures (including through 
     agreements with manufacturers under this part and contracts 
     with hospitals, physicians, and other providers of services 
     and suppliers and agreements under section 1197 with group 
     health plans and health insurance issuers of health insurance 
     coverage offered in the individual or group market) under 
     which, in the case of a selected drug furnished or 
     administered by such a hospital, physician, or other provider 
     of services or supplier to fair price eligible individuals 
     (who with respect to such drug are described in subparagraph 
     (B) of section 1191(c)(1)), the maximum fair price for the 
     selected drug is provided to such hospitals, physicians, and 
     other providers of services and suppliers (as applicable) 
     with respect to such individuals and providing that such 
     maximum fair price is used for determining cost-sharing under 
     the respective part, plan, or coverage for the selected drug.
       ``(C) The establishment of procedures (including through 
     agreements and contracts described in subparagraphs (A) and 
     (B)) to ensure that, not later than 90 days after the 
     dispensing of a selected drug to a fair price eligible 
     individual by a pharmacy or mail order service, the pharmacy 
     or mail order service is reimbursed for an amount equal to 
     the difference between--
       ``(i) the lesser of--

       ``(I) the wholesale acquisition cost of the drug;
       ``(II) the national average drug acquisition cost of the 
     drug; and
       ``(III) any other similar determination of pharmacy 
     acquisition costs of the drug, as determined by the 
     Secretary; and

       ``(ii) the maximum fair price for the drug.
       ``(D) The establishment of procedures to ensure that the 
     maximum fair price for a selected drug is applied before--
       ``(i) any coverage or financial assistance under other 
     health benefit plans or programs that provide coverage or 
     financial assistance for the purchase or provision of 
     prescription drug coverage on behalf of fair price eligible 
     individuals as the Secretary may specify; and
       ``(ii) any other discounts.
       ``(E) The establishment of procedures to enter into 
     appropriate agreements and protocols for the ongoing 
     computation of AIM prices for selected drugs, including, to 
     the extent possible, to compute the AIM price for selected 
     drugs and including by providing that the manufacturer of 
     such a selected drug should provide information for such 
     computation not later than 3 months after the first date of 
     the voluntary negotiation period for such selected drug.
       ``(F) The establishment of procedures to compute and apply 
     the maximum fair price across different strengths and dosage 
     forms of a selected drug and not based on the specific 
     formulation or package size or package type of the drug.
       ``(G) The establishment of procedures to negotiate and 
     apply the maximum fair price in a manner that does not 
     include any dispensing or similar fee.
       ``(H) The establishment of procedures to carry out the 
     provisions of this part, as applicable, with respect to--
       ``(i) fair price eligible individuals who are enrolled 
     under a prescription drug plan under part D of title XVIII or 
     an MA-PD plan under part C of such title;
       ``(ii) fair price eligible individuals who are enrolled 
     under a group health plan or health insurance coverage 
     offered by a health insurance issuer in the individual or 
     group market with respect to which there is an agreement in 
     effect under section 1197; and
       ``(iii) fair price eligible individuals who are entitled to 
     benefits under part A of title XVIII or enrolled under part B 
     of such title.
       ``(I) The establishment of a negotiation process and 
     renegotiation process in accordance with section 1194, 
     including a process for acquiring information described in 
     subsection (d) of such section and determining amounts 
     described in subsection (b) of such section.
       ``(J) The provision of a reasonable dispute resolution 
     mechanism to resolve disagreements between manufacturers, 
     fair price eligible individuals, and the third party with a 
     contract under subsection (c)(1).
       ``(2) Monitoring compliance.--
       ``(A) In general.--The Secretary shall monitor compliance 
     by a manufacturer with the terms of an agreement under 
     section 1193, including by establishing a mechanism through 
     which violations of such terms may be reported.

[[Page H2612]]

       ``(B) Notification.--If a third party with a contract under 
     subsection (c)(1) determines that the manufacturer is not in 
     compliance with such agreement, the third party shall notify 
     the Secretary of such noncompliance for appropriate 
     enforcement under section 4192 of the Internal Revenue Code 
     of 1986 or section 1198, as applicable.
       ``(b) Collection of Data.--
       ``(1) From prescription drug plans and ma-pd plans.--The 
     Secretary may collect appropriate data from prescription drug 
     plans under part D of title XVIII and MA-PD plans under part 
     C of such title in a timeframe that allows for maximum fair 
     prices to be provided under this part for selected drugs.
       ``(2) From health plans.--The Secretary may collect 
     appropriate data from group health plans or health insurance 
     issuers offering group or individual health insurance 
     coverage in a timeframe that allows for maximum fair prices 
     to be provided under this part for selected drugs.
       ``(3) Coordination of data collection.--To the extent 
     feasible, as determined by the Secretary, the Secretary shall 
     ensure that data collected pursuant to this subsection is 
     coordinated with, and not duplicative of, other Federal data 
     collection efforts.
       ``(c) Contract With Third Parties.--
       ``(1) In general.--The Secretary may enter into a contract 
     with 1 or more third parties to administer the requirements 
     established by the Secretary in order to carry out this part. 
     At a minimum, the contract with a third party under the 
     preceding sentence shall require that the third party--
       ``(A) receive and transmit information between the 
     Secretary, manufacturers, and other individuals or entities 
     the Secretary determines appropriate;
       ``(B) receive, distribute, or facilitate the distribution 
     of funds of manufacturers to appropriate individuals or 
     entities in order to meet the obligations of manufacturers 
     under agreements under this part;
       ``(C) provide adequate and timely information to 
     manufacturers, consistent with the agreement with the 
     manufacturer under this part, as necessary for the 
     manufacturer to fulfill its obligations under this part; and
       ``(D) permit manufacturers to conduct periodic audits, 
     directly or through contracts, of the data and information 
     used by the third party to determine discounts for applicable 
     drugs of the manufacturer under the program.
       ``(2) Performance requirements.--The Secretary shall 
     establish performance requirements for a third party with a 
     contract under paragraph (1) and safeguards to protect the 
     independence and integrity of the activities carried out by 
     the third party under the program under this part.

     ``SEC. 1197. VOLUNTARY PARTICIPATION BY OTHER HEALTH PLANS.

       ``(a) Agreement to Participate Under Program.--
       ``(1) In general.--Subject to paragraph (2), under the 
     program under this part the Secretary shall be treated as 
     having in effect an agreement with a group health plan or 
     health insurance issuer offering group or individual health 
     insurance coverage (as such terms are defined in section 2791 
     of the Public Health Service Act), with respect to a price 
     applicability period and a selected drug with respect to such 
     period--
       ``(A) with respect to such selected drug furnished or 
     dispensed at a pharmacy or by mail order service if coverage 
     is provided under such plan or coverage during such period 
     for such selected drug as so furnished or dispensed; and
       ``(B) with respect to such selected drug furnished or 
     administered by a hospital, physician, or other provider of 
     services or supplier if coverage is provided under such plan 
     or coverage during such period for such selected drug as so 
     furnished or administered.
       ``(2) Opting out of agreement.--The Secretary shall not be 
     treated as having in effect an agreement under the program 
     under this part with a group health plan or health insurance 
     issuer offering group or individual health insurance coverage 
     with respect to a price applicability period and a selected 
     drug with respect to such period if such a plan or issuer 
     affirmatively elects, through a process specified by the 
     Secretary, not to participate under the program with respect 
     to such period and drug.
       ``(b) Publication of Election.--With respect to each price 
     applicability period and each selected drug with respect to 
     such period, the Secretary and the Secretary of Labor and the 
     Secretary of the Treasury, as applicable, shall make public a 
     list of each group health plan and each health insurance 
     issuer offering group or individual health insurance 
     coverage, with respect to which coverage is provided under 
     such plan or coverage for such drug, that has elected under 
     subsection (a) not to participate under the program with 
     respect to such period and drug.

     ``SEC. 1198. CIVIL MONETARY PENALTY.

       ``(a) Violations Relating To Offering of Maximum Fair 
     Price.--Any manufacturer of a selected drug that has entered 
     into an agreement under section 1193, with respect to a plan 
     year during the price applicability period for such drug, 
     that does not provide access to a price that is not more than 
     the maximum fair price (or a lesser price) for such drug for 
     such year--
       ``(1) to a fair price eligible individual who with respect 
     to such drug is described in subparagraph (A) of section 
     1191(c)(1) and who is furnished or dispensed such drug during 
     such year; or
       ``(2) to a hospital, physician, or other provider of 
     services or supplier with respect to fair price eligible 
     individuals who with respect to such drug is described in 
     subparagraph (B) of such section and is furnished or 
     administered such drug by such hospital, physician, or 
     provider or supplier during such year;
     shall be subject to a civil monetary penalty equal to ten 
     times the amount equal to the difference between the price 
     for such drug made available for such year by such 
     manufacturer with respect to such individual or hospital, 
     physician, provider, or supplier and the maximum fair price 
     for such drug for such year.
       ``(b) Violations of Certain Terms of Agreement.--Any 
     manufacturer of a selected drug that has entered into an 
     agreement under section 1193, with respect to a plan year 
     during the price applicability period for such drug, that is 
     in violation of a requirement imposed pursuant to section 
     1193(a)(6) shall be subject to a civil monetary penalty of 
     not more than $1,000,000 for each such violation.
       ``(c) Application.--The provisions of section 1128A (other 
     than subsections (a) and (b)) shall apply to a civil monetary 
     penalty under this section in the same manner as such 
     provisions apply to a penalty or proceeding under section 
     1128A(a).

     ``SEC. 1199. MISCELLANEOUS PROVISIONS.

       ``(a) Paperwork Reduction Act.--Chapter 35 of title 44, 
     United States Code, shall not apply to data collected under 
     this part.
       ``(b) National Academy of Medicine Study.--Not later than 
     December 31, 2025, the National Academy of Medicine shall 
     conduct a study, and submit to Congress a report, on 
     recommendations for improvements to the program under this 
     part, including the determination of the limits applied under 
     section 1194(c).
       ``(c) MedPAC Study.--Not later than December 31, 2025, the 
     Medicare Payment Advisory Commission shall conduct a study, 
     and submit to Congress a report, on the program under this 
     part with respect to the Medicare program under title XVIII, 
     including with respect to the effect of the program on 
     individuals entitled to benefits or enrolled under such 
     title.
       ``(d) Limitation on Judicial Review.--The following shall 
     not be subject to judicial review:
       ``(1) The selection of drugs for publication under section 
     1192(a).
       ``(2) The determination of whether a drug is a negotiation-
     eligible drug under section 1192(d).
       ``(3) The determination of the maximum fair price of a 
     selected drug under section 1194.
       ``(4) The determination of units of a drug for purposes of 
     section 1191(c)(3).
       ``(e) Coordination.--In carrying out this part with respect 
     to group health plans or health insurance coverage offered in 
     the group market that are subject to oversight by the 
     Secretary of Labor or the Secretary of the Treasury, the 
     Secretary of Health and Human Services shall coordinate with 
     such respective Secretary.
       ``(f) Data Sharing.--The Secretary shall share with the 
     Secretary of the Treasury such information as is necessary to 
     determine the tax imposed by section 4192 of the Internal 
     Revenue Code of 1986.
       ``(g) GAO Study.--Not later than December 31, 2025, the 
     Comptroller General of the United States shall conduct a 
     study of, and submit to Congress a report on, the 
     implementation of the Fair Price Negotiation Program under 
     this part.''.
       (b) Application of Maximum Fair Prices and Conforming 
     Amendments.--
       (1) Under medicare.--
       (A) Application to payments under part b.--Section 
     1847A(b)(1)(B) of the Social Security Act (42 U.S.C. 1395w-
     3a(b)(1)(B)) is amended by inserting ``or in the case of such 
     a drug or biological that is a selected drug (as defined in 
     section 1192(c)), with respect to a price applicability 
     period (as defined in section 1191(b)(2)), 106 percent of the 
     maximum fair price (as defined in section 1191(c)(2) 
     applicable for such drug and a plan year during such period'' 
     after ``paragraph (4)''.
       (B) Exception to part d non-interference.--Section 1860D-
     11(i) of the Social Security Act (42 U.S.C. 1395w-111(i)) is 
     amended by inserting ``, except as provided under part E of 
     title XI'' after ``the Secretary''.
       (C) Application as negotiated price under part d.--Section 
     1860D-2(d)(1) of the Social Security Act (42 U.S.C. 1395w-
     102(d)(1)) is amended--
       (i) in subparagraph (B), by inserting ``, subject to 
     subparagraph (D),'' after ``negotiated prices''; and
       (ii) by adding at the end the following new subparagraph:
       ``(D) Application of maximum fair price for selected 
     drugs.--In applying this section, in the case of a covered 
     part D drug that is a selected drug (as defined in section 
     1192(c)), with respect to a price applicability period (as 
     defined in section 1191(b)(2)), the negotiated prices used 
     for payment (as described in this subsection) shall be the 
     maximum fair price (as defined in section 1191(c)(2)) for 
     such drug and for each plan year during such period.''.
       (D) Information from prescription drug plans and ma-pd 
     plans required.--
       (i) Prescription drug plans.--Section 1860D-12(b) of the 
     Social Security Act (42 U.S.C. 1395w-112(b)) is amended by 
     adding at the end the following new paragraph:
       ``(8) Provision of information related to maximum fair 
     prices.--Each contract entered into with a PDP sponsor under 
     this part with respect to a prescription drug plan offered by 
     such sponsor shall require the sponsor to provide information 
     to the Secretary as requested by the Secretary in accordance 
     with section 1196(b).''.
       (ii) MA-PD plans.--Section 1857(f)(3) of the Social 
     Security Act (42 U.S.C. 1395w-27(f)(3)) is amended by adding 
     at the end the following new subparagraph:
       ``(E) Provision of information related to maximum fair 
     prices.--Section 1860D-12(b)(8).''.
       (2) Under group health plans and health insurance 
     coverage.--
       (A) PHSA.--Part A of title XXVII of the Public Health 
     Service Act is amended by inserting after section 2729 the 
     following new section:

[[Page H2613]]

  


     ``SEC. 2729A. FAIR PRICE NEGOTIATION PROGRAM AND APPLICATION 
                   OF MAXIMUM FAIR PRICES.

       ``(a) In General.--In the case of a group health plan or 
     health insurance issuer offering group or individual health 
     insurance coverage that is treated under section 1197 of the 
     Social Security Act as having in effect an agreement with the 
     Secretary under the Fair Price Negotiation Program under part 
     E of title XI of such Act, with respect to a price 
     applicability period (as defined in section 1191(b) of such 
     Act) and a selected drug (as defined in section 1192(c) of 
     such Act) with respect to such period with respect to which 
     coverage is provided under such plan or coverage--
       ``(1) the provisions of such part shall apply--
       ``(A) if coverage of such selected drug is provided under 
     such plan or coverage if the drug is furnished or dispensed 
     at a pharmacy or by a mail order service, to the plans or 
     coverage offered by such plan or issuer, and to the 
     individuals enrolled under such plans or coverage, during 
     such period, with respect to such selected drug, in the same 
     manner as such provisions apply to prescription drug plans 
     and MA-PD plans, and to individuals enrolled under such 
     prescription drug plans and MA-PD plans during such period; 
     and
       ``(B) if coverage of such selected drug is provided under 
     such plan or coverage if the drug is furnished or 
     administered by a hospital, physician, or other provider of 
     services or supplier, to the plans or coverage offered by 
     such plan or issuers, to the individuals enrolled under such 
     plans or coverage, and to hospitals, physicians, and other 
     providers of services and suppliers during such period, with 
     respect to such drug in the same manner as such provisions 
     apply to the Secretary, to individuals entitled to benefits 
     under part A of title XVIII or enrolled under part B of such 
     title, and to hospitals, physicians, and other providers and 
     suppliers participating under title XVIII during such period;
       ``(2) the plan or issuer shall apply any cost-sharing 
     responsibilities under such plan or coverage, with respect to 
     such selected drug, by substituting an amount not more than 
     the maximum fair price negotiated under such part E of title 
     XI for such drug in lieu of the drug price upon which the 
     cost-sharing would have otherwise applied, and such cost-
     sharing responsibilities with respect to such selected drug 
     may not exceed such maximum fair price; and
       ``(3) the Secretary shall apply the provisions of such part 
     E to such plan, issuer, and coverage, such individuals so 
     enrolled in such plans and coverage, and such hospitals, 
     physicians, and other providers and suppliers participating 
     in such plans and coverage.
       ``(b) Notification Regarding Nonparticipation in Fair Price 
     Negotiation Program.--A group health plan or a health 
     insurance issuer offering group or individual health 
     insurance coverage shall publicly disclose in a manner and in 
     accordance with a process specified by the Secretary any 
     election made under section 1197 of the Social Security Act 
     by the plan or issuer to not participate in the Fair Price 
     Negotiation Program under part E of title XI of such Act with 
     respect to a selected drug (as defined in section 1192(c) of 
     such Act) for which coverage is provided under such plan or 
     coverage before the beginning of the plan year for which such 
     election was made.''.
       (B) ERISA.--
       (i) In general.--Subpart B of part 7 of subtitle B of title 
     I of the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1181 et. seq.) is amended by adding at the end the 
     following new section:

     ``SEC. 716. FAIR PRICE NEGOTIATION PROGRAM AND APPLICATION OF 
                   MAXIMUM FAIR PRICES.

       ``(a) In General.--In the case of a group health plan or 
     health insurance issuer offering group health insurance 
     coverage that is treated under section 1197 of the Social 
     Security Act as having in effect an agreement with the 
     Secretary under the Fair Price Negotiation Program under part 
     E of title XI of such Act, with respect to a price 
     applicability period (as defined in section 1191(b) of such 
     Act) and a selected drug (as defined in section 1192(c) of 
     such Act) with respect to such period with respect to which 
     coverage is provided under such plan or coverage--
       ``(1) the provisions of such part shall apply, as 
     applicable--
       ``(A) if coverage of such selected drug is provided under 
     such plan or coverage if the drug is furnished or dispensed 
     at a pharmacy or by a mail order service, to the plans or 
     coverage offered by such plan or issuer, and to the 
     individuals enrolled under such plans or coverage, during 
     such period, with respect to such selected drug, in the same 
     manner as such provisions apply to prescription drug plans 
     and MA-PD plans, and to individuals enrolled under such 
     prescription drug plans and MA-PD plans during such period; 
     and
       ``(B) if coverage of such selected drug is provided under 
     such plan or coverage if the drug is furnished or 
     administered by a hospital, physician, or other provider of 
     services or supplier, to the plans or coverage offered by 
     such plan or issuers, to the individuals enrolled under such 
     plans or coverage, and to hospitals, physicians, and other 
     providers of services and suppliers during such period, with 
     respect to such drug in the same manner as such provisions 
     apply to the Secretary, to individuals entitled to benefits 
     under part A of title XVIII or enrolled under part B of such 
     title, and to hospitals, physicians, and other providers and 
     suppliers participating under title XVIII during such period;
       ``(2) the plan or issuer shall apply any cost-sharing 
     responsibilities under such plan or coverage, with respect to 
     such selected drug, by substituting an amount not more than 
     the maximum fair price negotiated under such part E of title 
     XI for such drug in lieu of the drug price upon which the 
     cost-sharing would have otherwise applied, and such cost-
     sharing responsibilities with respect to such selected drug 
     may not exceed such maximum fair price; and
       ``(3) the Secretary shall apply the provisions of such part 
     E to such plan, issuer, and coverage, and such individuals so 
     enrolled in such plans.
       ``(b) Notification Regarding Nonparticipation in Fair Price 
     Negotiation Program.--A group health plan or a health 
     insurance issuer offering group health insurance coverage 
     shall publicly disclose in a manner and in accordance with a 
     process specified by the Secretary any election made under 
     section 1197 of the Social Security Act by the plan or issuer 
     to not participate in the Fair Price Negotiation Program 
     under part E of title XI of such Act with respect to a 
     selected drug (as defined in section 1192(c) of such Act) for 
     which coverage is provided under such plan or coverage before 
     the beginning of the plan year for which such election was 
     made.''.
       (ii) Application to retiree and certain small group health 
     plans.--Section 732(a) of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1191a(a)) is amended by 
     striking ``section 711'' and inserting ``sections 711 and 
     716''.
       (iii) Clerical amendment.--The table of sections for 
     subpart B of part 7 of subtitle B of title I of the Employee 
     Retirement Income Security Act of 1974 is amended by adding 
     at the end the following:

``Sec. 716. Fair Price Negotiation Program and application of maximum 
              fair prices.''.
       (C) IRC.--
       (i) In general.--Subchapter B of chapter 100 of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new section:

     ``SEC. 9816. FAIR PRICE NEGOTIATION PROGRAM AND APPLICATION 
                   OF MAXIMUM FAIR PRICES.

       ``(a) In General.--In the case of a group health plan that 
     is treated under section 1197 of the Social Security Act as 
     having in effect an agreement with the Secretary under the 
     Fair Price Negotiation Program under part E of title XI of 
     such Act, with respect to a price applicability period (as 
     defined in section 1191(b) of such Act) and a selected drug 
     (as defined in section 1192(c) of such Act) with respect to 
     such period with respect to which coverage is provided under 
     such plan--
       ``(1) the provisions of such part shall apply, as 
     applicable--
       ``(A) if coverage of such selected drug is provided under 
     such plan if the drug is furnished or dispensed at a pharmacy 
     or by a mail order service, to the plan, and to the 
     individuals enrolled under such plan during such period, with 
     respect to such selected drug, in the same manner as such 
     provisions apply to prescription drug plans and MA-PD plans, 
     and to individuals enrolled under such prescription drug 
     plans and MA-PD plans during such period; and
       ``(B) if coverage of such selected drug is provided under 
     such plan if the drug is furnished or administered by a 
     hospital, physician, or other provider of services or 
     supplier, to the plan, to the individuals enrolled under such 
     plan, and to hospitals, physicians, and other providers of 
     services and suppliers during such period, with respect to 
     such drug in the same manner as such provisions apply to the 
     Secretary, to individuals entitled to benefits under part A 
     of title XVIII or enrolled under part B of such title, and to 
     hospitals, physicians, and other providers and suppliers 
     participating under title XVIII during such period;
       ``(2) the plan shall apply any cost-sharing 
     responsibilities under such plan, with respect to such 
     selected drug, by substituting an amount not more than the 
     maximum fair price negotiated under such part E of title XI 
     for such drug in lieu of the drug price upon which the cost-
     sharing would have otherwise applied, and such cost-sharing 
     responsibilities with respect to such selected drug may not 
     exceed such maximum fair price; and
       ``(3) the Secretary shall apply the provisions of such part 
     E to such plan and such individuals so enrolled in such plan.
       ``(b) Notification Regarding Nonparticipation in Fair Price 
     Negotiation Program.--A group health plan shall publicly 
     disclose in a manner and in accordance with a process 
     specified by the Secretary any election made under section 
     1197 of the Social Security Act by the plan to not 
     participate in the Fair Price Negotiation Program under part 
     E of title XI of such Act with respect to a selected drug (as 
     defined in section 1192(c) of such Act) for which coverage is 
     provided under such plan before the beginning of the plan 
     year for which such election was made.''.
       (ii) Application to retiree and certain small group health 
     plans.--Section 9831(a)(2) of the Internal Revenue Code of 
     1986 is amended by inserting ``other than with respect to 
     section 9816,'' before ``any group health plan''.
       (iii) Clerical amendment.--The table of sections for 
     subchapter B of chapter 100 of such Code is amended by adding 
     at the end the following new item:

``Sec. 9816. Fair Price Negotiation Program and application of maximum 
              fair prices.''.
       (3) Fair price negotiation program prices included in best 
     price and amp.--Section 1927 of the Social Security Act (42 
     U.S.C. 1396r-8) is amended--
       (A) in subsection (c)(1)(C)(ii)--
       (i) in subclause (III), by striking at the end ``; and'';
       (ii) in subclause (IV), by striking at the end the period 
     and inserting ``; and''; and
       (iii) by adding at the end the following new subclause:

[[Page H2614]]

       ``(V) in the case of a rebate period and a covered 
     outpatient drug that is a selected drug (as defined in 
     section 1192(c)) during such rebate period, shall be 
     inclusive of the price for such drug made available from the 
     manufacturer during the rebate period by reason of 
     application of part E of title XI to any wholesaler, 
     retailer, provider, health maintenance organization, 
     nonprofit entity, or governmental entity within the United 
     States.''; and

       (B) in subsection (k)(1)(B), by adding at the end the 
     following new clause:
       ``(iii) Clarification.--Notwithstanding clause (i), in the 
     case of a rebate period and a covered outpatient drug that is 
     a selected drug (as defined in section 1192(c)) during such 
     rebate period, any reduction in price paid during the rebate 
     period to the manufacturer for the drug by a wholesaler or 
     retail community pharmacy described in subparagraph (A) by 
     reason of application of part E of title XI shall be included 
     in the average manufacturer price for the covered outpatient 
     drug.''.
       (4) FEHBP.--Section 8902 of title 5, United States Code, is 
     amended by adding at the end the following:
       ``(p) A contract may not be made or a plan approved under 
     this chapter with any carrier that has affirmatively elected, 
     pursuant to section 1197 of the Social Security Act, not to 
     participate in the Fair Price Negotiation Program established 
     under section 1191 of such Act for any selected drug (as that 
     term is defined in section 1192(c) of such Act).''.
       (5) Option of secretary of veterans affairs to purchase 
     covered drugs at maximum fair prices.--Section 8126 of title 
     38, United States Code, is amended--
       (A) in subsection (a)(2), by inserting ``, subject to 
     subsection (j),'' after ``may not exceed'';
       (B) in subsection (d), in the matter preceding paragraph 
     (1), by inserting ``, subject to subsection (j)'' after ``for 
     the procurement of the drug''; and
       (C) by adding at the end the following new subsection:
       ``(j)(1) In the case of a covered drug that is a selected 
     drug, for any year during the price applicability period for 
     such drug, if the Secretary determines that the maximum fair 
     price of such drug for such year is less than the price for 
     such drug otherwise in effect pursuant to this section 
     (including after application of any reduction under 
     subsection (a)(2) and any discount under subsection (c)), at 
     the option of the Secretary, in lieu of the maximum price 
     (determined after application of the reduction under 
     subsection (a)(2) and any discount under subsection (c), as 
     applicable) that would be permitted to be charged during such 
     year for such drug pursuant to this section without 
     application of this subsection, the maximum price permitted 
     to be charged during such year for such drug pursuant to this 
     section shall be such maximum fair price for such drug and 
     year.
       ``(2) For purposes of this subsection:
       ``(A) The term `maximum fair price' means, with respect to 
     a selected drug and year during the price applicability 
     period for such drug, the maximum fair price (as defined in 
     section 1191(c)(2) of the Social Security Act) for such drug 
     and year.
       ``(B) The term `negotiation eligible drug' has the meaning 
     given such term in section 1192(d)(1) of the Social Security 
     Act.
       ``(C) The term `price applicability period' has, with 
     respect to a selected drug, the meaning given such term in 
     section 1191(b)(2) of such Act.
       ``(D) The term `selected drug' means, with respect to a 
     year, a drug that is a selected drug under section 1192(c) of 
     such Act for such year.''.

     SEC. 302. DRUG MANUFACTURER EXCISE TAX FOR NONCOMPLIANCE.

       (a) In General.--Subchapter E of chapter 32 of the Internal 
     Revenue Code of 1986 is amended by adding at the end the 
     following new section:

     ``SEC. 4192. SELECTED DRUGS DURING NONCOMPLIANCE PERIODS.

