[Congressional Record (Bound Edition), Volume 163 (2017), Part 4]
[House]
[Pages 4638-4657]
[From the U.S. Government Publishing Office, www.gpo.gov]




               SMALL BUSINESS HEALTH FAIRNESS ACT OF 2017

  Ms. FOXX. Mr. Speaker, pursuant to House Resolution 210, I call up 
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, 
and ask for its immediate consideration.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Pursuant to House Resolution 210, in lieu of 
the amendment recommended by the Committee on Education and the 
Workforce printed in the bill, an amendment in the nature of a 
substitute consisting of the text of Rules Committee Print 115-9 is 
adopted and the bill, as amended, is considered read.
  The text of the bill, as amended, is as follows:

                               H.R. 1101

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Small 
     Business Health Fairness Act of 2017''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

       Sec. 1. Short title; table of contents.
       Sec. 2. Rules governing association health plans.
       Sec. 3. Clarification of treatment of single employer 
           arrangements.
       Sec. 4. Enforcement provisions relating to association 
           health plans.
       Sec. 5. Cooperation between Federal and State authorities.
       Sec. 6. Effective date and transitional and other rules.

     SEC. 2. RULES GOVERNING ASSOCIATION HEALTH PLANS.

       (a) In General.--Subtitle B of title I of the Employee 
     Retirement Income Security Act of 1974 is amended by adding 
     after part 7 the following new part:

           ``PART 8--RULES GOVERNING ASSOCIATION HEALTH PLANS

     ``SEC. 801. ASSOCIATION HEALTH PLANS.

       ``(a) In General.--For purposes of this part, the term 
     `association health plan' means a group health plan whose 
     sponsor is (or is deemed under this part to be) described in 
     subsection (b).
       ``(b) Sponsorship.--The sponsor of a group health plan is 
     described in this subsection if such sponsor--
       ``(1) is organized and maintained in good faith, with a 
     constitution and bylaws specifically stating its purpose and 
     providing for periodic meetings on at least an annual basis, 
     as a bona fide trade association, a bona fide industry 
     association (including a rural electric cooperative 
     association or a rural telephone cooperative association), a 
     bona fide professional association, or a bona fide chamber of 
     commerce (or similar bona fide business association, 
     including a corporation or similar organization that operates 
     on a cooperative basis (within the meaning of section 1381 of 
     the Internal Revenue Code of 1986)), for substantial purposes 
     other than that of obtaining or providing medical care;
       ``(2) is established as a permanent entity which receives 
     the active support of its members and requires for membership 
     payment on a periodic basis of dues or payments necessary to 
     maintain eligibility for membership in the sponsor; and
       ``(3) does not condition membership, such dues or payments, 
     or coverage under the plan on the basis of health status-
     related factors with respect to the employees of its members 
     (or affiliated members), or the dependents of such employees, 
     and does not condition such dues or payments on the basis of 
     group health plan participation.
     Any sponsor consisting of an association of entities which 
     meet the requirements of paragraphs (1), (2), and (3) shall 
     be deemed to be a sponsor described in this subsection.

     ``SEC. 802. CERTIFICATION OF ASSOCIATION HEALTH PLANS.

       ``(a) In General.--The applicable authority shall prescribe 
     by regulation a procedure under which, subject to subsection 
     (b), the applicable authority shall certify association 
     health plans which apply for certification as meeting the 
     requirements of this part.
       ``(b) Standards.--Under the procedure prescribed pursuant 
     to subsection (a), in the case of an association health plan 
     that provides at least one benefit option which does not 
     consist of health insurance coverage, the applicable 
     authority shall certify such plan as meeting the requirements 
     of this part only if the applicable authority is satisfied 
     that the applicable requirements of this part are met (or, 
     upon the date on which the plan is to commence operations, 
     will be met) with respect to the plan.
       ``(c) Requirements Applicable to Certified Plans.--An 
     association health plan with respect to which certification 
     under this part is in effect shall meet the applicable 
     requirements of this part, effective on the date of 
     certification (or, if later, on the date on which the plan is 
     to commence operations).
       ``(d) Requirements for Continued Certification.--The 
     applicable authority may provide by regulation for continued 
     certification of association health plans under this part.
       ``(e) Class Certification for Fully Insured Plans.--The 
     applicable authority shall establish a class certification 
     procedure for association health plans under which all 
     benefits consist of health insurance coverage. Under such 
     procedure, the applicable authority shall provide for the 
     granting of certification under this part to the plans in 
     each class of such association health plans upon appropriate 
     filing under such procedure in connection with plans in such 
     class and payment of the prescribed fee under section 807(a).
       ``(f) Certification of Self-Insured Association Health 
     Plans.--An association health plan which offers one or more 
     benefit options which do not consist of health insurance 
     coverage may be certified under this part only if such plan 
     consists of any of the following:
       ``(1) A plan which offered such coverage on the date of the 
     enactment of the Small Business Health Fairness Act of 2017.
       ``(2) A plan under which the sponsor does not restrict 
     membership to one or more trades and businesses or industries 
     and whose eligible participating employers represent a broad 
     cross-section of trades and businesses or industries.
       ``(3) A plan whose eligible participating employers 
     represent one or more trades or businesses, or one or more 
     industries, consisting of any of the following: agriculture; 
     equipment and automobile dealerships; barbering and 
     cosmetology; certified public accounting practices; child 
     care; construction; dance, theatrical and orchestra 
     productions; disinfecting and pest control; financial 
     services; fishing; food service establishments; hospitals; 
     labor organizations; logging; manufacturing (metals); mining; 
     medical and dental practices; medical laboratories; 
     professional consulting services; sanitary services; 
     transportation (local and freight); warehousing; wholesaling/
     distributing; or any other trade or business or industry 
     which has been indicated as having average or above-average 
     risk or health claims experience by reason of State rate 
     filings, denials of coverage, proposed premium rate levels, 
     or other means demonstrated by such plan in accordance with 
     regulations.

     ``SEC. 803. REQUIREMENTS RELATING TO SPONSORS AND BOARDS OF 
                   TRUSTEES.

       ``(a) Sponsor.--The requirements of this subsection are met 
     with respect to an association health plan if the sponsor has 
     met (or is deemed under this part to have met) the 
     requirements of section 801(b) for a continuous period of not 
     less than 3 years ending with the date of the application for 
     certification under this part.
       ``(b) Board of Trustees.--The requirements of this 
     subsection are met with respect to an association health plan 
     if the following requirements are met:
       ``(1) Fiscal control.--The plan is operated, pursuant to a 
     trust agreement, by a board of trustees which has complete 
     fiscal control over the plan and which is responsible for all 
     operations of the plan.
       ``(2) Rules of operation and financial controls.--The board 
     of trustees has in effect rules of operation and financial 
     controls, based on a 3-year plan of operation, adequate to 
     carry out the terms of the plan and to meet all requirements 
     of this title applicable to the plan.
       ``(3) Rules governing relationship to participating 
     employers and to contractors.--
       ``(A) Board membership.--
       ``(i) In general.--Except as provided in clauses (ii) and 
     (iii), the members of the board of trustees are individuals 
     selected from individuals who are the owners, officers, 
     directors, or employees of the participating employers or who 
     are partners in the participating employers and actively 
     participate in the business.
       ``(ii) Limitation.--

       ``(I) General rule.--Except as provided in subclauses (II) 
     and (III), no such member is an owner, officer, director, or 
     employee of, or partner in, a contract administrator or other 
     service provider to the plan.
       ``(II) Limited exception for providers of services solely 
     on behalf of the sponsor.--Officers or employees of a sponsor 
     which is a service provider (other than a contract 
     administrator) to the plan may be members of the board if 
     they constitute not more than 25 percent of the membership of 
     the board and they do not provide services to the plan other 
     than on behalf of the sponsor.
       ``(III) Treatment of providers of medical care.--In the 
     case of a sponsor which is an association whose membership 
     consists primarily of providers of medical care, subclause 
     (I) shall not apply in the case of any service provider 
     described in subclause (I) who is a provider of medical care 
     under the plan.

       ``(iii) Certain plans excluded.--Clause (i) shall not apply 
     to an association health plan

[[Page 4639]]

     which is in existence on the date of the enactment of the 
     Small Business Health Fairness Act of 2017.
       ``(B) Sole authority.--The board has sole authority under 
     the plan to approve applications for participation in the 
     plan and to contract with a service provider to administer 
     the day-to-day affairs of the plan.
       ``(c) Treatment of Franchise Networks.--In the case of a 
     group health plan which is established and maintained by a 
     franchiser for a franchise network consisting of its 
     franchisees--
       ``(1) the requirements of subsection (a) and section 801(a) 
     shall be deemed met if such requirements would otherwise be 
     met if the franchiser were deemed to be the sponsor referred 
     to in section 801(b), such network were deemed to be an 
     association described in section 801(b), and each franchisee 
     were deemed to be a member (of the association and the 
     sponsor) referred to in section 801(b); and
       ``(2) the requirements of section 804(a)(1) shall be deemed 
     met.

     The Secretary may by regulation define for purposes of this 
     subsection the terms `franchiser', `franchise network', and 
     `franchisee'.

     ``SEC. 804. PARTICIPATION AND COVERAGE REQUIREMENTS.

       ``(a) Covered Employers and Individuals.--The requirements 
     of this subsection are met with respect to an association 
     health plan if, under the terms of the plan--
       ``(1) each participating employer must be--
       ``(A) a member of the sponsor,
       ``(B) the sponsor, or
       ``(C) an affiliated member of the sponsor with respect to 
     which the requirements of subsection (b) are met,

     except that, in the case of a sponsor which is a professional 
     association or other individual-based association, if at 
     least one of the officers, directors, or employees of an 
     employer, or at least one of the individuals who are partners 
     in an employer and who actively participates in the business, 
     is a member or such an affiliated member of the sponsor, 
     participating employers may also include such employer; and
       ``(2) all individuals commencing coverage under the plan 
     after certification under this part must be--
       ``(A) active or retired owners (including self-employed 
     individuals), officers, directors, or employees of, or 
     partners in, participating employers; or
       ``(B) the beneficiaries of individuals described in 
     subparagraph (A).
       ``(b) Coverage of Previously Uninsured Employees.--In the 
     case of an association health plan in existence on the date 
     of the enactment of the Small Business Health Fairness Act of 
     2017, an affiliated member of the sponsor of the plan may be 
     offered coverage under the plan as a participating employer 
     only if--
       ``(1) the affiliated member was an affiliated member on the 
     date of certification under this part; or
       ``(2) during the 12-month period preceding the date of the 
     offering of such coverage, the affiliated member has not 
     maintained or contributed to a group health plan with respect 
     to any of its employees who would otherwise be eligible to 
     participate in such association health plan.
       ``(c) Individual Market Unaffected.--The requirements of 
     this subsection are met with respect to an association health 
     plan if, under the terms of the plan, no participating 
     employer may provide health insurance coverage in the 
     individual market for any employee not covered under the plan 
     which is similar to the coverage contemporaneously provided 
     to employees of the employer under the plan, if such 
     exclusion of the employee from coverage under the plan is 
     based on a health status-related factor with respect to the 
     employee and such employee would, but for such exclusion on 
     such basis, be eligible for coverage under the plan.
       ``(d) Prohibition of Discrimination Against Employers and 
     Employees Eligible To Participate.--The requirements of this 
     subsection are met with respect to an association health plan 
     if--
       ``(1) under the terms of the plan, all employers meeting 
     the preceding requirements of this section are eligible to 
     qualify as participating employers for all geographically 
     available coverage options, unless, in the case of any such 
     employer, participation or contribution requirements of the 
     type referred to in section 2711 of the Public Health Service 
     Act are not met;
       ``(2) upon request, any employer eligible to participate is 
     furnished information regarding all coverage options 
     available under the plan; and
       ``(3) the applicable requirements of sections 701, 702, and 
     703 are met with respect to the plan.

     ``SEC. 805. OTHER REQUIREMENTS RELATING TO PLAN DOCUMENTS, 
                   CONTRIBUTION RATES, AND BENEFIT OPTIONS.

       ``(a) In General.--The requirements of this section are met 
     with respect to an association health plan if the following 
     requirements are met:
       ``(1) Contents of governing instruments.--The instruments 
     governing the plan include a written instrument, meeting the 
     requirements of an instrument required under section 
     402(a)(1), which--
       ``(A) provides that the board of trustees serves as the 
     named fiduciary required for plans under section 402(a)(1) 
     and serves in the capacity of a plan administrator (referred 
     to in section 3(16)(A));
       ``(B) provides that the sponsor of the plan is to serve as 
     plan sponsor (referred to in section 3(16)(B)); and
       ``(C) incorporates the requirements of section 806.
       ``(2) Contribution rates must be nondiscriminatory.--
       ``(A) The contribution rates for any participating small 
     employer do not vary on the basis of any health status-
     related factor in relation to employees of such employer or 
     their beneficiaries and do not vary on the basis of the type 
     of business or industry in which such employer is engaged.
       ``(B) Nothing in this title or any other provision of law 
     shall be construed to preclude an association health plan, or 
     a health insurance issuer offering health insurance coverage 
     in connection with an association health plan, from--
       ``(i) setting contribution rates based on the claims 
     experience of the plan; or
       ``(ii) varying contribution rates for small employers in a 
     State to the extent that such rates could vary using the same 
     methodology employed in such State for regulating premium 
     rates in the small group market with respect to health 
     insurance coverage offered in connection with bona fide 
     associations (within the meaning of section 2791(d)(3) of the 
     Public Health Service Act),

     subject to the requirements of section 702(b) relating to 
     contribution rates.
       ``(3) Floor for number of covered individuals with respect 
     to certain plans.--If any benefit option under the plan does 
     not consist of health insurance coverage, the plan has as of 
     the beginning of the plan year not fewer than 1,000 
     participants and beneficiaries.
       ``(4) Marketing requirements.--
       ``(A) In general.--If a benefit option which consists of 
     health insurance coverage is offered under the plan, State-
     licensed insurance agents shall be used to distribute to 
     small employers coverage which does not consist of health 
     insurance coverage in a manner comparable to the manner in 
     which such agents are used to distribute health insurance 
     coverage.
       ``(B) State-licensed insurance agents.--For purposes of 
     subparagraph (A), the term `State-licensed insurance agents' 
     means one or more agents who are licensed in a State and are 
     subject to the laws of such State relating to licensure, 
     qualification, testing, examination, and continuing education 
     of persons authorized to offer, sell, or solicit health 
     insurance coverage in such State.
       ``(5) Regulatory requirements.--Such other requirements as 
     the applicable authority determines are necessary to carry 
     out the purposes of this part, which shall be prescribed by 
     the applicable authority by regulation.
       ``(b) Ability of Association Health Plans To Design Benefit 
     Options.--Subject to section 514(d), nothing in this part or 
     any provision of State law (as defined in section 514(c)(1)) 
     shall be construed to preclude an association health plan, or 
     a health insurance issuer offering health insurance coverage 
     in connection with an association health plan, from 
     exercising its sole discretion in selecting the specific 
     items and services consisting of medical care to be included 
     as benefits under such plan or coverage, except (subject to 
     section 514) in the case of (1) any law to the extent that it 
     is not preempted under section 731(a)(1) with respect to 
     matters governed by section 711, 712, or 713, or (2) any law 
     of the State with which filing and approval of a policy type 
     offered by the plan was initially obtained to the extent that 
     such law prohibits an exclusion of a specific disease from 
     such coverage.

     ``SEC. 806. MAINTENANCE OF RESERVES AND PROVISIONS FOR 
                   SOLVENCY FOR PLANS PROVIDING HEALTH BENEFITS IN 
                   ADDITION TO HEALTH INSURANCE COVERAGE.

       ``(a) In General.--The requirements of this section are met 
     with respect to an association health plan if--
       ``(1) the benefits under the plan consist solely of health 
     insurance coverage; or
       ``(2) if the plan provides any additional benefit options 
     which do not consist of health insurance coverage, the plan--
       ``(A) establishes and maintains reserves with respect to 
     such additional benefit options, in amounts recommended by 
     the qualified actuary, consisting of--
       ``(i) a reserve sufficient for unearned contributions;
       ``(ii) a reserve sufficient for benefit liabilities which 
     have been incurred, which have not been satisfied, and for 
     which risk of loss has not yet been transferred, and for 
     expected administrative costs with respect to such benefit 
     liabilities;
       ``(iii) a reserve sufficient for any other obligations of 
     the plan; and
       ``(iv) a reserve sufficient for a margin of error and other 
     fluctuations, taking into account the specific circumstances 
     of the plan; and
       ``(B) establishes and maintains aggregate and specific 
     excess/stop loss insurance and solvency indemnification, with 
     respect to such additional benefit options for which risk of 
     loss has not yet been transferred, as follows:
       ``(i) The plan shall secure aggregate excess/stop loss 
     insurance for the plan with an attachment point which is not 
     greater than 125 percent of expected gross annual claims. The 
     applicable authority may by regulation provide for upward 
     adjustments in the amount of such percentage in specified 
     circumstances in which the plan specifically provides for and 
     maintains reserves in excess of the amounts required under 
     subparagraph (A).
       ``(ii) The plan shall secure specific excess/stop loss 
     insurance for the plan with an attachment point which is at 
     least equal to an amount recommended by the plan's qualified 
     actuary. The

[[Page 4640]]

     applicable authority may by regulation provide for 
     adjustments in the amount of such insurance in specified 
     circumstances in which the plan specifically provides for and 
     maintains reserves in excess of the amounts required under 
     subparagraph (A).
       ``(iii) The plan shall secure indemnification insurance for 
     any claims which the plan is unable to satisfy by reason of a 
     plan termination.

