[Congressional Record Volume 169, Number 108 (Wednesday, June 21, 2023)]
[House]
[Pages H3022-H3036]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





    CUSTOM HEALTH OPTION AND INDIVIDUAL CARE EXPENSE ARRANGEMENT ACT


                             General Leave

  Mr. SMITH of Missouri. Madam Speaker, I ask unanimous consent that 
all Members have 5 legislative days to revise and extend their remarks 
and submit extraneous material on H.R. 3799.
  The SPEAKER pro tempore (Ms. Hageman). Is there objection to the 
request of the gentleman from Missouri?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to House Resolution 524 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the state of the Union for the consideration of the bill, H.R. 3799.
  The Chair appoints the gentleman from Arkansas (Mr. Crawford) to 
preside over the Committee of the Whole.

                              {time}  1524


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the state of the Union for the consideration of the bill 
(H.R. 3799) to amend the Internal Revenue Code of 1986 to provide for 
health reimbursement arrangements integrated with individual health 
insurance coverage, with Mr. Crawford in the chair.
  The Clerk read the title of the bill.
  The CHAIR. Pursuant to the rule, the bill is considered read the 
first time.
  General debate shall be confined to the bill and shall not exceed 80 
minutes equally divided among and controlled by the chair and ranking 
minority member of the Committee on Education and the Workforce, or 
their respective designees, and the chair and ranking minority member 
of the Committee on Ways and Means, or their respective designees.
  The gentlewoman from North Carolina (Ms. Foxx), the gentleman from 
Virginia (Mr. Scott), the gentleman from Missouri (Mr. Smith), and the 
gentleman from Texas (Mr. Doggett) each will control 20 minutes.
  The Chair recognizes the gentleman from Missouri (Mr. Smith).
  Mr. SMITH of Missouri. Mr. Chair, I yield myself such time as I may 
consume.
  Mr. Chair, we are here today considering this legislation because we 
have listened to the American people and are taking action on their 
behalf.
  The Ways and Means Committee has traveled over 5,000 miles to hear 
directly from working Americans about the impact today's economy has 
had on them and their communities. Whether it be in a lumber mill in 
West Virginia or a cattle ranch in Oklahoma, workers, families, 
farmers, and small businesses have told us the same thing: They need 
relief from the Biden economy.
  The legislation before us today will help make life a little bit 
easier on small businesses. It allows them to provide more options to 
their employees when it comes to health insurance benefits.
  The CHOICE Arrangement Act gives small businesses more flexibility to 
provide health insurance benefits to current and future workers. 
Introduced by Representative Hern, this legislation codifies a Trump 
administration rule allowing small businesses to reimburse employees 
for buying their own health insurance on the individual market.
  Washington should not stand in the way of workers getting the 
healthcare coverage that is best for them and their families. Just as 
important, workers should be able to take their insurance plan with 
them if they leave their current job. This bill gives small businesses 
the opportunity, if they so choose, to shed the administrative burden 
of managing traditional insurance coverage. At the same time, it gives 
workers more options for their own healthcare and makes the coverage 
portable.
  Also included in the underlying bill is a provision from 
Representative Tenney that ensures small businesses are made aware of 
the flexible, tax-advantaged insurance coverage options available to 
them and their employees. We have heard that 70 percent of small 
businesses are not aware of the various health insurance options out 
there, such as CHOICE arrangements, qualified small employer health 
reimbursement arrangements, or the small business healthcare tax 
credit. This bill would make sure small businesses are notified about 
the availability and tax benefits of these options so businesses can 
make more informed decisions about how to support their employees' 
healthcare choices.
  This legislation also includes important provisions to increase 
access to stop-loss insurance and expand association health plans, 
which will create more choices for American small businesses to offer 
health benefits to their workers at lower costs.
  Mom-and-pop stores did not set out to be paper pushers and benefit 
managers, and we should not force them into that role. I urge my 
colleagues to support this bill to help small businesses support 
their workforce and let them focus on what they do best: serving their 
customers and employees.

  Mr. Chair, I reserve the balance of my time.
  Mr. DOGGETT. Mr. Chair, I yield myself such time as I may consume.
  Millions of Americans are finding the security and the peace of mind 
that comes from having access to a family physician through the 
Affordable Care Act. If the gentleman has been listening to the 
American people, he has turned a tin ear to the 16 million Americans 
that have now enrolled in the marketplaces under the Affordable Care 
Act.
  Republicans, unwilling to accept the success of what they demeaned as 
ObamaCare, Republicans who failed more than 60 times in this House to 
repeal ObamaCare, who failed three times in the Supreme Court to 
undermine ObamaCare, have now embarked on a new strategy, which is to 
circumvent and undermine the invaluable protections of the Affordable 
Care Act.

                              {time}  1530

  With this bill, Republicans are demanding that every individual who 
gets stuck in one of these newfangled plans that they have is denied 
protection from having their insurer exclude preexisting conditions, no 
assurance of coverage for essential medical care, and no assurance of 
affordability.
  I offered an amendment to correct one part of this defective bill to 
give Americans statutory protection, so they are not back in the old 
pre-Affordable Care Act period of losing coverage when they needed it 
most because they had something the insurance company defined as a 
preexisting condition, but that was rejected.
  At the time, they claimed that was their intent, but when you look at 
the specific statutory language, there is no doubt that the protection 
for preexisting conditions and essential conditions is excluded from 
their legislation.
  These so-called Individual Coverage Health Reimbursement 
Arrangements, ICHRAs, are about as convoluted as the name suggests. 
They are as my grandson, Canyon, would say, they are icky.
  Handing people a voucher and telling them to go shop for coverage 
follows the same ill-conceived Republican approach to sabotage 
Medicare, which they continue to promote in their latest budget. 
Instead of giving Medicare beneficiaries guaranteed coverage, they 
would give seniors a voucher with declining value and tell them to go 
find coverage.
  Instead of the guaranteed, comprehensive coverage workers now 
receive, this bill would force so many people to find healthcare in a 
sea of junk, exposing them to misleading marketing and aggressive 
brokers. An estimated 2 million workers would be immediately impacted 
by this sorry bill, and with another provision that is in the bill that 
directs the Treasury Department to go out and promote access to junk 
plans, we could expect these numbers of impacted workers to increase.
  Inevitably, the result is bare-bones, junk insurance that misleads on 
coverage, has high out-of-pocket costs, and abandons those with 
preexisting conditions. The policy's fine print takes away all the bold 
promises of the marketing. Those who need coverage the most will be 
unable to afford it or receive minimal junk coverage.
  In a Nation that is as rich as America, going broke shouldn't be a 
side effect of trying to get healthcare, but exposing more people to 
financial ruin is exactly what this kind of legislative approach will 
achieve.
  This misguided scheme suffers, I think, from a form of preexisting 
condition itself. It is called amnesia, because they forget the 
conditions that

[[Page H3023]]

existed for so many Americans in this country before the Affordable 
Care Act became law. Situations like those who contacted me from Texas: 
Someone who had been a victim of domestic violence declared to have a 
preexisting condition; an infant born with some preexisting condition 
denied the coverage that they need; any number of excuses when coverage 
was needed the most because of preexisting conditions.
  That is why I thought it was so important to amend this legislation, 
and the refusal of my Republican colleagues to clarify that now sends 
forward loud and clear that that is their objective.
  There is even more ick to the ICHRA bill that is being introduced, 
and that is the opportunity that is created for class discrimination. 
This bill legalizes that discrimination. My amendment would have 
prevented that also.
  Employees that are out there on the assembly line; those who are in 
the chicken processing plant, or the meat-packer, or out in the 
cornfields; they are in the dirtiest, most difficult, and usually the 
lowest-paid jobs. They can be treated one way under this bill, while 
the executives sitting off in the office tower are treated another and 
getting an entirely different kind of coverage because of the way they 
have written their bill.
  Lower-wage workers who would be eligible, in fact, for a better 
policy under the Affordable Care Act with a no-premium or low-premium 
policy, would instead be required to search for a policy with more 
holes than safety net.
  Finally, we discover something on which Republicans are pro-choice. I 
didn't think they were pro-choice on anything, but the genuine choice 
they provide is to the employer, not to the employee, a choice to 
divide employees into the haves and the have-nots; providing employer 
coverage to some and leaving others to fend for themselves.
  Predictably, that burden will fall on the low-wage workers and the 
sick employees that employers don't want to cover. One survey already 
of employers found that 60 percent of large firms intended to offer 
ICHRA to only low-wage workers. That is icky.
  To prohibit discrimination by employers and junk plans alike, the 
amendment I offered would have offered protection. This bill, as it 
stands, does not. It should be rejected.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SMITH of Missouri. Mr. Chair, all CHOICE Arrangement Act plans 
must cover preexisting conditions, cap out-of-pocket expenses, and 
cover key health benefits.
  CHOICE arrangements do not allow employers to discriminate against 
any group of employees. They require equal contributions to all 
employees with the same employment status, and only adjust contribution 
amount for age and family size, to make the record straight.
  I yield 3 minutes to the gentleman from Oklahoma (Mr. Hern), the 
sponsor of this legislation.
  Mr. HERN. Mr. Chairman, as a small business owner and job creator for 
over the past 35 years, I offered healthcare plans to my employees and 
worked with them to find the best coverage for their families. I have 
seen firsthand the impact of increasing healthcare, and I have also 
done the burdensome paperwork to manage the plans on the back end.
  I came to Congress 4 years ago, and the reason I came was because of 
the burden that this Congress over the years has put on job creators 
across America.
  The small business healthcare package being debated today helps 
simplify healthcare and empower people in one of their most personal 
decisions, their healthcare.
  I find it ironic that the gentleman across the aisle identifies the 
ACA requirements as junk because the CHOICE Arrangement Act follows the 
ACA guidelines. It encourages people to go out and shop. It follows the 
rules on preexisting conditions.
  But what we really know, what they don't like about this is it 
doesn't go in the direction they want to go, which is to federalize all 
healthcare. That has been the mission since day one, for the government 
to run your healthcare. That just simply won't work.
  I am proud that this package includes my bill, the CHOICE Arrangement 
Act, which allows employees to use money from their employer to buy the 
healthcare plan that works best for them.
  Four years ago, the Trump administration finalized a rule to create 
CHOICE accounts, allowing businesses to reimburse their employees for 
the cost of the health insurance plan of their choosing. CHOICE 
accounts put individuals--individuals, not the Federal Government--in 
the driver's seat when it comes to picking their healthcare plan and 
lets their employer financially support their decision.
  This bill would codify that rule into law, benefiting everyone and, 
overall, increasing the amount of people who have health insurance. You 
would think that would be a good thing, but apparently not with my 
Democratic colleagues.
  Every patient's health needs are unique, and every person's situation 
is different. This is why it is so important to expand and protect the 
different options available to employers to provide health benefits in 
different ways.
  I am happy to see Congress address the burdens small businesses face 
when providing healthcare benefits to their employees. This bill 
fulfills part of a promise that the Republican Party has made to 
America, to bring back true choice to American healthcare by enabling 
small businesses to provide the best care for their employees.
  As the chairman said, time and time again, in hearings that we have 
been at across America talking to people that are experiencing the 
burdens that come out of this Congress, it is amazing to me that the 
Democrats who are businesspeople that are on the committee, when 
talking without their talking points identify--
The CHAIR. The time of the gentleman has expired.
  Mr. SMITH of Missouri. Mr. Chair, I yield an additional 1 minute to 
the gentleman from Oklahoma.
  Mr. HERN.--businesses as people who apparently abuse their employees 
and the employees continue to come to work. That is the irony of this. 
They have no idea what they are talking about.
  The reality is there are other job openings for everybody to go to, 
and yet, people continue to work. The only way you are prosperous in 
America and run a great business is if you take care of your people. 
That is it. That is all you have. That is what differentiates you in 
the world of a free market. I would hope that my Democratic colleagues 
would recognize that and give a little credit to the people who are out 
there putting their money and their risk on the line.
  In addition to my bill, this small business package includes 
legislation from my colleagues  Bob Good, Claudia Tenney and Tim 
Walberg that will provide small businesses access to the association 
health plans to build their negotiating power, stop-loss insurance to 
protect from catastrophic losses, and reporting from Treasury to update 
small business owners on new healthcare plans.
  Small businesses make up the foundation of the American economy and 
have true incentives, moral and financial, to pay to keep Americans 
healthy. We should enable them to do so. I urge my colleagues to vote 
``yes'' on this bill.
  Mr. DOGGETT. Mr. Chairman, I yield myself such time as I may consume.
  The gentleman has repeated his stated intent to provide the 
protection that his bill denies, and I would refer him, again, to page 
3, line 2 of this bill as it was presented in committee, and the 
failure to refer to section 2791(b)(5) of the Public Health Service Act 
means that that protection will not be there. It could easily have been 
added if that were the true intent. It is omitted.
  Same page, line 12, the failure to include guarantees against 
nondiscrimination is not there.
  He is concerned about federalizing healthcare. Well, all that I want 
to do is set a minimum Federal standard that no person in this country 
will be denied because of a preexisting condition the healthcare that 
they deserve. That is what the Affordable Care Act was designed to 
achieve, not only for those in the marketplace, but beyond.
  Secondly, I want to ensure that different classes of employees are 
not treated differently. Let me just describe a little more of what is 
involved there.
  Just as they would allow insurers to discriminate against a newborn 
with a