       ``(a) In General.--There is hereby imposed on the sale by 
     the manufacturer, producer, or importer of any selected drug 
     during a day described in subsection (b) a tax in an amount 
     such that the applicable percentage is equal to the ratio 
     of--
       ``(1) such tax, divided by
       ``(2) the sum of such tax and the price for which so sold.
       ``(b) Noncompliance Periods.--A day is described in this 
     subsection with respect to a selected drug if it is a day 
     during one of the following periods:
       ``(1) The period beginning on the June 16th immediately 
     following the selected drug publication date and ending on 
     the first date during which the manufacturer of the drug has 
     in place an agreement described in subsection (a) of section 
     1193 of the Social Security Act with respect to such drug.
       ``(2) The period beginning on the April 1st immediately 
     following the June 16th described in paragraph (1) and ending 
     on the first date during which the manufacturer of the drug 
     has agreed to a maximum fair price under such agreement.
       ``(3) In the case of a selected drug with respect to which 
     the Secretary of Health and Human Services has specified a 
     renegotiation period under such agreement, the period 
     beginning on the first date after the last date of such 
     renegotiation period and ending on the first date during 
     which the manufacturer of the drug has agreed to a 
     renegotiated maximum fair price under such agreement.
       ``(4) With respect to information that is required to be 
     submitted to the Secretary of Health and Human Services under 
     such agreement, the period beginning on the date on which 
     such Secretary certifies that such information is overdue and 
     ending on the date that such information is so submitted.
       ``(5) In the case of a selected drug with respect to which 
     a payment is due under subsection (c) of such section 1193, 
     the period beginning on the date on which the Secretary of 
     Health and Human Services certifies that such payment is 
     overdue and ending on the date that such payment is made in 
     full.
       ``(c) Applicable Percentage.--For purposes of this section, 
     the term `applicable percentage' means--
       ``(1) in the case of sales of a selected drug during the 
     first 90 days described in subsection (b) with respect to 
     such drug, 65 percent,
       ``(2) in the case of sales of such drug during the 91st day 
     through the 180th day described in subsection (b) with 
     respect to such drug, 75 percent,
       ``(3) in the case of sales of such drug during the 181st 
     day through the 270th day described in subsection (b) with 
     respect to such drug, 85 percent, and
       ``(4) in the case of sales of such drug during any 
     subsequent day, 95 percent.
       ``(d) Selected Drug.--For purposes of this section--
       ``(1) In general.--The term `selected drug' means any 
     selected drug (within the meaning of section 1192 of the 
     Social Security Act) which is manufactured or produced in the 
     United States or entered into the United States for 
     consumption, use, or warehousing.
       ``(2) United states.--The term `United States' has the 
     meaning given such term by section 4612(a)(4).
       ``(3) Coordination with rules for possessions of the united 
     states.--Rules similar to the rules of paragraphs (2) and (4) 
     of section 4132(c) shall apply for purposes of this section.
       ``(e) Other Definitions.--For purposes of this section, the 
     terms `selected drug publication date' and `maximum fair 
     price' have the meaning given such terms in section 1191 of 
     the Social Security Act.
       ``(f) Anti-Abuse Rule.--In the case of a sale which was 
     timed for the purpose of avoiding the tax imposed by this 
     section, the Secretary may treat such sale as occurring 
     during a day described in subsection (b).''.
       (b) No Deduction for Excise Tax Payments.--Section 275 of 
     the Internal Revenue Code of 1986 is amended by adding ``or 
     by section 4192'' before the period at the end of subsection 
     (a)(6).
       (c) Conforming Amendments.--
       (1) Section 4221(a) of the Internal Revenue Code of 1986 is 
     amended by inserting ``or 4192'' after ``section 4191''.
       (2) Section 6416(b)(2) of such Code is amended by inserting 
     ``or 4192'' after ``section 4191''.
       (d) Clerical Amendments.--
       (1) The heading of subchapter E of chapter 32 of the 
     Internal Revenue Code of 1986 is amended by striking 
     ``Medical Devices'' and inserting ``Other Medical Products''.
       (2) The table of subchapters for chapter 32 of such Code is 
     amended by striking the item relating to subchapter E and 
     inserting the following new item:

               ``subchapter e. other medical products''.

       (3) The table of sections for subchapter E of chapter 32 of 
     such Code is amended by adding at the end the following new 
     item:

``Sec. 4192. Selected drugs during noncompliance periods.''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to sales after the date of the enactment of this 
     Act.

     SEC. 303. FAIR PRICE NEGOTIATION IMPLEMENTATION FUND.

       (a) In General.--There is hereby established a Fair Price 
     Negotiation Implementation Fund (referred to in this section 
     as the ``Fund''). The Secretary of Health and Human Services 
     may obligate and expend amounts in the Fund to carry out this 
     title (and the amendments made by such title).
       (b) Funding.--There is authorized to be appropriated, and 
     there is hereby appropriated, out of any monies in the 
     Treasury not otherwise appropriated, to the Fund 
     $3,000,000,000, to remain available until expended, of 
     which--
       (1) $600,000,000 shall become available on the date of the 
     enactment of this Act;
       (2) $600,000,000 shall become available on October 1, 2020;
       (3) $600,000,000 shall become available on October 1, 2021;
       (4) $600,000,000 shall become available on October 1, 2022; 
     and
       (5) $600,000,000 shall become available on October 1, 2023.
       (c) Supplement Not Supplant.--Any amounts appropriated 
     pursuant to this section shall be in addition to any other 
     amounts otherwise appropriated pursuant to any other 
     provision of law.

                  TITLE IV--PUBLIC HEALTH INVESTMENTS

     SEC. 401. SUPPORTING INCREASED INNOVATION.

       (a) In General.--The Secretary of Health and Human 
     Services, acting through the Director of the National 
     Institutes of Health, shall continue to support and to 
     expand, as applicable, biomedical research carried out 
     through the National Institutes of Health innovation projects 
     described in section 1001(b)(4) of the 21st Century Cures Act 
     (Public Law 114-255). The Secretary shall ensure that any 
     such research (and related activities) is conducted in 
     compliance with section 492B of the Public Health Service Act 
     (42 U.S.C. 289a-2) (relating to the inclusion of women and 
     members of minority groups in research).
       (b) Authorization of Appropriations.--To carry out this 
     subsection, in addition to funds made available under 
     paragraph (2) of section 1001(b) of the 21st Century Cures 
     Act (Public Law 114-255), there is authorized to be 
     appropriated, and there is appropriated to the NIH Innovation 
     Account established under such section 1001(b), out of any 
     moneys in the Treasury not otherwise obligated, 
     $2,000,000,000 for fiscal year 2021, to remain available 
     until expended.


[[Page H2615]]


  The SPEAKER pro tempore. The bill, as amended, shall be debatable for 
3 hours equally divided among and controlled by the respective chairs 
and ranking minority members of the Committee on Education and Labor, 
the Committee on Energy and Commerce, and the Committee on Ways and 
Means.
  The gentleman from Virginia (Mr. Scott), the gentlewoman from North 
Carolina (Ms. Foxx), the gentleman from New Jersey (Mr. Pallone), the 
gentleman from Oregon (Mr. Walden), the gentleman from Massachusetts 
(Mr. Neal), and the gentleman from Texas (Mr. Brady) each will control 
30 minutes.
  The Chair recognizes the gentleman from New Jersey (Mr. Pallone).


                             General Leave

  Mr. PALLONE. Madam Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and add extraneous material on H.R. 1425, the Patient Protection and 
Affordable Care Enhancement Act.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, as Americans continue to face the COVID-19 pandemic 
and a severe economic downturn, they are justifiably concerned about 
their health and their financial future.
  Today, we are here to provide more relief to the American people, and 
I rise in strong support of H.R. 1425, the Patient Protection and 
Affordable Care Enhancement Act, legislation that will make healthcare 
and prescription drugs more affordable and will expand access to health 
coverage.
  Madam Speaker, this legislation strengthens the Affordable Care Act 
for the future, which is critical at a time when the Trump 
administration and Republicans continue to support a lawsuit before the 
Supreme Court that would strike down the entire ACA.
  These actions could result in 23 million Americans losing their 
health coverage and the elimination of critical consumer protections 
for more than 130 million people with preexisting conditions during the 
middle of a pandemic. Sadly, this is nothing new.
  Madam Speaker, over the last 4 years, much of the ACA's progress has 
been halted and, in some cases, reversed by the Trump administration's 
sabotage campaign.
  Thanks to the ACA, the uninsured rate fell to a historic low. 
However, the Trump administration's actions have driven up the 
uninsured rate. Today, millions more Americans are uninsured and afraid 
they will not be able to afford the cost of care if they become sick.

                              {time}  1015

  The Patient Protection and Affordable Care Enhancement Act will 
reverse these trends. This legislation is a commonsense, fiscally 
responsible one-two punch that uses the Federal Government's savings 
from lowering prescription drug costs to lower health insurance costs 
for Americans.
  The bill does this by empowering the Secretary of Health and Human 
Services to negotiate a fair price for prescription drugs. This 
legislation stops the gouging at the pharmacy counter and ensures that 
Americans no longer pay 4 or 5 or 10 times the amount people in other 
countries pay for the exact same drug. This negotiation not only levels 
the playing field, but it also saves hundreds of billions of dollars.
  H.R. 1425 will then reinvest these savings to lower healthcare costs 
for consumers and to expand access to affordable care. More middle-
class Americans would receive financial assistance with monthly 
premiums. A family of four, for example, with an annual income of 
$60,000 would save $2,000 annually, and a family of four with an annual 
income of $100,000, who previously did not qualify for subsidies, would 
save $8,000 every year.
  Now, this is in addition to the savings that they also had under the 
underlying ACA. This is, under this bill, in addition to what they 
normally saved--and that is real savings to hardworking families.
  This legislation also lowers Americans' healthcare costs by reversing 
some of the worst sabotage from the Trump administration. It reverses 
the administration's expansion of junk insurance plans that leave 
patients saddled with thousands of dollars in medical debt. It restores 
critical outreach in enrollment funding that was gutted by the Trump 
administration, and it reduces racial and ethnic healthcare 
disparities.
  H.R. 1425 also builds on the ACA's Medicaid expansion and further 
strengthens this important program and provides for additional 
incentives to States that stubbornly refuse to expand their programs. 
And for political reasons, many of the red States have done that; they 
just refuse to expand Medicaid. But these holdout States, if they 
expand Medicaid, 4.8 million people would gain Medicaid coverage 
overnight, including 2.3 million uninsured Americans.
  This bill also takes an important step to address the country's 
maternal mortality crisis by extending Medicaid postpartum coverage 
from 60 days to 1 year. Simply put, this policy will save lives.
  Madam Speaker, the Patient Protection and Affordable Care Enhancement 
Act lowers healthcare and prescription drug costs, expands coverage for 
millions of Americans, and reverses the Trump administration's years-
long effort to undermine Americans' access to quality and affordable 
healthcare.
  Madam Speaker, I strongly urge my colleagues to support this bill, 
and I reserve the balance of my time.
  Mr. WALDEN. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, our constituents are looking for us to put aside 
partisan politics. They want us not to play political games, and they 
want us to find common ground to address the unprecedented deadly 
challenges caused by COVID-19.
  We need to work together to lower prescription drug prices. We need 
to work together to aid States in stabilizing health markets damaged by 
the ACA. We need to work together to lower out-of-pocket costs for 
patients, including capping seniors' drug costs under Medicare, 
encourage participation of private health insurance, and we really need 
to fund our community health centers. We need to increase the options 
available through the market and end surprise medical billing. We could 
do all of that. We could do it together, and it could become law.
  Unfortunately, instead, here we are wasting time on a partisan bill 
that has zero chance of becoming law. This is no way to govern at any 
time, but especially in a pandemic.
  At a time when we are asking our Nation's innovators to find new 
cures and treatments to address COVID-19 at record speed and with 
record investment, Democrats want to enact a socialist drug pricing 
scheme that could devastate this country's innovation in the middle of 
a global pandemic. Frankly, it is unconscionable.
  This legislation before us today provides $100 billion in bailouts 
for insurance companies at a time when insurers are not paying for 
elective procedures due to COVID. Now, we all want to make premiums 
more affordable, but all signs are insurers do not need a bailout right 
now.
  Wouldn't that money be better spent, Madam Speaker, on funding our 
Nation's community health centers, giving them certainty, rather than 
letting their funding run out in just a matter of months? They are on 
the front lines of this fight in our communities. They are on the front 
lines of the fight on testing and treating patients in rural and 
underserved communities. Shouldn't we fund them, give them stability 
and certainty?
  And speaking of monies poorly spent, today Democrats are proposing we 
spend $400 million to prop up ObamaCare's enrollment. This includes 
$100 million for the failed and discredited Navigator Program; $100 
million for outreach and marketing, only for ACA-compliant plans, not 
any of the more affordable alternatives; and $200 million for States to 
boost enrollment, with no strings attached--no transparency, no 
accountability.
  This law has been on the books for 10 years, and we must spend nearly 
half a billion dollars to make it look like it is working?
  In this bill, Democrats want to force States to expand Medicaid, 
allowing expansion States to get 100 percent of

[[Page H2616]]

Federal Medicaid payments, while punishing, in the middle of a 
pandemic, taking money away from, nonexpansion States, taking it away 
from their Medicaid. That is what this bill does. If they don't expand, 
the Federal Government's heavy hand comes in and takes money back out 
of Medicaid. It is vindictive, and it is probably unconstitutional.
  You know, the Supreme Court, Madam Speaker, said expansion is the 
States' decision. This legislation violates that. We need to work 
together with the States as partners, not treat them like subordinates.

  Now, in the last Congress, I advocated for multiple policies that 
would help States stabilize health markets damaged by the ACA. But, 
unfortunately, House Democrats repeatedly blocked our ideas.
  We all want patients to have access to high-quality and affordable 
health coverage, but this measure doubles down on policies that have 
already failed.
  One thing is clear: We need to make our healthcare system work better 
for all Americans. That is why our goal should be to advance solutions 
to protect patients, to stabilize healthcare markets, to encourage 
greater flexibility for States, and to promote policies to help 
Americans get and keep coverage.
  Madam Speaker, I have great respect for the chairman. We have worked 
together on a number of different issues in the Congress with great 
success at the Energy and Commerce Committee. Unfortunately, our 
bipartisan work to lower drug prices was derailed by the Speaker in 
December when she decided to force politics over real progress.
  I recently read an article about a man suffering from ALS who has 
dedicated his life to finding a cure. And like Americans with ALS, 
there are millions of Americans suffering from other life-threatening 
or debilitating diseases, like cancer or sickle cell anemia. They are 
hoping, and their families are hoping, that one day there will be a 
cure.
  Now, it is not debatable the bill before us today will reduce the 
number of new treatments in the future, new medicines, new lifesaving 
medicines, perhaps. The Council of Economic Advisers found there could 
be more than 100 fewer treatments, fewer medicines, that would never be 
invented, never be discovered, if this legislation we are going to vote 
on becomes law--100 fewer.
  We can lower drug prices while preserving the hope those praying for 
a cure have. There is common ground to be had here, and I have offered 
many times to work on bipartisan legislation to lower drug costs 
without limiting--perhaps, even ending--innovation.
  H.R. 19 is a bill comprised entirely of bipartisan policies. That is 
our Republican alternative. But it is not just a Republican 
alternative. Everything in there is bipartisan. And already, seven of 
the provisions we put in months ago have been signed into law, proving 
that it is, indeed, a bipartisan package.
  Instead of pursuing proven bipartisan solutions, unfortunately, 
Democrats again are forcing partisan politics on this House and this 
country, fewer options for patients at a time when we need more 
treatments and more cures than most.
  This bill is a perfect illustration why Americans are so cynical 
about Washington. The American people deserve better.
  Madam Speaker, I urge a ``no'' vote, and I reserve the balance of my 
time.
  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentlewoman from 
California (Ms. Eshoo), a longtime champion of the ACA.
  Ms. ESHOO. Madam Speaker, I rise in support of H.R. 1425, the Patient 
Protection and Affordable Care Enhancement Act.
  Today, we deliver on our promise to the American people to undo the 
Trump administration's total sabotage of the Affordable Care Act and 
make healthcare affordable for every American.
  Since the ACA was signed into law, 23 million Americans have been 
insured, every person with a preexisting condition was protected, and 
children could stay on their parents' health insurance policy until 
they turned 26.
  Now, in the middle of a pandemic and a recession, the Trump 
administration and congressional Republicans are supporting a lawsuit 
before the Supreme Court--imagine this--to strike down the entirety of 
the ACA. I think that there is one word for this: cruel.
  H.R. 1425 does the opposite. It strengthens the ACA and makes 
healthcare affordable by lowering premiums and reducing drug prices.
  The bill ensures that no American will pay more than 8.5 percent of 
their income for insurance premiums, benefiting approximately 20 
million Americans.
  The bill allows Medicare to directly negotiate the price of the 
costliest drugs, and the lower prices will be available to every 
American, including those who receive their health insurance through 
their employer.
  H.R. 1425 extends coverage to nearly 5 million Americans by pushing 
the holdout States to finally expand Medicaid. This would be such a 
blessing to people in those States whose Governors denied them health 
insurance coverage.
  It also mandates 12 months of Medicaid coverage for eligible 
postpartum mothers.
  The SPEAKER pro tempore. The time of the gentlewoman has expired.
  Mr. PALLONE. Madam Speaker, I yield an additional 1 minute to the 
gentlewoman from California (Ms. Eshoo).
  Ms. ESHOO. Madam Speaker, it mandates 12 months of Medicaid coverage 
for eligible postpartum mothers and ensures that, once a person is 
enrolled in Medicaid, regardless of their income changes, they will be 
covered for a full year.
  The bill ends the Trump administration's expansion of junk insurance 
plans, which exclude coverage of routine care--imagine that; what kind 
of policy doesn't cover routine care?--and has left patients on the 
hook for thousands of dollars in medical bills, and it reinstates 
critical funding for outreach, marketing, and enrollment so more 
Americans can easily sign up for insurance.
  I am very proud that many parts of this bill originated in the Health 
Subcommittee, which I chair, where my first hearings as chair examined 
how to strengthen the ACA.
  This is good for the American people, especially during this crisis 
of a pandemic and a recession.
  Mr. WALDEN. Madam Speaker, I yield 3 minutes to the gentleman from 
Texas (Mr. Burgess), the ranking member and former chairman of the 
Health Subcommittee on the Energy and Commerce Committee.

  Mr. BURGESS. Madam Speaker, the Affordable Care Act, for the last 10 
years, really has been anything but affordable. Prices have gone up 
every year in spite of what we were promised. It has only been the last 
2 years that premiums have actually begun to reduce, and that is 
because of some of the policies enacted by the current administration 
expanding the usability of limited duration plans, expanding 
association health plans.
  So when we talk about this bill to expand the Affordable Care Act, 
what we are really doing is increasing the unaffordability of 
healthcare in this country.
  Now, H.R. 1425 establishes a new reinsurance program, and it is going 
to cost $10 billion per year forever. There is no end date.
  This reinsurance program does not include some of the longstanding 
protections that ensure that Federal funding cannot be used to pay for 
abortions.
  If we want to pass a bipartisan reinsurance policy, Energy and 
Commerce Republicans have a bill, H.R. 1510, which includes reinsurance 
coupled with structural reform of the Affordable Care Act and gives 
States more choice on how to repair their markets that have been 
damaged by the Affordable Care Act, and it is offset by stopping bad 
actors from gaming the system. Importantly, it does include the Hyde 
protections and, therefore, protects life.
  H.R. 1425 also punishes States that choose not to expand Medicaid by 
cutting their Federal share of Medicaid funding.
  So let's be very clear about this. A State such as mine that did not 
expand Medicaid reevaluates year by year, but if they choose not to 
expand, if they say they can't afford what this expansion would bring 
to the State, now this bill proposes to reduce the funding, the

[[Page H2617]]

Federal match, for the traditional Medicaid populations. And who are 
they? Blind, aged, disabled, medically fragile, children, women.

                              {time}  1030

  Why would we want to do that? Now, look, remember the reason that we 
have some States expanding Medicaid and some not is because of a 
Supreme Court case, National Federation of Independent Business v. 
Sebelius, which ruled that threatening States' Medicaid funding for not 
expanding is unconstitutional. Sections 204 and 205 of this bill would 
violate those very same principles and coerce States rather than 
incentivize them to expand Medicaid. This will be struck down by the 
Supreme Court as well.
  Lastly, this bill uses offsets that would actively harm our Nation's 
coronavirus response by using offsets from H.R. 3 that would require 
the government to set prices and confiscate dollars from pharmacologic 
developers. The Congressional Budget Office analysis found that such 
policies would lead to substantially fewer new drugs coming to market. 
We really can't afford a world without the next remdesivir.
  Mr. WALDEN. Madam Speaker, I would just point out that as we sit here 
today, Oklahoma, under a Republican Governor, has chosen to expand 
Medicaid coverage. That is how it should work, not a penalizing system.
  Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentleman from 
Oregon (Mr. Schrader), a member of the Energy and Commerce Committee.
  Mr. SCHRADER. Madam Speaker, I rise today to speak in favor of H.R. 
1425, the Patient Protection and Affordable Care Enhancement Act.
  The bill before us today has a variety of provisions that I have been 
a longtime supporter of, and now, given the current healthcare crisis 
with COVID-19, many of these provisions are more important than ever 
before. Negotiating drug prices to save people money, we do it in all 
aspects of our life, we need to do it here.
  I am also proud to colead an effort with Representative Harder, 
included in today's bill, to ensure that folks who are losing their 
employer-sponsored healthcare coverage are aware that options to 
maintain that healthcare include both COBRA and the marketplace. It 
also maintains State flexibility and has a mechanism to ensure 
resources get to the individuals that need the help the most.
  My home State of Oregon has a State innovation waiver reinsurance 
program under Section 1332 of the ACA, and within the first year it 
already started saving money for families by preventing a 10 to 15 
percent premium increase.
  These reinsurance provisions in H.R. 1425, widely bipartisan, will 
bolster and augment efforts States like mine who are already doing it, 
and provide other States additional opportunity to afford this type of 
program.
  While the impact of the marketplace may not be seen immediately, we 
know that the uncertainty around COVID-19 will likely drive rates up 
and may consolidate the options available in the marketplace that we 
have worked so hard to build robust, quality options for coverage.
  Since the ACA went into effect, we have seen positive trends in 
coverage and utilization. We must continue to build on the parts we 
know that are working, and in no small part, it is the Medicaid 
expansion that is helping so many. All of our States are facing budget 
crises right now, and more folks are shifting over to Medicaid as they 
lose their jobs. While providing healthcare is an investment upfront, 
it pays dividends on the back end by driving preventative care and 
reducing costly treatments.
  Madam Speaker, I encourage my colleagues on both sides of the aisle 
to consider supporting the comprehensive bill before us today.
  Mr. WALDEN. Madam Speaker, I yield 2 minutes to the gentleman from 
Indiana (Mr. Bucshon), a member of the Energy and Commerce Committee.
  Mr. BUCSHON. Madam Speaker, first of all, I want to echo all the 
points made by Mr. Walden in his opening statement.
  A decade ago, ObamaCare became the law of the land. This massive, 
near government takeover of our Nation's healthcare system came full of 
empty promises.
  President Obama and Congressional Democrats famously promised 
Americans that if you liked your doctor, you can keep your doctor. That 
turned out not to be true. Millions of Americans lost access to their 
doctors as insurances have resorted to narrowing networks.
  And instead of seeing premiums decrease by $2,500, as President Obama 
promised, American families have seen premiums and deductibles 
skyrocket. Americans deserve an accessible and affordable healthcare 
system that promotes quality care and peace of mind, not a system that 
is a downpayment on socialized, one-size-fits-all single-payer 
healthcare system that would put the government in charge of one of the 
most personal decisions families will ever make.
  Rather than working to find bipartisan solutions for patients, 
Democrats are choosing to double-down on ObamaCare's biggest flaws. I 
will focus on drug pricing.
  They are planning to give Washington the power to set drug prices. 
Well, we know that nonpartisan analysis has determined that this would 
result in fewer medicines being developed and fewer cures.
  As a physician, I have had to share bad news with families. I know 
all too well that by eliminating just one new drug, how devastating 
that would be. What if that new drug was a cure for Alzheimer's, sickle 
cell anemia, cancer, ALS, or maybe even a vaccine for COVID-19?
  If Democrats want to get serious about addressing our Nation's 
healthcare problems and lowering prescription drug prices, a good place 
to start would be H.R. 19, bipartisan legislation that would lower out-
of-pocket spending, protect access to new and innovative cures, and 
increase transparency.
  We can turn America's healthcare system around with common sense, 
patient-centered solutions. Sadly, H.R. 1425 puts the Federal 
Government at the center, not the patient.
  Madam Speaker, I urge my colleagues to vote ``no.''
  Mr. WALDEN. Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentleman from 
Massachusetts (Mr. Kennedy), a member of the Energy and Commerce 
Committee.
  Mr. KENNEDY. Madam Speaker, yesterday afternoon I spent a few moments 
on the porch of a woman named Therese in Lowell, Massachusetts. Through 
an oxygen tube and a mask, and surrounded by four generations of her 
family, she told me the challenges of living with COPD, even though she 
never smoked a cigarette.
  Her mother and her brother both passed away in that home. She was 
adamant that she would, too. She was hoping to make it for just a few 
more months, but that survival, Madam Speaker, was contingent on having 
access to healthcare. Access that our President, in court just this 
last week, was still trying to take away.
  Madam Speaker, how is our country made stronger by taking away 
Therese's healthcare? What kind of person, let alone administration, 
looks to the wreckage of nearly over 120,000 lives lost, 2\1/2\ million 
infected by a pandemic, and decides that the best response is to take 
away healthcare from millions more?
  What is great about an administration that idly watches 40 million 
Americans lose their jobs, and then tries to take away their 
healthcare, too? How morally bankrupt that we can lavish praise on 
essential workers, and then thank them by trying to strip away their 
access to medicine? All so that the rich can become richer, the 
powerful more powerful, backed up by a massive tax cut and aggregation 
of corporate power.
  Madam Speaker, this moment has proved, like many other moments of 
truth in our Nation, that our fates are linked. That our future is 
shared and uncertain. We have a choice to advance together or to 
scramble for our own. Four generations of Therese's family know the 
answer. We know that answer. Today is our chance to prove it.
  Mr. WALDEN. Madam Speaker, one of the greatest tragedies for 
Therese's family, and that of all other families in

[[Page H2618]]

America, is what the Congressional Budget Office tells us this bill 
will do, and that is, 38 fewer cures. 38. What if one of those was a 
cure for COPD?
  Madam Speaker, I yield 2 minutes to the gentleman from Georgia (Mr. 
Carter), our pharmacist on the committee.
  Mr. CARTER of Georgia. Madam Speaker, I rise today in opposition to 
this ObamaCare wish list legislation.
  I want to start off by saying, Madam Speaker, how disappointed I am. 
How disappointed I am that this comes--this partisan healthcare 
legislation is being moved at such a serious time in our Nation's 
response to the pandemic.
  This bill was developed and written without Republican input, which 
seems to be the thing to do these days. I was up here last week talking 
about the policing bill, same thing, no Republican input. Now we are 
talking about the healthcare bill. No Republican input. Partisan 
legislation, at a time when our country needs bipartisan solutions.
  You know, when a bill is developed and written without Republican 
input, that is usually a good sign that there is no real intention of 
moving this legislation; and there is not. The other side, Madam 
Speaker, knows that this is not going to move.
  Unfortunately, Americans are suffering right now, they are suffering 
from COVID-19. We should be working together, Republicans and 
Democrats, to create solutions that benefit every American. 
Unfortunately, this bill has many issues, it is a big government-
controlled healthcare agenda.
  Once again, Democrats are trying to mandate the price of drugs, or 
tax manufacturers out of the U.S. market if they don't comply, at a 
time when we need to be bringing back manufacturing to the United 
States. Now we are doing just the opposite with this partisan 
legislation.
  My colleagues across the aisle want fewer cures during the pandemic. 
Fewer cures during the pandemic. Are you kidding me? That is the last 
thing America needs right now.
  This legislation also expands ObamaCare subsidies, allowing some of 
the wealthiest Americans to get subsidies for insurance paid for by the 
hard-earned taxpayers' dollars.
  This is not the time to be partisan, Madam Speaker, this is a time 
for us to work together. I hope my colleagues across the aisle can set 
aside these efforts and work with us to pass meaningful, bipartisan 
legislation.
  Mr. WALDEN. Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentlewoman from 
Michigan (Mrs. Dingell), another member of the committee.
  Mrs. DINGELL. Madam Speaker, I rise in support of the Patient 
Protection and Affordable Care Enhancement Act.
  And, yes, I agree with my colleagues, this is not the time for 
partisan politics. It has been over 10 years since the passage of the 
historic Patient Protection and Affordable Care Act, which expanded 
healthcare to 20 million Americans. And now this administration is at 
the Supreme Court trying to repeal it, and it has been 4 years since 
our colleagues, who say they will protect people, have done anything. 
They have not given us anything else. All they do is take knocks.
  Many forget that when that bill passed the reforms ended lifetime 
limits. People could not get health insurance if they couldn't afford 
it, if they had pre-existing conditions. It allowed States to expand 
Medicaid and provide access to both quality, affordable healthcare and 
protection from crippling medical bills.
  In my home State, the bipartisan expansion under Governor Rick 
Snyder, a Republican Governor, Healthy Michigan, currently covers 
650,000 Michiganders, and supports rural hospitals in Michigan that 
would otherwise face a significant financial hardship. The reforms in 
today's bill, the Patient Protection and Affordable Care Enhancement 
Act, build on these successes.
  The legislation would reduce healthcare premiums for Americans by 
expanding existing subsidies under the Affordable Care Act to those 
that need the help. It would also support outreach and enrollment 
efforts and roll back the current administration's plans to promote 
junk insurance plans that lack the coverage of basic benefits.
  Finally, it would save Americans billions of dollars annually by 
allowing the Secretary of Health and Human Services, a Republican right 
now, to negotiate drug prices. The Congressional Budget Office also 
estimates that the drugs subject to negotiation would reduce prices by 
55 percent.
  Madam Speaker, I urge my colleagues to support this bill.
  Mr. WALDEN. Madam Speaker, may I inquire as to how much time each 
side has remaining?
  The SPEAKER pro tempore. The gentleman from Oregon has 16\1/2\ 
minutes remaining. The gentleman from New Jersey has 17 minutes 
remaining.
  Mr. WALDEN. Madam Speaker, I yield 4 minutes to the gentleman from 
Arkansas (Mr. Westerman).