     Any person issuing to a plan insurance described in clause 
     (i), (ii), or (iii) of subparagraph (B) shall notify the 
     Secretary of any failure of premium payment meriting 
     cancellation of the policy prior to undertaking such a 
     cancellation. Any regulations prescribed by the applicable 
     authority pursuant to clause (i) or (ii) of subparagraph (B) 
     may allow for such adjustments in the required levels of 
     excess/stop loss insurance as the qualified actuary may 
     recommend, taking into account the specific circumstances of 
     the plan.
       ``(b) Minimum Surplus in Addition to Claims Reserves.--In 
     the case of any association health plan described in 
     subsection (a)(2), the requirements of this subsection are 
     met if the plan establishes and maintains surplus in an 
     amount at least equal to--
       ``(1) $500,000, or
       ``(2) such greater amount (but not greater than $2,000,000) 
     as may be set forth in regulations prescribed by the 
     applicable authority, considering the level of aggregate and 
     specific excess/stop loss insurance provided with respect to 
     such plan and other factors related to solvency risk, such as 
     the plan's projected levels of participation or claims, the 
     nature of the plan's liabilities, and the types of assets 
     available to assure that such liabilities are met.
       ``(c) Additional Requirements.--In the case of any 
     association health plan described in subsection (a)(2), the 
     applicable authority may provide such additional requirements 
     relating to reserves, excess/stop loss insurance, and 
     indemnification insurance as the applicable authority 
     considers appropriate. Such requirements may be provided by 
     regulation with respect to any such plan or any class of such 
     plans.
       ``(d) Adjustments for Excess/Stop Loss Insurance.--The 
     applicable authority may provide for adjustments to the 
     levels of reserves otherwise required under subsections (a) 
     and (b) with respect to any plan or class of plans to take 
     into account excess/stop loss insurance provided with respect 
     to such plan or plans.
       ``(e) Alternative Means of Compliance.--The applicable 
     authority may permit an association health plan described in 
     subsection (a)(2) to substitute, for all or part of the 
     requirements of this section (except subsection 
     (a)(2)(B)(iii)), such security, guarantee, hold-harmless 
     arrangement, or other financial arrangement as the applicable 
     authority determines to be adequate to enable the plan to 
     fully meet all its financial obligations on a timely basis 
     and is otherwise no less protective of the interests of 
     participants and beneficiaries than the requirements for 
     which it is substituted. The applicable authority may take 
     into account, for purposes of this subsection, evidence 
     provided by the plan or sponsor which demonstrates an 
     assumption of liability with respect to the plan. Such 
     evidence may be in the form of a contract of indemnification, 
     lien, bonding, insurance, letter of credit, recourse under 
     applicable terms of the plan in the form of assessments of 
     participating employers, security, or other financial 
     arrangement.
       ``(f) Measures To Ensure Continued Payment of Benefits by 
     Certain Plans in Distress.--
       ``(1) Payments by certain plans to association health plan 
     fund.--
       ``(A) In general.--In the case of an association health 
     plan described in subsection (a)(2), the requirements of this 
     subsection are met if the plan makes payments into the 
     Association Health Plan Fund under this subparagraph when 
     they are due. Such payments shall consist of annual payments 
     in the amount of $5,000, and, in addition to such annual 
     payments, such supplemental payments as the Secretary may 
     determine to be necessary under paragraph (2). Payments under 
     this paragraph are payable to the Fund at the time determined 
     by the Secretary. Initial payments are due in advance of 
     certification under this part. Payments shall continue to 
     accrue until a plan's assets are distributed pursuant to a 
     termination procedure.
       ``(B) Penalties for failure to make payments.--If any 
     payment is not made by a plan when it is due, a late payment 
     charge of not more than 100 percent of the payment which was 
     not timely paid shall be payable by the plan to the Fund.
       ``(C) Continued duty of the secretary.--The Secretary shall 
     not cease to carry out the provisions of paragraph (2) on 
     account of the failure of a plan to pay any payment when due.
       ``(2) Payments by secretary to continue excess/stop loss 
     insurance coverage and indemnification insurance coverage for 
     certain plans.--In any case in which the applicable authority 
     determines that there is, or that there is reason to believe 
     that there will be: (A) A failure to take necessary 
     corrective actions under section 809(a) with respect to an 
     association health plan described in subsection (a)(2); or 
     (B) a termination of such a plan under section 809(b) or 
     810(b)(8) (and, if the applicable authority is not the 
     Secretary, certifies such determination to the Secretary), 
     the Secretary shall determine the amounts necessary to make 
     payments to an insurer (designated by the Secretary) to 
     maintain in force excess/stop loss insurance coverage or 
     indemnification insurance coverage for such plan, if the 
     Secretary determines that there is a reasonable expectation 
     that, without such payments, claims would not be satisfied by 
     reason of termination of such coverage. The Secretary shall, 
     to the extent provided in advance in appropriation Acts, pay 
     such amounts so determined to the insurer designated by the 
     Secretary.
       ``(3) Association health plan fund.--
       ``(A) In general.--There is established on the books of the 
     Treasury a fund to be known as the `Association Health Plan 
     Fund'. The Fund shall be available for making payments 
     pursuant to paragraph (2). The Fund shall be credited with 
     payments received pursuant to paragraph (1)(A), penalties 
     received pursuant to paragraph (1)(B); and earnings on 
     investments of amounts of the Fund under subparagraph (B).
       ``(B) Investment.--Whenever the Secretary determines that 
     the moneys of the fund are in excess of current needs, the 
     Secretary may request the investment of such amounts as the 
     Secretary determines advisable by the Secretary of the 
     Treasury in obligations issued or guaranteed by the United 
     States.
       ``(g) Excess/Stop Loss Insurance.--For purposes of this 
     section--
       ``(1) Aggregate excess/stop loss insurance.--The term 
     `aggregate excess/stop loss insurance' means, in connection 
     with an association health plan, a contract--
       ``(A) under which an insurer (meeting such minimum 
     standards as the applicable authority may prescribe by 
     regulation) provides for payment to the plan with respect to 
     aggregate claims under the plan in excess of an amount or 
     amounts specified in such contract;
       ``(B) which is guaranteed renewable; and
       ``(C) which allows for payment of premiums by any third 
     party on behalf of the insured plan.
       ``(2) Specific excess/stop loss insurance.--The term 
     `specific excess/stop loss insurance' means, in connection 
     with an association health plan, a contract--
       ``(A) under which an insurer (meeting such minimum 
     standards as the applicable authority may prescribe by 
     regulation) provides for payment to the plan with respect to 
     claims under the plan in connection with a covered individual 
     in excess of an amount or amounts specified in such contract 
     in connection with such covered individual;
       ``(B) which is guaranteed renewable; and
       ``(C) which allows for payment of premiums by any third 
     party on behalf of the insured plan.
       ``(h) Indemnification Insurance.--For purposes of this 
     section, the term `indemnification insurance' means, in 
     connection with an association health plan, a contract--
       ``(1) under which an insurer (meeting such minimum 
     standards as the applicable authority may prescribe by 
     regulation) provides for payment to the plan with respect to 
     claims under the plan which the plan is unable to satisfy by 
     reason of a termination pursuant to section 809(b) (relating 
     to mandatory termination);
       ``(2) which is guaranteed renewable and noncancellable for 
     any reason (except as the applicable authority may prescribe 
     by regulation); and
       ``(3) which allows for payment of premiums by any third 
     party on behalf of the insured plan.
       ``(i) Reserves.--For purposes of this section, the term 
     `reserves' means, in connection with an association health 
     plan, plan assets which meet the fiduciary standards under 
     part 4 and such additional requirements regarding liquidity 
     as the applicable authority may prescribe by regulation.
       ``(j) Solvency Standards Working Group.--
       ``(1) In general.--Within 90 days after the date of the 
     enactment of the Small Business Health Fairness Act of 2017, 
     the applicable authority shall establish a Solvency Standards 
     Working Group. In prescribing the initial regulations under 
     this section, the applicable authority shall take into 
     account the recommendations of such Working Group.
       ``(2) Membership.--The Working Group shall consist of not 
     more than 15 members appointed by the applicable authority. 
     The applicable authority shall include among persons invited 
     to membership on the Working Group at least one of each of 
     the following:
       ``(A) A representative of the National Association of 
     Insurance Commissioners.
       ``(B) A representative of the American Academy of 
     Actuaries.
       ``(C) A representative of the State governments, or their 
     interests.
       ``(D) A representative of existing self-insured 
     arrangements, or their interests.
       ``(E) A representative of associations of the type referred 
     to in section 801(b)(1), or their interests.
       ``(F) A representative of multiemployer plans that are 
     group health plans, or their interests.

     ``SEC. 807. REQUIREMENTS FOR APPLICATION AND RELATED 
                   REQUIREMENTS.

       ``(a) Filing Fee.--Under the procedure prescribed pursuant 
     to section 802(a), an association health plan shall pay to 
     the applicable authority at the time of filing an application 
     for certification under this part a filing fee in the amount 
     of $5,000, which shall be available in the case of the 
     Secretary, to the extent provided in appropriation Acts, for 
     the sole purpose of administering the certification 
     procedures applicable with respect to association health 
     plans.
       ``(b) Information To Be Included in Application for 
     Certification.--An application for certification under this 
     part meets the requirements of this section only if it 
     includes, in a manner and form which shall be prescribed by 
     the applicable authority by regulation, at least the 
     following information:
       ``(1) Identifying information.--The names and addresses 
     of--

[[Page 4641]]

       ``(A) the sponsor; and
       ``(B) the members of the board of trustees of the plan.
       ``(2) States in which plan intends to do business.--The 
     States in which participants and beneficiaries under the plan 
     are to be located and the number of them expected to be 
     located in each such State.
       ``(3) Bonding requirements.--Evidence provided by the board 
     of trustees that the bonding requirements of section 412 will 
     be met as of the date of the application or (if later) 
     commencement of operations.
       ``(4) Plan documents.--A copy of the documents governing 
     the plan (including any bylaws and trust agreements), the 
     summary plan description, and other material describing the 
     benefits that will be provided to participants and 
     beneficiaries under the plan.
       ``(5) Agreements with service providers.--A copy of any 
     agreements between the plan and contract administrators and 
     other service providers.
       ``(6) Funding report.--In the case of association health 
     plans providing benefits options in addition to health 
     insurance coverage, a report setting forth information with 
     respect to such additional benefit options determined as of a 
     date within the 120-day period ending with the date of the 
     application, including the following:
       ``(A) Reserves.--A statement, certified by the board of 
     trustees of the plan, and a statement of actuarial opinion, 
     signed by a qualified actuary, that all applicable 
     requirements of section 806 are or will be met in accordance 
     with regulations which the applicable authority shall 
     prescribe.
       ``(B) Adequacy of contribution rates.--A statement of 
     actuarial opinion, signed by a qualified actuary, which sets 
     forth a description of the extent to which contribution rates 
     are adequate to provide for the payment of all obligations 
     and the maintenance of required reserves under the plan for 
     the 12-month period beginning with such date within such 120-
     day period, taking into account the expected coverage and 
     experience of the plan. If the contribution rates are not 
     fully adequate, the statement of actuarial opinion shall 
     indicate the extent to which the rates are inadequate and the 
     changes needed to ensure adequacy.
       ``(C) Current and projected value of assets and 
     liabilities.--A statement of actuarial opinion signed by a 
     qualified actuary, which sets forth the current value of the 
     assets and liabilities accumulated under the plan and a 
     projection of the assets, liabilities, income, and expenses 
     of the plan for the 12-month period referred to in 
     subparagraph (B). The income statement shall identify 
     separately the plan's administrative expenses and claims.
       ``(D) Costs of coverage to be charged and other expenses.--
     A statement of the costs of coverage to be charged, including 
     an itemization of amounts for administration, reserves, and 
     other expenses associated with the operation of the plan.
       ``(E) Other information.--Any other information as may be 
     determined by the applicable authority, by regulation, as 
     necessary to carry out the purposes of this part.
       ``(c) Filing Notice of Certification With States.--A 
     certification granted under this part to an association 
     health plan shall not be effective unless written notice of 
     such certification is filed with the applicable State 
     authority of each State in which at least 25 percent of the 
     participants and beneficiaries under the plan are located. 
     For purposes of this subsection, an individual shall be 
     considered to be located in the State in which a known 
     address of such individual is located or in which such 
     individual is employed.
       ``(d) Notice of Material Changes.--In the case of any 
     association health plan certified under this part, 
     descriptions of material changes in any information which was 
     required to be submitted with the application for the 
     certification under this part shall be filed in such form and 
     manner as shall be prescribed by the applicable authority by 
     regulation. The applicable authority may require by 
     regulation prior notice of material changes with respect to 
     specified matters which might serve as the basis for 
     suspension or revocation of the certification.
       ``(e) Reporting Requirements for Certain Association Health 
     Plans.--An association health plan certified under this part 
     which provides benefit options in addition to health 
     insurance coverage for such plan year shall meet the 
     requirements of section 103 by filing an annual report under 
     such section which shall include information described in 
     subsection (b)(6) with respect to the plan year and, 
     notwithstanding section 104(a)(1)(A), shall be filed with the 
     applicable authority not later than 90 days after the close 
     of the plan year (or on such later date as may be prescribed 
     by the applicable authority). The applicable authority may 
     require by regulation such interim reports as it considers 
     appropriate.
       ``(f) Engagement of Qualified Actuary.--The board of 
     trustees of each association health plan which provides 
     benefits options in addition to health insurance coverage and 
     which is applying for certification under this part or is 
     certified under this part shall engage, on behalf of all 
     participants and beneficiaries, a qualified actuary who shall 
     be responsible for the preparation of the materials 
     comprising information necessary to be submitted by a 
     qualified actuary under this part. The qualified actuary 
     shall utilize such assumptions and techniques as are 
     necessary to enable such actuary to form an opinion as to 
     whether the contents of the matters reported under this 
     part--
       ``(1) are in the aggregate reasonably related to the 
     experience of the plan and to reasonable expectations; and
       ``(2) represent such actuary's best estimate of anticipated 
     experience under the plan.
     The opinion by the qualified actuary shall be made with 
     respect to, and shall be made a part of, the annual report.

     ``SEC. 808. NOTICE REQUIREMENTS FOR VOLUNTARY TERMINATION.

       ``Except as provided in section 809(b), an association 
     health plan which is or has been certified under this part 
     may terminate (upon or at any time after cessation of 
     accruals in benefit liabilities) only if the board of 
     trustees, not less than 60 days before the proposed 
     termination date--
       ``(1) provides to the participants and beneficiaries a 
     written notice of intent to terminate stating that such 
     termination is intended and the proposed termination date;
       ``(2) develops a plan for winding up the affairs of the 
     plan in connection with such termination in a manner which 
     will result in timely payment of all benefits for which the 
     plan is obligated; and
       ``(3) submits such plan in writing to the applicable 
     authority.

     Actions required under this section shall be taken in such 
     form and manner as may be prescribed by the applicable 
     authority by regulation.

     ``SEC. 809. CORRECTIVE ACTIONS AND MANDATORY TERMINATION.

       ``(a) Actions To Avoid Depletion of Reserves.--An 
     association health plan which is certified under this part 
     and which provides benefits other than health insurance 
     coverage shall continue to meet the requirements of section 
     806, irrespective of whether such certification continues in 
     effect. The board of trustees of such plan shall determine 
     quarterly whether the requirements of section 806 are met. In 
     any case in which the board determines that there is reason 
     to believe that there is or will be a failure to meet such 
     requirements, or the applicable authority makes such a 
     determination and so notifies the board, the board shall 
     immediately notify the qualified actuary engaged by the plan, 
     and such actuary shall, not later than the end of the next 
     following month, make such recommendations to the board for 
     corrective action as the actuary determines necessary to 
     ensure compliance with section 806. Not later than 30 days 
     after receiving from the actuary recommendations for 
     corrective actions, the board shall notify the applicable 
     authority (in such form and manner as the applicable 
     authority may prescribe by regulation) of such 
     recommendations of the actuary for corrective action, 
     together with a description of the actions (if any) that the 
     board has taken or plans to take in response to such 
     recommendations. The board shall thereafter report to the 
     applicable authority, in such form and frequency as the 
     applicable authority may specify to the board, regarding 
     corrective action taken by the board until the requirements 
     of section 806 are met.
       ``(b) Mandatory Termination.--In any case in which--
       ``(1) the applicable authority has been notified under 
     subsection (a) (or by an issuer of excess/stop loss insurance 
     or indemnity insurance pursuant to section 806(a)) of a 
     failure of an association health plan which is or has been 
     certified under this part and is described in section 
     806(a)(2) to meet the requirements of section 806 and has not 
     been notified by the board of trustees of the plan that 
     corrective action has restored compliance with such 
     requirements; and
       ``(2) the applicable authority determines that there is a 
     reasonable expectation that the plan will continue to fail to 
     meet the requirements of section 806,

     the board of trustees of the plan shall, at the direction of 
     the applicable authority, terminate the plan and, in the 
     course of the termination, take such actions as the 
     applicable authority may require, including satisfying any 
     claims referred to in section 806(a)(2)(B)(iii) and 
     recovering for the plan any liability under subsection 
     (a)(2)(B)(iii) or (e) of section 806, as necessary to ensure 
     that the affairs of the plan will be, to the maximum extent 
     possible, wound up in a manner which will result in timely 
     provision of all benefits for which the plan is obligated.

     ``SEC. 810. TRUSTEESHIP BY THE SECRETARY OF INSOLVENT 
                   ASSOCIATION HEALTH PLANS PROVIDING HEALTH 
                   BENEFITS IN ADDITION TO HEALTH INSURANCE 
                   COVERAGE.

       ``(a) Appointment of Secretary as Trustee for Insolvent 
     Plans.--Whenever the Secretary determines that an association 
     health plan which is or has been certified under this part 
     and which is described in section 806(a)(2) will be unable to 
     provide benefits when due or is otherwise in a financially 
     hazardous condition, as shall be defined by the Secretary by 
     regulation, the Secretary shall, upon notice to the plan, 
     apply to the appropriate United States district court for 
     appointment of the Secretary as trustee to administer the 
     plan for the duration of the insolvency. The plan may appear 
     as a party and other interested persons may intervene in the 
     proceedings at the discretion of the court. The court shall 
     appoint such Secretary trustee if the court determines that 
     the trusteeship is necessary to protect the interests of the 
     participants and beneficiaries or providers of medical care 
     or to avoid any unreasonable deterioration of the financial 
     condition of the plan. The trusteeship of such Secretary 
     shall continue until the conditions described in the first 
     sentence of this subsection are remedied or the plan is 
     terminated.

