[Congressional Record Volume 169, Number 110 (Friday, June 23, 2023)]
[Extensions of Remarks]
[Page E607]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





    CUSTOM HEALTH OPTION AND INDIVIDUAL CARE EXPENSE ARRANGEMENT ACT

                                 ______
                                 

                               speech of

                        HON. SHEILA JACKSON LEE

                                of texas

                    in the house of representatives

                        Wednesday, June 21, 2023

       The House in Committee of the Whole House on the state of 
     the Union 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.

  Ms. JACKSON LEE. Madam Chair, I rise today in strong opposition to 
H.R. 3799, which makes two substantial changes to health coverage 
policy, both of which are very harmful to workers.
  H.R. 3799 aims to codify a Trump Administration rule on Individual 
Coverage Health Reimbursement Accounts (ICHRAs) and rename them 
``CHOICE'' accounts.
  While this bill certainly allows employers to make choices, it also 
allows employers to discriminate against certain employees.
  First, H.R. 3799 could circumvent Affordable Care Act (ACA) 
protections on pre-existing conditions, lifetime and annual limits, and 
preventive care.
  This legislation describes individual market coverage but does not 
explicitly reference the code in defining an individual health 
insurance plan that requires the ACA market protections like pre-
existing conditions protections.
  The policy is intended to allow plans that are unable to selffund 
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.
  Secondly, this bill leaves room for employers to offer less coverage 
through ICHRAs to lower income workers, hourly workers, or seasonal 
workers, reserving better coverage for executives.
  The mere offer of an ICHRA may leave employees worse off.
  For example, an employee who has an offer of an ``affordable'' HRA is 
prevented from accessing premium tax credits in the marketplace.
  A Brookings analysis found that allowing employers to offer IHRAs 
alongside a traditional group health insurance plan could increase 
marketplace premiums by 16 percent to 93 percent.
  This offer hurts lower-wage workers where they would otherwise be 
able to find more affordable coverage in the marketplace and could lead 
to higher premiums and out-of-pocket costs than under ACA coverage for 
the employee.
  We have seen this from Republicans before, using policies to make the 
marketplace risk pool weaker, instead of more robust.
  Overall, this bill makes it easy for employers to target workers with 
higher health costs, sending them to the individual market with a 
voucher.
  Republicans once again, are putting wealth before health.
  We must work together to mitigate these concerns and include 
important safeguards that protect employees from discrimination.
  Every American is entitled to affordable healthcare, and we must 
ensure that every American can make the best health care choices for 
their families.

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