                              {time}  1045

  Mr. WESTERMAN. Madam Speaker, I am grateful that we are finally 
having a discussion on the important issue of healthcare. More than a 
decade of healthcare conflict has squandered trillions of dollars, 
driven up our national debt, done relatively little to improve 
healthcare, and destroyed the public's confidence in either party's 
ability to fix the system. We can do better, yet we don't.
  As an engineer, I learned that the first step to solving a problem is 
identifying and defining the problem. Our problem is not that we lack 
creative solutions to the issues that plague the healthcare system. Our 
problem is not that the electorate doesn't care about healthcare. They 
do. The need for healthcare is nonpartisan.
  There are no Republican, Democrat, or Independent strains of cancer, 
forms of dementia, types of diabetes, or hospitals that check your 
political party registration when you arrive at the emergency room.
  Our primary problem with fixing healthcare for America is that we 
have pushed and continue to push partisan solutions for a nonpartisan 
issue.
  Have we in both parties not learned that this will not work? We both 
paid the price for our failures on healthcare, but the folks who have 
lost the most are our constituents, the American citizens that sent us 
here.
  Let's be honest, face our past, learn from it, and craft a better 
healthcare future. The record is clear.
  In 2008, the Democratic Party controlled the House, the Senate, and 
the White House. You passed the Affordable Care Act on straight party 
lines. If it were the correct solution to America's healthcare 
problems, we wouldn't be here today with your bill to fix it.
  Fast forward to 2017. My Republican Party had majorities in the 
House, the Senate, and controlled the Presidency. We failed to even get 
the American Healthcare Act on the President's desk.
  Both of these attempts at solving healthcare failed, just like any 
other partisan attempt to solve healthcare will fail.
  The issue is so partisan that both parties had to ultimately resort 
to the parliamentary gymnastics of budget reconciliation to have a 
prayer of getting a bill on President Obama's or President Trump's 
desk.
  We know that budget reconciliation creates too many limits to 
implement the best solutions for healthcare policy. We know that you 
can pass whatever healthcare legislation you dream up with a simple 
majority here in the House.
  We also know that partisan bill from the House will not get past the 
60-vote cloture threshold in the Senate, much less get signed into law 
by the President of the opposing party.
  Must we continue learning our lessons in Congress at the expense of 
the American citizenry? Let's work on healthcare legislation that can 
get a veto-proof vote in the House and 60 votes in the Senate, 
regardless of which party controls each Chamber.
  Let's pass a healthcare bill that is too good for a President of 
either party not to sign into law.
  After the Republican failure to pass the American Health Care Act in 
2017, I called my staff together and told them, ``Even though we failed 
to pass a bill and moved on to the next issue, the problems with 
healthcare did not go away and we are not going to stop working on the 
issue.''
  We decided to reverse engineer legislation with the final goal being 
something that everyone could agree upon,

[[Page H2619]]

a bipartisan bill that covered preexisting conditions, insured more 
people, lowered cost, and gave Americans a fair shot at healthcare.
  After 1\1/2\ years of hard work, the result was the Fair Care Act of 
2019. After another year of work, scrutiny, and more good ideas, we are 
close to filing the Fair Care Act of 2020 with both a House and Senate 
version.
  It has more than 50 bipartisan bills from the House and Senate in the 
language, and a few of the bipartisan bills from the 2019 bill have 
already been signed into law. We should follow this pattern.
  Hopefully, you will be pleased to know that several of the provisions 
of your Affordable Care Enhancement Act can be found in the Fair Care 
Act. However, no one reached out to me for input on your bill.
  I am reaching across the aisle and asking you to consider working 
with us in cosponsoring the Fair Care Act or other bills with 
bipartisan policy.
  The American citizenry and I am tired of partisan healthcare in 
action. Will you please join us to change that?
  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentlewoman from 
Illinois (Ms. Kelly), who is a member of the committee and chairs the 
CBC Brain Trust.
  Ms. KELLY of Illinois. Madam Speaker, I rise today in support of H.R. 
1425.
  Since enactment of the ACA, millions of Americans have gained health 
coverage, but too many families have been left behind by GOP Governors 
and legislatures more interested in playing politics than helping 
families.
  Today, we build on that success.
  Each year, more than 700 American women die from pregnancy 
complications, and more than half of these deaths are entirely 
preventable.
  Tragically, Black moms die at three to four times the rate of White 
moms, but passing this bill will help address that by allowing new moms 
to remain on Medicaid for the entire postpartum period. And this piece 
of legislation left the Committee on Energy and Commerce with many 
Republican votes.
  This portion is just one example of the good in this bill and the 
lives it will save. We cannot allow preventable deaths to continue in 
this country. We must do more. It was safer for me to have my daughter 
than it is for my daughter now to have a baby.
  I hope my colleagues will join me in supporting this lifesaving 
legislation.
  There is a lot of talk about how we should care about the health of 
the American citizens, and one thing that we all can do is wear a mask.
  Mr. WALDEN. Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker I yield 2 minutes to the gentlewoman from 
Minnesota (Ms. Craig).
  Ms. CRAIG. Madam Speaker, I thank the gentleman for yielding.
  I ask you: What good is a cure if you can't access it because you 
can't afford it?
  The Patient Protection and Affordable Care Act is immensely personal 
to me. See, I grew up for a portion of my childhood without health 
insurance. I also spent more than 20 years working in two healthcare 
manufacturing companies and was responsible for providing healthcare to 
18,000 Americans at a U.S. company.
  These experiences and the stories I have heard across my district are 
why I am here today working to reduce out-of-pocket costs and the price 
of prescription drugs.
  Today, Les and his family, they farm in my district. They pay over 
$20,000 a year in premiums with a $12,000 deductible.
  Another family farms by flashlight and works another job during the 
day, just for the family health insurance.
  These examples show the heart of the problem: If healthcare isn't 
affordable, it is not accessible.
  I am proud that the base of this bill is my bipartisan bill, H.R. 
1425, the State Health Care Premium Reduction Act, the first healthcare 
legislation that I authored as a Member of Congress. This bill will 
allow States to lower the cost of premiums in the individual 
marketplace and to expand access to healthcare to more Americans. I am 
also pleased that this package includes the transformational drug price 
negotiation mechanism from the Elijah E. Cummings Lower Drug Costs Now 
Act, which finally takes on the high cost of prescription drugs.
  For the 51 percent of nonelderly with preexisting conditions in my 
congressional district, the ACA was a lifeline. This is a moment that 
requires us to come together as Americans to strengthen the ACA and 
reduce the cost and increase the access to healthcare.
  Mr. WALDEN. Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I neglected to mention that Ms. Craig is 
actually the prime sponsor of this legislation.
  I yield 2 minutes to the gentleman from California (Mr. Ruiz), who is 
a member of the Energy and Commerce Committee and has long worked on 
the ACA enhancement.
  Mr. RUIZ. Madam Speaker, I rise in support of H.R. 1425, the Patient 
Protection and Affordable Care Enhancement Act.
  We are in the middle of a global pandemic that has infected millions 
of Americans, left millions more unemployed and struggling to pay their 
bills, and underscored the American people's need for quality, 
affordable healthcare.
  It is precisely during this time; it is precisely in our moment of 
history, during American families' hardships and agony; it is precisely 
now that we must act for the people and fight to make healthcare more 
affordable and accessible.
  As an emergency physician, I have seen the faces of failed healthcare 
policies, the anguish from severe illness and death that could have 
been prevented if only the patient had routine care and health 
insurance.
  That is why today, for the patients who need to see a doctor and get 
treatment, for the recently laid-off workers who just lost their health 
insurance, for the families struggling economically, I ask you to join 
me in voting for H.R. 1425, the Patient Protection and Affordable Care 
Enhancement Act.
  This bill would lower healthcare premiums for middle-class families; 
encourage States to expand Medicaid; lower the cost of prescription 
drugs; and strengthen protections for preexisting conditions, the same 
ones that render a person more likely to die from COVID-19.
  The American people need our help in this moment, and they need this 
bill.
  Mr. WALDEN. Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentlewoman from 
Illinois (Mrs. Bustos).
  Mrs. BUSTOS. Madam Speaker, I thank the gentleman for yielding.
  I rise today to support the Patient Protection and Affordable Care 
Enhancement Act.
  So many in our Nation are facing extreme financial insecurity and 
extreme worry surrounding this global pandemic. And the Trump 
administration is trying to eliminate protections for people and 
families with preexisting conditions and leave millions of Americans 
without care. This includes more than 730,000 Illinoisans.
  A man from the congressional district I serve named Robert wrote to 
me about his family's rising healthcare costs. Robert and his wife have 
both worked hard almost their entire lives. Robert's first job went 
back to the age of 17. His wife started working when she was 16.
  Today, they are in their early sixties and they are facing 
skyrocketing premiums and astronomical deductibles. Robert currently 
pays more than $2,500 each and every month for just his premiums. That, 
along with his deductibles, cost his family about a quarter of all they 
earn every month. He has even been told that because of his age and his 
wife's age they are lucky to get coverage at all.
  Working your whole life and having to struggle so much just to afford 
a necessity like healthcare, that is not what the American Dream is all 
about.
  Robert said to me, ``I am hoping more than lip service will happen in 
Washington, D.C.'' For Robert and his wife and so many other Americans, 
we must pass this bill to lower the cost of healthcare and the cost of 
prescription drugs, and also to protect people with preexisting 
conditions.
  Mr. WALDEN. Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentleman from 
New Jersey (Mr. Malinowski).

  Mr. MALINOWSKI. Madam Speaker, 40 million Americans have lost their

[[Page H2620]]

jobs in the biggest global pandemic in modern history. Not long ago, 
most of them would have lost their health insurance, too. I bet that in 
the last 3 months every single one of us, Republican and Democrat, in 
private or public moments with our constituents has reassured them that 
at least the Affordable Care Act is there for you, you do not have to 
lose your health insurance in the middle of this crisis.
  So how can it be that at this very moment when the value of the ACA 
is so plainly obvious to tens of millions of Americans, the 
administration is in court trying to strike it down? The President has 
told us repeatedly he wants to protect people with preexisting 
conditions, but right there in his brief to the Supreme Court, it 
explicitly says that should be struck down, too.
  And when we ask him, What will you do to replace the ACA if it is 
struck down? He says, I won't tell you until after the election. Come 
on.
  Now, today we are going to pass the Patient Protection Act, which 
means, unlike the President, we are willing to tell the American 
people, now, exactly how we plan to improve healthcare in America.
  We believe that the ACA should be improved, not taken away. The 
Congressional Budget Office says that this plan for doing so will lower 
premiums Americans pay by 10 percent.
  We want what President Trump said he wanted in the 2016 election, to 
let Medicare negotiate the price of prescription drugs which will save 
Americans money and save the government over $500 billion.
  And we want to eliminate the junk insurance plans that the 
administration wants all those folks who are losing their jobs to take, 
even though they don't cover essential services like prescription drugs 
and maternity care.
  I hope everyone will vote for this bill. If there are Members who 
disagree, so be it. I would just ask, Madam Speaker, that they please 
be honest. Don't say you want to protect people with preexisting 
conditions if you won't vote to do so or put forward a plan to do so. 
Don't advise your constituents to take advantage of the ACA if you are 
not going to do anything while the President tries to strike it down.

                              {time}  1100

  Mr. WALDEN. Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Cox).
  Mr. COX of California. Madam Speaker, I am honored to be here today 
to speak about the Patient Protection and Affordable Care Enhancement 
Act.
  As the COVID-19 pandemic and the related recession causes massive 
suffering across the country, we have a duty to act. Government has a 
duty to act so as to minimize human suffering, not to exacerbate it.
  We must strengthen and enhance the Affordable Care Act rather than do 
what the Trump administration wants us to do and rip away health 
coverage for millions of Americans.
  A constituent of mine put it best. He said to me: ``You know, Donald 
Trump is bad for my health.''
  I am sure all of us here came to Congress to make a positive 
difference in the lives of our constituents.
  In my district, there are 325,000 people enrolled in Medicare, 
Medicaid, and CHIP. Almost 27,000 individuals, hardworking individuals, 
got their health insurance through the ACA, through ObamaCare. But what 
this administration and congressional Republicans want to do and what 
they are telling me is that these citizens and 23 million other 
Americans don't deserve healthcare.
  My Democratic colleagues and I feel differently. We are standing up 
to the Trump administration's attempts to kill the Affordable Care Act. 
We are not going to let this happen, not today, not on our watch.
  That is why I am glad the House Democrats have reintroduced this 
legislative package that will make healthcare and prescription drugs 
more affordable for American families.
  This is commonsense legislation that is a win for all Americans.
  This bill lowers health insurance premiums and makes prescription 
drugs more affordable by empowering Medicare to negotiate for lower 
prices, which is something we all know we should do. It is way past 
time to stop letting drug companies rip off Americans by allowing them 
to charge us more than other countries for the same drugs.
  This bill also strengthens the critical outreach and enrollment 
funding that has been gutted by the Trump administration.
  This is a personal passion of mine. Last year, I offered an amendment 
to H.R. 987 that would ensure that communities with high unemployment 
were prioritized in outreach, education, and enrollment assistance to 
Americans shopping for healthcare. And let me tell you, it works. In 
California, we are enrolling more people, who pay less, because of 
widespread enrollment.
  We all deserve healthcare. That is our right as Americans.
  Madam Speaker, I urge my colleagues to support this bill.
  Mr. WALDEN. Madam Speaker, may I inquire as to the amount of time 
remaining and if my friend has any other speakers. We do not, on our 
side.
  The SPEAKER pro tempore. The gentleman from Oregon has 12\1/2\ 
minutes remaining. The gentleman from New Jersey has 6 minutes 
remaining.
  Mr. WALDEN. Madam Speaker, I believe the gentleman has other 
speakers, so I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentlewoman from 
Florida (Ms. Mucarsel-Powell).
  Ms. MUCARSEL-POWELL. Madam Speaker, I stand here today as a Member of 
Congress because, 3 years ago, I watched as this body took a vote to 
repeal the Affordable Care Act, which would have ripped healthcare away 
from tens of thousands of constituents in my district and over 2 
million Floridians in my home State.
  This was an unconscionable move that would have taken away 
protections for millions with preexisting conditions, like my 
constituent Michelle Garcia, who still suffers after a faulty medical 
device left broken pieces in her that, to this day, cause her chronic 
pain that requires persistent treatment.
  It is because of the ACA that her coverage is protected.
  It is because of the ACA that disparities in coverage for Latino 
communities and African-American communities have narrowed.
  It is because of the ACA that insurance plans can't deny or make 
healthcare more expensive because of someone's gender.
  It is because I watched my colleagues across the aisle try to take 
the ACA away that I ran for Congress and am here fighting to protect 
their care.
  Today's vote is very important to me. While the President continues 
his efforts to take away much-needed healthcare, especially during a 
pandemic, we are making quality care more affordable and accessible 
while removing junk plans. We are lowering health insurance premiums 
and prescription drug prices. We are also putting in incentives for 
States like Florida so that they can expand Medicaid and bring care to 
millions who need it.
  It is simple. We shouldn't be taking care away from anyone right now, 
not ever. We shouldn't be making quality care more expensive.
  We need to make it more accessible. We need to make it more 
affordable.
  That is why I am proud to vote ``yes'' on today's legislation, and, 
Madam Speaker, I urge my colleagues to do the same.
  Mr. WALDEN. Madam Speaker, I reserve the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield 2 minutes to the gentlewoman from 
Texas (Ms. Jackson Lee).
  Ms. JACKSON LEE. Madam Speaker, I thank the chairman of the Energy 
and Commerce Committee for his dynamic leadership.

  Let me indicate that I stand here today in the midst of a 
catastrophic pandemic of COVID-19 in the State of Texas and in my 
congressional district in Houston and Harris County. Over the last 
couple of days, we have had upwards of 900 cases.
  There are 2.5 million cases over the Nation and growing, with 126,000 
who have died. In the last 3 days of last week, there were 45,000 new 
cases. Most of them were in Texas, California, and Arizona.
  That is why I am absolutely baffled and saddened by the fact that 
this administration would go to the Supreme Court to cut off, deny, 
extinguish, put

[[Page H2621]]

in harm's way Americans who need health insurance and who have 
preexisting conditions.
  This is legislation that is a lifeline. We are saving lives.
  A family of four earning $40,000 would save nearly $1,600. They may 
have a COVID patient in their family. A 60-year-old earning $57,000 
would save $8,000.
  It takes into account people who are unemployed by replacing 
insurance that they have lost.
  It takes into account the great need for drug price negotiation under 
the Elijah E. Cummings Lower Drug Costs Now Act, something that we have 
all been fighting for, for a very long time. Why can't we negotiate 
drug prices just like they do in Medicare?
  I am pleased that this legislation protects vulnerable populations 
from losing health coverage by ensuring that Medicaid and CHIP 
beneficiaries receive a full 12 months of coverage once enrolled, 
protecting them from interruption due to fluctuations in their income 
throughout the year. That has happened to a lot of hardworking parents.
  In addition, it improves Medicaid beneficiaries' access to primary 
care. And, yes, for those States that did not do the right thing, it 
encourages Medicaid expansion. It gets rid of junk policies.
  Madam Speaker, let us vote for this bill because it stops the 
devastation.
  Madam Speaker, as a senior member of this body and an original 
cosponsor of the legislation, I rise in strong and enthusiastic support 
of H.R. 1425, the ``Patient Protection and Affordable Care Enhancement 
Act,'' which expands tax credits to lower Americans' Marketplace health 
insurance premiums and allow more middle-class individuals and families 
to qualify for subsidies and know the peace of mind that comes with 
access to affordable, high quality health care.
  This legislation is especially needed in these dark and troubling 
times when the COVID-19 pandemic has already claimed the lives of more 
than 128,000 Americans and over 40 million have lost their jobs because 
of the Administration's catastrophic response to the crisis.
  Specifically, Madam Speaker, I support H.R. 1425 because under this 
legislation:
  1. A family of four earning $40,000 would save nearly $1,600 in 
premiums each year.
  2. A 64-year-old earning $57,420 would save more than $8,700 in 
premiums each year.
  3. A single adult with income of $31,900 would see premiums cut in 
half.
  4. An adult earning $19,140 would see premiums cut to zero, saving 
$800 dollars a year.
  Additionally, the legislation ensures that families who do not have 
an offer of affordable family coverage from an employer can qualify for 
subsidies in the Marketplaces and it provides funding for reinsurance 
initiatives to further lower premiums, deductibles, and other out-of-
pocket costs.
  Importantly, included in the legislation is the drug price 
negotiation mechanism from H.R. 3, the transformational Elijah E. 
Cummings Lower Drug Costs Now Act, (H.R. 3), which delivers immense 
savings to taxpayers, employers, workers and patients by preventing 
Americans from having to pay so much more for our medicines than 
pharmaceutical companies charge for the same drugs overseas.
  Madam Speaker, this legislation strongly encourages Medicaid 
expansion to hold-out states like my home state of Texas to reconsider 
by renewing the ACA's original expanded federal matching for states 
that adopt the Medicaid expansion and progressively reducing 
administrative FMAP for those who continue to refuse.
  Currently, nearly 5 million Americans have been cruelly excluded from 
coverage because states have refused to expand Medicaid.
  Madam Speaker, this legislation provides necessary funding for 
critical federal and state efforts to increase health coverage 
enrollment, educate consumers of their health care rights, and help 
individuals navigate the health insurance system.
  And it delivers funding for states who want to establish their own 
statebased Marketplaces.
  Madam Speaker, the COVID-19 pandemic has laid bare the racial and 
ethnic inequalities and disparities in our health care delivery system.
  That is why I am pleased that the legislation before us protects 
vulnerable populations from losing health coverage by ensuring that 
Medicaid and CHIP beneficiaries receive a full 12 months of coverage 
once enrolled, protecting them from interruptions due to fluctuations 
in their income throughout the year.
  And it improves Medicaid beneficiaries' access to primary care 
physicians, by reauthorizing the ACA's increased payments to primary 
care physicians who treat Medicaid recipients.
  Also, very important is that the legislation addresses the maternal 
mortality epidemic by requiring states to extend Medicaid or CHIP 
coverage to new mothers for 1-year post-partum.
  Finally, Madam Speaker, H.R. 1425 cracks down on junk plans & 
strengthens protections for people with pre-existing conditions and 
reverses the Trump Administration's expansion of junk health insurance 
plans that do not provide coverage for essential medical treatments and 
drugs, and that are allowed to discriminate against people with 
preexisting medical conditions.
  And it curtails the Trump Administration's pernicious practice of 
giving states waivers to undermine protections for people with pre-
existing conditions and weaken standards for essential health benefits.
  Madam Speaker, to stroll down memory lane for those of us who 
remember how things were before the enactment of the Affordable Care 
Act, dozens of our committees, including the Judiciary Committee, heard 
the pain of people whose family members had died because they had no 
access to healthcare and/ or they had junk policies.
  Access to affordable, high quality health insurance because of the 
ACA was a game changer or persons with preexisting conditions like 
Sickle Cell anemia, triple negative breast cancer, and diabetes which 
plague communities like the ones I represent.
  As a member of Congress who voted against each of the dozens of 
Republican efforts to repeal the Affordable Care Act, I know first-hand 
how important and critical access to affordable, high quality, 
accessible health care available to everyone, including those with pre-
existing conditions, to the well-being of American families.
  Because of the passage of the Affordable Care Act, the national 
uninsured rate has been slashed from 14.8 in 2012 to 8.8 percent in 
2018.
  Texas has long led the nation in rate of uninsured so the comparable 
rates are 24.6 and 15 percent, respectively.
  Madam Speaker, I distinctly recall a candidate for the highest public 
office in the land saying ``Obamacare is a disaster'' and appealing for 
voters to support him with this question: ``What have you got to 
lose?''
  The question deserves a response so I hope that person, who occupies 
the Oval Office, is listening to my answer.
  The Affordable Care Act, or ``Obamacare,'' has been an unmitigated 
success to the more than 20 million Americans who for the first time 
now have the security and peace of mind that comes with affordable, 
accessible, high quality health care.
  Madam Speaker, Tip O'Neill used to say that ``all politics is local'' 
so let me share with you how Obamacare has dramatically changed lives 
for the better for the people in my home state of Texas.
  1.874 million Texans gained coverage since the ACA was implemented 
but could lose their coverage if the ACA is entirely or partially 
repealed or invalidated.
  508,000 kids in Texas who have gained coverage since the ACA was 
implemented are also at risk of having their coverage rolled back.
  205,000 young adult Texans who were able to stay on a parent's health 
insurance plan thanks to the ACA now stand to lose coverage if the ACA 
is struck down, eliminating the requirement that insurers allow 
children to stay on their parents' plans until age 26.
  646,415 Texans who received cost-sharing reductions to lower out-of-
pocket costs such as deductibles, co-pays, and coinsurance but are now 
at risk of having healthcare become unaffordable if the Trump 
Administration has its way in the Supreme Court.
  10.28 million Texans who now have private health insurance that 
covers preventive services without any co-pays, coinsurance, or 
deductibles stand to lose this access if the provisions in the ACA 
requiring health insurers to cover important preventive services 
without cost-sharing is stricken.
  913,177 individuals Texans who received financial assistance to 
purchase Marketplace coverage in 2016, averaging $271 per individual, 
are at risk of having coverage become unaffordable if the ACA is not 
protected.
  Madam Speaker, millions more Texans could have insurance if all 
states adopted the ACA's Medicaid expansion.
  Women in Texas who can now purchase insurance for the same price as 
men are at risk of being charged more for insurance if the ACA's ban on 
gender rating in the individual and small group markets is invalidated.
  Before the ACA, women paid up to 56 percent more than men for their 
health insurance.
  Roughly 4.5 million Texans who have pre-existing health conditions 
are at risk of having their coverage rescinded, being denied coverage, 
or being charged significantly more for coverage if the ACA's ban on 
preexisting conditions is struck down.

[[Page H2622]]

  346,750 Texas seniors who have saved an average of $1,057 each as a 
result of closing the Medicare prescription drug ``donut hole'' gap in 
coverage stand to lose this critical help going forward.
  1.75 million Texas seniors who have received free preventive care 
services thanks to ACA provisions requiring coverage of annual wellness 
visits and eliminating cost-sharing for many recommended preventive 
services covered by Medicare Part B, such as cancer screenings, are at 
risk of losing access to these services if the ACA is not protected.
  The Affordable Care Act works and has made a life-affirming 
difference in the lives of millions of Americans, in Texas and across 
the country.
  This is what happens when a visionary president cares enough to work 
with a committed and empathetic Congress to address the real issues 
facing the American people. The Republicans have NO vision whether it 
is for Obamacare (ACA) or Medicare for all--they are denying health 
coverage to the most vulnerable American families and Americans with 
pre-existing conditions. Vote for this bill.
  You want to know why the American people have Obamacare?
  It is because Obama cared.
  The same cannot be said about this Republican president and 
congressional Republicans who have made careers of attacking and 
undermining the Affordable Care Act's protections and benefits for the 
American people.
  I urge all Members to vote for H.R. 1425 and send a powerful message 
to the President and the American people that this House will not stand 
idly by as this Administration tries to take away health care from more 
than 130 million persons.
  Mr. WALDEN. Madam Speaker, I believe neither of us has any more 
speakers. I yield myself such time as I may consume to close.
  Madam Speaker, we have had a good debate here on the floor. 
Unfortunately, it is not a debate over a bipartisan piece of 
legislation. It is a debate over a partisan bill that will never become 
law. The President's office has issued a recommendation that he would 
veto this bill, should it ever get out of the Senate and to his desk.
  Beyond that, let's talk about what impact this will have in this 
pandemic.
  We have heard a lot about drugs. We know from the Congressional 
Budget Office that this legislation will reverse the gains and 
innovation made in the bipartisan 21st Century Cures Act, that it would 
result in fewer new drug products developed and coming to market. In 
fact, the Congressional Budget Office estimates that up to 38 fewer 
medicines would be developed to cure diseases.
  My friend from Massachusetts talked about Therese on the doorstep in 
Lowell, Massachusetts, with COPD. What a tragedy it would be if one of 
those 38 medicines under development happened to cure COPD.
  Maybe it is a cure for COVID-19. Maybe it is a cure for ALS or 
Alzheimer's or some form of cancer, like the ovarian cancer that 
claimed my mother.
  What we do know is it puts a dagger in the heart of innovation. In 
fact, those scientists we are all turning to right now, Madam Speaker, 
these brilliant young men and women in laboratories all across America, 
especially those out in California at California Life Sciences 
Association, said this legislation, H.R. 3, part of which is 
incorporated in this bill, could lead to as much as a 58 percent 
reduction in revenue, which would significantly reduce investment in 
partnerships, licensing agreements, and emerging companies, and, 
therefore, lead to an 88 percent reduction in new medicines developed 
by small U.S. biotech companies. That number was an 88 percent 
reduction.
  Further, they expect it to eliminate 80,000 high-paying biotech and 
R&D jobs nationwide. Why would you do that now? Why would you knowingly 
enact a provision in legislation that would cut 80,000 American high-
tech and R&D jobs in the healthcare field, where we are pleading for a 
cure. We are, dare I say, praying for a cure or a treatment not only 
for COVID but for these other diseases. The legislation before us today 
would do that.
  We have heard a lot about international price controls this 
legislation would put in place, government price setting. Now, let's 
talk about what that means.
  For example, when looking at a sample of 270 new medicines launched 
in the United States from 2011 to 2018, of those available in the 
United States under our formula, 67 percent are available in Germany, 
64 percent in the U.K., 48 percent in Japan, 53 percent in France, 
about 52 percent in Canada, 41 percent in Australia.
  Even in countries where treatment may have been launched, patients 
often have to wait months, sometimes years, before they get access to 
that treatment. Compared to the United States, in Australia, it takes 
an average of 19 months longer for medicines to become available to 
patients.
  By the way, this is the scheme that this legislation wants to put 
into the United States.
  Compared to the U.S., in Canada, it takes an average of 14 months 
longer for medicines to become available to patients.
  More than a year is a long time to wait if you know there is a 
medicine that could help you with some disease and that medicine has 
just been developed, and you can get it in America tomorrow and wait 14 
months in Canada. In the U.K., it could be 11 months longer.
  It doesn't have to be that way. We have H.R. 19. We introduced it at 
the beginning of this debate some time ago. I think there were seven 
different provisions that have already become law. Everything in that 
legislation is bipartisan.
  Look, there are going to be differences of opinion among really good 
people that I work with on a regular basis, and we just disagree on 
policy. But wouldn't it make more sense to take the things upon which 
we do agree on policy and move those forward into law while we debate 
the things where we have a disagreement and work to try and find common 
ground? But that is not what is happening today.
  The navigator program, the bill dumps $100 million more into the 
exchange user fee program, into the failed navigator program. Let's 
talk about that a minute.
  Navigators enroll less than 1 percent of total enrollees, according 
to one report. In fact, one awardee of the navigator program had an 
enrollment goal of 2,000. It kind of missed their goal, Madam Speaker. 
They enrolled one person.

                              {time}  1115

  They eventually enrolled a total of 67 for $2,300 per enrollee. And 
in the private sector, they do that for about $2.40, not $2,300.
  The top 10 navigators signed up just 317 people in 2017. We are going 
to pump far more money into that. This legislation would do that. We 
have heard about some of that.
  The subsidies in here for some of the wealthiest Americans--kind of 
ironic that the Democrats would be doing this in their legislation, but 
they removed the subsidy cap that diverts taxpayer dollars for some of 
the highest earners in the country.
  There is a blank check for insurance companies. I have talked about 
the loss of cures, up to 38 in the next 20 years. Remember, the 10- and 
20-year pipelines here, there are some estimates that there could be 
hundreds of new drugs.
  When I think about the farmer in Minnesota we heard about with 
$20,000 in premiums per year and $12,000 copayments, that is what 
America got from the ``Affordable Care Act.'' That is what ObamaCare 
delivered. It didn't do anything to go after the costs of healthcare.
  The Trump administration, conversely, has done a lot to go after the 
cost of healthcare. I have been with the President when he announced 
initiatives to make hospitals disclose their costs so Americans could 
shop and we could get competition. We had no more left the Roosevelt 
Room and returned to the Oval Office when the Secretary of Health and 
Human Services announced the American Hospital Association already 
filed suit to stop that transparency in disclosure.
  By the way, the administration just won a judgment in court that they 
can proceed to get that disclosure so consumers can know what things 
cost and make informed decisions.
  We worked together across the aisle when I was chairman of the Energy 
and Commerce Committee on really powerful legislation to address the 
opioid crisis in America. We put enormous amounts of money into our 
community health centers. We fully funded, for a decade, the Children's 
Health Insurance Program, and we did all of that in a very, very 
bipartisan way.

