March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2393 Ferguson Lowey Russell Napolitano Renacci Stivers Sec. 116. Providing incentives for increased Fleischmann Lucas Rutherford Neal Rice (NY) Swalwell (CA) frequency of eligibility redeter- Fortenberry Luetkemeyer Scalise Noem Richmond Thompson (CA) minations. Foster Lujan Grisham, Schneider Nolan Roe (TN) Thompson (MS) Frankel (FL) M. Schweikert Norcross Rogers (AL) Thompson (PA) Subtitle C—Per Capita Allotment for Frelinghuysen Marchant Scott, Austin O’Halleran Rokita Tiberi Medical Assistance Gabbard Marino Scott, David Pallone Ros-Lehtinen Tipton Sec. 121. Per capita allotment for medical Gallego Marshall Sensenbrenner Palmer Rosen Turner assistance. Garamendi Massie Sessions Panetta Roskam Upton Garrett McCarthy Shea-Porter Paulsen Rouzer Valadao Subtitle D—Patient Relief and Health Gibbs McCaul Sherman Payne Roybal-Allard Vargas Insurance Market Stability Goodlatte McClintock Shimkus Pearce Ryan (OH) Veasey Sec. 131. Repeal of cost-sharing subsidy. Gottheimer McHenry Shuster Pelosi Sa´ nchez Vela´ zquez Gowdy McMorris Simpson Perlmutter Sanford Visclosky Sec. 132. Patient and State Stability Fund. Granger Rodgers Sinema Peters Sarbanes Walberg Sec. 133. Continuous health insurance cov- Graves (MO) McNerney Slaughter Peterson Schakowsky Waters, Maxine erage incentive. Grothman Meadows Smith (MO) Pingree Schiff Watson Coleman Sec. 134. Increasing coverage options. Guthrie Meeks Smith (NE) Pittenger Schrader Weber (TX) Sec. 135. Change in permissible age vari- Harper Meng Smith (NJ) Poe (TX) Scott (VA) Wilson (FL) ation in health insurance pre- Harris Messer Smith (TX) Poliquin Serrano Woodall mium rates. Heck Mitchell Smith (WA) Price (NC) Sewell (AL) Yoder Hensarling Moolenaar Smucker Raskin Sires Yoho TITLE II—COMMITTEE ON WAYS AND Higgins (LA) Mooney (WV) Speier Reichert Soto Young (AK) MEANS Himes Mullin Stefanik ANSWERED ‘‘PRESENT’’—1 Subtitle A—Repeal and Replace of Health- Hollingsworth Murphy (FL) Stewart Related Tax Policy Huffman Murphy (PA) Suozzi Tonko Huizenga Nadler Taylor Sec. 201. Recapture excess advance pay- Hultgren Newhouse Tenney NOT VOTING—9 ments of premium tax credits. Hunter Nunes Thornberry Budd Gohmert Rush Sec. 202. Additional modifications to pre- Issa O’Rourke Titus Ca´ rdenas Lieu, Ted Takano mium tax credit. Johnson (LA) Olson Torres Cole McCollum Tsongas Sec. 203. Premium tax credit. Johnson, Sam Palazzo Trott Kelly (MS) Pascrell Vela ANNOUNCEMENT BY THE SPEAKER PRO TEMPORE Sec. 204. Small business tax credit. Kelly (PA) Perry Wagner The SPEAKER pro tempore (during Sec. 205. Individual mandate. Kildee Pocan Walden the vote). There are 2 minutes remain- Sec. 206. Employer mandate. King (IA) Polis Walker Sec. 207. Repeal of the tax on employee King (NY) Posey Walorski ing. health insurance premiums and Knight Quigley Walters, Mimi b 1117 health plan benefits. Krishnamoorthi Ratcliffe Walz Sec. 208. Repeal of tax on over-the-counter Kuster (NH) Reed Wasserman So the Journal was approved. medications. Kustoff (TN) Rice (SC) Schultz The result of the vote was announced Labrador Roby Webster (FL) Sec. 209. Repeal of increase of tax on health LaHood Rogers (KY) Welch as above recorded. savings accounts. LaMalfa Rohrabacher Wenstrup f Sec. 210. Repeal of limitations on contribu- Lamborn Rooney, Francis Westerman tions to flexible spending ac- Latta Rooney, Thomas Williams AMERICAN HEALTH CARE ACT OF counts. Lawson (FL) J. Wilson (SC) 2017 Sec. 211. Repeal of medical device excise tax. Lewis (MN) Ross Wittman Sec. 212. Repeal of elimination of deduction Lipinski Rothfus Womack Mrs. BLACK. Mr. Speaker, pursuant Long Royce (CA) Yarmuth to House Resolution 228, I call up the for expenses allocable to medi- care part D subsidy. Loudermilk Ruiz Young (IA) bill (H.R. 1628) to provide for reconcili- Lowenthal Ruppersberger Zeldin Sec. 213. Repeal of increase in income ation pursuant to title II of the concur- threshold for determining med- NAYS—201 rent resolution on the budget for fiscal ical care deduction. Adams DeFazio Jenkins (KS) year 2017, and ask for its immediate Sec. 214. Repeal of Medicare tax increase. Aguilar DeGette Jenkins (WV) consideration. Sec. 215. Refundable tax credit for health in- Amash Delaney Johnson (GA) The Clerk read the title of the bill. surance coverage. Barr Denham Johnson (OH) The SPEAKER pro tempore (Mr. Sec. 216. Maximum contribution limit to Barraga´ n DeSantis Johnson, E. B. SIMPSON). Pursuant to House Resolu- health savings account in- Bass DeSaulnier Jones creased to amount of deductible Beatty Diaz-Balart Jordan tion 228, the amendments specified in Bera Dingell Joyce (OH) and out-of-pocket limitation. section 2 of House Resolution 228 shall Sec. 217. Allow both spouses to make catch- Bergman Doyle, Michael Kaptur be considered as adopted, and the bill, Beyer F. Katko up contributions to the same Biggs Duffy Keating as amended, is considered read. health savings account. Bishop (GA) Ellison Kelly (IL) The text of the bill, as amended, is as Sec. 218. Special rule for certain medical ex- Bishop (MI) Eshoo Kennedy follows: penses incurred before estab- Blum Espaillat Khanna lishment of health savings ac- Blunt Rochester Evans Kihuen H.R. 1628 count. Bost Fitzpatrick Kilmer Be it enacted by the Senate and House of Rep- Boyle, Brendan Flores Kind resentatives of the United States of America in Subtitle B—Repeal of Certain Consumer F. Foxx Kinzinger Congress assembled, Taxes Brady (PA) Franks (AZ) Lance Brown (MD) Fudge Langevin SECTION 1. SHORT TITLE. Sec. 221. Repeal of tax on prescription medi- Brownley (CA) Gaetz Larsen (WA) This Act may be cited as the ‘‘American cations. Buck Gallagher Larson (CT) Health Care Act of 2017’’. Sec. 222. Repeal of health insurance tax. Burgess Gonzalez (TX) Lawrence SEC. 2. TABLE OF CONTENTS. Subtitle C—Repeal of Tanning Tax Butterfield Gosar Lee The table of contents of this Act is as fol- Capuano Graves (GA) Levin Sec. 231. Repeal of tanning tax. lows: Carbajal Graves (LA) Lewis (GA) Subtitle D—Remuneration From Certain Carson (IN) Green, Al LoBiondo Sec. 1. Short title. Insurers Carter (GA) Green, Gene Loebsack Sec. 2. Table of contents. Sec. 241. Remuneration from certain insur- Cartwright Griffith Lofgren TITLE I—ENERGY AND COMMERCE Castor (FL) Grijalva Love ers. Clark (MA) Gutie´rrez Luja´ n, Ben Ray Subtitle A—Patient Access to Public Health Subtitle E—Repeal of Net Investment Clarke (NY) Hanabusa Lynch Programs Income Tax Cleaver Hartzler MacArthur Sec. 101. The Prevention and Public Health Sec. 251. Repeal of net investment income Clyburn Hastings Maloney, Fund. Coffman Herrera Beutler Carolyn B. tax. Sec. 102. Community health center program. Cohen Hice, Jody B. Maloney, Sean TITLE I—ENERGY AND COMMERCE Collins (GA) Higgins (NY) Mast Sec. 103. Federal payments to States. Conaway Hill Matsui Subtitle B—Medicaid Program Enhancement Subtitle A—Patient Access to Public Health Connolly Holding McEachin Sec. 111. Repeal of Medicaid provisions. Programs Costa Hoyer McGovern SEC. 101. THE PREVENTION AND PUBLIC HEALTH Costello (PA) Hudson McKinley Sec. 112. Repeal of Medicaid expansion. FUND. Courtney Hurd McSally Sec. 113. Elimination of DSH cuts. Crist Jackson Lee Meehan Sec. 114. Reducing State Medicaid costs. (a) IN GENERAL.—Subsection (b) of section Crowley Jayapal Moore Sec. 115. Safety net funding for non-expan- 4002 of the Patient Protection and Affordable Cummings Jeffries Moulton sion States. Care Act (42 U.S.C. 300u–11), as amended by