[[Page H3024]]

heart murmur and call that a preexisting condition, their bill would 
permit an employer to discriminate against their own employees.
  Just to give you a practical example. We have a lot of chicken 
processing plants down in northeast Texas. If there is a facility out 
there where the chicken pluckers are chasing the chickens, removing the 
feathers that are flying, those tough, dirty, hot jobs processing them 
may be managed by a group in some high-rise in Dallas or Tyler.
  Well, this bill, as it is written, will allow those executives to get 
their group health insurance policy with all the protections against 
preexisting conditions and being able to see, perhaps, a concierge 
service for their healthcare. But the folks that are down there chasing 
the chickens and plucking the chickens, they get an ICHRA. All they get 
is ick. That is wrong.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SMITH of Missouri. Mr. Chairman, the CHOICE Arrangement Act will 
expand coverage for more types of workers by allowing employers to 
offer a CHOICE Arrangement to different groups of employees who may not 
have been offered health insurance previously, such as part-time or 
seasonal workers.
  Under this policy, nearly 1 million workers will have health 
insurance coverage for the very first time.
  Mr. Chair, I yield 2 minutes to the gentlewoman from New York (Ms. 
Tenney), who is an author of a piece of this legislation.
  Ms. TENNEY. Mr. Chair, I rise today in support of the CHOICE 
Arrangement Act and my Small Business Flexibility Act, which is 
included in the underlying bill as the chairman just recognized.
  Over the past 10 years, health insurance premiums have gone up 130 
percent, and deductibles have increased by 125 percent, and that is on 
average. It is even greater in some areas, especially for small 
business owners.
  This lack of affordability has led to the percentage of small 
businesses providing health insurance decreasing from almost 45 percent 
to 31 percent today. In addition, 75 percent of businesses with fewer 
than 200 employees now only offer one healthcare choice. That is no 
choice.
  Small business operators want to provide for their employees. They 
want to offer competitive benefits that promote choice in the 
marketplace while prioritizing excellent care, quality, and 
affordability. The problem is these costs are simply prohibitive.
  We should not accept this as the status quo, and, thankfully, there 
are commonsense solutions that can help small businesses lower cost and 
increase choice for their employees.
  Recent surveys have found that 70 percent of small businesses are not 
even aware of the flexible opportunities to help them provide 
affordable health insurance as a benefit to their employees, such as 
the Small Business Healthcare Tax Credit, CHOICE Arrangement Act, and 
Qualified Small Employer Health Reimbursement Arrangements.
  My Small Business Flexibility Act will close this awareness gap by 
requiring the Treasury Department to notify and educate small 
businesses on the flexible coverage options.
  Small employers want to provide these benefits to their employees 
for, among so many other reasons, long-term retention to allow them to 
ensure that they have high quality of life, and each of them has access 
to healthcare.
  It is time that we increased awareness of these programs and address 
any obstacles to their successful and effective implementation. 
Therefore, I urge my colleagues to support the CHOICE Arrangement Act 
and the Small Business Flexibility Act.

                              {time}  1545

  Mr. DOGGETT. Mr. Chairman, I continue to reserve the balance of my 
time.
  Mr. SMITH of Missouri. Mr. Chairman, I yield 2 minutes to the 
gentleman from Pennsylvania (Mr. Smucker).
  Mr. SMUCKER. Mr. Chairman, I rise in support of H.R. 3799.
  The comments by Mr. Doggett and others would make you think it is an 
entirely different bill. There is nothing in this bill that would 
change coverage for preexisting conditions. I don't know what he is 
talking about with icky because more people will have healthcare 
available to them as a result of this bill.
  Mr. Chairman, I serve on two committees that have crafted pieces of 
this legislation, the Ways and Means Committee and the Education and 
the Workforce Committee. I think that all of us--and I think this is 
probably shared on both sides of the aisle--want all Americans to have 
access to the healthcare and to the insurance that they choose for 
themselves. As I said, I think we share that.
  Certainly, as a small business owner myself, I can relate to 
businessowners who want to ensure that their employees, their team 
members have access to the healthcare. They want them to be healthy; 
they want them to go home from work healthy; and they are very 
interested in ensuring that their employees have affordable coverage.
  This committee focused on expanding the CHOICE arrangements, which is 
a system that will provide numerous benefits for employees and small 
businesses because it lets job creators offer their workers cash to 
purchase individual health plans, which will help by ensuring that if 
workers move from one job to another, they can take their health plan 
with them. They are more portable, so that is a great change that will 
help a lot of individuals.
  On the Education and the Workforce Committee, we wrote legislation 
that expands association health plans, or AHPs, which enable employers 
and the self-employed to band together. I have heard from a lot of 
self-employed individuals in my community who are having trouble 
accessing health insurance that they prefer. This would allow them to 
band together across State lines to purchase health coverage for 
themselves and, in the case of small businesses, for their workers.
  The CHAIR. The time of the gentleman has expired.
  Mr. SMITH of Missouri. Mr. Chair, I yield an additional 1 minute to 
the gentleman from Pennsylvania.
  Mr. SMUCKER. Mr. Chair, there is one other thing in this bill which I 
think is very positive. We took action to preserve self-insurance. This 
is a system in which large and small employers pay for healthcare 
services directly instead of purchasing plans with a large insurer, 
which leads to savings and leads to collaboration between employers and 
workers at their company to ensure better wellness approach to keep 
employees healthy and not be required to access healthcare costs. It 
helps the workers, and it saves costs across the board. Self-insurance 
is another part of this bill that we preserve, which I think is very 
great.
  The bottom line is that American workers and businesses need 
affordable and flexible healthcare options. This package of bills 
achieves those goals, and I urge my colleagues to support this 
legislation.
  Mr. DOGGETT. Mr. Chairman, I yield myself such time as I may consume.
  Let me respond to the gentleman from Pennsylvania. He says there is 
nothing in this bill about preexisting conditions and discrimination, 
and he is absolutely right. That is the whole failing of this bill. It 
does not include the protections that are necessary to ensure that no 
American is discriminated against on the basis of preexisting 
conditions and that no employer can discriminate among groups of its 
employees.
  He also says this is going to open more opportunities for more people 
to get health coverage. I would point out that studies have shown that 
95 percent of the people who are in these icky plans now once had good 
group health coverage. My concern is that we will see even more people 
lose their good group health coverage and be put into an icky plan.
  As for the Small Business Flexibility Act, I am for the Treasury and 
others educating all employers and employees about their rights and 
opportunities, but I think this part of the overall package is very 
slanted. Treasury needs to be out there educating employers, some of 
whom may not know themselves the limitations that these junk plans have 
and how much they will disserve their employees. We need education of 
employees on how to understand whether their employer's offer of 
coverage meets the minimum standard and is truly affordable for the

[[Page H3025]]

purposes of being able to otherwise enroll in subsidized marketplace 
coverage. I think there are limitations on that portion of the bill as 
well and that it, therefore, should be rejected.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SMITH of Missouri. Mr. Chairman, when Democrats expanded 
ObamaCare subsidies in the Inflation Reduction Act, those billions of 
dollars flow directly to large health insurers. CHOICE arrangements, 
however, allows small businesses--small businesses--to reimburse their 
own employees directly for them to shop and purchase their own health 
insurance. This is how Washington should be empowering small 
businesses, not bailing out large health insurers.
  Mr. Chairman, I yield 1 minute to the gentlewoman from Oregon (Mrs. 
Chavez-DeRemer).
  Mrs. CHAVEZ-DeREMER. Mr. Chairman, I rise in support of the CHOICE 
Arrangement Act.
  Small business owners are being hamstrung by soaring healthcare 
costs. I know firsthand because I am a small business owner, but you 
don't have to take my word for it. The data speaks for itself.
  In Deschutes County in my district, the average small business 
premium for a family has increased by 111 percent from 2014 to 2022.
  It is past time to provide small business owners with more options so 
workers can access cheaper coverage. We can accomplish this by 
expanding association health plans and providing more flexibility to 
ensure employees can get the coverage that fits their needs best.
  Mr. Chairman, I am proud to support small businesses, which create 
jobs, foster innovation, and keep our economy running strong.
  Let's get this done to ensure these employers can keep their doors 
open.
  Mr. DOGGETT. Mr. Chairman, I yield myself such time as I may consume.
  The chairman of our committee says that there were great gifts to 
insurance companies. What the Build Back Better bill did was to give 
individuals additional tax credits. Some Republicans call those tax 
cuts, but they were credits given to people to be able to afford 
insurance. As a result of that improvement, many more Americans got the 
insurance that they need.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SMITH of Missouri. Mr. Chairman, I remind the body that Build 
Back Better was never signed into law because neither the Democrats in 
the Senate nor the White House would even support it.
  Mr. Chairman, I yield 1 minute to the gentleman from Pennsylvania 
(Mr. Meuser).
  Mr. MEUSER. Mr. Chairman, I thank the chairman of Ways and Means, my 
good friend from Missouri, very much for having this important debate 
for the CHOICE Arrangement Act.
  Mr. Chairman, this bill does nothing more than expand the association 
health plans. Businesses want to have current coverage that exists 
today. They can keep it. President Trump years back enacted an 
expansion of association health plans which greatly benefited the 
farmers in my district and the small businesses in my district to find 
plans that suited them.
  They used the power of their numbers to reduce costs 29 percent. We 
have better coverage, preferable to the entities, at lower costs. If 
they like their current coverage, they can keep it. It sounds way too 
logical, apparently, for this body. There is no logical reason to 
oppose H.R. 3799 other than for special interests or political 
motivation.
  Mr. DOGGETT. Mr. Chairman, I yield myself such time as I may consume.
  I say to the chairman, he is absolutely correct. I referred to the 
Build Back Better instead of the American Rescue Plan. It is easy to 
get confused about them. The American Rescue Plan was, of course, 
signed into law and has helped so many Americans. However, we always 
know that whatever the name, Republicans are against all of them, as 
they were, and voted unanimously against all of the opportunity that 
they created for millions more Americans to get and keep health 
insurance and provide themselves security.
  Mr. Chairman, I reserve the balance of my time.
  Mr. SMITH of Missouri. Mr. Chairman, if the gentleman from Texas has 
no further speakers, I am prepared to close. I reserve the balance of 
my time.
  Mr. DOGGETT. Mr. Chairman, I yield myself the balance of my time to 
close.
  I focused on one part of this entire package of bills, but together 
it is truly a thinly veiled attempt to circumvent the Affordable Care 
Act. Being unable to repeal it, having nothing but nothing care to 
replace it with is really kind of a death by a thousand cuts, making 
healthcare less accessible and affordable for so many at-risk workers.
  The bills in this package include a codification of the Trump-era 
rule that allows employers to offer these ICHRA plans to their 
employees instead of employer-sponsored health plans.
  Under this plan, employers may offer a voucher and force their 
employee to shop for their own coverage.
  Under this bill, employers are permitted to pick and choose among 
their employees and discriminate against some with their vouchers.
  This bill also includes an expansion of the association health plans, 
which my colleague from Virginia will discuss at greater length. That 
has been a standard tenet of Republicans' assault on the Affordable 
Care Act. It is a provision that would allow self-employed individuals 
and small businesses to circumvent the guarantees of the Affordable 
Care Act and steer consumers into shoddy coverage that does not cover 
the healthcare they most need when they need it, the essential health 
benefits.
  It also does not offer them protection against preexisting conditions 
or age or the fact that before the Affordable Care Act was adopted, 
women were discriminated against at a great rate and often denied the 
coverage that they needed or it was priced so high they could not 
afford it.
  The bill would also preempt State regulation of association health 
plans and disrupt risk pools as these plans do not have to follow 
standard premium-setting rules and risk adjustment. This bill is 
similar to the Trump administration rule that was struck down in 2019.
  If you are beginning to recognize a pattern here, this is all Trump, 
Trump, Trump because he is still the Pied Piper for the Republican 
Conference, as we just saw in this disgraceful presentation about our 
honorable colleague Adam Schiff.
  This package also contains a provision to encourage employers to 
offer self-funded plans, which are not required to comply with ACA 
protections, again, on preexisting conditions, on essential health 
benefits, and more. Most employers do not want to take on the risk of 
offering a self-funded plan. However, by expanding stop-loss coverage, 
which sets a catastrophic amount the employer will be responsible for, 
and then covers any other costs that may come up from covering their 
employees, self-funded plans will be more attractive.
  This legislation prevents Federal and State governments from 
regulating stop-loss coverage and risks more employers opting for self-
funded plans that do not protect healthcare consumers.
  Finally, without providing any additional resources, this legislative 
package tells the Treasury Department to educate employers about how 
great these new icky plans are and their health reimbursement accounts, 
which would bar workers from more affordable coverage under the 
marketplace already available.
  At the heart of this effort is just the perpetual push by House 
Republicans to weaken the protections of the Affordable Care Act, which 
have prevented financial ruin for so many people and assured access to 
healthcare for so many people.
  Under the provisions of this bill, employers can form association 
health plans to skirt some of the requirements of the ACA like the 
essential health benefits. State and Federal regulators will be 
hamstrung in their ability to protect small businesses and workers in 
self-funded plans.
  Utilizing these icky ICHRA plans, employers can also push those with 
preexisting conditions, women, and older workers into the individual 
market with vouchers while keeping their younger and healthier 
employees on employee-sponsored insurance. Therefore, the sick get 
treated differently.

