[Congressional Record (Bound Edition), Volume 163 (2017), Part 4]
[House]
[Pages 4534-4541]
[From the U.S. Government Publishing Office, www.gpo.gov]




    PROVIDING FOR CONSIDERATION OF H.R. 1101, SMALL BUSINESS HEALTH 
                          FAIRNESS ACT OF 2017

  Mr. BYRNE. Mr. Speaker, by direction of the Committee on Rules, I 
call up House Resolution 210 and ask for its immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 210

       Resolved, That upon adoption of this resolution it shall be 
     in order to consider in the House the bill (H.R. 1101) to 
     amend title I of the Employee Retirement Income Security Act 
     of 1974 to improve access and choice for entrepreneurs with 
     small businesses with respect to medical care for their 
     employees. All points of order against consideration of the 
     bill are waived. In lieu of the amendment recommended by the 
     Committee on Education and the Workforce now printed in the 
     bill, an amendment in the nature of a substitute consisting 
     of the text of Rules Committee Print 115-9 shall be 
     considered as adopted. The bill, as amended, shall be 
     considered as read. All points of order against provisions in 
     the bill, as amended, are waived. The previous question shall 
     be considered as ordered on the bill, as amended, and on any 
     further amendment thereto, to final passage without 
     intervening motion except: (1) one hour of debate equally 
     divided and controlled by the chair and ranking minority 
     member of the Committee on Education and the Workforce; (2) 
     the further amendment printed in the report of the Committee 
     on Rules accompanying this resolution, if offered by the 
     Member designated in the report, which shall be in order 
     without intervention of any point of order, shall be 
     considered as read, shall be separately debatable for the 
     time specified in the report equally divided and controlled 
     by the proponent and an opponent, and shall not be subject to 
     a demand for a division of the question; and (3) one motion 
     to recommit with or without instructions.

  The SPEAKER pro tempore. The gentleman from Alabama is recognized for 
1 hour.
  Mr. BYRNE. Mr. Speaker, for the purpose of debate only, I yield the 
customary 30 minutes to the gentleman from Colorado (Mr. Polis), 
pending which I yield myself such time as I may consume. During 
consideration of this resolution, all time yielded is for the purpose 
of debate only.


                             General Leave

  Mr. BYRNE. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days to revise and extend their remarks.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Alabama?
  There was no objection.
  Mr. BYRNE. Mr. Speaker, House Resolution 210 provides for 
consideration of H.R. 1101, the Small Business Health Fairness Act of 
2017.
  President Trump promised to repeal and replace ObamaCare, which is 
negatively affecting our economy and causing great hardship on the 
American people. Congress is responding this week with multiple bills 
to do just that.
  After years of endless premium increases, we must take steps to make 
health insurance more accessible and affordable, including for small 
businesses that employ the majority of Americans. H.R. 1101, the Small 
Business Health Fairness Act, will do just that by helping to level 
inequalities between large and small employers, ultimately making 
health insurance more affordable for millions of Americans.
  Simply put, the Small Business Health Fairness Act will empower small 
businesses to band together through association health plans to 
purchase health insurance. This will allow them to increase their 
bargaining power, negotiating for lower health insurance rates on 
behalf of their employees, just like their large competitors do.
  Additionally, the bill will allow their plans to fall under the 
Employee Retiree Income Security Act of 1974, or ERISA, and the 
Department of Labor, just like the large self-funded employer plans, 
preempting a myriad of State regulations that often make insurance 
unaffordable for small businesses.
  The usefulness of this legislation is easy to imagine. For example, a 
small accounting firm might employ just three or four people while the 
largest firms employ tens of thousands. If that small firm could join 
together with others just like it to provide health insurance through 
their national association, it could have the same bargaining power and 
be subject to the same regulation as the firm with thousands of 
employees. This parity means more options and lower costs for employers 
and employees.
  Mr. Speaker, our Nation's small businesses were hit especially hard 
by the passage of ACA. In fact, a 2016 survey by the National 
Federation of Independent Businesses found that small businesses 
identified the cost of health care as their number one challenge.
  An estimated 300,000 small-business jobs were destroyed, and an 
estimated 10,000 small businesses closed altogether due to the failed 
ObamaCare policies.
  Since 2008, 36 percent of all small businesses with fewer than 10 
employees have stopped offering healthcare coverage. This has resulted 
in less overall healthcare options for working families.
  ObamaCare's compliance costs and mandates have resulted in $19 
billion in lost wages for small-business employees.
  The bottom line is that small businesses--the backbone of our 
Nation's economy--and their employees are feeling the pain of 
ObamaCare's failures and broken promises.
  I meet with these small-business owners from south Alabama every day. 
They want to take care of their employees and provide them with high-
quality health insurance. Through enacting the Small Business Health 
Fairness Act, we can help thousands of small businesses achieve that 
goal.
  Mr. Speaker, I also want to point out that this legislation includes 
strong protections to ensure association health plans are solvent and 
that the families covered by them are indeed protected. A sponsor of a 
plan must be a bona fide trade, industry, or professional organization 
and can't be established for the purpose of providing medical care.
  The sponsor must have existed for a period of at least 3 consecutive 
years before providing group health insurance coverage. The association 
health plan must be operated by a board of trustees and will be 
supervised by the Department of Labor. This will include minimum 
capital requirements and a requirement that plans have a stop-loss and 
solvency insurance.
  Finally and most importantly, the bill prohibits association health 
plans from discriminating based upon health status and preexisting 
conditions.
  Mr. Speaker, the Small Business Health Fairness Act is about ensuring 
our Nation's small businesses are afforded the same opportunities given 
to large corporations and labor unions. When similar legislation has 
been brought to the floor in the past, it has received strong 
bipartisan support, as I hope this bill will today.
  Ultimately, this bill is just one part of our larger plan to rescue 
the American people from the failures of ObamaCare. This week, the 
House intends to vote to repeal ObamaCare, along with its mandates and 
its taxes.
  But we do also understand that the pre-ObamaCare status quo is not 
acceptable. That is why the House is already moving to consider bills 
to give

[[Page 4535]]

Americans the freedom, choices, and control they deserve.
  Our solutions are built on free market and patient-centered 
principles. By getting the government out of the way and increasing 
competition, we can draw down costs and help Americans obtain health 
care that actually works for them.
  Mr. Speaker, I urge my colleagues to support House Resolution 210 and 
the underlying bill.
  Mr. Speaker, I reserve the balance of my time.