[[Page H2623]]

  We, in the last few years, under the Republican majorities, rewrote 
America's mental health laws. We all know there is more to be done to 
get mental health services into our communities, but we have put an 
unprecedented amount of support into mental health services.
  Meanwhile, our community health centers, under the Democrats, 
continue to get an every-couple-of-month infusion of money, which is 
enormously frustrating for them. I know when I was chairman, it made 
national headlines that there were some levels of delay in fully 
funding our community health centers, and we ended up getting them a 2-
year, fully funded, at the highest level ever, funding guarantee.
  Their money runs out in November. Why are we doing that? Why aren't 
we taking that up?
  The President led the effort on surprise medical billing so that, 
even if you have insurance and you end up like a woman in Colorado who, 
a few years back, gave birth to her second son. That child, born in a 
hospital, covered by her insurance, doctors covered by her insurance, 
had a medical issue after birth and had to go to the neonatal intensive 
care unit--just down the hall, by the way. It turned out that that 
hospital had contracted out that neonatal intensive care unit, and it 
turns out it wasn't in her insurance at all. Now, how in the heck does 
a consumer know that?
  We have bipartisan surprise billing legislation. It passed out of the 
Energy and Commerce Committee a year ago and has yet to come to the 
floor of the House under the Democrats. So, meanwhile, consumers are 
getting stuck with surprise bills when they are playing by the rules. 
It continues and it shouldn't. Hopefully, we can get that legislation 
to the President's desk. He is ready to sign it.
  Meanwhile, we have made record investments at NIH, and we 
reauthorized the user fee agreement so that FDA, the Food and Drug 
Administration, our innovators, can bring their drugs and new medical 
devices to market faster than any time and still safe. We did that 
under Republican legislation and signed by President Trump.
  President Trump invoked the Defense Production Act when we didn't 
have enough ventilators or masks or gowns to order companies to make 
swabs, to make ventilators and move forward and continued that 
investment.
  And that was in a bipartisan way, by the way, with the CARES Act. We 
can do bipartisan work. We are just not doing it today.
  The choice to do partisan or bipartisan work is always made by the 
majority. When I was chairman I could move anything I wanted, generally 
speaking, at any time, but I chose to try and make the bulk of our 
work--nearly all of our work--bipartisan because I actually wanted it 
to become law.
  The drug bill Democrats passed earlier this year that takes away 
access to new medicines and put 88,000 jobs in the high-tech world of 
innovation in medicine, that bill is going nowhere. This bill is going 
nowhere. The police reform bill is going nowhere.
  What a tragedy. What a lot of opportunity. Because there are many, 
many of us on this side of the aisle, as the Speaker knows, who stand 
ready to work in a bipartisan way to get good policy and to solve 
problems for the American people.
  Madam Speaker, it is unfortunate we find ourselves here today when 
Americans expect so much more out of this institution. I hope people 
will show up and we can actually do our work and actually do it in a 
way that will bring a positive view on this House and on our ability to 
solve these enormous problems that the American people are facing, 
whether they are suffering from COPD or simply higher insurance 
premiums and deductibles.
  What good is your insurance plan if you can't afford to use it, or 
when you think you followed all of the rules to use it and then find 
out they contracted out the emergency room and nobody covers the costs 
there?
  So let's defeat this now. Let's go to a room where we can work these 
things out, we can find common ground here that won't put a dagger in 
the heart of innovative jobs in America, that won't slow innovation in 
medicine and medical devices, lifesaving medicines, but that will bring 
better healthcare for Americans.
  Finally, on the issue of preexisting conditions, the President has 
been very clear he supports protecting people with preexisting 
conditions, as do I, going back to when I was in the State legislature 
in Oregon. We made efforts to do that.
  I have had legislation since the opening day of this Congress to make 
sure, regardless of how the lawsuit comes out, that we protect people 
with preexisting conditions. The Democrats won't let us bring this bill 
to the floor.
  So, Madam Speaker, I urge a ``no'' vote on this legislation, and I 
yield back the balance of my time.
  Mr. PALLONE. Madam Speaker, I yield myself the balance of my time.
  Madam Speaker, I respect, greatly, my colleague, the ranking member, 
but I have to say, the tragedy that we face is the President, President 
Trump, who has totally neglected the situation here.
  The tragedy is not this Congress. This Congress passed the HEROES 
Act, but we have a President who simply ignores the COVID crisis, who 
doesn't want to take the bull by the horns and actually do something 
nationally to deal with testing, to deal with medical supplies, to deal 
with what needs to be done, and continues to suggest that somehow the 
pandemic has gone away.
  This Congress took action with the HEROES Act. The tragedy is a 
President who continues to seek repeal of the Affordable Care Act.
  The Affordable Care Act, Madam Speaker, had led to over 90 percent of 
Americans having health insurance when President Obama left office. 
That number is going down. Last week, the Trump administration filed a 
brief again to repeal the Affordable Care Act.
  The tragedy is what he has done, what President Trump has done to 
encourage junk plans, which basically don't allow people with 
preexisting conditions to even get health insurance. This is the 
tragedy. And we in this Congress are doing things to reverse this 
sabotage of the Trump administration, beginning today, again, with this 
enhancement act.
  Now, I just want to say that one of the things that we are doing here 
that is so important is reversing the Trump administration's pushing of 
these junk plans. The Energy and Commerce Committee did a report 
investigation of it last year, and what we found was that these junk 
plans discriminate against people with preexisting conditions. They 
rescind coverage if they have to pay out too much. They limit coverage.
  Remember, the Affordable Care Act provided an essential benefit 
package, robust coverage, that you would have mental health coverage, 
that you would have hospitalization, that you would have the things 
that people expect to have in their insurance policy; but instead, the 
Trump administration is pushing out to millions of people--and the 
numbers keep growing every year--these junk plans that discriminate and 
do the opposite.
  And we are going to bring down prescription drugs.
  Madam Speaker, I urge support of this bill, and I yield back the 
balance of my time.
  The SPEAKER pro tempore. The time for the Committee on Energy and 
Commerce has expired.
  The gentleman from Massachusetts (Mr. Neal) and the gentleman from 
Texas (Mr. Brady) each will control 30 minutes.
  The Chair recognizes the gentleman from Massachusetts.
  Mr. NEAL. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I am really pleased today to join with the Speaker and 
other committee chairs to have successfully introduced the Patient 
Protection and Affordable Care Enhancement Act and welcome the 
measure's consideration in this House today.
  Hearing the former chairman of the Energy and Commerce Committee a 
few minutes ago, a decent guy, he said that there was room for 
bipartisanship in the healthcare debate. I mean, I have been here for a 
long time. Where was the bipartisanship--and I am going to submit 
something. Republicans, in all the years I have been in this House, 
they have not agreed amongst themselves on healthcare, never mind 
agreeing with Democrats on healthcare.
  So, for years, we have worked to expand access. That is what this 
argument is about today. We want to make sure that affordable 
healthcare exists

[[Page H2624]]

for the American family and to build upon the coverage gains of the 
Affordable Care Act.
  The COVID-19 crisis only adds urgency to an already pressing problem 
for millions of American families, a problem that has been consistently 
exacerbated by the Trump administration's relentless crusade to 
dismantle the American healthcare system.
  Recall on the campaign trail when President Trump was asked by 
reporters what he intended to replace ObamaCare with, and he said: 
Don't worry, pal, you are going to love it.
  That was the answer.
  Just last week, under the cover of night and while many Americans 
were likely sleeping, the Trump administration took another step toward 
invalidating our healthcare laws. They filed a brief with the Supreme 
Court in support of undoing the ACA and ending protections for nearly 
130 million Americans with preexisting conditions.
  I helped to write this law. I am really proud of it.
  They staked out this position during a pandemic, when millions of 
Americans need healthcare more than ever.
  Our new Patient Protection and Affordable Care Enhancement Act is 
utilized to expand tax credits for lower premium costs for the American 
consumer. For the first time in the history of the ACA, no one will pay 
more than 8.5 percent of their income on a silver plan through the 
marketplace.

                              {time}  1130

  I will quickly share the other scenarios that people will witness 
savings through:
  A family of four earning $40,000 would save nearly $1,600 in premiums 
each year.
  An adult earning about $19,000 would see premiums cut to zero, saving 
$800 a year.
  And a 64-year-old earning $57,000 a year would save more than $8,700 
in premiums each year.
  These are significant savings that would make a big difference for 
Americans particularly during the current health and economic crisis 
that we find ourselves in.
  I want to thank Representative Underwood for her tireless work on 
these provisions and advocating for the millions of Americans who will 
see their premium costs go down, recalling that when the ACA was 
offered and embraced 20 million Americans received health insurance.
  I want to thank Representative Wild for leading the effort to remove 
a longstanding barrier for families with an offer of affordable family 
coverage, as well as Representative Neguse for his work on behalf of 
Social Security beneficiaries who were at risk of losing premium tax 
credits for the time they were covered by the ACA marketplace.
  These tax credits aren't the only benefits consumers can expect under 
this very important legislation. We also slashed prescription drug 
costs, we reduced consumers' deductibles, encouraged more States to 
expand Medicaid and establish their own ACA marketplace, and to put an 
end to the expansion of junk insurance plans.
  Notably, this legislation reduces the number of uninsured Americans 
by more than 4 million people. These are issues that matter to everyday 
Americans perhaps now in this COVID crisis more than ever. Ensuring all 
Americans can access quality healthcare without risking their family's 
financial security really shouldn't be a partisan issue.
  After almost 70 votes on Republican bills to repeal or undermine the 
ACA, I am really happy to stand on this floor today in support of this 
legislation that will continue to build on the gains of the ACA, for 
legislation that increases access to affordable, quality healthcare, 
and for legislation that is for the American people.
  Madam Speaker, I urge my colleagues to vote in favor of this timely 
legislation, and I reserve the balance of my time.
  Mr. BRADY. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, as a Republican in Congress, I am proud of our 
Republican congressional efforts creating the Medicare part D 
prescription drug program for seniors which then-Leader Nancy Pelosi 
and Democrats tried to kill. You may remember that Speaker Pelosi 
famously predicted that creating the crucial part D prescription plan 
for the elderly ``would end Medicare as we know it.''
  Can you imagine how many seniors' lives would have been lost if she 
had succeeded in stopping the affordable Medicare drug program 43 
million seniors have come to depend on today?
  We are in the middle of an unprecedented national pandemic. Americans 
are worried about their health and their jobs. Yet here we go again in 
the Democratic House, another partisan bill with no input from 
Republicans but lots of input from campaign operatives and special 
interest groups. The American people are sick and tired of this 
partisanship.
  To my Democratic colleagues and friends, I say: Stop playing 
political games with healthcare.
  Madam Speaker, this bill is dangerous to your health in three key 
ways: It stops lifesaving cures from getting to the patients who need 
them most. It blocks Americans from buying affordable, short-term 
health plans that cover them in between jobs. And it threatens to slash 
State support for Medicaid for the most vulnerable and poor. As if that 
isn't enough, it doubles down on the most unpopular healthcare plan in 
modern history: the Affordable Care Act.
  Madam Speaker, you remember that disaster. It broke every promise 
Democrats made to the American public.
  Do you remember: If you like your healthcare plan you can keep it? 
False.
  If you like your doctors, you can keep them? False.
  Your healthcare costs will go down by $2,500 a year? Big false.
  No American making less than $250,000 a year will see a tax increase? 
False.
  ObamaCare won't add a dime to the Federal deficit? False.
  By the way, it will add over $1.5 trillion in debt this decade.
  Here we are battling the coronavirus and hoping against hope as 
companies partnering with the government are racing heroically to bring 
new treatments and medicines that will save our lives and prevent 
Americans from being infected.
  Yet today, House Democrats are unbelievably advancing a bill with 
provisions that the Congressional Budget Office and the Council of 
Economic Advisers predicts will stop as many as 100 lifesaving cures 
from ever getting to the patients who need them most.
  The California Life Sciences Association says that the Pelosi plan 
for government setting medicine prices would mean nearly nine of ten 
new drugs would never be made available--never--from their researchers 
in small biotech companies. These are the medicines that could be the 
answer to some of the most heartbreaking and devastating diseases--
including COVID-19--that our children, seniors, and families are 
facing.
  As this pandemic makes urgently clear, we need more cures, not fewer. 
Fewer cures means more lives cut short. Yet leading Democrats shrugged 
off these research experts and say: We are fine with that.
  Although the Affordable Care Act has improved under President Trump--
no sabotage--prices went down in most States, insurance companies have 
stabilized, and many families see more choices today. But it remains 
fatally flawed.
  Here is proof: two out of three Americans eligible for ObamaCare are 
turning it down--two out of three. They say that it is healthcare they 
don't want, they can't afford, and it doesn't work for them.

  Unbelievably, Democrats are so hellbent on forcing Americans on to 
the ACA, today they are threatening to slash State support for Medicaid 
unless States buckle to expand ObamaCare.
  Holding the poor hostage, threatening to defund the operations of 
Medicaid at the State level? That is immoral. Maybe they don't remember 
that the Supreme Court quickly struck down their last scheme to extort 
States.
  Finally, despite the claims they are expanding healthcare choice, 
this misguided bill blocks Americans from buying legal, affordable, 
short-term plans often used by small business workers and Americans who 
are out of work or in between jobs. Yes, these health plans aren't for 
everyone. But to the 3 million Americans with these lifesaving plans, 
Democrats say: Tough. If you don't like your plan, or even if you do, 
you can't keep it.

[[Page H2625]]

  There is a better way than this dangerous, partisan waste of time. 
Real people are hurting. We should work together in Congress to make 
affordable, patient-centered healthcare a reality for Americans.
  Last year Republicans proposed legislation that brought together 
ideas and bills from Members of Congress from both parties to lower 
drug prices and accelerate new cures. Healthcare policy fails when it 
is partisan. We must work together now to make drugs more affordable, 
to expand access to quality care, and, yes, to lower costs. This bill 
doesn't achieve any of those goals. It is partisan business as usual 
during a time when our Nation calls out for so much more.
  I reserve the balance of my time, Madam Speaker.
  Mr. NEAL. Madam Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Thompson).
  Mr. THOMPSON of California. Madam Speaker, I rise in strong support 
of H.R. 1425, legislation expanding and enhancing the Affordable Care 
Act and lowering healthcare costs for all Americans.
  In the past 6 months over 120,000 Americans have died due to COVID-
19. Millions have lost their jobs and, in many cases, their health 
insurance. That is why it is so critical that we strengthen and build 
upon the foundation of the Affordable Care Act, which is exactly what 
this bill does.
  This legislation reduces the price of expensive pharmaceuticals--
including insulin--saving taxpayers billions of dollars while driving 
down drug costs for all Americans.
  The bill uses those savings to lower insurance premiums and expand 
tax credits, helping more Americans afford the coverage that they need.
  This bill bolsters State Medicaid programs, funds COVID-19 vaccine 
research, and cuts the number of uninsured Americans by nearly 4 
million.
  The President and my Republican colleagues are actively trying to gut 
protections for preexisting conditions and take healthcare away from 
millions of Americans.
  By contrast, this legislation reduces healthcare costs for millions 
of Americans at this critical time. It is vital that we give our 
constituents the help they need.
  I heard so many of my friends on the other side talk about how they 
want to protect people who have preexisting conditions, every one of 
which is in support of the lawsuit to repeal the Affordable Care Act, 
the very bill and the very law that protects people who have 
preexisting conditions.
  Madam Speaker, you cannot be for protecting preexisting conditions 
and for repealing the law that provides that protection.
  Madam Speaker, I urge my colleagues to vote ``yes'' on this bill.
  Mr. BRADY. Madam Speaker, I yield 3 minutes to the gentleman from 
Pennsylvania (Mr. Kelly), who is a key member of the Ways and Means 
Committee.
  Mr. KELLY of Pennsylvania. Madam Speaker, the objective of this bill 
is to prop up the Affordable Care Act, so we want to pump money into 
Medicaid the program and then impose price controls on prescription 
drugs.
  H.R. 1425 lifted the provision in Speaker Pelosi's drug bill, H.R. 3, 
that gives the Secretary of HHS the power to set Medicare drug price 
controls for pharmaceutical manufacturers and use it as a pay-for. The 
savings from this price-setting power is meant for the expansion of the 
Affordable Care Act.
  Now, the facts are clear. Private investment in drug research and 
development fuels the innovation ecosystem for the new medicines. It is 
just that simple.
  Madam Speaker, the Congressional Budget Office has already determined 
that H.R. 3's negotiation provision would result in fewer cures. You 
have to be especially tone deaf to introduce legislation that punishes 
the very pharmaceutical companies that are going to innovate and mass-
produce the vaccine the entire world is counting on to counter the 
spread of COVID-19.
  Last year, we were 80 percent of the way there on a bipartisan 
measure before we got sidelined by H.R. 3 and legislation just like 
this. Let's get back to the people's work and work together on 
solutions that make sense, like H.R. 19, drug legislation that would 
actually make it to the President's desk.
  Now, with all that in mind, let's talk about who it is that we are 
really talking for today, who it is that we represent on the people's 
floor, and who it is that we are looking out for because too often this 
becomes about November 3, 2020, and not about everyday lives back in 
the Districts and the folks whom we represent.
  I want to read a letter that I have read before because I think it 
really deserves to be repeated. This was sent to me in October of 2019.
  ``Dear Congressman Kelly: My name is Sara Stewart, and I'm from St. 
Petersburg, Pennsylvania. It is my understanding that the House Ways 
and Means Committee is having a public hearing on H.R. 3--the Lower 
Drug Costs Now Act of 2019.''
  This is the very H.R. 3, by the way, that is being included in H.R. 
1425.
  ``It appears this legislation does not have bipartisan support and 
needs to take a more balanced approach. The balance is needed for 
patients like my 10-year-old daughter Maddie.
  ``Maddie suffers from a rare mitochondrial deletion condition called 
Pearson's syndrome, which is a disorder that occurs as the result of 
mutated genes in the body. These genes impact the mitochondria of her 
cells and prevent them from producing enough energy for the body to 
function properly. Pearson's syndrome is difficult to diagnose because 
it affects each individual differently. Maddie's symptoms through the 
years have included being blood transfusion dependent for several 
years, the inability to heal after sun exposure damage, becoming type 1 
diabetic, progressively losing her hearing and her vision, kidney 
failure, and several other daily complications including developmental 
delays when having a body that runs on limited energy. It has been 
truly heartbreaking to see her endure this disease, but she continues 
to defy the odds.''
  This child is a 10-year-old.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. BRADY. Madam Speaker, I yield the gentleman an additional 30 
seconds.
  Mr. KELLY of Pennsylvania. ``My simple message to you, Mr. Kelly, and 
the rest of the committee''--and the rest of Congress--``is: There is 
no cure or treatments for Pearson's syndrome. Each day is a struggle to 
keep Maddie balanced so her body is able to better cope with symptoms 
of this terrible disorder. All we have, as well as many other families 
across the world, is hope. Please, don't let partisan bickering impact 
the ability of researchers to discover and innovate new therapies that 
could save Maddie's life one day. The clock is ticking, and Maddie is 
waiting.''
  Madam Speaker, it simply comes down to this: if you want to develop 
new drugs, then don't penalize the people who develop them. Don't hold 
them as the bad guys when we require them. Please come up with 
something to address COVID-19.

                              {time}  1145

  Mr. NEAL. Madam Speaker, I yield 2 minutes to the gentleman from 
Texas (Mr. Doggett).
  Mr. DOGGETT. Madam Speaker, approaching July Fourth, we should be 
celebrating the greatness of our country. Instead, we are mired in a 
pandemic when we have more people infected and more deaths from this 
pandemic than any country in the entire world--with President Trump 
floundering and whining.
  His approach to this pandemic--denial, delay, and ongoing deception--
has been exposed for the fraud that it is. And because of his multiple 
failures, now is a time when more Americans desperately need the 
opportunity to enroll in health insurance, not the junk insurance that 
he has been promoting. Instead, he seeks to eliminate--as do our 
Republican colleagues--the Affordable Care Act and the coverage that it 
has today for millions of our citizens.
  Madam Speaker, today's bill offers a reaffirmation that the 
Affordable Care Act should be strengthened, not destroyed. 
Strengthening that would have been occurring long ago but for the 
fanatic decade of our Republican colleagues in trying to destroy the 
Affordable Care Act. Next year, however, we have to do much more for 
healthcare than simply to return where it should have been. Millions of 
Americans, particularly in a State like

[[Page H2626]]

Texas, which has more uninsured children than any State in America, 
they are still likely to be excluded because of obstructionist 
Republican State leaders. And even those who have insurance, are still 
often the victims of prescription price gouging.
  Madam Speaker, the exceedingly modest pharmaceutical provision in 
today's bill excludes the uninsured and falls well short of what is 
needed to prevent monopoly prices for drugs developed at taxpayer 
expense. This bill pours more billions into pharmaceutical development 
with no assurance that the prices or the resulting cures will be 
affordable. We see only today with the pricing of remdesivir, a drug 
that would have been left in the scrap heap of failures but for 
taxpayer funding, that the same taxpayers that developed the drugs will 
be charged billions to get them.
  Let's look forward to a day when we have a competent and committed 
President to bring healthcare for all.
  Mr. BRADY. Madam Speaker, I yield 2 minutes to the gentleman from 
Nebraska (Mr. Smith), a leader in rural healthcare reform.
  Mr. SMITH of Nebraska. Madam Speaker, I rise today in opposition to 
H.R. 1425.
  I stand here somewhat surprised that there is celebration of the 
successes of the so-called Affordable Care Act. Many of my constituents 
are offended by the mere name of the bill, the Affordable Care Act, 
because they don't find it affordable. They found it quite 
unaffordable.
  I would argue that is why we are here today, with a fairly clever 
scheme of taking money from here and putting it there, which likely 
will still drive up the cost of healthcare. It is just a few different 
people paying for it.
  Madam Speaker, if we want true healthcare reform, we should do that, 
but we haven't done that. Let's look for the bipartisan opportunities 
on drug costs, as mentioned earlier. Those had been advancing, but 
those were all pushed aside for H.R. 3.
  H.R. 3 passed the House knowing that it wasn't going to go anywhere. 
I would argue that some people probably even voted ``yes'' on H.R. 3 
because they knew the Senate would not take it up and because they also 
know that it has major problems.
  But here we are today, again, with this scheme that I think will fail 
the American people, just like so much of the so-called Affordable Care 
Act has failed the American people in its mere cost, not to mention 
other things.
  Yes, I remember those comments of, ``If you like your healthcare 
plan, you can keep it.'' We know that didn't happen. So many other 
promises were made that were not kept.
  And the American people want us to work together, especially now. 
Probably more than in the history of our country, the people want us to 
work together on bipartisan solutions.
  Madam Speaker, we need to do that. We can do that. There is even 
evidence that there is productive work already done in a bipartisan 
fashion.
  So let's not do this bill, H.R. 1425, today. Let's go about it in a 
bipartisan way where we know the American people will benefit more and 
our system can support that.
  Mr. NEAL. Madam Speaker, I would point out that 100 percent of the 
children in Massachusetts have healthcare today and 97 percent of the 
adults.
  Madam Speaker, I yield 2 minutes to the gentleman from Oregon (Mr. 
Blumenauer).
  Mr. BLUMENAUER. Madam Speaker, I listened to my colleagues cry out 
for a bipartisan cooperation and progress. I listened to them talk 
about somehow having promises not kept.
  Think for a moment. My colleagues--the promise of Donald Trump and 
the Republicans to replace and enhance the Affordable Care Act. They 
are going to eliminate it, and they are going to replace it with 
something better.
  No, they could not do it.
  They have been assaulting the Affordable Care Act since the moment it 
was passed and they got their hands on part of the political control.
  They fought to protect Big Pharma so that we have this corrupt 
bargain where Americans have to pay the highest prescription drug 
prices in the world in order to bribe pharmaceutical companies to 
continue research. And they wouldn't unless Americans pay more than 
anybody else in the world--including, in many instances, people who 
can't afford their prescription drugs. That corrupt bargain needs to be 
rejected.
  Madam Speaker, now we are hearing, I think, starkly, the difference 
between Republicans and Democrats--night and day--that active sabotage 
of the Affordable Care Act, today with the Republican attorneys general 
and the full weight of the Trump administration to try again to repeal 
it in its entirety.
  Madam Speaker, our legislation would increase coverage for 4 million 
people. You know, it is interesting watching people fight against the 
efforts of the Trump administration and the Republicans to deny them 
coverage. Almost one-half million people figured out a way to apply, 
demonstrating the need in the time of coronavirus.
  Madam Speaker, my Republican friends have nothing to offer. They have 
no plan. The Trump administration only wants to destroy the Affordable 
Care Act at a time when it is more important than ever.
  Madam Speaker, I strongly urge approval of this package.
  Mr. BRADY. Madam Speaker, I yield 1 minute to the gentleman from New 
York (Mr. Reed), a key leader of the Committee on Ways and Means on 
healthcare reform.
  Mr. REED. Madam Speaker, I thank the gentleman for yielding.
  Madam Speaker, I rise today in opposition to the bill before us.
  The debate, America, is very simple. I am a proud Republican, and I 
stand with the private market. I stand with you, as the people.
  My Democratic colleagues, they offer you a vision of healthcare 
defined and controlled by the government. If you believe the government 
can do a better job with your healthcare, then so be it, vote with the 
Democratic colleagues. But if you believe in entrepreneurs, if you 
believe in innovators, then vote with the Republican ideas that lead to 
more innovation.
  The bill before us today, we had a conversation with the Health and 
Human Services Secretary in the Committee on Ways and Means and with 
the Congressional Budget Office independently confirming that there 
will be dozens fewer innovations when it comes to treatments and cures 
for Americans with the passage of this bill.
  That is what you are doing--eyes wide open--and we are not going to 
let you get away with it.
  Madam Speaker, when you vote for this bill, you are dooming millions 
of Americans to not have a cure for the disease. Vote for the 
bipartisan bill, H.R. 19, Lower Costs, More Cures. That is the bill 
that will get through the system.
  Mr. NEAL. Madam Speaker, I yield 2 minutes to the gentlewoman from 
Washington State (Ms. DelBene).
  Ms. DelBENE. Madam Speaker, I rise today in support of the Patient 
Protection and Affordable Care Enhancement Act.
  The high price of prescription drugs is one of the top issues I hear 
about from my constituents. In 2019, I received nearly four times as 
many comments about prescription drug costs as the year before. Now, 
with the COVID-19 pandemic and resulting economic crisis, addressing 
the issue of drug pricing is more urgent than ever.
  The patient stories are numerous and never-ending. I would like to 
share just one with my colleagues and the American people to remind us 
why this legislation is so necessary.
  A constituent of mine, Dana, from Kenmore, Washington, has lived with 
type 1 diabetes for 14 years. When Dana was first diagnosed with 
diabetes, insulin cost her $50 each month. Today, that same insulin 
costs over $600 per month.
  That is an 1,100 percent increase for the exact same product, and 
there have been virtually no changes to insulin since Dana's diagnosis, 
so the price spike is inexplicable.
  Madam Speaker, Dana is not only a diabetes patient but also a nurse 
practitioner and diabetes educator. She has told me about her patients 
who go to Canada, where they can get insulin for just $40 a month. But 
with the border closed because of the pandemic, for many, that option 
is shut off to them.
  Dana has also shared stories of her own patients who can't afford 
their medications and ration their insulin, which we know can lead to 
poor health, vision loss, kidney failure, and even death.

[[Page H2627]]

  Madam Speaker, I strongly support the Patient Protection and 
Affordable Care Enhancement Act, which will strengthen and improve upon 
the ACA and finally give the Health and Human Services Secretary the 
power to negotiate a fair price for insulin, which will dramatically 
help patients, like Dana, and all the patients that Dana serves in my 
district.
  Madam Speaker, I urge my colleagues to support this legislation.
  Mr. BRADY. Madam Speaker, I include in the Record a veto threat from 
President Trump that states the administration strongly opposes H.R. 
1425, further demonstrating this bill has no chance of becoming law.