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00021 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.022 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2394 CONGRESSIONAL RECORD — HOUSE March 24, 2017 section 5009 of the 21st Century Cures Act, is Subtitle B—Medicaid Program Enhancement for periods after December 31, 2019, are amended— SEC. 111. REPEAL OF MEDICAID PROVISIONS. grandfathered expansion enrollees (as de- (1) in paragraph (2), by adding ‘‘and’’ at the The Social Security Act is amended— fined in section 1902(nn)(2))’’; and end; (1) in section 1902 (42 U.S.C. 1396a)— (B) in subsection (z)(2)— (2) in paragraph (3)— (A) in subsection (a)(47)(B), by inserting (i) in subparagraph (A), by inserting after (A) by striking ‘‘each of fiscal years 2018 ‘‘and provided that any such election shall ‘‘section 1937’’ the following: ‘‘and, for peri- and 2019’’ and inserting ‘‘fiscal year 2018’’; cease to be effective on January 1, 2020, and ods after December 31, 2019, who are grand- and no such election shall be made after that fathered expansion enrollees (as defined in (B) by striking the semicolon at the end date’’ before the semicolon at the end; and section 1902(nn)(2))’’; and and inserting a period; and (B) in subsection (l)(2)(C), by inserting (ii) in subparagraph (B)(ii)— (3) by striking paragraphs (4) through (8). ‘‘and ending December 31, 2019,’’ after ‘‘Janu- (I) in subclause (III), by adding ‘‘and’’ at (b) RESCISSION OF UNOBLIGATED FUNDS.—Of ary 1, 2014,’’; the end; and the funds made available by such section (2) in section 1915(k)(2) (42 U.S.C. (II) by striking subclauses (IV), (V), and 4002, the unobligated balance at the end of 1396n(k)(2)), by striking ‘‘during the period (VI) and inserting the following new sub- fiscal year 2018 is rescinded. described in paragraph (1)’’ and inserting ‘‘on clause: or after the date referred to in paragraph (1) ‘‘(IV) 2017 and each subsequent year is 80 SEC. 102. COMMUNITY HEALTH CENTER PRO- GRAM. and before January 1, 2020’’; and percent.’’. (3) in section 1920(e) (42 U.S.C. 1396r–1(e)), (b) SUNSET OF ESSENTIAL HEALTH BENEFITS Effective as if included in the enactment of by striking ‘‘under clause (i)(VIII), clause REQUIREMENT.—Section 1937(b)(5) of the So- the Medicare Access and CHIP Reauthoriza- (i)(IX), or clause (ii)(XX) of subsection cial Security Act (42 U.S.C. 1396u–7(b)(5)) is tion Act of 2015 (Public Law 114–10, 129 Stat. (a)(10)(A)’’ and inserting ‘‘under clause amended by adding at the end the following: 87), paragraph (1) of section 221(a) of such (i)(VIII) or clause (ii)(XX) of section ‘‘This paragraph shall not apply after De- Act is amended by inserting ‘‘, and an addi- 1902(a)(10)(A) before January 1, 2020, section cember 31, 2019.’’. tional $422,000,000 for fiscal year 2017’’ after 1902(a)(10)(A)(i)(IX),’’. SEC. 113. ELIMINATION OF DSH CUTS. ‘‘2017’’. SEC. 112. REPEAL OF MEDICAID EXPANSION. Section 1923(f) of the Social Security Act SEC. 103. FEDERAL PAYMENTS TO STATES. (a) IN GENERAL.—Title XIX of the Social (42 U.S.C. 1396r–4(f)) is amended— (a) IN GENERAL.—Notwithstanding section Security Act (42 U.S.C. 1396 et seq.) is (1) in paragraph (7)— 504(a), 1902(a)(23), 1903(a), 2002, 2005(a)(4), amended— (A) in subparagraph (A)— 2102(a)(7), or 2105(a)(1) of the Social Security (1) in section 1902 (42 U.S.C. 1396a)— (i) in clause (i)— Act (42 U.S.C. 704(a), 1396a(a)(23), 1396b(a), (A) in subsection (a)(10)(A)— (I) in the matter preceding subclause (I), 1397a, 1397d(a)(4), 1397bb(a)(7), 1397ee(a)(1)), or (i) in clause (i)(VIII), by inserting ‘‘and by striking ‘‘2025’’ and inserting ‘‘2019’’; and the terms of any Medicaid waiver in effect on ending December 31, 2019,’’ after ‘‘2014,’’; (ii) in clause (ii)— the date of enactment of this Act that is ap- (ii) in clause (ii)(XX), by inserting ‘‘and (I) in subclause (I), by adding ‘‘and’’ at the proved under section 1115 or 1915 of the So- ending December 31, 2017,’’ after ‘‘2014,’’; and end; cial Security Act (42 U.S.C. 1315, 1396n), for (iii) in clause (ii), by adding at the end the (II) in subclause (II), by striking the semi- the 1-year period beginning on the date of following new subclause: colon at the end and inserting a period; and the enactment of this Act, no Federal funds ‘‘(XXIII) beginning January 1, 2020— (III) by striking subclauses (III) through provided from a program referred to in this ‘‘(aa) who are expansion enrollees (as de- (VIII); and subsection that is considered direct spending fined in subsection (nn)(1)); or (B) by adding at the end the following new for any year may be made available to a ‘‘(bb) who are grandfathered expansion en- subparagraph: State for payments to a prohibited entity, rollees (as defined in subsection (nn)(2));’’; ‘‘(C) EXEMPTION FROM REDUCTION FOR NON- whether made directly to the prohibited en- and EXPANSION STATES.— (B) by adding at the end the following new tity or through a managed care organization ‘‘(i) IN GENERAL.—In the case of a State under contract with the State. subsection: that is a non-expansion State for a fiscal ‘‘(nn) EXPANSION ENROLLEES.—In this title: year, subparagraph (A)(i) shall not apply to (b) DEFINITIONS.—In this section: ‘‘(1) IN GENERAL.—The term ‘expansion en- the DSH allotment for such State and fiscal (1) PROHIBITED ENTITY.—The term ‘‘prohib- rollee’ means an individual— year. ited entity’’ means an entity, including its ‘‘(A) who is under 65 years of age; ‘‘(ii) NO CHANGE IN REDUCTION FOR EXPAN- affiliates, subsidiaries, successors, and clin- ‘‘(B) who is not pregnant; SION STATES.—In the case of a State that is ics— ‘‘(C) who is not entitled to, or enrolled for, an expansion State for a fiscal year, the DSH (A) that, as of the date of enactment of benefits under part A of title XVIII, or en- this Act— rolled for benefits under part B of title allotment for such State and fiscal year (i) is an organization described in section XVIII; shall be determined as if clause (i) did not 501(c)(3) of the Internal Revenue Code of 1986 ‘‘(D) who is not described in any of sub- apply. and exempt from tax under section 501(a) of clauses (I) through (VII) of subsection ‘‘(iii) NON-EXPANSION AND EXPANSION STATE such Code; (a)(10)(A)(i); and DEFINED.— (ii) is an essential community provider de- ‘‘(E) whose income (as determined under ‘‘(I) The term ‘expansion State’ means scribed in section 156.235 of title 45, Code of subsection (e)(14)) does not exceed 133 per- with respect to a fiscal year, a State that, as Federal Regulations (as in effect on the date cent of the poverty line (as defined in section of July 1 of the preceding fiscal year, pro- of enactment of this Act), that is primarily 2110(c)(5)) applicable to a family of the size vides for eligibility under clause (i)(VIII) or engaged in family planning services, repro- involved. (ii)(XX) of section 1902(a)(10)(A) for medical ductive health, and related medical care; and ‘‘(2) GRANDFATHERED EXPANSION ENROLL- assistance under this title (or a waiver of the (iii) provides for abortions, other than an EES.—The term ‘grandfathered expansion en- State plan approved under section 1115). abortion— rollee’ means an expansion enrollee who— ‘‘(II) The term ‘non-expansion State’ (I) if the pregnancy is the result of an act ‘‘(A) was enrolled under the State plan means, with respect to a fiscal year, a State of rape or incest; or under this title (or under a waiver of such that is not an expansion State.’’; and (II) in the case where a woman suffers from plan) as of December 31, 2019; and (2) in paragraph (8), by striking ‘‘fiscal a physical disorder, physical injury, or phys- ‘‘(B) does not have a break in eligibility for year 2025’’ and inserting ‘‘fiscal year 2019’’. ical illness that would, as certified by a phy- medical assistance under such State plan (or SEC. 114. REDUCING STATE MEDICAID COSTS. sician, place the woman in danger of death waiver) for more than one month after such (a) LETTING STATES DISENROLL HIGH DOL- unless an abortion is performed, including a date. LAR LOTTERY WINNERS.— life-endangering physical condition caused ‘‘(3) APPLICATION OF RELATED PROVISIONS.— (1) IN GENERAL.—Section 1902 of the Social by or arising from the pregnancy itself; and Any reference in subsection (a)(10)(G), (k), or Security Act (42 U.S.C. 1396a) is amended— (B) for which the total amount of Federal (gg) of this section or in section 1903, 1905(a), (A) in subsection (a)(17), by striking and State expenditures under the Medicaid 1920(e), or 1937(a)(1)(B) to individuals de- ‘‘(e)(14), (e)(14)’’ and inserting ‘‘(e)(14), program under title XIX of the Social Secu- scribed in subclause (VIII) of subsection (e)(15)’’; and rity Act in fiscal year 2014 made directly to (a)(10)(A)(i) shall be deemed to include a ref- (B) in subsection (e)— the entity and to any affiliates, subsidiaries, erence to expansion enrollees (including (i) in paragraph (14) (relating to modified successors, or clinics of the entity, or made grandfathered expansion enrollees).’’; and adjusted gross income), by adding at the end to the entity and to any affiliates, subsidi- (2) in section 1905 (42 U.S.C. 1396d)— the following new subparagraph: aries, successors, or clinics of the entity as (A) in subsection (y)(1), in the matter pre- ‘‘(J) TREATMENT OF CERTAIN LOTTERY part of a nationwide health care provider ceding subparagraph (A)— WINNINGS AND INCOME RECEIVED AS A LUMP network, exceeded $350,000,000. (i) by inserting ‘‘and that has elected to SUM.— (2) DIRECT SPENDING.—The term ‘‘direct cover newly eligible individuals before ‘‘(i) IN GENERAL.—In the case of an indi- spending’’ has the meaning given that term March 1, 2017’’ after ‘‘that is one of the 50 vidual who is the recipient of qualified lot- under section 250(c) of the Balanced Budget States or the District of Columbia’’; and tery winnings (pursuant to lotteries occur- and Emergency Deficit Control Act of 1985 (2 (ii) by inserting after ‘‘subclause (VIII) of ring on or after January 1, 2020) or qualified U.S.C. 900(c)). section 1902(a)(10)(A)(i)’’ the following: ‘‘who, lump sum income (received on or after such