                              {time}  1400

  Mr. POLIS. Mr. Speaker, I yield myself such time as I may consume, 
and I thank the gentleman for yielding me the customary 30 minutes.
  Mr. Speaker, I rise in opposition to this rule today that provides 
for consideration of H.R. 1101, the so-called Small Business Health 
Fairness Act of 2017.
  This bill, first of all, from a procedural basis, did not allow even 
a discussion of the amendments that my Democratic colleagues brought 
forward to improve the bill. This rule has something called the 
structured amendment process, which basically means that Democrats are 
locked out from presenting our ideas for improving this bill. We are 
not even allowed a 10-minute debate or a vote on any of the ideas that 
many of my colleagues brought forward.
  The gentlewoman from Oregon (Ms. Bonamici) proposed an amendment to 
require the legislation only take effect if the Congressional Budget 
Office determined premiums for older workers wouldn't increase. Sounds 
like a reasonable idea to at least debate for an hour, 10 minutes. It 
is important to do.
  The gentlewoman from California (Mrs. Torres) offered an amendment 
that would have required all association health plans to continue the 
10 essential health benefits of the Patient Protection and Affordable 
Care Act to obtain State certification--again, not even allowed to vote 
on her amendment.
  The gentleman from New York (Mr. Espaillat) offered an amendment to 
allow States to continue regulating any association health plan, 
including regulations related to benefits, consumer protections, and 
rating restrictions--not allowed.
  These amendments would have improved the underlying legislation. They 
should have been allowed to proceed to the floor. Unfortunately, the 
only amendment that made it in was from the Republican side of the 
aisle, and all of the great ideas that Members on my side of the aisle 
offered were prevented from being even allowed to be debated under this 
restrictive rule.
  I find it very troubling that my colleagues on the other side seem to 
prefer a partisan vote to collaboration and to considering valuable 
proposals that might help improve the quality of health care just 
because they happen to come from Democrats.
  But there is a bigger issue here. Of course, in addition to the 
faulty process, the bill is simply a bad bill and does nothing to 
address the problems with the repeal of the Affordable Care Act, which 
is pending before this body.
  One of the issues raised under this bill is it could lure away young 
and healthy workers, creating a distortion in the market. The ACA 
changed that practice by requiring health insurance sold through an 
association to meet the same insurance standards of coverage sold to 
the individual and small group market, preventing cherry-picking and 
providing a basic level of protection for consumers. This bill would 
roll back that progress, creating a separate set of rules for 
association health plans, essentially exempting them from complying 
with State regulations.
  There is also little evidence that it has even been effective to 
expand coverage. That is why many consumer and advocacy groups, 
including, for instance, the National Association of Insurance 
Commissioners, have come out opposed to this bill.
  But even more disturbing is the fact that we are considering a bill 
that even its proponents would agree does not in any way, shape, or 
form replace the protections of the Affordable Care Act. This is a bill 
that is narrow in scope. In fact, when we marked it up in our 
committee, the Education and the Workforce Committee, that very same 
day, the Energy and Commerce and Ways and Means Committees were marking 
up a bill to create a brand-new entitlement program, remove health care 
from 24 million Americans who have it today, and increase costs by 15 
to 20 percent for those who are paying for their insurance today.
  At that time, the Republican healthcare bill had only been public for 
24 hours. When the committees marked it up, we didn't even know how 
much the bill cost or how many people would lose coverage as a result. 
That information only came later, after committee members voted to 
amend or not amend the bill.
  Frankly, it is unconscionable to deny people healthcare insurance. It 
may be a life-or-death proposition, and we need to do a better job 
understanding bills before we vote on them, which is one of the reasons 
that we need to make sure we know the cost of this so-called manager's 
amendment, these midnight changes to the repeal of the Affordable Care 
Act.
  What is interesting with this proposed American Health Care Act the 
Republicans plan to bring to the floor, it was just reported--and I 
will be submitting the article for the Record--that the Republican bill 
actually results in more people being uninsured than if ObamaCare were 
simply repealed outright.
  So rather than repealing it outright, what Republicans are doing is 
giving a tax break to billionaires, creating a brand-new entitlement 
program, throwing 24 million people off the insurance rolls, and 
increasing costs by 15 to 20 percent. It would actually throw less 
people off insurance if they simply repealed ObamaCare.
  Mr. Speaker, I include in the Record an article from The New York 
Times.

                [From The New York Times, Mar. 21, 2017]

                       The Upshot--Public Health

  Fewer Americans Would Be Insured With G.O.P. Plan Than With Simple 
                                 Repeal

                        (By Margot Sanger-Katz)