                   Statement of Administration Policy


H.R. 1425--Patient Protection and Affordable Care Enhancement Act--Rep. 
                     Craig, D-MN, and 61 cosponsors

       The Administration strongly opposes House passage of H.R. 
     1425. This bill attempts to exploit the coronavirus pandemic 
     to resuscitate tired, partisan proposals that would send 
     hundreds of billions of dollars to insurance companies in 
     order to paper over serious flaws in Obamacare. Furthermore, 
     H.R. 1425 would pay for this bailout by imposing price 
     controls that undermine the American innovation the entire 
     globe is depending on to deliver the vaccines and 
     therapeutics needed to respond to the coronavirus.
       Since the beginning of this crisis, the Administration has 
     taken a whole-of-America approach to fight the corona virus. 
     This includes a productive partnership with both houses of 
     Congress to respond to the healthcare needs of our citizens. 
     The Administration has delivered millions of pieces of 
     personal protective equipment to frontline healthcare 
     responders, surged hospital capacity, and dramatically scaled 
     up diagnostic and surveillance testing capabilities. The 
     Administration also launched Operation Warp Speed to 
     collaborate with the private sector to develop a coronavirus 
     vaccine, therapeutics, and diagnostics. Additionally, the 
     Administration is working to reimburse providers for corona 
     virus testing and treatment of uninsured Americans so they do 
     not have to worry about the financial implications of 
     obtaining these services.
       All this was done while putting the country in the 
     strongest possible position to rebound from the most 
     significant economic challenge since the Great Depression. 
     Working with Congress, the Administration has delivered 
     financial relief directly to over 160 million Americans, over 
     4.5 million businesses and their employees, and over one 
     million healthcare providers.
       Instead of building on these vital, bipartisan efforts, 
     H.R. 1425 reads as if the corona virus never emerged. It 
     repurposes failed proposals from years past that would 
     literally pay insurance companies more to hide the true cost 
     of Obamacare from consumers. Even the additional billions of 
     taxpayer funding is not enough to prop up Obamacare on its 
     own, thus H.R. 1425 goes out of its way to systematically 
     eliminate any competition by prohibiting more affordable 
     coverage options and the consideration of alternative 
     approaches by States. At the same time, the bill lacks any 
     provision to ensure the Federal Government adheres to the 
     long-held consensus to not fund abortion services or abortion 
     coverage.
       To create a facade of ``paying'' for the revival of last 
     decade's most partisan project, Obamacare, H.R. 1425 invokes 
     another partisan misadventure reflected in provisions of H.R. 
     3. In its Statement of Administration Policy on H.R. 3, the 
     Administration explained that these provisions would impose 
     price controls under the guise of ``negotiation'' that would 
     ultimately ``harm seniors and all who need lifesaving 
     medicines.'' In perhaps an indication of the intentions of 
     H.R. 1425, it does not even attempt to include those 
     provisions of H.R. 3 that had previously garnered bipartisan 
     support, such as establishing a cap on out-of-pocket expenses 
     for all beneficiaries in Medicare Part D and other 
     improvements to that program for seniors.
       While any time is an inopportune time to dramatically 
     undermine the development of innovative medicines, H.R. 1425 
     is even more imprudent given the current focus on developing 
     vaccines and therapeutics rapidly to help America and the 
     world combat the coronavirus. To take such an action simply 
     to double down on the same expensive, inefficient, and 
     bureaucratic approach to health coverage that the American 
     people endured for the past decade makes it even more 
     misguided and counter to the most urgent needs of the 
     country.
       If H.R. 1425 were resented to the President his advisors 
     would recommend that he veto the bill.
  Mr. BRADY. Madam Speaker, I yield 2 minutes to the gentleman from 
North Carolina (Mr. Holding), a leading healthcare expert in the 
Committee on Ways and Means.
  Mr. HOLDING. Madam Speaker, I thank the chairman for yielding.
  Madam Speaker, one thing that I think has become abundantly clear 
during this pandemic is how important it is to incentivize 
biopharmaceutical innovation. Over the past few months, Federal 
officials worked tirelessly with drug companies to identify and develop 
treatments that can help mitigate the effects of the coronavirus--
indeed, save thousands of lives.
  In my district, the town of Wilson, North Carolina, is home to one of 
the three manufacturing sites that produce over 40 percent of the 
world's supply of dexamethasone, which has been identified as one of 
the first lifesaving drugs for coronavirus patients. This site in 
Wilson is preparing to ramp up production and meet global demands.
  Madam Speaker, to effectively fight this pandemic, policymakers must 
continue working with healthcare stakeholders to spur innovation and 
ensure a steady supply of vital drugs to treat the coronavirus.
  Madam Speaker, unfortunately, we are wasting time today talking about 
government price controls that would do the exact opposite. Rather than 
incentivize the development of a vaccine and new and innovative 
treatments, these price-setting proposals will discourage companies 
from investing in new drugs, and the tax penalty for noncompliance 
threatens to force companies and certain drugs out of the United States 
entirely.
  That not only means that thousands of Americans could lose access to 
the drugs they desperately need, but thousands of folks in towns like 
Wilson could lose their jobs as companies leave the United States.
  Madam Speaker, under no circumstances--no circumstances--can we adopt 
a policy that will curtail patient access to vital drugs and discourage 
the development of new, innovative treatments. Even the development of 
one less drug as a result of this policy is too many in the middle of a 
pandemic.
  Madam Speaker, I urge my colleagues to vote ``no'' on this misguided 
bill.
  Mr. NEAL. Madam Speaker, I yield 2 minutes to the gentleman from 
Illinois (Mr. Schneider).
  Mr. SCHNEIDER. Madam Speaker, I am proud to rise in strong support of 
H.R. 1425, the Patient Protection and Affordable Care Enhancement Act.
  Our country is in the midst of an unprecedented pandemic requiring 
unprecedented actions, like the HEROES Act the House sent to the Senate 
more than 6 weeks ago. Beating back this virus will test us in 
unimaginable ways, and we cannot afford to allow petty politics to push 
us backward.
  Sadly, inconceivably, that is exactly what the Trump administration 
asked from the Supreme Court last week when they argued to fully 
overturn the Affordable Care Act.
  With more than 2.5 million infections, and more than 125,000 lives 
tragically lost, we need to expand access to affordable healthcare; 
lower the cost of prescription drugs; and improve outcomes for those 
hardest hit, especially in communities of color and rural communities.
  Madam Speaker, the end of the Affordable Care Act and other actions 
previously announced by this administration, with no plan of their own, 
will instead leave millions of Americans at risk of losing their 
insurance. It will result in higher premiums for millions of 
individuals and small businesses.
  Remember this: The 130,000 of us with preexisting conditions, 
including those who have been infected with COVID-19, will pay the 
heaviest price.
  Madam Speaker, the Affordable Care Act is essential to ensuring 
Americans have access to affordable and quality healthcare. It is still 
under attack by our President and his allies.
  Today, I and my colleagues demonstrate our commitment to protecting 
it. The Patient Protection and Affordable Care Enhancement Act will 
strengthen the ACA by strengthening protections for those with 
preexisting conditions. It will ensure that no one pays more than 8.5 
percent of their income for quality coverage. It will allow 
negotiations for lower drug costs. It will help address the 
inequalities in healthcare faced by so many in our country, especially 
communities of color.
  Madam Speaker, this is the kind of bill that should receive 
bipartisan support in the middle of a historic pandemic, and I urge my 
colleagues to vote for it.

                              {time}  1200

  Mr. BRADY. Madam Speaker, I yield 2 minutes to the gentleman from 
Arizona (Mr. Schweikert), a key member

[[Page H2628]]

of the Ways and Means Committee and a technology leader.
  Mr. SCHWEIKERT. Madam Speaker, 2 minutes is almost impossible to 
actually have an honest and detailed debate/discussion in here.
  But do understand--and I believe this is a sin of both sides--we are 
playing this game where we are moving around who pays. We are doing 
almost nothing to actually reduce the underlying cost of healthcare. 
Your bill is doing it; ours has done it.
  But this bill actually has a very cynical mechanism in it. This board 
is being recycled from H.R. 3. We are all familiar with the mechanism 
of reference pricing. We have debated it around here for years.
  So, if you are in Great Britain and there is a new drug that gives 
you a year of healthy life and it costs more than $37,000, it is not 
purchased. That pricing, that scarcity mechanism, is what the 
Democrats' bill is importing. So its savings are actually very cynical, 
because it is going to take away pharmaceuticals that make people 
healthy.
  How could we be doing this, even allow this mechanism, in a time of a 
pandemic?
  You are about to crush all of the little biopharma companies that we 
are hoping desperately produce miracle cures, and, in a perverse way, 
for large pharma. You have just given them the market, because you have 
taken away those who are nipping at their heels.
  I beg of you, think about what you are actually doing, because this 
type of financing mechanism will kill people. It will end lives, 
because it will create a dearth, a shortage, of the next generation of 
cures.
  Let's not engage in that cruelty. There are better ways to get there. 
And we have proposed many of them. It would just be nice to get heard, 
because there are solutions, and this is a really dark one.
  Mr. NEAL. Madam Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from Alabama (Ms. Sewell).
  Ms. SEWELL of Alabama. Madam Speaker, I am proud to support the 
Patient Protection and Affordable Care Enhancement Act today because it 
is high time that we reduce prescription drug costs for all Americans.
  Likewise, this bill includes provisions to expand access to Medicaid 
and quality healthcare insurance with expanded tax credits and premium 
subsidies.
  This bill includes a provision in the bill--that is, the bill that I 
have been advocating with my colleagues   John Lewis and Mark Veasey 
for some time now--to ensure that all States that expand Medicaid 
coverage receive an equal Federal match for expansion, regardless of 
when they expanded. That means that the 14 States--like Alabama, that I 
represent--could expand Medicaid and get equal Federal coverage in 
their match.
  This provision incentivizes Medicaid expansion because it would help 
113 million Americans living in nonexpansion States. In my State alone, 
over 300,000 more Alabamians would qualify for coverage from Medicaid 
if we had this bill passed.
  The writing is on the wall and the facts are clear: Premiums and 
healthcare costs are higher in States that haven't expanded Medicaid, 
and over 70 percent of the rural hospital closures are in States that 
have not expanded Medicaid.
  The public health emergency and economic crisis that we are currently 
facing means that more uninsured and more unemployed constituents are 
more vulnerable.
  Let's pass this legislation. It will not only expand Medicaid and 
give Medicaid expansion opportunities with equal Federal match in 
States like Alabama, but it would also decrease prescription drug costs 
and protect the preexisting conditions that are so important for all 
Americans.
  This is an important tool, providing our States with enhanced Federal 
matching funds to ensure Medicaid is one of the best tools that we have 
to help the communities we represent now and into the future. I urge my 
colleagues to support this important bill.
  Mr. BRADY. Madam Speaker, I yield 1 minute to the gentleman from 
California (Mr. Nunes), the ranking member of the Health Subcommittee.
  Mr. NUNES. Madam Speaker, I rise today in opposition to H.R. 1425.
  Per usual, this is a partisan bill that will go nowhere in the Senate 
and the President will not sign into law.
  Among the various problems in this bill is the Democrats' insistence 
on including provisions which will prevent scientists from finding new 
cures--at a time when our Nation is working to overcome the 
coronavirus.
  According to the California Life Sciences Association, if this bill 
passes, 88 percent of new drugs in the pipeline will be discontinued. 
That is hundreds of diseases that will not be cured and countless lives 
that will be lost. That is not something that I can support.
  Rather than engineer a government takeover of the prescription drug 
industry, we can work together to provide lower prices for families, 
and we can do it without reducing cures. But this bill we have before 
us today is not the answer.
  I urge all of my colleagues to vote ``no'' on H.R. 1425.
  Mr. NEAL. Madam Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Panetta).
  Mr. PANETTA. Madam Speaker, I rise today in support of H.R. 1425, the 
Patient Protection and Affordable Care Enhancement Act.
  This comprehensive legislation will do what I have always said needs 
to be done to the ACA: It won't get rid of it, but it does fix it. This 
bill does that by lowering healthcare costs and raising access to 
quality healthcare, especially for those who need it the most.
  We must do this now, more than ever, with COVID-19 numbers spiking 
and an administration that is trying to overturn the ACA and reduce 
healthcare access rather than expand it.
  In my district on the central coast of California, the numbers of 
COVID-19 are growing, but impacting certain communities more than 
others. Nearly 80 percent of all COVID cases in Monterey County have 
been found to be in the Latinx community.

  Across the Nation, Latinos make up 34 percent of the cases of COVID-
19, despite only representing 18 percent of the total U.S. population, 
while, nationally, Latinos have the highest uninsured rate. H.R. 1425 
would fix that by eliminating barriers to affordable healthcare for 
Latinos and expanding coverage for DACA recipients.
  This bill would improve healthcare for all Americans by increasing 
protections for people with preexisting conditions, strengthening the 
State marketplaces, expanded premium tax credits, and helping low-
income postpartum women and children.
  So I call on my colleagues to come together and vote for this bill 
because now, more than ever, it is time for us to do our job: Improve 
the Affordable Care Act so that we can provide the necessary healthcare 
to those who need it the most and everybody in our Nation.
  Mr. BRADY. Madam Speaker, I yield 2 minutes to the gentlewoman from 
West Virginia (Mrs. Miller).
  Mrs. MILLER. Madam Speaker, I rise in opposition to H.R. 1425, which 
should be called the expanding government and killing cures act.
  With this legislation, my colleagues across the aisle are bending 
American healthcare to the will of Washington bureaucrats.
  Any way you look at this, House Democrats took a bipartisan issue, 
improving healthcare and lowering prices, and botched it. We are now 
left with bad policy that will stifle innovation for new treatments and 
therapeutics and do what government does worst: pick winners and losers 
in the private sector.
  This absolutely will not fix ObamaCare's failed policies. This bill 
gives billions in taxpayer-funded bailouts and subsidies, while doing 
nothing to streamline services, lower costs, or cut taxes.
  Today, House Democrats are wasting everyone's time pushing a bill 
with price controls, punitive taxes, blank checks, bailouts, and more 
red tape and bureaucracy.
  I want a bill that protects preexisting conditions, lowers drug 
pricing, incentivizes innovation, fixes our healthcare system, cuts 
taxes, and actually lets you keep your own doctor--but this is not it.
  For these reasons, I urge my colleagues to oppose this legislation so 
we can get to work and actually pass a bill that improves the lives of 
our citizens.

[[Page H2629]]

  

  Mr. NEAL. Madam Speaker, I am pleased to yield 1\1/2\ minutes to the 
gentlewoman from Florida (Mrs. Murphy).
  Mrs. MURPHY of Florida. Madam Speaker, every American should have 
affordable access to doctor care, hospital care, and prescription 
drugs. This is important in normal times and vital during a pandemic.
  Before COVID, Florida had one of the worst uninsured rates in the 
country. That is because State leaders refused to expand Medicaid, 
placing politics over public health. It is also because many Floridians 
chose not to buy a marketplace plan because they couldn't find an 
affordable option.
  COVID has made a bad situation worse. In Florida, cases, 
hospitalizations, and deaths are rising sharply. Millions of workers 
have lost their jobs and their employer-sponsored health coverage.
  Passage of this bill would make an immediate difference in the lives 
of my constituents who are really struggling. The bill would encourage 
Florida and other holdout States to expand Medicaid by having the 
Federal Government pay nearly the full cost. It would make exchange 
coverage more affordable, reducing premiums and deductibles. It would 
lower the cost of prescription drugs, which are far too high.
  Finally, it would guarantee that no American can be denied coverage 
because of a preexisting condition. This protection is even more 
important than ever since there is a risk that insurers could classify 
a COVID-19 diagnosis as a preexisting condition.
  I strongly support this bill and urge its passage.
  Mr. BRADY. Madam Speaker, I yield 2 minutes to the gentleman from 
Texas (Mr. Arrington), a member of the Ways and Means Committee.
  Mr. ARRINGTON. Madam Speaker, at a time when our Nation is reeling 
from an unprecedented public health crisis and our fellow Americans are 
struggling just to survive, the Democrat leadership is wasting precious 
time on yet another partisan messaging bill.
  This legislation is going nowhere, and my friends on the other side 
of the aisle know it. The name Patient Protection and Affordable Care 
Enhancement Act is no such thing. It is the protecting ObamaCare act. 
It is the pretend we are legislating under the guise of partisan 
messaging act. It is the perpetuate the broken promises of ObamaCare 
act. It is empty; it is devoid; it is going nowhere. We are wasting 
time in this national crisis.
  If it did pass, it would take flexibility and responsibility from 
States. It would coerce States to expand Medicaid--a flawed Medicaid 
system, I might add--and it would allow for these monies to be used on 
abortion, which is a nonstarter. We know it is not serious when that is 
in there. That is a poison pill.

  Madam Speaker, I encourage my colleagues to stop wasting the American 
people's time, and let's get back to governing this great Nation.
  Mr. NEAL. Madam Speaker, I yield 2 minutes to gentlewoman from 
California (Ms. Judy Chu).
  Ms. JUDY CHU of California. Madam Speaker, last week, as COVID-19 
cases continued to spread, even reaching historic highs, and as the 
number of Americans killed by this virus rose well above 100,000, 
Donald Trump asked the Supreme Court to strike down the entire 
Affordable Care Act. If Trump and Republicans got their way, millions 
of Americans would immediately lose their health insurance in the 
middle of a pandemic, with no alternative available.
  Ending the ACA is life-threatening, especially as we battle COVID-19. 
That is why I am proud to support the Affordable Care Enhancement Act. 
This bill would build on the success of the ACA by expanding tax 
credits to ensure more Americans have access to health insurance, not 
fewer. And it expands eligibility for these credits so that Dreamers 
can access affordable healthcare as well, something we know will 
benefit entire communities.
  The coronavirus does not discriminate, and neither should we.
  Critically, this bill undoes the Trump administration's expansion of 
junk insurance plans, which offer minimal coverage and leave patients 
with massive bills when they do get sick; because, while access to 
healthcare is essential, it must be affordable.
  That is why it is so important that this bill also includes language 
from H.R. 3, the Elijah Cummings Lower Drug Costs Now Act. This will 
lower prescription drug prices by allowing the government to negotiate 
for those prices, bringing our prescription drug prices in line with 
what they cost overseas.
  This bill puts the health of the American people first when we need 
it most. I am proud to support this legislation, and I urge my 
colleagues to vote ``yes.''
  Mr. BRADY. Madam Speaker, I yield 3 minutes to the to gentleman from 
Louisiana (Mr. Scalise), the Republican whip.

                              {time}  1215

  Mr. SCALISE. Madam Speaker, I think we all remember: If you like what 
you have, you can keep it. Remember that phrase? Probably the most 
broken promise in political history.
  Millions of people lost the good healthcare that they liked because 
Washington bureaucrats came in and said not ``if you like what you 
have, you can keep it,'' but ``if Washington likes what you have, you 
can keep it.'' And they took it away.
  After that, you still see, years later, they are trying to pull more 
people out of the private insurance market who actually like what they 
have, and say, ``Get back on this.''
  If it works so well, by the way, Madam Speaker, wouldn't people be 
going in droves to it? In fact, it works so poorly that, under this 
bill, they have to bribe you with over $400 billion more in taxpayer 
money.
  That is how much this costs, more than $400 billion to take you off 
the private health insurance that you like. This is free market. If you 
don't like it, you can go somewhere else. But most people like their 
private health insurance, so they are going to push them onto this at 
the expense of over $400 billion.
  If that isn't bad enough, Madam Speaker, what else do they do? They 
pay for it--get this--by limiting the amount of drugs that will come to 
market. Yes. The Council of Economic Advisers has advised ``as many as 
100 fewer drugs entering the United States market over the next decade, 
or about one-third of the total number of drugs expected to enter the 
market.''
  Can you believe this? In the middle of a global pandemic, when we are 
trying and rushing to find a cure and a vaccine for COVID-19, they are 
going to bring a bill to the floor to stop drugs from coming to the 
market, over 100 of them.
  Let's read more. This ``would reduce Americans' average life 
expectancy by about 4 months.'' My God, what are we doing, bringing a 
bill to the floor right now when we are trying to find a cure that will 
make it harder to find a cure? All to push more people, including 
wealthy people who would be eligible under the bill that already have 
private insurance, onto a heavily taxpayer-subsidized program that has 
been failing under its own weight, failing so much they need to add 
$400 billion to try to entice you to take it and, in the process, limit 
the ability to bring lifesaving drugs, like a cure for COVID-19, to the 
market.
  This is absurd. This is psychotic that we are even debating this 
right now. We should be focusing on helping expedite a cure, not making 
it harder to bring that very cure for COVID-19 to the market.
  Madam Speaker, I would strongly urge a ``no.''
  Mr. NEAL. Madam Speaker, I yield 2 minutes to the gentleman from 
California (Mr. Gomez).
  Mr. GOMEZ. Madam Speaker, first, I want to remind my colleagues from 
the other side of the aisle that this President has attempted to get 
rid of, to eliminate, the Affordable Care Act, ObamaCare, over and over 
and over again. So when you pretend to care about expanding healthcare 
or taking care of people who don't have healthcare, it seems a little 
hollow to me.
  That is why I am proud to stand up here to support the Patient 
Protection and Affordable Care Enhancement Act because it would invest 
in working families by expanding affordability, strengthening consumer 
protections, and increasing coverage. And there is a lot to like in 
this bill.
  For the first time ever, under this legislation, doctor recipients 
would be

[[Page H2630]]

eligible for help with their premiums for plans they purchased under 
Covered California or HealthCare.gov.
  For DACA recipients, home is here. Many of them have been working as 
first responders and frontline health providers during the pandemic, 
and they should have affordable healthcare like any other American.
  Madam Speaker, I would like to thank Chairman Neal for working with 
me on this important provision.
  Second, this bill makes changes so that Medicaid more effectively 
serves its patients.
  For instance, under the legislation, Medicaid enrollees would have 
better access to primary care physicians, and they won't lose their 
healthcare coverage just because of small fluctuations in their income 
over the course of a year.
  Forty-seven percent of my congressional district is enrolled in 
Medicaid or Medi-Cal, so these provisions are crucial.
  Last, this bill makes healthcare more affordable by increasing 
subsidies for working families on the marketplace. This provision is 
similar to the Healthcare Affordability Act of 2019 that I introduced 
with Congresswoman Lauren Underwood. This is a historic step.
  The Affordable Care Act was a big step, but it is not done. We are 
going to keep pushing, and we are not going to negotiate with the other 
side of the aisle that keeps trying to eliminate and roll back 
protections and affordable healthcare for millions of Americans.
  Mr. BRADY. Madam Speaker, I yield 3 minutes to the gentleman from 
Ohio (Mr. Wenstrup), a leader on the Ways and Means Committee.
  Mr. WENSTRUP. Madam Speaker, I thank the gentleman from Texas for 
yielding and for his leadership.
  Madam Speaker, I rise today in opposition to this bill.
  I grew up watching a show called ``Medical Center'' as a kid. It led 
me to wanting to become a doctor because I wanted to help people.
  After I graduated and completed my surgical residency, I owned a 
small practice with two employees. Eventually, I merged with a larger 
provider group, in part because the administrative burdens of complying 
with new laws and regulations were just too costly for my solo 
practice.
  That wasn't the end, though. Costs continued to rise, and my 
physician-owned surgery center was ultimately sold to a local hospital. 
Medicare reimbursement rates nearly doubled overnight, including an 
increase in patient co-pays.
  When I got to Congress, I joined the GOP Doctors Caucus, and I am now 
proud to serve as the vice chair. Most of us in the Doctors Caucus 
agree that one of the reasons we came to Congress is because of the 
mountains of red tape, red tape involved in practicing medicine that 
has killed much of the joy of providing care to patients.

  Now, the bill we are debating today is another perfect example of an 
attempt to expand Big Government, making it harder on the medical 
community. In this case, it is patients who rely on prescription drugs 
who stand to lose the most.
  In the midst of the COVID-19 outbreak and responses, we rush toward 
finding treatments and a vaccine. My colleagues on the other side of 
the aisle want to pass a bill that will result in fewer cures for 
Americans in need.
  That is right. The CBO analysis concluded that this bill would result 
in fewer cures coming to market to help the American people. Drug 
manufacturers that may feel government isn't willing to pay a 
reasonable price for their product would have their revenue taxed at 
astronomical rates, essentially coercing the drugmaker into submission 
or cease to exist.
  The reason America leads the world in producing new medicines is 
because we allow competition, competition to drive innovation.
  Right now, Congress needs to be fostering innovation through 
competition, not imposing one-size-fits-all Washington mandates that 
accomplish just the opposite.
  We have already proven that we can do some work together. Last year, 
the Ways and Means Committee marked up a bipartisan drug-pricing 
legislation bill only to have it die because of partisan leadership. I 
know the Energy and Commerce and Judiciary Committees have done the 
same. Let's debate and find compromise on that legislation, which 
actually stand a chance of becoming law.
  I urge my friends on the other side of the aisle to work with us on 
bipartisan legislation that would result in finding more cures for the 
American people because cures save money and save lives. I oppose this 
legislation.
  Mr. NEAL. Madam Speaker, I yield 2 minutes to the gentleman from 
Nevada (Mr. Horsford).
  Mr. HORSFORD. Madam Speaker, I rise today in support of the Patient 
Protection and Affordable Care Enhancement Act.
  In the middle of the historic health and financial security crisis of 
the coronavirus pandemic, especially in my home State of Nevada that 
has suffered the most debilitating economic impact, affordable 
healthcare is now more important than ever.
  Last week, in the middle of this COVID-19 crisis, President Trump 
petitioned the Supreme Court to strike down every last protection and 
benefit of the Affordable Care Act. On Friday, I learned that such a 
ruling would cost 23 million Americans, including 309,000 Nevadans, to 
lose their health insurance.
  There is no excuse for this cruelty ever. But it is truly 
unconscionable at a time when over 100,000 Americans have lost their 
lives to a virus that we have yet to curb completely. When access to 
quality healthcare could be the difference between life and death, we 
should be building on the Affordable Care Act to lower health costs, 
not ripping away every last benefit.
  With all due respect to my colleagues on the other side who keep 
saying this bill has no chance in the Senate, who do you work for: 
Mitch McConnell or the American people? My constituents elected me to 
do my job, and that is to fight for their healthcare.
  Madam Speaker, I fully support the Patient Protection and Affordable 
Care Enhancement Act because we need to do more to provide affordable 
healthcare and bring down the rising costs of prescription drugs.
  This bill does that, and I urge my colleagues to join us. Do your job 
today.
  Mr. BRADY. Madam Speaker, I yield myself such time as I may consume.
  I have here a host of letters in opposition to this dangerous 
legislation, one signed by more than 40 State and regional life science 
organizations and another signed by over 130 small biotech companies, 
many of whom are currently working to develop COVID-19 therapies and 
vaccines. In these letters, they emphasize that this bill will deter 
badly needed investment that will harm their ability to manufacture and 
produce therapies and cures for American families.
  Madam Speaker, in the midst of a pandemic, we just heard a question: 
Why do we oppose this bill? In the midst of a pandemic where countless 
lives will depend upon the development of these new cures, this cannot 
happen on our watch. We will not stand idly by.
  Madam Speaker, I include in the Record the letters, and I reserve the 
balance of my time.
                                                 October 16, 2019.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate,
     Washington, DC.
     Hon. Charles Schumer,
     Democratic Leader, U.S. Senate,
     Washington, DC.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Republican Leader, House of Representatives,
     Washington, DC.
       Dear Senate Majority Leader McConnell, Senate Democratic 
     Leader Schumer, House Speaker Pelosi, and House Republican 
     Leader McCarthy: As state and regional life sciences 
     organizations across the country, all dedicated to supporting 
     the development and delivery of innovative life-enhancing and 
     life-saving products, we write to express our strong concerns 
     about recent legislative proposals that seek to introduce 
     international reference pricing and foreign price controls as 
     a strategy to reduce prescription drug costs. We are gravely 
     concerned that such polices will consequentially threaten 
     patient access and choice and cede America's global 
     leadership in biomedical innovation.
       At the outset, we underscore our appreciation for the 
     bipartisan and bicameral efforts underway to provide relief 
     to patients from unaffordable out-of-pocket costs for 
     prescription drugs. This is a critical challenge for our 
     nation, and we are committed to being