[[Page H3026]]

Those who have disabilities, who have had long-term chronic conditions, 
could be treated very differently and put at great risk.
  I think for all these reasons that this legislation should be soundly 
rejected. This is an opportunity to defend all that the Affordable Care 
Act has meant to Americans and offer that opportunity to more people 
rather than deception that is the hallmark of this bill and following 
the Trump approach that junk insurance is what would be most available 
to Americans.
  Mr. Chairman, I yield back the balance of my time.

                              {time}  1600

  Mr. SMITH of Missouri. Mr. Chair, I yield myself the balance of my 
time.
  Congress has an opportunity to help small businesses by making it 
easier for those who choose to provide health insurance for their 
employees.
  This bill is the best of both worlds for small businesses and 
workers. It relieves many small businesses of the burden of 
administering a complex health insurance plan by allowing them to 
instead offer meaningful financial support to employees so that they 
can buy their own insurance. It takes some of the guessing game out of 
offering coverage by making sure small businesses are informed of the 
various options they have. It gives workers the freedom to choose the 
best possible coverage for themselves and their families.
  By passing this legislation, we will allow small businesses to get 
back to the basics, helping their customers, taking care of their 
employees, and serving their communities.
  I want to address the misleading claims we have heard from our 
Democrat colleagues. At our markup, one of my Democrat colleagues 
called the health plan options under this bill junk plans. That is 
unequivocally false. These funds can only be used to purchase plans 
that cover preexisting conditions. Regardless of what you hear on the 
other side, this covers plans with preexisting conditions. It covers 
plans that cap out-of-pocket expenses and guarantees coverage during 
open enrollment.
  They also claim that we are opening a backdoor for businesses to 
discriminate in the health benefits offered to their employees. CHOICE 
arrangements provide the opposite of discrimination. They provide equal 
contributions to all employees with the same employment status, only 
adjusting for age and family size.
  In fact, many businesses today don't offer health benefits to any of 
their part-time employees. Through CHOICE arrangements, these employees 
may be seeing their first offer of meaningful health benefits.
  Today, we are taking another step forward to cut the bureaucratic red 
tape holding back small businesses. We should make it easier, not 
harder, to give America's workers, families, farmers, and small 
businesses access to flexible healthcare options.
  Madam Chair, I urge my colleagues to support this legislation, and I 
yield back the balance of my time.
  The Acting CHAIR (Mrs. Wagner). The Chair now recognizes the 
Committee on Education and the Workforce. The gentlewoman from North 
Carolina (Ms. Foxx) and the gentleman from Virginia (Mr. Scott) each 
will control 20 minutes.
  The Chair recognizes the gentlewoman from North Carolina.
  Ms. FOXX. Madam Chair, I yield myself such time as I may consume.
  Madam Chair, I rise today to support the House Republican package to 
alleviate rising healthcare costs for small businesses. I am proud that 
the Committee on Education and the Workforce has taken a leading role 
in this effort.
  Healthcare cost is the number one issue facing small businesses 
today. In fact, according to the NFIB, it has been their top issue for 
over 30 straight years. Through the dot-com bubble, the Great 
Recession, the COVID-19 pandemic, and record inflation, small 
businesses have consistently identified healthcare costs as their 
greatest concern.
  House Republicans recognize that these small businesses are the 
engines of the American economy, and this package is the first step 
toward much-needed relief.
  I will take a moment to discuss the two pieces of this package from 
the jurisdiction of the Education and the Workforce Committee. First, 
this package incorporates Representative Good's Self-Insurance 
Protection Act. We passed the Self-Insurance Protection Act through 
committee because small businesses are being squeezed. There is no 
other way to put it.
  On the one hand, premiums are skyrocketing, and it is costing small 
businesses a fortune to cover their employees. Single-coverage premiums 
cost about $8,000 per year now, and they are drastically outpacing 
inflation. The bottom-up inflationary pressures have inevitably forced 
small businesses out of the insurance marketplace, and more and more 
are deciding to self-insure. Experts predicted this when the ACA 
passed, and it has held true.
  On the other hand, the government is coming from the top down and 
telling small businesses they cannot access stop-loss insurance. Stop-
loss insurance is a financial tool that self-insured businesses 
typically buy to protect themselves from catastrophic costs, but the 
government overreaches, overregulates, and denies many small businesses 
this critical tool.
  For example, in New York, insurers are expressly prohibited from 
selling stop-loss insurance to employers with fewer than 100 employees. 
The New York State Association of Health Underwriters wrote regarding 
the law: ``Some groups have already lost their employer-provided health 
coverage altogether and have had to go into the New York health 
insurance marketplace exchange to obtain coverage, only to find that 
their new coverage has higher copays, larger deductibles, greater total 
out-of-pocket annual limits, narrower in-plan healthcare provider 
networks, and fewer out-of-network medical specialists.''
  Like in a pincer maneuver, the government is coming from both sides 
and trapping small businesses in the middle with no options.
  The Self-Insurance Protection Act is the solution. It provides a 
lifeline to small businesses and hardworking Americans who are being 
squeezed by the soaring cost of traditional health insurance. It would 
stop Federal and State overregulation of stop-loss insurance, allowing 
self-insured small businesses a way out of the government's two-sided 
trap.
  Next, this package also incorporates Representative Walberg's 
Association Health Plans Act, which is perhaps the single best cost-
saving tool at our disposal. The Association Health Plans Act would 
offer immediate relief for everyday workers, taxpayers, and job 
creators. I know this because it has been tested.

  In 2019, before the courts stopped President Trump's association 
health plan, AHP rule, America got a chance to see and feel the impact 
of deregulation. AHPs produced savings of up to 29 percent on average. 
At the upper limit, groups saved 50 percent with their newly formed 
AHPs.
  AHPs achieve these savings by allowing small businesses to band 
together to increase their bargaining power when purchasing health 
insurance. Currently, many regulations restrict small businesses and 
individuals from doing so.
  Enabling small economic actors to pool resources is critical to their 
competitiveness in the market. In healthcare, big companies enjoy large 
economies of scale, and only more so with each passing year.
  Countless studies and evidence point toward this worrisome trend of 
market consolidation. Three pharmacy benefit managers own 80 percent of 
the market. Physician practices and hospitals are merging at a rapid 
pace. Thankfully, hospital mergers have slowed during and after the 
pandemic, but it is not enough. This bill helps mom-and-pop shops and 
self-employed workers fight back.
  I should also clarify that this bill does not turn healthcare into 
the Wild West, like some Members claim. Important regulatory guidelines 
exist to make sure enrollees would not be defrauded under AHPs.
  For example, every AHP must have a board consisting of at least 75 
percent employer membership. This ensures that AHPs are maintained in 
good faith.
  They are also required to abide by existing consumer protections, 
such as prohibitions against discriminating

[[Page H3027]]

based on an individual's health status and prohibitions against using 
preexisting conditions to deny coverage, increase premiums, or impose 
waiting periods.
  The benefits of the Association Health Plans Act can be summed up in 
the words of Trump's DOL: ``AHPs are about more choice, more access, 
and more coverage.'' I agree.
  Let's help small businesses get the relief they need and working 
Americans the coverage they deserve.
  Madam Chair, I urge passage of this healthcare package, and I reserve 
the balance of my time.
  Mr. SCOTT of Virginia. Madam Chair, I yield myself such time as I may 
consume.
  Madam Chair, the proposals in H.R. 3799 are yet another recycled, 
futile attempt to sabotage the Affordable Care Act and actually make it 
harder for workers and families to find affordable, high-quality health 
insurance.
  This legislative package includes two bills that were marked up by 
the Committee on Education and the Workforce.
  The first is the Association Health Plans Act. This act undermines a 
core promise of the ACA, access to affordable healthcare for all. This 
faulty legislation may provide lower costs for some enrollees, but it 
would do so by skimping on benefits and increasing costs for everybody 
else.
  Specifically, the bill would allow association health plans to 
cherry-pick low-risk, young individuals for a pool separate from the 
ACA marketplace. You may hear my colleagues on the other side of the 
aisle tout the bill's nominal protections against discrimination based 
on preexisting conditions, but they omit the details regarding the 
other large loopholes that leave consumers vulnerable in this bill, 
such as charging higher risk groups more so that the plan will not be 
attractive to them and charging low-risk groups less so that they will 
be the ones that come in.
  In fact, this legislation explicitly authorizes AHPs to set premiums 
based on the ``specific risk profile'' of employer members, enabling 
them to charge higher premiums to groups based on their age, gender, 
and other factors. AHPs could also exclude certain categories of 
coverage, such as maternity care, mental health, or substance abuse 
disorder, to dissuade certain groups or individuals from enrolling. 
Under the bill, association health plans could also evade essential 
health benefits and other consumer protections under State and Federal 
law.
  It is a bad idea because of simple arithmetic. If healthy, low-risk 
individuals can leave the Affordable Care Act marketplace risk pool and 
join a separate association and pay lower rates on average, those that 
did not get into these plans will, on average, pay higher premiums.
  Let's be clear. Only low-cost groups will be in these plans because 
if you are a high-risk group, the cost will be too much and will not be 
attractive. If they are high-risk groups with preexisting conditions, 
older groups, and whatnot, they will not be able to form groups that 
charge less than the ACA marketplace, and nobody will want to join.
  Under the ACA, everybody pays an average. If you have a preexisting 
condition or do not have a preexisting condition, everybody pays the 
same, and everybody gets insurance at an affordable cost.
  Everybody enjoys all the essential benefits under the ACA. 
Association plans, for example, do not have to provide coverage for 
essential benefits like maternity benefits. All the costs of maternity 
care will be borne by fewer and fewer people.
  The average cost of insurance for those not in the plans will slowly 
grow as the number of association plans grows.

                              {time}  1615

  Various versions of this legislation have been pushed by Republicans 
for decades, but all iterations suffer from the same fundamental flaw, 
they shift costs to the most vulnerable. That is why more than 30 
leading consumer and patient groups have expressed serious concerns 
with this harmful legislation.
  The other bill marked up in the Education and the Workforce Committee 
was the Self-Insurance Protection Act, legislation that further erodes 
the ACA by exempting stop-loss insurance from key consumer protections.
  The bill would prevent the Secretaries of Health and Human Services, 
Labor, and the Treasury from regulating stop-loss insurance coverage. 
Even more troubling, the bill makes it virtually impossible for States 
to protect consumers from abusive practices by invalidating State laws 
that regulate stop-loss.
  Stop-loss insurance usually covers costs above a catastrophic level, 
over a million dollars or something like that. They can be written to 
cover everything over a thousand dollars when they become essentially 
regular insurance except that they are not regulated. There are no 
solvency regulations, no benefit regulations, no nothing.
  We can all agree that small businesses and self-insured people 
deserve access to affordable healthcare, and that is what you get under 
the Affordable Care Act. We should also agree that people deserve basic 
consumer protections to ensure that they have insurance with quality, 
solvency, an agency to call if something goes wrong, and coverage for 
essential benefits. That is why we passed the Affordable Care Act in 
the first place. It is also why, when Democrats were in charge in the 
last Congress, we passed the American Rescue Plan and the Inflation 
Reduction Act to make coverage even more affordable.
  The question before us is: Do we want to make sure that every 
individual can continue to find affordable and quality healthcare 
coverage, or do we want to pass H.R. 3799 and create roadblocks for 
Americans seeking care?
  Madam Chair, I would hope that we would oppose this bill, and I 
reserve the balance of my time.
  Ms. FOXX. Madam Chair, our colleagues are opposed to freedom in 
choosing healthcare. They want everyone in government-controlled 
healthcare and are quite willing to mislead the American people on what 
these bills do.
  Madam Chair, I yield 3 minutes to the gentleman from Michigan (Mr. 
Walberg), a member of the Committee on Education and the Workforce.
  Mr. WALBERG. Madam Chair, I rise in support of H.R. 3799, the CHOICE 
Arrangement Act. I thank both the Ways and Means Committee and the 
Committee on Education and the Workforce for their hard work in 
bringing this important bill to the floor.
  I must state that what I have heard over the last 20 minutes of 
sitting here and listening to my colleagues, it would lead me to 
believe that they think Republicans don't want good healthcare, that we 
don't need good healthcare, that we don't use good healthcare, and that 
we would support employers not giving us good healthcare or our 
constituents good healthcare, and that we would expect that Republican 
employers wouldn't feel the same impact of trying to compete with other 
employers whose benefits their employees look for.
  That is just not true. I don't think the American public believes 
that. We have the same concerns. We want good healthcare. That is why 
this bill has been put forward.
  With the ACA, true, everybody had insurance, but not everybody had 
healthcare when they tried to use it. The high cost of healthcare 
remains a struggle for small businesses, many of whom are facing 
lingering hardships from the pandemic as well as inflation.
  In fact, a recent survey from the NFIB showed that while employers by 
and large believe offering health benefits is important, 98 percent of 
small businesses are concerned that healthcare costs will become 
unsustainable within the next 5 to 10 years.
  The CHOICE Arrangement Act provides innovative healthcare solutions 
to bring down healthcare costs for small businesses.
  I am proud that H.R. 3799 includes my legislation to expand 
association health plans. AHPs are commonsense solutions that empower 
small employers and their employees when making health coverage 
decisions.
  Right now, small businesses are often on an unequal playing field 
with larger companies and unions. Because they have fewer employees, 
small businesses have limited bargaining power when it comes to 
negotiating for lower insurance costs for their workers and higher care 
coverage.

