July 25, 2018 CONGRESSIONAL RECORD — HOUSE H7651 I announce my support for this reso- Chairman THORNBERRY and Chairman than $250 of specified services for self-only cov- lution, along with the two previous res- GRANGER for their important efforts. erage (twice such amount in the case of family olutions, and look forward to its imme- Mr. Speaker, I urge adoption of this coverage) during a plan year. diate passage. resolution, and I yield back the balance ‘‘(ii) SPECIFIED SERVICES.—For purposes of Mr. Speaker, I yield back the balance this subparagraph, the term ‘specified services’ of my time. means, with respect to a plan, services other of my time. The SPEAKER pro tempore. The than preventive care (within the meaning of Ms. CHENEY. Mr. Speaker, I yield question is on the motion offered by subparagraph (C)) identified under the terms of myself the balance of my time. the gentlewoman from Wyoming (Ms. the plan as being services to which clause (i) ap- Mr. Speaker, I thank my colleague, CHENEY) that the House suspend the plies.’’. Mr. GARAMENDI from California, for his rules and agree to the resolution, H.R. (b) INFLATION ADJUSTMENT.—Section 223(g)(1) support of these resolutions and for his 1007. of such Code is amended— time focusing on them today on the The question was taken; and (two- (1) by striking ‘‘and (c)(2)(A)’’ each place it appears and inserting ‘‘, (c)(2)(A), and floor. thirds being in the affirmative) the I also want to thank my colleague (c)(2)(E)’’, and rules were suspended and the resolu- from Oklahoma. There is no stronger (2) in subparagraph (B)— tion was agreed to. supporter of our men and women in (A) by striking ‘‘such taxable year’’ in the A motion to reconsider was laid on matter preceding clause (i) and inserting ‘‘the uniform that I know of in this body the table. taxable year (plan year in the case of the dollar than Mr. RUSSELL from Oklahoma. He amount in subsection (c)(2)(E))’’, and understands, I would say, more than f (B) by striking ‘‘clause (ii)’’ and inserting most because of his own service that RESTORING ACCESS TO ‘‘clauses (ii) and (iii)’’ in clause (i), by striking what we do in this body and what we do MEDICATION ACT OF 2018 ‘‘and’’ at the end of clause (i), by striking the on this floor has a direct impact on the period at the end of clause (ii) and inserting ‘‘, levels of risk, on the safety, and on the Ms. JENKINS of Kansas. Mr. Speak- and’’, and by inserting after clause (ii) the fol- effectiveness of our men and women in er, pursuant to House Resolution 1012, I lowing new clause: ‘‘(iii) in the case of the dollar amount in sub- uniform. call up the bill (H.R. 6199) to amend the Internal Revenue Code of 1986 to in- section (c)(2)(E) for plan years beginning in cal- Mr. Speaker, this resolution high- endar years after 2019, ‘calendar year 2018’.’’. lights the damage that we have seen to clude certain over-the-counter medical products as qualified medical expenses, (c) EFFECTIVE DATE.—The amendments made the readiness of the United States by this section shall apply with respect to plan Army over 9 years of continuing reso- and ask for its immediate consider- years beginning after December 31, 2018. ation. lutions, sequestration, and overall SEC. 3. TREATMENT OF DIRECT PRIMARY CARE budget dysfunction. The Clerk read the title of the bill. SERVICE ARRANGEMENTS. I want to echo the remarks of my The SPEAKER pro tempore. Pursu- (a) IN GENERAL.—Section 223(c)(1) of the In- colleague from Oklahoma. Let’s change ant to House Resolution 1012, in lieu of ternal Revenue Code of 1986 is amended by add- that. Let’s make this a new start. Let’s the amendment in the nature of a sub- ing at the end the following new subparagraph: make this the year that we don’t hold stitute recommended by the Com- ‘‘(D) TREATMENT OF DIRECT PRIMARY CARE military funding hostage and we pass a mittee on Ways and Means printed in SERVICE ARRANGEMENTS.— the bill, an amendment in the nature of ‘‘(i) IN GENERAL.—A direct primary care serv- clean Defense Appropriations bill. We ice arrangement shall not be treated as a health have done it here in the House. We a substitute consisting of the text of plan for purposes of subparagraph (A)(ii). know they can do it in the Senate. We Rules Committee Print 115–82 is adopt- ‘‘(ii) DIRECT PRIMARY CARE SERVICE ARRANGE- need to get the bill, take it up, and ed, and the bill, as amended, is consid- MENT.—For purposes of this paragraph— pass it. ered read. ‘‘(I) IN GENERAL.—The term ‘direct primary All these other arguments and dis- The text of the bill, as amended, is as care service arrangement’ means, with respect to cussions are important. They are im- follows: any individual, an arrangement under which such individual is provided medical care (as de- portant for the future of the Nation. H.R. 6199 They are important for our economy. fined in section 213(d)) consisting solely of pri- Be it enacted by the Senate and House of Rep- mary care services provided by primary care But we should not force our men and resentatives of the United States of America in practitioners (as defined in section 1833(x)(2)(A) women in uniform to have to wait, to Congress assembled, of the Social Security Act, determined without have stand by and watch, not knowing SECTION 1. SHORT TITLE; TABLE OF CONTENTS. regard to clause (ii) thereof), if the sole com- whether we are going to be able to pass (a) SHORT TITLE.—This Act may be cited as pensation for such care is a fixed periodic fee. the bills that they need for the funding the ‘‘Restoring Access to Medication and Mod- ‘‘(II) LIMITATION.—With respect to any indi- they need to continue to keep us all ernizing Health Savings Accounts Act of 2018’’. vidual for any month, such term shall not in- safe. (b) TABLE OF CONTENTS.—The table of con- clude any arrangement if the aggregate fees for We did our job for fiscal year 2018, al- tents for this Act is as follows: all direct primary care service arrangements (de- though we were too slow, but we have Sec. 1. Short title; table of contents. termined without regard to this subclause) with Sec. 2. First dollar coverage flexibility for high respect to such individual for such month ex- now appropriated the $700 billion for ceed $150 (twice such dollar amount in the case that fiscal year. Let’s do it this year on deductible health plans. Sec. 3. Treatment of direct primary care service of an individual with any direct primary care time, with sufficient funding, and with arrangements. service arrangement (as so determined) that cov- a level of accountability, and also Sec. 4. Certain employment related services not ers more than one individual). making sure that our men and women treated as disqualifying coverage ‘‘(iii) CERTAIN SERVICES SPECIFICALLY EX- in uniform know that those funds are for purposes of health savings ac- CLUDED FROM TREATMENT AS PRIMARY CARE coming to them. counts. SERVICES.—For purposes of this paragraph, the It is going to take us more than a Sec. 5. Contributions permitted if spouse has a term ‘primary care services’ shall not include— single year to get ourselves out of the health flexible spending account. ‘‘(I) procedures that require the use of general Sec. 6. FSA and HRA terminations or conver- anesthesia, crisis we face, Mr. Speaker. We have ‘‘(II) prescription drugs (other than vaccines), made a good start. But I think we sions to fund HSAs. Sec. 7. Inclusion of certain over-the-counter and should all come together, both sides of medical products as qualified ‘‘(III) laboratory services not typically admin- the aisle and, frankly, on both sides of medical expenses. istered in an ambulatory primary care setting. Capitol Hill, to say: Look, this is an Sec. 8. Certain amounts paid for physical activ- The Secretary, after consultation with the Sec- issue on which we are going to agree. ity, fitness, and exercise treated retary of Health and Human Services, shall The security of the Nation is an issue as amounts paid for medical care. issue regulations or other guidance regarding that ought to cross party lines. The SEC. 2. FIRST DOLLAR COVERAGE FLEXIBILITY the application of this clause.’’. support that we are seeing for this res- FOR HIGH DEDUCTIBLE HEALTH (b) DIRECT PRIMARY CARE SERVICE ARRANGE- olution and for all the resolutions we PLANS. MENT FEES TREATED AS MEDICAL EXPENSES.— have done for our services dem- (a) IN GENERAL.—Section 223(c)(2) of the In- Section 223(d)(2)(C) is amended by striking ‘‘or’’ ternal Revenue Code of 1986 is amended by add- at the end of clause (iii), by striking the period onstrates that. Let’s make this the ing at the end the following new subparagraph: at the end of clause (iv) and inserting ‘‘, or’’, year that we do it differently and we do ‘‘(E) FIRST DOLLAR COVERAGE FLEXIBILITY.— and by adding at the end the following new it right, Mr. Speaker. ‘‘(i) IN GENERAL.—A plan shall not fail to be clause: With that, I thank everyone who has treated as a high deductible health plan by rea- ‘‘(v) any direct primary care service arrange- participated in this effort. I thank son of failing to have a deductible for not more ment.’’.

