[House Report 116-43]
[From the U.S. Government Publishing Office]


116th Congress    }                                  {    Rept. 116-43
                        HOUSE OF REPRESENTATIVES
 1st Session      }                                  {          Part 1

======================================================================



 
    PROVIDING THAT THE RULE ENTITLED ``SHORT-TERM, LIMITED DURATION 
               INSURANCE'' SHALL HAVE NO FORCE OR EFFECT

                                _______
                                

                 April 29, 2019.--Ordered to be printed

                                _______
                                

   Mr. Scott of Virginia, from the Committee on Education and Labor, 
                        submitted the following

                              R E P O R T

                             together with

                             MINORITY VIEWS

                        [To accompany H.R. 1010]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Education and Labor, to whom was referred 
the bill (H.R. 1010) to provide that the rule entitled ``Short-
Term, Limited Duration Insurance'' shall have no force or 
effect, having considered the same, report favorably thereon 
without amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Committee Action.................................................     2
Committee Views..................................................     4
Section-by-Section Analysis......................................     9
Explanation of Amendments........................................     9
Application of Law to the Legislative Branch.....................     9
Unfunded Mandate Statement.......................................     9
Earmark Statement................................................     9
Roll Call Votes..................................................     9
Statement of Performance Goals and Objectives....................    15
Duplication of Federal Programs..................................    15
Hearings.........................................................    15
Statement of Oversight Findings and Recommendations of the 
  Committee......................................................    15
New Budget Authority and CBO Cost Estimate.......................    15
Committee Cost Estimate..........................................    19
Changes in Existing Law Made by the Bill, as Reported............    19
Minority Views...................................................    20

                          PURPOSE AND SUMMARY

    The purpose of H.R. 1010, To provide that the rule entitled 
``Short-Term, Limited Duration Insurance'' shall have no force 
or effect, is to protect consumers by reversing the harmful 
rule promulgated by the U.S. Department of the Treasury, the 
U.S. Department of Labor, and the U.S. Department of Health and 
Human Services that has expanded Short-Term, Limited Duration 
Insurance (STLDI). The bill is necessary because STLDI is 
exempt from many basic consumer protections such as 
prohibitions on medical underwriting, prohibitions on denying 
coverage due to health status, and prohibitions on lifetime or 
annual coverage limits. Although the Patient Protection and 
Affordable Care Act (ACA) eliminated these and other harmful 
practices in the individual insurance market, the rule has 
created a loophole, allowing plans to circumvent these vital 
consumer protections.

                            COMMITTEE ACTION

115th Congress

    On September 13, 2018, Congresswoman Kathy Castor (D-FL-14) 
and fifty-six House Democratic cosponsors introduced H.J. Res. 
140, Providing for congressional disapproval under chapter 8 of 
title 5, United States Code, of the final rule of the 
Department of the Treasury, the Department of Labor, and the 
Department of Health and Human Services relating to ``Short-
Term, Limited-Duration Insurance.'' H.J. Res. 140 was referred 
to the Committees on Energy and Commerce, Education and the 
Workforce, and Ways and Means. No further action was taken 
during the 115th Congress.

116th Congress

    On February 6, 2019, Congresswoman Castor, Congresswoman 
Lauren Underwood (D-IL-14), Congressman Mark DeSaulnier (D-CA-
11), Congresswoman Gwen Moore (D-WI-4), Congresswoman Nanette 
Diaz Barragan (D-CA-44), and Congressman Steven Horsford (D-NV-
04) introduced H.J. Res. 43, Providing for congressional 
disapproval under chapter 8 of title 5, United States Code, of 
the final rule of the Department of the Treasury, the 
Department of Labor, and the Department of Health and Human 
Services relating to ``Short-Term, Limited-Duration 
Insurance.'' H.J. Res. 43 was referred to the Committees on 
Energy and Commerce, Education and Labor, and Ways and Means.
    On February 6, 2019, Congresswoman Castor, Congresswoman 
Underwood, Congressman DeSaulnier, Congresswoman Moore, 
Congresswoman Barragan, and Congressman Horsford introduced 
H.R. 1010, To provide that the rule entitled ``Short-Term, 
Limited Duration Insurance'' shall have no force or effect. 
H.R. 1010 was referred to the Committees on Energy and 
Commerce, Education and Labor, and Ways and Means.
    On February 6, 2019, the Committee on Education and Labor 
held a hearing entitled ``Examining Threats to Workers with 
Preexisting Conditions'' to examine executive, judicial, and 
legislative threats to working Americans with preexisting 
medical conditions, including the Administration's expansion of 
STLDI through the final rule of the U.S. Departments of 
Treasury, Labor, and Health and Human Services. Witnesses 
included: Dr. Rahul Gupta, Senior Vice President and Chief 
Medical Health Officer, March of Dimes, Arlington, VA; Ms. 
Grace Marie Turner, President, Galen Institute, Paeonian 
Springs, VA; Ms. Sabrina Corlette, Research Professor, 
Georgetown University Health Policy Institute Center on Health 
Insurance Reforms, Washington, D.C.; and Mr. Chad Riedy, 
patient advocate living with Cystic Fibrosis, Alexandria, VA.
    On February 13, 2019, the Committee on Energy and 
Commerce's Subcommittee on Health held a hearing entitled 
``Strengthening Our Health Care System: Legislation to Reverse 
ACA Sabotage and Ensure Pre-Existing Conditions Protections.'' 
The hearing examined a number of important legislative 
proposals to undo sabotage of the ACA, protect patients with 
preexisting medical conditions, and improve access to 
affordable and comprehensive health coverage. Among the bills 
considered at the hearing was H.R. 1010. Witnesses included: 
Ms. Grace-Marie Turner, President, Galen Institute, Paeonian 
Springs, VA; Ms. Katie Keith, Associate Research Professor and 
Adjunct Professor of Law, Georgetown University, Washington, 
D.C.; and Ms. Jessica K. Altman, Commissioner, Pennsylvania 
Insurance Department, Harrisburg, PA. On March 27, 2019, the 
Health Subcommittee marked up H.R. 1010 and favorably forwarded 
the bill to the full Committee on Energy and Commerce. On April 
3, 2019, the full Committee on Energy and Commerce marked up 
H.R. 1010 and ordered it to be favorably reported to the House 
of Representatives.
    On April 9, 2019, the Committee on Education and Labor (the 
Committee) held a full committee markup of H.R. 1010. The 
Committee ordered the bill to be favorably reported without 
amendment to the House of Representatives by a vote of 26-19.
    During the markup, the following amendments were offered 
but not adopted:
     Congressman David P. Roe (R-TN-1) offered an 
amendment to: strike Section 1 of H.R. 1010, thereby keeping in 
place the final rule on short-term, limited duration insurance; 
amend the Public Health Service Act to define short-term, 
limited duration insurance as insurance coverage with an 
expiration date that is less than 12 months; and provide that 
short-term, limited duration insurance coverage be subject to 
guaranteed renewability. The amendment was ruled not germane.
     Congressman Dusty Johnson (R-SD-At Large) offered 
an amendment to provide for the application of the short-term, 
limited duration insurance rule in a State if the State submits 
a request that the rule be offered for the year. The amendment 
was defeated by a vote of 19-25.
     Congressman Tim Walberg (R-MI-7) offered an 
amendment to condition the implementation of H.R. 1010 on a 
study by the Secretaries of Health and Human Services, Labor, 
and Treasury to determine whether consumers are provided with 
adequate disclosures by entities offering short-term, limited 
duration insurance. The amendment was defeated by a vote of 19-
26.
     Congressman Ron Wright (R-TX-6) offered an 
amendment to provide for the continued application of the 
short-term, limited duration insurance rule in a plan year for 
any rating area where the average premium for the second-
lowest-cost silver plan increased by 20 percent or more 
relative to the previous year. The amendment was defeated by a 
vote of 19-26.
     Congressman William R. Timmons, IV (R-SC-4) 
offered an amendment to provide for the continued application 
of the short-term, limited duration insurance rule in a local 
jurisdiction if there are fewer than two qualified health plan 
issuers in a plan year in that jurisdiction. The amendment was 
defeated by a vote of 19-26.