[[Page 4642]]

       ``(b) Powers as Trustee.--The Secretary, upon appointment 
     as trustee under subsection (a), shall have the power--
       ``(1) to do any act authorized by the plan, this title, or 
     other applicable provisions of law to be done by the plan 
     administrator or any trustee of the plan;
       ``(2) to require the transfer of all (or any part) of the 
     assets and records of the plan to the Secretary as trustee;
       ``(3) to invest any assets of the plan which the Secretary 
     holds in accordance with the provisions of the plan, 
     regulations prescribed by the Secretary, and applicable 
     provisions of law;
       ``(4) to require the sponsor, the plan administrator, any 
     participating employer, and any employee organization 
     representing plan participants to furnish any information 
     with respect to the plan which the Secretary as trustee may 
     reasonably need in order to administer the plan;
       ``(5) to collect for the plan any amounts due the plan and 
     to recover reasonable expenses of the trusteeship;
       ``(6) to commence, prosecute, or defend on behalf of the 
     plan any suit or proceeding involving the plan;
       ``(7) to issue, publish, or file such notices, statements, 
     and reports as may be required by the Secretary by regulation 
     or required by any order of the court;
       ``(8) to terminate the plan (or provide for its termination 
     in accordance with section 809(b)) and liquidate the plan 
     assets, to restore the plan to the responsibility of the 
     sponsor, or to continue the trusteeship;
       ``(9) to provide for the enrollment of plan participants 
     and beneficiaries under appropriate coverage options; and
       ``(10) to do such other acts as may be necessary to comply 
     with this title or any order of the court and to protect the 
     interests of plan participants and beneficiaries and 
     providers of medical care.
       ``(c) Notice of Appointment.--As soon as practicable after 
     the Secretary's appointment as trustee, the Secretary shall 
     give notice of such appointment to--
       ``(1) the sponsor and plan administrator;
       ``(2) each participant;
       ``(3) each participating employer; and
       ``(4) if applicable, each employee organization which, for 
     purposes of collective bargaining, represents plan 
     participants.
       ``(d) Additional Duties.--Except to the extent inconsistent 
     with the provisions of this title, or as may be otherwise 
     ordered by the court, the Secretary, upon appointment as 
     trustee under this section, shall be subject to the same 
     duties as those of a trustee under section 704 of title 11, 
     United States Code, and shall have the duties of a fiduciary 
     for purposes of this title.
       ``(e) Other Proceedings.--An application by the Secretary 
     under this subsection may be filed notwithstanding the 
     pendency in the same or any other court of any bankruptcy, 
     mortgage foreclosure, or equity receivership proceeding, or 
     any proceeding to reorganize, conserve, or liquidate such 
     plan or its property, or any proceeding to enforce a lien 
     against property of the plan.
       ``(f) Jurisdiction of Court.--
       ``(1) In general.--Upon the filing of an application for 
     the appointment as trustee or the issuance of a decree under 
     this section, the court to which the application is made 
     shall have exclusive jurisdiction of the plan involved and 
     its property wherever located with the powers, to the extent 
     consistent with the purposes of this section, of a court of 
     the United States having jurisdiction over cases under 
     chapter 11 of title 11, United States Code. Pending an 
     adjudication under this section such court shall stay, and 
     upon appointment by it of the Secretary as trustee, such 
     court shall continue the stay of, any pending mortgage 
     foreclosure, equity receivership, or other proceeding to 
     reorganize, conserve, or liquidate the plan, the sponsor, or 
     property of such plan or sponsor, and any other suit against 
     any receiver, conservator, or trustee of the plan, the 
     sponsor, or property of the plan or sponsor. Pending such 
     adjudication and upon the appointment by it of the Secretary 
     as trustee, the court may stay any proceeding to enforce a 
     lien against property of the plan or the sponsor or any other 
     suit against the plan or the sponsor.
       ``(2) Venue.--An action under this section may be brought 
     in the judicial district where the sponsor or the plan 
     administrator resides or does business or where any asset of 
     the plan is situated. A district court in which such action 
     is brought may issue process with respect to such action in 
     any other judicial district.
       ``(g) Personnel.--In accordance with regulations which 
     shall be prescribed by the Secretary, the Secretary shall 
     appoint, retain, and compensate accountants, actuaries, and 
     other professional service personnel as may be necessary in 
     connection with the Secretary's service as trustee under this 
     section.

     ``SEC. 811. STATE ASSESSMENT AUTHORITY.

       ``(a) In General.--Notwithstanding section 514, a State may 
     impose by law a contribution tax on an association health 
     plan described in section 806(a)(2), if the plan commenced 
     operations in such State after the date of the enactment of 
     the Small Business Health Fairness Act of 2017.
       ``(b) Contribution Tax.--For purposes of this section, the 
     term `contribution tax' imposed by a State on an association 
     health plan means any tax imposed by such State if--
       ``(1) such tax is computed by applying a rate to the amount 
     of premiums or contributions, with respect to individuals 
     covered under the plan who are residents of such State, which 
     are received by the plan from participating employers located 
     in such State or from such individuals;
       ``(2) the rate of such tax does not exceed the rate of any 
     tax imposed by such State on premiums or contributions 
     received by insurers or health maintenance organizations for 
     health insurance coverage offered in such State in connection 
     with a group health plan;
       ``(3) such tax is otherwise nondiscriminatory; and
       ``(4) the amount of any such tax assessed on the plan is 
     reduced by the amount of any tax or assessment otherwise 
     imposed by the State on premiums, contributions, or both 
     received by insurers or health maintenance organizations for 
     health insurance coverage, aggregate excess/stop loss 
     insurance (as defined in section 806(g)(1)), specific excess/
     stop loss insurance (as defined in section 806(g)(2)), other 
     insurance related to the provision of medical care under the 
     plan, or any combination thereof provided by such insurers or 
     health maintenance organizations in such State in connection 
     with such plan.

     ``SEC. 812. DEFINITIONS AND RULES OF CONSTRUCTION.

       ``(a) Definitions.--For purposes of this part--
       ``(1) Group health plan.--The term `group health plan' has 
     the meaning provided in section 733(a)(1) (after applying 
     subsection (b) of this section).
       ``(2) Medical care.--The term `medical care' has the 
     meaning provided in section 733(a)(2).
       ``(3) Health insurance coverage.--The term `health 
     insurance coverage' has the meaning provided in section 
     733(b)(1).
       ``(4) Health insurance issuer.--The term `health insurance 
     issuer' has the meaning provided in section 733(b)(2).
       ``(5) Applicable authority.--The term `applicable 
     authority' means the Secretary, except that, in connection 
     with any exercise of the Secretary's authority regarding 
     which the Secretary is required under section 506(d) to 
     consult with a State, such term means the Secretary, in 
     consultation with such State.
       ``(6) Health status-related factor.--The term `health 
     status-related factor' has the meaning provided in section 
     733(d)(2).
       ``(7) Individual market.--
       ``(A) In general.--The term `individual market' means the 
     market for health insurance coverage offered to individuals 
     other than in connection with a group health plan.
       ``(B) Treatment of very small groups.--
       ``(i) In general.--Subject to clause (ii), such term 
     includes coverage offered in connection with a group health 
     plan that has fewer than 2 participants as current employees 
     or participants described in section 732(d)(3) on the first 
     day of the plan year.
       ``(ii) State exception.--Clause (i) shall not apply in the 
     case of health insurance coverage offered in a State if such 
     State regulates the coverage described in such clause in the 
     same manner and to the same extent as coverage in the small 
     group market (as defined in section 2791(e)(5) of the Public 
     Health Service Act) is regulated by such State.
       ``(8) Participating employer.--The term `participating 
     employer' means, in connection with an association health 
     plan, any employer, if any individual who is an employee of 
     such employer, a partner in such employer, or a self-employed 
     individual who is such employer (or any dependent, as defined 
     under the terms of the plan, of such individual) is or was 
     covered under such plan in connection with the status of such 
     individual as such an employee, partner, or self-employed 
     individual in relation to the plan.
       ``(9) Applicable state authority.--The term `applicable 
     State authority' means, with respect to a health insurance 
     issuer in a State, the State insurance commissioner or 
     official or officials designated by the State to enforce the 
     requirements of title XXVII of the Public Health Service Act 
     for the State involved with respect to such issuer.
       ``(10) Qualified actuary.--The term `qualified actuary' 
     means an individual who is a member of the American Academy 
     of Actuaries.
       ``(11) Affiliated member.--The term `affiliated member' 
     means, in connection with a sponsor--
       ``(A) a person who is otherwise eligible to be a member of 
     the sponsor but who elects an affiliated status with the 
     sponsor,
       ``(B) in the case of a sponsor with members which consist 
     of associations, a person who is a member of any such 
     association and elects an affiliated status with the sponsor, 
     or
       ``(C) in the case of an association health plan in 
     existence on the date of the enactment of the Small Business 
     Health Fairness Act of 2017, a person eligible to be a member 
     of the sponsor or one of its member associations.
       ``(12) Large employer.--The term `large employer' means, in 
     connection with a group health plan with respect to a plan 
     year, an employer who employed an average of at least 51 
     employees on business days during the preceding calendar year 
     and who employs at least 2 employees on the first day of the 
     plan year.
       ``(13) Small employer.--The term `small employer' means, in 
     connection with a group health plan with respect to a plan 
     year, an employer who is not a large employer.
       ``(b) Rules of Construction.--
       ``(1) Employers and employees.--For purposes of determining 
     whether a plan, fund, or program is an employee welfare 
     benefit plan which is an association health plan, and for 
     purposes of applying this title in connection with such plan, 
     fund, or program so determined to be such an employee welfare 
     benefit plan--

[[Page 4643]]

       ``(A) in the case of a partnership, the term `employer' (as 
     defined in section 3(5)) includes the partnership in relation 
     to the partners, and the term `employee' (as defined in 
     section 3(6)) includes any partner in relation to the 
     partnership; and
       ``(B) in the case of a self-employed individual, the term 
     `employer' (as defined in section 3(5)) and the term 
     `employee' (as defined in section 3(6)) shall include such 
     individual.
       ``(2) Plans, funds, and programs treated as employee 
     welfare benefit plans.--In the case of any plan, fund, or 
     program which was established or is maintained for the 
     purpose of providing medical care (through the purchase of 
     insurance or otherwise) for employees (or their dependents) 
     covered thereunder and which demonstrates to the Secretary 
     that all requirements for certification under this part would 
     be met with respect to such plan, fund, or program if such 
     plan, fund, or program were a group health plan, such plan, 
     fund, or program shall be treated for purposes of this title 
     as an employee welfare benefit plan on and after the date of 
     such demonstration.''.
       (b) Conforming Amendments to Preemption Rules.--
       (1) Section 514(b)(6) of such Act (29 U.S.C. 1144(b)(6)) is 
     amended by adding at the end the following new subparagraph:
       ``(E) The preceding subparagraphs of this paragraph do not 
     apply with respect to any State law in the case of an 
     association health plan which is certified under part 8.''.
       (2) Section 514 of such Act (29 U.S.C. 1144) is amended--
       (A) in subsection (b)(4), by striking ``Subsection (a)'' 
     and inserting ``Subsections (a) and (f)'';
       (B) in subsection (b)(5), by striking ``subsection (a)'' in 
     subparagraph (A) and inserting ``subsection (a) of this 
     section and subsections (a)(2)(B) and (b) of section 805'', 
     and by striking ``subsection (a)'' in subparagraph (B) and 
     inserting ``subsection (a) of this section or subsection 
     (a)(2)(B) or (b) of section 805''; and
       (C) by adding at the end the following new subsection:
       ``(f)(1) Except as provided in subsection (b)(4), the 
     provisions of this title shall supersede any and all State 
     laws insofar as they may now or hereafter preclude, or have 
     the effect of precluding, a health insurance issuer from 
     offering health insurance coverage in connection with an 
     association health plan which is certified under part 8.
       ``(2) Except as provided in paragraphs (4) and (5) of 
     subsection (b) of this section--
       ``(A) In any case in which health insurance coverage of any 
     policy type is offered under an association health plan 
     certified under part 8 to a participating employer operating 
     in such State, the provisions of this title shall supersede 
     any and all laws of such State insofar as they may preclude a 
     health insurance issuer from offering health insurance 
     coverage of the same policy type to other employers operating 
     in the State which are eligible for coverage under such 
     association health plan, whether or not such other employers 
     are participating employers in such plan.
       ``(B) In any case in which health insurance coverage of any 
     policy type is offered in a State under an association health 
     plan certified under part 8 and the filing, with the 
     applicable State authority (as defined in section 812(a)(9)), 
     of the policy form in connection with such policy type is 
     approved by such State authority, the provisions of this 
     title shall supersede any and all laws of any other State in 
     which health insurance coverage of such type is offered, 
     insofar as they may preclude, upon the filing in the same 
     form and manner of such policy form with the applicable State 
     authority in such other State, the approval of the filing in 
     such other State.
       ``(3) Nothing in subsection (b)(6)(E) or the preceding 
     provisions of this subsection shall be construed, with 
     respect to health insurance issuers or health insurance 
     coverage, to supersede or impair the law of any State--
       ``(A) providing solvency standards or similar standards 
     regarding the adequacy of insurer capital, surplus, reserves, 
     or contributions, or
       ``(B) relating to prompt payment of claims.
       ``(4) For additional provisions relating to association 
     health plans, see subsections (a)(2)(B) and (b) of section 
     805.
       ``(5) For purposes of this subsection, the term 
     `association health plan' has the meaning provided in section 
     801(a), and the terms `health insurance coverage', 
     `participating employer', and `health insurance issuer' have 
     the meanings provided such terms in section 812, 
     respectively.''.
       (3) Section 514(b)(6)(A) of such Act (29 U.S.C. 
     1144(b)(6)(A)) is amended--
       (A) in clause (i)(II), by striking ``and'' at the end;
       (B) in clause (ii), by inserting ``and which does not 
     provide medical care (within the meaning of section 
     733(a)(2)),'' after ``arrangement,'', and by striking 
     ``title.'' and inserting ``title, and''; and
       (C) by adding at the end the following new clause:
       ``(iii) subject to subparagraph (E), in the case of any 
     other employee welfare benefit plan which is a multiple 
     employer welfare arrangement and which provides medical care 
     (within the meaning of section 733(a)(2)), any law of any 
     State which regulates insurance may apply.''.
       (4) Section 514(d) of such Act (29 U.S.C. 1144(d)) is 
     amended--
       (A) by striking ``Nothing'' and inserting ``(1) Except as 
     provided in paragraph (2), nothing''; and
       (B) by adding at the end the following new paragraph:
       ``(2) Nothing in any other provision of law enacted on or 
     after the date of the enactment of the Small Business Health 
     Fairness Act of 2017 shall be construed to alter, amend, 
     modify, invalidate, impair, or supersede any provision of 
     this title, except by specific cross-reference to the 
     affected section.''.
       (c) Plan Sponsor.--Section 3(16)(B) of such Act (29 U.S.C. 
     102(16)(B)) is amended by adding at the end the following new 
     sentence: ``Such term also includes a person serving as the 
     sponsor of an association health plan under part 8.''.
       (d) Disclosure of Solvency Protections Related to Self-
     Insured and Fully Insured Options Under Association Health 
     Plans.--Section 102(b) of such Act (29 U.S.C. 102(b)) is 
     amended by adding at the end the following: ``An association 
     health plan shall include in its summary plan description, in 
     connection with each benefit option, a description of the 
     form of solvency or guarantee fund protection secured 
     pursuant to this Act or applicable State law, if any.''.
       (e) Savings Clause.--Section 731(c) of such Act is amended 
     by inserting ``or part 8'' after ``this part''.
       (f) Report to the Congress Regarding Certification of Self-
     Insured Association Health Plans.--Not later than January 1, 
     2022, the Secretary of Labor shall report to the Committee on 
     Education and the Workforce of the House of Representatives 
     and the Committee on Health, Education, Labor, and Pensions 
     of the Senate the effect association health plans have had, 
     if any, on reducing the number of uninsured individuals.
       (g) Clerical Amendment.--The table of contents in section 1 
     of the Employee Retirement Income Security Act of 1974 is 
     amended by inserting after the item relating to section 734 
     the following new items:

           ``Part 8. Rules Governing Association Health Plans

       ``801. Association health plans.
       ``802. Certification of association health plans.
       ``803. Requirements relating to sponsors and boards of 
           trustees.
       ``804. Participation and coverage requirements.
       ``805. Other requirements relating to plan documents, 
           contribution rates, and benefit options.
       ``806. Maintenance of reserves and provisions for solvency 
           for plans providing health benefits in addition to 
           health insurance coverage.
       ``807. Requirements for application and related 
           requirements.
       ``808. Notice requirements for voluntary termination.
       ``809. Corrective actions and mandatory termination.
       ``810. Trusteeship by the Secretary of insolvent 
           association health plans providing health benefits in 
           addition to health insurance coverage.
       ``811. State assessment authority.
       ``812. Definitions and rules of construction.''.

     SEC. 3. CLARIFICATION OF TREATMENT OF SINGLE EMPLOYER 
                   ARRANGEMENTS.

       Section 3(40)(B) of the Employee Retirement Income Security 
     Act of 1974 (29 U.S.C. 1002(40)(B)) is amended--
       (1) in clause (i), by inserting after ``control group,'' 
     the following: ``except that, in any case in which the 
     benefit referred to in subparagraph (A) consists of medical 
     care (as defined in section 812(a)(2)), two or more trades or 
     businesses, whether or not incorporated, shall be deemed a 
     single employer for any plan year of such plan, or any fiscal 
     year of such other arrangement, if such trades or businesses 
     are within the same control group during such year or at any 
     time during the preceding 1-year period,''; 
       (2) in clause (iii), by striking ``(iii) the 
     determination'' and inserting the following:
       ``(iii)(I) in any case in which the benefit referred to in 
     subparagraph (A) consists of medical care (as defined in 
     section 812(a)(2)), the determination of whether a trade or 
     business is under `common control' with another trade or 
     business shall be determined under regulations of the 
     Secretary applying principles consistent and coextensive with 
     the principles applied in determining whether employees of 
     two or more trades or businesses are treated as employed by a 
     single employer under section 4001(b), except that, for 
     purposes of this paragraph, an interest of greater than 25 
     percent may not be required as the minimum interest necessary 
     for common control, or
       ``(II) in any other case, the determination'';
       (3) by redesignating clauses (iv) and (v) as clauses (v) 
     and (vi), respectively; and
       (4) by inserting after clause (iii) the following new 
     clause:
       ``(iv) in any case in which the benefit referred to in 
     subparagraph (A) consists of medical care (as defined in 
     section 812(a)(2)), in determining, after the application of 
     clause (i), whether benefits are provided to employees of two 
     or more employers, the arrangement shall be treated as having 
     only one participating employer if, after the application of 
     clause (i), the number of individuals who are employees and 
     former employees of any one participating employer and who 
     are covered under the arrangement is greater than 75 percent 
     of the aggregate number of all individuals who are employees 
     or former employees of participating employers and who are 
     covered under the arrangement,''.

     SEC. 4. ENFORCEMENT PROVISIONS RELATING TO ASSOCIATION HEALTH 
                   PLANS.