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(c) INFLATION ADJUSTMENT.—Section 223(g)(1) of clause (ii), by striking the period at the end (1) IN GENERAL.—Section 6051(a) of such Code, of such Code, as amended by section 2(b), is of clause (iii) and inserting ‘‘, and’’, and by in- as amended by section 3(d), is amended by strik- amended— serting after clause (iii) the following new ing ‘‘and’’ at the end of paragraph (17), by (1) by inserting ‘‘(c)(1)(D)(ii)(II),’’ after clause: striking the period at the end of paragraph (18) ‘‘(b)(2),’’ each place it appears, and ‘‘(iv) coverage under a health flexible spend- and inserting ‘‘, and’’, and by inserting after (2) in subparagraph (B), by striking ‘‘and ing arrangement of the spouse of the individual paragraph (18) the following new paragraph: (iii)’’ and inserting ‘‘, (iii) and (iv)’’ in clause for any plan year of such arrangement if the ‘‘(19) the amount of any qualified HSA dis- (i), by striking ‘‘and’’ at the end of clause (ii), aggregate reimbursements under such arrange- tribution (as defined in section 106(e)(2)) with by striking the period at the end of clause (iii) ment for such year do not exceed the aggregate respect to such employee.’’. and inserting ‘‘, and’’, and by inserting after expenses which would be eligible for reimburse- (2) CONFORMING AMENDMENT.—Section clause (iii) the following new clause: ment under such arrangement if such expenses 6051(a)(12) of such Code is amended by inserting ‘‘(iv) in the case of the dollar amount in sub- were determined without regard to any expenses ‘‘(other than any qualified HSA distribution, as section (c)(1)(D)(ii)(II) for taxable years begin- paid or incurred with respect to such indi- defined in section 106(e)(2))’’ before the comma ning in calendar years after 2019, ‘calendar year vidual.’’. at the end. 2018’.’’. (b) EFFECTIVE DATE.—The amendment made (e) EFFECTIVE DATE.—The amendments made (d) REPORTING OF DIRECT PRIMARY CARE by this section shall apply to plan years begin- by this section shall apply to distributions made SERVICE ARRANGEMENT FEES ON W–2.—Section ning after December 31, 2018. after December 31, 2018, in taxable years ending 6051(a) of such Code is amended by striking SEC. 6. FSA AND HRA TERMINATIONS OR CON- after such date. ‘‘and’’ at the end of paragraph (16), by striking VERSIONS TO FUND HSAS. SEC. 7. INCLUSION OF CERTAIN OVER-THE- the period at the end of paragraph (17) and in- (a) IN GENERAL.—Section 106(e)(2) of the In- COUNTER MEDICAL PRODUCTS AS serting ‘‘, and’’, and by inserting after para- ternal Revenue Code of 1986 is amended to read QUALIFIED MEDICAL EXPENSES. graph (17) the following new paragraph: as follows: (a) HSAS.—Section 223(d)(2) of the Internal ‘‘(18) in the case of a direct primary care serv- ‘‘(2) QUALIFIED HSA DISTRIBUTION.—For pur- Revenue Code of 1986 is amended— ice arrangement (as defined in section poses of this subsection— (1) by striking the last sentence of subpara- 223(c)(1)(D)(ii)) which is provided in connection ‘‘(A) IN GENERAL.—The term ‘qualified HSA graph (A) and inserting the following: ‘‘For with employment, the aggregate fees for such distribution’ means, with respect to any em- purposes of this subparagraph, amounts paid arrangement for such employee.’’. ployee, a distribution from a health flexible for menstrual care products shall be treated as (e) EFFECTIVE DATE.—The amendments made spending arrangement or health reimbursement paid for medical care.’’, and by this section shall apply to months beginning arrangement of such employee directly to a (2) by adding at the end the following new after December 31, 2018, in taxable years ending health savings account of such employee if— subparagraph: after such date. ‘‘(i) such distribution is made in connection ‘‘(D) MENSTRUAL CARE PRODUCT.—For pur- with such employee establishing coverage under poses of this paragraph, the term ‘menstrual SEC. 4. CERTAIN EMPLOYMENT RELATED SERV- care product’ means a tampon, pad, liner, cup, ICES NOT TREATED AS DISQUALI- a high deductible health plan (as defined in sec- FYING COVERAGE FOR PURPOSES OF tion 223(c)(2)) after a significant period of not sponge, or similar product used by women with HEALTH SAVINGS ACCOUNTS. having such coverage, and respect to menstruation or other genital-tract se- (a) IN GENERAL.—Section 223(c)(1) of the In- ‘‘(ii) such arrangement is described in section cretions.’’. ternal Revenue Code of 1986, as amended by sec- 223(c)(1)(B)(iii) with respect to the portion of (b) ARCHER MSAS.—Section 220(d)(2)(A) of tion 3(a), is amended by adding at the end the the plan year after such distribution is made. such Code is amended by striking the last sen- following new subparagraph: ‘‘(B) DOLLAR LIMITATION.—The aggregate tence and inserting the following: ‘‘For purposes ‘‘(E) SPECIAL RULE FOR QUALIFIED ITEMS AND amount of distributions from health flexible of this subparagraph, amounts paid for men- SERVICES.— spending arrangements and health reimburse- strual care products (as defined in section ‘‘(i) IN GENERAL.—An individual shall not be ment arrangements of any employee which may 223(d)(2)(D)) shall be treated as paid for medical treated as covered under a health plan for pur- be treated as qualified HSA distributions in con- care.’’. poses of subparagraph (A)(ii) merely because the nection with an establishment of coverage de- (c) HEALTH FLEXIBLE SPENDING ARRANGE- individual, in connection with the employment scribed in subparagraph (A)(i) shall not exceed MENTS AND HEALTH REIMBURSEMENT ARRANGE- of the individual or the individual’s spouse, re- the dollar amount in effect under section MENTS.—Section 106 of such Code is amended by ceives (or is eligible to receive) qualified items 125(i)(1) (twice such amount in the case of cov- striking subsection (f) and inserting the fol- and services at— erage which is described in section lowing new subsection: ‘‘(I) a healthcare facility located at a facility 223(b)(2)(B)).’’. ‘‘(f) REIMBURSEMENTS FOR MENSTRUAL CARE owned or leased by the employer of the indi- (b) PARTIAL REDUCTION OF LIMITATION ON DE- PRODUCTS.—For purposes of this section and vidual (or of the individual’s spouse), or oper- DUCTIBLE HSA CONTRIBUTIONS.—Section section 105, expenses incurred for menstrual care ated primarily for the benefit of such employer’s 223(b)(4) of such Code is amended by striking products (as defined in section 223(d)(2)(D)) employees, or ‘‘and’’ at the end of subparagraph (B), by strik- shall be treated as incurred for medical care.’’. ‘‘(II) a healthcare facility located within a su- ing the period at the end of subparagraph (C) (d) EFFECTIVE DATES.— permarket, pharmacy, or similar retail establish- and inserting ‘‘, and’’, and by inserting after (1) DISTRIBUTIONS FROM HEALTH SAVINGS AC- ment. subparagraph (C) the following new subpara- COUNTS.—The amendments made by subsections (a) and (b) shall apply to amounts paid after ‘‘(ii) QUALIFIED ITEMS AND SERVICES DE- graph: December 31, 2018. FINED.—For purposes of this subparagraph, the ‘‘(D) so much of any qualified HSA distribu- (2) REIMBURSEMENTS.—The amendment made term ‘qualified items and services’ means the fol- tion (as defined in section 106(e)(2)) made to a by subsection (c) shall apply to expenses in- lowing: health savings account of such individual dur- curred after December 31, 2018. ‘‘(I) Physical examinations. ing the taxable year as does not exceed the ag- ‘‘(II) Immunizations, including injections of gregate increases in the balance of the arrange- SEC. 8. CERTAIN AMOUNTS PAID FOR PHYSICAL antigens provided by employees. ment from which such distribution is made ACTIVITY, FITNESS, AND EXERCISE TREATED AS AMOUNTS PAID FOR ‘‘(III) Drugs other than a prescribed drug (as which occur during the portion of the plan year MEDICAL CARE. such term is defined in section 213(d)(3)). which precedes such distribution (other than (a) IN GENERAL.—Section 213(d)(1) of the In- ‘‘(IV) Treatment for injuries occurring in the any balance carried over to such plan year and ternal Revenue Code of 1986 is amended by course of employment. determined without regard to any decrease in striking ‘‘or’’ at the end of subparagraph (C), by ‘‘(V) Drug testing, if required as a condition such balance during such portion of the plan striking the period at the end of subparagraph of employment. year).’’. (D) and inserting ‘‘, or’’, and by adding at the ONVERSION TO HSA-COMPATIBLE AR- ‘‘(VI) Hearing or vision screenings. (c) C end the following new subparagraph: ‘‘(VII) Other similar items and services that RANGEMENT FOR REMAINDER OF PLAN YEAR.— ‘‘(E) for qualified sports and fitness ex- do not provide significant benefits in the nature Section 223(c)(1)(B)(iii) of such Code, as amend- penses.’’. of medical care. ed by section 5(a), is amended to read as fol- (b) QUALIFIED SPORTS AND FITNESS EX- ‘‘(iii) AGGREGATION.—For purposes of clause lows: PENSES.—Section 213(d) of such Code is amended (i)(I), all persons treated as a single employer ‘‘(iii) coverage under a health flexible spend- by adding at the end the following paragraph: under subsection (b), (c), (m), or (o) of section ing arrangement or health reimbursement ar- ‘‘(12) QUALIFIED SPORTS AND FITNESS EX- 414 shall be treated as a single employer.’’. rangement for the portion of the plan year after PENSES.— (b) EFFECTIVE DATE.—The amendments made a qualified HSA distribution (as defined in sec- ‘‘(A) IN GENERAL.—The term ‘qualified sports by this section shall apply to months beginning tion 106(e)(2) determined without regard to sub- and fitness expenses’ means amounts paid for— after December 31, 2018, in taxable years ending paragraph (A)(ii) thereof) is made, if the terms ‘‘(i) membership at a fitness facility, after such date. of such arrangement which apply for such por- ‘‘(ii) participation or instruction in a program SEC. 5. CONTRIBUTIONS PERMITTED IF SPOUSE tion of the plan year are such that, if such of qualified physical activity, or HAS A HEALTH FLEXIBLE SPENDING terms applied for the entire plan year, then such ‘‘(iii) safety equipment for use in a program ACCOUNT. arrangement would not be taken into account (including a self-directed program) of qualified (a) CONTRIBUTIONS PERMITTED IF SPOUSE HAS under subparagraph (A)(ii) of this paragraph physical activity. A HEALTH FLEXIBLE SPENDING ACCOUNT.—Sec- for such plan year, and’’. ‘‘(B) LIMITATIONS.— tion 223(c)(1)(B) of the Internal Revenue Code (d) INCLUSION OF QUALIFIED HSA DISTRIBU- ‘‘(i) OVERALL DOLLAR LIMITATION.—The ag- of 1986 is amended by striking ‘‘and’’ at the end TIONS ON W–2.— gregate amount treated as qualified sports and