[[Page H2631]]

     part of the solution to address it, while also ensuring that 
     incentives still exist to spawn future innovation. However, 
     we are deeply concerned by proposals by some in Congress to 
     introduce price controls, particularly foreign reference 
     pricing, into government and private healthcare programs. 
     These proposals are concerning for states and regions of the 
     country with established life sciences communities, as well 
     as for emerging biomedical innovation ecosystems working to 
     attract capital investment and support entrepreneurship to 
     build the companies and therapies of the future. Most 
     importantly, they would be devastating for those patients 
     hoping for medicines to treat serious, life-threatening 
     diseases.
       For example, 96 percent of new cancer drugs are available 
     in the U.S., at an average delay of 3 months. By comparison, 
     Japanese patients have access to 50% of new medicines and 
     wait on average 23 months. German and Canadian patients wait 
     four times longer, French patients wait six times longer. 
     None of these countries even approach the access to new 
     therapies that our patients have. Should the U.S. implement 
     foreign price controls, patient choice and access to the full 
     range of life-saving therapies would undoubtedly be 
     threatened.
       Proposals to implement foreign price controls also put at 
     risk the U.S.'s world-leading innovative biopharmaceutical 
     sector that has created nearly one million jobs across all 50 
     states and represents a large portion of our nation's Gross 
     Domestic Product (GDP)--generating an economic output of 
     approximately $1.3 trillion annually. As a sector that 
     already takes on extraordinary risks and significant 
     investments with the hope that a few will eventually become 
     the next life-saving treatment for patients, the looming 
     potential of foreign price controls brings a threat that 
     risks the support of future investment.
       It is also important to remember that the overwhelming 
     majority--over 80 percent--of biopharmaceutical innovators in 
     the US are small, start-up, pre-revenue companies without a 
     single product yet on the market. A recent report by IQVIA 
     showed that emerging biopharmaceutical (EBP) companies 
     account for over 70 percent of the total late-stage R&D 
     pipeline and were responsible for almost two-thirds of the 
     patents for new drugs launched in 2018. These mostly pre-
     revenue companies without a product on the market are the 
     ones to be most affected by fluctuations in investment caused 
     by the political and public policy environment.
       The recent actions taken by the Administration and Congress 
     on drug pricing are seen as extremely threatening by the life 
     sciences sector, and we are therefore concerned that the 
     proposed foreign price controls policies will scare 
     investment away from life sciences investment, and towards 
     other industry sectors that pose far less risk. If price 
     controls as proposed are implemented it may reduce drug 
     pricing in the short term, but it will certainly result in 
     significantly reduced innovation and severely restricted 
     access to life-saving medicines.
       On behalf of the US's innovative life sciences community, 
     we urge you to reject any efforts to undermine America's 
     global leadership in biomedical innovation through 
     international reference pricing or other price controls. 
     Patients deserve access to and choice of the lifesaving 
     therapies of today and tomorrow. As you move forward, we 
     stand ready to work with you to consider alternative 
     proposals that will propel American innovation forward and 
     deliver affordable, accessible and innovative therapies for 
     patients who need them.
           Sincerely,
       Alabama: BIO Alabama.
       Arizona: Arizona Bioindustry Association, Inc. (AZBio).
       California: California Life Sciences Association--CLSA, 
     BIOCOM, SoCalBio.
       Colorado: Colorado BioScience Association.
       Connecticut: BioCT.
       Delaware: Delaware Bioscience Association (Delaware BIO).
       Florida: BioFlorida.
       Georgia: Georgia BIO.
       Illinois: Illinois Biotechnology Innovation Organization 
     (iBIO).
       Indiana: Indiana Health Industry Forum (IHIF).
       Iowa: Iowa Biotechnology Association (IowaBio).
       Kansas: Bio Kansas.
       Kentucky: Kentucky Life Sciences Council.
       Louisiana: Louisiana BIO.
       Maryland: Maryland Technology Council.
       Massachusetts: MassBio.
       Maine: Bioscience Association of Maine (BioME).
       Michigan: Michigan Biosciences Industry Association 
     (MichBio).
       Minnesota: Medical Alley Association.
       Missouri: Missouri Biotechnology Association (MOBIO).
       Montana: Montana Bioscience Association.
       Nebraska: Bio Nebraska.
       Nevada: The Nevada Biotechnology and Life Science 
     Association.
       New Jersey: BioNJ, HealthCare Institute of New Jersey 
     (HINJ).
       New Mexico: NMBio.
       New York: New York BIO.
       North Carolina: North Carolina Biosciences Organization 
     (NCBIO).
       North Dakota: BioScience Association of North Dakota.
       Ohio: BioOhio.
       Oregon: Oregon Bioscience Association (Oregon BIO).
       Pennsylvania: Life Sciences Pennsylvania (LSPA).
       South Carolina: SCBIO.
       South Dakota: South Dakota Biotech.
       Tennessee: Life Science Tennessee.
       Texas: Texas Healthcare and Biosciences Institute (THBI).
       Utah: BioUtah.
       Virginia: VirginiaBio.
       Washington: Life Science Washington.
       West Virginia: Biosciences Association of West Virginia.
       Wisconsin: BioForward Wisconsin.
       Puerto Rico: Industry-University (INDUNIV) Research Center 
     Inc/Bio Alliance Puerto Rico.
  Mr. NEAL. Madam Speaker, I yield 2 minutes to the gentleman from New 
York (Mr. Suozzi).
  Mr. SUOZZI. Madam Speaker, I rise today in strong support of H.R. 
1425, the Patient Protection and Affordable Care Enhancement Act.
  Madam Speaker, the Democrats have been debating internally over the 
past couple of years: What is the best way to reduce healthcare costs? 
What is the best way to provide more access to people? What should we 
be doing?
  Some people push for Medicare for All. People like myself say: Let's 
build upon the Affordable Care Act. Let's try and figure out how we can 
provide more access and reduce drug costs. That is what we are doing 
here today.
  Meanwhile, our Republican colleagues are continuing to hurtle down a 
dark and misguided path to take away coverage from almost 20 million 
Americans in the middle of the worst economic and health crisis we have 
had in almost a century.
  I am mystified by the strategy of my colleagues on the other side. 
What are they thinking?
  Now, they say that they want to protect people with preexisting 
conditions. In fact, the President tweeted over the weekend, saying he 
will always protect people with preexisting conditions. And I have 
heard colleagues of mine in the Ways and Means Committee say: We are 
convinced. We know now that we have to protect people with preexisting 
conditions.
  Yet, what do they do? Not what they say, what do they do? Their 
policies don't match their rhetoric.
  In 2017, they tried to repeal the ACA altogether, which would take 
away people's preexisting conditions protections. Now, in the midst of 
a pandemic that has already killed 130,000 Americans, this 
administration and the Republicans are pursuing a lawsuit to actually 
undo the Affordable Care Act. That will get rid of preexisting 
conditions protections. It doesn't make any sense.
  Prescription drugs, the President said during his campaign and 
thereafter, when talking about Big Pharma, he said that these guys are 
getting away with murder. We should be negotiating prescription drug 
prices. Yet, we have passed the bill before. We are doing it again 
today, to actually negotiate prescription drug prices, and they are 
opposing it once again, and they are not doing anything to try to 
negotiate prescription drug prices.
  Today, Democrats are, once again, taking steps to reduce premiums, 
lower drug prices, and expand coverage.
  Madam Speaker, I urge my colleagues on both sides of the aisle to 
support this bill.
  Mr. BRADY. Madam Speaker, I yield myself 30 seconds.
  Madam Speaker, just a quick fact check, because you know the 
Republican Congress in 1996 enacted the first comprehensive protections 
for preexisting conditions, which cover, today, 275 million Americans 
who are not affected by the lawsuit. There is simply too much fear-
mongering and bad information in this debate.
  Madam Speaker, I reserve the balance of my time.
  Mr. NEAL. Madam Speaker, I yield 1 minute to the gentlewoman from 
Chicago (Ms. Schakowsky).

                              {time}  1230

  Ms. SCHAKOWSKY. Madam Speaker, I thank the chairman for yielding to 
me.
  I would think that my colleagues on the other side of the aisle, the 
Republicans, would get tired of trying to take healthcare away from 
Americans, particularly right now.
  The Patient Protection and Affordable Care Enhancement Act would 
actually make such incredible improvements and make healthcare more 
affordable, but, no.

[[Page H2632]]

  The bill includes the No More Narrow Networks Act that I actually 
introduced that would ensure that consumers can access more 
comprehensive, equitable, and timely healthcare within their own 
insurance network now. It also includes the Protecting Consumers from 
Unreasonable Rates Act and allows the Federal Government to help lower 
prices when those rates, those premiums are too high.
  This is a great bill. You should be for this.
  Mr. BRADY. Madam Speaker, I yield myself the balance of my time.
  Madam Speaker, Republicans support children, seniors, and patients 
with preexisting conditions. A Republican Congress created the popular 
Children's Health Insurance Program that millions of families rely on 
today.
  A Republican Congress created the prescription drug program and 
Medicare to help seniors get the medicine they need, and every Democrat 
and Speaker Pelosi tried to kill that bill.
  A Republican Congress created the Medicare Advantage program that 
serves 20 million seniors in America.
  And a Republican Congress created the first law that established 
protections for patients with preexisting conditions that covered 275 
million Americans today regardless of this ACA lawsuit.
  We want people to have access to quality, affordable healthcare that 
fits their needs, not Speaker Pelosi's. We also support cures now for 
serious and life-threatening diseases that plague so many families and 
our loved ones. Eliminating the hope for those cures is why this bill 
is just so dangerous.
  Let me also be clear about what isn't in this bill, Madam Speaker. We 
have heard a lot today from my friends on the other side of the aisle 
bemoaning the Trump administration's effort to root out 
unconstitutional laws while committing to protect people with 
preexisting conditions.
  The Democrats could end this uncertainty now. They are in charge of 
the House. Bring to the floor a measure Republicans support that sever 
the individual mandate from the rest of the ACA. Bring to the floor a 
legislative fix for your unconstitutional law. Bring to the floor 
certainty for all Americans, especially those with preexisting health 
conditions.
  But House Democrats won't do that. No, they find the political fear-
mongering to be too potent an election-year weapon. So we continue this 
charade.
  Let me state it all again for all to hear: Republicans support 
protections for those with preexisting conditions. We wrote the law 
that protects 275 million Americans today. And we warned Democrats 
about this unconstitutional law, and we knew it would get struck down 
in court.
  But we cannot have a healthy society, we cannot protect all 
Americans, if we don't have access to lifesaving cures. As we continue 
to fight COVID-19, what are you thinking? Why are we destroying the 
incentives for new medicine and cures? We ought to be doing all we can 
to accelerate medical innovation, not destroy it in this bill.
  Democrats would force patients to choose between affordable medicines 
and lifesaving cures for Alzheimer's ALS, Parkinson's, diabetes, or 
cancer. That is a false choice. And we are not talking about just a few 
cures for some very rare diseases, we are talking about up to 100 
cures, dozens lost.
  Our country is in a time of uncertainty. Millions are unemployed. 
States still have deep restrictions in place. For folks who are relying 
on short-term limited plans for this period of uncertainty, why do 
Democrats propose to make their lives harder?
  I oppose this dangerous bill and urge everyone to oppose it.
  Madam Speaker, I yield back the balance of my time.
  Mr. NEAL. Mr. Speaker, I yield myself the balance of my time.
  Madam Speaker, this is very sensible legislation. It builds upon the 
Affordable Care Act. It keeps the protections of preexisting 
conditions. It makes the children's healthcare initiative permanent. 
But most importantly, it expands the opportunity.
  I am going to reiterate something I said earlier about the experience 
we have had in Massachusetts with the Affordable Care Act. 100 percent 
of the children in Massachusetts have health insurance. Ninety-seven 
percent of the adults in Massachusetts have health insurance, and it 
polls in the high seventies in terms of consumer satisfaction. It was 
the experiment that worked.
  We should be expanding healthcare opportunities for members of the 
American family, not trying to deny them. We shouldn't be filing a 
lawsuit in front of the Supreme Court suggesting that we should do away 
with the Affordable Care Act.
  Last point, and I mean this very sincerely, as long as I have been in 
this House, Republicans have never agreed amongst themselves on health 
insurance, never mind trying to find an agreement with us. They have 
always disagreed sharply about the role of government in health 
insurance. So before they give us a lecture on how this ought to 
proceed, perhaps they could offer a competing plan that has never 
happened in my time in Congress.
  Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mrs. Luria). All time for the Committee on 
Ways and Means has expired.
  The gentleman from Virginia (Mr. Scott) and the gentlewoman from 
North Carolina (Ms. Foxx) each will control 30 minutes.
  The gentleman from Virginia is recognized.
  Mr. SCOTT of Virginia. Madam Speaker, I yield myself 3 minutes.
  Madam Speaker, I rise in support of the Patient Protection and 
Affordable Care Enhancement Act.
  As we continue to confront the worst public health emergency in 
recent history, our first priority must be to protect the health and 
safety of the American people. But during this pandemic, millions of 
people have lost their jobs and, regrettably, in America when you lose 
your job you frequently lose your health insurance.
  Based on the job losses in March and April alone, experts estimate 
that over 26 million people across the country have lost their job-
based health insurance.
  With so many workers looking to turn to the Affordable Care Act 
marketplaces for healthcare, we must be building on the progress we 
have made to expand access to affordable coverage. This is exactly what 
this bill does.
  For example, as my colleagues have noted, under this proposal, no 
person would pay more than 8.5 percent of income on benchmark silver 
plans through the marketplace. Moreover, we fix the so-called family 
glitch, a technical problem that prohibits families from getting 
affordable coverage, and we make that affordable coverage available for 
millions of working families.
  The legislation will also provide incentives to expand Medicaid so 
that low-income families across the country will have coverage 
regardless of where they live.
  It builds on existing patient protections by reversing the Trump 
administration's expansion of short-term so-called junk health plans, 
which discriminate against patients with preexisting conditions and are 
not required to cover essential health benefits.
  These plans raise costs for everybody not in a plan and then abandon 
the patients when they get sick and actually need coverage.
  Finally, the Patient Protection and Affordable Care Enhancement Act 
would save money for workers and employees by cutting the cost of 
prescription drugs and bringing them in line with the cost people in 
other countries pay.
  And when they talk about the loss in investments and research, listen 
very carefully because they are saying that reducing the cost of 
prescription drugs is a bad thing. And second, they are talking about a 
previous version of the bill.
  In this version of the bill we have an amendment in here that puts 
more money into research and NIH, so that those investments will 
continue to get made.
  In contrast, the Trump administration has continued to aggressively 
pursue the Texas v. United States lawsuit. Just last week, the 
Department of Justice filed briefs urging that the Supreme Court 
overturn the Affordable Care Act.
  If that suit is successful, all of the benefits of the ACA will be 
lost. Tens

[[Page H2633]]

of millions of people will lose insurance. People with preexisting 
conditions will lose their protections. Affordability credits will 
evaporate. Consumer protections will be lost. This will happen in the 
middle of a public health emergency.
  And for all those on the other side that say that the Affordable Care 
Act has problems, and they have a replacement, remember what the CBO 
said.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. SCOTT of Virginia. Madam Speaker, I yield myself an additional 1 
minute.
  Remember what the CBO said about the bill that the Republicans passed 
when they had the majority a few years ago. They said the costs would 
go up 20 percent the first year, 20 something million fewer people 
would have insurance, people with preexisting conditions would lose 
their insurance, and the insurance you get is worse than what you got.
  We can't afford to take this major step backwards in our efforts to 
put quality insurance within the reach of all Americans, and this is 
why I urge all of my colleagues to support the Patient Protection and 
Affordable Care Enhancement Act so that we can strengthen the ACA and 
ensure millions of Americans will have access to better health 
insurance than they have now and certainly better than they would have 
if this lawsuit is successful.
  Madam Speaker, I reserve the balance of my time.
  Ms. FOXX of North Carolina. Madam Speaker, I yield myself such time 
as I may consume.
  Madam Speaker, I rise today in opposition to H.R. 1425, the so-called 
Patient Protection and Affordable Care Enhancement Act, the latest in a 
series of attempts by House Democrats to score cheap political points 
at the expense of hardworking taxpayers.
  And speaking of scoring cheap political points, I think most of my 
colleagues and I are tired of having words put in our mouths that 
aren't there. We do not oppose reducing the cost of drugs. We want 
that. We don't believe it is a bad thing.
  At a time when Congress should be united in our continued fight 
against the novel coronavirus and ensuring the country can reopen 
safely, we are instead here today debating a bill that amounts to 
nothing more than political posturing. Rather than solve any pressing 
healthcare problems, including the Nation's response to the COVID-19 
pandemic, this misguided legislation will limit healthcare options for 
patients, contribute to already skyrocketing healthcare costs, and 
double down on the many failures of the Affordable Care Act or the ACA.
  As the Republican leader of the Committee on Education and Labor, I 
am committed to improving and enhancing employer-sponsored healthcare 
options for American workers and their families.
  Yet today, we are debating legislation that would enlarge ObamaCare 
even further by providing subsidies for some of the wealthiest 
Americans, providing a blank check bailout for insurance companies, 
strong-arming States into expanding Medicaid, and eliminating lower 
cost healthcare options like short-term, limited-duration insurance 
plans.
  Short-term insurance plans offer healthcare options for Americans who 
might find themselves between jobs or unable to afford rising premiums 
in the already expensive individual market. What is astonishing to me 
is that Democrats conveniently failed to mention that these short-term, 
limited-duration plans were legal under the Obama administration and 
that States still have the authority to regulate these plans.

  As Republicans, we believe in federalism. If States choose to limit 
or prohibit the sale of these plans, they are free to do so. Instead of 
respecting the judgment of State lawmakers and local authorities to act 
in their States' and constituents' best interest, House Democrats are 
doubling down on a one-size-fits-all Federal mandate.
  As we have seen over and over again, Washington-knows-best 
requirements simply do not work. In the case of the ill-advised 
legislation before us today, Federally dictated policies will only lead 
to fewer choices and higher premiums.
  Additionally, House Democrats have missed the mark with H.R. 1425 
when it comes to COBRA notices for millions of workers.
  While there is room for improvement in this area, such as increasing 
transparency and allowing consumers to decide which plans work best for 
them, Democrats are instead blocking consumer access to information 
about other forms of valued coverage options outside of the ACA.

                              {time}  1245

  Just when you thought it couldn't get worse, the blatantly political 
bill we are considering today incorporates Speaker Pelosi's socialist 
drug-pricing scheme to cover up the hundreds of billions of dollars 
this government healthcare expansion would cost American taxpayers.
  The rising costs of prescription drugs is an issue that resonates 
with everyone in this Chamber. Seventy percent of Americans consider 
reducing the price of prescription drugs to be a top priority, and they 
are looking to us, their elected representatives, to get the job done 
to get drug prices under control.
  That is why Congress started a collaborative effort and bipartisan 
process last year to tackle this issue. Unfortunately, this bipartisan 
collaboration was abruptly cut short by Speaker Pelosi's introduction 
of H.R. 3, which was written in secret without Member input or the 
regular committee process.
  Lowering drug costs should not be a partisan issue, yet the 
underlying partisan, socialist provisions in H.R. 3 are included in the 
legislation before us today.
  Democrats are well aware that H.R. 3 will never become law. Senate 
Majority Leader Mitch McConnell has said it will go nowhere in the 
Senate, and President Trump has said he will veto the bill if it comes 
to his desk.
  Still, House Democrats continue to waste time during an unprecedented 
health and economic crisis on legislation that will die after House 
passage.
  Their socialist drug-pricing scheme is nothing more than a leftwing 
downpayment on a government-run healthcare system that would eliminate 
private insurance and implement government-controlled rationing of 
prescription drugs.
  As I have said many times before, governments don't negotiate; they 
dictate. The Democrats' radical drug-pricing scheme will eliminate 
choice and competition and jeopardize innovation, investment, and 
access to future cures. And we are considering this at a time when we 
are in the process of developing treatments and a vaccine for COVID-19.
  This type of unprecedented government interference in private market 
negotiations and substantial increase in regulatory red tape proves one 
thing: The Democrat Party is being held hostage by their most radical 
leftwing Members.
  The American people deserve better from Congress than the socialist 
drug-pricing scheme in the bill before us today. They deserve a real 
solution that will lower the cost of prescription drugs without 
jeopardizing access to new treatments and cures.
  That is why House Republicans have introduced H.R. 19, the Lower 
Costs, More Cures Act. This bill contains bipartisan, bicameral 
measures, and it can become law this year. Specifically, H.R. 19 will 
help lower out-of-pocket costs, protect access to new medicines and 
cures, strengthen transparency and accountability, and champion 
competition.
  Yet, House Democrats are ignoring this bipartisan, commonsense 
legislation. Clearly, they prefer politics over progress.
  Madam Speaker, I am deeply disappointed that we are here today 
debating yet another partisan ploy from my colleagues on the other side 
of the aisle. There are bipartisan solutions to many pressing issues at 
our fingertips, including continuing to fight the COVID-19 pandemic, 
but Speaker Pelosi and her Democrat colleagues continue to turn their 
backs on bipartisan legislation to help the American people, and that 
is truly shameful.
  Madam Speaker, I reserve the balance of my time.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 2 minutes to the 
gentlewoman from Florida (Ms. Shalala), a distinguished member of the 
Committee on Education and Labor, and

[[Page H2634]]

the former Secretary of the United States Department of Health and 
Human Services.
  Ms. SHALALA. Madam Speaker, I rise today in support of H.R. 1425, the 
Patient Protection and Affordable Care Enhancement Act.
  Our country is facing multiple interwoven catastrophes: a global 
pandemic, an economic crisis, and a reckoning over the denial of racial 
justice. Our job as Congresspeople is to help the American people 
through these trying times. This bill does just that, and the time to 
pass it is long overdue.
  Madam Speaker, my district has the highest enrollment in the 
Affordable Care Act's marketplaces, with more than 100,000 people 
getting their health insurance from the ACA. My constituents are likely 
to have never had health insurance before the Affordable Care Act 
became law, but there still are at least another 120,000 people in 
Miami-Dade County who do not have access to health insurance because my 
State, the State of Florida, has refused to expand Medicaid.
  This bill will take critical steps to improve and expand the ACA and 
lower drug costs. It requires the Secretary of HHS to negotiate with 
drug manufacturers for affordable drugs for all Americans, a power I 
would have loved to have had when I was Secretary. It does exactly what 
the President asked for during his campaign. This provision alone will 
save Medicare $448 billion.
  Other critical provisions include expanding tax credits deeper into 
the middle class so that everyone can get affordable, comprehensive 
health coverage.
  My constituents are worried about their jobs, their loved ones, their 
healthcare, and their country. Let's help them not worry about how they 
will pay for critical healthcare if they get sick.
  Ms. FOXX of North Carolina. Madam Speaker, I yield 3 minutes to the 
gentleman from Pennsylvania (Mr. Keller).
  Mr. KELLER. Madam Speaker, I urge my colleagues to join me in 
opposing H.R. 1425.
  While we can all agree that Americans pay too much for healthcare and 
that the rising costs of prescription drugs need to be addressed, this 
bill is not the answer.
  The COVID-19 pandemic has affected each of our communities in 
different ways. We need to remain focused on helping our constituents 
reopen their businesses, get back to work, and remain protected from 
the virus. This bill does none of these things.

  Once again, we are wasting the American people's time debating 
something that will harm the healthcare system, move us toward 
socialized medicine, and provide fewer cures.
  This is especially troubling as it is at odds with the Trump 
administration's steadfast goal of finding treatments and a vaccine for 
COVID-19, as well as protecting Americans from future pandemics.
  Just like H.R. 3, this bill irresponsibly coerces drug manufacturers 
into negotiating drug prices with the government, slapping a 65 percent 
tax on revenue if they don't come to terms, which increases to as much 
as 95 percent.
  In any negotiations that I have been part of, that is not how it 
works.
  In fact, according to the analysis done by the Congressional Research 
Service, letting the government set drug prices would violate both the 
Fifth Amendment's Takings Clause and the Eighth Amendment's Excessive 
Fines Clause.
  Before the pandemic, I traveled across Pennsylvania's 12th 
Congressional District and met with patients and medical professionals, 
who have told me that the best way to address rising prescription drug 
costs include patent reform to get generics to market quickly, price 
transparency so consumers know the actual cost of the medication they 
are purchasing, and incentivizing innovation to help find new cures.
  Rather than working toward fixing the disaster that has been brought 
about on the healthcare industry by ObamaCare, this bill expands its 
flawed structure and attempts to force non-Medicaid expansion States 
into complying with the radical fantasy that resembles socialized 
medicine.
  There has been bipartisan work on healthcare reform, like H.R. 19, 
which Republicans put forward last year. If the majority were more 
interested in finding real results, they might have engaged with us in 
real discussions to find common ground. We are interested in lower 
prices, more cures, and a healthier healthcare marketplace.
  Unfortunately, this legislation continues us down the wrong road. For 
these reasons, Madam Speaker, I oppose H.R. 1425 and urge all others to 
do so.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 2 minutes to the 
gentlewoman from California (Mrs. Davis), the chair of the Subcommittee 
on Higher Education and Workforce Investment.
  Mrs. DAVIS of California. Madam Speaker, I thank the chairman for 
yielding.
  Usually, one's healthcare is not top of mind, until it is. This, 
Madam Speaker, is one of those times.
  We have to protect people's healthcare, men and women, whether it is 
battling the coronavirus, finding a cure for cancer, or even birth.
  Currently, Medicaid covers women for only 60 days postpartum, but 
life-threatening complications from pregnancy, as we all know, can 
continue much longer.
  These illnesses don't follow the calendar. Regulations, of course, 
must align with reality.
  This needs to be changed. Fortunately, this bill would extend 
Medicaid coverage to a year postpartum and provide women with critical 
coverage to help detect, diagnose, and treat potentially fatal 
complications.
  By ensuring better health awareness from the beginning, we can ensure 
that all babies are protected and cared for as they grow.
  When our Nation is facing a health crisis, the logical reaction 
should be to strengthen healthcare, not to weaken it.
  We need to secure these smart policies to protect future Americans 
from the start.
  Madam Speaker, I urge my colleagues to support the Affordable Care 
Enhancement Act.
  Ms. FOXX of North Carolina. Madam Speaker, I yield 2 minutes to the 
gentleman from North Carolina (Mr. Murphy).
  Mr. MURPHY of North Carolina. Madam Speaker, I rise today in 
opposition to H.R. 1425.
  To be honest, I am a little bit baffled. We are in the midst of a 
global pandemic the likes of which this world has not seen in over 100 
years, but sadly enough, my Democratic colleagues think it is a good 
idea to pass a law that would handcuff the ability of industry to 
create a vaccine and medicines to fight this disease.
  Are you kidding me?
  The price controls and regulations proposed in this bill completely 
eliminate any incentive for these drug developers to spend money to 
invent new drugs. Can you imagine any company, pharmaceutical or not, 
being taxed at the rate of 65 to 95 percent of what they make?
  We need the next remdesivir or dexamethazone to save people's lives, 
and such policy would not allow this to happen.
  What has happened in the past because of overregulation of industry 
in the U.S.? These companies have left the U.S. and gone where? Gone to 
China. How has that worked out for us during this pandemic? China has 
thus had a stranglehold on this Nation when it comes to the drugs that 
we need.
  At a time of national consensus that we need to purchase fewer drugs 
from China, the Democrats want to ensure that more of them are 
developed there and that we have to respond to them. This is insanity.
  Madam Speaker, make no mistake: I absolutely do agree that the costs 
of drugs in this country are too high. I am a physician. I still 
practice. I still see patients when we are back in our districts, and 
this is their number one complaint. But there are bipartisan and 
commonsense measures that we can implement to decrease the cost of 
drugs.
  Like I have said many times before, if we want to lower the cost of 
drugs, we need pharmacy benefit manager reform. We are the only country 
in the world that allows these middlemen to drive up costs. They cost 
this Nation over $800 million a year in unnecessary drug costs.
  This is a bipartisan and commonsense reform, rather than this 
nonsense

[[Page H2635]]

legislation, that we can work on together to decrease the cost of 
drugs.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 2 minutes to the 
gentleman from Connecticut (Mr. Courtney), a distinguished member of 
the Committee on Education and Labor.
  Mr. COURTNEY. Madam Speaker, today, we vote on this bill that 
improves the Affordable Care Act by cutting the cost of healthcare for 
families at an unprecedented, anxious time in American life.
  More than 2.5 million Americans have been diagnosed with COVID-19. In 
the insurance world, that means millions more with a preexisting 
condition.
  Astonishingly, in the midst of this healthcare emergency, when we 
should be protecting coverage, the Trump administration, last week, 
asked the Supreme Court to strike down the entire ACA.
  If Mr. Trump has his wish, those 2.5 million Americans, along with 
130 million others with preexisting conditions, will lose the landmark 
pro-patient protection that has been on the books for the past 10 
years, namely, the right to health coverage even if you have been sick 
before and the confidence and serenity to know that you won't be 
charged more because of an illness in your past.
  It is right there on the first page of the ACA, section 2704: 
``Prohibition of preexisting condition exclusions or other 
discrimination based on health status.''
  Yet, the administration in its brief filed with the U.S. Supreme 
Court a few days ago says: ``The entire ACA must fall.'' That is a 
verbatim quote.
  Well, Madam Speaker, if the ACA falls, preexisting condition 
protections fall with it, along with age-26 coverage for dependent 
children and the elimination of lifetime limits on health coverage, 
which will devastate patients with chronic illness.