       (a) Criminal Penalties for Certain Willful 
     Misrepresentations.--Section 501 of the

[[Page 4644]]

     Employee Retirement Income Security Act of 1974 (29 U.S.C. 
     1131) is amended by adding at the end the following new 
     subsection:
       ``(c) Any person who willfully falsely represents, to any 
     employee, any employee's beneficiary, any employer, the 
     Secretary, or any State, a plan or other arrangement 
     established or maintained for the purpose of offering or 
     providing any benefit described in section 3(1) to employees 
     or their beneficiaries as--
       ``(1) being an association health plan which has been 
     certified under part 8;
       ``(2) having been established or maintained under or 
     pursuant to one or more collective bargaining agreements 
     which are reached pursuant to collective bargaining described 
     in section 8(d) of the National Labor Relations Act (29 
     U.S.C. 158(d)) or paragraph Fourth of section 2 of the 
     Railway Labor Act (45 U.S.C. 152, paragraph Fourth) or which 
     are reached pursuant to labor-management negotiations under 
     similar provisions of State public employee relations laws; 
     or
       ``(3) being a plan or arrangement described in section 
     3(40)(A)(i),

     shall, upon conviction, be imprisoned not more than 5 years, 
     be fined under title 18, United States Code, or both.''.
       (b) Cease Activities Orders.--Section 502 of the Employee 
     Retirement Income Security Act of 1974 (29 U.S.C. 1132) is 
     amended by adding at the end the following new subsection:
       ``(n) Association Health Plan Cease and Desist Orders.--
       ``(1) In general.--Subject to paragraph (2), upon 
     application by the Secretary showing the operation, 
     promotion, or marketing of an association health plan (or 
     similar arrangement providing benefits consisting of medical 
     care (as defined in section 733(a)(2))) that--
       ``(A) is not certified under part 8, is subject under 
     section 514(b)(6) to the insurance laws of any State in which 
     the plan or arrangement offers or provides benefits, and is 
     not licensed, registered, or otherwise approved under the 
     insurance laws of such State; or
       ``(B) is an association health plan certified under part 8 
     and is not operating in accordance with the requirements 
     under part 8 for such certification,
     a district court of the United States shall enter an order 
     requiring that the plan or arrangement cease activities.
       ``(2) Exception.--Paragraph (1) shall not apply in the case 
     of an association health plan or other arrangement if the 
     plan or arrangement shows that--
       ``(A) all benefits under it referred to in paragraph (1) 
     consist of health insurance coverage; and
       ``(B) with respect to each State in which the plan or 
     arrangement offers or provides benefits, the plan or 
     arrangement is operating in accordance with applicable State 
     laws that are not superseded under section 514.
       ``(3) Additional equitable relief.--The court may grant 
     such additional equitable relief, including any relief 
     available under this title, as it deems necessary to protect 
     the interests of the public and of persons having claims for 
     benefits against the plan.''.
       (c) Responsibility for Claims Procedure.--Section 503 of 
     the Employee Retirement Income Security Act of 1974 (29 
     U.S.C. 1133) is amended by inserting ``(a) In General.--'' 
     before ``In accordance'', and by adding at the end the 
     following new subsection:
       ``(b) Association Health Plans.--The terms of each 
     association health plan which is or has been certified under 
     part 8 shall require the board of trustees or the named 
     fiduciary (as applicable) to ensure that the requirements of 
     this section are met in connection with claims filed under 
     the plan.''.

     SEC. 5. COOPERATION BETWEEN FEDERAL AND STATE AUTHORITIES.

       Section 506 of the Employee Retirement Income Security Act 
     of 1974 (29 U.S.C. 1136) is amended by adding at the end the 
     following new subsection:
       ``(d) Consultation With States With Respect to Association 
     Health Plans.--
       ``(1) Agreements with states.--The Secretary shall consult 
     with the State recognized under paragraph (2) with respect to 
     an association health plan regarding the exercise of--
       ``(A) the Secretary's authority under sections 502 and 504 
     to enforce the requirements for certification under part 8; 
     and
       ``(B) the Secretary's authority to certify association 
     health plans under part 8 in accordance with regulations of 
     the Secretary applicable to certification under part 8.
       ``(2) Recognition of primary domicile state.--In carrying 
     out paragraph (1), the Secretary shall ensure that only one 
     State will be recognized, with respect to any particular 
     association health plan, as the State with which consultation 
     is required. In carrying out this paragraph--
       ``(A) in the case of a plan which provides health insurance 
     coverage (as defined in section 812(a)(3)), such State shall 
     be the State with which filing and approval of a policy type 
     offered by the plan was initially obtained, and
       ``(B) in any other case, the Secretary shall take into 
     account the places of residence of the participants and 
     beneficiaries under the plan and the State in which the trust 
     is maintained.''.

     SEC. 6. EFFECTIVE DATE AND TRANSITIONAL AND OTHER RULES.

       (a) Effective Date.--The amendments made by this Act shall 
     take effect 1 year after the date of the enactment of this 
     Act. The Secretary of Labor shall first issue all regulations 
     necessary to carry out the amendments made by this Act within 
     1 year after the date of the enactment of this Act.
       (b) Treatment of Certain Existing Health Benefits 
     Programs.--
       (1) In general.--In any case in which, as of the date of 
     the enactment of this Act, an arrangement is maintained in a 
     State for the purpose of providing benefits consisting of 
     medical care for the employees and beneficiaries of its 
     participating employers, at least 200 participating employers 
     make contributions to such arrangement, such arrangement has 
     been in existence for at least 10 years, and such arrangement 
     is licensed under the laws of one or more States to provide 
     such benefits to its participating employers, upon the filing 
     with the applicable authority (as defined in section 
     812(a)(5) of the Employee Retirement Income Security Act of 
     1974 (as amended by this subtitle)) by the arrangement of an 
     application for certification of the arrangement under part 8 
     of subtitle B of title I of such Act--
       (A) such arrangement shall be deemed to be a group health 
     plan for purposes of title I of such Act;
       (B) the requirements of sections 801(a) and 803(a) of the 
     Employee Retirement Income Security Act of 1974 shall be 
     deemed met with respect to such arrangement;
       (C) the requirements of section 803(b) of such Act shall be 
     deemed met, if the arrangement is operated by a board of 
     directors which--
       (i) is elected by the participating employers, with each 
     employer having one vote; and
       (ii) has complete fiscal control over the arrangement and 
     which is responsible for all operations of the arrangement;
       (D) the requirements of section 804(a) of such Act shall be 
     deemed met with respect to such arrangement; and
       (E) the arrangement may be certified by any applicable 
     authority with respect to its operations in any State only if 
     it operates in such State on the date of certification.
     The provisions of this subsection shall cease to apply with 
     respect to any such arrangement at such time after the date 
     of the enactment of this Act as the applicable requirements 
     of this subsection are not met with respect to such 
     arrangement.
       (2) Definitions.--For purposes of this subsection, the 
     terms ``group health plan'', ``medical care'', and 
     ``participating employer'' shall have the meanings provided 
     in section 812 of the Employee Retirement Income Security Act 
     of 1974, except that the reference in paragraph (7) of such 
     section to an ``association health plan'' shall be deemed a 
     reference to an arrangement referred to in this subsection.
  The SPEAKER pro tempore. The bill shall be debatable for 1 hour 
equally divided and controlled by the chair and ranking minority member 
of the Committee on Education and the Workforce.
  After 1 hour of debate, it shall be in order to consider the further 
amendment printed in House Report 115-51, if offered by the Member 
designated in the report, which shall be considered read and shall be 
separately debatable for the time specified in the report equally 
divided and controlled by the proponent and an opponent.
  The gentlewoman from North Carolina (Ms. Foxx) and the gentleman from 
Virginia (Mr. Scott) each will control 30 minutes.
  The Chair recognizes the gentlewoman from North Carolina.


                             General Leave

  Ms. FOXX. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on H.R. 1101.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from North Carolina?
  There was no objection.
  Ms. FOXX. Mr. Speaker, I yield myself such time as I may consume.
  I rise today in support of H.R. 1101, the Small Business Health 
Fairness Act of 2017.
  Mr. Speaker, this week marks 7 years since ObamaCare was signed into 
law. We all remember the promises former President Obama and Washington 
Democrats made at the time.
  Families were promised that their healthcare costs would go down. 
They were promised more choices and more competition. Small businesses 
and their employees were promised greater access to affordable health 
care.
  But for 7 years, we have watched as all of those promises were 
broken. For 7 years, we have heard from families and small businesses 
across the country that have seen their healthcare costs skyrocket and 
their choices diminish.
  Members of the House Education and the Workforce Committee recently 
heard from Scott Bollenbacher, an Indiana small-business owner with 11 
full-time employees. The company has been forced to switch healthcare 
plans

[[Page 4645]]

twice now under ObamaCare, and their only viable option this year was a 
plan with a 78 percent premium increase.
  Mr. Bollenbacher is one of countless small-business owners struggling 
to make ends meet under a failed government takeover of health care. 
Because of ObamaCare, 300,000 small-business jobs have been destroyed, 
including nearly 8,000 in my home State of North Carolina.

                              {time}  1400

  Additionally, an estimated 10,000 small businesses nationwide have 
closed their doors, and small business employees have lost $19 billion 
each year in wages.
  It should come as no surprise that, since 2008, the share of small 
businesses with fewer than 10 employees offering health coverage has 
dropped 36 percent. It is not that they don't want to; it is that 
onerous mandates and regulations have made it simply unaffordable to do 
so.
  Fortunately, relief is on the way. This week we are not only moving 
to repeal ObamaCare, we are also advancing positive reforms that 
promote affordable coverage for working families, including the Small 
Business Health Fairness Act.
  As its title implies, this important legislation is about fairness 
for small businesses and their employees. Today, small businesses are 
on an unfair playing field with larger companies and unions when it 
comes to health care. Large businesses have the ability to negotiate 
for more affordable healthcare costs for their employees, but small 
businesses do not have the same advantage. Because of their size, small 
businesses have limited bargaining power, which means their employees 
can end up paying more for health insurance.
  With millions of Americans employed by a small business, it is long 
past time to level the playing field. That is exactly what this 
commonsense legislation is about. This bill would empower small 
businesses to band together through association health plans, or AHPs, 
to purchase high-quality health care at a lower cost for workers.
  This bill represents a first step toward a more competitive health 
insurance market that crosses State lines. Under H.R. 1101, small 
businesses in different States could join together through a group 
health plan. These plans would have strong protections and solvency 
requirements to ensure workers can count on healthcare coverage when 
they and their families need it.
  What does all of this mean: more choices, more freedom, and more 
affordable health care for working families and small-business owners 
like Scott Bollenbacher. This is a better way, one that stands in stark 
contrast to ObamaCare's failed approach. Instead of more mandates, this 
bill empowers individuals to access the high-quality, affordable 
healthcare plan that meets their needs.
  I want to thank my colleague Representative Sam Johnson for 
championing, for years, the positive reforms in this bill.
  I urge Members to vote ``yes'' on H.R. 1101 so we can level the 
playing field for small businesses and expand affordable health 
coverage for working families.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SCOTT of Virginia. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, today we are considering a bill that purports to make it 
easier for small businesses to obtain coverage, and tomorrow we will 
vote on a bill that will take away health insurance coverage for 24 
million Americans and force everyone else to pay more for less. So not 
only are we considering a bill today that will make things worse, we 
are considering it a day before we vote on ruining health security for 
working families in order to provide tax cuts for the wealthy.
  As we debate the possible replacement of the Affordable Care Act, I 
think it is instructive that we look back at what the situation was 
before the ACA passed.
  Listening to some, you would think that the costs weren't going up at 
all. In fact, costs were going through the roof before the ACA, and 
small businesses, particularly, were having spectacular cost 
increases--and that is until somebody got sick. At that point, you were 
unlikely to be able to afford any insurance at all.
  Every year before the ACA, small businesses were dropping insurance 
right and left, particularly after somebody got sick. Also, before the 
Affordable Care Act, people with preexisting conditions couldn't get 
insurance. Women were paying more than men. Millions of people were 
losing their insurance every year.
  Since then, the costs have continued to go up, but at the lowest rate 
in the last 50 years. People with preexisting conditions can get 
insurance at the standard rate. Small businesses can cover their 
employees through the Affordable Care Act at the average cost, whether 
or not anybody in their small business has cancer or diabetes. Women 
are not paying more than men. Instead of millions of people losing 
their insurance every year, 20 million more people have insurance.
  In addition to that, families now enjoy strong consumer protections. 
The full name of the Affordable Care Act is the Patient Protection and 
Affordable Care Act. Now there are no caps on what an insurance company 
pays, and they can't cancel your policy for anything other than 
nonpayment. Preventive services such as cancer screenings are available 
with no copay or deductible. Those up to 26 can stay on their parents' 
policy, and the doughnut hole is being closed.
  The ACA did not cure every problem, but it went a long way to making 
Americans healthier and giving them some economic security. It could 
have gone further if, in the past 7 years, Republicans would have been 
willing to work with Democrats to build on the progress instead of 
forcing over 60 votes to repeal all parts of the Affordable Care Act.
  If we do anything now, we ought to improve the situation, not make it 
worse. The Republican plan makes things worse. The CBO analysis 
concluded that 24 million fewer people will have insurance, and most of 
those that get insurance in the future will be paying more for policies 
that don't deliver as much.
  For seniors, particularly, the costs will skyrocket. And, in fact, 
the prediction that the rates will go down in the future are a result 
of the conclusion that so few seniors will be able to buy insurance 
that they will no longer be in the insurance pool.
  The insurance pool would be younger, and, therefore, the costs would 
go down. But that is only because seniors won't be able to afford the 
insurance. Therefore, the insurance pool will be younger and cheaper 
for those who can actually afford it, but that is not a good thing for 
seniors who need the insurance and can't afford it.
  So today we are considering another failed policy. The association 
plan ideas have been studied for years, and it has been concluded that 
it is a bad idea. Under the Affordable Care Act, essentially everybody 
pays average. If you change that arithmetic so some can pay a little 
less, then arithmetic matters. Everybody else is going to pay a little 
more.
  In the association plans, quite frankly, I will admit, they will 
always work for the few that can get into them. That is because, if you 
can draw out your own group, if they are healthier than average and can 
pay less, they will pay less and the association will work. But if you 
pull out a group and it turns out they are a little sicker than average 
and the bids come in above average, then the association will dissolve 
and everybody will go back into the insurance pool.
  So if you can pull out a group, they will always pay less until 
somebody gets sick, and then everybody jumps back into the insurance 
pool. The higher cost groups will be left behind. The lower cost groups 
will segment out, and then the rates will go down for a few and up for 
everybody else.
  This is exactly why the American Academy of Actuaries has said that 
expanding association plans ``could result in unintended consequences 
such as

[[Page 4646]]

market segmentation that could threaten . . . viability and make it 
more difficult for high-cost individuals and groups to obtain 
coverage.''
  One of the other problems is a lack of regulation. If a group is 
allowed to circumvent State regulations, that policy may be cheaper 
because the policy is not as good.
  There are a lot of ways that you can save money. You can pull out a 
group of just young men and save on maternity benefits. That would be 
cheaper for them but more expensive for everybody else.
  And what happens when a new spouse needs coverage and tries to get it 
as an optional benefit? They won't be able to afford it.
  Workers and businessowners are likely to get fewer benefits under the 
association approach and will be disadvantaged compared to those in the 
regular pool getting comprehensive benefits.
  This is exactly why Consumers Union has stated that the legislation 
is ``likely . . . to provide minimal and nonuniform benefits.''
  Mr. Speaker, this bill will make it easier to set up these kinds of 
associations and let them avoid State regulations, which could require 
solvency, nice solvency requirements, and consumer protections. The 
protections in this bill are not sufficient to protect consumers, and 
most States would require stronger capital requirements than the bill 
requires.
  Much like the Republican replacement bill, this bill goes in the 
wrong direction, so I urge my colleagues to vote ``no.''
  Mr. Speaker, I reserve the balance of my time.
  Ms. FOXX. Mr. Speaker, I yield 6 minutes to the gentleman from Texas 
(Mr. Sam Johnson), the author of the bill.
  Mr. SAM JOHNSON of Texas. Mr. Speaker, I thank the gentlewoman for 
yielding.
  I would like to start off by thanking Chairwoman Foxx and Chairman 
Walberg for their strong support of my bill, the Small Business Health 
Fairness Act.
  Mr. Speaker, the legislation before us today is on an issue that has 
long been near and dear to my heart: association health plans. 
Association health plans would allow small businesses to join together 
and provide healthcare coverage just like large corporations and unions 
do today.
  Association health plans are also a central part of replacing 
ObamaCare with commonsense solutions.
  You know, ObamaCare has been an absolute disaster. My constituents in 
Collin County, Texas, have shared with me their negative experiences 
with it since it became law nearly 7 years ago.
  One of the groups hardest hit by ObamaCare is small businesses, the 
backbone of our economy. Since 2008, over one-third of businesses with 
fewer than 10 employees offering health insurance have dropped 
insurance; and, you know, that is just wrong.
  Because ObamaCare is failing, we need to repeal it and replace it 
with better solutions for the American people. One of these solutions 
is my association health plan bill.
  What my bill does is simply allow small businesses to join together 
through trade or professional organizations. As we all know, the basic 
rule of insurance is the bigger the risk pool, the lower the cost.
  Furthermore, my bill allows small businesses to join together across 
State lines. My bill would also free small businesses from costly and 
burdensome State and Federal requirements. This isn't anything 
different from what large employers and unions already do. My bill is 
simply about leveling the playing field for small businesses and their 
hardworking employees.
  This bill also has wide support from the business community, 
including the United States Chamber of Commerce, the National 
Federation of Independent Business, the National Retail Federation, and 
the International Franchise Association.
  Not everyone knows this, but I was a small-business owner myself 
between my time in the Air Force and coming to Congress. In fact, I 
established a home building business in north Texas from scratch, so I 
can understand where small businesses are coming from.
  For example, Bob Gibbons and his wife own a commercial real estate 
business in my hometown of Plano, Texas. They have had a tough time 
obtaining good, affordable health insurance, a problem that has gotten 
worse since ObamaCare.
  Bob sums up this entire issue pretty well in two sentences: ``Why 
should someone's status as an employee give them preferential right to 
decent group health coverage? Entrepreneurs are penalized when they 
start a small business because they can't get comparable coverage.''

                              {time}  1415

  Bob's experience underscores the entire point behind the Small 
Business Health Fairness Act.
  Mr. Speaker, I include Bob's letter in the Record, along with letters 
from the cities of Frisco, Richardson, and Anna in my district.

                                REATA Commercial Realty, Inc.,

                                         Plano, TX, March 2, 2017.
     Re Association Health Plans.