VerDate Sep 11 2014 07:22 Jul 26, 2018 Jkt 079060 PO 00000 Frm 00014 Fmt 4634 Sfmt 6333 E:\CR\FM\A25JY7.019 H25JYPT2 lotter on DSKBCFDHB2PROD with HOUSE July 25, 2018 CONGRESSIONAL RECORD — HOUSE H7653 fitness expenses with respect to any taxpayer for The SPEAKER pro tempore. Is there counter medicines. This legislation any taxable year shall not exceed $500 (twice objection to the request of the gentle- would end the need for those prescrip- such amount in the case of a joint return or a woman from Kansas? tions. head of household (as defined in section 2(b))). There was no objection. It doesn’t make any sense to require ‘‘(ii) DOLLAR LIMITATION ON SAFETY EQUIP- Ms. JENKINS of Kansas. Mr. Speak- the millions of American families that MENT.—The amount treated as qualified sports and fitness expenses with respect to any item of er, I yield myself such time as I may use HSAs and FSAs to manage their safety equipment described in subparagraph consume. healthcare needs to go to the doctor in (A)(iii) shall not exceed $250. Mr. Speaker, I am pleased to come to order to access over-the-counter medi- ‘‘(iii) EXCLUSION OF EXERCISE VIDEOS, ETC.— the floor today to speak in support of cines for things like basic pain man- Qualified sports and fitness expenses shall not the Restoring Access to Medication agement and cold and allergy symp- include videos, books, or similar materials. and Modernizing Health Savings Ac- toms. ‘‘(C) QUALIFIED PHYSICAL ACTIVITY.—For pur- count Act of 2018. Nobody benefits from this nonsen- poses of this paragraph— This legislation makes a variety of sical policy that requires consumers to ‘‘(i) IN GENERAL.—Except as provided in simple but much-need changes to clause (ii), the term ‘qualified physical activity’ jump through unnecessary hoops and means any physical exercise or physical activ- health savings accounts, or HSAs, rules increases the burdens on the ity. to ensure that folks have more access healthcare system, all while providing ‘‘(ii) EXCLUSIONS.—The Secretary, after con- and choice when using their HSAs. no medical benefit. Over-the-counter sultation with the Secretary of Health and This bill contains five separate bipar- medicines are often the frontline treat- Human Services, shall issue guidance to deter- tisan pieces of legislation that passed ment for many common illnesses and mine for purposes of this paragraph what does the Ways and Means Committee earlier for maintenance of chronic diseases, not constitute a qualified physical activity, in- this month. It includes a bipartisan and they should be treated as medi- cluding golf, hunting, sailing, horseback riding, policy by Mr. ROSKAM and Mr. THOMP- and other similar activities. cally reimbursable healthcare thera- SON that would allow HSA-eligible ‘‘(D) FITNESS FACILITY DEFINED.—For pur- pies, just as prescription medications. poses of subparagraph (A)(i), the term ‘fitness plans to offer a certain amount of first- Mr. Speaker, I am pleased the House facility’ means a facility— dollar coverage in their plan design is considering H.R. 6199, which gives in- ‘‘(i) providing instruction in a program of without losing their HSA-eligibility. dividuals and families more control qualified physical activity or facilities for quali- This allows HSA plans to offer cov- over their healthcare spending and in- fied physical activity, erage for valuable services like tele- creases their options when it comes to ‘‘(ii) which is not a private club owned and health or primary care appointments health savings accounts. operated by its members, without a deductible. Today marks a nice opportunity to ‘‘(iii) whose health or fitness facility is not in- The bill permits patients with HSAs cidental to its overall function and purpose, and pass bipartisan legislation to simply ‘‘(iv) which is fully compliant with applicable to access the innovative and patient- make it easier for consumers to meet State and Federal anti-discrimination laws. centered direct primary care arrange- their basic medical needs. These are ‘‘(E) PROGRAMS WHICH INCLUDE COMPONENTS ments with HSA plans, provisions commonsense, simple, bipartisan solu- OTHER QUALIFIED PHYSICAL ACTIVITY.—Rules championed by the bipartisan team of tions, and I urge my colleagues to sup- similar to the rules of paragraph (6) shall apply Mr. PAULSEN and Mr. BLUMENAUER. port this legislation. in the case of any program or facility that in- The bill also allows coverage for cer- Mr. Speaker, I reserve the balance of cludes qualified physical activity (or facilities tain medical services from a retail or my time. therefore) and also other components. For pur- onsite clinic and permits contributions Mr. BLUMENAUER. Mr. Speaker, I poses of the preceding sentence, travel and ac- commodations shall be treated as an other com- to an HSA if their spouse has a health yield myself such time as I may con- ponent. FSA, which is prohibited today. sume. ‘‘(F) INFLATION ADJUSTMENT.—In the case of Another commonsense provision in Mr. Speaker, I am pleased to be here any taxable year beginning in a calendar year the bill allows rollovers from other with Ms. JENKINS, moving forward on after 2019, the $500 amount in subparagraph tax-advantaged health accounts to be this legislation. It represents an oppor- (B)(i) and the $250 amount in subparagraph able to fund HSAs. These proposals tunity for us to deal with a series of, as (B)(ii) shall each be increased by an amount were included in Mr. KELLY and Mr. she mentioned, bipartisan ideas, rel- equal to— BLUMENAUER’s bipartisan legislation. atively simple, to enhance service de- ‘‘(i) such dollar amount, multiplied by Additionally, this bill contains the livery. ‘‘(ii) the cost-of-living adjustment determined under section 1(f)(3) for the calendar year in PHIT Act, introduced in a bipartisan I state from the outset that I am which such taxable year begins, determined by manner by Mr. JASON SMITH and Mr. troubled that we were not able to pro- substituting ‘calendar year 2018’ for ‘calendar KIND, that would allow certain quali- vide opportunities to pay for these. year 2016’ in subparagraph (A)(ii) thereof. fied fitness expenses to be eligible They carry a cost. In committee, even If any increase determined under the preceding items that can be paid for with tax-ad- though I thought they were a good sentence is not a multiple of $10, such increase vantaged dollars, offsetting a portion idea, I voted against some of them be- shall be rounded to the next lowest multiple of of their costs and promoting healthy cause they were rather expensive. $10.’’. activity. In the aggregate, these are things, (c) EFFECTIVE DATE.—The amendments made Lastly, this legislation repeals the moving forward, that will improve by this section shall apply to taxable years be- Affordable Care Act’s unnecessary bar- healthcare, and I am hopeful that, as ginning after December 31, 2018. riers when it comes to using tax-advan- we move along the process, we can find The SPEAKER pro tempore. The bill, taged health accounts to purchase some ways to offset the costs involved. as amended, shall be debatable for 1 over-the-counter medicines, something Some of us have philosophical ques- hour equally divided and controlled by that I have been pleased to work on tions about the role of HSAs and how it the chair and ranking minority mem- with my good friend Congressman KIND fits overall, but this legislation will ber of the Committee on Ways and for the last several years, and I am en- make key consumer-friendly improve- Means. couraged that the bipartisan duo of ments to our existing system. Direct The gentlewoman from Kansas (Ms. Representatives MENG and PAULSEN primary care medical homes are an im- JENKINS) and the gentleman from Or- have also joined us in introducing the portant example of successful delivery egon (Mr. BLUMENAUER) each will con- underlying legislation. reforms that will become easier to ac- trol 30 minutes. In addition to expanding access for cess under this legislation. The Chair recognizes the gentle- over-the-counter medication, the bill DPC arrangements offer individuals woman from Kansas. also allows for feminine hygiene prod- access to comprehensive primary care GENERAL LEAVE ucts to be considered a qualified med- and prevention services in a medical Ms. JENKINS of Kansas. Mr. Speak- ical expense. home setting for a flat monthly fee, as er, I ask unanimous consent that all Since the passage of the Affordable opposed to concierge services that Members may have 5 legislative days Care Act, Americans have had to seek some people have in mind. Most of within which to revise and extend their prescriptions in order to use their these practices typically charge a low remarks and include extraneous mate- health savings and flexible spending monthly fee, perhaps $50 to $100, in rials on the bill under consideration. accounts on safe and effective over-the- most cases, and they serve low- and