                            COMMITTEE VIEWS

Introduction

    Short-term, limited duration insurance (STLDI) plans are 
marketed to consumers as an alternative to traditional health 
insurance. They are designed to be temporary in nature, 
providing coverage for consumers during brief periods of 
uninsurance. Due to the meager benefits they provide, their 
harmful impact on the overall risk pool, and their largely 
unregulated status under federal law, these plans directly 
threaten Americans' access to quality, affordable health 
coverage. The final rule issued by the U.S. Department of the 
Treasury, the U.S. Department of Labor, and the U.S. Department 
of Health and Human Services will expand the prevalence of 
STLDI, weakening the stability of the insurance market and 
undermining vital consumer protections.

The Affordable Care Act Strengthened Consumer Protections

    On March 23, 2010, President Barack Obama signed the 
Patient Protection and Affordable Care Act (ACA) into law. The 
law has improved the lives of millions of Americans by 
increasing the affordability of health insurance, slashing the 
uninsured rate, and improving the quality of health coverage. 
Since enactment, the ACA has expanded health insurance coverage 
to over 20 million Americans.\1\ The ACA also instituted 
dramatically more comprehensive protections in both the 
individual and group health care markets, particularly for 
people with preexisting conditions. The law's consumer 
protections include:
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    \1\Democratic Staff of the U.S. House Committee on Education and 
the Workforce, Accessible, Affordable Health Care: A Right, Not a 
Privilege 1 (2017), https://edlabor.house.gov/imo/media/doc/Report%20-
%20Accessible,%20Affordable%20Health%20Care%20A%20Right%20Not%20A% 
20Privilege_Ed %20&%20the%20Workforce%20Dems.pdf.
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     Guaranteed Issue and Renewability: The ACA's 
guaranteed issue and renewability of coverage provisions 
require insurers to accept every applicant for health coverage, 
regardless of health status.\2\ Practically, this means an 
insurer must accept and renew health coverage, even if the 
consumer has a preexisting condition, is sick, or has sought 
medical treatment.
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    \2\ Provisions of the Health Insurance Portability and 
Accountability Act of 1996, Pub. L. 104-191, 110 Stat. 1936 (HIPAA), 
applied this protection generally to the small group market and to 
certain ``HIPAA-eligible'' individuals in the nongroup market.
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     Adjusted Community Rating: Under the ACA, insurers 
in the individual and small group market are prohibited from 
charging higher premiums based on health status and may only 
vary premiums based on family size, age,\3\ geographic area, 
and tobacco use.
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    \3\Age rating is restricted such that plans may charge older 
individuals no more than three times more than younger individuals.
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     Essential Health Benefits: Under the ACA, 
individual market and small group plans must cover ten 
categories of essential health benefits.\4\ Prior to the ACA, 
insurers often excluded coverage of maternity care, mental 
health care, substance use disorder treatment, among other 
benefits.\5\
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    \4\While large group and self-insured plans do not need to comply 
with Essential Health Benefits (EHB) requirements, if these plans cover 
a specific EHB category, then the plan cannot impose an annual or 
lifetime limit on that category of coverage.
    \5\Gary Claxton et al., Would States Eliminate Key Benefits if AHCA 
Waivers are Enacted? 1 (2017), http://files.kff.org/attachment/Issue-
Brief-Would-States-Eliminate-Key-Benefits-if-AHCA-Waivers-are-Enacted.
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     Elimination of Lifetime and Annual Caps: Under the 
ACA's elimination of lifetime and annual benefit caps, 
consumers--including those with job-based insurance--are 
protected from these coverage limits. Consumers now have new 
safeguards against unreasonable out-of-pocket expenses, which 
can be financially crippling for many families, especially 
those struggling to make ends meet while facing or recovering 
from a major health issue. Before the ACA, more than 90 percent 
of nongroup plans had annual or lifetime caps on coverage; most 
employer-provided plans also imposed lifetime limits.\6\
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    \6\Loren Adler & Paul B. Ginsburg, Health Insurance as Assurance: 
The Importance of Keeping the ACA's Limits on Enrollee Health Costs, 
Brookings, (Jan. 1, 2017), https://www.brookings.edu/blog/usc-
brookings-schaeffer-on-health-policy/2017/01/17/health-insurance-as-
assurance-the-importance-of-keeping-the-acas-limits-on-enrollee-health-
costs/.
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     Elimination of Preexisting Health Condition 
Exclusions: Under the ACA, all health plans are prohibited from 
excluding coverage for preexisting health conditions.\7\ In 
2002, roughly one in three workers were in a plan that had 
preexisting condition exclusions.\8\ Prior to the ACA, 
protections for people with preexisting conditions were 
inconsistent across the country, but in the majority of states 
consumers could be subjected to denials of coverage, higher 
premiums, or exclusions.\9\
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    \7\ Previously, HIPAA provided that individuals with employer-
sponsored coverage could generally be subject to up to a 12-month 
exclusion period for preexisting health conditions for which the 
enrollee sought treatment in the previous six months before enrollment 
in the health plan. Non-HIPAA-eligible individuals in the individual 
market had no federal protections from these exclusions whatsoever.
    \8\Kaiser Family Foundation, Employer Health Benefits Annual Survey 
138 (2002), https://kaiserfamilyfoundation.files.wordpress.com/2013/04/
3251.pdf.
    \9\Sandy Ahn, How Accessible and Affordable were Individual Market 
Health Plans before the Affordable Care Act? Depends Where You Lived 3 
(2017), https://www.rwjf.org/content/dam/farm/reports/issue_briefs/
2017/rwjf434339.
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Short-Term, Limited Duration Insurance is Harmful to Consumers