       The Congressional Budget Office recently said that around 
     24 million fewer Americans would have health insurance in 
     2026 under the Republican repeal plan than if the current law 
     stayed in place.
       That loss was bigger than most experts anticipated, and led 
     to a round of predictable laments from congressional 
     Democrats--and less predictable ones from Republican 
     senators, including Bill Cassidy of Louisiana and John Thune 
     of South Dakota, who told reporters that the bill needed to 
     be ``more helpful'' to low-income people who wanted 
     insurance.
       But one piece of context has gone little noticed: The 
     Republican bill would actually result in more people being 
     uninsured than if Obamacare were simply repealed. Getting rid 
     of the major coverage provisions and regulations of Obamacare 
     would cost 23 million Americans their health insurance, 
     according to another recent C.B.O. report. In other words, 1 
     million more Americans would have health insurance with a 
     clean repeal than with the Republican replacement plan, 
     according to C.B.O. estimates.
       The C.B.O. estimated what would happen after a simple 
     repeal when it considered a bill that Congress passed last 
     year. (President Obama later vetoed that bill.) The bill left 
     parts of Obamacare in place, so the 23 million estimate 
     didn't come with the kind of detailed analysis that 
     accompanied last week's score of the American Health Care 
     Act. But the similarity of the two estimates highlights some 
     of the difficulties of the current proposal, both for 
     Democrats, who are strongly criticizing potential coverage 
     losses, and for the repeal-or-die crowd, who hate the 
     structure of this new bill.
       ``It's reaffirmed how exceedingly complicated and 
     convoluted the approach the House leadership took,'' said Dan 
     Holler, the vice president for communications and government 
     relations at Heritage Action, an advocacy group firmly in the 
     repeal-or-die camp.
       Late Monday, House leadership revealed a set of amendments 
     to the bill, which will be considered when the bill comes up 
     for a vote. But, if they are adopted, the changes are 
     unlikely to have major effects on overall coverage numbers. 
     If anything, the changes might lead to a larger increase in 
     the number of Americans without health insurance.
       The people who would end up without health insurance are 
     slightly different in the two cases. The current bill would 
     cause more people to lose employer insurance, while a 
     straight repeal bill would most likely cause more people who 
     buy their own coverage to become uninsured. A simple repeal 
     would be

[[Page 4536]]

     worse for Americans with pre-existing conditions, but the 
     current bill would be worse for older Americans who are 
     relatively healthy. Both approaches would lead to major 
     reductions in the number of Americans covered by Medicaid.
       The bill that Congress passed in 2016 is the third 
     scenario. It would have kept Obamacare's major insurance 
     regulations on the books, including its rule that health 
     insurers need to sell insurance at the same price to healthy 
     and sick customers of the same age. It would have removed 
     funding for the expansion of Medicaid, dropped subsidies to 
     help people buy health coverage, and eliminated the 
     individual and employer mandates in the law.
       The results of those changes would be drastic: In a decade, 
     32 million more people would be without health insurance, 
     according to the estimates. The C.B.O. essentially said it 
     was a policy combination that would break the insurance 
     market, resulting in substantially more people losing 
     coverage than gained it under Obamacare.
       The kind of full repeal that some Republicans are calling 
     for would, of course, be hard to pass. Even if every member 
     of their caucus supported the approach, most experts believe 
     that repealing Obamacare's major insurance provisions would 
     require a type of legislation that would be vulnerable to a 
     Senate filibuster, and would thus require at least eight 
     Democratic votes.
       All three approaches would result in meaningful reductions 
     in the number of Americans with health coverage. But, in the 
     end, it appears that the long-term effects of the current 
     Republican plan don't look that different from full repeal.

  Mr. POLIS. Mr. Speaker, Margo Sanger-Katz said, in part: ``But one 
piece of context has gone little noticed: The Republican bill would 
actually result in more people being uninsured than if ObamaCare were 
simply repealed. Getting rid of the major coverage provisions and 
regulations of ObamaCare would cost 23 million Americans their health 
insurance. . . . In other words, 1 million more Americans would have 
health insurance with a clean repeal than with the Republican 
replacement plan, according to CBO estimates.''
  So it is just unclear what the Republicans are trying to do here. If 
the goal was to come up with something worse than repealing the 
Affordable Care Act, they certainly reached that goal: less people will 
have coverage, more tax breaks for billionaires, higher rate increases 
for most Americans. On every account, it actually underperforms a 
cleaner repeal.
  What Democrats wanted to do is improve the Affordable Care Act. And I 
want to be clear, none of us have ever argued the Affordable Care Act 
is perfect. I pushed for fixes. So many of my Democratic and Republican 
colleagues have pushed for fixes to strengthen the law, like repealing 
the medical device tax, which adds cost to health care, and altering 
the Cadillac tax on insurance premiums.
  In the Education and the Workforce Committee, I actually offered 
three amendments to show some of the ideas that I and some of my 
colleagues had to improve the Affordable Care Act. They offered an 
amendment to establish a public option in the exchange, to provide a 
baseline of competition in every ZIP Code in this country--defeated on 
a partisan vote. I should add that my proposal for a public option--and 
I am a cosponsor of the bill to do the same--would actually reduce the 
budget deficit by over $50 billion.
  I also offered an amendment for pricing transparency to help make the 
market in health care work. One of the major market fallacies in health 
care is a Byzantine pricing structure where, frequently, different 
entities and people are paying different amounts for the same thing. If 
we had simple pricing transparency and quality transparency, we would 
go a long way towards making markets work in health care--defeated on a 
party vote.
  Finally, I offered an amendment that would have allowed reimportation 
of prescription drugs. When you have a situation where--we have a 
popular example of this in the EpiPen, costing Americans who need 
access to the EpiPen over $400, and yet in neighboring countries--
Canada, Australia--EpiPens cost $40 or $50, one-tenth as much.
  It is not unique to the EpiPen. By no means is that an exception to 
the rule. In fact, it is the rule. By allowing reimportation of 
prescription drugs, a proposal that was backed in the Senate in a 
bipartisan way by many of my Democratic and Republican colleagues as a 
budget amendment, we could actually reduce costs in health care, making 
the goal of expanding coverage even easier with those reduced costs.
  You know, when I think about health care, I think it is important to 
think about who in our districts and States it most affects. I think of 
Pat Hayward, a constituent in my district who lives in Loveland.
  Pat has so many family members who would be directly impacted by the 
repeal of the ACA. For instance, her husband has melanoma and over the 
years has needed several procedures to remove cancerous cells from his 
skin. Had those procedures not been done in a timely and efficient 
manner, it could cause major complications, including premature death 
for Pat's husband.
  Prior to the Affordable Care Act, when they tried to change insurance 
carriers, her husband was told that any coverage would exclude coverage 
of cancers, the very type of coverage he needed, because it was a 
preexisting condition. They literally would have had to choose between 
bankruptcy or being forced out of their home and into destitution or 
not getting the lifesaving melanoma treatments that he needed.
  But it is not just Pat's husband who has benefited and perhaps is 
alive and thriving today because of the protections of the Affordable 
Care Act. Pat's eldest son took advantage of a provision that allowed 
him to stay on his parents' plan until he got a job with health 
insurance at age 25.
  Their younger son has struggled with anxiety and panic attacks, but 
thanks to comprehensive mental health treatment and the protections of 
the mental health parity that are in the Affordable Care Act--and being 
rolled back under the American Health Care Act, the Republican bill to 
replace it--their son is now back in college and thriving.
  Pat, herself, expressed gratitude. The Affordable Care Act covers 
wellness visits and tests like mammograms, which can detect problems 
early, reduce costs, and save lives.
  I share this story--and Pat wanted me to share her story--because 
families like the Haywards are like families in every State, in every 
county, in every ZIP Code in the country. American families have faced 
their share of medical challenges, as have mine, and I am sure that 
yours has as well, Mr. Speaker. Medical challenges crop up 
unexpectedly. They don't have any bias toward a political party. They 
affect Democrats and Republicans and Independents and Greens and 
apathetic voters and diligent participants in our civic system. They 
make no distinction.
  But the Affordable Care Act is there to make it easier for families 
across our country to stay healthy, to get better, to save their lives 
so that kids can grow up with their parents healthy, kids can grow up 
and be able to go to school and get good jobs.
  And like so many of my constituents, Pat told me she would rather see 
the current system improved than thrown out entirely, and I agree. That 
is why I offered the pricing transparency amendment, the public option 
amendment, and the reimportation of prescription drug amendment; and 
there are dozens of other ideas to improve the Affordable Care Act from 
my side of the aisle. I offered amendments in committee that would have 
codified these provisions into law.
  I plan to continue to fight to improve access and lower healthcare 
costs, but dismantling the Affordable Care Act is simply 
counterproductive towards that end.
  The Republican proposal to create a brand-new entitlement program 
would cause 24 million Americans to lose their insurance--over 1 
million more than repealing the Affordable Care Act. For those who are 
lucky enough to still have their insurance, it would increase rates by 
15 to 20 percent.
  It would also, for reasons unknown, have an enormous tax cut for 
billionaires and millionaires. We know Republicans want to do that, but 
they should do that through a tax bill, not through something that is 
supposed to be a healthcare bill--enormous tax cuts. We are not even 
talking the