     Hon. Sam Johnson,
     House of Representatives,
     Washington, DC.
       Dear Representative Johnson: I would like to register my 
     support of your recently introduced bill, H.R. 1101, which 
     would provide for association health plans. I am a small 
     business owner in your district in Plano, Texas. My wife and 
     I have been on a roller coaster of health coverage over the 
     years. We were covered by employer plans when I was an 
     employee (pre-ACA). Then we had to negotiate for an 
     individual plan when I started my own business (pre-ACA). 
     Then we were again covered by an employer plan when my wife 
     went to work (post-ACA). And now that she works with me, we 
     must navigate the purchase of an individual plan again, but 
     in the post-ACA failure environment.
       I have always thought it was ridiculous that the only 
     decent health coverage was available to employees of 
     companies that provided it. Why should someone's status as an 
     employee give them a preferential right to decent group 
     health coverage? Entrepreneurs are penalized when they start 
     a small business because they can't get comparable coverage.
       I was thrilled when I ran into Gabi Pate at a Plano Chamber 
     of Commerce Public Policy Committee meeting yesterday and 
     heard you were trying to help. Association health plans would 
     be a step in the right direction. At least then I could get 
     in on a group plan through trade associations, a chamber of 
     commerce or another qualified group. I truly hope that the 
     bill will allow for portability of that health coverage, 
     however, so I can leave the association if I choose and still 
     have coverage.
       Thank you for your leadership in this area. Please don't 
     hesitate to contact me if you have any questions.
           Sincerely,
     Bob Gibbons.
                                  ____



                                   Frisco Chamber of Commerce,

                                       Frisco, TX, March 22, 2017.
       On behalf of the Frisco Chamber of Commerce in Frisco, 
     Texas, I write in strong support of the Small Business Health 
     Fairness Act. The Frisco Chamber of Commerce provides 
     advocacy support for over 1,300 businesses of all sizes. We 
     consistently hear from our small business members about the 
     hardship in providing appropriate and adequate healthcare for 
     their employees at an affordable price. This legislation will 
     increase small businesses' bargaining power with health 
     insurance providers and ensure a level playing field for 
     smaller entities that want to help their workers and families 
     with healthcare costs.
       Locally owned small businesses are a huge contributor in 
     the fabric of a business community. It is through the small 
     and medium businesses that we see the greatest job growth. It 
     is through the small and medium businesses that we see the 
     greatest increase in retail spending in the local 
     communities. However, while many see the benefit of a strong 
     small business community, they have been neglected in being 
     able to negotiate for competitive pricing in healthcare 
     costs.
       For these reasons, the Frisco Chamber of Commerce strongly 
     supports the Small Business Health Fairness Act, which will 
     allow small businesses the opportunity to band together to 
     provide their employees with better, more affordable health 
     insurance coverage. With rising medical costs being a top 
     concern of both individuals and employers, the impact of this 
     increased availability of affordable insurance would be 
     significant.
           Sincerely,
                                                      Tony Felker,
                                                    President/CEO.

[[Page 4647]]

     
                                  ____
                                                Richardson, Texas,


                                          Chamber of Commerce,

                                   Richardson, TX, March 21, 2017.
     Re Association Health Plans.

     Hon. Sam Johnson,
     House of Representatives,
     Washington DC.
       Dear Chairman Johnson: On behalf of the Richardson Chamber 
     of Commerce, a 5-star chamber, I write in strong support of 
     the Small Business Health Fairness Act. This legislation will 
     increase small businesses' bargaining power with health 
     insurance providers and ensure a level playing field for 
     smaller entities that want to help their workers and families 
     with health care costs. The Richardson Chamber of Commerce 
     commends you for your longstanding leadership on this 
     important issue to the small business community. With more 
     than 650 member organizations, the Richardson Chamber of 
     Commerce continues the goal of its founding fathers to serve 
     as the cornerstone of economic and community development for 
     the city of Richardson. In order to continue that growth, our 
     small businesses must be allowed to offer affordable 
     healthcare to their employees.
       While the small business community's economic output is 
     great, its negotiating power in the health care market is at 
     a competitive disadvantage. The federal Employee Retirement 
     Income Security Act, which currently permits large 
     corporations and labor organizations to ``self-insure'' and 
     offer insurance with certain exemptions from state law, does 
     not provide small business with the same advantage. The law 
     must be reformed to empower small employers with the ability 
     to obtain and offer competitively priced health insurance.
       For these reasons, the Richardson Chamber of Commerce and 
     our member companies, strongly support the Small Business 
     Health Fairness Act, which will allow small businesses the 
     opportunity to band together to provide their employees with 
     better, more affordable health insurance coverage. With 
     rising medical costs being a top concern of both individuals 
     and employers, the impact of this increased availability of 
     affordable insurance would be significant.
       The Richardson Chamber commends your efforts to provide 
     small businesses with health care options in a thoughtful and 
     constructive manner. We look forward to working with you on 
     this key legislation.
           Sincerely,
                                               William C. Sproull,
     President and CEO.
                                  ____

                                                      Greater Anna


                                          Chamber of Commerce,

                                         Anna, TX, March 21, 2017.
     Hon. Sam Johnson,
     House of Representatives,
     Washington, DC.
       Dear Representative Johnson: On behalf of the Greater Anna 
     Chamber of Commerce and our more than 200 members, including 
     a majority of small business, I would like to show our 
     support of the H.R. 101, the Small Business Health Fairness 
     Act. There are many small businesses in our community that 
     cannot currently economically and efficiently afford 
     healthcare for their employees. We hope this legislation will 
     help ease that affordability on both our businesses and 
     employees.
       With better access to healthcare, employees could be more 
     willing to work at these smaller businesses instead of only 
     working for larger corporations. This will help our local 
     community by keeping our employees closer to their home, 
     families and children's schools. Again, we support for Small 
     Business Health Fairness Act and look forward to a better 
     solution to our current healthcare problem.
           Best Regards,

                                                   Kevin Hall,

                                               Executive Director,
                                 Greater Anna Chamber of Commerce.
  Mr. SAM JOHNSON of Texas. Mr. Speaker, by allowing small businesses 
to band together, they can collectively purchase more affordable health 
insurance for their employees.
  Let's get this commonsense plan passed. Let's help those who power 
our economy be able to get the health care they want, need, and deserve 
for themselves and their workers.
  Mr. Speaker, I urge all my colleagues to vote in favor of H.R. 1101.
  Mr. SCOTT of Virginia. Mr. Speaker, I yield 4 minutes to the 
gentleman from New York (Mr. Espaillat).
  Mr. ESPAILLAT. Mr. Speaker, I rise today in opposition to H.R. 1101, 
the Small Business Health Fairness Act.
  Mr. Speaker, the concept of association health plans, AHPs, is 
nothing new. Versions of this bill have been around for many years. 
They don't work.
  Currently, AHPs are regulated by the States, ensuring the ability to 
protect consumers. H.R. 1101, however, will yank association health 
plans from the realm of State oversight by federally certifying them 
and holding them to few, if any, regulatory requirements. This would 
strip the States of the ability and fidelity to regulate beneficiary 
protections that exist to protect their citizens.
  Federally certifying AHPs will allow selective choice of which 
benefits are provided and which persons can enroll. This is a complete 
and total disservice to all individuals and citizens in a State's 
health insurance market. Association health plans currently exist and 
operate in New York State, serving many thousands of beneficiaries and 
avail New Yorkers' protections, benefits guarantees, and avenues for 
appeal through the Department of Financial Services.
  This bill does nothing to offer guaranteed affirmative coverage. It 
would permit preexisting conditions as a legitimate reason to exclude 
individuals. It has no minimum threshold for anything resembling 
essential health benefits, and it fails to offer a requirement for the 
actuarial value of the insurance product to cover total health costs.
  What then remains is not a health plan. In fact, what remains is 
strikingly similar to what the American Health Care Act purports to 
offer millions of Americans: less coverage for those enrolled and more 
expense for those who are too sick, too old, and too poor to be 
approached by an AHP.
  AHPs would lead to higher costs for seniors and individuals who are 
sicker and will dilute the risk pool of entire States, leading to 
higher premiums and out-of-pocket expenses. Where the American Health 
Care Act will unilaterally hurt all Americans, H.R. 1101 would 
accomplish the same harm directed at the sickest and most underserved 
in a more prejudicial manner.
  Mr. Speaker, I offered an amendment to this bill, which was germane, 
yet not made in order. My amendment would have protected the rights of 
the States to regulate association health plans, to include regulation 
of benefits, consumer protections, and rating restrictions. The goal of 
my amendment was to ensure that all States and their constituents have 
the same security and protections that my constituents have benefited 
from over the past 7 years: consumer protections against surprise 
billing and adverse selection, provider protection for prompt claim 
payment and preauthorization, protection for local and regional 
insurers so that large national insurance companies cannot cherry-pick 
the good risk.
  I certainly believe and would hope that my colleagues on the other 
side of the aisle support program integrity and protecting our 
constituents, which is what my amendment would have made clear.
  Lastly, I would like to be clear that I am supportive of increasing 
access to health care that is comprehensive and affordable for all 
Americans. The bill before us does not do that. The American Health 
Care Act certainly does not do that.
  Mr. Speaker, I urge my colleagues to strongly oppose this rolling 
back of health care.
  Ms. FOXX. Mr. Speaker, I yield 2 minutes to the gentleman from 
Michigan (Mr. Walberg), the chairman of the Subcommittee on Health, 
Employment, Labor, and Pensions.
  Mr. WALBERG. Mr. Speaker, I rise today in support of H.R. 1101, the 
Small Business Health Fairness Act, a bill that will help people in 
Michigan and across the country by expanding affordable coverage for 
workers and their families.
  I thank our colleague, Representative Sam Johnson of Texas, for 
introducing this legislation. I really enjoyed hearing the gentleman 
from Texas and his comments about this being common sense. 
Representative Sam Johnson of Texas defines common sense and 
patriotism. He has tirelessly championed this bill for years, and it is 
a pleasure to join him in pushing for these positive reforms.
  Mr. Speaker, health care in this country has become simply 
unaffordable for far too many small businesses and working families. 
The Patient Protection and Affordable Care Act has proved to be an 
utter failure for most people in the United States. It is snowballing 
out of control and rolling over working families and small businesses.

[[Page 4648]]

  Ninety-five percent of small businesses have reported increased 
health insurance costs over the past 5 years. A 2015 study by the 
National Federation of Independent Businesses found that the cost of 
health insurance is the principal reason that small businesses do not 
offer coverage.
  As a result, since 2008, 36 percent of small businesses with fewer 
than 10 employees have stopped offering healthcare coverage to their 
employees. It is not that they don't want to offer healthcare benefits. 
The truth of the matter is that small businesses have been hit 
especially hard by the government takeover of health care. Under 
ObamaCare, the working families I speak to in my district are paying 
more for less and finding they have fewer options for coverage.
  H.R. 1101 is a key part of the third phase of our efforts to reform 
our healthcare system so it works for all Americans. It aims to 
increase the negotiating power of small businesses so they can bring 
down health insurance costs for their employees.
  Right now, small businesses are often on an unequal playing field 
with larger companies and unions. Because they have few employees, 
small businesses have limited bargaining power when it comes to 
negotiating for lower insurance costs for their workers.
  The SPEAKER pro tempore (Mr. Rogers of Kentucky). The time of the 
gentleman from Michigan has expired.
  Ms. FOXX. Mr. Speaker, I yield an additional 15 seconds to the 
gentleman.
  Mr. WALBERG. Mr. Speaker, this bill levels the playing field for 
small businesses, allowing them to band together through association 
health plans and negotiate the best deals to provide health care 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 a transition 
toward a patient-centered healthcare system.
  Mr. Speaker, I urge my colleagues to support this legislation.
  Mr. SCOTT of Virginia. Mr. Speaker, I yield 4 minutes to the 
gentleman from Connecticut (Mr. Courtney).
  Mr. COURTNEY. Mr. Speaker, again, as someone who was a small-business 
employer for 27 years and provided health benefits for my staff, I am 
acutely aware of the challenges in the small-business market which long 
predate passage of the Affordable Care Act and which is still something 
that we can do better in terms of helping folks deal with this issue, 
which, again, is so important because small businesses are the job 
creators in the American economy.
  What I want to sort of point out is that this legislation, in my 
opinion, is just a complete misfire. Let's, first of all, remind 
everyone that there are over 670 association health plans existing in 
America today.
  The notion that the Affordable Care Act somehow is smothering or 
stifling association health plans is, in fact, just factually false. 
There are many that are in business, providing coverage, as has been 
said by some of the prior speakers, for people in industries like 
restaurants, et cetera. Again, we are not talking about some 
existential threat that is out there in terms of association health 
plans today.
  The guts of this bill--and it is quite extraordinary coming from, 
again, the Republican Party--is to preempt State Governments from 
having any say over the solvency and the benefit design of plans that 
operate under association health plans.
  Back in the 1990s, there was a spate of problems with association 
health plans going belly up because, again, there was no State 
insurance solvency standards to make sure that there were funds set 
aside to pay the bills of people who were employed in the businesses 
that these plans were set up to serve.
  As a result, Congress acted. We basically said that the Federal 
Government was doing a lousy job in terms of protecting patients. And 
we gave States the ability, through their State insurance departments, 
to make sure that certain solvency standards were met and, as was 
stated earlier, that they weren't able to cherry-pick just the 
healthiest and leave the rest for the other segments of the health 
insurance industry.
  As a result of the fact that we made this change, again, the State 
insurance commissioners all across America, Republican States and 
Democratic States, have weighed in. They sent a letter on February 28 
pleading with Congress not to do this, not to pass this bill which 
eliminates their ability to protect the citizens of their States.
  So this bill is actually an anti-states' rights bill because it is 
basically saying the Federal Government is just going to step in and 
wipe out the way in which these plans operate and just lead, again, a 
race to the bottom, the lowest threshold of protections for patients; 
and that is considered healthcare reform or somehow advancing the ball 
in terms of helping small businesses.
  There are many other ways to deal with this issue, and this is not 
the right one. Again, this is not some new idea that we are debating. 
This has been back and forth over the years, in the 1990s and the early 
2000s. It predates the Affordable Care Act by decades, and it is just 
an old chestnut that is being thrown out in the floor in the name of 
some idea to sound like we are doing something for small businesses.
  Again, under the Affordable Care Act, we set up a 50 percent tax 
credit for businesses that qualify for it to make health insurance 
affordable.
  I did two townhalls back in my district. I had a plumber from the 
next town over who, again, took advantage of that 50 percent tax 
credit. He saved thousands of dollars in terms of providing health 
benefits for his small business.
  We can expand that tax credit to get a wider universe of small 
businesses, and that is what we should be doing. We should be building 
on what is successful, again, not watering down existing patient 
protection and consumer protection laws that ensure that plans are 
actually going to have enough funds to pay the bills when people get 
sick or go to the hospital and certainly not be able to cherry-pick 
what benefits are considered essential or not.
  The SPEAKER pro tempore. The time of the gentleman from Connecticut 
has expired.
  Mr. SCOTT of Virginia. Mr. Speaker, I yield an additional 1 minute to 
the gentleman.
  Mr. COURTNEY. Mr. Speaker, we should not be allowing health plans to 
decide we are not going to cover maternity or that they can pick and 
choose what essential benefits that, again, the rest of the universe of 
businesses have to provide now under the Affordable Care Act, which 
are, again, based on sound medical research, not political decisions or 
not just the whims of people who are running health plans, like 
association health plans.
  Again, this is the wrong approach. This is, again, turning the clock 
backwards. It is not going to provide any protections, and it certainly 
is not responding to some existential threat of association health 
plans. There are 672 in operation today. Let's help them with programs 
like tax credits. Let's not just sort of turn that whole sector of the 
health insurance marketplace into the Wild West because it is patients 
who are going to lose. Our citizens are going to lose. We can do better 
than that as a Congress.
  Mr. Speaker, again, I strongly urge a ``no'' vote on this measure.
  Ms. FOXX. Mr. Speaker, I yield 2 minutes to the gentleman from 
Tennessee (Mr. Roe), a distinguished colleague, a member of the 
committee, and the chair of the Veterans' Affairs Committee.

                              {time}  1430

  Mr. ROE of Tennessee. Mr. Speaker, I rise today in strong support of 
H.R. 1101, the Small Business Health Fairness Act, sponsored by my good 
friend and true American hero, Sam Johnson. I encourage all of my 
colleagues to do the same. This bill is an important tool to help 
empower small businesses to offer more affordable healthcare options to 
their employees.
  Mr. Speaker, as a former small-business owner myself, I know that 
most

[[Page 4649]]

small-business owners want to do the right thing and offer health 
insurance to their employees. We did so in my practice.
  But many of these businesses are struggling with the cost and 
complexities of offering health insurance to their employees. ObamaCare 
has exacerbated this problem for small businesses. Thousands of jobs 
and thousands of small businesses have closed.
  We have a better way. We are going to start by passing the American 
Health Care Act, which will repeal many of ObamaCare's taxes and 
mandates and replace it with free market reforms.
  But there is much more that can be done. Perhaps the only thing that 
has prevented ObamaCare from causing even more widespread damage was 
the success of ERISA, employer-sponsored health insurance.
  We believe small businesses deserve the same protections that large 
businesses do, and that is why we are passing this legislation today. 
The Small Business Health Fairness Act takes positive steps toward 
creating a more competitive healthcare marketplace, lowering insurance 
costs for many small employers.
  Mr. Speaker, why would anybody care if association health plans got 
together and allowed me to purchase insurance across a State line?
  I have a community in my district where the State line on one side of 
the street is Bristol, Virginia, on the other side is Bristol, 
Tennessee. Why would it matter? Why couldn't I purchase that insurance 
across the State line if it helped my employees and lowered costs?
  And, by the way, Mr. Speaker, the Affordable Care Act is working so 
well for consumers that 18 out of 23 of the co-ops went broke, leaving 
hundreds of thousands of people to search for insurance coverage.
  For the past 8 years, House Republicans have engaged the 
administration and encouraged them to work with us to implement a more 
patient-centered healthcare system; but, instead of working with us on 
a common goal, they have layered on additional costs for small 
businesses.
  I again want to encourage my colleagues to support H.R. 1101.
  Mr. SCOTT of Virginia. Mr. Speaker, would the Chair advise us how 
much time is available on both sides?
  The SPEAKER pro tempore. The gentleman from Virginia has 14\1/2\ 
minutes remaining, and the gentlewoman from North Carolina has 16\3/4\ 
minutes remaining.
  Mr. SCOTT of Virginia. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I just wanted to point out a few letters that we have 
received, one from the Diabetes Association, which includes, in part: 
``The Association has serious concerns that AHPs would lead to a two-
tiered market, in which AHPs offer inadequate coverage to healthy 
groups only, while State-regulated plans provide adequate coverage with 
consumer protections but at an increasingly higher premiums. For these 
reasons, we urge you to oppose the Small Business Health Fairness Act 
of 2017, H.R. 1101.''
  We have also received a letter, Mr. Speaker, from the National 
Association of Insurance Commissioners. They said in their letter: 
``The legislation as written would eliminate all State consumer 
protections and solvency standards that ensure consumers receive the 
coverage for which they pay their monthly premium. These protections 
are the very core of a State regulatory system that has protected 
consumers for nearly 150 years . . . history has demonstrated that AHP-
type entities have done more harm than good to small businesses.''
  Mr. Speaker, we also received a letter from The Main Street Alliance, 
which said: ``In short, H.R. 1101 would result in higher premiums and 
poorer coverage for the most vulnerable small-business owners, would 
destabilize the small group market, and would lead small-business 
owners and employees to assume unnecessary financial risks.''
  We also heard from the Consumers Union: ``Consumer's Union has long 
raised the inadequacies of AHPs . . . and urges Congress to reject them 
as likely to fragment the insurance risk pool and provide minimal and 
nonuniform benefits exempt from State benefit mandates.''
  We also heard from a long coalition of consumer groups, providers, 
and labor unions which said that this bill would just move backward to 
a two-tiered system that makes it harder to purchase comprehensible, 
affordable coverage for all but a minority of small businesses.
  Mr. Speaker, I include in the Record these letters.