    STLDI plans are not clearly defined in federal law and have 
explicitly been excluded from the definition of individual 
health insurance coverage under the Public Health Service 
Act.\10\ Because they are not individual health insurance 
coverage, these plans are not subject to vital consumer 
protections that apply to traditional health insurance plans. 
For example, plans offered for sale in the individual market 
are prohibited from denying coverage or charging individuals 
more for having a preexisting condition. In contrast, STLDI 
plans are permitted to limit coverage of services associated 
with a preexisting condition as well as charge higher premiums 
based on age, gender, and health status--or deny coverage 
altogether. The implications of the ability of STLDI to 
circumvent these protections are enormous. One major insurer 
has even defined a preexisting condition as one ``that would 
cause a reasonable person to seek diagnosis, care or 
treatment,'' even if the individual has not actually sought 
care for the condition.\11\
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    \10\See Public Health Service Act Sec. 2791(b)(5), 42 U.S.C. 
Sec. 300gg-91(b)(5).
    \11\Dania Palanker et al., New Executive Order: Expanding Access to 
Short-Term Health Plans is Bad for Consumers and the Individual Market, 
Commonwealth Fund (Oct. 11, 2017), http://www.commonwealthfund.org/
publications/blog/2017/aug/short-term-health-plans#/.
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    There is also no guarantee that STLDI will meet the health 
coverage needs of enrollees. STLDI plans do not have to offer 
essential health benefits, and as a result, consumers can be 
denied access to basic health care that would otherwise be 
covered in a traditional individual market plan.\12\ In fact, 
one analysis of plans offered on leading brokerage sites found 
that more than half of the short-term plans offered did not 
cover substance use disorder treatment, seven in ten did not 
cover outpatient prescription drugs, and none covered maternity 
care.\13\
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    \12\Karen Pollitz et al., Understanding Short-Term Limited Duration 
Health Insurance 2 (2018), http://files.kff.org/attachment/Issue-Brief-
Understanding-Short-Term-Limited-Duration-Health-Insurance.
    \13\Id.
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    In addition, consumers enrolled in STLDI plans may be 
subject to devastating out-of-pocket costs when they have a 
major medical expense. Because STLDI plans are not subject to 
the ACA's annual and lifetime caps on out-of-pocket expenses, 
consumers often have little protection against exorbitant out-
of-pocket costs arising from their care. For example, one heart 
attack victim was left with $900,000 in bills after his insurer 
refused to cover bypass surgery under his short-term plan, and 
a stroke victim ``was left with $250,000 in unpaid medical 
bills because the policy did not cover prescription drugs and 
other basic treatment.''\14\ STLDI is not subject to other ACA 
requirements--such as rate review or the medical loss ratio. 
While ACA-compliant plans are required to spend at least 80 
percent of premiums on claims and actual health care-related 
expenses, rather than corporate bonuses and administration, the 
average loss ratio for individual market short-term plans in 
2016 was 67 percent; for the top two insurers the average loss 
ratio was even lower, at a mere 50 percent.\15\
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    \14\Reed Abelson, Without Obamacare Mandate, `You Open the 
Floodgates' for Skimpy Health Plans, New York Times (Nov. 30, 2017), 
https://www.nytimes.com/2017/11/30/health/health-insurance-obamacare-
mandate.html.
    \15\Karen Pollitz et al., supra note 12, at 2.
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The Trump Administration's Efforts To Roll Back Consumer Protections 
        Against Short-Term, Limited Duration Coverage