[[Page H3028]]

  By providing small businesses with greater bargaining power, the 
Association Health Plans Act allows them to offer more quality options 
for workers at a better price.
  Madam Chair, the Association Health Plans Act will level the playing 
field for small businesses and empower their employees to access 
quality healthcare at a lower cost. It also represents an important 
step toward purchasing health insurance across State lines.
  Today's vote is an immediate first step to help job creators provide 
affordable healthcare options to their employees and transition toward 
a patient-centered healthcare system that works for Republicans and 
Democrats.
  Madam Chair, I encourage support of H.R. 3799.
  Mr. SCOTT of Virginia. Madam Chair, I yield such time as he may 
consume to the gentleman from Texas (Mr. Doggett), the ranking member 
of the Health Subcommittee of the Ways and Means Committee.
  Mr. DOGGETT. Madam Chair, I would say to the gentleman from Michigan, 
I am sure there are many Republicans who want to assure good healthcare 
to all people. The problem is with this specific bill.
  The one-page amendment that I offered could have guaranteed these 
ICHRA employees that they would face no discrimination among classes of 
employees and no barrier of preexisting conditions.
  That clarification would have solved this problem, and their failure 
repeatedly to accept that one-page amendment, with no explanation other 
than that they wanted to do the same thing, or that it was duplicative, 
betrays the promise of this bill and suggests that discrimination and 
denial of coverage based on preexisting conditions is what Americans in 
these plans will face.
  The chairman of the Ways and Means Committee, our colleague from 
Missouri (Mr. Smith) closed by saying that his goal is to cut red tape. 
Well, that is a goal that I think all of us can share, but I am afraid 
that this bill, as written, will only throw more Americans into the red 
and into medical debt, which is already high despite the protections 
that we have provided to date.
  There are so many families overwhelmed by medical debt, and some who 
will be denied the opportunity to get the protection they need from 
their healthcare providers because they simply cannot afford it.
  Madam Chair, I would say at the appropriate time I will offer a 
motion to recommit to this bill and send it back to committee. If the 
House rules permit it, I would have offered this motion with an 
appropriate amendment to the bill.
  My amendment would ensure that this bill does not take effect unless 
the Secretary of Health and Human Services certifies that this bill 
will not result in anyone losing access to coverage of essential health 
benefits or see their healthcare costs rise, the very objective that 
the gentleman from Virginia has been discussing.
  Madam Chair, I include in the Record the text of this amendment.
  Mr. Doggett moves to recommit the bill H.R. 3799 to the Committee on 
Ways and Means with instructions to report the same back to the House 
forthwith, with the following amendment:
  Add at the end the following new title:

                        TITLE VI--EFFECTIVE DATE

     SEC. 601. EFFECTIVE DATE.

       Notwithstanding any other provision of this Act, the 
     provisions of this Act and the amendments made by this Act 
     shall not apply unless the Secretary of Health and Human 
     Services submits to Congress a certification that such 
     provisions and amendments will not result in--
       (1) individuals losing access to coverage of essential 
     health benefits (as defined for purposes of section 1302(b) 
     of the Patient Protection and Affordable Care Act (42 U.S.C. 
     18022(b))); or
       (2) higher costs to individuals for coverage that includes 
     such benefits.

  Mr. DOGGETT. Madam Chair, I hope my colleagues will join us in 
supporting it, recommitting this, pursuing the objective of better 
healthcare for all, and protecting all Americans from preexisting 
condition barriers, and ensuring they are not the subject of 
discrimination.
  Ms. FOXX. Madam Chair, I yield 3 minutes to the gentleman from 
Virginia (Mr. Good), who introduced this resolution, and is chair of 
the Health, Employment, Labor, and Pensions Subcommittee.
  Mr. GOOD of Virginia. Madam Chair, I rise in support of the CHOICE 
Arrangement Act because it charts a course for Americans to take charge 
of their healthcare.
  This bill includes several important provisions, including one of my 
bills, the Self-Insurance Protection Act. Self-insured healthcare plans 
give employers more choices to build and tailor health plans that best 
meet the needs of their employees.
  Self-insured plans are popular. In fact, in 2022, 65 percent of 
workers were enrolled in self-insured plans. Small and midsize 
businesses are turning to self-insured plans because of the 
flexibilities they provide in offering high-quality healthcare coverage 
at an affordable cost to employees.
  Stop-loss insurance is a critical component of an employer's ability 
to successfully self-insure in a way that best suits their needs. Most 
employers choose to purchase stop-loss insurance to manage financial 
risk, shielding them from potentially catastrophic medical claims that 
could sink their businesses.
  Unfortunately, Washington bureaucrats have tried to regulate stop-
loss insurance into nonexistence. The Obama administration threatened 
to regulate stop-loss as traditional health insurance, a move that 
would make self-insurance inaccessible, and force individuals onto the 
ObamaCare exchange and drive up costs.
  My bill would make sure the Biden administration can't mandate the 
decision of small business owners and weaponize regulations to prevent 
access to stop-loss policies for small business owners.
  Additionally, some State laws unfairly limit small businesses from 
accessing the self-insured market solely based on the size of their 
operations. My legislation would protect the ability for businesses to 
self-insure and ensure that no government entity can prevent them from 
making the best possible decision for their business and their 
employees.
  Another key provision of the CHOICE Arrangement Act would make 
Association Health Plans more accessible for small businesses and self-
employed workers.
  This policy is a big win for my home State of Virginia. Last year, 
Virginia passed a law allowing realtors to form Association Health 
Plans. Sadly, the Biden administration has threatened to block 
implementation of the State law because it doesn't comply with 
ObamaCare.
  Voting for the legislation today would allow for the Virginia law to 
flourish without Federal Government intervention. The Medicare for All 
mentality thinks that businessowners aren't equipped to provide quality 
health coverage for their employees. That simply is not the case.
  A majority of Americans, 159 million, in fact, have health benefits 
through their jobs, and they like their plans. Madam Chair, 78 percent 
of employers decide to enroll in employer-sponsored insurance when 
given the option.
  The CHOICE Arrangement Act responds to the needs of the American 
people, and I hope all of my colleagues can support this effort to 
empower small business owners across America.
  Mr. SCOTT of Virginia. Madam Chair, I would inquire as to how much 
time is remaining.
  The Acting CHAIR. The gentleman from Virginia has 11\1/2\ minutes 
remaining, and the gentlewoman from North Carolina has 7\1/2\ minutes 
remaining.
  Mr. SCOTT of Virginia. Madam Chair, I yield myself such time as I may 
consume.
  Madam Chair, the gentleman from Michigan talked about the motive of 
employers. I think the employers want to give good coverage. The 
problem with this bill is it enables one company to find loopholes to 
get a good deal for that company even if it results in higher costs for 
everybody else. That is the problem with this legislation.
  Madam Chair, I include in the Record a letter of opposition written 
by the AFL-CIO.
  Among other things, the letter states that this bill undermines 
comprehensive coverage and subjects workers to financial risk.
                                                           AFL-CIO


                                            Legislative Alert,

                                                    June 20, 2023.
       Dear Representative: On behalf of the AFL-CIO, I urge you 
     to oppose the CHOICE Arrangement Act (H.R. 3799). This 
     package would make two substantial changes in

[[Page H3029]]

     health coverage policy--both harmful to workers.
       First, H.R. 3799 will loosen the definition of association 
     health plans (AHPs), opening the door for more employers to 
     establish plans that evade Affordable Care Act (ACA) 
     requirements to cover essential health benefits and 
     participate in market-wide risk pools. Despite what their 
     name suggests, association health plans are not a form of 
     niche coverage for professional associations. Under current 
     rules, AHPs may be established by multiple employers and draw 
     broadly from insurance markets to enroll self-employed 
     individuals. With the ability to set rates based on a limited 
     pool of enrollees, AHPs have been able to offer coverage with 
     lower premiums, but their track record is poor. Too often, 
     these plans misjudged the risks involved and have gone 
     insolvent, leaving enrollees in the lurch. In other cases, 
     enrollees have been defrauded by scammers who exploited the 
     AHP regulatory loopholes.
       Second, under the guise of ``protecting'' stop-loss 
     insurance for self-funded group health plans, H.R. 3799 would 
     allow employer health plans to avoid the ACA requirement that 
     insured plans cover essential health benefits. The policy is 
     intended to allow plans that are unable to actually self-fund 
     with adequate reserves to instead purchase a high level of 
     stop-loss insurance. Lack of adequate reserves leave many of 
     these plans, and their enrollees, at risk since stop-loss 
     insurers often retain the right to drop the insurance if 
     medical costs for the group begin to climb. This is not a 
     stable form of coverage.
       By allowing plans to offer coverage that does not comply 
     with ACA essential health benefits requirements, both of 
     these policies would allow plans to cherry pick healthier, 
     less-costly enrollees from the small group and individual 
     markets. This will increase premiums for good comprehensive 
     coverage because risks cannot be spread widely to reduce 
     costs for all.
       We urge you to protect working people by opposing this 
     legislation that undermines comprehensive coverage and 
     subjects workers to financial risk.
           Sincerely,
                                                   William Samuel,
                                     Director, Government Affairs.
  Mr. SCOTT of Virginia. Madam Chair, I include in the Record a broad 
post written by the Center on Budget and Policy Priorities.
  Among other things, the post states that the bill will undermine 
consumer protections, segment insurance markets, and impose new burdens 
on individuals to navigate an already complex system.

    [From the Center on Budget and Policy Priorities, June 20, 2023]

    Health Bills Headed for a Vote in the House Undermine Consumer 
                      Protections and Market Rules

                            (By Sarah Lueck)