[[Page 4537]]

wealthiest 1 percent. Most of those tax cuts go to the wealthiest one-
tenth of 1 percent of Americans. That certainly doesn't help reduce the 
cost of health care.
  Again, this bill can be debated, and, frankly, many of us feel it 
presents a problem in the risk pools that remove consumer protections. 
There is a solvency issue around some of these groups. There is a 
legitimate debate to be had, but we certainly haven't heard anybody 
present that somehow this bill is any kind of answer to making health 
care more affordable or expanding coverage.
  What we have before us over the next couple of days is a bill that 
not only is the answer, but is a bill that creates an even bigger 
problem. The Republican healthcare bill would dig us in a deeper hole 
with regard to health care, leaving more Americans without coverage, 
creating a costly, brand-new entitlement program, and raising rates for 
those Americans who are lucky enough to still have their insurance 
after the Republicans remove it from tens of millions of people.
  If that bill is the answer, what is the question?
  Is the question, Mr. Speaker: How do we make health care cost more 
for American families?
  Is the question, Mr. Speaker: How do we have less people covered and 
throw 20 million people off of health care insurance?
  Is the question, Mr. Speaker: How do we make sure that, rather than 
work hard and try to get a raise or work two jobs, Americans are forced 
to quit their jobs and be lazy and not work just so that they can have 
Medicaid eligibility, which is what the brand-new Republican 
entitlement program would do?
  Or, is the answer to move forward in a bipartisan way to improve the 
Affordable Care Act, a discussion that so many of us are excited to 
have.
  I was disappointed that my three amendments were shut out in partisan 
votes in committee, and I am hopeful that by resetting this process, we 
can work together to reduce costs and expand coverage. Defeating the 
rule today will be the first step towards accomplishing that.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BYRNE. Mr. Speaker, I yield myself such time as I may consume.
  My colleague from Colorado raised an important question: What are the 
Republicans trying to accomplish here? It is pretty simple. We are 
trying to give freedom and choice back to the American people who lost 
their freedom and choice and control over their healthcare plans, who 
lost freedom and control over their health care because of an ill-
considered law passed by this Congress several years ago.
  He talked about the cost to American consumers. If you want to pass 
something that is going to increase cost to American consumers, this 
Congress did that several years ago. Look at the dramatic increase in 
healthcare insurance premiums, the dramatic increase in people's 
deductibles that have occurred since the Affordable Care Act--the so-
called Affordable Care Act--was passed here in Congress several years 
ago.
  We are trying to reverse that. We are trying to get control back. 
And, in fact, we know from the Congressional Budget Office score that 
it will lower premiums by 10 percent. We haven't seen premiums go lower 
in years. So if they want to know what we are trying to accomplish, it 
is plain on its face.
  The gentleman referred to some amendments that he offered in 
committee. Every one of those amendments was ruled nongermane.
  And for those of us that maybe don't understand a lot about what 
``germane'' means, it is pretty simple. You can't offer amendments to a 
bill that aren't related to the subject matter of the bill.
  The chairwoman of the committee ruled that he offered amendments that 
weren't germane to the bill that we have today. So the gentleman didn't 
lose because people were trying to lock him out of the process. He just 
offered amendments that had nothing to do with the underlying bill.
  He talked about the fact that this underlying bill for the rule we 
have today will lure away young and healthy workers.