    Concerned the STLDI plans were increasingly being relied 
upon as a primary form of health insurance coverage, the Obama 
Administration took steps to protect consumers from the sale of 
these policies. On October 31, 2016, the U.S. Departments of 
Health and Human Services, Labor, and the Treasury 
(collectively, the Departments), jointly published a final rule 
to ensure that STLDI plans were offered for truly short-term, 
gap-filling coverage, noting that ``these policies may have 
significant limitations, such as lifetime and annual dollar 
limits on essential health benefits and pre-existing condition 
exclusions, and therefore may not provide meaningful health 
coverage.''\16\ Accordingly, the Departments' final rule 
required improved disclosures to warn consumers that STLDI 
plans do not constitute minimum essential coverage under the 
ACA, and it restricted the duration for which policies could be 
sold and renewed to three months.\17\
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    \16\81 Fed. Reg. 75317 (Oct. 31, 2016).
    \17\Id.
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    On October 12, 2017, President Trump signed an Executive 
Order (EO) entitled ``Promoting Healthcare Choice and 
Competition across the United States.''\18\ In the EO, the 
President attacked the ACA and promised to loosen consumer 
protections and expand the prevalence of health plans that do 
not comply with federal law. Pursuant to the EO, on February 
21, 2018, the Departments jointly published a proposed rule 
expanding the availability of short-term plans.\19\ On August 
3, 2018, the Departments jointly published a final rule to 
extend the allowable duration of STLDI from three months to up 
to 12 months, with plans renewable for up to 36 months.\20\
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    \18\Exec. Order No. 13813, 82 Fed. Reg. 48385 (Oct. 12, 2017).
    \19\83 Fed. Reg. 7437 (Feb. 21, 2018).
    \20\83 Fed. Reg. 38212 (Aug. 3, 2018).
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    The Departments' rulemaking was widely criticized by 
stakeholders. Twenty-one of the largest organizations that 
represent patients and consumers across America found that the 
expansion of STLDI plans would ``seriously undermine the key 
principles of access, adequacy, and affordability [that 
underpin the ACA].''\21\ These groups asserted that 
``implementing these policies will once again leave patients 
and consumers in the lurch with insufficient coverage, unpaid 
medical bills, long-term impacts on their financial wellbeing, 
and lifelong health implications--just as many of these plans 
did prior to the enactment of the ACA.''\22\ Strikingly, an 
analysis published by the Los Angeles Times found that 98 
percent of the over 300 patient and consumer advocates, 
physician and provider organizations, and other health care 
stakeholders that submitted comments opposing or criticizing 
the rule.\23\
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    \21\Letter from American Cancer Society Cancer Action Network et 
al. to Secretary of Health and Human Services Alex Azar (Apr. 23, 
2018), https://www.fightcancer.org/sites/default/files/
National%20Documents/042318%20Coalition%20Comments%20on%20STLDPs%20%20-
%20SIGNED%20FINAL.pdf (Comment on the Centers for Medicare Medicaid 
Services (CMS) Proposed Rule: Short-Term, Limited-Duration Insurance).
    \22\Id. at 3.
    \23\Noam N. Levey, Trump's New Insurance Rules are Panned by Nearly 
Every Healthcare Group that Submitted Formal Comments, LA Times (May 
30, 2018, 3:00 AM), https://www.latimes.com/politics/la-na-pol-trump-
insurance-opposition-20180530-story.html.
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Why Congressional action is needed to protect consumers, including 
        those with preexisting conditions

    STLDI is a threat to the wellbeing of millions of 
Americans, particularly those living with preexisting 
conditions. According to the U.S. Department of Health and 
Human Services, the number of Americans with preexisting 
conditions ranges from at least 61 million people (or 23 
percent of Americans)\24\ to as many as 133 million people (51 
percent of Americans).\25\ With respect to STLDI plans, there 
are no safeguards to protect these individuals against actions 
by insurers that would discriminate, deny coverage, medically 
underwrite, or otherwise not provide coverage to individuals 
with preexisting conditions who enroll or attempt to enroll in 
a policy.
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    \24\Based on a narrow definition using eligibility criteria for 
pre-ACA state high-risk pools. U.S. Department of Health and Human 
Services; see ASPE Issue Brief, Health Insurance Coverage for Americans 
with Preexisting Conditions: The Impact of the Affordable Care Act 1 
(2017), https://aspe.hhs.gov/system/files/pdf/255396/Pre-
ExistingConditions.pdf.
    \25\Based on a broader definition more similar to the underwriting 
criteria used by insurers prior to the ACA. Id.
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    On February 6, 2019, the House Committee on Education and 
Labor's hearing on ``Examining Threats to Workers with 
Preexisting Conditions'' explored this issue in more detail. As 
Congressman Robert C. ``Bobby'' Scott, Chairman of the 
Committee, noted in his opening statement, the lack of 
protections for patients with preexisting conditions and other 
federal consumer protections in STLDI plans poses a severe 
threat to millions of Americans.\26\ Dr. Rahul Gupta, Senior 
Vice President and Chief Medical and Health Officer for March 
of Dimes, testified that STLDI plans could be ``disastrous'' to 
the health of moms and babies because these plans often do not 
cover ``preventive care like contraception, as well as 
prenatal, maternity and newborn care.''\27\ Sabrina Corlette, 
Research Professor at the Georgetown University Health Policy 
Institute's Center on Health Insurance Reforms, testified that 
``[w]ith respect to the preexisting conditions . . . [STLDI 
plans] will look at your medical history and even if you were 
not given a formal diagnosis they might say that you had the 
condition . . . before you enrolled and might disenroll you 
because of that.''\28\
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    \26\Examining Threats to Workers with Preexisting Conditions, 
Before the H. Comm. on Education and Labor, 116th Cong. (2019) (opening 
statement of Congressman Robert C. ``Bobby'' Scott, Chairman, at 2).
    \27\Id. (written testimony of Rahul Gupta, Senior Vice President 
and Chief Medical and Health Officer for March of Dimes, at 10).
    \28\Id. (testimony of Sabrina Corlette, Research Professor at the 
Georgetown University Health Policy Institute's Center on Health 
Insurance Reforms).
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    Moreover, the expansion of STLDI threatens the overall 
stability of the larger health care market.\29\ As the Blue 
Cross Blue Shield Association noted in their comment on the 
Obama Administration's 2016 proposed rule, the expansion of 
STLDI would create ``two risk pools, the ACA pool for people 
with pre-existing conditions and the STLD[I] pool for persons 
without pre-existing conditions.''\30\ Similarly, multiple 
studies have found that the adverse selection associated with 
the expansion of SLDTI will have a deleterious impact on 
consumers enrolled in traditional health coverage.\31\ 
According to the Urban Institute, premiums in the nongroup 
market could be expected to increase by more than 18 percent in 
states that do not restrict these plans.\32\
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    \29\Letter from Congressman Frank Pallone, Jr., et al., to 
Secretary of the Treasury Steven Mnuchin, et al. (Jan. 8, 2019), 
https://energycommerce.house.gov/sites/
democrats.energycommerce.house.gov/files/documents/
Letter%20re%20the%20Administration 
%e2%80%99s%20Final%20Rule%20on%20Short-Term%20Plans.pdf.
    \30\Letter from Blue Cross Blue Shield Association (Aug. 9, 2016), 
https://www.regulations.gov/contentStreamer?documentId=IRS-2016-0021-
0127&attachmentNumber=1&contentType=pdf (Comments on Proposed Rule on 
Expatriate Health Plans, Expatriate Health Plan Issuers, and Qualified 
Expatriates; Excepted Benefits; Lifetime and Annual Limits; and Short-
Term, Limited-Duration Insurance).
    \31\Katie Keith, The Short-Term, Limited-Duration Coverage Final 
Rule: The Background, The Content, and What Could Come Next, Health 
Affairs (Aug. 1, 2018), https://www.healthaffairs.org/do/10.1377/
hblog20180801.169759/full/.
    \32\Linda J. Blumberg, et al., The Potential Impact of Short-Term, 
Limited Duration Policies on Insurance Coverage, Premiums, and Federal 
Spending 18 (2018), https://www.urban.org/sites/default/files/
publication/96781/stld_draft_0226_finalized_0.pdf.
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H.R. 1010 will protect consumers by reversing the Trump 
        Administration's harmful rule

    H.R. 1010 would undo the Trump Administration's harmful 
2018 rule that has expanded STLDI. The legislation would 
restore the treatment of these plans to their appropriate role 
as temporary insurance to fill an unexpected gap in coverage. 
It would also prevent consumers from being exposed to a future 
expansion of these harmful policies by ensuring that the 
Departments do not promulgate a substantially similar rule in 
the future.