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date) and whose eligibility for medical as- (A) INTERCEPTION OF LOTTERY WINNINGS AL- the first regular session of the State legisla- sistance is determined based on the applica- LOWED.—Nothing in the amendment made by ture that begins after the date of the enact- tion of modified adjusted gross income under paragraph (1)(B)(i) shall be construed as pre- ment of this Act. For purposes of the pre- subparagraph (A), a State shall, in deter- venting a State from intercepting the State vious sentence, in the case of a State that mining such eligibility, include such lottery winnings awarded to an individual in has a 2-year legislative session, each year of winnings or income (as applicable) as income the State to recover amounts paid by the the session shall be considered to be a sepa- received— State under the State Medicaid plan under rate regular session of the State legislature. ‘‘(I) in the month in which such winnings title XIX of the Social Security Act for med- SEC. 115. SAFETY NET FUNDING FOR NON-EXPAN- or income (as applicable) is received if the ical assistance furnished to the individual. SION STATES. amount of such winnings or income is less (B) APPLICABILITY LIMITED TO ELIGIBILITY Title XIX of the Social Security Act is than $80,000; OF RECIPIENT OF LOTTERY WINNINGS OR LUMP amended by inserting after section 1923 (42 ‘‘(II) over a period of 2 months if the SUM INCOME.—Nothing in the amendment U.S.C. 1396r–4) the following new section: amount of such winnings or income (as appli- made by paragraph (1)(B)(i) shall be con- ‘‘ADJUSTMENT IN PAYMENT FOR SERVICES OF cable) is greater than or equal to $80,000 but strued, with respect to a determination of SAFETY NET PROVIDERS IN NON-EXPANSION less than $90,000; household income for purposes of a deter- STATES ‘‘(III) over a period of 3 months if the mination of eligibility for medical assistance ‘‘SEC. 1923A. (a) IN GENERAL.—Subject to amount of such winnings or income (as appli- under the State plan under title XIX of the the limitations of this section, for each year cable) is greater than or equal to $90,000 but Social Security Act (42 U.S.C. 1396 et seq.) during the period beginning with fiscal year less than $100,000; and (or a waiver of such plan) made by applying 2018 and ending with fiscal year 2022, each ‘‘(IV) over a period of 3 months plus 1 addi- modified adjusted gross income under sub- State that is one of the 50 States or the Dis- tional month for each increment of $10,000 of paragraph (A) of section 1902(e)(14) of such trict of Columbia and that, as of July 1 of such winnings or income (as applicable) re- Act (42 U.S.C. 1396a(e)(14)), as limiting the the preceding fiscal year, did not provide for ceived, not to exceed a period of 120 months eligibility for such medical assistance of any eligibility under clause (i)(VIII) or (ii)(XX) of (for winnings or income of $1,260,000 or individual that is a member of the household section 1902(a)(10)(A) for medical assistance more), if the amount of such winnings or in- other than the individual (or the individual’s under this title (or a waiver of the State plan come is greater than or equal to $100,000. spouse) who received qualified lottery approved under section 1115) (each such ‘‘(ii) COUNTING IN EQUAL INSTALLMENTS.— winnings or qualified lump-sum income (as State or District referred to in this section For purposes of subclauses (II), (III), and (IV) defined in subparagraph (J) of such section for the fiscal year as a ‘non-expansion of clause (i), winnings or income to which 1902(e)(14), as added by paragraph (1)(B)(i) of State’) may adjust the payment amounts such subclause applies shall be counted in this subsection). otherwise provided under the State plan (b) REPEAL OF RETROACTIVE ELIGIBILITY.— equal monthly installments over the period under this title (or a waiver of such plan) to (1) IN GENERAL.— of months specified under such subclause. health care providers that provide health (A) STATE PLAN REQUIREMENTS.—Section ‘‘(iii) HARDSHIP EXEMPTION.—An individual care services to individuals enrolled under 1902(a)(34) of the Social Security Act (42 whose income, by application of clause (i), this title (in this section referred to as ‘eligi- U.S.C. 1396a(a)(34)) is amended by striking exceeds the applicable eligibility threshold ble providers’) so long as the payment ad- ‘‘in or after the third month before the established by the State, may continue to be justment to such an eligible provider does month in which he made application’’ and in- eligible for medical assistance to the extent not exceed the provider’s costs in furnishing serting ‘‘in or after the month in which the that the State determines, under procedures health care services (as determined by the individual made application’’. established by the State under the State Secretary and net of payments under this (B) DEFINITION OF MEDICAL ASSISTANCE.— plan (or in the case of a waiver of the plan title, other than under this section, and by Section 1905(a) of the Social Security Act (42 under section 1115, incorporated in such uninsured patients) to individuals who either U.S.C. 1396d(a)) is amended by striking ‘‘in or waiver), or as otherwise established by such are eligible for medical assistance under the after the third month before the month in State in accordance with such standards as State plan (or under a waiver of such plan) which the recipient makes application for may be specified by the Secretary, that the or have no health insurance or health plan assistance’’ and inserting ‘‘in or after the denial of eligibility of the individual would coverage for such services. cause an undue medical or financial hardship month in which the recipient makes applica- ‘‘(b) INCREASE IN APPLICABLE FMAP.—Not- as determined on the basis of criteria estab- tion for assistance’’. withstanding section 1905(b), the Federal lished by the Secretary. (2) EFFECTIVE DATE.—The amendments medical assistance percentage applicable ‘‘(iv) NOTIFICATIONS AND ASSISTANCE RE- made by paragraph (1) shall apply to medical with respect to expenditures attributable to QUIRED IN CASE OF LOSS OF ELIGIBILITY.—A assistance with respect to individuals whose a payment adjustment under subsection (a) State shall, with respect to an individual eligibility for such assistance is based on an for which payment is permitted under sub- who loses eligibility for medical assistance application for such assistance made (or section (c) shall be equal to— under the State plan (or a waiver of such deemed to be made) on or after October 1, ‘‘(1) 100 percent for calendar quarters in fis- plan) by reason of clause (i), before the date 2017. cal years 2018, 2019, 2020, and 2021; and on which the individual loses such eligi- (c) UPDATING ALLOWABLE HOME EQUITY ‘‘(2) 95 percent for calendar quarters in fis- bility, inform the individual of the date on LIMITS IN MEDICAID.— cal year 2022. which the individual would no longer be con- (1) IN GENERAL.—Section 1917(f)(1) of the ‘‘(c) ANNUAL ALLOTMENT LIMITATION.