VerDate Sep 11 2014 07:22 Jul 26, 2018 Jkt 079060 PO 00000 Frm 00015 Fmt 4634 Sfmt 0634 E:\CR\FM\A25JY7.019 H25JYPT2 lotter on DSKBCFDHB2PROD with HOUSE H7654 CONGRESSIONAL RECORD — HOUSE July 25, 2018 moderate-income patients. These fees the Affordable Care Act by the admin- Ms. JENKINS of Kansas. Mr. Speak- support the delivery of high-quality, istration and some of my Republican er, I yield 3 minutes to the gentleman coordinated care by providing better colleagues. By zeroing out the mandate from South Carolina (Mr. RICE), a dis- healthcare upfront in primary care set- penalty, estimates are that insurance tinguished member of the House Ways tings. premiums will rise 15 percent. None of and Means Committee. DPC practices reduce unnecessary these bills before us today undo that Mr. RICE of South Carolina. Mr. hospital and specialty care, as well as premium hike that is visited upon our Speaker, I am proud to stand before administrative expenses. This empow- constituents unnecessarily. you today to discuss two bills that ex- ers the doctor-patient relationship, en- These premium increases are coming pand choice and offer lower cost. And abling providers to resist financial in- after Republicans gave insurance com- lower cost and choice are what are centives that distort the decision- panies billions in tax cuts in their tax needed in healthcare. making process in primary care. bills. Republican attempts to expand Back home in South Carolina, the av- It also reduces the conveyor belt HSAs is no replacement for the Afford- erage premium before ObamaCare, in process, where people are typically able Care Act’s financial assistance. 2013, in the individual market, was shuttled into the office in 8-minute in- Attempts to expand HSAs are a con- $233. In 2017—which the premiums were crements. This is not the case in direct tinuation of a platform of shifting fam- set before the President took office— primary care. It is not uncommon for ilies into health plans which provide before the ‘‘assault’’ on ObamaCare appointments to last half an hour or fewer health benefits and higher out-of- that my colleague was speaking of, the even an hour. So they build a better re- pocket costs, while providing greater premium reached $512. That is a $279- lationship with patients, and they are tax benefits for those who need them per-month increase in 4 years, a 120 able to better understand and address least. percent increase from 2013 to 2017. healthcare needs. HSAs and high-deductible healthcare Before ObamaCare, 85 percent of the By offering a high level of access to plans shift costs to consumers without people in the country were covered by primary care, evidence shows that di- bending the cost curve or addressing health insurance. At the peak, under rect primary care medical homes im- underlying costs of medical care in the the Affordable Care Act, 91 percent were covered. So we covered 6 percent prove health outcomes and reduce United States. I think we can and more people, and that is a good thing. costs. Today, DPC medical homes serve should do better. But what was the cost of that? To individuals of all ages and income in at For instance, the President has cover 6 percent more of our population, least 47 States. promised action on lowering prescrip- the other 85 percent, who were already This legislation simplifies existing tion drug costs. These bills today do covered, either by Medicare, Medicaid, IRS regulations and clarifies that di- nothing to lower the cost of drugs con- or private insurance, had to pay an- rect primary care medical homes are sumers buy, and seek to move more other 120 percent on their premiums in qualified health expenses—medical people into plans that provide only cat- South Carolina, 105 percent nation- services—and not health plans. astrophic coverage, exposing more peo- wide. And the premiums are going to I personally question the IRS ruling. ple to pay the full freight of drug price go up double digits again this year. hikes. We have debated with them, but we We need lower cost, and we need Now, we have legislation before our have lost that. We fix it with this legis- choice. In South Carolina, all of the in- committees that could move forward to lation. surance companies have pulled out of do something about this, and I am sad- b 1600 the exchanges except for one. In fact, dened, despite Trump’s talking about 40 percent of the counties in the coun- As more individuals and employers it, that we have really not taken ac- try have only one choice for health in- seek to utilize the direct primary care tion to do so. And we could, on a bipar- delivery model, it is important that surance. That is no choice at all. It is tisan basis, if we were enabled to do so. either health insurance or nothing. this outdated tax barrier not get in the The collection of bills on the floor You select from that one company, or way of patients accessing this success- this week will reduce Federal revenues you get nothing. We need lower cost, ful model. by about $90 billion and will do nothing The legislation will allow HSA plans and we need choice. to reduce the number of uninsured peo- These bills today, by allowing more to cover onsite employee clinics. Think ple that will increase as a result of pol- liberal contributions to health savings for a moment about the nursing sta- icy changes my Republican friends accounts, by allowing easier access to tions that we have here in the House of have done in this Congress. Their sabo- health savings accounts, by allowing Representatives to provide that serv- tage efforts under the Trump adminis- health savings accounts to be used for ice. They can offer physical exams, im- tration have caused millions of people more purposes—like private family munization, over-the-counter drugs, to lose coverage, and millions more care or for nonprescription drugs, over- drug testing, hearing and vision screen- will do so in the future. the-counter drugs—they are serving ing, and other minor primary care pre- Now we are seeing, in the budget pro- the exact causes, the exact purposes, ventive services to help employers as- posal, my Republican friends proposing that I hear the most complaints about semble a benefits package for their em- to cut Medicare and Medicaid by near- back home. ployees that is both practical and can ly $1 trillion to try and pay for the My folks back home are saying: How give them a competitive edge. deficits that have been exaggerated by can I afford these insurance policies? Allowing employees to access this tax cuts they have enacted. The bills With the high deductibles that are basic healthcare service at work means that we will be considering, especially being forced on us by these insurance it doesn’t disrupt the worksite. It is the next one, will only add fuel to that companies, even if I have the insurance more convenient for them; it is better fire. policy, I cannot afford to use it. for the employer. So, I am pleased that we have got Mr. Speaker, I am proud to stand be- Another key consumer change made some bipartisan pieces that we can fore you today to recommend these by this bill is to recognize that employ- move forward. I am hopeful that we bills. ees change jobs. This bill allows indi- don’t abandon a sense of fiscal respon- Mr. BLUMENAUER. Mr. Speaker, I viduals to streamline the conversion of sibility to be able to work together to yield 4 minutes to the gentleman from a medical savings account, flexible sav- pay for them, and I hope that we can Wisconsin (Mr. KIND), a senior member ings account, or HSA so they won’t encourage some of my friends on the of the Committee on Ways and Means, lose savings when they change jobs. other side of the aisle to dial back the author of several of these reform provi- These reasonable changes will help assault on the Affordable Care Act, es- sions, and a champion of value over consumers make the most of their em- pecially by the administration, so that volume in healthcare, as well as fiscal ployer-sponsored coverage. we don’t destabilize the system fur- restraint. Now—make no mistake—while this ther, drive up costs, and increase the Mr. KIND. Mr. Speaker, I thank my legislation will certainly help some number of uninsured. friend and colleague from Oregon for consumers, it doesn’t atone for the sys- Mr. Speaker, I reserve the balance of yielding me this time. I agree with my tematic sabotage that we have seen of my time. colleague.