Conclusion

    H.R. 1010 protects consumers from being denied coverage for 
a preexisting condition. By repealing the 2018 STLDI rule 
submitted by the U.S. Department of the Treasury, the U.S. 
Department of Labor, and the U.S. Department of Health and 
Human Services, H.R. 1010 helps protect Americans from heath 
care plans that arbitrarily limit coverage, lack consumer 
protections for preexisting conditions, and allow for 
discrimination.

                      SECTION-BY-SECTION ANALYSIS

    Section 1: States that the U.S. Department of the Treasury, 
the U.S. Department of Labor, and the U.S. Department of Health 
and Human Services may not take any action to implement, 
enforce, or otherwise give effect to the ``Short-Term, Limited-
Duration Insurance'' rule. It would further provide that the 
Departments may not promulgate any substantially similar rule 
in the future.

                       EXPLANATION OF AMENDMENTS

    The amendments offered during the Committee markup of H.R. 
1010 are explained in the descriptive portions of this report.

              APPLICATION OF LAW TO THE LEGISLATIVE BRANCH

    H.R. 1010 does not apply to terms and conditions of 
employment or to access to public services or accommodations 
within the legislative branch.

                       UNFUNDED MANDATE STATEMENT

    Pursuant to Section 423 of the Congressional Budget and 
Impoundment Control Act (as amended by Section 101(a)(2) of the 
Unfunded Mandates Reform Act, Pub. L. 104-4), H.R. 1010 
contains no unfunded mandates. The Committee adopts as its own 
the estimate of federal mandates regarding H.R. 1010, prepared 
by the Director of the Congressional Budget Office.

                           EARMARK STATEMENT

    In accordance with clause 9 of rule XXI of the Rules of the 
House of Representatives, H.R. 1010 does not contain any 
congressional earmarks, limited tax benefits, or limited tariff 
benefits as described in clauses 9(e), 9(f), and 9(g) of rule 
XXI.

                            ROLL CALL VOTES

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
following roll call votes occurred during the Committee's 
consideration of H.R. 1010:

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

             STATEMENT OF PERFORMANCE GOALS AND OBJECTIVES

    Pursuant to clause (3)(c) of rule XIII of the Rules of the 
House of Representatives, the goals of H.R. 1010 are to protect 
Americans' access to affordable and comprehensive health 
insurance and preserve consumer protections in health coverage.

                    DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII of the Rules of the 
House of Representatives, the Committee states that no 
provision of H.R. 1010 establishes or reauthorizes a program of 
the Federal Government known to be duplicative of another 
federal program, a program that was included in any report from 
the Government Accountability Office to Congress pursuant to 
section 21 of Public Law 111-139, or a program related to a 
program identified in the most recent Catalog of Federal 
Domestic Assistance.

                                HEARINGS

    Pursuant to section 103(i) of H. Res. 6 for the 116th 
Congress, the Committee held a legislative hearing entitled 
``Examining Threats to Workers with Preexisting Conditions,'' 
which was used to consider H.R. 1010. The Committee heard 
testimony on the threats posed by short-term, limited duration 
health plans to workers with preexisting conditions, including 
discrimination, higher costs, exclusions on coverage, and 
financial burden, among other issues. Witnesses included: Dr. 
Rahul Gupta, Senior Vice President and Chief Medical Health 
Officer, March of Dimes, Arlington, VA; Ms. Grace Marie Turner, 
President, Galen Institute, Paeonian Springs, VA; Ms. Sabrina 
Corlette, Research Professor, Georgetown University Health 
Policy Institute Center on Health Insurance Reforms, 
Washington, D.C.; and Mr. Chad Riedy, patient advocate living 
with Cystic Fibrosis, Alexandria, VA.

  STATEMENT OF OVERSIGHT FINDINGS AND RECOMMENDATIONS OF THE COMMITTEE

    In compliance with clause 3(c)(1) of rule XIII and clause 
2(b)(1) of rule X of the Rules of the House of Representatives, 
the Committee's oversight findings and recommendations are 
reflected in the descriptive portions of this report.

               NEW BUDGET AUTHORITY AND CBO COST ESTIMATE

    Pursuant to clause 3(c)(2) of rule XIII of the Rules of the 
House of Representatives and section 308(a) of the 
Congressional Budget Act of 1974, and pursuant to clause 
3(c)(3) of rule XIII of the Rules of the House of 
Representatives and section 402 of the Congressional Budget Act 
of 1974, the Committee has received the following estimate for 
H.R. 1010 from the Director of the Congressional Budget Office:

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, April 29, 2019.
Hon. Bobby Scott,
Chairman, Committee on Education and Labor,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1010, a bill to 
provide that the rule entitled ``Short-Term, Limited Duration 
Insurance'' shall have no force or effect.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Alice Burns 
and Kevin McNellis.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    