—Pay- sidered ineligible by reason of such clause to Social Security Act (42 U.S.C. 1396p(f)(1)) is ment under section 1903(a) shall not be made receive medical assistance under the State amended— to a State with respect to any payment ad- plan or under any waiver of such plan and (A) in subparagraph (A), by striking ‘‘sub- justment made under this section for all cal- the date on which the individual would be el- paragraphs (B) and (C)’’ and inserting ‘‘sub- endar quarters in a fiscal year in excess of igible to reapply to receive such medical as- paragraph (B)’’; the $2,000,000,000 multiplied by the ratio of— sistance. (B) by striking subparagraph (B); ‘‘(1) the population of the State with in- ‘‘(v) QUALIFIED LOTTERY WINNINGS DE- (C) by redesignating subparagraph (C) as come below 138 percent of the poverty line in FINED.—In this subparagraph, the term subparagraph (B); and 2015 (as determined based the table entitled ‘qualified lottery winnings’ means winnings (D) in subparagraph (B), as so redesignated, ‘Health Insurance Coverage Status and Type from a sweepstakes, lottery, or pool de- by striking ‘‘dollar amounts specified in this by Ratio of Income to Poverty Level in the scribed in paragraph (3) of section 4402 of the paragraph’’ and inserting ‘‘dollar amount Past 12 Months by Age’ for the universe of Internal Revenue Code of 1986 or a lottery specified in subparagraph (A)’’. the civilian noninstitutionalized population operated by a multistate or multijuris- (2) EFFECTIVE DATE.— for whom poverty status is determined based dictional lottery association, including (A) IN GENERAL.—The amendments made on the 2015 American Community Survey 1– amounts awarded as a lump sum payment. by paragraph (1) shall apply with respect to Year Estimates, as published by the Bureau ‘‘(vi) QUALIFIED LUMP SUM INCOME DE- eligibility determinations made after the of the Census), to FINED.—In this subparagraph, the term date that is 180 days after the date of the en- ‘‘(2) the sum of the populations under para- ‘qualified lump sum income’ means income actment of this section. graph (1) for all non-expansion States. that is received as a lump sum from one of (B) EXCEPTION FOR STATE LEGISLATION.—In ‘‘(d) DISQUALIFICATION IN CASE OF STATE the following sources: the case of a State plan under title XIX of COVERAGE EXPANSION.—If a State is a non-ex- ‘‘(I) Monetary winnings from gambling (as the Social Security Act that the Secretary pansion for a fiscal year and provides eligi- defined by the Secretary and including mon- of Health and Human Services determines re- bility for medical assistance described in etary winnings from gambling activities de- quires State legislation in order for the re- subsection (a) during the fiscal year, the scribed in section 1955(b)(4) of title 18, United spective plan to meet any requirement im- State shall no longer be treated as a non-ex- States Code). posed by amendments made by this sub- pansion State under this section for any sub- ‘‘(II) Income received as liquid assets from section, the respective plan shall not be re- sequent fiscal years.’’. the estate (as defined in section 1917(b)(4)) of garded as failing to comply with the require- SEC. 116. PROVIDING INCENTIVES FOR IN- a deceased individual.’’; and ments of such title solely on the basis of its CREASED FREQUENCY OF ELIGI- (ii) by striking ‘‘(14) EXCLUSION’’ and in- failure to meet such an additional require- BILITY REDETERMINATIONS. serting ‘‘(15) EXCLUSION’’. ment before the first day of the first cal- (a) IN GENERAL.—Section 1902(e)(14) of the (2) RULES OF CONSTRUCTION.— endar quarter beginning after the close of Social Security Act (42 U.S.C. 1396a(e)(14))

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00023 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.001 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2396 CONGRESSIONAL RECORD — HOUSE March 24, 2017 (relating to modified adjusted gross income), with respect to State administrative expend- ‘‘(i) the amount of the medical assistance as amended by section 114(a)(1), is further itures during a calendar quarter for which expenditures (as defined in paragraph (2)) for amended by adding at the end the following: the State receives payment under such sub- the State and fiscal year, reduced by the ‘‘(K) FREQUENCY OF ELIGIBILITY REDETER- section shall, in addition to any other in- amount of any excluded expenditures (as de- MINATIONS.—Beginning on October 1, 2017, crease to such Federal matching percentage, fined in paragraph (3)) for the State and fis- and notwithstanding subparagraph (H), in be increased for such calendar quarter by 5 cal year otherwise included in such medical the case of an individual whose eligibility for percentage points with respect to State ex- assistance expenditures; and medical assistance under the State plan penditures attributable to activities carried ‘‘(ii) the 1903A FY16 population percentage under this title (or a waiver of such plan) is out by the State (and approved by the Sec- (as defined in paragraph (4)) for the State; or determined based on the application of modi- retary) to implement subsection (oo) of sec- ‘‘(B) for fiscal year 2019 or a subsequent fis- fied adjusted gross income under subpara- tion 1902.’’. cal year, the amount of the medical assist- graph (A) and who is so eligible on the basis Subtitle C—Per Capita Allotment for Medical ance expenditures (as defined in paragraph of clause (i)(VIII) or clause (ii)(XX) of sub- Assistance (2)) for the State and fiscal year that is at- section (a)(10)(A), a State shall redetermine tributable to 1903A enrollees, reduced by the such individual’s eligibility for such medical SEC. 121. PER CAPITA ALLOTMENT FOR MEDICAL amount of any excluded expenditures (as de- ASSISTANCE. assistance no less frequently than once every fined in paragraph (3)) for the State and fis- Title XIX of the Social Security Act is 6 months.’’. cal year otherwise included in such medical amended— (b) INCREASED ADMINISTRATIVE MATCHING assistance expenditures and includes non- (1) in section 1903 (42 U.S.C. 1396b)— PERCENTAGE.—For each calendar quarter DSH supplemental payments (as defined in (A) in subsection (a), in the matter before during the period beginning on October 1, subsection (d)(4)(A)(ii)) and payments de- paragraph (1), by inserting ‘‘and section 2017, and ending on December 31, 2019, the scribed in subsection (d)(4)(A)(iii) but shall Federal matching percentage otherwise ap- 1903A(a)’’ after ‘‘except as otherwise provided not be construed as including any expendi- plicable under section 1903(a) of the Social in this section’’; and tures attributable to the program under sec- Security Act (42 U.S.C. 1396b(a)) with respect (B) in subsection (d)(1), by striking ‘‘to tion 1928. In applying subparagraph (B), non- to State expenditures during such quarter which’’ and inserting ‘‘to which, subject to DSH supplemental payments (as defined in that are attributable to meeting the require- section 1903A(a),’’; and subsection (d)(4)(A)(ii)) and payments de- ment of section 1902(e)(14) (relating to deter- (2) by inserting after such section 1903 the scribed in subsection (d)(4)(A)(iii) shall be minations of eligibility using modified ad- following new section: treated as fully attributable to 1903A enroll- justed gross income) of such Act shall be in- ‘‘SEC. 1903A. PER CAPITA-BASED CAP ON PAY- ees. creased by 5 percentage points with respect MENTS FOR MEDICAL ASSISTANCE. ‘‘(2) MEDICAL ASSISTANCE EXPENDITURES.— to State expenditures attributable to activi- ‘‘(a) APPLICATION OF PER CAPITA CAP ON In this section, the term ‘medical assistance ties carried out by the State (and approved PAYMENTS FOR MEDICAL ASSISTANCE EXPEND- expenditures’ means, for a State and fiscal by the Secretary) to increase the frequency ITURES.— year, the medical assistance payments as re- of eligibility redeterminations required by ‘‘(1) IN GENERAL.—If a State has excess ag- ported by medical service category on the subparagraph (K) of such section (relating to gregate medical assistance expenditures (as Form CMS-64 quarterly expense report (or eligibility redeterminations made on a 6- defined in paragraph (2)) for a fiscal year (be- successor to such a report form, and includ- month basis) (as added by subsection (a)). ginning with fiscal year 2020), the amount of ing enrollment data and subsequent adjust- SEC. 117. PERMITTING STATES TO APPLY A WORK payment to the State under section 1903(a)(1) ments to any such report, in this section re- REQUIREMENT FOR NONDISABLED, for each quarter in the following fiscal year ferred to collectively as a ‘CMS-64 report’) NONELDERLY, NONPREGNANT shall be reduced by 1⁄4 of the excess aggregate for which payment is (or may otherwise be) ADULTS UNDER MEDICAID. medical assistance payments (as defined in (a) IN GENERAL.