VerDate Sep 11 2014 07:22 Jul 26, 2018 Jkt 079060 PO 00000 Frm 00016 Fmt 4634 Sfmt 0634 E:\CR\FM\K25JY7.112 H25JYPT2 lotter on DSKBCFDHB2PROD with HOUSE July 25, 2018 CONGRESSIONAL RECORD — HOUSE H7655 Mr. Speaker, I rise in opposition to We ought to be working together, Ms. JENKINS of Kansas. Mr. Speak- this legislation, not because of the pol- finding out what is working with the er, I appreciate my friend’s point of icy initiatives underlying these bills, healthcare system and fixing what view on the other side of the aisle. Mr. but because of how fiscally irrespon- isn’t. KIND and I have worked really hard on sible it is being done. What is not working is the elimi- this legislation for many years. I want This week, out of the Ways and nation of cost-sharing reduction pay- to, for the Record, just remind folks Means Committee, we have 10 bills to ments that help health insurance pro- that this bill is simply allowing people be debated and voted on on the House viders spread the risk in the health in- to keep more of their hard-earned floor, at a total cost of roughly $90 bil- surance exchanges. That is one of the money. lion. There was no effort made to try reasons why premiums are being driven Letting people keep their own money to find an offset or a pay-for in order to up right now. is not government spending that needs maintain some fiscal discipline in this What is not working is refusing to to be offset. Each of these bills con- place. That is problematic, because we provide funding to the navigators, who tained in this package were authored keep digging the hole deeper. help people make the choices with the with our Democratic colleagues with- But my name is on a few of these health plans that they have available, out an offset. Each of these bills went bills. Yesterday we had the repeal of or undercutting funding for any edu- through committee, with bipartisan the medical device tax, legislation that cation outreach with patients, or the support, without an offset. It is ironic I had authored with my friend from elimination of the individual responsi- that Democrats want to, all of a sud- Minnesota, ERIK PAULSEN. But that bility component so that young and den, claim to be fiscally conservative. came at a cost of $20 billion. No offset. healthy people don’t get to sit around This is the same Democratic Party No pay-for. Just borrow more money and wait until they get sick or injured that passed the stimulus in 2009. Re- from China and let future generations and then go out and acquire health in- member, that bill added nearly $800 bil- wrestle with it. surance. That is not how insurance lion to the deficit. But it made sense policy-wise to try markets work. Mr. Speaker, I yield 3 minutes to the to repeal that in a fiscally responsible What also doesn’t work is an admin- gentleman from Pennsylvania (Mr. manner, because we were taxing these istration that is trying to undermine KELLY), a real leader on these issues on manufacturers whether they were mak- the protections that are in place under the House Committee on Ways and ing a profit or not. In fact, the pre-rev- the Affordable Care Act for people with Means. enue companies were getting hit by the preexisting conditions. There is a law- Mr. KELLY of Pennsylvania. Mr. same tax. Policy-wise, it didn’t make a suit pending right now. This adminis- Speaker, I thank the gentlewoman for lot of sense. tration should be defending that pre- including my bill, H.R. 6305, the Bipar- Today, I was happy to introduce leg- existing condition exclusion, and they tisan HSA Improvement Act of 2018, in islation from our friend and colleague, are refusing to do so. That will impli- H.R. 6199, the Restoring Access to Ms. JENKINS, on the Restoring Access cate millions of lives throughout our Medication and Modernizing Health to Medication Act. This will make it country. Savings Accounts Act. easier for patients to purchase over- There is a lot that we can and should b 1615 the-counter medicine with their HSA be working on together to improve the This important legislation expands and FSA account money without hav- healthcare system, to reduce access to and enhances the utility of ing to first run to their doctor to get a healthcare costs for all Americans. health savings accounts, also known as prescription. Just for the sake of effi- This approach, this piecemeal ap- HSAs. ciency and the cost savings, policy- proach, while policy-wise there is a lot My legislation gives employers more wise, that makes sense; but the legisla- of justification and explanation for flexibility to offer quality healthcare tion comes with a cost, and there was what is happening, is being done in a in the setting that is best for them, no effort to pay for that. very fiscally irresponsible manner, just like onsite or retail clinics. Employers Also part of this package is legisla- piling on the debt. around the country are offering inno- tion I have introduced with our col- The SPEAKER pro tempore (Mr. vative ways to deliver healthcare to league, Mr. SMITH, called the Personal BOST). The time of the gentleman has their associates, and this provision Health Investment Today Act, or the expired. makes sure that individual health sav- PHIT Act. This would allow HSA and Mr. BLUMENAUER. Mr. Speaker, I ings accounts can utilize these same FSA dollars to be used for physical ex- yield the gentleman from Wisconsin 1 services. ercise, for gym memberships, so that additional minute. It also fixes the spouse penalty by al- we are investing in the front end of Mr. KIND. Mr. Speaker, this comes, lowing individuals to make health sav- wellness and keeping people healthy in by the way, on the heels, in this session ings account contributions if a spouse their lives rather than the hundreds of of Congress, of the passage of a major has a flexible spending account, while billions of dollars we spend at the back tax cut last year that will add over $2 preventing double-dipping in tax bene- end dealing with chronic disease man- trillion to our national debt over the fits. agement. next 10 years because, again, there was Lastly, it makes it easier for people Policy-wise that makes sense, but no attempt to pay for it. It comes on to save for their healthcare by stream- the legislation, again, comes with a the heels of the passage of a 2-year lining the conversion of other tax-pre- cost. No attempt to pay for it. I think budget that will increase spending by ferred accounts to health savings ac- that is fiscally irresponsible. over half a trillion dollars, none of it counts. At the time when we worked on and paid for, none of it offset. Ultimately, this bill modernizes passed the Affordable Care Act, Presi- Just yesterday, President Trump just healthcare delivery and gives employ- dent Obama had one major request, announced a $12 billion subsidy bailout ers the freedom to innovate and im- that all of it had to be paid for, all of program for our family farmers be- prove their employees’ health. it had to be offset. We worked hard to cause of the adverse effects that they I am also very pleased to see that the accomplish it, and, in fact, we did, and are feeling due to his tariffs. And that PHIT Act was included in this package. then some. We did not add one nickel is going to be borrowed money from I strongly support adding more of an to our budget deficit or to future budg- China, again, to pay our farmers be- emphasis on exercise and wellness to et debt forecasts because of how we cause they can’t now sell their prod- build a healthy American population. dealt with that in a fiscally responsible uct—guess where—into the Chinese We spend an incredible amount of manner. market. money on healthcare but very little on All we are asking is that our col- How crazy is this? I hope we are not maintenance, like exercise and leagues on the other side who are in in an era now where budget deficits and wellness, before we get sick. The PHIT charge now and running this place try debt only matters when there is a Dem- Act will better incentivize healthy life- to practice some semblance of that fis- ocrat in the White House. Over the last styles. cal discipline that we showed with the year and a half, that certainly seems to Mr. Speaker, we are trying to im- passage of the Affordable Care Act. be the case in this Congress. prove healthcare for all Americans.