                              {time}  1300

  Last night, The Wall Street Journal reported that the President once 
again admitted that neither he nor his Senate majority have the 
slightest clue what their plan is if their wrecking ball of the ACA 
succeeds.
  Madam Speaker, during the last 4 months' avalanche of layoffs, 
millions of Americans have desperately reached out to their State's ACA 
exchanges in search of health coverage after losing job-based 
insurance, 54,000 just in Connecticut alone.
  At this time of severe economic uncertainty when a deadly virus is 
ravaging communities both rural and urban, we must do everything in our 
power to strengthen health insurance and make it more affordable, which 
this bill does. To shrink from this challenge and roll back the clock 
on 10 years of progress would be a complete dereliction of duty.
  Vote ``yes'' on this bill.
  Ms. FOXX of North Carolina. Madam Speaker, I yield 1 minute to the 
gentleman from North Carolina (Mr. Bishop).
  Mr. BISHOP of North Carolina. Madam Speaker, I thank the gentlewoman 
for yielding.
  Madam Speaker, Democrats present a false choice: either support the 
expansion of an already-failed, government-run healthcare scheme, or 
let people go without healthcare. They want you to think that 
Republicans and the Trump administration have no ideas about how to 
expand coverage--not the case.
  One of the first bills I introduced after joining last September was 
the Increasing Health Coverage through HRAs Act. My legislation would 
codify the Trump administration's rule allowing employers to fund 
health reimbursement arrangements for their employees.
  Thanks to President Trump, these HRAs can now be used to purchase 
individual market coverage. That change is expected to lead to covering 
800,000 more people, all without costly and counterproductive 
government mandates.
  The American people want more choices, lower costs, and increased 
access to care, not a continued government takeover. I urge Members to 
vote against H.R. 1425 and for Democrats to work with Republicans on 
commonsense proposals like mine.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 1 minute to the 
gentlewoman from Oregon (Ms. Bonamici), the chair of the Subcommittee 
on Civil Rights and Human Services.
  Ms. BONAMICI. Madam Speaker, this is the 10th anniversary of the 
Affordable Care Act. Over the past 10 years, our country has made 
significant progress in improving access to affordable healthcare--
despite the Trump administration's constant assault on the ACA.
  Now, in the middle of an unprecedented global health crisis, the 
administration is in court trying to get rid of the ACA, including its 
critical protections for people with preexisting conditions. This 
threatens the health coverage of more than 20 million Americans, nearly 
half a million of them Oregonians.
  The coronavirus pandemic has been devastating for those with 
underlying conditions, disproportionately harming Black and Latinx 
people in communities of color. We should be doing all we can to expand 
access to affordable healthcare for everyone, not take it away.
  I strongly support the Patient Protection and Affordable Care 
Enhancement Act. This bill will increase coverage, lower costs, and 
make quality care more accessible for all.
  I urge my colleagues to join me in supporting this important 
legislation to keep millions of Americans covered and build on the 
legacy of the Affordable Care Act.
  Ms. FOXX of North Carolina. Madam Speaker, I yield 2 minutes to the 
gentleman from Alabama (Mr. Byrne).
  Mr. BYRNE. Madam Speaker, I thank the distinguished ranking member 
for yielding.
  Madam Speaker, to borrow a line from President Reagan: Here we go 
again.
  In the midst of a nationwide pandemic where there is so much work we 
should be doing for the American people, the Democrat majority has 
again brought a partisan messaging bill to the floor of the House that 
is dead on arrival in the United States Senate.
  As the majority knows, this bill includes numerous provisions that 
are nonstarters for Republicans in any legislation related to 
healthcare, including: expanding ObamaCare, no protections against 
taxpayer-funded abortion, the rolling back of numerous Trump 
administration regulations that have made health insurance more 
affordable, and financial penalties for States that don't expand 
Medicaid.
  Certainly, it seems bad timing to be enacting legislation that the 
nonpartisan Congressional Budget Office has already confirmed will lead 
to fewer new drugs on the market, but the Democrats have again included 
their socialist prescription drug bill in this legislation.
  Madam Speaker, there are real areas where we could be working 
together to find common ground in healthcare. There could be common 
ground on reinsurance.
  Six months ago, Republicans suggested over 40 bipartisan prescription 
drug provisions we could actually enact that would encourage innovation 
and groundbreaking new cures and promote low-cost options for patients. 
We are still waiting on Speaker Pelosi to take up that package of 
bipartisan bills.
  The truth is Democrats are not actually interested in finding 
solutions. They are interested in ramming political legislation through 
the House in an effort to influence the 2020 Presidential race and 
decry additional controversies for Democrat House Members to run on.
  Republicans are ready to have a serious conversation about making 
healthcare more affordable and accessible, but just like with police 
reform last week, the other side is not.
  The American people are ready for us to get back to working for them.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 2 minutes to the 
gentlewoman from Pennsylvania (Ms. Wild), a distinguished member of the 
Committee on Education and Labor.
  Ms. WILD. Madam Speaker, I thank the chairman for yielding.
  I rise in support of the Patient Protection and Affordable Care 
Enhancement Act, which builds upon the achievements of the ACA, 
including its coverage of an additional 20 million people.
  I am glad to see that the bill includes the tenets of H.R. 3, 
allowing the HHS to negotiate prescription drug prices rather than 
continuing to pay the outrageous prices set by companies that

[[Page H2636]]

have long blocked competitors from the market.
  With the limited time I have to speak, though, I would like to 
highlight my appreciation that it includes my bill, the Family Health 
Care Affordability Act, which fixes the family glitch in the ACA.
  Under the Affordable Care Act, workers are to have access to 
affordable healthcare plans, defined as healthcare plans that cost no 
more than 9.56 percent of the employee's monthly household income. But 
the interpretation of ``affordable'' only looks at whether coverage is 
affordable to cover the employee, not whether it is affordable to cover 
spouses and dependents.
  When factoring in the family unit, coverage can easily surpass 25 
percent of household income and still be deemed affordable and block 
the family from marketplace subsidies. This bill fixes that and makes 
sure that hardworking families have access to coverage without risk of 
financial ruin.
  I call on my colleagues to pass this important bill.
  Ms. FOXX of North Carolina. Madam Speaker, I yield 2 minutes to the 
gentleman from Michigan (Mr. Walberg).
  Mr. WALBERG. Madam Speaker, thanks to my chairman in exile.
  Madam Speaker, I rise in opposition to H.R. 1425, the slow 
coronavirus cures act.
  There are many problematic provisions in this bill, but, ultimately, 
it is yet another political ploy that will not be considered in the 
Senate or become law, and we don't want it to be because it is not 
good.
  This bill is a step toward nationalizing the drug industry and 
opening the door to one-size-fits-all, government-controlled rationing 
of prescription drugs.
  Governments don't negotiate; they dictate.
  The radical approach taken by H.R. 1425 includes troubling and 
unprecedented government interference in private, market negotiations, 
which will eliminate choice and competition and jeopardizes innovation 
and access to future cures.
  Countries that have adopted drug pricing systems like the one 
proposed in this bill face decreased access to innovative new 
medicines, increased wait times for treatment, and supply shortages for 
in-demand drugs. The bill will negatively impact investment and 
research and development of future treatments, putting breakthrough 
cures for diseases like Alzheimer's, cancer, and sickle cell disease at 
risk.
  At a time when we have the best minds urgently working on a vaccine 
for COVID-19, why would we want to slow down the development of 
lifesaving medications? Congress should be putting in place policies to 
incentivize difficult research and development for these rare and 
devastating diseases, not discouraging it.
  I stand ready to work with my Democrat colleagues and advance 
bipartisan legislation that would lower healthcare and drug costs 
without sacrificing innovation.
  But that is not the bill before us today. Sadly, like last week's 
police reform bill, the majority is once again focused on messaging, 
not legislating, and that is too bad.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 2 minutes to the 
gentlewoman from Georgia (Mrs. McBath), a distinguished member of the 
Committee on Education and Labor.
  Mrs. McBATH. Madam Speaker, I thank the chair for yielding.
  Madam Speaker, I rise today in support of H.R. 1425, the Patient 
Protection and Affordable Care Enhancement Act.
  As a two-time breast cancer survivor, I know how important it is to 
have access to quality, affordable healthcare, especially for those 
like me who have preexisting conditions.
  This pandemic has shown us that every American needs access to 
quality, affordable healthcare. Many Americans have lost their 
employer-sponsored insurance and found affordable health coverage 
outside of their grasp, outside of their own reach.
  The Patient Protection and Affordable Care Enhancement Act 
incentivizes Medicaid expansion, improves Medicaid coverage, fixes the 
family glitch, and ensures that every American has access to quality, 
affordable healthcare. That is our right. That is our right as 
Americans, to have affordable healthcare, to be able to take care of 
our loved ones, take care of ourselves and live a good, sustainable 
quality of life.
  There is so much work that needs to be done, but this legislation 
truly takes important steps to ensuring that every American has the 
ability to be able to have access to health coverage.
  Madam Speaker, I urge my colleagues across the aisle to vote ``yes.''
  I am a preexisting condition, and in my district there are over 
300,000 people like me who have preexisting conditions--45,000 of those 
in my district are children under the age of 17--and we deserve to be 
cared for, and we deserve to have a good quality of life afforded by 
affordable and good, quality healthcare.
  Ms. FOXX of North Carolina. Madam Speaker, I yield 5 minutes to the 
distinguished gentleman from Tennessee (Mr. David P. Roe).
  Mr. DAVID P. ROE of Tennessee. Madam Speaker, I rise today in 
opposition to H.R. 1425, which doubles down on the flawed premise 
underlying the ACA and threatens access to lifesaving treatments in the 
middle of an ongoing public health epidemic.
  All of us agree in this country that there is a dire need for 
healthcare reform. Our current system costs too much, is too complex, 
and often doesn't promote quality or value. This hasn't changed since 
the ACA was first passed into law.
  Remember, the premise of the ACA was to lower costs and increase 
access. The scheme that the Democrats set up to accomplish this was an 
individual mandate to force people to purchase insurance they sometimes 
couldn't afford, a requirement for all plans to cover government-
mandated essential health benefits--10 of them, to be exact--community 
rating to drive costs up for the youngest consumers, and massive 
subsidies that, today, are available to families of four with incomes 
as much as $104,000.
  In addition, the bill requires States to greatly expand their 
Medicaid programs, a requirement that was subsequently mitigated by the 
Supreme Court.
  What are the results? The CBO estimated 4 million individuals would 
receive coverage through the ACA. In reality, approximately 9 million 
received coverage, 80 percent of whom are on a highly subsidized plan. 
Costs exploded, as they tend to do with highly subsidized care, and 
plans responded by raising copays and deductibles.
  I said it before and I will say it again: If you have a $5,000 out-
of-pocket, Madam Speaker, for most folks, you don't have insurance; you 
have a card.
  Meanwhile, the competition and plan choice that was promised never 
materialized. Plan options have decreased over time.
  Seventy-five percent of the increases in coverage most likely would 
have occurred with two reforms: allowing individuals to stay on their 
parents' plan until age 26, which I agree with, and a simple Medicaid 
expansion.

                              {time}  1315

  Here we are again. Democrats appear to have learned none of the 
lessons that have become plainly evident since they passed their first 
government takeover of healthcare. Today we are considering legislation 
that will significantly expand premium subsidies for ACA insurance 
while prohibiting the 1332 waivers from States designing their own 
plans for their populations' unique needs.
  One of the best examples of these waivers is Maryland--hardly a 
conservative State--which reduced premiums for its residents an average 
of 13 percent in 2019 and an average of 10 percent in 2020. The 
Democrats want to block this. I have no Earthly idea why.
  That is not all.
  The most outrageous aspect of this legislation is that it would 
offset the cost expansion of the ACA by allowing government bureaucrats 
to set drug prices. This is a provision that--if it sounds familiar, it 
is, because it was the heart and soul of H.R. 3, the Democrats' flawed 
drug pricing plan from December--that would have reduced access to new 
lifesaving treatments. Every study that examined H.R. 3 concluded that 
it would stop cures from coming to market. They only disagreed on how 
many cures it would stop. Our country currently leads the way in 
bringing new medications to market. It would save lives and improve 
patients' quality of life.

[[Page H2637]]

  In fact, at this very moment American innovators are working at light 
speed to develop and mass-produce a COVID vaccine. The idea of passing 
legislation that discourages this type of innovation is absurd.
  My first in-patient pediatric rotation in medical school in Memphis 
was at St. Jude's Children's Hospital. At that time, Madam Speaker, 80 
percent of those children that I saw died. Today, 80 percent of those 
children live. If we don't stifle innovation, my prayer is that 100 
percent of these children will survive in the future.
  While Democrats continue to double down on the failure of ObamaCare, 
the Trump administration has been working to implement reforms that 
actually work and has acted aggressively in these last few months, in 
particular, to modernize our healthcare system and ensure patients 
continue receiving care during this pandemic. The Trump administration 
has been working to give patients new insurance options through short-
term plans which cover only benefits essential to that patient. They 
have a potentially game-changing rule to increase transparency in 
hospital prices. They have expanded telehealth in Medicare--which I use 
today--given States the authority to experiment with plan design and 
encouraged States to innovate with their Medicaid programs.
  This should be a time for Congress to work together and pursue 
patient-centered policies that will ensure we have a strong healthcare 
system to come back to. I hope my Democratic colleagues will work with 
Republicans in a bipartisan manner to advance policies that increase 
access to quality care, lower costs for all Americans, and put patients 
back in charge of their healthcare decision-making.
  Madam Speaker, I, once again, urge my colleagues to vote against H.R. 
1425.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 1 minute to the 
distinguished gentlewoman from California (Ms. Pelosi), who is the 
distinguished Speaker of the United States House of Representatives.
  Ms. PELOSI. Madam Speaker, I thank the gentleman for his tremendous 
leadership in bringing this important and historic legislation to the 
floor. He has been a part of advancing lower costs for healthcare and 
better benefits for all Americans in his career in Congress. I thank 
Mr. Scott for his tremendous leadership as chair of the Education and 
Labor Committee and for the opportunity he is giving us today. I salute 
the gentleman and Chairman Pallone, the chair of the Energy and 
Commerce Committee, who has played such an important role in all of 
this, as well as Mr. Richard Neal, chair of the Ways and Means 
Committee, so much an important part. These three committees of 
jurisdiction and the members of their committees have been so essential 
to its excellence and to its success.
  I also salute our freshmen who have been leading the charge to lower 
healthcare costs and strengthen healthcare protections every step of 
the way from the first day they arrived in the Congress.
  In the election of this past 2018, Democrats made a pledge to the 
American people. For the people we would do three things. For the 
people we would lower the cost of healthcare by lowering the cost of 
prescription drugs and preserving the preexisting medical condition. We 
are doing that today.
  For the people we would not only lower healthcare costs, we had 
bigger paychecks by building the infrastructure of America in a green 
way with good paying jobs. We will be doing that the rest of the week.
  For the people we would be having cleaner government, and that is 
what we did the end of last week with the Justice in Policing Act, as 
well as part of our H.R. 1, voting for statehood for the District of 
Columbia. There is certainly more to come on the cleaner government 
front as we fight for voting at home and removing obstacles to 
participation.
  But here today we are focused on that first for the people priority. 
Access to affordable care is a matter of life and death. That is so 
self-evident as we see every day during the COVID-19 crisis which now 
has killed more than 125,000 Americans, infected over 2.5 million 
Americans, and left tens of millions of people without jobs.
  As Dr. Martin Luther King, Jr. once said: ``Of all the forms of 
inequality, injustice in health is the most shocking and most inhuman 
because it often results in physical death.'' Yes. As lives and 
livelihoods are shattered by the coronavirus, the protections of the 
Affordable Care Act are more important now than ever, and this is a 
health justice issue.
  Democrats with this bill will strengthen America's health and 
financial security during this time of crisis and for years to come. It 
lowers Americans' healthcare coverage costs: Significantly increasing 
the Affordable Care Act's affordability subsidies to be more generous 
and cover more middle class families. It negotiates lower prescription 
drug prices: Drawing from our H.R. 3 legislation to ensure that 
Americans no longer have to pay more for our medicines than Big Pharma 
charges for the same drugs overseas.

  This has been a long-term goal of Democrats in the Congress. In 2006 
when we were running and won the majority, our For the People 
equivalent agenda was a new direction for America, Six for '06, and we 
had six bills that we said we would pass immediately upon obtaining the 
majority. We passed all six of them in the House of Representatives. 
Five of them became law. Only one of them did not, the law enabling the 
Secretary of HHS to negotiate for lower prescription drug prices. This 
has been a fight over the years we continue to make because it is 
central to not only the health but the financial health security of 
America's working families.
  In addition, this legislation expands coverage and pushes holdout 
States to adopt Medicaid expansion for the 4.8 million cruelly excluded 
from the coverage.
  It combats inequity in health coverage faced by communities of color, 
expands more affordable coverage to vulnerable populations, and fights 
the maternal mortality epidemic.
  And it cracks down on junk plans which are such a rip--let me just 
pay you all the time for my health insurance but you won't be there for 
me when I need care. So it cracks down on those junk plans and 
strengthens protections for people with preexisting conditions.
  What is interesting in this whole debate is to hear the President and 
Members on the other side of the side say that, oh, they are all for 
protecting preexisting conditions.
  Oh, really?
  Then why are you in the Supreme Court of the United States to 
overturn them?
  Now, just back to this bill. According to analysis from the Center 
for Budget and Policy Priorities, our legislation that we have on the 
floor today will help lower the costs for well over 17 million more 
Americans and safeguard the Affordable Care Act's lifesaving 
protections for 130 million Americans with preexisting conditions.
  When they say they are for allowing people with preexisting 
conditions to get coverage, they don't say at what cost. This is one of 
the biggest differences--well, with stiff competition--but one of the 
biggest differences between Democrats and Republicans on healthcare for 
Americans. We guarantee affordability and protect the preexisting 
medical condition as not being an obstacle to access. They are in Court 
trying to overturn it.
  Sadly--and this is a stark contrast, as I point out--as Democrats 
unveiled our lifesaving legislation last week, President Trump went to 
the Court doubling down on his lawsuit to tear down the ACA and 
dismantle every one of its protections, including the preexisting 
medical condition benefit. At a time when families need healthcare more 
than ever, the President is trying to strip protections from about 130 
million Americans with preexisting conditions and take coverage away 
from 23 million Americans. That does not even go into what he is trying 
to do to the enhanced benefits that all Americans with healthcare 
enjoy.
  We need to build on the progress of the Patient Protection and 
Affordable Care Act to lower health costs and prescription drug prices, 
not rip away American healthcare in the middle of a pandemic.
  What sense does that make?
  On day one of this Congress led by Representative Colin Allred, the 
House voted to throw our full legal

[[Page H2638]]

weight into defending this lawsuit. Yet more than 190 Republicans have 
voted against that resolution, choosing to be fully complicit in the 
President's attempt to tear away health protections. We continue to 
call on the President to abandon his lawsuit to destroy the Affordable 
Care Act and urge him instead to call on the 14 States who have refused 
to expand Medicaid to do so.
  Doesn't it just make sense at the time of a pandemic? It is always 
important.
  It would have been amusing if this were not so deadly serious to hear 
Senator Cornyn say: Well, these people who have lost their jobs because 
of this pandemic could always sign up for the Affordable Care Act.
  Really?
  But he is trying to take it down.
  The administration has a responsibility to defend the law of the 
land, not to tear it down. Today, Members of Congress have a choice to 
strengthen America's healthcare protections and lower healthcare costs 
or to be complicit--once again, I use that word--in President Trump's 
campaign to dismantle families' healthcare. Make no mistake. A vote 
against this bill is a vote to weaken America's health and financial 
security during a pandemic.
  When I was growing up, I remember my mother used to always say: If 
you don't have your health, you don't have anything.
  Health is so central. As you see, the American people place a high 
value on it when they say they don't want to go out too soon to 
jeopardize their health or the health of those they have at home.
  So, in every language when people salute each other they salute 
people to their health. The Spanish say salud, the Dutch say proost, 
the French say sante, the Germans say prost, the Irish say--now, this 
is hard because Gaelic is a hard language--slainte, the Italian I can 
say better, salute, and in Hebrew it is l'chaim.
  It is all about life and health. That is the salute. Everybody knows 
it is centrally important. With this bill Democrats in the House are 
offering our salute to good health to the American people, and we hope 
the Republicans will join us in that salute to good health to the 
American people.
  Madam Speaker, I urge a strong vote for the Patient Protection and 
Affordable Care Enhancement Act for the people, for the children, and 
for the future.

                              {time}  1330

  Ms. FOXX of North Carolina. Madam Speaker, I yield 2 minutes to the 
gentleman from Georgia (Mr. Allen).
  Mr. ALLEN. Madam Speaker, I am really disappointed with, once again, 
my colleagues across the aisle using this COVID-19 crisis as an 
opportunity to push their partisan agenda. You would think a crisis 
like this would bring us together.
  And this thing is going nowhere. H.R. 1425 is nothing more than 
another government power grab in an attempt to double down on the 
failed policies of ObamaCare.
  Remember the promise that was made to lower your premiums? Yet, they 
have skyrocketed. Not only does this bill rescind the Trump 
administration's rule on short-term, limited duration insurance, which 
aims to provide relief from rising premiums and flexibility for 
consumers, it also implements government price-setting for drugs.
  The American people want choice, not one-size-fits-all, top-down, Big 
Government programs. Why in the world would you send a hard-earned tax 
dollar to Washington and maybe get 20 cents back to take care of a 
patient?
  Madam Speaker, I made a promise to the people of Georgia's 12th 
District that I would fight to lower drug prices, and this bill would 
lead to drug price hikes and shortages. Under this proposal, the 
Secretary of HHS would be required to set government rates for a number 
of lifesaving drugs, like insulin. The CBO estimates that price-setting 
policies like these will result in fewer cures and treatments coming to 
the market.
  H.R. 1425 would expand ObamaCare after we spent years working to roll 
back the burdensome mandates that the American people cried out for 
Congress to repeal.
  As I said, the American people want choice. My Democrat colleagues 
have allowed the far-left radicals within their party to take over 
their agenda.
  Let's be clear what the Democrats want here. They want the government 
to be in charge of your healthcare, of everyone's healthcare. Democrats 
believe they and their fellow bureaucrat friends know what is best for 
your healthcare, not your doctor. I can tell you right now that, in my 
district, we know better and can see right through these schemes.
  Now more than ever, for the sake of our country, we must come 
together to provide real healthcare solutions, not far-left political 
messaging bills. Unfortunately, it is business-as-usual here for the 
Democrats, putting policies over country.
  Madam Speaker, I urge my colleagues to oppose this bill.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 2 minutes to the 
gentlewoman from Washington (Ms. Schrier), a distinguished member of 
the Committee on Education and Labor.
  Ms. SCHRIER. Madam Speaker, I thank the chairman for yielding.
  Madam Speaker, I rise in support of the Patient Protection and 
Affordable Care Enhancement Act.
  As a pediatrician, and a patient with type 1 diabetes, I know how 
important it is to have real access to healthcare. The Affordable Care 
Act was a phenomenal first step. It provided protection for 26 million 
Americans with preexisting conditions who otherwise would not have had 
access to health insurance, made sure young people were covered until 
age 26, and designated primary care and access to birth control as 
essential.
  Of course, it was imperfect. It was intended to be a first step. Now, 
with 10 years of experience, we know how to improve it by addressing 
the serious issues of cost and access.
  The Patient Protection and Affordable Care Enhancement Act does just 
that, with a special emphasis on children and communities of color who, 
for too long, have faced health disparities.
  Also, with this bill, a family of four in my district would save an 
estimated $8,000 a year on health insurance. This legislation provides 
permanent funding for the Children's Health Insurance Program so that 
children will be able to get healthcare they need right from the start. 
I am particularly excited that this bill also includes the Kids' Access 
to Primary Care Act, a bipartisan bill I introduced to expand primary 
care access for children and families on Medicaid.
  By matching Medicaid reimbursement rates to higher Medicare rates, 
Medicaid patients will have access to more physicians, and children 
will get the care they need when they need it from their very own 
primary care physician. That kind of access to care should not depend 
on ZIP Code, income, or skin color.
  The toll this pandemic has taken on already disadvantaged communities 
drives home the need for everyone to have affordable access to the care 
they need. That is why this bill, the Patient Protection and Affordable 
Care Enhancement Act, is so important.
  No family should ever face bankruptcy because of medical expenses. As 
one of the few doctors in Congress, I will always work to ensure that 
everyone can afford the care they need.
  Ms. FOXX of North Carolina. Madam Speaker, I yield 2 minutes to the 
gentleman from Pennsylvania (Mr. Smucker).
  Mr. SMUCKER. Madam Speaker, I start by wishing the ranking member of 
the committee a very happy birthday and a wonderful day.
  Madam Speaker, I rise today in opposition to H.R. 1425.
  I do agree with my colleagues on both sides of the aisle that we need 
to enact reforms that will make health insurance and access to care 
more affordable. I also agree that we need to protect individuals with 
preexisting conditions. But the approach under the legislation being 
debated today will not bring us closer to a better-functioning 
marketplace. It is like putting a Band-Aid on a broken system.
  To truly lower the costs of insurance and care, we need to address 
the underlying cost drivers of healthcare. Yet, the legislation before 
us today ignores what is driving prices higher. Instead, it 
broadens government subsidies to

[[Page H2639]]

more individuals, including the wealthy, so that, on its face, the 
price of insurance looks cheaper. But don't be fooled by generous tax 
credits. These credits will be paid for by all taxpayers when they are 
passed along to hardworking families in the form of higher taxes.

  Madam Speaker, I would welcome the opportunity to work with my 
colleagues on the other side of the aisle on real reforms that will 
increase choices for insurance and care options; that will cut through 
healthcare monopolies to increase competition in the marketplace; that 
will allow for more personalized plans that will better target 
taxpayer-funded subsidies to the poor, the sick, and the vulnerable, 
not high-earning individuals; and that would enable a system that 
fosters innovation in patient care, not stifle it through burdensome 
government mandate.
  Before I close, I want to touch on my colleagues' decision to include 
the same government-controlled drug-pricing scheme in this patchwork of 
stale proposals that was passed a few months ago. At a time when the 
world is fighting to emerge from a global pandemic, my colleagues on 
the other side of the aisle believe it is an appropriate time to raise 
taxes on lifesaving cures by 95 percent.
  We have already worked, in a bipartisan manner, on policy ideas that 
we all agree will help lower drug prices. Each of those policies was 
included in H.R. 19, the Lower Costs, More Cures Act.
  Madam Speaker, I hope, one day, we can set the shenanigans aside and 
bring real reforms, like those included in H.R. 19, up for 
consideration.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 1 minute to the 
gentleman from Maryland (Mr. Hoyer), the distinguished majority leader 
of the United States House of Representatives.
  Mr. HOYER. Madam Speaker, I thank the gentleman for yielding.
  Madam Speaker, I have only been on the floor a short time, but I am 
sure there have been the repeated opposition statements that: ``Oh, if 
only we could get agreement.'' ``If only we could do this, we would 
have a wonderful healthcare program.''
  Madam Speaker, frankly, my friends on the other side of the aisle 
have had 12, 14 years, at least, to come up with a program.
  Madam Speaker, they did come up with a program, and they passed it 
through the House--they were in charge--and it went to the Senate. The 
Republicans were in charge of the Senate.
  When they passed it through the House, they all went down to the 
White House, and they had a big party. ``What a wonderful deal this 
is.'' Lo and behold, within 2 weeks, the President, who was extolling 
that bill, called it a ``mean'' bill.
  That is not me. That is the President of the United States about the 
bill that he was celebrating with his Republican colleagues.
  The Republicans talk a good game, but they don't play a game. It is 
not that they don't play a good game. They don't play a game. There is 
no bill coming from the President of the United States.
  Madam Speaker, last week, in the middle of the worst pandemic in our 
lifetimes, the Trump administration submitted briefs to the Supreme 
Court in support of a lawsuit by Republican-led States seeking to 
overturn the law that provides millions of Americans with access to 
affordable healthcare. They offer no substitute. They said they were 
going to, but they have never done it.
  In spite of a decade of Republican efforts--a decade, 10 years--they 
have had to work on this and come up with a plan that all of them are 
talking about--``Oh, we want to protect preexisting conditions.'' ``We 
don't want to have lifetime limits''--you know, all these things.
  Where is the bill? Where is the meat? It is not here. It hasn't been 
offered. The one bill that was offered and passed in this House was 
called by the President of the United States a ``mean'' bill.
  Not our President, their President--I mean, he is the President of 
all of us, but he is a member of the Republican Party, just like Obama 
was a member of the Democratic Party.
  We passed an alternative. It was signed, and the majority of the 
American people supported it. As a matter of fact, 53 percent of 
independents supported it.
  Madam Speaker, when the Supreme Court hears oral arguments in the 
Republican lawsuit this autumn--in the Republicans' lawsuit; these are 
Republican AGs--it will hear their arguments for taking away 
protections for those with preexisting conditions, those most 
vulnerable to COVID-19, at the very moment healthcare experts predict 
another wave of infections and the start of the flu season. And where 
do we see the spike? Along the southern border: Texas, Florida, 
Arizona.
  Madam Speaker, taking away Americans' coverage and throwing our 
healthcare system into chaos is not what the American people want or 
need during this global public health and economic crisis. When 
President Trump ran for office--this was before he called the bill that 
the House passed a ``mean'' bill, under Republican leadership--
President Trump falsely promised that he would offer an alternative to 
the Affordable Care Act that was far less expensive and better quality.
  Madam Speaker, I ask any of my colleagues if they have seen that 
bill, either side of the aisle, have they seen that bill. This 
President has been President for 3.5 years. There is no Republican bill 
to make sure that Americans have affordable quality healthcare and have 
them able to get insurance irrespective of preexisting conditions. 
There is no such legislation.
  Now, having failed to produce an alternative, the President and his 
Republican allies are determined simply to repeal it entirely. That has 
been their position for the last 12 years.
  I am proud that one of the first acts of our Democrat House majority 
was to defend the ACA in the Republican lawsuit. Indeed, Americans 
don't want to scrap the law. They want to strengthen and expand it.
  They understand that it is not an option, having healthcare coverage. 
Protecting your health is not an option.

  When Democrats won the majority in the House, we did so promising to 
work to expand coverage, lower out-of-pocket costs, and provide greater 
stability for health insurance marketplaces. That is what we promised, 
and we picked up 40 net seats. This bill is part of that promise.
  Now, we passed another one. It sits untouched in the Senate, as some 
of my Republican colleagues predict for this one. I understand that. 
The Republicans are not for healthcare being affordable, being quality, 
being accessible for people. At least, they haven't offered a bill to 
accomplish that objective, notwithstanding what the President said.
  Importantly, among the other provisions that you have heard about 
from my colleagues this morning, this legislation addresses the racial 
disparities in healthcare that have become so starkly evident during 
this pandemic. Expanding Medicaid will help close those disparities, 
and the bill's provision to require Medicaid coverage of maternal 
healthcare for 12 months postpartum will help reduce disparities that 
make African-American women as much as four times as likely to die as a 
result of a birth or pregnancy complication than White women.
  Those disparities aren't acceptable, and our House majority is taking 
action to address them.
  Madam Speaker, I congratulate Mr. Scott. I congratulate Mr. Pallone. 
I congratulate Mr. Neal. And I congratulate Speaker Pelosi.
  Moreover, this bill would require the Secretary of Health and Human 
Services to negotiate over the most expensive prescription drugs that 
do not have marketplace competition, that do not have market 
competition. That is what keeps prices down, consumers having choices. 
If they don't have choices, they have to take the drug, no matter what 
it costs, which is a key component to lowering prices.
  That said, I want to be clear that, while we use international 
measures, we will continue to work with the patient and disability 
community to ensure that our efforts to reduce out-of-pocket costs do 
not have the unintended result of rationing lifesaving and life-
sustaining treatments or discriminate against our most vulnerable 
communities.
  Madam Speaker, I thank all the chairs and their committees that came 
together to produce this bill. I have

[[Page H2640]]

mentioned Chairman Pallone, Chairman Scott, Chairman Neal, and others, 
and I thank all the Members who were instrumental in bringing these 
policies together, including the many freshman Members who ran on 
strengthening the ACA.
  I see Ms. Underwood on the floor, but there are many others in the 
freshman class who have worked very hard. Why? Because they campaigned 
on For the People, bringing costs down.
  I urge every Member of the House to join in supporting this bill. Now 
is the time, Madam Speaker, to strengthen access to high-quality, 
affordable healthcare, to bring costs down, and to address the stark 
racial disparities in our healthcare system that have come into full 
view with COVID-19.
  I urge all my colleagues on both sides of the aisle, if your rhetoric 
is about bringing costs down, if your rhetoric is about accessibility, 
if your rhetoric is about equality, walk the walk; don't just talk the 
talk. Vote for this bill, because it does what you say you want to do.