       The House is moving toward a vote on legislation that would 
     weaken Affordable Care Act (ACA) consumer protections and 
     private market rules. Proponents of these changes claim they 
     will increase choices and reduce red tape for employers, but 
     a closer look shows the problems they would create. The 
     legislation would:
       Expand association health plans (AHPs). The legislation 
     would allow AHPs, a type of health plan that trade 
     associations, professional groups, and other organizations 
     may offer their members, to cover self-employed individuals 
     and small businesses as if they were large employers. This 
     would exempt them from ACA standards that otherwise apply to 
     health plans in the individual and small group markets. 
     Similar to a Trump-era rule a court struck down in 2019, the 
     bill would segment insurance risk pools: some individuals who 
     are younger and healthier, or small businesses whose 
     employees have that profile, could get plans with lower 
     premiums because they would be priced separately from ACA-
     compliant coverage and would not have to meet ACA standards, 
     such as a requirement to cover a set of essential health 
     benefits. As a result, other individuals and small businesses 
     remaining in ACA-regulated markets would see higher premiums.
       Expand Individual Coverage Health Reimbursement 
     Arrangements (ICHRAs). The legislation would codify 
     provisions similar to a Trump-era rule currently in place 
     that allows employers to forgo offering a regular group 
     health insurance plan and instead offer an HRA (a tax-
     favored, employer-funded account) that workers could use to 
     buy their own individual insurance coverage. Increasing such 
     arrangements could raise ACA marketplace premiums; they are 
     likely to attract sicker-than-average firms that can spend 
     less to fund an ICHRA than they must pay for a group health 
     plan. And firms may find strategies to shift sicker workers 
     to HRAs, even with guardrails in the legislation meant to 
     prevent this.
       Plus, these arrangements require employees to do 
     considerable work compared with signing up for an employer 
     plan--they must apply for and select a plan, set up premium 
     payments, and understand what expenses the ICHRA covers. 
     Also, workers offered an ICHRA could be confused about 
     whether the offer renders them ineligible for a marketplace 
     premium tax credit--that is, whether it constitutes an 
     ``affordable'' employer offer that precludes credit 
     eligibility. And while employers must give workers a notice 
     of HRA rules, they needn't personalize them to tell 
     individual workers whether their plan is affordable. These 
     complications for employees could drive down coverage.
       Increase self-insured employer plans. Another provision 
     would encourage more small employers with healthier workers 
     to self-insure (meaning that the employer bears the financial 
     risk), rather than offering a fully insured health plan (for 
     which an insurer bears the risk). Specifically, the bill 
     would protect a complex self-insurance arrangement known as 
     level funding from tighter regulation. Similar to AHPs, this 
     scheme allows small firms with healthier workers to provide 
     plans that avoid ACA small-group market premium and benefit 
     standards without being a large employer or taking on the 
     risk of self-insurance. This provision would make level 
     funding an even more common way for smaller firms to avoid 
     having to offer plans that meet ACA market rules--this would 
     raise premiums for small businesses that remain in the fully 
     insured, small-group market if small firms with younger and 
     healthier workers move to self-insure.
       House committees recently approved other health bills that 
     raise concerns. The Ways and Means Committee moved to expand 
     health savings accounts (HSAs), which overwhelmingly benefit 
     high income people and exacerbate racial and ethnic 
     inequities in coverage access and wealth accumulation. HSA 
     tax benefits currently are only available when someone has a 
     high-deductible health plan that meets certain federal rules. 
     But the committee approved a bill that would allow high-
     deductible plans to cover telehealth services pre-deductible, 
     while still qualifying for HSA tax benefits. It is estimated 
     to cost $5 billion from 2025 through 2033.
       Another bill, approved by the House Education and Workforce 
     Committee, would let employers offer workers stand-alone 
     telehealth-only plans and exempt the plans from providing ACA 
     consumer protections or meeting other federal laws that 
     otherwise apply to employer coverage. The bill would exempt 
     telehealth plans from, for example, covering mental health 
     care at parity with other care and providing preventive 
     services at no cost to enrollees. The plans could also impose 
     annual and lifetime limits on coverage and sharply limit the 
     types of conditions they would address.
       Additional policy changes are needed to make health 
     coverage and care more affordable for many people, despite 
     the ACA's significant benefits for individuals and small 
     businesses. But the legislation heading to the House floor is 
     misguided. It would undermine consumer protections, segment 
     insurance markets, and impose new burdens on individuals to 
     navigate an already complex system.
  Mr. SCOTT of Virginia. Madam Chair, I reserve the balance of my time.
  Ms. FOXX. Madam Chair, I yield 3 minutes to the gentleman from 
Georgia (Mr. Allen), a member of the Committee on Education and the 
Workforce.
  Mr. ALLEN. Madam Chair, I rise today to urge a vote in support of the 
CHOICE Arrangement Act to enhance the flexibility and affordability of 
healthcare options for small businesses. Competition is the only way to 
drive down costs.

                              {time}  1630

  Democratic policies like ObamaCare have led to consolidation in the 
marketplace, skyrocketing premiums, and a broken individual health 
market that costs taxpayers more than $1 trillion a year while covering 
only 4.6 percent of the population. Make no mistake, Madam Chair, the 
Federal Government owns healthcare, and there is no private system to 
compete with it.
  As a small business owner, I was fortunate to be able to offer my 
employees private health insurance without having to send them to the 
ACA exchange, and I understand how much employers want to be able to 
offer their employees quality healthcare coverage at a low cost. I 
guarantee you, Madam Chair, that the business community will figure out 
healthcare and how to lower costs.
  Unfortunately, many small businesses lack the economies of scale 
needed to negotiate lower prices with insurance companies. This 
commonsense package aims to reduce administrative burdens and empower 
small employers to be able to provide healthcare coverage to their 
employees by removing barriers and implementing innovative solutions 
like association health plans.
  Small businesses and private employers can band together in 
association health plans to be in a better bargaining position to 
reduce healthcare costs for their employees. As an original cosponsor 
of the Association Health Plans Act, I am pleased it was included in 
the package we have before us today.
  This legislation will also expand association health plans by 
allowing self-

[[Page H3030]]

employed individuals to participate in an ERISA-covered health plan.
  I was proud to work with Congressman Hern on the Healthy Future Task 
Force Affordability Subcommittee last Congress, and the legislation we 
are debating today is a culmination of our hard work. We were able to 
produce solutions to provide high quality, affordable, and personalized 
healthcare for workers and their families, as well as innovative 
policies so more small businesses can offer healthcare benefits.
  I am proud to have worked on the solutions included in the CHOICE 
Arrangement Act which will give small businesses the freedom to focus 
on serving their customers and employees.
  Madam Chair, I urge my colleagues to support this bill.
  Mr. SCOTT of Virginia. Madam Chair, I am prepared to close, and I 
yield myself the balance of my time.
  Madam Chair, I regret that my Republican colleagues continue to 
relitigate the Affordable Care Act. However, what we have seen is not 
new. It is what we have seen time and time again over the last 13 
years. They continue using every tool they can to undermine the ACA and 
limit access to quality healthcare, weaken consumer protections, and 
increase average costs.
  The provisions of this package do nothing to lower overall healthcare 
costs for workers and their families. In fact, for most consumers, the 
result of this legislation is that while some may save a little bit, 
most consumers will end up paying more.
  Madam Chair, I strongly urge my colleagues to oppose the bill, and I 
yield back the balance of my time.
  Ms. FOXX. Madam Chair, I yield myself the balance of my time.
  Madam Chair, my colleagues have explained that many things that our 
colleagues across the aisle have said about these bills are not 
accurate.
  I am not going to say it again, but I think it is important that we 
say that these bills are going to do good things for the American 
people. It is going to provide choice and it is going to provide lower 
costs.
  I am certain of two things: one, healthcare costs present a 
significant burden on small businesses; and, two, inaction is not going 
to cut it.
  This comprehensive small business healthcare package is a proven 
first step on free market principles and reducing government 
interference. By empowering small businesses with choice in 
competition, we can lower healthcare costs and increase access to high-
quality care.
  I hope the other side of the aisle gives this legislation the serious 
consideration it deserves. I often hear complaints that Republicans 
don't have a plan to fix healthcare costs. Here it is.
  Let's reduce healthcare costs together and pass this package.
  Madam Chair, I yield back the balance of my time.
  The Acting CHAIR. All time for general debate has expired.
  Pursuant to the rule, the bill shall be considered for amendment 
under the 5-minute rule.
  In lieu of the amendment in the nature of a substitute recommended by 
the Committee on Ways and Means, printed in the bill, an amendment in 
the nature of a substitute consisting of the text of Rules Committee 
Print 118-9, modified by the amendment printed in part C of House 
Report 118-115, shall be considered as adopted. The bill, as amended, 
shall be considered as the original bill for the purpose of further 
amendment under the 5-minute rule and shall be considered as read.
  The text of the bill, as amended, is as follows:

                               H.R. 3799

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

                 TITLE I--ASSOCIATION HEALTH PLANS ACT

     SEC. 101. SHORT TITLE.

       This title may be cited as the ``Association Health Plans 
     Act''.

     SEC. 102. TREATMENT OF GROUP OR ASSOCIATION OF EMPLOYERS.

       (a) In General.--Section 3(5) of the Employee Retirement 
     Income Security Act of 1974 (29 U.S.C. 1002(5)) is amended--
       (1) by striking ``The term'' and inserting ``(A) The 
     term''; and
       (2) by adding at the end the following:
       ``(B) For purposes of subparagraph (A), a group or 
     association of employers shall be treated as an `employer', 
     regardless of whether the employers composing such group or 
     association are in the same industry, trade, or profession, 
     if such group or association--
       ``(i)(I) has established and maintains an employee welfare 
     benefit plan that is a group health plan (as defined in 
     section 733(a)(1));
       ``(II) provides coverage under such plan to at least 51 
     employees after all of the employees employed by all of the 
     employer members of such group or association have been 
     aggregated and counted together as described in subparagraph 
     (D);
       ``(III) has been actively in existence for at least 2 years 
     prior to establishing and maintaining an employer welfare 
     benefit plan that is a group health plan (as defined in 
     section 733(a)(1));
       ``(IV) has been formed and maintained in good faith for 
     purposes other than providing medical care (as defined in 
     section 733(a)(2)) through the purchase of insurance or 
     otherwise;
       ``(V) does not condition membership in the group or 
     association on any health status-related factor (as described 
     in section 702(a)(1)) relating to any individual;
       ``(VI) makes coverage under such plan available to all 
     employer members of such group or association regardless of 
     any health status-related factor (as described in section 
     702(a)(1)) relating to such employer members;
       ``(VII) does not provide coverage under such plan to any 
     individual other than an employee of an employer member of 
     such group or association;
       ``(VIII) has established a governing board with by-laws or 
     other similar indications of formality to manage and operate 
     such plan in both form and substance, of which at least 75 
     percent of the board members shall be made up of employer 
     members of such group or association participating in the 
     plan that are duly elected by each participating employer 
     member casting 1 vote during a scheduled election;
       ``(IX) is not a health insurance issuer (as defined in 
     section 733(b)(2)), and is not owned or controlled by such a 
     health insurance issuer or by a subsidiary or affiliate of 
     such a health insurance issuer, other than to the extent such 
     a health insurance issuer--
       ``(aa) may participate in the group or association as a 
     member; and
       ``(bb) may provide services such as assistance with plan 
     development, marketing, and administrative services to such 
     group or association;
       ``(ii) meets any set of criteria to qualify for such 
     treatment in an advisory opinion issued by the Secretary 
     prior to the date of enactment of the Association Health 
     Plans Act; or
       ``(iii) meets any other set of criteria to qualify for such 
     treatment that the Secretary by regulation may provide.
       ``(C)(i) For purposes of subparagraph (B), a self-employed 
     individual shall be treated as--
       ``(I) an employer who may become a member of a group or 
     association of employers;
       ``(II) an employee who may participate in an employee 
     welfare benefit plan established and maintained by such group 
     or association; and
       ``(III) a participant of such plan subject to the 
     eligibility determination and monitoring requirements set 
     forth in clause (iii).
       ``(ii) For purposes of this subparagraph, the term `self-
     employed individual' means an individual who--
       ``(I) does not have any common law employees;
       ``(II) has an ownership right in a trade or business, 
     regardless of whether such trade or business is incorporated 
     or unincorporated;
       ``(III) earns wages (as defined in section 3121(a) of the 
     Internal Revenue Code of 1986) or self-employment income (as 
     defined in section 1402(b) of such Code) from such trade or 
     business; and
       ``(IV) works at least 10 hours per week or 40 hours per 
     month providing personal services to such trade or business.
       ``(iii) The board of a group or association of employers 
     shall--
       ``(I) initially determine whether an individual meets the 
     requirements under clause (ii) to be considered a self-
     employed individual for the purposes of being treated as an--
       ``(aa) employer member of such group or association (in 
     accordance with clause (i)(I)); and
       ``(bb) employee who may participate in the employee welfare 
     benefit plan established and maintained by such group or 
     association (in accordance with clause (i)(II));
       ``(II) through reasonable monitoring procedures, 
     periodically determine whether the individual continues to 
     meet such requirements; and
       ``(III) if the board determines that an individual no 
     longer meets such requirements, not make such plan coverage 
     available to such individual (or dependents thereof) for any 
     plan year following the plan year during which the board 
     makes such determination. If, subsequent to a determination 
     that an individual no longer meets such requirements, such 
     individual furnishes evidence of satisfying such 
     requirements, such individual (and dependents thereof) shall 
     be eligible to receive plan coverage.
       ``(D) For purposes of subparagraph (B), all of the 
     employees (including self-employed individuals) employed by 
     all of the employer members (including self-employed 
     individuals) of a group or association of employers shall 
     be--
       ``(i) treated as employed by a single employer; and
       ``(ii) aggregated and counted together for purposes of any 
     regulation of an employee welfare benefit plan established 
     and maintained by such group or association.''.
       (b) Determination of Employer or Joint Employer Status.--
     The provision of employee welfare benefit plan coverage by a 
     group or association of employers shall not be construed as 
     evidence for establishing an employer or joint employer 
     relationship under any Federal or State law.

[[Page H3031]]

  


     SEC. 103. RULES APPLICABLE TO GROUP HEALTH PLANS ESTABLISHED 
                   AND MAINTAINED BY A GROUP OR ASSOCIATION OF 
                   EMPLOYERS.

       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:

     ``SEC. 736. RULES APPLICABLE TO GROUP HEALTH PLANS 
                   ESTABLISHED AND MAINTAINED BY A GROUP OR 
                   ASSOCIATION OF EMPLOYERS.