                                  1415

  Let me say it again. I said this in my principal remarks. Under this 
bill, none of these association health plans can discriminate against 
anybody. They can't do that. They can't say we are only going to let 
young or healthy people in the plan. They have to admit everyone. So 
there is no discrimination here. Everyone will be covered.
  And remember how many people in America work for small businesses. 
All types of Americans work for small businesses. We are not trying to 
hurt them. We are trying to give them more opportunities to get better 
health insurance that will cost less money.
  And if there was anything in here that would cause discrimination, we 
would have heard long and hard about that before this point. I would 
suggest to you, Mr. Speaker, that that is not a relevant argument to 
this particular bill. Every plan that is going to be under this bill 
must comply with the regulations of the Department of Labor, just like 
big corporation plans have to comply with the regulations of the 
Department of Labor.
  We are simply treating small businesses through these associations 
the same way we treat big corporations. We have essentially denied to 
the employees of small businesses the same opportunities to get good 
health insurance at a lower cost that their colleagues that work for 
bigger corporations get.
  The reason the bigger corporations have this is because the 
Department of Labor comes up with a nationwide rule so you don't have 
all these different variations from State to State and allows for those 
big companies to do the things that they can do so very well because of 
their size to get better health care for an affordable cost for their 
employees. We are giving the same thing to these small businesses 
through their associations.
  And remember, this is not just one bill. We actually just passed a 
rule. We will be considering another bill that will exempt, from the 
provisions of McCarran-Ferguson, health insurance so we get more 
competition into the health insurance market.
  This bill is on top of that. It is on top of the AHCA that we will be 
considering later this week and other bills that will be coming, 
because there are a host of things that we are doing on this side of 
the aisle to make sure we restore freedom and choice and affordable 
care to the people of our country.
  We are not removing people from health insurance in any of the bills 
that we are doing. We are giving them the freedom to choose. And that 
is what America is really all about: the freedom to choose.
  Right now we are coercing, by law, people to go out and buy health 
insurance that they don't want. That shouldn't be done in America. We 
are going to give them their freedom back. And if they chose not to buy 
health insurance, that is their right as Americans. That is not taking 
something away from somebody. That is giving them their freedom back.
  So I would suggest to the gentleman that, if he wants to look for 
something that is going to help the workers of America, this bill and 
the other bills that our side of the aisle are proposing will do just 
that.
  Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr. 
Dunn).
  Mr. DUNN. Mr. Speaker, I thank my friend, the gentleman from Alabama, 
for yielding me time.
  Mr. Speaker, I rise today in support of H.R. 1101, the Small Business 
Health Fairness Act.
  As a surgeon in north Florida, I witnessed, firsthand, the disaster 
that is ObamaCare. After ObamaCare was passed and implemented, small 
medical practices across the country were faced with new, crippling 
regulations that threatened their very existence.
  I ran a small urology practice in Panama City and faced the very 
devastation that these new regulations on small business imposed. 
Thankfully, I was able to work with several other small practices to 
create the Advanced Urology Institute, a 45-physician practice with 
over 400 employees and offices

[[Page 4538]]

throughout north Florida. Cooperation and pooling of our resources 
allowed our practice to reduce costs and to better serve our patients.
  My experience underscores why the Small Business Health Fairness Act 
is so crucial. The Small Business Health Fairness Act allows small 
businesses to operate under the same principle when purchasing health 
insurance for their employees.
  By joining together across State lines through associations, small 
businesses can achieve the economies of scale enjoyed by big businesses 
and unions when purchasing health care. It will empower small 
businesses to purchase better plans at a lower cost, which means 
working families can get the care they need at a price they can afford.
  It is time to put small business employees on a level playing field 
with those of large businesses and those in unions. The health 
insurance market and this bill does just that.
  Mr. POLIS. Mr. Speaker, I yield myself as much time as I may consume.
  Mr. Speaker, first of all, amendments that were brought forward by 
Ms. Bonamici, germane. Republicans shut it down, didn't allow a debate.
  Amendment brought forward by Norma Torres for this very bill, 
germane--not allowed to be debated for not even 10 minutes, not 5 
minutes, not even 1 minute. Mrs. Torres wasn't even allowed to offer 
her amendment under this rule that only allowed Republican amendments.
  Finally, Mr. Espaillat's amendment to this bill, yes, germane. He 
was, nevertheless, shut out in a party-line vote by the Rules Committee 
and not allowed to present his amendment before the floor that would 
simply allow States to continue protecting the benefits and consumer 
protections and rating restrictions in associated health plans, very 
simply.
  Mr. Speaker, we are here considering the rule for H.R. 1101 and we 
still don't have a cost estimate from our nonpartisan experts at CBO. 
We certainly believe this legislation will increase premiums for the 
middle class and seniors, but we don't have any idea how much so. It is 
becoming a pattern, Mr. Speaker.
  Two weeks ago, the Republican majority pushed ahead with their 
healthcare repeal bill without a cost estimate. A week later, it turned 
out it will cost 24 million Americans their insurance and 15 to 20 
percent increases for those who would still have it.
  Late last night, there was a backroom, secretive manager's amendment 
that was proposed which we don't know the cost of or how it would 
affect coverage, and it is irresponsible for the Republicans to move 
forward without knowing the effect of the bill as amended.
  If we defeat the previous question, I will offer an amendment to the 
rule that would require a CBO cost estimate that analyzes the impact of 
any legislation amending or repealing the Affordable Care Act, as well 
as the impact of any manager's amendment to that legislation, to be 
made publicly available before the bill may be considered on the House 
floor.
  Mr. Speaker, I ask unanimous consent to insert the text of my 
amendment in the Record, along with extraneous material, immediately 
prior to the vote on the previous question.
  The SPEAKER pro tempore (Mr. Mooney of West Virginia). Is there 
objection to the request of the gentleman from Colorado?
  There was no objection.
  Mr. POLIS. Mr. Speaker, I yield 3 minutes to the distinguished 
gentlewoman from California (Ms. Lee) to discuss our proposal to make 
sure we actually know the cost of what is before this body.
  Ms. LEE. Mr. Speaker, I first want to thank the gentleman from 
Colorado for yielding and for his tireless advocacy on behalf of the 
American people.
  Mr. Speaker, I rise in opposition, first, to this terrible rule, of 
course, which made no Democratic amendments in order, but also in 
strong support of Congressman Polis' amendment that requires the 
nonpartisan Congressional Budget Office to score the final bill, which 
is the bill to take away health care from 24 million people, to score 
it as amended by the Republican manager's amendment before the bill is 
on the House floor.
  This clearly is nothing new for Republicans, though. In fact, just 2 
weeks ago, Republicans shamefully pushed ahead with the markup of their 
terrible ACA repeal bill without a score from the Congressional Budget 
Office. And this week, on the seventh anniversary of the Affordable 
Care Act, Republicans' terrible plan to repeal this lifesaving 
legislation will make it to the House floor.
  One thing is clear. Republicans' proposals, of course written in 
secret back rooms, would be a disaster for struggling families, 
seniors, people with disabilities, low-income individuals, the poor, 
and the middle class.
  It would, yes, rip away health care from 24 million people, reduce 
benefits, increase rates for those who can least afford this, and 
transfer $600 billion in tax cuts to the very wealthy. That is 
outrageous, but it gets even worse.
  Late last night, in secret back rooms, Republicans introduced a 
dangerous manager's amendment that doubles down on the war on women's 
health and the poor, low-income, and struggling families.
  Yes, once again, Republicans are attempting to move forward with a 
vote on the final GOP's take away health care from 24 million 
Americans, a bill that includes a manager's amendment, without an 
updated Congressional Budget Office score.
  The American people deserve to know the full damage of this 
disastrous bill. I urge my colleagues to vote ``no'' on the previous 
question and support Congressman Polis' amendment to ensure that we 
have updated Congressional Budget Office scores before this bill is 
brought to the House floor.
  I thank the gentleman for this amendment, and I thank him for 
yielding me time.
  Mr. BYRNE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, the manager's amendment that has been referred to was 
put on a public website last night. Everyone in the House of 
Representatives will have 3 days to read the manager's amendment. There 
is nothing secret about it.
  Bills are not written in front of cameras. They are written so that 
they can be put on public websites for all of us to see it. This 
manager's amendment was handled like many, many other manager's 
amendments are handled, including the way manager's amendments have 
been handled by the other side when they were in the majority.
  Let's remember, in 2010 when the reconciliation bill was passed that 
established the ACA, no amendments were allowed on the floor--none, 
zero. So if there is a precedent that has been set in this House, it 
was set by my friends on the other side of the aisle when they passed 
the Affordable Care Act and wouldn't allow any amendments by any Member 
of the House. That is the precedent.
  There is nothing new about the way this manager's amendment was 
handled. It was handled the way manager's amendments are handled 
virtually all the time. Everybody in this House now has a copy of it, 
has plenty of time to read it and ask questions about it. Nothing 
secret going on here.
  The truth of the matter is that we are moving forward with our plan, 
as we said we were, to repeal and replace ObamaCare, to give freedom 
and choice back to the people of America so that patients control their 
health care, not a bureaucrat in Washington.
  I reserve the balance of my time.
  Mr. POLIS. Mr. Speaker, I yield myself as much time as I may consume.
  Mr. Speaker, first of all, over 150 amendments by Democrats were 
rejected to this healthcare bill before us today, contrary to the 
process of 8 years ago when over 120 Republican amendments were not 
only made in order, but were actually incorporated into the healthcare 
bill despite the fact that, for final passage, not a single Republican 
voted for it.
  So when we talk about the record and the precedent, there couldn't 
more of a night-and-day difference between what is occurring today 
where Democrats are locked out and the effort 8 years ago where 
Republican ideas were welcomed in the process.