VerDate Sep 11 2014 07:22 Jul 26, 2018 Jkt 079060 PO 00000 Frm 00017 Fmt 4634 Sfmt 0634 E:\CR\FM\K25JY7.080 H25JYPT2 lotter on DSKBCFDHB2PROD with HOUSE H7656 CONGRESSIONAL RECORD — HOUSE July 25, 2018 This means giving consumers a choice sabotage will cost a typical 55-year-old mium Plans and Expanding Health in their healthcare by incentivizing couple in my congressional district Savings Accounts Act of 2018, spon- wellness and exercise. This is a pre- $3,570 more in 2019. sored by Representatives PETER ROS- emptive effort to build a healthier, The 2019 premium hikes follow an av- KAM and MICHAEL BURGESS. stronger America and the freedom to erage 37 percent increase in 2018. These H.R. 6311 provides relief from design insurance products that work premium hikes are especially dis- ObamaCare’s rising premiums and lim- best for them. turbing when contrasted with the bil- ited choices by allowing the premium If you want to keep healthcare costs lions in tax cuts the Republicans gave tax credit to be used for plans offered down, let’s just make sure people are to insurance companies in their tax outside of ObamaCare exchanges. The healthier. That is the best way to do it. law. bill also expands access to the lowest And do you know what? I really like H.R. 6199 makes a small change to premium plans for people purchasing this debate because we talk about how health savings accounts used exclu- coverage in the individual market and the deficit has grown. And for my col- sively by the wealthy. Many of my con- allows the premium tax credit to be leagues on the other side, I wasn’t here stituents have trouble paying for basic used to offset the cost of such plans. at the time, but I watched the deficit living costs like heat, food, and hous- These measures increase competition grow in the beginning of the Obama ad- ing. They ask me regularly for a few for consumers and seek to drive down ministration from $9 trillion to $20 tril- hundred dollars to help their kids stay the cost of health insurance. lion, and I am glad that, finally, some- in college. I want to thank the Ways and Means body has awakened to the fact that we The vast majority of my constituents Committee for bringing forward are working with huge deficits. can’t set aside tens of thousands of dol- thoughtful healthcare solutions that Now, this bill was passed by the Ways lars to pay for their medical care out of will help American families. I urge my and Means Committee in a bipartisan pocket in a health savings account. colleagues to support both bills. fashion, and I want to thank my friend This legislation does nothing to in- Mr. BLUMENAUER. Mr. Speaker, I EARL BLUMENAUER for working on this crease coverage, improve affordability, yield myself such time as I may con- issue. or change the skyrocketing costs of sume. This issue is extremely important for healthcare. Mr. Speaker, I take modest exception the 175 million Americans who get I urge my colleagues to reject this to the notion that somehow the Afford- their health insurance from their em- bill, and I urge my Republican col- able Care Act failed. It represents the ployer. I strongly urge my colleagues leagues to bring up meaningful legisla- largest expansion of healthcare that we tion to improve coverage and lower have seen in decades. It is so popular on both sides of the aisle to vote in costs to help the tens of millions of and important that, when my Repub- favor of H.R. 6199. Mr. BLUMENAUER. Mr. Speaker, I Americans in need. lican friends attempted to repeal it, Ms. JENKINS of Kansas. Mr. Speak- something they have been working on yield myself 1 minute just to respond er, I yield 3 minutes to the gentleman for 7 years, it blew up in their face. briefly. from Kansas (Mr. ESTES), my friend Mr. Speaker, I was here in 2009. The Even President Trump said their bill and colleague. was mean. And it continues, even very month President Obama took of- Mr. ESTES of Kansas. Mr. Speaker, I though they are working to dismantle fice, there were 700,000 jobs lost. There rise to speak in support of two bills it bolt by bolt. was great fear that we were going to being considered today as part of our I would hope that we will return to have a complete collapse of the auto overall goal to improve healthcare for sanity to be able to work to be able to industry. There was a whole range of families across the country. move forward on things like some of things that we were in an emergency Currently, ObamaCare is broken. As I the elements in this bill here today situation on, and the worst economic mentioned in an opinion piece, from that we agree upon that could move us crisis since the Great Depression. 2010 to 2016, health insurance premiums forward rather than the continued bat- As it was, a major portion of that bill increased by nearly $4,400 per family. tle over the notion that the Affordable was tax cuts to try and stimulate the This year, health insurance costs Care Act is something that needs to be economy. I do point out that as we rose about 30 percent and are expected destroyed. The American people de- move forward, our healthcare bill was to go up an additional 10 to 20 percent serve better. entirely paid for, and that is what we in 2019. Mr. Speaker, I reserve the balance of need to get back to. These skyrocketing costs are not due my time. Mr. Speaker, I yield 3 minutes to the to some sabotage, as some folks have Ms. JENKINS of Kansas. Mr. Speak- gentleman from Illinois (Mr. DANNY K. suggested. Instead, they are a product er, I yield 2 minutes to the gentleman DAVIS), a champion of healthcare, deal- of a system that was designed and des- from Illinois (Mr. ROSKAM), who has ing with disparities in the healthcare tined to fail. provided great leadership in this area. system, a champion for balance and vi- Today, we all recognize that Mr. ROSKAM. Mr. Speaker, I am sion, and I appreciate him being here. ObamaCare has failed to provide insur- pleased to see the inclusion of the Pro- Mr. DANNY K. DAVIS of Illinois. Mr. ance for all Americans. Rather than moting High-Value Health Care Speaker, I thank my colleague who create more government-run Through Flexibility for Deductible demonstrates with regularity the in- healthcare, we need competition and Health Plans in this bill today. This is tensification of real care for the peo- free market solutions like health sav- legislation that is bipartisan that I in- ple. ings accounts to put patients in con- troduced, along with the Congressman Today, we take up another bill that trol of their own healthcare. That is from California (Mr. THOMPSON), that does nothing to make up for the long- why I am proud to support H.R. 6199, gives consumers the choice and flexi- term Republican sabotage of the Af- the Restoring Access to Medication bility that they need to be engaged in fordable Care Act. Tens of millions of Act of 2018, sponsored by Representa- their healthcare. working families also see their tive LYNN JENKINS and Representative In a nutshell, the bill allows plans to healthcare costs skyrocket due to the GRACE MENG. offer coverage for high-value, low-cost repeated Republican efforts to under- H.R. 6199 repeals provisions of the Af- services like telehealth, chronic dis- mine the healthcare system. fordable Care Act that restrict health ease management such as diabetic test- Tens of millions of Americans with savings accounts, medical savings ac- ing strips, or primary care visits below preexisting conditions will still fear counts, health flexible spending ar- the deductible. In a nutshell, what we the loss of guaranteed health protec- rangements, and health reimbursement are trying to do is give patients more tions with the horrible choice of loss of arrangements to only be used for pre- choices, more capacity to be more de- health insurance or untenable pre- scription drugs or insulin. Removing monstrative about navigating through miums. these restrictions will allow people to their own healthcare needs. The Republicans’ sabotage will cost a use such accounts for over-the-counter This is a good bipartisan approach. I typical family of four in my congres- drugs. thank the gentlewoman for including sional district $2,250 more in insurance I am also proud to support H.R. 6311, it, and I thank her for the time. I urge premiums in 2019. The Republicans’ the Increasing Access to Lower Pre- its passage.