    H.R. 1010 would prevent the Administration from 
implementing or enforcing a recent regulation aimed at 
increasing the number of people with short-term limited 
duration insurance (short-term plans) and would prohibit the 
Administration from promulgating similar regulations in the 
future.
    CBO and JCT estimate that enacting the legislation would 
result in roughly 1.5 million fewer people purchasing short-
term plans each year over the 2020-2029 period. Of those, more 
than 500,000 would instead purchase nongroup coverage through 
the marketplaces established by the Affordable Care Act, a 
small number would obtain coverage through an employer, and 
about 500,000 would become uninsured. The agencies expect that 
additional enrollees in the nongroup market would have the 
effect of lowering nongroup premiums by about 1 percent on 
average because those enrollees are likely to be healthier than 
the average nongroup enrollee under current law.
    On net, CBO and JCT estimate that enacting H.R. 1010 would 
decrease the deficit by $8.9 billion over the 2019-2029 period 
primarily because premiums for subsidized nongroup insurance 
would be lower. That amount includes a $7.8 billion reduction 
in direct spending and a $1.1 billion increase in revenues.
    H.R. 1010 would impose a private-sector mandate as defined 
in the Unfunded Mandates Reform Act (UMRA) by restricting the 
terms under which insurers may offer short-term plans. CBO 
estimates the cost of the mandate, which would include the 
revenue lost as a result of the restriction, would exceed the 
private-sector threshold established by UMRA in each of the 
first five years the mandate is in effect ($164 million in 
2019, adjusted annually for inflation).
    Details of the estimated budgetary effects of H.R. 1010 are 
shown in Table 1. The costs of the legislation fall within 
budget function 550 (health).

                                                                       TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 1010
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                              By fiscal year, millions of dollars--
                                                                --------------------------------------------------------------------------------------------------------------------------------
                                                                   2019     2020     2021     2022     2023     2024     2025      2026       2027       2028       2029    2019-2024  2019-2029
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  Decreases in Direct Spending
 
Estimated Budget Authority.....................................        0     -289     -632     -746     -738     -806     -883       -873       -895       -928       -963     -3,211     -7,753
Estimated Outlays..............................................        0     -289     -632     -746     -738     -806     -883       -873       -895       -928       -963     -3,211     -7,753
 
                                                                                      Increases in Revenues
 
Estimated Revenues.............................................        0       33       74       91       96      114      109        144        149        160        132        409      1,103
    On-Budget..................................................        0        0        9       20       31       37       35         43         41         48         30         98        295
    Off-Budget.................................................        0       33       66       70       64       77       74        101        108        112        103        310        808
 
                                                              Decrease in the Deficit From Changes in Direct Spending and Revenues
 
Effect on the Deficit..........................................        0     -322     -706     -837     -834     -920     -992     -1,017     -1,044     -1,088     -1,095     -3,619     -8,856
    On-Budget..................................................        0     -289     -641     -767     -770     -843     -918       -916       -936       -976       -992     -3,309     -8,048
    Off-Budget.................................................        0      -33      -66      -70      -64      -77      -74       -101       -108       -112       -103       -310       -808
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Components may not sum to totals because of rounding. All off-budget effects would come from changes in Social Security revenues.
Sources: Congressional Budget Office; staff of the Joint Committee on Taxation.

    On April 25, 2019, CBO issued a cost estimate for H.R. 
1010, a bill to provide that the rule entitled ``Short-Term, 
Limited Duration Insurance'' shall have no force or effect, as 
ordered reported by the House Committee on Energy and Commerce 
on April 3, 2019. The two pieces of legislation are identical 
and CBO's estimate of their budgetary effects are the same.
    The CBO staff contacts for this estimate are Kevin McNellis 
and Alice Burns (for federal costs) and Andrew Laughlin (for 
mandates). The estimate was reviewed by Leo Lex, Deputy 
Assistant Director for Budget Analysis.

                        COMMITTEE COST ESTIMATE

    Clause 3(d)(1) of rule XIII of the Rules of the House of 
Representatives requires an estimate and a comparison of the 
costs that would be incurred in carrying out H.R. 1010. 
However, clause 3(d)(2)(B) of that rule provides that this 
requirement does not apply when the committee has included in 
its report a timely submitted cost estimate of the bill 
prepared by the Director of the Congressional Budget Office 
under section 402 of the Congressional Budget Act.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    The bill does not change existing law for purposes of 
clause 3(e) of rule XIII of the Rules of the House of 
Representatives.