—Section 1902 of the Social made pursuant to section 1903(a)(1). paragraph (3)) for that previous fiscal year. Security Act (42 U.S.C. 1396a), as previously ‘‘(3) EXCLUDED EXPENDITURES.—In this sec- In this section, the term ‘State’ means only amended, is further amended by adding at tion, the term ‘excluded expenditures’ the 50 States and the District of Columbia. the end the following new subsection: means, for a State and fiscal year, expendi- ‘‘(oo) WORK REQUIREMENT OPTION FOR NON- ‘‘(2) EXCESS AGGREGATE MEDICAL ASSIST- tures under the State plan (or under a waiver DISABLED, NONELDERLY, NONPREGNANT ANCE EXPENDITURES.—In this subsection, the of such plan) that are attributable to any of ADULTS.— term ‘excess aggregate medical assistance the following: ‘‘(1) IN GENERAL.—Beginning October 1, expenditures’ means, for a State for a fiscal ‘‘(A) DSH.—Payment adjustments made for 2017, subject to paragraph (3), a State may year, the amount (if any) by which— disproportionate share hospitals under sec- elect to condition medical assistance to a ‘‘(A) the amount of the adjusted total med- tion 1923. nondisabled, nonelderly, nonpregnant indi- ical assistance expenditures (as defined in ‘‘(B) MEDICARE COST-SHARING.—Payments vidual under this title upon such an individ- subsection (b)(1)) for the State and fiscal made for medicare cost-sharing (as defined ual’s satisfaction of a work requirement (as year; exceeds in section 1905(p)(3)). defined in paragraph (2)). ‘‘(B) the amount of the target total med- ‘‘(C) SAFETY NET PROVIDER PAYMENT AD- ‘‘(2) WORK REQUIREMENT DEFINED.—In this ical assistance expenditures (as defined in JUSTMENTS IN NON-EXPANSION STATES.—Pay- section, the term ‘work requirement’ means, subsection (c)) for the State and fiscal year. ment adjustments under subsection (a) of with respect to an individual, the individ- ‘‘(3) EXCESS AGGREGATE MEDICAL ASSIST- section 1923A for which payment is per- ual’s participation in work activities (as de- ANCE PAYMENTS.—In this subsection, the mitted under subsection (c) of such section. fined in section 407(d)) for such period of term ‘excess aggregate medical assistance ‘‘(4) 1903A FY 16 POPULATION PERCENTAGE.— time as determined by the State, and as di- payments’ means, for a State for a fiscal In this subsection, the term ‘1903A FY16 pop- rected and administered by the State. year, the product of— ulation percentage’ means, for a State, the ‘‘(3) REQUIRED EXCEPTIONS.—States admin- ‘‘(A) the excess aggregate medical assist- Secretary’s calculation of the percentage of istering a work requirement under this sub- ance expenditures (as defined in paragraph the actual medical assistance expenditures, section may not apply such requirement to— (2)) for the State for the fiscal year; and as reported by the State on the CMS–64 re- ‘‘(A) a woman during pregnancy through ‘‘(B) the Federal average medical assist- ports for calendar quarters in fiscal year the end of the month in which the 60-day pe- ance matching percentage (as defined in 2016, that are attributable to 1903A enrollees riod (beginning on the last day of her preg- paragraph (4)) for the State for the fiscal (as defined in subsection (e)(1)). nancy) ends; year. ‘‘(c) TARGET TOTAL MEDICAL ASSISTANCE ‘‘(B) an individual who is under 19 years of ‘‘(4) FEDERAL AVERAGE MEDICAL ASSISTANCE EXPENDITURES.— age; MATCHING PERCENTAGE.—In this subsection, ‘‘(1) CALCULATION.—In this section, the ‘‘(C) an individual who is the only parent the term ‘Federal average medical assistance term ‘target total medical assistance ex- or caretaker relative in the family of a child matching percentage’ means, for a State for penditures’ means, for a State for a fiscal who has not attained 6 years of age or who is a fiscal year, the ratio (expressed as a per- year and subject to paragraph (4), the sum of the only parent or caretaker of a child with centage) of— the products, for each of the 1903A enrollee disabilities; or ‘‘(A) the amount of the Federal payments categories (as defined in subsection (e)(2)), ‘‘(D) an individual who is married or a head that would be made to the State under sec- of— of household and has not attained 20 years of tion 1903(a)(1) for medical assistance expend- ‘‘(A) the target per capita medical assist- age and who— itures for calendar quarters in the fiscal year ance expenditures (as defined in paragraph ‘‘(i) maintains satisfactory attendance at if paragraph (1) did not apply; to (2)) for the enrollee category, State, and fis- secondary school or the equivalent; or ‘‘(B) the amount of the medical assistance cal year; and ‘‘(ii) participates in education directly re- expenditures for the State and fiscal year. ‘‘(B) the number of 1903A enrollees for such lated to employment.’’. ‘‘(b) ADJUSTED TOTAL MEDICAL ASSISTANCE enrollee category, State, and fiscal year, as (b) INCREASE IN MATCHING RATE FOR IMPLE- EXPENDITURES.—Subject to subsection (g), determined under subsection (e)(4). MENTATION.—Section 1903 of the Social Secu- the following shall apply: ‘‘(2) TARGET PER CAPITA MEDICAL ASSIST- rity Act (42 U.S.C. 1396b) is amended by add- ‘‘(1) IN GENERAL.—In this section, the term ANCE EXPENDITURES.—In this subsection, the ing at the end the following: ‘adjusted total medical assistance expendi- term ‘target per capita medical assistance ‘‘(aa) The Federal matching percentage tures’ means, for a State— expenditures’ means, for a 1903A enrollee otherwise applicable under subsection (a) ‘‘(A) for fiscal year 2016, the product of— category and State—

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00024 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.001 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2397 ‘‘(A) for fiscal year 2020, an amount equal ‘‘(B) The number of 1903A enrollees for the graph (A)(ii)) and payments described in sub- to— State in fiscal year 2016 (as determined under paragraph (A)(iii) for the State for fiscal ‘‘(i) the provisional FY19 target per capita subsection (e)(4)). year 2016; to amount for such enrollee category (as cal- ‘‘(C) The average per capita medical assist- ‘‘(ii) the amount described in subsection culated under subsection (d)(5)) for the ance expenditures for the State for fiscal (b)(1)(A) for the State for fiscal year 2016. State; increased by year 2016 equal to— ‘‘(D) For each 1903A enrollee category an ‘‘(ii) the applicable annual inflation factor ‘‘(i) the amount calculated under subpara- average medical assistance expenditures per (as defined in paragraph (3)) for fiscal year graph (A); divided by capita for the State for fiscal year 2019 for 2020; and ‘‘(ii) the number calculated under subpara- the enrollee category equal to— ‘‘(B) for each succeeding fiscal year, an graph (B). ‘‘(i) the amount calculated under subpara- amount equal to— ‘‘(2) FISCAL YEAR 2019 AVERAGE PER CAPITA graph (A) for the State, increased by the ‘‘(i) the target per capita medical assist- AMOUNT BASED ON INFLATING THE FISCAL YEAR non-DSH supplemental and pool payment ance expenditures (under subparagraph (A) 2016 AMOUNT TO FISCAL YEAR 2019 BY CPI-MED- percentage for the State (as calculated under or this subparagraph) for the 1903A enrollee ICAL.—The Secretary shall calculate a fiscal subparagraph (C)); divided by category and State for the preceding fiscal year 2019 average per capita amount for each ‘‘(ii) the number calculated under subpara- year, increased by State equal to— graph (B) for the State for the enrollee cat- ‘‘(ii) the applicable annual inflation factor ‘‘(A) the average per capita medical assist- egory. for that succeeding fiscal year. ance expenditures for the State for fiscal ‘‘(5) PROVISIONAL FY19 PER CAPITA TARGET ‘‘(3) APPLICABLE ANNUAL INFLATION FAC- year 2016 (calculated under paragraph (1)(C)); AMOUNT FOR EACH 1903A ENROLLEE CATEGORY.— TOR.