       ``(a) Premium Rates for a Group or Association of 
     Employers.--
       ``(1)(A) In the case of a group health plan established and 
     maintained by a group or association of employers described 
     in section 3(5)(B), such plan may--
       ``(i) establish base premium rates formed on an actuarially 
     sound, modified community rating methodology that considers 
     the pooling of all plan participant claims; and
       ``(ii) utilize the specific risk profile of each employer 
     member of such group or association to determine contribution 
     rates for each such employer member's share of a premium by 
     actuarially adjusting above or below the established base 
     premium rates.
       ``(B) For purposes of paragraph (1), the term `employer 
     member' means--
       ``(i) an employer who is a member of such group or 
     association of employers and employs at least 1 common law 
     employee; or
       ``(ii) a group made up solely of self-employed individuals, 
     within which all of the self-employed individual members of 
     such group or association are aggregated together as a single 
     employer member group, provided the group includes at least 
     20 self-employed individual members.
       ``(2) In the event a group or association is made up solely 
     of self-employed individuals (and no employers with at least 
     1 common law employee are members of such group or 
     association), the group health plan established by such group 
     or association shall--
       ``(A) treat all self-employed individuals who are members 
     of such group or association as a single risk pool;
       ``(B) pool all plan participant claims; and
       ``(C) charge each plan participant the same premium rate.
       ``(b) Discrimination and Pre-existing Condition 
     Protections.--A group health plan established and maintained 
     by a group or association of employers described in section 
     3(5)(B) shall be prohibited from--
       ``(1) establishing any rule for eligibility (including 
     continued eligibility) of any individual (including an 
     employee of an employer member or a self-employed individual, 
     or a dependent of such employee or self-employed individual) 
     to enroll for benefits under the terms of the plan that 
     discriminates based on any health status-related factor that 
     relates to such individual (consistent with the rules under 
     section 702(a)(1));
       ``(2) requiring an individual (including an employee of an 
     employer member or a self-employed individual, or a dependent 
     of such employee or self-employed individual), as a condition 
     of enrollment or continued enrollment under the plan, to pay 
     a premium or contribution that is greater than the premium or 
     contribution for a similarly situated individual enrolled in 
     the plan based on any health status-related factor that 
     relates to such individual (consistent with the rules under 
     section 702(b)(1)); and
       ``(3) denying coverage under such plan on the basis of a 
     pre-existing condition (consistent with the rules under 
     section 2704 of the Public Health Service Act).''.

     SEC. 104. RULE OF CONSTRUCTION.

       Nothing in this title shall be construed to exempt a group 
     health plan which is an employee welfare benefit plan offered 
     through a group or association of employers from the 
     requirements 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.), including the provisions of part A of title 
     XXVII of the Public Health Service Act as incorporated by 
     reference into this Act through section 715.

                    TITLE II--CHOICE ARRANGEMENT ACT

     SEC. 201. SHORT TITLE.

       This title may be cited as the ``Custom Health Option and 
     Individual Care Expense Arrangement Act'' or the ``CHOICE 
     Arrangement Act''.

     SEC. 202. TREATMENT OF HEALTH REIMBURSEMENT ARRANGEMENTS 
                   INTEGRATED WITH INDIVIDUAL MARKET COVERAGE.

       (a) In General.--Section 9815(b) of the Internal Revenue 
     Code of 1986 is amended--
       (1) by striking ``Exception.--Notwithstanding subsection 
     (a)'' and inserting the following: ``Exceptions.--
       ``(1) Self-insured group health plans.--Notwithstanding 
     subsection (a)'', and
       (2) by adding at the end the following new paragraph:
       ``(2) Custom health option and individual care expense 
     arrangements.--
       ``(A) In general.--For purposes of this subchapter, a 
     custom health option and individual care expense arrangement 
     shall be treated as meeting the requirements of sections 2711 
     and 2713 of title XXVII of the Public Health Service Act.
       ``(B) Custom health option and individual care expense 
     arrangements defined.--For purposes of this section, the term 
     `custom health option and individual care expense 
     arrangement' means a health reimbursement arrangement--
       ``(i) which is an employer-provided group health plan 
     funded solely by employer contributions to provide payments 
     or reimbursements for medical care subject to a maximum fixed 
     dollar amount for a period,
       ``(ii) under which such payments or reimbursements may only 
     be made for medical care provided during periods during which 
     the individual is covered--

       ``(I) under individual health insurance coverage (other 
     than coverage that consists solely of excepted benefits), or
       ``(II) under part A and B of title XVIII of the Social 
     Security Act or part C of such title,

       ``(iii) which meets the nondiscrimination requirements of 
     subparagraph (C),
       ``(iv) which meets the substantiation requirements of 
     subparagraph (D), and
       ``(v) which meets the notice requirements of subparagraph 
     (E).
       ``(C) Nondiscrimination.--
       ``(i) In general.--An arrangement meets the requirements of 
     this subparagraph if an employer offering such arrangement to 
     an employee within a specified class of employee--

       ``(I) offers such arrangement to all employees within such 
     specified class on the same terms, and
       ``(II) does not offer any other group health plan to any 
     employees within such specified class.

       ``(ii) Specified class of employee.--For purposes of this 
     subparagraph, any of the following may be designated as a 
     specified class of employee:

       ``(I) Full-time employees.
       ``(II) Part-time employees.
       ``(III) Salaried employees.
       ``(IV) Non-salaried employees.
       ``(V) Employees whose primary site of employment is in the 
     same rating area.
       ``(VI) Employees who are included in a unit of employees 
     covered under a collective bargaining agreement to which the 
     employer is subject (determined under rules similar to the 
     rules of section 105(h)).
       ``(VII) Employees who have not met a group health plan, or 
     health insurance issuer offering group health insurance 
     coverage, waiting period requirement that satisfies the of 
     section 2708 of the Public Health Service Act.
       ``(VIII) Seasonal employees.
       ``(IX) Employees who are nonresident aliens and who receive 
     no earned income (within the meaning of section 911(d)(2)) 
     from the employer which constitutes income from sources 
     within the United States (within the meaning of section 
     861(a)(3)).
       ``(X) Such other classes of employees as the Secretary may 
     designate.

     An employer may designate (in such manner as is prescribed by 
     the Secretary) two or more of the classes described in the 
     preceding subclauses as the specified class of employees to 
     which the arrangement is offered for purposes of applying 
     this subparagraph.
       ``(iii) Special rule for new hires.--An employer may 
     designate prospectively so much of a specified class of 
     employees as are hired after a date set by the employer. Such 
     subclass of employees shall be treated as the specified class 
     for purposes of applying clause (i).
       ``(iv) Rules for determining type of employee.--For 
     purposes for clause (ii), any determination of full-time, 
     part-time, or seasonal employment status shall be made under 
     rules similar to the rules of section 105(h) or 4980H, 
     whichever the employer elects for the plan year. Such 
     election shall apply with respect to all employees of the 
     employer for the plan year.
       ``(v) Permitted variation.--For purposes of clause (i)(I), 
     an arrangement shall not fail to be treated as provided on 
     the same terms within a specified class merely because the 
     maximum dollar amount of payments and reimbursements which 
     may be made under the terms of the arrangement for the year 
     with respect to each employee within such class--

       ``(I) increases as additional dependents of the employee 
     are covered under the arrangement, and
       ``(II) increases with respect to a participant as the age 
     of the participant increases, but not in excess of an amount 
     equal to 300 percent the lowest maximum dollar amount with 
     respect to such a participant determined without regard to 
     age.

       ``(D) Substantiation requirements.--An arrangement meets 
     the requirements of this subparagraph if the arrangement has 
     reasonable procedures to substantiate--
       ``(i) that the participant is, or will be, enrolled in 
     coverage described in subparagraph (B)(ii) as of the 
     beginning of the plan year of the arrangement (or as of the 
     beginning of coverage under the arrangement in the case of an 
     employee who first becomes eligible to participate in the 
     arrangement after the date notice is given with respect to 
     the plan under subparagraph (E) (determined without regard to 
     clause (iii) thereof), and
       ``(ii) any requests made for payment or reimbursement of 
     medical care under the arrangement and that the participant 
     remains so enrolled.
       ``(E) Notice.--
       ``(i) In general.--Except as provided in clause (iii), an 
     arrangement meets the requirements of this subparagraph if, 
     under the arrangement, each employee eligible to participate 
     is, not later than 90 days before the beginning of the plan 
     year, given written notice of the employee's rights and 
     obligations under the arrangement which--

       ``(I) is sufficiently accurate and comprehensive to 
     appraise the employee of such rights and obligations, and
       ``(II) is written in a manner calculated to be understood 
     by the average employee eligible to participate.

       ``(ii) Notice requirements.--Such notice shall include such 
     information as the Secretary may by regulation prescribe.
       ``(iii) Notice deadline for certain employees.--In the case 
     of an employee--

       ``(I) who first becomes eligible to participate in the 
     arrangement after the date notice is given

[[Page H3032]]

     with respect to the plan under clause (i) (determined without 
     regard to this clause), or
       ``(II) whose employer is first established fewer than 120 
     days before the beginning of the first plan year of the 
     arrangement,

     the requirements of this subparagraph shall be treated as met 
     if the notice required under clause (i) is provided not later 
     than the date the arrangement may take effect with respect to 
     such employee.''.
       (b) No Inference.--To the extent not inconsistent with the 
     amendments made by this section--
       (1) no inference shall be made from such amendments with 
     respect to the rules prescribed in the Federal Register on 
     June 20, 2019, (84 Fed. Reg. 28888) relating to health 
     reimbursement arrangements and other account-based group 
     health plans, and
       (2) any reference to custom health option and individual 
     care expense arrangements shall for purposes of such rules be 
     treated as including a reference to individual coverage 
     health reimbursement arrangements.
       (c) Effective Date.--The amendments made by this section 
     shall apply to plan years beginning after December 31, 2023.

                TITLE III--SELF-INSURANCE PROTECTION ACT

     SEC. 301. SHORT TITLE.

       This title may be cited as the ``Self-Insurance Protection 
     Act''.

     SEC. 302. FINDINGS.

       Congress finds the following:
       (1) Small and large employers offer health benefit plan 
     coverage to employees in self-funded arrangements using 
     company assets or a fund, or by paying premiums to purchase 
     fully-insured coverage from a health insurance company.
       (2) Employers that self-fund health benefit plans will 
     often purchase stop-loss insurance as a financial risk 
     management tool to protect against excess or unexpected 
     catastrophic health plan claims losses that arise above 
     projected costs paid out of company assets.
       (3) Stop-loss coverage insures the employer sponsoring the 
     health benefit plan against unforeseen health plan claims, 
     does not insure the employee health benefit plan itself, and 
     does not pay health care providers for medical services 
     provided to the employees.
       (4) Employer-sponsored health benefit plans are regulated 
     under the Employee Retirement Income Security Act of 1974, 
     however, States regulate the availability and the coverage 
     terms of stop-loss insurance coverage that employers purchase 
     to protect company assets and to protect a fund against 
     excess or unexpected claims losses.
       (5) Both large and small employers that choose to self-fund 
     must also be able to protect company assets or a fund against 
     excess or unexpected claims losses and States must reasonably 
     regulate stop-loss insurance to assure its availability to 
     both large and small employers.

     SEC. 303. CERTAIN MEDICAL STOP-LOSS INSURANCE OBTAINED BY 
                   CERTAIN PLAN SPONSORS OF GROUP HEALTH PLANS NOT 
                   INCLUDED UNDER THE DEFINITION OF HEALTH 
                   INSURANCE COVERAGE.

       Section 733(b)(1) of the Employee Retirement Income 
     Security Act of 1974 (29 U.S.C. 1191b(b)(1)) is amended by 
     adding at the end the following sentence: ``Such term shall 
     not include a stop-loss policy obtained by a self-insured 
     group health plan or a plan sponsor of a group health plan 
     that self-insures the health risks of its plan participants 
     to reimburse the plan or sponsor for losses that the plan or 
     sponsor incurs in providing health or medical benefits to 
     such plan participants in excess of a predetermined level set 
     forth in the stop-loss policy obtained by such plan or 
     sponsor.''.

     SEC. 304. EFFECT ON OTHER LAWS.

       Section 514(b) of the Employee Retirement Income Security 
     Act of 1974 (29 U.S.C. 1144(b)) is amended by adding at the 
     end the following:
       ``(10) The provisions of this title (including part 7 
     relating to group health plans) shall preempt State laws 
     insofar as they may now or hereafter prevent an employee 
     benefit plan that is a group health plan from insuring 
     against the risk of excess or unexpected health plan claims 
     losses.''.

                TITLE IV--SMALL BUSINESS FLEXIBILITY ACT

     SEC. 401. SHORT TITLE.

       This title may be cited as the ``Small Business Flexibility 
     Act''.

     SEC. 402. NOTIFICATION OF FLEXIBLE HEALTH INSURANCE BENEFITS.

       (a) In General.--Subchapter C of chapter 100 of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new section:

     ``SEC. 9835. NOTIFICATION OF FLEXIBLE HEALTH INSURANCE 
                   BENEFITS.