                                American Diabetes Association,

                                                   March 21, 2017.
     Hon. Paul Ryan,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Nancy Pelosi,
     Democratic Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Ryan and Leader Pelosi: On behalf of the 
     nearly 30 million Americans living with diabetes and the 86 
     million more with prediabetes, the American Diabetes 
     Association (Association) is writing to express our strong 
     opposition to the Small Business Health Fairness Act (H.R. 
     1101). This legislation is nearly identical to legislation 
     considered by previous Congresses and that last passed the 
     House of Representatives in 2003. The Association opposed 
     that legislation and writes now to express our strong 
     concerns with this bill and the impact it will have for 
     people with, and at risk for, diabetes.
       The legislation would create federally certified 
     association health plans (AHPs) with the goal of making 
     coverage more affordable for small businesses by allowing 
     them to band together to purchase coverage on behalf of a 
     larger insurance pool. We share the goal of making coverage 
     more affordable, but not at the expense of required consumer 
     protections, signed into law in 47 states, which ensure 
     people with diabetes have access to the services and 
     financial protection they need.
       H.R. 1101 would broadly exempt AHPs from critical state 
     benefit standards, solvency rules, and consumer protections, 
     including requirements to cover health services essential to 
     those with diabetes. Specifically, H.R. 1101 would confer on 
     AHPs wide authority to:
       Determine benefits to be covered: Other than requiring AHPs 
     to meet limited federal requirements for ERISA-governed 
     plans, H.R. 1101 would give AHPs broad discretion to omit 
     important health benefits.
       Determine eligibility for coverage: While H.R. 1101 would 
     require AHPs to comply with ERISA non-discrimination 
     provisions, the AHP board would retain sole discretion to 
     approve applications for participation in the plan and to set 
     premiums based on an employer's health care claims 
     experience.
       Maintain inadequate reserves: H.R. 1101 applies federally 
     determined solvency standards that are weaker than state 
     standards, exposing plan members to the risk of insolvency 
     and unpaid medical bills.
       Because AHPs would compete with state-regulated plans on an 
     uneven playing field, they would likely cherry-pick healthy 
     small employer groups, making the risk pool in the state-
     regulated market less healthy and more costly. In addition, 
     those who obtain coverage through an AHP would likely have 
     benefits that lack coverage for essential services and would 
     expose them to higher out-of-pocket costs and potential plan 
     insolvencies. In fact, numerous AHPs offered in the past have 
     gone insolvent and left consumers uninsured and with unpaid 
     medical bills.
       The Association has serious concerns that AHPs would lead 
     to a two-tiered market, in which AHPs offer inadequate 
     coverage to healthy groups only, while state-regulated plans 
     provide adequate coverage with consumer protections but at 
     increasingly higher premiums. For these reasons, we urge you 
     to oppose the Small Business Health Fairness Act of 2017, 
     H.R. 1101.
       If you have questions or would like to discuss this issue, 
     please contact Rob Goldsmith, Director, Federal Government 
     Affairs.
           Sincerely,

                                      Lashawn McIver, MD, MPH,

                                Senior Vice President of Advocacy,
     American Diabetes Association.
                                  ____

         National Association of Insurance Commissioners & the 
           Center for Insurance Policy and Research,
                                                February 28, 2017.
     Hon. Virginia Foxx,
     Chair, Committee on Education and the Workforce, House of 
         Representatives, Washington, DC.
     Hon. Robert C. Scott,
     Ranking Member, Committee on Education and the Workforce, 
         House of Representatives, Washington, DC.
       Dear Madame Chairwoman and Mr. Ranking Member: The U.S. 
     House Education and the Workforce Committee is once again 
     scheduled to consider legislation that would allow a new 
     category of health insurance company, ``Association Health 
     Plans (AHPs),'' to form and operate outside the authority of 
     state regulators and beyond the

[[Page 4650]]

     reach of proven state consumer protections and solvency laws. 
     This bill, H.R. 1101, would adversely impact consumers and 
     the National Association of Insurance Commissioners (NAIC) 
     urges you to oppose it.
       The NAIC, which represents the nation's insurance 
     regulators, shares the sponsors' concern for the growing 
     number of small business owners and employees who cannot 
     afford adequate coverage. However, the root cause of this 
     problem is the steadily rising cost of healthcare merely 
     reflected in premiums, and this legislation would do nothing 
     to address that reality. In fact, we fear the legislation 
     could actually increase the cost of insurance for many small 
     businesses whose employees are not members of an AHP.
       Even more troubling than prescribing a treatment that does 
     not address the underlying disease, the legislation would 
     actually harm consumers by further segmenting the small group 
     market, eliminating critical state consumer protections, and 
     could lead to increased fraud and plan failures. This 
     legislation would encourage AHPs to ``cherry-pick'' healthy 
     groups by designing benefit packages and setting rates so 
     that unhealthy groups are disadvantaged. This, in turn, would 
     make existing state risk pools even riskier and more 
     expensive for insurance carriers, thus making it even harder 
     for sick groups to afford insurance. In addition, the 
     legislation as written would eliminate all state consumer 
     protections and solvency standards that ensure consumers 
     receive the coverage for which they pay their monthly 
     premium. These protections are the very core of a state 
     regulatory system that has protected consumers for nearly 150 
     years. As we have already seen in the past when such plans 
     were allowed under federal law, consumers will be left with 
     unpaid claims and nowhere to turn when they are harmed. A 
     prior law along the lines of H.R. 1101 was repealed because 
     it was found to harm consumers; the same mistake should not 
     be made again.
       We recognize that supporters of AHPs are well intentioned, 
     looking for solutions to the same problems we are seeking to 
     address, but history has demonstrated that AHP-type entities 
     have done more harm than good to small businesses. A far 
     broader approach to the existing problems--one that addresses 
     healthcare spending, allows more innovation, and permits more 
     state flexibility--is necessary to bring real relief to small 
     businesses. The federal government and the states need to 
     work with healthcare providers, insurers and consumers to 
     implement effective reforms that will curb spending and make 
     insurance more affordable to small businesses. Rehashing 
     strategies that have failed would not be a step forward. It 
     is time to move on and find more effective solutions.
           Sincerely,
     Ted Nickel,
       NAIC President, Commissioner, Wisconsin Office of the 
     Commissioner of Insurance.
     Eric A. Cioppa,
       NAIC Vice President, Superintendent, Maine Bureau of 
     Insurance.
     Julie Mix McPeak,
       NAIC President-Elect, Commissioner, Tennessee Department of 
     Commerce & Insurance.
     David C. Mattax,
       NAIC Secretary-Treasurer, Commissioner of Insurance, Texas 
     Department of Insurance.
                                  ____



                                     The Main Street Alliance,

                                    Washington, DC, March 8, 2017.
     Chairwoman Virginia Foxx,
     Washington, DC.
     Ranking Member Bobby Scott,
     Washington, DC.
       Dear Chairwoman Foxx, Ranking Member Scott, and Members of 
     the House Education and Workforce Committee: On behalf of the 
     Main Street Alliance, I write to express opposition to the 
     ``Small Business Health Fairness Act'' (H.R. 1101). The Main 
     Street Alliance is a national network of small business 
     owners across the country. Access to affordable, high-quality 
     health coverage has been a core concern for small businesses 
     for years, and slowing the skyrocketing rate increases 
     continues to be a top priority for our membership. 
     Unfortunately, the proposed legislation would erode important 
     gains in premium stabilization while causing our business 
     owners to assume unnecessary financial risks.
       As you may know, prior to the Affordable Care Act (ACA) 
     small business owners paid substantially more on average for 
     health coverage and received fewer comprehensive benefits 
     than larger companies. They also experienced broad 
     unpredictability in costs, with premiums varying wildly from 
     year to year. One employee's expensive illness could cause 
     the insurance rates for the whole firm to spike in subsequent 
     years.
       Critical market reforms instituted through the ACA 
     addressed many of these concerns. Insurance companies in the 
     individual and small-group market--including association 
     health plans--can no longer charge small firms higher 
     premiums based on their business sector, an employee's health 
     status, age, or gender. Nor can they offer sub-par plans that 
     exclude essential services, such as maternity care or 
     pediatric care. Instead, they must now base their pricing on 
     the cost of covering all individuals in the market, not just 
     one firm. Participating in this larger risk pool means that 
     small business owners, like their larger counterparts, are no 
     longer vulnerable to sharp swings in their rates based on the 
     health of a few employees. It also means that they can expect 
     a basic quality assurance with any health plan they select.
       H.R. 1101 would undermine these protections by allowing 
     small employer groups and individuals to join together to 
     obtain health insurance through an unregulated association 
     health plan (AHP). These plans would be exempt from the ACA 
     reforms identified above, along with any state laws. This 
     would allow them to ``cherry pick'' good risk through the 
     design of the benefit package or choice of service area. AHPs 
     could also have limited risk simply due to the types of 
     businesses that belong to the association. While AHPs may 
     save money in the short-term by avoiding costs of consumer 
     protections, enrollees would receive less robust coverage and 
     may be left without important protections right when they 
     need them the most.
       Furthermore, the bill would destabilize the small group and 
     individual market by exacerbating adverse selection, driving 
     up costs for the most vulnerable enrollees. Under the 
     proposed legislation, AHPs would compete with other small 
     group and individual market plans. The proposed legislation 
     would allow employers with younger, healthier workforces to 
     withdraw their employees from a state's small group market 
     thus leaving behind small businesses with older and sicker 
     employees. While the rates may drop for those businesses that 
     belong to associations, which offer health coverage, premiums 
     will increase for the remaining. This adverse selection would 
     make it harder for higher-cost individuals or groups to 
     obtain coverage.
       Finally, the proposed legislation could expose employers 
     and employees to financial ruin. The proposed legislation 
     would allow certain AHPs to self-insure and accept insurance 
     risk. Because of the current regulatory void, AHPs are not 
     subject to state solvency requirements that are in place to 
     ensure insurance companies have sufficient resources to avoid 
     financial failure. As with unregulated multiple employer 
     welfare arrangements, AHPs could experience bankruptcies--
     leaving millions of small employers and workers without 
     health coverage due to insolvencies.
       In short, H.R. 1101 would result in higher premiums and 
     poorer coverage for the most vulnerable small business 
     owners, would destabilize the small group market, and would 
     lead small business owners and employees to assume 
     unnecessary financial risks. The Main Street Alliance 
     strongly urges you to oppose the legislation.
       Please feel free to contact Michelle Sternthal, Policy 
     Director for the Main Street Alliance, with any questions.
           Sincerely,
                                                Amanda Ballantyne,
     National Director.
                                  ____



                                               ConsumersUnion,

                                                   March 21, 2017.
     House of Representatives,
     Washington, DC.
       Dear Representative: We are writing today to oppose the 
     Small Business Health Fairness Act (H.R. 1101) and the 
     proposed rules for association health plans.
       Today, small businesses are already able to join together 
     to purchase coverage through Association Health Plans (AHPs). 
     These AHPs are currently regulated by the states, just like 
     other insurance in the small group market. H.R. 1101 would 
     allow an AHP to be entirely exempt from state regulation by 
     being self-insured or following the rules of a single state 
     nationwide.
       ConsumersUnion has long raised the inadequacies of AHPs as 
     a solution to improving access and strengthening the health 
     of insurance markets, and urges Congress to reject them as 
     likely to fragment the insurance risk pool and to provide 
     minimal and non-uniform benefits exempt from state benefit 
     mandates. These plans would split the healthy from the sick 
     and drive up costs for those who do not enroll in them.
       As a non-partisan, independent organization that has 
     advocated for the best consumer products and policies for 
     more than 80 years, we believe that altering the rules for 
     AHPs as proposed in this bill would undermine consumers' 
     access to fairly priced, quality health coverage.
       Our objections are that:
       AHPs would be offered alongside other small group and 
     individual market plans. However, they would operate under 
     different rules. Past experience shows this is likely to lead 
     to cherry-picking, adverse selection, and increased costs for 
     sicker individuals and small businesses. Put another way, 
     this would lead to health risk being segmented with the less 
     healthy consumers excluded

[[Page 4651]]

     from the AHP risk pool. A core, long-held ConsumersUnion 
     principle is to support broad pooling of risk as fairer and 
     more cost-effective for consumers. We do not support lower 
     rates for healthiest consumers at the expense of older or 
     sicker consumers.
       This Act would undermine state consumer protection laws by 
     restricting the ability of states to regulate AHPs. This loss 
     of protections could lead to increased fraud, inadequate 
     coverage and consumer-unfriendly benefit designs. In July 
     2003, Consumer Reports profiled similar plans in a story 
     entitled Phony Health Insurance. The story noted that 
     fraudulent sales and financial instability stiffed consumers 
     for $65 million in unpaid medical bills.
       This Act would give AHPs sole discretion to select what 
     type of care they will and will not include in their 
     products; this is a departure from current policy, which only 
     permits AHPs that meet insurance standards set for the 
     individual and small group market. Consumers who buy into 
     these plans will lose the guarantees of care created by the 
     ACA's essential health benefits and actuarial value 
     requirements--likely unknowingly--and will have difficulty 
     knowing what AHPs cover.
       It is unlikely that these AHPs will be able to attract 
     enough members to be able to negotiate more effectively with 
     providers, compared to large insurers already operating in 
     these states. Consequently, we do not believe that these 
     designs will lower costs for consumers.
       Multiple Employer Welfare Arrangements (MEWAs) once 
     operated in a regulatory vacuum similar to the one proposed 
     through H.R. 1101. Self-funded MEWAs had no clear regulatory 
     authority, as initially it appeared that ERISA exempted them 
     from state-level regulatory oversight. Multiple MEWA 
     bankruptcies resulted, and consumers had limited avenue for 
     redress. In the absence of clear regulatory authority over 
     AHPs, insolvencies could leave millions of small employers 
     and workers without health coverage or redress. Current state 
     solvency standards have a 150 year track record of protecting 
     consumers and should not be undermined.
       We believe there are much better, time-tested ways to 
     increase the availability, affordability, and accessibility 
     of health insurance for consumers--approaches that rely on 
     the wise and accepted insurance principles of broad pooling 
     of risks and avoidance of risk selection--without resorting 
     to the detrimental effects of H.R. 1101. We note that the 
     National Association of Insurance Commissioners, as well as 
     the American Academy of Actuaries, has similar, grave 
     concerns about this Act.
     Sincerely,
     Laura MacCleery,
       Vice President, Consumer Policy and Mobilization, Consumer 
     Reports.
     Lynn Quincy,
       Associate Director, Health Policy, Consumer Policy and 
     Mobilization, Consumer Reports.
  Mr. SCOTT of Virginia. Mr. Speaker, I reserve the balance of my time.
  Ms. FOXX. Mr. Speaker, I now yield 1\1/2\ minutes to the gentleman 
from Ohio (Mr. Chabot), the distinguished chairman of the Small 
Business Committee.
  Mr. CHABOT. Mr. Speaker, I want to thank the gentlewoman from North 
Carolina for her leadership on this issue.
  Mr. Speaker, I rise to voice my strong support for H.R. 1101, the 
Small Business Health Fairness Act. I thank my colleagues from Ways and 
Means and from the Education and the Workforce Committee for getting 
this great idea onto paper and moving this bill forward today.
  As chairman of the House Small Business Committee, I am always very 
appreciative to see Members from across this body find solutions for 
small businesses. That is exactly what this bill is.
  For virtually any one of us in this Chamber, it can be said that 
hundreds of thousands of our constituents depend on small businesses 
for their livelihoods. They have been looking to those same small 
businesses for options, as ObamaCare has done the opposite of what it 
was supposed to do and it has diminished choices for workers.
  By allowing small businesses to join together through association 
health plans, the Small Business Health Fairness Act would give small 
business employees at least as many choices as those who happen to work 
for larger companies.
  Association health plans have long been a solution suggested by small 
businesses that share their views with me and other members of the 
Small Business Committee. This bill puts that idea finally into action.
  Mr. Speaker, in our current state of affairs, there are fewer and 
fewer healthcare options available for hardworking Americans. This bill 
addresses that problem for our hardest hit small businesses and 
communities.
  While we begin the hard work of making health care not only 
affordable but worth buying at all, this bill is an important step in 
giving Americans the certainty and choices that they want. I would urge 
my colleagues on both sides of the aisle to support this bill.
  Mr. SCOTT of Virginia. Mr. Speaker, I reserve the balance of my time.
  Ms. FOXX. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Georgia (Mr. Allen), a member of our committee.
  Mr. ALLEN. Mr. Speaker, I thank the chairwoman for her leadership on 
this important bill.
  Mr. Speaker, today I rise in support of H.R. 1101, the Small Business 
Health Fairness Act.
  Since 2008, the number of small businesses offering health insurance 
to its employees has dwindled nearly 36 percent. The culprit? Well, 
ObamaCare.
  You know, the American people deserve choice. I have lived this 
reality. I owned and operated a small business for over 40 years back 
home in Georgia. I know how ObamaCare premium increases hurt and, in 
some cases, affect a business' ability to provide health care for its 
employees.
  I believe the greatest gift God gave me as a small-business owner was 
the ability to give others a good job along with the dignity and 
respect they deserve to provide for their family, their community, 
their church, and, yes, this Nation.
  All hardworking American small-business owners should be able to give 
their employees these same opportunities. For this reason, I am a 
strong supporter of the Small Business Health Fairness Act legislation, 
which would allow small businesses to band together and purchase health 
care for workers and their families at a lower cost.
  Folks, this is innovation. This is what the small business community 
does. Small businesses are the backbone of America. I will fight for 
their strength and their survival.
  Mr. SCOTT of Virginia. Mr. Speaker, I reserve the balance of my time.
  Ms. FOXX. Mr. Speaker, I now yield 2 minutes to the distinguished 
gentleman from Michigan (Mr. Mitchell), a member of the committee.
  Mr. MITCHELL. I thank the gentlewoman from North Carolina for 
yielding me time.
  Mr. Speaker, I rise in support of the Small Business Health Fairness 
Act. We have all talked a lot about our plan to repeal and replace 
ObamaCare. This legislation is a key component of our rescue mission 
for health care in America.
  Small businesses have been hit particularly hard by ObamaCare's 
mandates, skyrocketing costs, and limited choices. Small-business 
owners, many of whom want to provide health care for their employees, 
have told me that they are struggling to do so because of ObamaCare.
  This legislation would level the playing field for small businesses 
by allowing them to band together to increase bargaining power to lower 
costs. It would expand affordable care for families trying to secure 
health insurance through their employer and lower costs for small 
businesses with limited resources.
  In addition, this bill includes strong protections for patients with 
preexisting conditions, a top priority of mine and many of my 
colleagues as we work for healthcare reform in America.
  Today we are acting on our promises to deliver relief from ObamaCare. 
We are returning power where it belongs, choice where it belongs: to 
patients and doctors, not Washington.
  I urge you to support the Small Business Health Fairness Act.
  Mr. SCOTT of Virginia. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, the bad idea in this plan has been exposed in one of the 
letters that I mentioned. I said there are a lot of consumer groups, 
and I just want to name the groups that signed the letter.