                             MINORITY VIEWS

                              INTRODUCTION

    Committee Republicans have consistently promoted and 
supported policies to lower costs and improve competition in 
health care including Trump administration initiatives to 
expand access to Association Health Plans (AHPs), Short-Term 
Limited Duration Insurance Plans (STLDI), and Health 
Reimbursement Arrangements (HRAs). Committee Republicans agree 
with the Trump administration that the STLDI final rule 
provides additional and significant options for individuals 
struggling to afford insurance coverage.
Legislative History and Regulatory Definitions
    STLDI is designed for short-term coverage, and federal 
statutes have recognized the importance of making short-term 
options available to health care consumers for over 20 years. 
Because it is designed to fill coverage gaps, STLDI is 
deliberately excluded from the definition of ``individual 
health insurance coverage'' included in the Public Health 
Service Act (PHSA) as amended by the Health Insurance 
Portability and Accountability Act of 1996 (HIPAA). The 
Affordable Care Act (ACA) used the same definition, cross-
referencing the PHSA. This exemption from the definition of 
``individual health insurance coverage'' means that plans do 
not have to comply with federal requirements for health 
insurance, including rules under the ACA. As a result, these 
short-term plans can offer coverage at significantly lower 
prices for consumers in transition.
    Since the Clinton administration, STLDI was defined through 
regulation as health insurance coverage that expires less than 
12 months after the original effective date. In October 2016, 
the Department of Labor (DOL), Department of the Treasury 
(Treasury), and Department of Health and Human Services (HHS) 
under the Obama administration published a final rule that 
restricted STLDI to less than three months, effective January 
1, 2017.\1\ Instead of working to make health care more 
affordable, the previous administration, in the final weeks of 
President Obama's term, used a last-minute ploy to decrease 
affordable options by limiting the length of time a consumer 
could maintain STLDI coverage.
---------------------------------------------------------------------------
    \1\Excepted Benefits; Lifetime and Annual Limits; and Short-Term 
Limited Duration Insurance, 81 Fed. Reg. 75,316 (Oct. 31, 2016).
---------------------------------------------------------------------------
Trump Administration Actions
    On October 12, 2017, President Trump signed an executive 
order (EO) focused on expanding access to insurance options, 
including selling insurance across state lines.\2\ The EO 
directed DOL, HHS, and Treasury to issue new guidance and 
review existing regulations to allow more regulatory 
flexibility for AHPs, STLDI, and HRAs.
---------------------------------------------------------------------------
    \2\Exec. Order No. 13,813, 82 Fed. Reg. 48,385 (Oct. 17, 2017).
---------------------------------------------------------------------------
    In consultation with DOL and Treasury, HHS revised the 
Obama administration regulations limiting STLDI by allowing 
plans to be available to consumers for up to 364 days and 
renewable for up to 36 months.\3\ Even though federal 
regulations allow this duration and renewability, Democrats 
refuse to acknowledge that states are still able to issue and 
apply their own laws and requirements regarding STLDI, 
including restricting their sale or requiring STLDI to cover 
specific benefits. Restricting the allowable duration of STLDI 
in this manner eliminates access to short-term coverage for 
consumers that need it.
---------------------------------------------------------------------------
    \3\Short-Term, Limited-Duration Insurance, 83 Fed. Reg. 38,212 
(Aug. 3, 2018).
---------------------------------------------------------------------------
H.R. 1010: Legislation Which Eliminates Affordable Options for 
        Consumers
    Historically, health insurance coverage on the ACA Exchange 
(Exchange) has been very difficult for many consumers to 
afford. According to data from the Center for Medicare and 
Medicaid Services (CMS), after the ACA regulations took effect 
in 2014, average individual market premiums more than doubled 
from $2,784 per year in 2013 on HealthCare.gov to $5,712 on 
HealthCare.gov, an increase of $2,928 or 105 percent.\4\ In the 
HealthCare.gov states, between 2017 and 2018, the average 
premium increased by 37 percent, and between 2016 and 2017, the 
hike in average premiums was 25 percent.\5\ In October 2018, 
CMS announced that thanks to immediate actions taken by the 
Trump administration, the average premium for individual market 
plans dropped by 1.5 percent, the first time that average 
premiums dropped since the implementation of the federally-
facilitated Exchange in 2014.\6\
---------------------------------------------------------------------------
    \4\Centers For Medicare And Medicaid Serv., Premiums on the 
Federally-Facilitated Exchanges Drop in 2019 (Oct. 11, 2018).
    \5\Id.
    \6\Id.
---------------------------------------------------------------------------
    Market participation has also been a longstanding concern 
for the Exchange. From 2016 to 2017 alone, the number of 
insurance carriers offering plans on the Exchange decreased by 
nearly 30 percent.\7\ In 2018, 56 percent of U.S. counties on 
the federal platform had only one issuer offering coverage, 
while in 2019, after the Trump administration's market 
stabilization efforts, the number of counties with one issuer 
dropped to 39 percent.\8\
---------------------------------------------------------------------------
    \7\Id.
    \8\Id.
---------------------------------------------------------------------------
    STLDI plans, which would be prohibited by H.R. 1010, can 
represent more affordable, attractive options for individuals 
who are between jobs or cannot afford ACA coverage. In 
testimony to the House Committee on Energy and Commerce, Grace-
Marie Turner of the Galen Institute discussed the different 
circumstances where STLDI may benefit consumers:

          Short-term plans are helpful to people with gaps in 
        employment, to early retirees who no longer have 
        employer-sponsored health insurance and need bridge 
        coverage before they qualify for Medicare, people 
        between jobs, young people who no longer have coverage 
        from their parents and are working in the gig economy, 
        people who are leaving the workforce temporarily to 
        attend school or training programs, and entrepreneurs 
        starting new businesses. Premiums for short-term health 
        plans typically are less than half those of ACA plans.
          The administration's rule also extended consumer 
        protections. Under the Obama administration's previous 
        2016 rule, people could lose their coverage after three 
        months if they acquired a medical condition during the 
        three-month period. By extending the contract period, 
        people can be protected from a period of uninsurance 
        until the next ACA open enrollment period.\9\
---------------------------------------------------------------------------
    \9\Strengthening Our Health Care System: Legislation to Reverse ACA 
Sabotage and Ensure Pre-Existing Conditions Protections: Hearing on 
H.R. 986, H.R. 987, H.R. 1010, and H.R. 1143 Before the Subcomm. on 
Health of the H. Comm. on Energy and Commerce, 116th Cong. (2019) 
(statement of Grace-Marie Turner, President, Galen Institute).

    The Trump administration and HHS Secretary Alex Azar have 
stated that expanding STLDI will help people struggling to 
afford ACA coverage while still providing robust disclosure so 
that consumers know what benefits are covered under a STLDI 
policy. According to CMS, ``[i]n the fourth quarter of 2016, a 
short-term, limited-duration policy cost approximately $124 a 
month compared to $393 for an unsubsidized ACA-compliant 
plan.''\10\ The administration projected roughly 100,000 to 
200,000 individuals would move from ACA-compliant plans to 
STLDI in 2019.\11\
---------------------------------------------------------------------------
    \10\Centers for Medicare and Medicaid Serv., Fact Sheet: Short-
Term, Limited-Duration Insurance Proposed Rule (Feb. 20, 2018).
    \11\Id.
---------------------------------------------------------------------------
H.R. 1010 Does Not Improve Employer-Sponsored Coverage
    The Committee on Education and Labor has jurisdiction over 
the Employee Retirement Income Security Act (ERISA) and, 
therefore, jurisdiction over legislation and regulations 
affecting employer-provided health coverage. Approximately 152 
million Americans receive their coverage from an employer-
provided plan, the single largest source of health care 
coverage in the country.\12\
---------------------------------------------------------------------------
    \12\Kaiser Family Found., Employer Health Benefits Annual Survey 
(Oct. 2018).
---------------------------------------------------------------------------
    Notably, H.R. 1010 does not affect employer-sponsored 
coverage, and this Committee does not have jurisdiction over 
the statute (PHSA) that exempts STLDI from the definition of 
individual health insurance. Republican Leader Virginia Foxx 
(R-NC) noted this in her opening statement:

          This Committee has jurisdiction over employer-
        sponsored health care. Our focus should be on improving 
        those options. Rather than focus on this priority, we 
        are here today to consider H.R. 1010, which would 
        eliminate short-term limited duration insurance plans. 
        These plans are an obvious potential solution for 
        millions of Americans, working or not, who may find 
        themselves between jobs, or unable to afford rising 
        premiums in the already expensive individual 
        market.\13\
---------------------------------------------------------------------------
    \13\H.R. 1010, To provide that the rule entitled ``Short-Term, 
Limited Duration Insurance'' shall have no force or effect: Markup 
Before the H. Comm. on Educ. and Labor, 116th Cong. (2019) (statement 
of Virginia Foxx, Republican Leader, Committee on Education and Labor).