       ``(a) In General.--Not later than 1 year after the date of 
     enactment of this section, the Secretary shall notify 
     employers of the availability of tax-advantaged flexible 
     health insurance benefits, with an initial focus on small 
     businesses.
       ``(b) Definitions.--In this section:
       ``(1) Employer.--The term `employer' has the meaning given 
     such term in section 3(5) of the Employee Retirement Income 
     Security Act (29 U.S.C. 1002(5)).
       ``(2) Flexible health insurance benefits.--The term 
     `flexible health insurance benefits' means--
       ``(A) an individual contribution health reimbursement 
     arrangement (as described in the rule entitled `Health 
     Reimbursement Arrangements and Other Account-Based Group 
     Health Plans' (84 Fed. Reg. 28888 (June 20, 2019));
       ``(B) a qualified small employer health reimbursement 
     arrangement (as defined in section 9831(d)(2)); and
       ``(C) the small employer health insurance credit determined 
     under section 45R.''.
       (b) Clerical Amendment.--The table of sections for 
     subchapter C of chapter 100 of such Code is amended by adding 
     at the end the following new item:

``Sec. 9835. Notification of flexible health insurance benefits.''.

                          TITLE V--RESCISSIONS

     SEC. 501. PREVENTION AND PUBLIC HEALTH FUND.

       Section 4002(b)(7) of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 300u-11(b)(7)) is amended by striking 
     ``for each of fiscal years 2024 and 2025, $1,300,000,000'' 
     and inserting ``for fiscal year 2024, $1,055,000,000, and for 
     fiscal year 2025, $1,300,000,000''.

  The Acting CHAIR. No further amendment to the bill, as amended, shall 
be in order except those printed in part D of House Report 118-115. 
Each such further amendment may be offered only in the order printed in 
the report, by the Member designated in the report, shall be considered 
as read, shall be debatable for the time specified in the report 
equally divided and controlled by the proponent and an opponent, shall 
not be subject to amendment, and shall not be subject to a demand for 
division of the question.


                 Amendment No. 1 Offered by Mrs. Hayes

  The Acting CHAIR. It is now in order to consider amendment No. 1 
printed in part D of House Report 118-115.
  Mrs. HAYES. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 23, after line 13, insert:

                        TITLE V--EFFECTIVE DATE

     SEC. 501. EFFECTIVE DATE.

       This Act shall not take effect unless the Secretary of 
     Labor certifies that the amendments made by this Act would 
     not result in higher premium rates for older workers.

  The Acting CHAIR. Pursuant to House Resolution 524, the gentlewoman 
from Connecticut (Mrs. Hayes) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Connecticut.
  Mrs. HAYES. Madam Chair, I yield myself such time as I may consume.
  Madam Chair, I rise in support of my amendment to the CHOICE 
Arrangement Act.
  This bill, as written, makes healthcare less accessible and 
affordable for our most at-risk workers. My amendment prevents older 
workers from obscene healthcare premiums and discrimination.
  As of January 2023, a record 16.3 million people, including older 
Americans, were insured under the Affordable Care Act.
  According to the Center on Budget and Policy Priorities, under the 
Affordable Care Act, older adults' uninsured rate has dropped by one-
third, a factor that is a key indicator their health and wellness has 
improved. Further, they are now protected from coverage exclusions and 
cost increases due to preexisting conditions.
  In 2019, people aged 55 to 64 had the lowest uninsured rate among 
nonelderly adults, but instead of working to build upon this success, 
my colleagues are bolstering individual coverage health reimbursement 
arrangements and association health plans which have a long, well-
documented history of cutting costs for themselves by cherry-picking 
the cheapest people to cover, leaving the more expensive and vulnerable 
ones behind. This raises costs for those not chosen and causes premiums 
to go up for the rest of the insurance market.
  Republicans have been pushing these efforts for decades, and experts 
have consistently found it to be harmful. In its final rule adopted in 
2018 by the Trump administration, the Department of Labor acknowledged 
as much, noting the ``AHPs could use their regulatory flexibility to 
design more tailored, less comprehensive health coverage . . . Which 
will necessarily lead to some favorable risk selection toward AHPs and 
adverse selection against individuals and small group markets.''
  They predicted this would raise premiums for consumers who are left 
behind in the small group and individual markets.
  For decades, independent experts at the American Academy of Actuaries 
and the Congressional Budget Office have repeatedly found premiums for 
older workers would be higher as a result of the association health 
plan legislation.
  The bill has only superficial protections from discrimination based 
on

[[Page H3033]]

health status and is entirely silent on discrimination and pricing 
against older individuals. In fact, by explicitly allowing associations 
to base premiums on the risk factor on each employee within the group, 
it invites them to discriminate against other characteristics.
  My amendment requires the Department of Labor to certify that the 
bill would not raise premiums for older Americans before taking effect.
  I ask my colleagues to support my amendment to protect older 
Americans and implore that we work together to address the real 
healthcare problems in our Nation and move toward a more equitable 
healthcare system for older workers.
  Madam Chair, I reserve the balance of my time.
  Ms. FOXX. Madam Chair, I rise in opposition to the amendment.
  The Acting CHAIR. The gentlewoman from North Carolina is recognized 
for 5 minutes.
  Ms. FOXX. Madam Chair, I yield myself such time as I may consume.
  Madam Chair, I am pleased my Democratic colleagues are finally 
expressing some concern for rising healthcare costs, particularly the 
burden those costs can impose on our Nation's seniors.
  I remind my Democrat colleagues that Medicare is expected to become 
insolvent in 8 years. Increasing access to AHPs may be a lifesaving 
option for these seniors if Congress does not address Medicare's 
insolvency issues.
  Unfortunately, for seniors, premiums of older Americans have risen 
drastically thanks to ObamaCare. In fact, health plans in New York just 
requested rate bumps of up to 40 percent.
  The percentage of healthcare costs paid by a health insurance plan is 
known as the actuarial value, AV. On average, the AV of an individual 
employer-sponsored plan is 83 percent. When compared to the 70 percent 
AV of a silver plan and even the 80 percent AV of a gold plan on the 
Affordable Care Act exchanges, employer-sponsored plans provide 
affordable and more comprehensive coverage than ACA plans.
  Employer-sponsored plans also have lower average deductibles: $1,763 
for an individual employer-sponsored insurance plan compared with 
$5,155 for an individual ACA exchange silver plan.
  I will repeat that: $1,763 on an employer-sponsored plan, for an 
individual employer-sponsored insurance plan, compared with $5,155 for 
an individual ACA exchange silver plan.
  Individual employer-sponsored plans have lower average out-of-pocket 
costs than ACA exchange plans.
  Madam Chair, $4,355 is the average maximum for an individual-
sponsored insurance plan compared with an average maximum of $8,519 for 
an individual marketplace silver/ACA plan.
  Clearly, our government-run and government-subsidized healthcare 
programs are facing incredible fiscal challenges. I urge my colleagues 
to be more concerned with the older adults enrolled in those programs 
than those enrolled in large group employer plans.
  This amendment is an insincere attempt to delay implementation of 
commonsense policy that will increase health coverage options for all 
Americans. Instead, AHPs and the coverage options provided under this 
bill give older Americans more affordable coverage options.
  Madam Chair, for these reasons, I urge my colleagues to vote ``no'' 
on the amendment and ``yes'' on the underlying bill, and I reserve the 
balance of my time.

  Mrs. HAYES. Madam Chair, I yield 2 minutes to the gentleman from 
Virginia (Mr. Scott), who is the distinguished ranking member of the 
Committee on Education and the Workforce.
  Mr. SCOTT of Virginia. Madam Chair, I thank the gentlewoman for 
yielding.
  Madam Chair, I rise in support of this amendment. Association health 
plans have a long, well-documented history of cutting costs for 
themselves by cherry-picking the cheapest people to cover and leaving 
the more expensive behind. This raises costs for everybody else and 
causes premiums to go up in the rest of the market. Republicans have 
been pushing this idea for decades, and experts have consistently found 
it to be harmful.
  The Affordable Care Act made a number of reforms to commercial 
insurance markets, including a requirement that plans in the individual 
and small group markets cover essential health benefits such as 
maternity care and prescription drugs. The ACA also prevented these 
plans from charging higher rates based on health status and limited the 
premium amount that older people could be charged compared to younger 
people. This was a vital protection that ensured that an age tax would 
not make coverage unaffordable for older individuals.

                              {time}  1645

  This legislation has no protection without this amendment. The bill 
is entirely silent on discriminatory pricing against older people. In 
fact, by explicitly allowing associations to base premiums on risk 
factors of each employer within the group, it actually invites them to 
charge older Americans much more.
  This amendment would ensure that older workers are protected by 
providing in this bill that it would not take effect until the 
Secretary of Labor certifies that it would not have the impact of 
raising premiums for older workers.
  I thank the gentlewoman from Connecticut for her leadership on the 
Education and the Workforce Committee.
  Madam Chair, I urge my colleagues to support the amendment.
  Ms. FOXX. Madam Chair, I believe I have the right to close, so I 
reserve the balance of my time.
  Mrs. HAYES. Madam Chair, I urge my colleagues to support this 
commonsense amendment to protect older Americans with preexisting 
conditions.
  The ACA expanded Medicaid for low-income Americans and protected 
coverage for people with preexisting conditions. We want to make sure 
we continue that tradition and make sure that the CHOICE Arrangement 
Act will not go into effect until the Secretary of Labor certifies that 
this bill will not result in higher premiums for older Americans and 
seniors. It is critical that we protect this access.
  Madam Chair, I yield back the balance of my time.
  Ms. FOXX. Madam Chair, again, our colleagues continue to try to 
mislead the American people about what this bill does. These plans 
cannot cherry-pick, cannot exclude, and must cover preexisting 
conditions.
  The opposition to this bill from our colleagues across the aisle, 
unfortunately, is to freedom of choice. The title of this bill is the 
CHOICE Arrangement Act, freedom of choice, which would allow people to 
stay out of the non-affordable care act, known as ObamaCare, but still 
have affordable health insurance.
  This bill is about choice, freedom, and good healthcare coverage, and 
we should approve the bill without this amendment.
  Madam Chair, I ask my colleagues to vote ``no'' on the amendment, and 
I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Connecticut (Mrs. Hayes).
  The question was taken; and the Acting Chair announced that the noes 
appeared to have it.
  Mrs. HAYES. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentlewoman from 
Connecticut will be postponed.


                Amendment No. 2 Offered by Mr. Molinaro

  The Acting CHAIR. It is now in order to consider amendment No. 2 
printed in part D of House Report 118-115.
  Mr. MOLINARO. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 22, line 17, insert ``, particularly in rural areas 
     (as defined in section 1393(a)(2))'' after ``businesses''.
  The Acting CHAIR. Pursuant to House Resolution 524, the gentleman 
from New York (Mr. Molinaro) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from New York.
  Mr. MOLINARO. Madam Chair, I yield myself such time as I may consume.
  Madam Chair, I appreciate the opportunity this afternoon to speak on 
my

[[Page H3034]]