VerDate Sep 11 2014 07:22 Jul 26, 2018 Jkt 079060 PO 00000 Frm 00018 Fmt 4634 Sfmt 0634 E:\CR\FM\K25JY7.082 H25JYPT2 lotter on DSKBCFDHB2PROD with HOUSE July 25, 2018 CONGRESSIONAL RECORD — HOUSE H7657 Mr. BLUMENAUER. Mr. Speaker, I tleman from Minnesota (Mr. PAULSEN) pick fights with our allies, like Canada reserve the balance of my time. on this notion of direct primary care. and the European Union. Ms. JENKINS of Kansas. Mr. Speak- It is a simple notion that runs athwart Mr. Speaker, on top of all of this, we er, I yield 2 minutes to the gentleman IRS regulations. I still don’t fully un- are going to advance legislation today from Minnesota (Mr. PAULSEN), who derstand why these should be classified that have some nuggets of positive has worked tirelessly in this area. as ‘‘health plan’’ rather than ‘‘payment things. I have worked with my col- Mr. PAULSEN. Mr. Speaker, I thank for service.’’ leagues on some of them. There are im- the chairwoman for yielding. But, nonetheless, we were able to portant advances, but they are coming Mr. Speaker, as an advocate for giv- work together on a bipartisan basis to at a price of $90 billion added to the ing consumers more choice in move this forward. It is not expensive. deficit, without even an attempt to healthcare and lowering costs, I sup- The score is less than $2 billion out of work with us to offset. I think we could port this bill, which also gives more $90 billion that we are tossing around have offset the direct primary care flexibility for those who have here, and I personally believe that it piece that we are talking about here. It healthcare savings accounts, as well as will result in substantial savings in is relatively small potatoes compared some of the other provisions that were order to provide more efficient cov- to $90 billion, and compared to $12 bil- already just previously mentioned. erage. lion for tariff relief for a trade war we I want to highlight my support for But I must say that I am a little didn’t need. one of the provisions in this bill that troubled by the continuing assault on Mr. Speaker, I enjoy the conversa- will allow people to use their what we are doing with the fiscal fu- tion about some of these items. I think healthcare savings account to pay for ture of this country. it is important to spotlight them. But direct primary care and those arrange- I am hopeful that we are able to return b 1630 ments. to fiscal stability, not having bailouts The concept of direct primary care is We just saw the latest reports that for farmers that they don’t want and simple, and it is supported by a lot of because of what my Republican friends wouldn’t need if we had a rational tar- family doctors, a lot of primary care have done with the budget and with the iff policy. I am hopeful that we are not doctors. People pay a monthly fee to tax bill, we have doubled the deficit going to have a parade of other things see their physician in this area any- this year. It is doubled. that undermine the Affordable Care time they choose, over the phone, Now, there were complaints from my Act and add unnecessary costs to the through telemedicine, or in person, and friend from Kansas about deficit spend- deficit. then they get a whole host of services. ing when President Obama took office. Mr. Speaker, I yield back the balance It is really important for strengthening Remember, he was only President for of my time. the doctor-patient relationship, and it one-third of that month and lost 700,000 Ms. JENKINS of Kansas. Mr. Speak- er, I yield myself the remainder of my means that more people will have ac- jobs. The economy was in free fall. Ab- time. cess to primary care services instead of solutely we took steps: cutting taxes Mr. Speaker, we have heard my just going to the emergency room in and moving in areas to try and strengthen parts of the economy that friends on the other side of the aisle order to get care. suggest here, this afternoon, this bill But, unfortunately, the IRS has stat- was posing huge problems for people might, in some way, hurt people with ed that direct primary care arrange- across the board. And this was broadly supported by people in business. Eco- preexisting conditions. However, we ments are essentially health insurance, know that is simply not true. This bill nomic experts actually agree that and they categorize them in this way doesn’t touch preexisting conditions. It probably we didn’t do enough, and that so you cannot use your HSAs and those doesn’t raise costs or premiums on slowed the economic recovery. But the funds to pay for direct primary care. families. And it doesn’t take away any- That is why Congressman BLUMENAUER economy has recovered. We have seen 9 consecutive years of one’s choice of a healthcare plan. and I authored legislation to fix this Millions of Americans use tax-advan- private sector job growth. That is what and to allow HSAs, health savings ac- tage healthcare accounts to save and Trump inherited: over 7 years of job counts, to be used for direct primary pay for healthcare expenses. In fact, growth. The economy was strong. It care, and I am pleased that it is in- there are twice as many Americans wasn’t in free fall. Yet, in that strong cluded in this bill. with an HSA than those who get cov- position, we are doubling the deficit Another important reform will allow erage on the Affordable Care Act’s ex- this year. We are looking at trillion employers to offer direct primary care changes. Almost 22 million people had dollar deficits as far as the eye can see. arrangements to employees that have an HSA in 2017, and there is only about And we just had the President an- an HSA, also. This will let more people 10 million people enrolled on the ex- nounce that he wants to spend $12 bil- have access to direct primary care changes in 2018. Forty-four percent of lion more, not because we are in eco- through their healthcare savings ac- all civilian workers had access to a nomic free fall, but because his ruinous counts, allowing family practice doc- health flexible spending arrangement trade policies have resulted in losses to tors like Dr. Julie Anderson in Min- in 2017. nesota to expand their practice with- the farming sector. They are going to The provisions in this bill allow more out having to worry about the head- provide extra government bailout, not things to be paid for out of these ac- ache of filling out mountains of paper- because farmers want it, but because counts, like over-the-counter drugs, work and excessive insurance forms, they are being injured by these ruinous feminine products, and fitness activi- because direct primary care let’s the trade policies. ties. This means people are paying less doctor work directly with the patient There was a time when most of my because they are able to use pre-tax and you don’t have to go through ex- Republican friends would rise up in op- dollars or take a deduction for their tensive billing services and insurance. position. It is certain that if these were contribution. Healthcare savings accounts, Mr. offered by Bill Clinton or Barack As a reminder, the policies in the bill Speaker, have already been proven to Obama, they would be screaming at the are all bipartisan. We have worked to- help lower healthcare costs; and ex- top of their lungs. Most of them are gether to write and advance them. panding them, giving consumers more strangely silent now, but it is another This bill helps middle class families flexibility and more choices, will mean $12 billion to try to fix a problem that afford their healthcare expenses, and I families are also going to be better off. Trump has created by starting trade hope my colleagues will continue to So let’s allow healthcare savings ac- wars with our friends, trying to punish support this legislation. counts to be used for direct primary China, and, in fact, we are punishing Mr. Speaker, I yield back the balance care and support the underlying bill. our allies. And somehow auto imports of my time. Mr. BLUMENAUER. Mr. Speaker, I are national security. The SPEAKER pro tempore. All time yield myself the balance of my time. This is embarrassing that we are in for debate has expired. Mr. Speaker, I appreciate the oppor- this situation. But it is not just embar- Pursuant to House Resolution 1012, tunity for us to have this discussion. It rassing, it is dangerous. We are weak- the previous question is ordered on the has been fun working with the gen- ening ourselves economically, while we bill, as amended.