—In paragraph (2), the term ‘applicable increased by Subject to subsection (f)(2), the Secretary annual inflation factor’ means, for a fiscal ‘‘(B) the percentage increase in the med- shall calculate for each State a provisional year— ical care component of the consumer price FY19 per capita target amount for each 1903A ‘‘(A) for each of the 1903A enrollee cat- index for all urban consumers (U.S. city av- enrollee category equal to the average med- egories described in subparagraphs (C), (D), erage) from September, 2016 to September, ical assistance expenditures per capita for and (E) of subsection (e)(2), the percentage 2019. the State for fiscal year 2019 (as calculated increase in the medical care component of ‘‘(3) AGGREGATE AND AVERAGE EXPENDI- under paragraph (4)(D)) for such enrollee cat- the consumer price index for all urban con- TURES PER CAPITA FOR FISCAL YEAR 2019.—The egory multiplied by the ratio of— sumers (U.S. city average) from September Secretary shall calculate for each State the ‘‘(A) the product of— of the previous fiscal year to September of following: ‘‘(i) the fiscal year 2019 average per capita the fiscal year involved; and ‘‘(A) The amount of the adjusted total amount for the State, as calculated under ‘‘(B) for each of the 1903A enrollee cat- medical assistance expenditures (as defined paragraph (2); and egories described in subparagraphs (A) and in subsection (b)(1)) for the State for fiscal ‘‘(ii) the number of 1903A enrollees for the (B) of subsection (e)(2), the percentage in- year 2019. State in fiscal year 2019, as calculated under crease described in subparagraph (A) plus 1 ‘‘(B) The number of 1903A enrollees for the paragraph (3)(B); to percentage point. State in fiscal year 2019 (as determined under ‘‘(B) the amount of the adjusted total med- ‘‘(4) DECREASE IN TARGET EXPENDITURES subsection (e)(4)). ical assistance expenditures for the State for FOR REQUIRED EXPENDITURES BY CERTAIN PO- ‘‘(4) PER CAPITA EXPENDITURES FOR FISCAL fiscal year 2019, as calculated under para- LITICAL SUBDIVISIONS.— YEAR 2019 FOR EACH 1903A ENROLLEE CAT- graph (3)(A). ‘‘(A) IN GENERAL.—In the case of a State EGORY.—The Secretary shall calculate (and ‘‘(e) 1903A ENROLLEE; 1903A ENROLLEE CAT- that had a DSH allotment under section provide notice to each State not later than EGORY.—Subject to subsection (g), for pur- 1923(f) for fiscal year 2016 that was more than January 1, 2020, of) the following: poses of this section, the following shall 6 times the national average of such allot- ‘‘(A)(i) For each 1903A enrollee category, apply: ments for all the States for such fiscal year the amount of the adjusted total medical as- ‘‘(1) 1903A ENROLLEE.—The term ‘1903A en- and that requires political subdivisions with- sistance expenditures (as defined in sub- rollee’ means, with respect to a State and a in the State to contribute funds towards section (b)(1)) for the State for fiscal year month and subject to subsection (i)(1)(B), medical assistance or other expenditures 2019 for individuals in the enrollee category, any Medicaid enrollee (as defined in para- under the State plan under this title (or calculated by excluding from medical assist- graph (3)) for the month, other than such an under a waiver of such plan) for a fiscal year ance expenditures those expenditures attrib- enrollee who for such month is in any of the (beginning with fiscal year 2020), the target utable to expenditures described in clause following categories of excluded individuals: total medical assistance expenditures for (iii) or non-DSH supplemental expenditures ‘‘(A) CHIP.—An individual who is provided, such State and fiscal year shall be decreased (as defined in clause (ii)). under this title in the manner described in by the amount that political subdivisions in ‘‘(ii) In this paragraph, the term ‘non-DSH section 2101(a)(2), child health assistance the State are required to contribute under supplemental expenditure’ means a payment under title XXI. the plan (or waiver) without reimbursement to a provider under the State plan (or under ‘‘(B) IHS.—An individual who receives any from the State for such fiscal year, other a waiver of the plan) that— medical assistance under this title for serv- than contributions described in subpara- ‘‘(I) is not made under section 1923; ices for which payment is made under the graph (B). ‘‘(II) is not made with respect to a specific third sentence of section 1905(b). ‘‘(B) EXCEPTIONS.—The contributions de- item or service for an individual; ‘‘(C) BREAST AND CERVICAL CANCER SERV- scribed in this subparagraph are the fol- ‘‘(III) is in addition to any payments made ICES ELIGIBLE INDIVIDUAL.—An individual who lowing: to the provider under the plan (or waiver) for is entitled to medical assistance under this ‘‘(i) Contributions required by a State from any such item or service; and title only pursuant to section a political subdivision that, as of the first ‘‘(IV) complies with the limits for addi- 1902(a)(10)(A)(ii)(XVIII). day of the calendar year in which the fiscal tional payments to providers under the plan ‘‘(D) PARTIAL-BENEFIT ENROLLEES.—An in- year involved begins— (or waiver) imposed pursuant to section dividual who— ‘‘(I) has a population of more than 5,000,000, 1902(a)(30)(A), including the regulations ‘‘(i) is an alien who is entitled to medical as estimated by the Bureau of the Census; specifying upper payment limits under the assistance under this title only pursuant to and State plan in part 447 of title 42, Code of Fed- section 1903(v)(2); ‘‘(II) imposes a local income tax upon its eral Regulations (or any successor regula- ‘‘(ii) is entitled to medical assistance residents. tions). under this title only pursuant to subclause ‘‘(ii) Contributions required by a State ‘‘(iii) An expenditure described in this (XII) or (XXI) of section 1902(a)(10)(A)(ii) (or from a political subdivision for administra- clause is an expenditure that meets the cri- pursuant to a waiver that provides only com- tive expenses if the State required such con- teria specified in subclauses (I), (II), and (III) parable benefits); tributions from such subdivision without re- of clause (ii) and is authorized under section ‘‘(iii) is a dual eligible individual (as de- imbursement from the State as of January 1, 1115 for the purposes of funding a delivery fined in section 1915(h)(2)(B)) and is entitled 2017. system reform pool, uncompensated care to medical assistance under this title (or ‘‘(d) CALCULATION OF FY19 PROVISIONAL pool, a designated state health program, or under a waiver) only for some or all of medi- TARGET AMOUNT FOR EACH 1903A ENROLLEE any other similar expenditure (as defined by care cost-sharing (as defined in section CATEGORY.—Subject to subsection (g), the the Secretary). 1905(p)(3)); or following shall apply: ‘‘(B) For each 1903A enrollee category, the ‘‘(iv) is entitled to medical assistance ‘‘(1) CALCULATION OF BASE AMOUNTS FOR number of 1903A enrollees for the State in under this title and for whom the State is FISCAL YEAR 2016.—For each State the Sec- fiscal year 2019 in the enrollee category (as providing a payment or subsidy to an em- retary shall calculate (and provide notice to determined under subsection (e)(4)). ployer for coverage of the individual under a the State not later than April 1, 2018, of) the ‘‘(C) For fiscal year 2016, the State’s non- group health plan pursuant to section 1906 or following: DSH supplemental and pool payment per- section 1906A (or pursuant to a waiver that ‘‘(A) The amount of the adjusted total centage is equal to the ratio (expressed as a provides only comparable benefits). medical assistance expenditures (as defined percentage) of— ‘‘(2) 1903A ENROLLEE CATEGORY.—The term in subsection (b)(1)) for the State for fiscal ‘‘(i) the total amount of non-DSH supple- ‘1903A enrollee category’ means each of the year 2016. mental expenditures (as defined in subpara- following:

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‘‘(A) ELDERLY.—A category of 1903A enroll- (4)(C) of subsection (d) for a State for fiscal ‘‘(B) the previous provisions of this section ees who are 65 years of age or older. year 2016, and the amounts of the adjusted shall be applied as if— ‘‘(B) BLIND AND DISABLED.—A category of total medical assistance expenditures cal- ‘‘(i) block grant individuals within the ap- 1903A enrollees (not described in the previous culated under subsection (b) and the number plicable block grant category for the State subparagraph) who are eligible for medical of Medicaid enrollees and 1903A enrollees de- and period were not section 1903A enrollees assistance under this title on the basis of termined under subsection (e)(4) for a State for each 10-fiscal year period for which the being blind or disabled. for fiscal year 2016, fiscal year 2019, and any State elects to apply this subsection; and ‘‘(C) CHILDREN.—A category of 1903A enroll- subsequent fiscal year, may be adjusted by ‘‘(ii) if such option is not extended at the ees (not described in a previous subpara- the Secretary based upon an appeal (filed by end of a 10-fiscal-year-period, the per capita graph) who are children under 19 years of the State in such a form, manner, and time, limitations under such previous provisions age. and containing such information relating to shall again apply after such period and such ‘‘(D) EXPANSION ENROLLEES.—A category of data errors that support such appeal, as the limitations shall be applied as if the election 1903A enrollees (not described in a previous Secretary specifies) that the Secretary de- under this subsection had never taken place; subparagraph) for whom the amounts ex- termines to be valid, except that any adjust- ‘‘(C) the payment under this subsection pended for medical assistance are subject to ment by the Secretary under this subsection may only be used consistent with the State an increase or change in the Federal medical for a State may not result in an increase of plan under paragraph (2) for block grant assistance percentage under subsection (y) or the target total medical assistance expendi- health care assistance (as defined in para- (z)(2), respectively, of section 1905. tures exceeding 2 percent. graph (7)); and ‘‘(E) OTHER NONELDERLY, NONDISABLED, ‘‘(h) REQUIRED REPORTING AND AUDITING OF ‘‘(D) with respect to block grant individ- NON-EXPANSION ADULTS.—A category of 1903A CMS–64 DATA; TRANSITIONAL INCREASE IN uals within the applicable block grant cat- enrollees who are not described in any pre- FEDERAL MATCHING PERCENTAGE FOR CERTAIN egory for the State for which block grant vious subparagraph. ADMINISTRATIVE EXPENSES.— health care assistance is made available ‘‘(3) MEDICAID ENROLLEE.—The term ‘Med- ‘‘(1) REPORTING.—In addition to the data under this subsection, such assistance shall icaid enrollee’ means, with respect to a State required on form Group VIII on the CMS–64 be instead of medical assistance otherwise for a month, an individual who is eligible for report form as of January 1, 2017, in each provided to the individual under this title. medical assistance for items or services CMS-64 report required to be submitted (for ‘‘(2) STATE PLAN FOR ADMINISTERING BLOCK under this title and enrolled under the State each quarter beginning on or after October 1, GRANT OPTION.— plan (or a waiver of such plan) under this 2018), the State shall include data on medical ‘‘(A) IN GENERAL.—No payment shall be title for the month. assistance expenditures within such cat- made under this subsection to a State pursu- ‘‘(4) DETERMINATION OF NUMBER OF 1903A EN- egories of services and categories of enroll- ant to an election for a 10-fiscal-year period ROLLEES.—The number of 1903A enrollees for ees (including each 1903A enrollee category under paragraph (1) unless the State has a a State and fiscal year, and, if applicable, for and each category of excluded individuals plan, approved under subparagraph (B), for a 1903A enrollee category, is the average under subsection (e)(1)) and the numbers of such period that specifies— monthly number of Medicaid enrollees for enrollees within each of such enrollee cat- ‘‘(i) the applicable block grant category such State and fiscal year (and, if applicable, egories, as the Secretary determines are nec- with respect to which the State will apply in such category) that are reported through essary (including timely guidance published the option under this subsection for such pe- the CMS–64 report under (and subject to as soon as possible after the date of the en- riod; audit under) subsection (h). actment of this section) in order to imple- ‘‘(ii) the conditions for eligibility of block ‘‘(f) SPECIAL PAYMENT RULES.— ment this section and to enable States to grant individuals within such applicable ‘‘(1) APPLICATION IN CASE OF RESEARCH AND comply with the requirement of this para- block grant category for block grant health DEMONSTRATION PROJECTS AND OTHER WAIV- graph on a timely basis. care assistance under the option, which shall ERS.—In the case of a State with a waiver of ‘‘(2) AUDITING.—The Secretary shall con- be instead of other conditions for eligibility the State plan approved under section 1115, duct for each State an audit of the number of under this title, except that in the case of a section 1915, or another provision of this individuals and expenditures reported State that has elected the applicable block title, this section shall apply to medical as- through the CMS–64 report for fiscal year grant category described in— sistance expenditures and medical assistance 2016, fiscal year 2019, and each subsequent ‘‘(I) subparagraph (A) of paragraph (6), the payments under the waiver, in the same fiscal year, which audit may be conducted on plan must provide for eligibility for pregnant manner as if such expenditures and pay- a representative sample (as determined by women and children required to be provided ments had been made under a State plan the Secretary). medical assistance under subsections under this title and the limitations on ex- ‘‘(3) TEMPORARY INCREASE IN FEDERAL (a)(10)(A)(i) and (e)(4) of section 1902; or penditures under this section shall supersede MATCHING PERCENTAGE TO SUPPORT IMPROVED ‘‘(II) subparagraph (B) of paragraph (6), the any other payment limitations or provisions DATA REPORTING SYSTEMS FOR FISCAL YEARS plan must provide for eligibility for pregnant (including limitations based on a per capita 2018 AND 2019.—For amounts expended during women required to be provided medical as- limitation) otherwise applicable under such calendar quarters beginning on or after Octo- sistance under subsection (a)(10)(A)(i); and a waiver. ber 1, 2017, and before October 1, 2019— ‘‘(iii) the types of items and services, the ‘‘(2) TREATMENT OF STATES EXPANDING COV- ‘‘(A) the Federal matching percentage ap- amount, duration, and scope of such services, ERAGE AFTER FISCAL YEAR 2016.—In the case of plied under section 1903(a)(3)(A)(i) shall be the cost-sharing with respect to such serv- a State that did not provide for medical as- increased by 10 percentage points to 100 per- ices, and the method for delivery of block sistance for the 1903A enrollee category de- cent; grant health care assistance under this sub- scribed in subsection (e)(2)(D) during fiscal ‘‘(B) the Federal matching percentage ap- section, which shall be instead of the such year 2016 but which provides for such assist- plied under section 1903(a)(3)(B) shall be in- types, amount, duration, and scope, cost- ance for such category in a subsequent year, creased by 25 percentage points to 100 per- sharing, and methods of delivery for medical the provisional FY19 per capita target cent; and assistance otherwise required under this amount for such enrollee category under ‘‘(C) the Federal matching percentage ap- title, except that the plan must provide for subsection (d)(5) shall be equal to the provi- plied under section 1903(a)(7) shall be in- assistance for— sional FY19 per capita target amount for the creased by 10 percentage points to 60 percent ‘‘(I) hospital care; 1903A enrollee category described in sub- but only with respect to amounts expended ‘‘(II) surgical care and treatment; section (e)(2)(E). that are attributable to a State’s additional ‘‘(III) medical care and treatment; ‘‘(3) IN CASE OF STATE FAILURE TO REPORT administrative expenditures to implement ‘‘(IV) obstetrical and prenatal care and NECESSARY DATA.—If a State for any quarter the data requirements of paragraph (1). treatment; in a fiscal year (beginning with fiscal year ‘‘(i) FLEXIBLE BLOCK GRANT OPTION FOR ‘‘(V) prescribed drugs, medicines, and pros- 2019) fails to satisfactorily submit data on STATES.— thetic devices; expenditures and enrollees in accordance ‘‘(1) IN GENERAL.