    Republican Leader Foxx also noted that this bill does 
nothing to address the main concerns of millions of hardworking 
---------------------------------------------------------------------------
Americans:

          H.R. 1010 is a one-sentence bill that will not lower 
        drug prices, will not protect anyone from surprise 
        billing, will not lower premiums, will not cut any out-
        of-pocket costs, and will not provide one cent of tax 
        relief. Its failure to achieve any of those objectives 
        makes it simply unacceptable to us as Republicans.\14\
---------------------------------------------------------------------------
    \14\Id.
---------------------------------------------------------------------------

H.R. 1010 Ignores Existing State and Federal Regulatory Authority

    H.R. 1010 invalidates the Trump administration's STLDI plan 
rule and prohibits the Secretaries of HHS, DOL, and Treasury 
from promulgating any substantially similar rules. Since 1996, 
Congress has chosen to deliberately exclude STLDI from the 
definition of ``individual health insurance'' included in 
HIPAA, the PHSA, and the ACA. Therefore, the Departments are 
within their authority to issue regulations defining STLDI, and 
should continue to propose regulations, such as the STLDI final 
rule, which promote affordability, flexibility, and market 
competition for consumers seeking health coverage.
    Additionally, under the Trump administration's STLDI rule, 
and under previous rules, states maintain the ability to 
prohibit or restrict sales or determine whether these policies 
should include certain benefits or services. Some states, such 
as New Jersey and California, have chosen to prohibit the sale 
of STLDI plans. Since states are the primary regulators of 
insurance markets, they make decisions based on the specific 
and varied needs of consumers in their state and local 
jurisdictions. States should continue to be allowed to regulate 
STLDI plans and their insurance markets in ways they see fit, 
but H.R. 1010 seeks to eliminate this state authority and 
market choice.

                         REPUBLICAN AMENDMENTS

    H.R. 1010 takes away affordable options for Americans 
struggling to afford health insurance coverage under the ACA. 
In an attempt to preserve the STLDI rule, Republican Committee 
members offered the following amendments.
    Representative Phil Roe (R-TN) questioned the Committee's 
motivation for spending time to debate an issue where the 
Committee has no jurisdiction over the underlying statute. He 
offered an amendment to codify the STLDI rule and allow for 
guaranteed renewability. The amendment was ruled by the 
Chairman to be not germane which underscored the fact that this 
Committee's consideration of H.R. 1010 is a political ploy to 
shield the costly, rigid plans offered under the ACA from 
competition while eliminating additional choice and flexible 
options that offer Americans the level of coverage they want at 
rates they can afford.
    Representative Dusty Johnson (R-SD) offered an amendment to 
add a section to H.R. 1010 to allow states to use the STLDI 
final rule's definition if they choose. Republicans embrace the 
principle of federalism and respect the judgment of state 
lawmakers and authorities similarly elected by the people to 
act in their state's best interest. What works best for one 
state may not be the best approach for others. Democrats 
disagreed with allowing the states this freedom and further 
demonstrated their desire to eliminate affordable options in 
favor of one-size-fits-all government-mandated coverage by 
defeating the amendment by a vote of 19-25.
    Representative Tim Walberg (R-MI) offered an amendment that 
would require the Secretaries of HHS, DOL, and Treasury to 
conduct a study to determine whether consumers who are 
considering purchasing an STLDI plan are provided with adequate 
information on coverage exclusions and premium variations in 
marketing resources, consumer application, and enrollment 
materials. STLDI coverage is one option for consumers 
struggling to afford ACA coverage and Republicans support 
affordable choices but also want to ensure that consumers have 
adequate information when purchasing STLDI. Under the Walberg 
amendment, if the study finds that these materials do not 
provide sufficient consumer information on these plans, H.R. 
1010 would take effect in 90 days. Otherwise, if the study 
finds consumer information is sufficient, H.R. 1010 would not 
go into effect. Despite claims from Democrats that consumers do 
not have enough information to make informed choices, the 
amendment was defeated by a vote of 19-26.
    Representative Ron Wright (R-TX) offered an amendment that 
allows the sale of STLDI in counties where the average Exchange 
benchmark premium increased by 20 percent or more in a year. 
Health care costs are one of the top areas of concern for 
American families, and this is especially true for consumers 
purchasing coverage on the individual market. If consumers are 
faced with double digit premium increases, affordable and 
flexible plan options should be preserved. Although the Wright 
amendment preserves choice and recognizes that consumers have 
unique needs and want more affordable coverage, Democrats 
defeated it by a vote of 19-26.
    Representative William Timmons (R-SC) offered an amendment 
to allow the sale of STLDI in counties where fewer than two 
issuers offer coverage on the Exchange. Cost is not the only 
concern for American families as many consumers who purchase 
Exchange coverage often have few plan options. Although the 
Timmons amendment preserves choice in places that need it most, 
Democrats defeated it by a vote of 19-26.

                               CONCLUSION

    H.R. 1010 eliminates affordable and flexible options for 
Americans struggling to find health insurance coverage for 
themselves and their families at a time when they need options 
most. H.R. 1010 reduces consumer choice, does not improve 
employer-sponsored coverage, and fails to respect federalism 
and the role of state and federal regulatory authority. H.R. 
1010 also attacks policies issued under a statute which is not 
in the jurisdiction of this Committee. For these reasons and 
those outlined above, Committee Republicans strongly oppose 
enactment of H.R. 1010 as reported by the Committee on 
Education and Labor.

                                   Virginia Foxx,
                                           Ranking Member.
                                   David P. Roe.
                                   Glenn ``GT'' Thompson.
                                   Tim Walberg.
                                   Brett Guthrie.
                                   Bradley Byrne.
                                   Glenn Grothman.
                                   Elise M. Stefanik.
                                   Rick W. Allen.
                                   Francis Rooney.
                                   Lloyd Smucker.
                                   Jim Banks.
                                   Mark Walker.
                                   James Comer.
                                   Ben Cline.
                                   Russ Fulcher.
                                   Van Taylor.
                                   Steven C. Watkins, Jr.
                                   Ron Wright.
                                   Daniel Meuser,
                                   William R. Timmons IV.
                                   Dusty Johnson.

                                  [all]