[[Page 4652]]

The American Nurses Association; the Alliance for Retired Americans; 
the American Cancer Society Cancer Action Network; the American 
Diabetes Association; the American Federation of State, County and 
Municipal Employees; the Association of Reproductive Health 
Professionals; Bazelon Center for Mental Health Law; Community 
Catalyst; Consumers Union; Families USA; International Union, United 
Automobile, Aerospace and Agricultural Implement Workers of America--
the UAW; NARAL Pro-Choice America; the National Council of La Raza; the 
National Education Association; the National Institute for Reproductive 
Health; National Partnership for Women and Families; National Women's 
Health Network; Raising Women's Voices for the Health Care We Need; and 
the Service Employees International Union all oppose this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Ms. FOXX. Mr. Speaker, I yield 2 minutes to the distinguished 
gentleman from Minnesota (Mr. Lewis), a member of our committee.
  Mr. LEWIS of Minnesota. Mr. Speaker, I thank the gentlewoman from 
North Carolina for her leadership here and on the committee as well.
  Mr. Speaker, I rise today in support of H.R. 1101, the Small Business 
Health Fairness Act.
  It is amazing as a freshman in this body to watch this debate over 
what we are trying to do on this side when we know what has already 
transpired, what has been done:
  The Affordable Care Act was going to lower our premiums $2,500. That 
is what the President said. But they went up by $4,800.
  In my home State of Minnesota, we have seen back-to-back increases of 
55 and 67 percent, 100,000 people thrown off their plan.
  We have got 1,000 counties in this country with just one insurer.
  The exchanges are imploding. As young, healthy people can't afford 
the premiums, they drop out, and the pools only have the older and the 
sicker.
  We have job lock, where people trying to start a small business can't 
get the same tax advantages or purchasing power as those in big 
companies.
  So what to do? We are going to stabilize the insurance markets 
through choice and competition, and that is what H.R. 1101 does. It 
lowers premiums. It enlarges pools. We do that. We must do that to save 
the health insurance markets and health care in America. That is the 
agenda of H.R. 1101. That is the agenda of what we are trying to do in 
global healthcare reform.
  So today, as we debate how to fix health care in America, let us not 
forget the status quo and the debacle it is. So I stand and I urge my 
colleagues to support this bill, and I further urge my colleagues to 
finish the job over what we are starting on real healthcare reform.
  Mr. SCOTT of Virginia. Mr. Speaker, I just want to quote from another 
letter that we received from Blue Cross Blue Shield Association. They 
say: ``We have very serious concerns that H.R. 1101 would create 
preferential rules that would allow an AHP to be entirely exempt from 
State regulation by being self-insured or follow the rules of a single 
State nationwide. Research clearly shows that creating special rules 
for AHPs and exempting them from State regulation would lead to major 
problems, including . . . increased insolvency risk . . . increased 
costs for older, sicker workers.'' Therefore, they are also in 
opposition to this legislation.
  I include in the Record the entire letter.


                             BlueCross BlueShield Association,

                                    Washington, DC, March 7, 2017.
     Hon. Virginia Foxx,
     Chair, Committee on Education and the Workforce, House of 
         Representatives, Washington, DC.
     Hon. Robert C. Scott,
     Ranking Member, Committee on Education and the Workforce, 
         House of Representatives, Washington, DC.
       Dear Madam Chairwoman and Mr. Ranking Member: The Blue 
     Cross and Blue Shield Association shares your commitment to 
     ensuring small employers are able to provide their employees 
     with high quality, affordable health coverage. However, we 
     are concerned that H.R. 1101, the ``Small Business Health 
     Fairness Act'' would not accomplish this critical goal, as it 
     does not reflect key principles that are essential to 
     ensuring a viable private health insurance market: (1) all 
     competitors should abide by the same set of rules; and (2) 
     states should have clear authority to regulate.
       Today, small businesses are able to join together to 
     purchase coverage through association health plans (AHPs). 
     AHPs are currently regulated by the states, just like other 
     insurance in the small group market, and can be a good option 
     for small employers who want to provide their employees with 
     affordable coverage.
       We have very serious concerns that H.R. 1101 would create 
     preferential rules that would allow an AHP to be entirely 
     exempt from state regulation by being self-insured or follow 
     the rules of a single state nationwide. Research clearly 
     shows that creating special rules for AHPs and exempting them 
     from state regulation would lead to major problems, 
     including:
       Increased insolvency risk: The legislation as drafted would 
     allow for some AHPs to be entirely exempt from state 
     regulation, and instead operate under very limited federal 
     rules and oversight. Past experiences with these kinds of 
     arrangements left millions without health coverage and unpaid 
     claims due to insolvencies.
       Increased costs for older, sicker workers: Ultimately, H.R. 
     1101 would make it much harder for small employers with 
     older, sicker workers to obtain coverage. This is because 
     lower-cost groups would move to a more loosely regulated AHP 
     with fewer benefit and rating rules, while older and/or high-
     cost groups would remain in traditional insurance plans.
       Attached is a compendium of research findings, which 
     provides overwhelming evidence that AHP legislation would 
     make health insurance less accessible, less affordable and 
     less secure for small employers and individual consumers.
       We look forward to working with you on solutions that can 
     be taken to improve access and affordability for small 
     employers.
       Sincerely,
                                                       Alissa Fox,
                                            Senior Vice President.

                              {time}  1445

  Mr. SCOTT of Virginia. Mr. Speaker, I reserve the balance of my time.
  Ms. FOXX. Mr. Speaker, I have no further speakers, and I reserve the 
balance of my time.
  Mr. SCOTT of Virginia. Mr. Speaker, I yield myself the balance of my 
time.
  Mr. Speaker, association plans will help the fortunate few who can 
get in so long as the members of that association remain healthier than 
average. But everybody else will pay more. Furthermore, these plans, 
when they are formed under the bill, will evade important State 
regulations that could improve solvency and provide important consumer 
protections.
  This is not unlike the philosophy, I guess, on the other replace bill 
where 24 million fewer people will have insurance; the rest will pay 
more and get less; while millionaires benefit with huge tax cuts. In 
this, the fortunate few benefit to the expense of everybody else.
  I would hope we would defeat the legislation.
  Mr. Speaker, I yield back the balance of my time.
  Ms. FOXX. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, some of our colleagues on the other side of the aisle 
have spent a lot of their time extolling ObamaCare and indicating that 
we should just stay with what we have, but we all know that ObamaCare 
is failing.
  Republicans are on a rescue mission. We truly do have a better way. 
As some of my colleagues have stated, we will be passing the American 
Health Care Act tomorrow. What we are doing here with this bill is 
something we could not include in that legislation that will round out 
what it is we want to do with keeping our promise in what we promised 
last year in our program called A Better Way.
  Let me just talk a little bit about the failures of ObamaCare. As my 
colleagues have said, all the promises were broken: if you wanted to 
keep your doctor, you could keep your doctor; if you wanted to keep 
your healthcare plan, you could keep your healthcare plan. Those 
promises were the most obvious ones that went away. The cost of health 
care would be going down, and none of that happened.
  Mr. Speaker, in addition to that, there is a 25 percent average 
increase in premiums this year for millions of

[[Page 4653]]

Americans trapped in ObamaCare, healthcare.gov exchanges. Nearly one-
third of U.S. counties have only one insurer offering exchange plans; 
4.7 million Americans were kicked off their healthcare plans by 
ObamaCare. There was $1 trillion in new taxes, mostly falling on 
families and job creators; 18 failed ObamaCare co-ops out of 23, which 
my colleague from Tennessee so eloquently pointed out.
  These were established as an alternative to the public option. Those 
healthcare co-ops collapsed, costing taxpayers nearly 1.9 billion and 
forcing patients to find new insurance; $53 billion in new regulations 
requiring more than 176,800,000 hours of paperwork. ObamaCare 
regulations are driving up healthcare premiums and costing small-
business employees at least $19 billion annually.
  As I said in the hearing that we had on this bill, the Democrats want 
a coercive system. Republicans want a system based on freedom.
  Today we have an opportunity to make a real difference in the lives 
of hardworking men and women who are employed by small business. We 
have an opportunity to deliver much-needed relief to small-business 
owners who are trying to do the right thing and provide high-quality 
healthcare coverage for their employees. This legislation represents a 
truly positive reform that will help lower healthcare costs for working 
families and put small businesses on a fair and level playing field.
  Small businesses are the backbone of our Nation's economy, and there 
is no reason why they should be at a disadvantage when it comes to 
finding an affordable healthcare plan. They should be treated in the 
same fashion as larger businesses and have the ability to craft 
healthcare plans that meet the needs of their employees. If we want to 
encourage small businesses to offer health care at a lower cost to 
workers, this is one commonsense step we can make.
  Again, I thank our colleague, Congressman Sam Johnson, a true patriot 
and servant of this country, for his longtime support of this 
legislation.
  I urge my colleagues to vote ``yes'' on H.R. 1101, the Small Business 
Health Fairness Act, which will help more Americans access high-
quality, affordable health care.
  Mr. Speaker, I yield back the balance of my time.
  Mr. COLLINS of Georgia. Mr. Speaker, I rise in support of H.R. 1101, 
the Small Business Health Fairness Act of 2017.
  Small businesses are the backbone of our economy, providing economic 
opportunity and employment for millions of Americans across our 
country.
  Too often, we have seen the economic engine stall due to intrusion 
and overregulation that come courtesy of the federal government. There 
are few places where this is more obvious than in the staggering health 
care costs small businesses face, costs which Obamacare have only 
driven up.
  Obamacare's burdensome mandates have driven premiums up and insurance 
providers out of the market, and small employers have found themselves 
increasingly unable to cover their employees. The big picture for small 
businesses is that the ACA has smothered patient choice and patient-
centered care in the process of overregulating our job creators.
  In the House, we are empowering small businesses to fight back by 
increasing their bargaining power with insurance providers and leveling 
the playing field that they share with larger companies. The Small 
Business Health Fairness Act will help lower health care costs for 
employees by allowing small businesses to join together through 
association health plans.
  Ultimately, this bill will bring relief to American employees and 
their families by making insurance more affordable and accessible.
  H.R. 1101 is an important step toward empowering small businesses to 
care for their employees while prioritizing the job creation that 
strengthens our communities. At the same time, this bill would 
contribute to a patient-centered, competitive, and low-cost health care 
system for all Americans. I am proud to support this legislation as we 
return choice to our businesses and loved ones.
  The SPEAKER pro tempore. All time for debate on the bill has expired.


             Amendment No. 1 Offered by Ms. Herrera Beutler

  Ms. HERRERA BEUTLER. Mr. Speaker, I have an amendment at the desk.
  The SPEAKER pro tempore. The Clerk will designate the amendment.
  The text of the amendment is as follows:
       Add at the end of section 6 the following:
       (c) Coordination With Existing Law.--Nothing in this Act 
     shall require plans to become certified under section 802 of 
     the Employee Retirement Income Security Act of 1974, as 
     amended by this Act, or require plans that are not certified 
     under such section to comply with the requirements under part 
     8 of such Act, except to the extent provided in section 809 
     of such Act.
  The SPEAKER pro tempore. Pursuant to House Resolution 210, the 
gentlewoman from Washington (Ms. Herrera Beutler) and a Member opposed 
each will control 5 minutes.
  The Chair recognizes the gentlewoman from Washington.
  Ms. HERRERA BEUTLER. Mr. Speaker, I thank Chairwoman Foxx and the 
Committee on Education and the Workforce for their work on this 
important bill that will benefit small businesses and the families who 
work for them.
  My amendment to the Small Business Health Fairness Act provides a 
straightforward clarification to ensure that existing association 
health plans can continue to operate and provide high-quality, 
affordable care to as many people as possible.
  This amendment safeguards association health plans that have been 
successfully operating under State and Federal law--many of them for 
decades. We will be making certain that they would not inadvertently be 
disadvantaged by new Federal legislation or regulation or vulnerable to 
efforts to restrict access and limit choices.
  Why do we need this amendment?
  Because I fear what happened in my State will happen in others, where 
the insurance commissioner attempted to reject 42 out of about 60 
association health plans. His office interpreted ObamaCare as giving 
him a mandate as justification for attempting to eliminate virtually 
all of these popular plans. By adopting my amendment, it will make 
crystal clear in the underlying bill that this won't be tolerated, and 
it will support both existing and future association health plans.
  Talk to one of the nearly 400,000 individuals in my home State of 
Washington who get their care from an association plan, and you will 
find out why so many Washington businesses renew their plans every 
year.
  Our State has been fortunate to have a robust AHP market that has 
become essential to providing cost-effective choices to small-business 
employers, thanks to bipartisan legislation enacted in the mid-1990s. 
In the case of one association plan operating in my State, roughly 40 
percent of participating small-business employers did not previously 
offer health coverage.
  My amendment is supported by the U.S. Chamber of Commerce. In its 
letter to me, which I include in the Record, the U.S. Chamber indicated 
that it shares my interest in making sure that State-based association 
health plans that currently exist are able to continue operating in 
accordance with existing State and Federal law. My amendment is also 
supported by the Association of Washington Business.

                                        Chamber of Commerce of the


                                     United States of America,

                                   Washington, DC, March 20, 2017.
     Hon. Jaime Herrera Beutler,
     House of Representatives,
     Washington, DC.
       Dear Congresswoman Herrera Beutler: Thank you for your 
     attention to the concerns raised by the Association of 
     Washington Businesses regarding H.R. 1101, the ``Small 
     Business Health Fairness Act.'' The U.S. Chamber of Commerce 
     has several state chambers of commerce members that provide 
     state-based quality health care coverage to their member 
     companies. The Chamber shares your interest in making sure 
     that the state-based Association Health Plans that currently 
     exist are able to continue to operate in accordance with 
     existing state and federal law without being disadvantaged by 
     this new federal legislation.
       The Chamber appreciates your commitment to small businesses 
     and to ensuring that current affordable coverage options 
     continue to be available alongside new options in a 
     nondiscriminatory and fair environment. Thank you for your 
     dedication and efforts, and we look forward to continuing to 
     work with you to advance the priorities and interest of 
     business.
           Sincerely,
                                                Randel K. Johnson.


[[Page 4654]]

  Ms. HERRERA BEUTLER. Mr. Speaker, I am confident that the underlying 
legislation before us today will improve the ability of small 
businesses to access affordable, high-quality health coverage in every 
State across the country. However, first, this body should, as clearly 
as possible, ensure that those States that already have successfully 
operating association health plans are not disrupted, which is what my 
amendment would do.
  I urge my colleagues to support this amendment, and I thank the 
chairwoman for her work on this.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SCOTT of Virginia. Mr. Speaker, I ask unanimous consent to claim 
the time in opposition, although I am not opposed to the amendment.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman?
  There was no objection.
  The SPEAKER pro tempore. The gentleman is recognized for 5 minutes.
  Mr. SCOTT of Virginia. Mr. Speaker, I appreciate the intent of the 
amendment offered by the gentlewoman from Washington, which seems to 
allow health association plans that are currently in existence to 
continue to operate under existing State and Federal law. In fact, 
giving States the ability to regulate association plans is very 
important. That is why I oppose the underlying bill.
  The amendment also points out another interesting fact, and that is 
associations currently exist under current law, and the underlying bill 
simply unravels most of the regulations that apply to them, and this 
amendment would at least maintain State regulations.
  We know that this bill creates winners and losers. The winners are 
those who are young and healthy enough to be invited into an 
association. The losers are small businesses and employers who are 
older, sicker, or just have more costly health bills. There is no 
guarantee that plans under this legislation will have the standard 
level of benefits or consumer protections, and that is why I am 
disappointed that the majority failed to rule any Democratic amendments 
submitted to the Rules Committee in order, although each and every one 
was germane.
  The gentleman from New York (Mr. Espaillat), who is a member of the 
committee, offered an amendment that would have protected the ability 
of the States to regulate any association health plan, including 
regulation related to benefits, consumer protections, and rating 
restrictions. Representative Torres from California offered an 
amendment to ensure that association plans cover 10 essential health 
benefits under the Patient Protection and Affordable Care Act.
  One amendment was offered by Representatives Susan Davis of 
California and Suzanne Bonamici from Oregon--both committee members--
would have required association plans to provide for women's health 
benefits, including maternity care.
  Representatives Bonamici, Davis, and Wilson also offered an amendment 
to prevent this legislation from taking effect if it would lead to 
increased premiums for older workers. These older workers will not be 
able to get into the associations because they would increase average 
costs of the association, and the point of the association is to get 
away from high-cost enrollees like older Americans. So these older 
people will be left out of the pool with other older and sicker workers 
where they will necessarily be paying more.
  It is simple arithmetic. Their amendment would have been particularly 
important because we know that the Republican replacement plan contains 
an age tax that will severely disadvantage older populations.
  None of the Democratic amendments, although germane, were allowed 
under the rule, and there does not seem to be any earnest attempt to 
look to try to correct the shortcomings of the bill. So while I do not 
intend to oppose this amendment, I do not think the amendment is enough 
of an improvement of the bill, nor does it change the underlying fact 
that the legislation does not adequately protect small businesses, 
workers, and their families, nor does it help those left behind who are 
not invited into the association who will necessarily be paying more.
  Mr. Speaker, if those on the other side of the aisle want to go on a 
rescue mission, they ought to improve things, not make things worse. 
For most Americans, this bill will make things worse, and, tomorrow, 24 
million Americans will be left out while many others will be paying 
more for less while millionaires get huge tax cuts. That is not an 
improvement.
  Mr. Speaker, I reserve the balance of my time.
  Ms. HERRERA BEUTLER. Mr. Speaker, how much time do I have remaining?
  The SPEAKER pro tempore. The gentlewoman has 2\1/2\ minutes 
remaining.
  Ms. HERRERA BEUTLER. Mr. Speaker, I would just like to say that part 
of the reason this underlying bill is so critical is because we just 
don't believe one size fits all. When it comes to health coverage, we 
need to make sure that there are many different options for families, 
individuals, and businesses. We are clarifying basically a technical 
change here that allows continued existing plans to operate.
  Who can be opposed to existing plans operating and offering more 
options and more plans?
  This is exactly what Republicans are doing right now. We are fighting 
to make sure that the families and the people we represent have those 
options and their choices, that they can keep their doctor, that their 
health premiums will come down, that they can maybe get a plan through 
their work, or maybe they will be able to get into the individual 
market and self-insure--options--because one size does not fit all, 
which is why this bill is crucial and why my amendment to this bill 
makes it better. That is why we are going to move forward and make sure 
that more Americans have access to care--not just on paper--but care 
that gets them to in to the doctor, that gets them the care that they 
need, whether it is a specialist or a primary care doctor.
  Mr. Speaker, I yield back the balance of my time.
  Mr. SCOTT of Virginia. Mr. Speaker, I would point out that when one 
size fits all, everybody can benefit; but when you start picking and 
choosing winners and losers, some will benefit and many others will 
lose. Under this bill, a fortunate few who get into association plans 
will benefit; everybody else loses.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to the rule, the previous question is ordered on the bill, 
as amended, and on the amendment offered by the gentlewoman from 
Washington (Ms. Herrera Beutler).
  The question is on the amendment by the gentlewoman from Washington 
(Ms. Herrera Beutler).
  The amendment was agreed to.
  The SPEAKER pro tempore. The question is on the engrossment and third 
reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.