                              {time}  1345

  Ms. FOXX of North Carolina. Madam Speaker, I reserve the balance of 
my time.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 2 minutes to the 
gentlewoman from Illinois (Ms. Underwood), a distinguished member of 
the Committee on Education and Labor.
  Ms. UNDERWOOD. Madam Speaker, I rise today in strong support of the 
Patient Protection and Affordable Care Enhancement Act.
  Last June, I visited Kaylee Heap at her family's farm in Minooka, 
Illinois. Mrs. Heap told me: It would be really nice to come home and 
work on the farm with my husband and grow our business, but I can't do 
that until we overcome the obstacle of getting quality, affordable 
health insurance.
  People like Kaylee are why I introduced legislation, the Healthcare 
Affordability Act, to improve premium tax credits to make insurance 
more affordable to more Americans, including those who don't currently 
qualify for tax credits.
  This legislation would reduce premiums by hundreds or thousands of 
dollars for nearly 20 million Americans, and I am so pleased that it 
was included in this bill today.
  This bill delivers on our promise to ensure that all Americans have 
access to quality, affordable healthcare. I urge all of my colleagues 
to support this bill and join me in this effort.
  Ms. FOXX of North Carolina. Madam Speaker, I reserve the balance of 
time.
  Mr. SCOTT of Virginia. Madam Speaker, may I inquire as to how much 
time each side has remaining.
  The SPEAKER pro tempore. The gentleman from Virginia has 11 minutes 
remaining. The gentlewoman from North Carolina has 4\1/2\ minutes 
remaining.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 2 minutes to the 
gentleman from Maryland (Mr. Trone), a distinguished member of the 
Committee on Education and Labor.
  Mr. TRONE. Madam Speaker, healthcare is a human right. The Affordable 
Care Act helped us live up to that value by giving over 20 million 
American people healthcare coverage, including millions with 
preexisting conditions.
  But still, too many Americans don't have access to good, affordable 
healthcare, and drug prices are through the roof.
  One of those Americans is Suzette from Germantown, Maryland. Suzette 
told me that her insulin prices have skyrocketed over the last year, 
making it hard to afford a drug that she needs to survive. As Elijah 
Cummings said: We are better than that.
  The Patient Protection and Affordable Care Enhancement Act will cut 
premiums in half; allow negotiations for drug prices; and expand 
Medicaid, a lifeline for many who need support for mental health and 
addiction treatment services.
  During a global pandemic, we should be acting with compassion for the 
most vulnerable in our country. This bill does just that. I urge a 
``yes'' vote.
  Ms. FOXX of North Carolina. Madam Speaker, I reserve the balance of 
time.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 2 minutes to the 
gentlewoman from Nevada (Mrs. Lee), a distinguished member of the 
Committee on Education and Labor.
  Mrs. LEE of Nevada. Madam Speaker, on behalf of the people of 
Nevada's Third Congressional District, I rise today to stand up for my 
constituents' access to healthcare and lifesaving treatments and 
support the Patient Protection and Affordable Care Enhancement Act.
  A constituent of mine, Mark, wrote to me recently. He is retired and 
on Medicare, and he is also a diabetic who requires insulin to survive. 
He told me that the cost of his insulin is going up 400 percent, with 
no warning or explanation. It is life or death for him, because he 
needs the insulin but can't afford it.
  This moment should give us all pause. Millions are out of work; 
thousands are sick and dying from a global pandemic; yet lifesaving 
medications are still out of reach for Americans who need them.
  It is unbelievable that this administration continues its campaign to 
take away people's healthcare. Seniors like Mark deserve better, 
Nevadans deserve better, and Americans deserve better.
  Medication costs, rising premiums, and junk insurance plans are 
forcing people to choose between lifesaving treatment and paying their 
bills. No one in this great country should have to make that choice.
  I urge my colleagues to vote for the Patient Protection and 
Affordable Care Enhancement Act, and give every American access to 
affordable health care.
  Ms. FOXX of North Carolina. Madam Speaker, I reserve the balance of 
time.
  Mr. SCOTT of Virginia. Madam Speaker, I yield 2 minutes to the 
gentleman from Rhode Island (Mr. Cicilline).
  Mr. CICILLINE. Madam Speaker, I thank the gentleman for his 
extraordinary leadership. I thank Chairman Scott, Chairman Neal, and 
Chairman Pallone.
  122,000 Americans have died from COVID-19, nearly 2.6 million are 
infected. And, in the midst of this deadly and historic global health 
pandemic, with infection rates continuing to rise all across our 
country, there has never been a worse time to try to rip away 
healthcare from the American people.
  But just last week, President Trump and my Republican colleagues 
filed a pleading in the Supreme Court to take away healthcare from 20 
million Americans and to gut protections for 135 million Americans with 
preexisting conditions.

  Now, more than ever, Democrats are standing up to fight to protect 
access to quality, affordable healthcare. And the Patient Protection 
and Affordable Care Enhancement Act does just that. It lowers 
healthcare costs; it protects patients with preexisting conditions; it 
expands Medicaid; and it lowers the cost of prescription drugs.
  Our colleagues on the other side of the aisle have described these 
ideas as radical. Only in the Republican Conference is expanding health 
coverage and driving down costs and covering more people with 
preexisting conditions radical. For the rest of the American people, it 
is a basic human right: access to quality, affordable healthcare. The 
Patient Protection and Affordable Healthcare Enhancement Act will do 
just that.
  My colleagues have been on a relentless campaign to repeal the 
Affordable Care Act in its entirety and promised they were going to 
repeal and replace. They have only tried to repeal. There has never 
been a replacement.
  Once again, we are stepping into the breach, building on the success 
of the Affordable Care Act in the midst of a global health pandemic to 
drive down healthcare costs, expand coverage, and protect people with 
preexisting conditions.
  I urge my colleagues to vote ``aye.''
  Ms. FOXX of North Carolina. Madam Speaker, I yield myself the balance 
of my time.
  Madam Speaker, propagandists have said that if one repeats a lie 
often enough, people will soon believe the lie and not the truth. My 
colleagues are entitled to their own opinion but not to their own facts 
or rewriting history.
  I want to repeat some comments from my Texas colleague, Mr. Brady, 
who spoke earlier in this debate.
  Republicans support children, seniors, and patients with preexisting 
conditions.
  Republicans created the popular Children's Health Insurance Program 
that millions of families rely on today.

[[Page H2641]]

  Republicans created the prescription drug program in Medicare to help 
seniors get the medicine they need.
  Republicans created the first law that established protection for 
patients with preexisting conditions. That law, passed in 1996, is the 
Health Insurance and Portability Act of 1996.
  We want people to have access to high-quality, affordable healthcare 
that fits their needs and make their own choices, not what Speaker 
Pelosi demands for them.
  Madam Speaker, the devastating effects of COVID-19 are still being 
felt across our Nation, yet today Democrats are spending time pushing a 
deeply flawed, partisan bill that is being used to score cheap 
political points instead of working on bipartisan solutions like 
lowering drug costs, ending surprise billing, and getting our economy 
back on its feet.
  We are left with H.R. 1425, a radical bill which will limit 
healthcare choices, increase costs, and double down on the failures of 
the Affordable Care Act. No innovation, investment, or solutions, just 
more of the failed status quo from House Democrats, which will go 
nowhere after the vote today.
  Contrary to what Speaker Pelosi said, Democrats do not and cannot, in 
this bill, guarantee affordability of healthcare. What they do 
guarantee is government control with rationing, fewer cures, and less 
freedom for Americans. Republicans believe in just the opposite.
  Madam Speaker, I strongly urge a ``no'' vote on H.R. 1425, and I 
yield back the balance of my time.
  Mr. SCOTT of Virginia. Madam Speaker, I yield myself the balance of 
my time.
  Madam Speaker, this bill will reduce the cost of prescription drugs. 
Americans pay twice as much, three times as much, as much as 10 times 
more than those in other countries pay for the exact same drugs. This 
bill will allow the Department of Health and Human Services to try to 
negotiate better prices.
  Those on the other side have criticized reduced prices because they 
potentially could reduce investments and research, but this bill 
offsets any such reductions with significant increases in investment in 
research at the National Institutes of Health.
  This bill makes improvements to the Affordable Care Act by reducing 
premiums, expanding coverage to families, protecting those with 
preexisting conditions, and reducing the number of uninsured.
  We have heard criticisms but no description of a better alternative.
  We have heard about the 1996 law on preexisting conditions, but that 
did nothing in the individual market. And that is what the Affordable 
Care Act protects: preexisting conditions in the individual market.
  But look at what the CBO said about the Republican bill when they had 
the majority and were able to pass a bill. They actually passed a bill 
that CBO scored, and they said that it would increase costs 20 percent 
the first year, 20-some-million fewer people would be insured, those 
with preexisting conditions would lose some of their protections, and 
the insurance you get is worse than what you have.
  We can do better than that by passing the Patient Protection and 
Affordable Care Enhancement Act, and that is what we should do today by 
voting ``yes'' on this legislation.
  Madam Speaker, I yield back the balance of my time.
  Ms. JOHNSON of Texas. Madam Speaker, today, I rise in support of H.R. 
1425, the Patient Protection and Affordable Care Enhancement Act. This 
bill will make critical improvements to our current health care system 
by ensuring affordable access to medical services and lifesaving 
prescriptions. By expanding the insurance affordability subsidies, 
establishing a federal negotiating authority for lower drug prices, and 
extending Medicaid coverage to crucial populations, this legislation 
will ensure that our communities can better withstand and recover from 
the seismic impact of this COVID-19 pandemic.
  It is inacceptable that during this public health emergency, our 
federal government should act in any manner except to strengthen and 
protect our health system. The current administration's request last 
week to the Supreme Court to overturn the Affordable Care Act threatens 
the very protections and medical services that our constituents and 
communities are relying on for life saving care during this pandemic.
  As the first registered nurse elected to Congress, I can attest to 
the importance of the Affordable Care Act in improving our country's 
health care, especially through the protections for the 133 million 
Americans living with pre-existing conditions--of which 11.5 million 
live in my home state of Texas. If our country were to lose the gains 
of the Affordable Care Act, all these individuals will have to face 
uncertain insurance markets without critical protections. It is more 
abhorrent for any efforts to be made to destabilize our health system 
during a time of crisis, especially since our communities of color are 
already facing disproportionate impacts of this virus through higher 
rates of comorbidities and higher reported rates of hospitalizations 
and deaths. To further jeopardize access to existing health care 
services amidst these compounding factors would prove devastating for 
the health and wellbeing of our minority communities.
  Therefore, I am proud to support the Patient Protection and 
Affordable Care Enhancement Act, and I am committed to fighting for the 
preservation of accessible and quality health care services for the 
families throughout North Texas.
  Ms. MATSUI. Madam Speaker, I rise today to support the Patient 
Protection and Affordable Care Enhancement Act.
  This legislation is the collective achievement of House Democrats 
from across the country who are working to reverse the Trump 
Administration's health care sabotage by updating and improving the 
Affordable Care Act.
  This bill expands eligibility for health care tax credits to purchase 
ACA plans and encourages remaining states to expand Medicaid. These 
concrete steps will provide new coverage options to those navigating 
recent job loss and economic uncertainty.
  Critically, this legislation also empowers Medicare to negotiate a 
better deal on prescription drug prices, which will bring an end to 
price gouging of American consumers and finally allow people to afford 
the drugs they need.
  As the pandemic continues to challenge our collective public health 
and well-being, now, more than ever, American families need relief from 
soaring health care and prescription drug costs.
  I encourage my colleagues to support this effort to protect patients, 
expand access, and lower health care costs.
  Mr. CURTIS. Madam Speaker, today, I rise in opposition to H.R. 1425. 
Right now, we must deliver the most effective treatments to patients 
infected with COVID-19 and all those suffering from other life-
threatening illnesses. Breaking down barriers to receiving timely care 
must remain our number one priority in order to halt transmission of 
the virus.
  H.R. 1425 does the opposite by dramatically expanding the role of 
government through unconstitutional inventions in our pharmaceutical 
industry and broader healthcare system. This would put our brightest 
scientific minds in handcuffs and threaten their ability to develop 
future cures for COVID-19 and other life-threatening diseases.
  These are especially concerning decisions to make without bipartisan 
input. We have to work together in order to deliver solutions that give 
Americans more control over how they are receiving their health care. 
Solutions could include expanding access to health savings accounts or 
association health plans to be sold across state lines and with more 
portability. I recently introduced legislation to increase access to 
both options and I encourage my Democratic colleagues to join me as I 
look for creative solutions to make health care more affordable for 
millions of hard-working Americans.
  Finally, I want to point out that Congress has already taken 
unprecedented steps to increase access to care for the uninsured and 
any American household dealing with the effects of COVID-19. It is 
critical that our focus remains defeating this virus, keeping Americans 
healthy, and allowing hard-working men and women across our great 
nation to return to work. We cannot place greater strains on our 
already over-worked health care system through one-size-fits-all policy 
making.
  Ms. ROYBAL-ALLARD. Madam Speaker, ten years ago, this March, I 
proudly cast my vote in support of the Patient Protection and 
Affordable Care Act. The ACA built on the promise that was begun with 
the passage of Medicare in 1965, which represented a milestone in our 
nation's history by framing healthcare as a universal right for all 
Americans.
  Like many of my colleagues at that time, I would have preferred to 
see the bill go much further towards granting universal access to 
health care for every man, woman, and child in this country. 
Nevertheless, it was an important first step to improving the quality 
and affordability of health services, prioritizing prevention and the 
reduction of health disparities, and taking the necessary albeit 
difficult steps to rein in the escalating costs of health care in this 
country.

[[Page H2642]]

  The intent of the Democrat Majority in the 111th Congress was always 
to build on the ACA and modify and improve its programs and policies. 
Instead, what followed was at least 70 Republican led attempts over the 
next 8 years to defund benefits, dismantle programs, and repeal parts, 
or all, of the Affordable Care Act, with no serious effort to fix 
problems or replace the critical law with a viable alternative.
  For the last three years, Democrats have watched in frustration as a 
series of misguided and meanspirited Presidential executive orders have 
slashed funding, delayed implementation of programs, and limited 
benefits for consumers. And when President Trump's ``Repeal and 
Replace'' efforts failed, his administration turned to the courts to 
declare unconstitutional all, or parts, of the ACA.
  Today, with the Patient Protection and Affordable Care Enhancement 
Act, we say ENOUGH IS ENOUGH. This important legislation will 
strengthen and expand the Affordable Care Act by including provisions 
to reduce the cost of prescription drugs, reduce the number of 
uninsured Americans, expand access to quality and affordable health 
coverage, and protect people with pre-existing conditions.
  The bill expands Marketplace tax credits to lower health insurance 
premiums and allows more middle-class individuals and families to 
qualify for subsidies. It expands Medicaid coverage for states who have 
not taken advantage of this provision and reverses the Trump 
Administration's expansion of junk health insurance plans that 
discriminate against people with pre-existing conditions. The bill also 
requires the federal government to negotiate certain drug prices to 
ensure consumers have access to affordable and fair prices for drugs 
they depend upon to live healthy and productive lives.
  According to the Congressional Budget Office (CBO), this bill would 
reduce the number of uninsured by 4 million below the current law, and 
it would lower individual market premiums by 10 percent and drug prices 
by up to 55 percent.
  Americans have overwhelmingly told us their number one concern is 
access to high quality and affordable health care. H.R. 1425 builds on 
the ACA and takes the next critical step towards reducing health 
disparities and providing more families with affordable and 
comprehensive health insurance. I am proud to vote YES for the Patient 
Protection and Affordable Care Enhancement Act.
  Mr. DeFAZIO. Madam Speaker, today I will vote in support of H.R. 
1425, the Patient Protection and Affordable Care Enhancement Act.
  I am pleased that this legislation bolsters the Affordable Care Act 
(ACA) and further protects it against years of attempts by the Trump 
administration and congressional Republicans to undermine and repeal 
this important healthcare legislation--and thus take away health 
coverage and protections from millions of Americans--all without ever 
proposing a viable replacement.
  The timing of this legislation could not be more crucial. Just last 
week, in the midst of a global pandemic that has killed more than 
120,000 Americans and threatened the health insurance coverage of 
millions more, the Trump administration filed a legal brief to the 
Supreme Court supporting a case that would fully repeal the ACA. This 
reckless and heartless move would strip healthcare coverage from an 
estimated 23 million Americans and threaten coverage for 135 million 
Americans with pre-existing medical conditions--all while delivering a 
huge tax cut to millionaires. In my congressional district alone, 
repealing the ACA would cause 72,000 Oregonians to lose their health 
insurance and threaten the coverage of 317,000 Oregonians with pre-
existing conditions. This is absurd.
  That's why I strongly support H.R. 1425's provisions to strengthen 
protections for individuals with pre-existing conditions, as well as 
its reversal of the Trump administration's expansion of junk short-term 
health insurance plans that do not provide coverage for essential 
medical treatments and drugs--and which are allowed to discriminate 
against people with pre-existing conditions. I am also pleased that 
this legislation increases healthcare coverage by delivering additional 
support for states to expand Medicaid, establish state-based health 
insurance marketplaces, and bolster efforts to increase enrollment and 
help individuals sign up for ACA coverage.
  I also strongly support this legislation's efforts to lower 
Americans' health insurance costs by expanding tax credits to reduce 
ACA marketplace premiums, placing a cap on premium costs, allowing more 
individuals and families to qualify for ACA subsidies, and providing 
funding for reinsurance initiatives to further lower premiums, 
deductibles, and other out-of-pocket costs.
  This legislation also takes long-overdue steps to help combat 
inequalities in health coverage faced by communities of color in Oregon 
and throughout the United States. This includes fighting the maternal 
mortality epidemic by requiring states to extend Medicaid or CHIP 
coverage to new mothers for 1-year post-partum; improving Medicaid 
beneficiaries' access to primary care physicians; and protecting 
vulnerable populations from losing health coverage by ensuring that 
Medicaid and CHIP beneficiaries receive a full 12 months of coverage 
once enrolled--thereby protecting them from interruptions due to 
fluctuations in their income throughout the year.
  I have always said that the ACA is not perfect, but I believe the law 
should be reformed rather than repealed. The original ACA bill that 
passed the House in 2009, with national exchanges and a government not-
for-profit option, was far superior than the final bill that became 
law. In my opinion, a government-run, not-for-profit health plan would 
have paved the way to a single-payer system with more comprehensive 
coverage at a lower cost. That's why I have once again introduced 
legislation, H.R. 1419, that would establish such a plan and bring down 
premium costs.
  I am also once again an original cosponsor of H.R. 1384, the Medicare 
for All Act, which would transition the U.S. to a universal single-
payer system to ensure that everyone has access to health insurance 
coverage, no matter their income.
  Additionally, because of pharmaceutical companies' price gouging, 
Americans pay more out-of-pocket for prescription drugs than 
individuals in any other country. Americans need lower drug prices now, 
and Congress has the ability to enact important reforms to deliver 
immediate relief.
  By incorporating provisions from H.R. 3, the Elijah E. Cummings Lower 
Drug Costs Now Act--which passed the House in December--I believe H.R. 
1425 takes some important first steps towards delivering drug price 
relief and improving the health and financial security of American 
seniors and families. Specifically, H.R. 1425 requires the federal 
government to negotiate affordable prices for at least 25--and 
eventually 50--prescription drugs, as well as insulin, every year. It 
also imposes an excise tax on drug manufacturers who do not comply with 
this affordable pricing provision.
  While I believe these provisions will ultimately deliver relief to 
millions of Americans, including seniors, I believe Congress can and 
must do more to combat rising drug prices and price-gouging 
pharmaceutical companies.
  To combat this ridiculous practice, I reintroduced H.R. 4640, the 
Affordable Drug Pricing for Taxpayer-Funded Prescription Drugs Act, 
which would end price-gouging on prescription drugs developed with 
taxpayer-funded research. Americans should not pay to develop a drug 
only to see it put on the shelves in the U.S. at a much higher price 
than other nations. I am also co-leading legislation, the Make 
Medications Affordable by Preventing Pandemic Pricegouging Act, to 
prevent price-gouging for any taxpayer-funded drug or vaccine developed 
to treat COVID-19.
  Moreover, I have consistently supported legislation to allow the 
federal government to negotiate affordable drug prices for Medicare 
Part D, and I am also cosponsor of legislation to require the federal 
government to secure affordable pricing agreements for all prescription 
drugs, as well as to approve cheaper generic versions of drugs if 
manufacturers refuse to negotiate.
  The bottom line is that seniors shouldn't have to ration their pills 
or limit their dosage because they can't afford to pay for 
prescriptions each month, and drug companies should not be free to 
charge Medicare recipients--or any American--prices that are higher 
than anywhere else in the world. These practices are wholly 
unacceptable, and I will continue fighting to ensure that every 
American can afford the prescription drugs they need.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 1017, the previous question is ordered 
on the bill, as amended.
  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.

                              {time}  1400


                           Motion to Recommit

  Mr. WALDEN. Madam Speaker, I have a motion to recommit at the desk.
  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. WALDEN. Madam Speaker, in its current form, I am.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:
       Mr. Walden moves to recommit the bill H.R. 1425 to the 
     Committee on Energy and Commerce with instructions to report 
     the same back to the House forthwith with the following 
     amendment:
       After section 2, insert the following:

     SEC. 3. EFFECTIVE DATE.

       This Act and the amendments made by this Act shall not take 
     effect unless the Secretary of Health and Human Services, in 
     consultation with the Commissioner of Food and

[[Page H2643]]

     Drugs, the Director of the National Institutes of Health, and 
     the Director of the National Institute of Allergy and 
     Infectious Diseases, certifies that no provision of this Act 
     and the amendments made by this Act will adversely affect 
     research on, development of, or approval of any drug 
     (including any biological product) intended to treat or 
     prevent infection with the virus that causes COVID-19.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Oregon is recognized for 5 minutes in support of his motion.
  Mr. WALDEN. Madam Speaker, this motion should be adopted. It would 
prevent the bill from upending the very progress we are all counting on 
for our innovators to develop new vaccines and therapies to confront 
this killer coronavirus.
  You see, it simply states the legislation cannot take effect unless 
the Secretary of Health and Human Serves certifies that no provision 
will adversely impact the research, the development, or the approval of 
any drug intended to treat or prevent COVID-19.
  Now, Democrats, with a straight face, come to the floor today to move 
a bill that would do grave damage to medical innovation. The 
Congressional Budget Office has told us that on many occasions. Upwards 
of 30 to 100 drugs, depending upon the source, could never make it into 
the pipeline. Will that be a cure for COVID or a cure for ALS or a cure 
for cancer? We don't know, and neither do the Democrats bringing it. 
But we do know the independent analyses show we will not see a lot of 
new medicines.
  So let's make sure one of those new medicines is not the cure to 
COVID or a treatment to save lives for people who are on ventilators. 
That is what our motion to recommit says: Before you move forward with 
a known innovation killer, let's at least exclude treatments and cures 
for COVID-19.
  Communities are being ravaged, we all know these stories. We all 
share them with each other about incredible damage done to lungs, 
organs, and lives as a result of COVID-19. In the wake of this public 
health crisis, medical innovators have worked at an unprecedented speed 
to develop safe and effective products so we can safely begin to open 
our country back up and eventually return to normal lives.
  We have seen public-private partnerships to a degree never seen 
before. Private companies are joining forces with competitors, 
government agencies, and nonprofits, and they have taken on substantial 
financial risk in order to bring safe and effective vaccines and 
treatment to patients as quickly as possible.
  But now Democrats, with passage of this bill, want to gut innovation 
in America.
  California Life Sciences tells us the provisions of this bill that 
were included in H.R. 3 can result in 88,000 innovation tech jobs, R&D 
jobs going away from America to somewhere else. That is the price of 
this bill. We know House Democrats voted to impose these dangerous 
price controls with passage of H.R. 3.
  We also know that one of the side benefits, shall we say, of adopting 
socialized medicine is you don't get access to new medicines when they 
do become available in as timely a manner as you do here. Compared to 
the U.S., in Australia, it takes an average of 19 months longer for 
medicines to become available to patients; for Canada, it is up to 14 
months longer; United Kingdom, 11 months longer for those cures for 
cancer, those new medicines on the market, revolutionary sort of new 
innovations we all want.
  So all we are asking for here is, before your bill becomes law--and, 
by the way, the administration said they will recommend a veto--before 
it moves through the path, let's at least make sure that an unintended 
but dangerous consequence of this bill does not take effect, and that 
is let's make sure that it will not inhibit research and innovation for 
a treatment or cure to COVID-19. That is what our motion asks for.
  Madam Speaker, I urge a ``yes'' vote on the motion to recommit.
  Madam Speaker, I yield back the balance of my time.
  Mr. PALLONE. Madam Speaker, I rise in opposition to the motion to 
recommit.
  The SPEAKER pro tempore. The gentleman from New Jersey is recognized 
for 5 minutes.
  Mr. PALLONE. Madam Speaker, I urge my colleagues to vote against the 
Republican motion to recommit.
  This motion to recommit is a distraction, and it provides cover to 
the pharmaceutical industry to continue to raise prices, just as we 
have seen them do on thousands of drugs this year alone.
  Moreover, my Republican colleagues would have you believe that it is 
the pharmaceutical industry alone that is responsible for innovation 
and for funding innovation in this country, which omits the critical 
role that the Federal Government has played and will continue to play 
in drug development and the discovery of novel therapies.
  Let me be clear, Madam Speaker: The investments in research for 
COVID-19 treatments and vaccines aren't being put on the backs of the 
pharmaceutical industry. It is Congress and the American taxpayer who 
have made unprecedented investments as we race to find a cure for 
COVID-19.
  In response to COVID-19, Congress has invested over $8 billion for 
innovative biomedical research development and the purchase of new 
vaccines and therapeutics, including $4.4 billion in the CARES Act, and 
$3.8 billion in the Supplemental Appropriations Act in the last month 
or so.
  This Enhancement Act combined with the HEROES Act, which the Senate 
has still not taken up, would more than double this historic 
investment, bringing it to over $19 billion. And the manager's 
amendment to this bill is another $2 billion.
  So, based on the claims by Republicans here today and this motion to 
recommit, my colleagues on the other side of the aisle would have you 
believe that we are forced to choose between two competing 
alternatives: either finding vaccines and treatments for diseases and 
viruses like COVID, or reducing drug prices that are gouging American 
families at the pharmacy counter every day. This is a false choice.
  From the Republican perspective, we have no choice but to allow the 
pharmaceutical industry to continue to go unchecked and rake in record 
profits at the expense of those who need lifesaving medicines. But it 
is fear-mongering at its worst, and it is blatantly untrue. This Nation 
can and is doing both. There is more than enough spending in the system 
to reduce drug prices and ensure we do not impact research and 
development for treatments and cures, including a vaccine for COVID-19.

  We know that most big pharmaceutical companies spend more on 
marketing, sales, and overhead than research and development, and there 
is no reason why American families are forced to pay 3, 5, or 10 times 
more for the same treatments as those in other countries. It is simply 
unfair.
  That is why new polling has shown that 9 out of 10 Americans support 
direct negotiations by the Federal Government for the price of a 
treatment for COVID-19 and why people are scared that they are going to 
be gouged for coronavirus treatment when it is available, just like 
they have been so often gouged by other drugs that their families have 
needed to stay healthy.
  So the bottom line, Madam Speaker: We can have innovation and lower 
costs, and that is what this underlying bill does. This bill will 
establish a fair price negotiating program that rewards true innovation 
by directing the Secretary to prioritize a drug's research and 
development spending, as well as the extent to which a drug represents 
a true therapeutic advance over existing drugs.
  Madam Speaker, I urge my colleagues to reject the motion to recommit. 
We know that, in the last few months, drug prices have gone up 
tremendously around the country, and drug prices increasingly take a 
larger percent of your healthcare cost. People simply can't afford it, 
and that is why this bill is necessary. Do not believe the false choice 
of my Republican colleagues.
  Madam Speaker, I urge my colleagues to vote against the motion to 
recommit.
  Madam 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.

[[Page H2644]]

  

  Mr. WALDEN. Madam Speaker, on that I demand the yeas and nays.
  The SPEAKER pro tempore. Pursuant to section 3 of House Resolution 
965, the yeas and nays are ordered.
  Pursuant to clause 8 of rule XX, further proceedings on this question 
will be postponed.

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