amendment to the underlying bill, which, as we know, does help to 
unlock the growth and prosperity of our Nation's small businesses and 
their employees.
  My amendment is simple and straightforward. It will ensure that small 
businesses and employers, particularly those in rural communities 
across the country, are made aware of tax-advantaged flexible health 
insurance benefits. Employers, especially in the rural areas like the 
ones I represent in upstate New York, should have the tools to provide 
their employees with various options to lower their healthcare costs 
and to access quality care.
  As a member of the House Committee on Small Business, I know the 
unique challenges businesses in rural communities and those 
businessowners and employees face every day. With a comprehensive focus 
on rural areas, we can help ensure that all businesses, regardless of 
their ZIP Code, have equal opportunity to provide affordable, high-
quality healthcare benefits.
  Madam Chair, I appreciate the opportunity to speak to this amendment. 
I urge its consideration, and I reserve the balance of my time.
  Mr. DOGGETT. Madam Chair, I rise in opposition to the amendment.
  The Acting CHAIR. The gentleman from Texas is recognized for 5 
minutes.
  Mr. DOGGETT. Madam Chair, I yield myself such time as I may consume.
  This amendment has a rather nominal effect in not improving what is a 
very bad and deceptive bill.
  It is appealing to talk about rural areas. I am concerned about those 
rural areas, about the chicken pluckers, about the meatpackers, about 
the field workers, and the way they will be discriminated against under 
this bill.
  I will elaborate on that. While this is mainly a Republican caucus 
that follows the seditious pied piper who was our President, in this 
case, even under the Trump administration, when they considered this 
kind of proposal, the Treasury Department, the Labor Department, and 
the Health and Human Services Department came together and recognized 
the danger of discriminating against different classes of employees.
  Ultimately, unfortunately, the Trump administration did not provide 
the protection against discrimination, so that people who are working 
in rural areas under this bill may be discriminated against by their 
employer as a result of this legislation.
  It is the failure to have clear language in this bill to prevent such 
discrimination against rural workers, in favor of those who are in the 
office towers managing everything, that is at the heart of our 
opposition, as well as the refusal to provide protection and guarantees 
against people being denied as a result of their preexisting 
conditions.
  Rural Americans are more likely to die from heart disease, cancer, 
stroke, unintentional injury, and respiratory disease. Yet, we would 
take our sickest workers, our most vulnerable low-income workers, and 
deny them a comprehensive employer plan with many protections and allow 
them to be the subject of discrimination.
  There has already been too much discrimination against rural areas 
and rural workers. We ought to prevent it, not make it worse.
  There are no guarantees that these people can find any coverage with 
their ICHRA plan, let alone affordable and quality coverage.
  I think rural Americans deserve far better than this amendment to try 
to put a patch on a very sorry bill that undermines the protections of 
the Affordable Care Act that has offered great benefit to so many 
Americans, and I urge everyone to vote ``no.''
  Madam Chair, I reserve the balance of my time.
  Mr. MOLINARO. Madam Chair, I yield 30 seconds to the gentlewoman from 
North Carolina (Ms. Foxx).
  Ms. FOXX. Madam Chair, I appreciate Mr. Molinaro's amendment. I 
support it, and I appreciate his working to make a good bill better.
  Mr. MOLINARO. Madam Chair, this amendment, as a reminder to my 
colleagues across the aisle, is simply meant to broaden access and 
educate small business owners all across this country as to the 
benefits that are available to them to access affordable, quality 
healthcare.
  Madam Chair, I yield back the balance of my time.
  Mr. DOGGETT. Madam Chair, I yield myself the balance of my time.
  Madam Chair, I would say that the only education that would be really 
helpful on this bill would be to educate both employers and employees 
about all the shortcomings of this bill.
  Educating employers that they ought not to be discriminating against 
classes of workers and treating the rural, hardworking employees there 
at lower wages differently where they get an ICHRA policy that denies 
them preexisting conditions, that denies them the essential benefits 
under the Affordable Care Act, while the folks in the city in 
management get treated differently--they get a concierge kind of 
treatment that is not available to the rural workers. Just educating 
about this bill, which allows that discrimination, would not accomplish 
much of anything.
  I think what we are going to see with this kind of legislation is 
more and more workers in rural areas, as well as urban areas, who face 
discrimination and who face great medical debt because these plans are 
so weak. They are junk insurance that will deny the benefits that most 
people need.
  Educating about them, if truthful education, if not the kind of 
deception that is buried in this bill, educating about them will only 
tell people the limitations and the shortcomings. Otherwise, it will be 
a kind of education that covers up, as this bill does, the great harm 
that is being done in denying folks access to a family physician with 
the protection that is there.
  Remember that in moving to these ICHRA plans, we already know that 95 
percent of those that are in ICHRA plans today, that have this icky 
kind of coverage, are people who once had good group health insurance 
that I would like to see available to more Americans.
  Again, I urge my colleagues to definitely vote ``no'' on this 
amendment and vote ``no'' on this sorry bill and support our motion to 
recommit.
  Madam Chair, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from New York (Mr. Molinaro).
  The question was taken; and the Acting Chair announced that the ayes 
appeared to have it.
  Mr. DOGGETT. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from New York 
will be postponed.


                   Amendment No. 3 Offered by Mr. Roy

  The Acting CHAIR. It is now in order to consider amendment No. 3 
printed in part D of House Report 118-115.
  Mr. ROY. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 23, after line 13, insert the following:

TITLE V--SENSE OF CONGRESS THAT AMERICANS SHALL HAVE HEALTHCARE FREEDOM

     SEC. 501. SENSE OF CONGRESS THAT HEALTHCARE FREEDOM IS THE 
                   FUTURE.

       It is the sense of Congress that--
       (1) the future of healthcare lies in healthcare freedom, 
     not in socialized medicine;
       (2) Congress should take steps to address the broken 
     healthcare system by restoring free market practices to lower 
     costs;
       (3) coverage is not care, and expanding direct access to 
     healthcare should be prioritized over expanding access to 
     coverage; and
       (4) patients and doctors, not government bureaucrats or 
     insurance bureaucrats, should make healthcare decisions.

  The Acting CHAIR. Pursuant to House Resolution 524, the gentleman 
from Texas (Mr. Roy) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Texas.
  Mr. ROY. Madam Chair, I notice that my friend and colleague from 
Texas talks about the current system discriminating. Well, the current 
system discriminates against small businesses and people who can't 
afford the massive cost of insurance or care. That is the truth.
  My colleague refers to an icky kind of coverage. The fact of the 
matter is

[[Page H3035]]

that we have a large segment of the American people who are trapped in 
so-called coverage, but they are not able to get care.
  That is why we are here. We are trying to increase options for the 
American people.
  My only concern about what we are doing with this legislation, which 
I wholeheartedly support, and trying to encourage small businesses and 
give them options to be able to provide better options for their 
employees, is I don't believe that, in America, you should only be able 
to get insurance through government or your employer.
  We should be freeing up the system. We should be embracing healthcare 
freedom. We should be creating an environment where the American people 
control their healthcare rather than employers and government. That is 
the truth.
  I offered an amendment to simply spell that out in the form of a 
sense of Congress, a sense of Congress that the future of healthcare 
lies in healthcare freedom, not in socialized medicine; that Congress 
should take steps to address the broken healthcare system by restoring 
free market practices to lower costs; that coverage is not care and 
expanding direct access to healthcare should be prioritized over 
expanding access to coverage; and that patients and doctors, not 
government bureaucrats or insurance bureaucrats, should make healthcare 
decisions.
  Why do I think that? Well, the deals that are struck with the 
government by big corporations are the problem. For example, most 
recently, ObamaCare guaranteed their actual growth and profit. For 
example, Anthem had a 344 percent increase in government revenue from 
2010 to 2020. UnitedHealthcare had a 198 percent increase. Cigna, 
Anthem, UnitedHealthcare, and Humana have seen an average increase of 
562 percent in their stock prices from January 2011 to January 2021.
  Here is the kicker. In 2018, for at least three of these companies, 
the majority of their revenue came from the government: 
UnitedHealthcare, 53.4 percent; Anthem, 58.7 percent; and Humana, a 
whopping 86.9 percent.
  It is that corporate cronyism that is reducing options. They are 
making it more difficult for the American people.
  The fact is, for Americans who are trapped in coverage through 
ObamaCare--for example, when I came to Congress as a Member of 
Congress, I was put on ObamaCare, not some gold-plated plan that flies 
around on the internet that we supposedly have, but on ObamaCare. The 
place I went to cure the cancer that I had a decade ago, MD Anderson, I 
wouldn't be allowed to use. What kind of coverage is that?
  That is what we are telling the American people. That is the best we 
can do in the freest, greatest country in the history of the world. Bow 
down to the altar of government and corporate America to be able to 
figure out how you should get care.
  Madam Chair, I reserve the balance of my time.
  Mr. DOGGETT. Madam Chair, I rise in opposition to the amendment.
  The ACTING Chair. The gentleman from Texas is recognized for 5 
minutes.
  Mr. DOGGETT. Madam Chair, I yield myself such time as I may consume.
  Madam Chair, I don't believe that we have noted yet in the course of 
this debate the great irony, the fact that this is called the CHOICE 
Arrangement Act, that we have some pro-choice Republicans here who want 
to give employers the choice and allow them to discriminate against 
different classes of their own employees. All of this is happening the 
same horrible anniversary week of the Supreme Court's wrongful decision 
to overturn decades of reliance upon Roe v. Wade and to eliminate the 
right to an abortion with an effect on women's healthcare that is so 
far-reaching that it is affecting our colleges of medicine across the 
country and delivery of healthcare to women who may never have been 
involved in the slightest way with an abortion.

                              {time}  1700

  They called this healthcare freedom today. I call it the repression 
and the interference with the basic healthcare rights of women.
  By the terms of their own amendment, patients and doctors should make 
healthcare decisions, not government bureaucrats or insurance 
companies. The CHOICE Arrangement Act comes at the same time that they 
interfere with what happens in our bedrooms and our doctors' offices 
and, most recently, even in our kitchens.
  They would sentence patients under this basic legislation with 
preexisting conditions to a future of very few choices and no freedom. 
With no choices for adequate and affordable healthcare, this 
legislation guarantees one kind of prescription and one kind of 
prescription only, and that is a prescription for personal bankruptcy 
and unlimited medical debt from policies that do not provide essential 
healthcare benefits.
  It is really a shame that, in a country as wealthy as ours, we still 
have millions of citizens who go without health coverage. Over 30 
million Americans, in fact, lack coverage, and many in our home State 
of Texas lack coverage because of the fact that our State legislature 
and Governor were never willing to provide the guarantee we anticipated 
with the Affordable Care Act of Medicaid expansion as most States have 
done.
  Patients do not have a choice, do not have freedom when they suffer a 
heart attack or are diagnosed with a dreaded disease or a broken arm, 
and they lack insurance coverage that provides them the benefits that 
they need.
  Under this amendment, which is a sense of Congress resolution that 
really doesn't accomplish much of anything, this bill is not improved. 
Americans would have so much skin in the game they would get burned 
just as the Republican dirty fossil fuel plan would burn up our planet.
  It is not just the Affordable Care Act that is being targeted today. 
There is reference to socialized medicine of the kind that Newt 
Gingrich once attacked in this body when he suggested Medicare should 
``wither on the vine.''
  Contrary to Republican attacks, we have heard about public insurance 
programs. Seniors on Medicare value their Medicare as do the 16 million 
people who signed up for the Affordable Care Act this year.
  Madam Chair, I reserve the balance of my time.
  Mr. ROY. Madam Chair, do you know who should decide what an essential 
health benefit is? The consumer, the American, not a government 
bureaucrat or a corporate bureaucrat. I will stand up for the 5,000 
babies that have been born in Texas greater than last year's number of 
babies in the wake of the Dobbs decision.
  Let me just say this. According to the CBO, Federal subsidies for 
health insurance coverage for Americans under the age of 65 will hit $1 
trillion this year. The average American family spends more than 
$22,000 a year on premiums for themselves through their employees. 
Again, coverage is not care.
  There are other healthcare models that work. The Wall Street Journal 
showed what cutting out the middleman in healthcare can do for costs: 
$150 a month to cover a family of five on a direct primary care model.
  A DPC practice in my district charges only $50 to $80 for an X-ray 
compared to the national average of $125. MRIs are $300 to $450 
compared to the national average of $1,325.
  It is not just primary care. For example, at the Surgery Center of 
Oklahoma, a direct care model, a knee replacement costs $18,000 
compared to the average cost of $50,000 in the United States.
  Healthcare sharing ministries are driving down costs for the American 
people, giving them coverage and giving them options.
  The fact is we should imagine an America where, through a health 
savings account, your employer can give you real dollars, rather than a 
faceless insurance company, to pursue real care of your choice, so for 
a flat monthly fee, you and your children have unlimited access to the 
physician of your choice. You could still get insurance for the big 
stuff, walking into a doctor's office and knowing how much things are 
going to cost.
  Right now, the American people do not have options. I support this 
bill, but this amendment is important because we need a trajectory 
change in this country in favor of healthcare freedom, in favor of 
personalized care, in favor of patients and doctors over bureaucrats 
and corporations that are getting rich because the government is 
subsidizing their corporate cronyism.

[[Page H3036]]

  Madam Chair, I yield back the balance of my time.
  Mr. DOGGETT. Madam Chair, this is the freedom resolution on the week 
that we have the anniversary of the anti-choice Dobbs decision as part 
of the CHOICE Arrangement Act.
  Well, I am reminded of the lyrics of a famous Janis Joplin song: 
``Freedom is just another word for nothing left to lose.'' No choice is 
left. No freedom is left. This is our future under Republican plans--so 
much to lose, nothing left tomorrow.
  We need to protect more Americans from the dangers of health debt and 
bankruptcy. We need to ensure broader coverage. There is a huge 
coverage gap that is leaving perhaps as many as 2 million Texans 
without coverage because of the failures and ideological objections of 
our State Republican government.
  Those Americans deserve the same protection that 16 million Americans 
got when they signed up for the Affordable Care Act this year. They 
have access to a family physician that is so very important. They have 
access to the essential benefits of the Affordable Care Act, getting 
access to the kind of care that they need to ensure their family is 
secure.
  I believe that there are many improvements that are necessary in the 
Affordable Care Act. We were limited in being able to make those 
improvements when all we had for more than a decade were 60-plus 
Republican attempts to repeal the Affordable Care Act.

  Let us reject this bill and this amendment.
  Madam Chair, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from Texas (Mr. Roy).
  The question was taken; and the Acting Chair announced that the ayes 
appeared to have it.
  Mr. DOGGETT. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from Texas will 
be postponed.
  Ms. FOXX. Madam Chair, I move that the Committee do now rise.
  The motion was agreed to.
  Accordingly, the Committee rose; and the Speaker pro tempore (Mr. 
Self) having assumed the chair, Mrs. Wagner, Acting Chair of the 
Committee of the Whole House on the state of the Union, reported that 
that Committee, having had under consideration the bill (H.R. 3799) to 
amend the Internal Revenue Code of 1986 to provide for health 
reimbursement arrangements integrated with individual health insurance 
coverage, had come to no resolution thereon.

                          ____________________