[[Page 4539]]

  I also want to ask my colleague from Alabama--I was hoping that he 
would yield me the time to do so, and I will have to yield him time for 
an answer--he mentioned that this manager's amendment has already been 
posted and we will have 3 days to look at it. I just want to get his 
assurance that the version that we saw posted is the actual version 
that will be brought to the Rules Committee and presented on the floor 
and there will be no further changes to the manager's amendment, if the 
gentleman can assure me of that.
  Mr. BYRNE. Will the gentleman yield?
  Mr. POLIS. I yield to the gentleman from Alabama.
  Mr. BYRNE. As far as I know, speaking back to the gentleman from 
Colorado, the manager's amendments that were posted last night are 
going to be the manager's amendments that we will consider tomorrow in 
the Rules Committee.
  Mr. POLIS. Reclaiming my time, Mr. Speaker, I also would like to ask 
if we are going to have a score from the Congressional Budget Office 
prior to the House having to vote on that manager's amendment?
  I yield, for an answer, to the gentleman from Alabama.
  Mr. BYRNE. Mr. Speaker, I am ready to answer the question.
  We believe that we will be receiving the CBO table prior to the vote 
on the floor of the House of Representatives.
  Mr. POLIS. Mr. Speaker, reclaiming my time, again, that simply 
confirms what our previous question would simply require, that before 
the bill is voted on we will simply know how much it costs and who it 
impacts. What could be more important than finding that out.
  I think it is important to note that Democrats have been shut out of 
the process, at the committee level, in the amendments I offered. Even 
the germane amendments of this particular bill before us today, 
Democrats were locked out.
  Rather than allow Members of both parties to participate in reducing 
the costs of health care and increasing coverage, Republicans have come 
up with a bill that actually increases costs and decreases coverage.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BYRNE. Mr. Speaker, from what I saw in the CBO score of the bill, 
the AHCA bill actually reduces government spending, reduces taxes, and 
reduces health insurance premiums over the window of the CBO score.