VerDate Sep 11 2014 07:22 Jul 26, 2018 Jkt 079060 PO 00000 Frm 00019 Fmt 4634 Sfmt 0634 E:\CR\FM\K25JY7.084 H25JYPT2 lotter on DSKBCFDHB2PROD with HOUSE H7658 CONGRESSIONAL RECORD — HOUSE July 25, 2018 The question is on the engrossment and Expanding Health Savings Accounts Act of SEC. 3. INDIVIDUALS ENTITLED TO PART A OF and third reading of the bill. 2018’’. MEDICARE BY REASON OF AGE AL- LOWED TO CONTRIBUTE TO HEALTH (b) TABLE OF CONTENTS.—The table of con- The bill was ordered to be engrossed SAVINGS ACCOUNTS. tents for this Act is as follows: and read a third time, and was read the (a) IN GENERAL.—Section 223(c)(1)(B) of the third time. Sec. 1. Short title; table of contents. Internal Revenue Code of 1986 is amended by The SPEAKER pro tempore. The Sec. 2. Carryforward of health flexible spending striking ‘‘and’’ at the end of clause (ii), by strik- question is on the passage of the bill. arrangement account balances. ing the period at the end of clause (iii) and in- The question was taken; and the Sec. 3. Individuals entitled to part A of Medi- serting ‘‘, and’’, and by adding at the end the Speaker pro tempore announced that care by reason of age allowed to following new clause: contribute to health savings ac- ‘‘(iv) entitlement to hospital insurance bene- the ayes appeared to have it. counts. fits under part A of title XVIII of the Social Se- Mr. BLUMENAUER. Mr. Speaker, on Sec. 4. Maximum contribution limit to health curity Act by reason of section 226(a) of such that I demand the yeas and nays. savings account increased to Act.’’. The yeas and nays were ordered. amount of deductible and out-of- (b) CONFORMING AMENDMENT.—Section The SPEAKER pro tempore. Pursu- pocket limitation. 223(b)(7) of such Code is amended by inserting ant to clause 8 of rule XX, further pro- Sec. 5. Allow both spouses to make catch-up ‘‘(other than an entitlement to benefits de- ceedings on this question will be post- contributions to the same health scribed in subsection (c)(1)(B)(v))’’ after ‘‘Social poned. savings account. Security Act’’. Sec. 6. Special rule for certain medical expenses (c) EFFECTIVE DATE.—The amendments made f incurred before establishment of by this section shall apply to months beginning REPORT ON RESOLUTION PRO- health savings account. after December 31, 2018, in taxable years ending VIDING FOR CONSIDERATION OF Sec. 7. Allowance of bronze and catastrophic after such date. CONFERENCE REPORT ON H.R. plans in connection with health SEC. 4. MAXIMUM CONTRIBUTION LIMIT TO savings accounts. HEALTH SAVINGS ACCOUNT IN- 5515, NATIONAL DEFENSE AU- CREASED TO AMOUNT OF DEDUCT- THORIZATION ACT FOR FISCAL Sec. 8. Allowing all individuals purchasing IBLE AND OUT-OF-POCKET LIMITA- YEAR 2019 health insurance in the individual TION. market the option to purchase a (a) SELF-ONLY COVERAGE.—Section Mr. BYRNE, from the Committee on lower premium copper plan. 223(b)(2)(A) of the Internal Revenue Code of Rules, submitted a privileged report Sec. 9. Delay of reimposition of annual fee on 1986 is amended by striking ‘‘$2,250’’ and insert- (Rept. No. 115–875) on the resolution (H. health insurance providers. ing ‘‘the amount in effect under subsection Res. 1027) providing for consideration SEC. 2. CARRYFORWARD OF HEALTH FLEXIBLE (c)(2)(A)(ii)(I)’’. of the conference report to accompany SPENDING ARRANGEMENT ACCOUNT (b) FAMILY COVERAGE.—Section 223(b)(2)(B) the bill (H.R. 5515) to authorize appro- BALANCES. of such Code is amended by striking ‘‘$4,500’’ priations for fiscal year 2019 for mili- (a) IN GENERAL.—Section 106 of the Internal and inserting ‘‘the amount in effect under sub- Revenue Code of 1986 is amended by adding at section (c)(2)(A)(ii)(II)’’. tary activities of the Department of the end the following new subsection: (c) CONFORMING AMENDMENTS.—Section Defense, for military construction, and ‘‘(h) CARRYFORWARD OF HEALTH FLEXIBLE 223(g)(1) of such Code is amended— for defense activities of the Depart- SPENDING ARRANGEMENT ACCOUNT BALANCES.— (1) by striking ‘‘subsections (b)(2) and’’ both ment of Energy, to prescribe military A plan shall not fail to be treated as a health places it appears and inserting ‘‘subsection’’, personnel strengths for such fiscal flexible spending arrangement under this section and year, and for other purposes, which was or section 105 merely because the lesser of— (2) in subparagraph (B), by striking ‘‘deter- referred to the House Calendar and or- ‘‘(1) such arrangement’s account balance (or mined by’’ and all that follows through ‘‘ ‘cal- dered to be printed. any portion thereof) determined as of the end of endar year 2003’.’’ and inserting ‘‘determined by any plan year, or substituting ‘calendar year 2003’ for ‘calendar f ‘‘(2) the product of the dollar limitation in ef- year 2016’ in subparagraph (A)(ii) thereof.’’. INCREASING ACCESS TO LOWER fect under section 125(i) for such plan year (de- (d) EFFECTIVE DATE.—The amendments made PREMIUM PLANS AND EXPAND- termined without regard to paragraph (2) there- by this section shall apply to taxable years be- ginning after December 31, 2018. ING HEALTH SAVINGS ACCOUNTS of) multiplied by 3, ACT OF 2018 may be carried forward to the succeeding plan SEC. 5. ALLOW BOTH SPOUSES TO MAKE CATCH- year.’’. UP CONTRIBUTIONS TO THE SAME HEALTH SAVINGS ACCOUNT. Mr. ROSKAM. Mr. Speaker, pursuant (b) COORDINATION WITH LIMITATION ON SAL- (a) IN GENERAL.—Section 223(b)(5) of the In- to House Resolution 1011, I call up the ARY REDUCTION CONTRIBUTIONS.— ternal Revenue Code of 1986 is amended to read bill (H.R. 6311) to amend the Internal (1) IN GENERAL.—Section 125(i) of such Code is as follows: amended by redesignating paragraph (2) as Revenue Code of 1986 and the Patient ‘‘(5) SPECIAL RULE FOR MARRIED INDIVIDUALS paragraph (3) and by inserting after paragraph Protection and Affordable Care Act to WITH FAMILY COVERAGE.— (1) the following new paragraph: modify the definition of qualified ‘‘(A) IN GENERAL.—In the case of individuals ‘‘(2) COORDINATION WITH CARRYFORWARD OF health plan for purposes of the health who are married to each other, if both spouses ACCOUNT BALANCES.—The dollar amount other- are eligible individuals and either spouse has insurance premium tax credit and to wise in effect under paragraph (1) for any plan family coverage under a high deductible health allow individuals purchasing health in- year shall be reduced (but not below zero) by plan as of the first day of any month— surance in the individual market to the excess (if any) of— purchase a lower premium copper plan, ‘‘(i) the limitation under paragraph (1) shall ‘‘(A) the amount of any account balance be applied by not taking into account any other and ask for its immediate consider- which is carried forward to such plan year from high deductible health plan coverage of either ation. the preceding plan year, over spouse (and if such spouses both have family The Clerk read the title of the bill. ‘‘(B) twice the dollar limitation in effect under coverage under separate high deductible health The SPEAKER pro tempore. Pursu- paragraph (1) (determined without regard to plans, only one such coverage shall be taken ant to House Resolution 1011, in lieu of this paragraph).’’. into account), the amendment in the nature of a sub- (2) CONFORMING AMENDMENTS.—Section 125(i) ‘‘(ii) such limitation (after application of of such Code is amended by striking ‘‘taxable clause (i)) shall be reduced by the aggregate stitute recommended by the Com- year’’ each place it appears in paragraphs (1) mittee on Ways and Means, an amend- amount paid to Archer MSAs of such spouses and (3) (as redesignated by paragraph (1) of this for the taxable year, and ment in the nature of a substitute con- subsection) and inserting ‘‘plan year’’. ‘‘(iii) such limitation (after application of sisting of the text of Rules Committee (c) COORDINATION WITH CAFETERIA PLAN LIM- clauses (i) and (ii)) shall be divided equally be- Print 115–83 is adopted, and the bill, as ITATION ON DEFERRED COMPENSATION.—Section tween such spouses unless they agree on a dif- amended, is considered read. 125(d)(2) of such Code is amended by adding at ferent division. The text of the bill, as amended, is as the end the following new subparagraph: ‘‘(B) TREATMENT OF ADDITIONAL CONTRIBU- follows: ‘‘(E) EXCEPTION FOR HEALTH FLEXIBLE SPEND- TION AMOUNTS.—If both spouses referred to in ING ARRANGEMENTS.—Subparagraph (A) shall subparagraph (A) have attained age 55 before H.R. 6311 not apply to a plan to the extent of amounts in the close of the taxable year, the limitation re- Be it enacted by the Senate and House of Rep- a health flexible spending arrangement which ferred to in subparagraph (A)(iii) which is sub- resentatives of the United States of America in may be carried forward as described in section ject to division between the spouses shall in- Congress assembled, 106(h).’’. clude the additional contribution amounts de- SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (d) EFFECTIVE DATE.—The amendments made termined under paragraph (3) for both spouses. (a) SHORT TITLE.—This Act may be cited as by this section shall apply to plan years begin- In any other case, any additional contribution the ‘‘Increasing Access to Lower Premium Plans ning after December 31, 2018. amount determined under paragraph (3) shall

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