                              {time}  1500


                           Motion to Recommit

  Ms. SHEA-PORTER. Mr. Speaker, I have a motion to recommit at the 
desk.
  The SPEAKER pro tempore. Is the gentlewoman opposed to the bill?
  Ms. SHEA-PORTER. I am opposed in its current form.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Ms. Shea-Porter moves to recommit the bill H.R. 1101 to the 
     Committee on Education and the Workforce, with instructions 
     to report the same back to the House forthwith with the 
     following amendment:
       Page 15, after line 22, insert the following:
       ``(6) Substance use disorder treatment.--Notwithstanding 
     subsection (b), the plan provides for coverage for substance 
     use disorder treatment, including opioid use disorder 
     treatment, consistent with the substance use disorder 
     services defined as an essential health benefit by the 
     Secretary under subparagraph (E) of section 1302(b)(1) of the 
     Patient Protection and Affordable Care Act (42 U.S.C. 
     18022(b)(1)).''.
  Ms. SHEA-PORTER (during the reading). Mr. Speaker, I ask unanimous 
consent to dispense with the reading.

[[Page 4655]]

  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from New Hampshire?
  There was no objection.
  The SPEAKER pro tempore. The gentlewoman from New Hampshire is 
recognized for 5 minutes.
  Ms. SHEA-PORTER. Mr. Speaker, this is the final amendment to the 
bill, which will not kill the bill or send it back to committee. If 
adopted, the bill will immediately proceed to final passage, as 
amended.
  Mr. Speaker, I rise today on behalf of the families and communities 
across the Nation that are confronting a public health threat of our 
time: the heroin, fentanyl, and prescription opioid crisis.
  This motion would simply ensure that the health insurance plans that 
today's bill would permit must still cover substance use disorder 
treatment, including for opioids, as an essential health benefit.
  Under current law, we require insurers to cover this treatment. 
Before the Affordable Care Act, many insurers either didn't cover 
treatment at all or imposed onerous requirements that blocked people 
from getting needed care.
  H.R. 1101 would roll back that guarantee. It would allow association 
health plans to return to the kind of skimpy coverage that left so many 
people struggling with an opioid disorder in dire straits at critical 
moments. We know there is often a narrow window of opportunity--after 
an overdose, for example--for someone to commit to treatment, and these 
are the moments when being able to make a single phone call can make 
all the difference.
  This week's debate about health care is extremely important. Will we 
decide to work together to improve the American people's access to 
quality, affordable health care or weaken benefits and kick 24 million 
or more of our constituents off their plans? We all need to speak up on 
behalf of those whose lives have been turned around because they can 
now access health care.
  As I talk to families, medical professionals, and law enforcement 
officials in my district, I hear stories that highlight the dramatic 
impact that improved access to coverage has had in making treatment a 
real option for people with substance use disorder. This week, we see 
that base of coverage is under serious threat. In fact, experts 
estimate that repealing the Affordable Care Act's coverage provisions 
would cause about 2.8 million Americans with a substance use disorder 
to lose some or all of their coverage. The quality of that coverage is 
also at risk.
  Thanks to the Affordable Care Act, insurance must now cover treatment 
for behavioral health and substance use disorder, just the same as it 
would cover any other medical service. These parity protections mean 
insurers must cover treatment for substance use disorder with 
comparable cost-sharing, with no surprises like annual visit limits, 
higher copays, or frequent preauthorization requirements and medical 
necessity reviews.
  Badly needed facilities are opening because plans now cover these 
services. I recently visited a recovery home for pregnant women and new 
mothers in my district. They were able to open the doors this year in 
my hometown only because it could rely on Medicaid expansion. 
Legislation like H.R. 1101 would cause fewer people to have this 
coverage, meaning fewer facilities can open and treat.
  Many of you know that my home State of New Hampshire is on the front 
lines of the heroin, fentanyl, and prescription opioid crisis. Our 
communities are struggling, and helping people get treatment is key to 
turning the tide. I have met people who couldn't be in a recovery 
facility without Medicaid expansion.
  Today, Members of Congress can say to my constituents in New 
Hampshire and their constituents across this great Nation: we hear you. 
We know your sons and daughters, your nieces and nephews, your 
neighbors and friends are struggling, and we have your back.
  We believe all Americans deserve good health insurance they can count 
on when they need it most. We aren't going to pull the rug out from 
under people who are about to turn their lives around.
  I urge my colleagues to support this motion, which would not delay 
passage of the underlying bill.
  Mr. Speaker, I yield back the balance of my time.
  Ms. FOXX. Mr. Speaker, I rise in opposition to the motion to 
recommit.
  The SPEAKER pro tempore. The gentlewoman from North Carolina is 
recognized for 5 minutes.
  Ms. FOXX. Mr. Speaker, this motion is nothing more than a last-ditch 
attempt to defeat a commonsense bill that will help expand access to 
affordable healthcare coverage for working families. In fact, this 
motion represents the same failed approach to health care we have 
experienced in recent years.
  We have seen what happens when the Federal Government dictates the 
kind of health insurance individuals can and cannot buy. Healthcare 
costs skyrocket and patients have fewer choices.
  While our Democrat colleagues offer a motion that doubles down on a 
failed approach to health care, my Republican colleagues and I are 
offering the American people a better way.
  The Small Business Health Fairness Act is about empowering 
individuals, families, and small-business owners so more Americans have 
access to affordable healthcare coverage. By rejecting this motion and 
supporting the underlying bill, we can take an important step in 
keeping our promise to deliver free-market, patient-centered healthcare 
solutions.
  I urge my colleagues to vote ``no'' on the motion to recommit and 
``yes'' on the Small Business Health Fairness Act.
  Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Without objection, the previous question is 
ordered on the motion to recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.
  Ms. SHEA-PORTER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 and clause 9 of rule 
XX, this 15-minute vote on the motion to recommit will be followed by 
5-minute votes on passage of the bill, if ordered; and the motion to 
suspend the rules and pass H.R. 1238.
  The vote was taken by electronic device, and there were--yeas 179, 
nays 233, not voting 17, as follows:

                             [Roll No. 185]

                               YEAS--179

     Adams
     Aguilar
     Barragan
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brady (PA)
     Brownley (CA)
     Bustos
     Butterfield
     Capuano
     Carbajal
     Cardenas
     Cartwright
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Cohen
     Connolly
     Conyers
     Cooper
     Correa
     Costa
     Courtney
     Crist
     Crowley
     Cuellar
     Cummings
     Davis (CA)
     Davis, Danny
     DeFazio
     DeGette
     Delaney
     DeLauro
     DelBene
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Duncan (TN)
     Ellison
     Engel
     Eshoo
     Espaillat
     Esty
     Evans
     Foster
     Frankel (FL)
     Fudge
     Gabbard
     Gallego
     Garamendi
     Gonzalez (TX)
     Gottheimer
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hanabusa
     Hastings
     Heck
     Higgins (NY)
     Himes
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson, E. B.
     Jones
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Kind
     Krishnamoorthi
     Kuster (NH)
     Langevin
     Larsen (WA)
     Lawson (FL)
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren
     Lowenthal
     Lowey
     Lujan Grisham, M.
     Lujan, Ben Ray
     Lynch
     Maloney, Carolyn B.
     Maloney, Sean
     Matsui
     McCollum
     McGovern
     McNerney
     Meeks
     Meng
     Moulton
     Murphy (FL)
     Nadler
     Napolitano
     Neal
     Nolan
     Norcross
     O'Halleran
     O'Rourke
     Pallone
     Panetta
     Pascrell
     Pelosi
     Perlmutter
     Peters
     Peterson
     Pingree
     Pocan
     Polis
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Rosen
     Roybal-Allard
     Ruiz
     Ruppersberger
     Ryan (OH)
     Sanchez
     Sarbanes
     Schakowsky
     Schiff
     Schneider
     Schrader
     Scott (VA)

[[Page 4656]]


     Scott, David
     Serrano
     Sewell (AL)
     Shea-Porter
     Sherman
     Sires
     Smith (WA)
     Soto
     Speier
     Suozzi
     Swalwell (CA)
     Thompson (CA)
     Thompson (MS)
     Titus
     Tonko
     Torres
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Welch
     Wilson (FL)
     Yarmuth

                               NAYS--233

     Abraham
     Aderholt
     Allen
     Amash
     Amodei
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barton
     Bergman
     Biggs
     Bilirakis
     Bishop (MI)
     Bishop (UT)
     Black
     Blackburn
     Blum
     Bost
     Brady (TX)
     Brat
     Bridenstine
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess
     Byrne
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Chaffetz
     Cheney
     Coffman
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Comstock
     Conaway
     Cook
     Costello (PA)
     Cramer
     Crawford
     Culberson
     Curbelo (FL)
     Davidson
     Davis, Rodney
     Denham
     Dent
     DeSantis
     DesJarlais
     Diaz-Balart
     Donovan
     Duffy
     Duncan (SC)
     Dunn
     Emmer
     Farenthold
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gaetz
     Gallagher
     Garrett
     Gibbs
     Gohmert
     Goodlatte
     Gosar
     Gowdy
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Griffith
     Grothman
     Guthrie
     Harper
     Harris
     Hartzler
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins (LA)
     Hill
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hultgren
     Hunter
     Hurd
     Issa
     Jenkins (KS)
     Jenkins (WV)
     Johnson (LA)
     Johnson (OH)
     Johnson, Sam
     Jordan
     Joyce (OH)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Kustoff (TN)
     Labrador
     LaHood
     LaMalfa
     Lamborn
     Lance
     Latta
     Lewis (MN)
     LoBiondo
     Long
     Loudermilk
     Love
     Lucas
     Luetkemeyer
     MacArthur
     Marchant
     Marino
     Marshall
     Massie
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     McMorris Rodgers
     McSally
     Meadows
     Meehan
     Messer
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Murphy (PA)
     Newhouse
     Noem
     Olson
     Palazzo
     Palmer
     Paulsen
     Pearce
     Perry
     Pittenger
     Poe (TX)
     Poliquin
     Posey
     Ratcliffe
     Reed
     Reichert
     Renacci
     Rice (SC)
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney, Francis
     Rooney, Thomas J.
     Ros-Lehtinen
     Roskam
     Ross
     Rothfus
     Rouzer
     Royce (CA)
     Russell
     Rutherford
     Sanford
     Scalise
     Schweikert
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smucker
     Stefanik
     Stewart
     Stivers
     Taylor
     Tenney
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Trott
     Turner
     Upton
     Valadao
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Weber (TX)
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yoder
     Yoho
     Young (AK)
     Young (IA)
     Zeldin

                             NOT VOTING--17

     Bass
     Brown (MD)
     Carson (IN)
     Clyburn
     Larson (CT)
     Lawrence
     Lieu, Ted
     McEachin
     Moore
     Nunes
     Payne
     Richmond
     Rush
     Sinema
     Slaughter
     Takano
     Tsongas

                              {time}  1530

  Mr. BISHOP of Michigan, Ms. GRANGER, Messrs. GOSAR, and YOUNG of 
Alaska changed their vote from ``yea'' to ``nay.''
  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  Stated for:
  Mr. LARSON of Connecticut. Mr. Speaker, on March 22nd, 2017--I was 
not present for rollcall vote 185. If I had been present for this vote, 
I would have voted ``yea.''
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.


                             Recorded Vote

  Mr. SCOTT of Virginia. Mr. Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This is a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 236, 
noes 175, not voting 18, as follows:

                             [Roll No. 186]

                               AYES--236

     Abraham
     Aderholt
     Allen
     Amash
     Amodei
     Arrington
     Babin
     Bacon
     Banks (IN)
     Barletta
     Barr
     Barton
     Bergman
     Biggs
     Bilirakis
     Bishop (MI)
     Bishop (UT)
     Black
     Blackburn
     Blum
     Bost
     Brady (TX)
     Brat
     Bridenstine
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burgess
     Byrne
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Chaffetz
     Cheney
     Coffman
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Comstock
     Conaway
     Cook
     Costello (PA)
     Cramer
     Crawford
     Cuellar
     Culberson
     Curbelo (FL)
     Davidson
     Davis, Rodney
     Denham
     Dent
     DeSantis
     DesJarlais
     Diaz-Balart
     Donovan
     Duffy
     Duncan (SC)
     Duncan (TN)
     Dunn
     Emmer
     Farenthold
     Faso
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Foxx
     Franks (AZ)
     Frelinghuysen
     Gaetz
     Gallagher
     Garrett
     Gibbs
     Gohmert
     Goodlatte
     Gosar
     Gottheimer
     Gowdy
     Granger
     Graves (LA)
     Graves (MO)
     Griffith
     Grothman
     Guthrie
     Harper
     Harris
     Hartzler
     Hensarling
     Herrera Beutler
     Hice, Jody B.
     Higgins (LA)
     Hill
     Holding
     Hollingsworth
     Huizenga
     Hultgren
     Hunter
     Hurd
     Issa
     Jenkins (KS)
     Jenkins (WV)
     Johnson (LA)
     Johnson (OH)
     Johnson, Sam
     Jones
     Jordan
     Joyce (OH)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Knight
     Kustoff (TN)
     Labrador
     LaHood
     LaMalfa
     Lamborn
     Lance
     Latta
     Lewis (MN)
     LoBiondo
     Long
     Loudermilk
     Love
     Lucas
     Luetkemeyer
     MacArthur
     Marchant
     Marino
     Marshall
     Massie
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     McMorris Rodgers
     McSally
     Meadows
     Meehan
     Messer
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Murphy (PA)
     Newhouse
     Noem
     Nunes
     Olson
     Palazzo
     Palmer
     Paulsen
     Pearce
     Perry
     Peterson
     Pittenger
     Poe (TX)
     Poliquin
     Posey
     Ratcliffe
     Reed
     Reichert
     Renacci
     Rice (SC)
     Roby
     Roe (TN)
     Rogers (AL)
     Rogers (KY)
     Rohrabacher
     Rokita
     Rooney, Francis
     Rooney, Thomas J.
     Ros-Lehtinen
     Roskam
     Ross
     Rothfus
     Rouzer
     Royce (CA)
     Russell
     Rutherford
     Sanford
     Scalise
     Schrader
     Schweikert
     Scott, Austin
     Sensenbrenner
     Sessions
     Shimkus
     Shuster
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smith (TX)
     Smucker
     Stefanik
     Stewart
     Stivers
     Taylor
     Tenney
     Thompson (PA)
     Thornberry
     Tiberi
     Tipton
     Trott
     Turner
     Upton
     Valadao
     Wagner
     Walberg
     Walden
     Walker
     Walorski
     Walters, Mimi
     Weber (TX)
     Webster (FL)
     Wenstrup
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Yoder
     Young (AK)
     Young (IA)
     Zeldin

                               NOES--175

     Adams
     Aguilar
     Barragan
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brady (PA)
     Brownley (CA)
     Bustos
     Butterfield
     Capuano
     Carbajal
     Cardenas
     Cartwright
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Cohen
     Connolly
     Conyers
     Cooper
     Correa
     Costa
     Courtney
     Crist
     Crowley
     Cummings
     Davis (CA)
     Davis, Danny
     DeFazio
     DeGette
     Delaney
     DeLauro
     DelBene
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Ellison
     Engel
     Eshoo
     Espaillat
     Esty
     Evans
     Foster
     Frankel (FL)
     Fudge
     Gabbard
     Gallego
     Garamendi
     Gonzalez (TX)
     Green, Al
     Green, Gene
     Grijalva
     Gutierrez
     Hanabusa
     Hastings
     Heck
     Higgins (NY)
     Himes
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson, E. B.
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kihuen
     Kildee
     Kilmer
     Kind
     Krishnamoorthi
     Kuster (NH)
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawson (FL)
     Lee
     Levin
     Lewis (GA)
     Lipinski
     Loebsack
     Lofgren
     Lowenthal
     Lowey
     Lujan Grisham, M.
     Lujan, Ben Ray
     Lynch
     Maloney, Carolyn B.
     Maloney, Sean
     Matsui
     McCollum
     McEachin
     McGovern
     McNerney
     Meeks
     Meng
     Moulton
     Murphy (FL)
     Nadler
     Napolitano
     Neal
     Nolan
     Norcross
     O'Halleran
     O'Rourke
     Pallone
     Panetta
     Pascrell
     Pelosi
     Perlmutter
     Peters
     Pingree
     Pocan
     Polis
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Rosen
     Roybal-Allard
     Ruiz
     Ruppersberger
     Ryan (OH)
     Sanchez
     Sarbanes
     Schakowsky
     Schiff
     Schneider
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shea-Porter
     Sherman
     Sires
     Smith (WA)
     Soto
     Speier
     Suozzi
     Swalwell (CA)
     Thompson (CA)
     Thompson (MS)
     Titus
     Tonko
     Torres
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Walz
     Wasserman Schultz
     Waters, Maxine
     Watson Coleman
     Welch
     Wilson (FL)
     Yarmuth

                             NOT VOTING--18

     Bass
     Brown (MD)
     Carson (IN)
     Clyburn
     Fortenberry
     Graves (GA)

[[Page 4657]]


     Hudson
     Lawrence
     Lieu, Ted
     Moore
     Payne
     Richmond
     Rush
     Sinema
     Slaughter
     Takano
     Tsongas
     Yoho


                Announcement by the Speaker Pro Tempore

  The SPEAKER pro tempore (during the vote). There are 2 minutes 
remaining.

                              {time}  1539

  Mr. CLEAVER changed his vote from ``aye'' to ``no.''
  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.
  Stated for:
  Mr. YOHO. Mr. Speaker, I was unavoidably detained. Had I been 
present, I would have voted ``yea'' on rollcall No. 186.
  Mr. FORTENBERRY. Mr. Speaker, I was inadvertently detained. Had I 
been present, I would have voted ``yea'' on rollcall No. 186.

                          ____________________