                              {time}  1430

  So it does the exact opposite of what the gentleman suggested. It 
does exactly what the American people sent us here to do.
  Mr. Speaker, I reserve the balance of my time.
  Mr. POLIS. Mr. Speaker, I yield myself the balance of my time.
  Mr. Speaker, the statistics we are talking about, the fact that it 
will cost Americans 15 to 20 percent more to get health care, the fact 
that it will cost 24 million Americans their insurance, these are not 
statistics that are made up by some group that wants to oppose the 
Republican effort. They are facts that are arrived upon by the 
Congressional Budget Office, the head of which was appointed by a 
Republican. They do diligent work to determine how much bills cost and 
what their effect is.
  Now, of course, you know, those are best estimates. Maybe, instead of 
24 million people who will lose coverage under the Republican 
healthcare bill, maybe it will be 25 million, maybe it will be 23 
million. There is always a little bit of variation on what those 
predictions are.
  But whether it is 23 million or 25.6 million, the fact that 
Americans--millions, tens of millions of Americans--will lose coverage 
under this Republican bill should be a flashing warning sign that it is 
time to slow down and work in a collaborative manner to improve the 
Affordable Care Act, rather than create a brand new entitlement program 
that throws 24 million people off the insurance rolls, and increases 
the cost for those who remain by 15 to 20 percent.
  This bill immediately before us is a diversion from the real story in 
health care. In my home State alone, 600,000 Coloradans would likely 
lose coverage if the American Health Care Act is rammed through 
Congress, as my Republican colleagues intend to do.
  The American Health Care Act would roll back important protections 
and coverage gains. It would create a brand new entitlement program, 
while delivering record tax breaks for billionaires in New York and 
California.
  It is clear that this bill threatens the health and welfare of 
hundreds of thousands of families in Colorado alone, tens of millions 
across the country. It is time that we get this process right and slow 
down, rather than cramming a midnight bill through the House of 
Representatives that we don't even know the cost of, before we are 
voting on it.
  This is simple, Mr. Speaker. Democrats are excited to roll up our 
sleeves and work together to create a plan that will reduce healthcare 
costs. If you don't like the amendment I offered for allowing 
reimportation of prescription drugs, let's talk about other options.
  What about Medicare negotiating prescription drug rates? What about 
removing tax deductibility for the advertisements for pharmaceutical 
companies?
  What about expediting approval process at the FDA, which President 
Trump himself mentioned in this very Chamber as a proposal that can 
reduce the cost of approving drugs from the $1.2 billion it costs 
today, which is passed along to consumers, to a much lower cost, 
thereby passing the savings along to consumers.
  There are plenty of good ideas the Democrats and Republicans can work 
together on. None of them are this bill before us today. None of them 
are in the repeal of the Affordable Care Act. So let's just stop this 
ridiculous partisan process.
  I don't want 24 million Americans to be victims of partisanship in 
Washington. I don't want other Americans who pay for their healthcare 
insurance to be victims of partisanship in Washington.
  I want to make sure that people in my district who are working hard 
and only able to afford coverage under the Affordable Care Act because 
of the healthcare subsidies are not forced into medical bankruptcy and 
to give up their jobs and rely on Medicaid because of Republican 
efforts to ram through this brand new entitlement program.
  Let's get this right. There is plenty of opportunity to work together 
to reduce costs and expand coverage. The American Health Care Act does 
the exact opposite. It increases costs and reduces coverage.
  And instead of these incremental bills, like this so-called Small 
Business Health Fairness Act, which actually winds up removing 
protections and pushing more costs onto working families and seniors, 
we should improve upon and fix the Affordable Care Act that we put in 
place 7 years ago. We should support innovation to produce healthier 
outcomes, to reduce costs, and, yes, to expand coverage across our 
country.
  We have a unique opportunity in this Congress to put partisanship 
behind us, to work together to make affordable health care a reality 
for every American family. Because you know what? When you have a 
preexisting condition, like I talked about Pat's husband in my district 
who suffers from melanoma, it doesn't matter whether he is a Republican 
or a Democrat or Independent or whether he is not even registered at 
all.
  What matters is that he is a father to two children, a husband to his 
wife, and he wants the ability to work with dignity, support himself, 
and have medical insurance to receive his lifesaving monthly injections 
that allow him to maintain his quality of life and continue to work and 
pay taxes and support his kids and family. That is what healthcare 
coverage is all about.
  So let's stop this silly partisanship. This Republican American 
Health Care Act actually kicks more people off of the healthcare rolls 
than simply repealing ObamaCare. By creating this brand new entitlement 
program, they

[[Page 4540]]

are actually costing an additional 1 millions Americans their 
healthcare insurance.
  But the answer is not to cost 23 million people their healthcare 
insurance. It is not to take it away from 24 million people. You know 
what the answer is, Mr. Speaker, is to provide a way that more people 
can work hard and pay into the system, and that we decrease the number 
of Americans who lack access to healthcare insurance which, in turn, 
reduces the costs for the rest of us because of the cost shifting that 
occurs within health care.
  Mr. Speaker, I know so many of my friends on the Republican and 
Democratic side of the aisle, dedicated public servants with thoughtful 
ideas that they have based on their life experiences, that they want to 
present before this body to reduce the cost of health care. Let's let 
them do it. Let's have an open process.
  So, 150 amendments from Democrats were shot down in committees, not 
even allowed to be debated, not even allowed to be included in this 
healthcare bill. Three of mine were shot down. In this very rule today, 
amendments by Mr. Espaillat and Ms. Bonamici were not even allowed to 
be debated.
  The American people want health care to be affordable, and they want 
Republicans and Democrats to work together to accomplish that end.
  Let's vote ``no'' on this rule. Let's reset the process. Let's fix 
health care. Let's expand coverage. Let's reduce costs. I look forward 
to working with my colleagues on both sides of the aisle to accomplish 
those important goals that my constituents have sent me here to work 
on.
  I urge my colleagues to vote ``no'' on the previous question so we 
can know the cost of any manager's amendment before we vote on it; to 
vote ``no'' on the rule, and to vote ``no'' on the underlying bill.
  Mr. Speaker, I yield back the balance of my time.
  Mr. BYRNE. Mr. Speaker, I yield myself such time as I may consume.
  I certainly agree with my colleague from Colorado that we should 
avoid silly partisanship, and I hope that that means we won't see silly 
partisan procedural motions and points of order between now and the end 
of the week. We have seen plenty of those up until this point in time 
by our friends on the other side of the aisle, and I hope that his 
statement means we won't see any more since he believes that silly 
partisanship is bad for this body and the consideration of these 
important healthcare bills.
  We are not here today to talk about the AHCA. We are here today to 
talk about the Small Business Health Fairness Act. That is what this 
rule covers.
  Let me go over again what has happened to small businesses, but, more 
importantly, what has happened to the people who work for small 
businesses. An estimated 300,000 small-business jobs were destroyed by 
ObamaCare; 10,000 small businesses closed because of ObamaCare.
  Since 2008, 36 percent of small businesses that have fewer than 10 
employees have stopped offering healthcare coverage altogether. 
ObamaCare's compliance costs and mandates have resulted in $19 billion 
in lost wages for small-business employees.
  The majority of people in this country work for small businesses. We 
are trying to give them a fair shake. We are trying to give them their 
freedom and their choice back. We are trying to give them affordable 
care because their freedom and their choice and the affordability of 
their care has evaporated over the last several years.
  Ask anybody in America. They come up to me all the time in my 
district and tell me this.
  We, through this bill and the other bills we are considering, are 
repairing the damage done to the people of America by ObamaCare.
  Now, my colleagues can throw up dilatory points of order and other 
procedural items later on if they want to engage in silly partisanship, 
or we can get down to the business of taking care of the workers in 
America.
  This bill, or a concept like this bill, has been on this floor before 
and enjoyed bipartisan support. If we are going to drop silly 
partisanship, let's drop it right now on this rule and on this bill, 
and adopt it for the good of the workers in these small businesses 
throughout America.
  Mr. Speaker, I again urge my colleagues to support House Resolution 
210 and the underlying bill.
  The material previously referred to by Mr. Polis is as follows:

            An Amendment to H. Res. 210 Offered by Mr. Polis

       At the end of the resolution, add the following new 
     section:
       Sec. 2. In rule XXI add the following new clause:
       13. (a) It shall not be in order to consider a measure or 
     matter proposing to repeal or amend the Patient Protection 
     and Affordable Care Act (PL 111-148) and the Health Care and 
     Education Affordability Reconciliation Act of 2010 (PL 111-
     152), or part thereof, in the House or in the Committee of 
     the Whole House on the state of the Union unless an easily 
     searchable electronic estimate and comparison prepared by the 
     Director of the Congressional Budget Office is made available 
     on a publicly available website of the House.
       (b) It shall not be in order to consider a measure or 
     matter proposing to repeal or amend the Patient Protection 
     and Affordable Care Act (PL 111-148) and the Health Care and 
     Education Affordability Reconciliation Act of 2010 (PL 111-
     152), or part thereof, in the House or in the Committee of 
     the Whole House on the state of the Union, that is called up 
     pursuant to a rule or order that makes a manager's amendment 
     in order or considers such an amendment to be adopted, unless 
     an easily searchable updated electronic estimate and 
     comparison prepared by the Director of the Congressional 
     Budget Office reflecting such amendment is made available on 
     a publicly available website of the House.
       (c) It shall not be in order to consider a rule or order 
     that waives the application of paragraphs (a) or (b).
                                  ____


        The Vote on the Previous Question: What It Really Means

       This vote, the vote on whether to order the previous 
     question on a special rule, is not merely a procedural vote. 
     A vote against ordering the previous question is a vote 
     against the Republican majority agenda and a vote to allow 
     the Democratic minority to offer an alternative plan. It is a 
     vote about what the House should be debating.
       Mr. Clarence Cannon's Precedents of the House of 
     Representatives (VI, 308-311), describes the vote on the 
     previous question on the rule as ``a motion to direct or 
     control the consideration of the subject before the House 
     being made by the Member in charge.'' To defeat the previous 
     question is to give the opposition a chance to decide the 
     subject before the House. Cannon cites the Speaker's ruling 
     of January 13, 1920, to the effect that ``the refusal of the 
     House to sustain the demand for the previous question passes 
     the control of the resolution to the opposition'' in order to 
     offer an amendment. On March 15, 1909, a member of the 
     majority party offered a rule resolution. The House defeated 
     the previous question and a member of the opposition rose to 
     a parliamentary inquiry, asking who was entitled to 
     recognition. Speaker Joseph G. Cannon (R-Illinois) said: 
     ``The previous question having been refused, the gentleman 
     from New York, Mr. Fitzgerald, who had asked the gentleman to 
     yield to him for an amendment, is entitled to the first 
     recognition.''
       The Republican majority may say ``the vote on the previous 
     question is simply a vote on whether to proceed to an 
     immediate vote on adopting the resolution . . . [and] has no 
     substantive legislative or policy implications whatsoever.'' 
     But that is not what they have always said. Listen to the 
     Republican Leadership Manual on the Legislative Process in 
     the United States House of Representatives, (6th edition, 
     page 135). Here's how the Republicans describe the previous 
     question vote in their own manual: ``Although it is generally 
     not possible to amend the rule because the majority Member 
     controlling the time will not yield for the purpose of 
     offering an amendment, the same result may be achieved by 
     voting down the previous question on the rule. . . . When the 
     motion for the previous question is defeated, control of the 
     time passes to the Member who led the opposition to ordering 
     the previous question. That Member, because he then controls 
     the time, may offer an amendment to the rule, or yield for 
     the purpose of amendment.''
       In Deschler's Procedure in the U.S. House of 
     Representatives, the subchapter titled ``Amending Special 
     Rules'' states: ``a refusal to order the previous question on 
     such a rule [a special rule reported from the Committee on 
     Rules] opens the resolution to amendment and further 
     debate.'' (Chapter 21, section 21.2) Section 21.3 continues: 
     ``Upon rejection of the motion for the previous question on a 
     resolution reported from the Committee on Rules, control 
     shifts to the Member leading the opposition to the previous 
     question, who may offer a proper amendment or motion and who 
     controls the time for debate thereon.''

[[Page 4541]]

       Clearly, the vote on the previous question on a rule does 
     have substantive policy implications. It is one of the only 
     available tools for those who oppose the Republican 
     majority's agenda and allows those with alternative views the 
     opportunity to offer an alternative plan.

  Mr. BYRNE. Mr. Speaker, I yield back the balance of my time, and I 
move the previous question on the resolution.
  The SPEAKER pro tempore (Mr. Duncan of Tennessee). The question is on 
ordering the previous question.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. POLIS. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________