—In the case of a State ‘‘(VI) other medical supplies and services; with subsection (h)(1), for such fiscal year that elects the option of applying this sub- and and any succeeding fiscal year for which section for a 10-fiscal-year period (beginning ‘‘(VII) health care for children under 18 such data are not satisfactorily submitted— no earlier than fiscal year 2020 and, at the years of age. ‘‘(A) the Secretary shall calculate and State option, for any succeeding 10-fiscal- ‘‘(B) REVIEW AND APPROVAL.—A plan de- apply subsections (a) through (e) with re- year period) and that has a plan approved by scribed in subparagraph (A) shall be deemed spect to the State as if all 1903A enrollee cat- the Secretary under paragraph (2) to carry approved by the Secretary unless the Sec- egories for which such expenditure and en- out the option for such period— retary determines, within 30 days after the rollee data were not satisfactorily submitted ‘‘(A) the State shall receive, instead of date of the Secretary’s receipt of the plan, were a single 1903A enrollee category; and amounts otherwise payable to the State that the plan is incomplete or actuarially ‘‘(B) the growth factor otherwise applied under this title for medical assistance for unsound and, with respect to such plan and under subsection (c)(2)(B) shall be decreased block grant individuals within the applicable its implementation under this subsection, by 1 percentage point. block grant category (as defined in para- the requirements of paragraphs (1), (10)(B), ‘‘(g) RECALCULATION OF CERTAIN AMOUNTS graph (6)) for the State during the period in (17), and (23) of section 1902(a) shall not FOR DATA ERRORS.—The amounts and per- which the election is in effect, the amount apply. centage calculated under paragraphs (1) and specified in paragraph (4); ‘‘(3) AMOUNT OF BLOCK GRANT FUNDS.—

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‘‘(A) FOR INITIAL FISCAL YEAR.—The block spect to activities funded under this sub- ‘‘(B) Early identification and intervention grant amount under this paragraph for a section for each fiscal year for which the for children and young adults with serious State for the initial fiscal year in the first State elects to apply this subsection to en- mental illness. 10-fiscal-year period is equal to the sum of sure that such funds are used consistent with ‘‘(8) Providing payments, directly or indi- the products (for each applicable block grant this subsection and shall make such audits rectly, to health care providers for the provi- category for such State and period) of— available to the Secretary upon the request sion of such health care services as are speci- ‘‘(i) the target per capita medical assist- of the Secretary.’’. fied by the Administrator. ance expenditures for such State for such fis- Subtitle D—Patient Relief and Health ‘‘(9) Providing assistance to reduce out-of- cal year (under subsection (c)(2)); Insurance Market Stability pocket costs, such as copayments, coinsur- ‘‘(ii) the number of 1903A enrollees for such ance, premiums, and deductibles, of individ- SEC. 131. REPEAL OF COST-SHARING SUBSIDY. category and State for fiscal year 2019, as de- uals enrolled in health insurance coverage in (a) IN GENERAL.—Section 1402 of the Pa- termined under subsection (e)(4); and the State. ‘‘(iii) the Federal average medical assist- tient Protection and Affordable Care Act is ‘‘(b) REQUIRED USE OF INCREASE IN ALLOT- ance matching percentage (as defined in sub- repealed. MENT.—A State shall use the additional allo- section (a)(4)) for the State for fiscal year (b) EFFECTIVE DATE.—The repeal made by cation provided to the State from the funds 2019. subsection (a) shall apply to cost-sharing re- ductions (and payments to issuers for such appropriated under the second sentence of ‘‘(B) FOR ANY SUBSEQUENT FISCAL YEAR.— section 2204(b) for each year only for the pur- The block grant amount under this para- reductions) for plan years beginning after poses described in paragraphs (6) and (7) of graph for a State for each succeeding fiscal December 31, 2019. subsection (a). year (in any 10-fiscal-year period) is equal to SEC. 132. PATIENT AND STATE STABILITY FUND. the block grant amount under subparagraph The Social Security Act (42 U.S.C. 301 et ‘‘SEC. 2203. STATE ELIGIBILITY AND APPROVAL; (A) (or this subparagraph) for the State for seq.) is amended by adding at the end the fol- DEFAULT SAFEGUARD. lowing new title: the previous fiscal year increased by the an- ‘‘(a) ENCOURAGING STATE OPTIONS FOR AL- nual increase in the consumer price index for ‘‘TITLE XXII—PATIENT AND STATE LOCATIONS.— all urban consumers (all items; U.S. city av- STABILITY FUND ‘‘(1) IN GENERAL.—To be eligible for an allo- erage) for the fiscal year involved. ‘‘SEC. 2201. ESTABLISHMENT OF PROGRAM. cation of funds under this title for a year ‘‘(C) AVAILABILITY OF ROLLOVER FUNDS.— ‘‘There is hereby established the ‘Patient during the period described in section 2201 The block grant amount under this para- and State Stability Fund’ to be administered for use for one or more purposes described in graph for a State for a fiscal year shall re- by the Secretary of Health and Human Serv- section 2202, a State shall submit to the Ad- main available to the State for expenditures ices, acting through the Administrator of ministrator an application at such time (but, under this subsection for the succeeding fis- the Centers for Medicare & Medicaid Serv- in the case of allocations for 2018, not later cal year but only if an election is in effect ices (in this section referred to as the ‘Ad- than 45 days after the date of the enactment under this subsection for the State in such ministrator’), to provide funding, in accord- of this title and, in the case of allocations succeeding fiscal year. ance with this title, to the 50 States and the for a subsequent year, not later than March ‘‘(4) FEDERAL PAYMENT AND STATE RESPON- District of Columbia (each referred to in this 31 of the previous year) and in such form and SIBILITY.—The Secretary shall pay to each section as a ‘State’) during the period, sub- manner as specified by the Administrator State with an election in effect under this ject to section 2204(c), beginning on January and containing— subsection for a fiscal year, from its block 1, 2018, and ending on December 31, 2026, for ‘‘(A) a description of how the funds will be grant amount under paragraph (3) available used for such purposes; for such fiscal year, an amount for each the purposes described in section 2202. ‘‘(B) a certification that the State will quarter of such fiscal year equal to the en- ‘‘SEC. 2202. USE OF FUNDS. make, from non-Federal funds, expenditures hanced FMAP described in the first sentence ‘‘(a) IN GENERAL.—Subject to subsection for such purposes in an amount that is not of section 2105(b) of the total amount ex- (b), a State may use the funds allocated to less than the State percentage required for pended under the State plan under this sub- the State under this title for any of the fol- the year under section 2204(e)(1); and section during such quarter, and the State is lowing purposes: ‘‘(C) such other information as the Admin- responsible for the balance of funds to carry ‘‘(1) Helping, through the provision of fi- istrator may require. out such plan. nancial assistance, high-risk individuals who ‘‘(2) AUTOMATIC APPROVAL.—An application ‘‘(5) BLOCK GRANT INDIVIDUAL DEFINED.—In do not have access to health insurance cov- this subsection, the term ‘block grant indi- erage offered through an employer enroll in so submitted is approved unless the Adminis- vidual’ means, with respect to a State for a health insurance coverage in the individual trator notifies the State submitting the ap- 10-fiscal-year period, an individual who is market in the State, as such market is de- plication, not later than 60 days after the not disabled (as defined for purposes of the fined by the State (whether through the es- date of the submission of such application, State plan) and who is within an applicable tablishment of a new mechanism or mainte- that the application has been denied for not block grant category for the State and such nance of an existing mechanism for such pur- being in compliance with any requirement of period. pose). this title and of the reason for such denial. ‘‘(6) APPLICABLE BLOCK GRANT CATEGORY ‘‘(2) Providing incentives to appropriate ‘‘(3) ONE-TIME APPLICATION.—If an applica- DEFINED.—In this subsection, the term ‘appli- entities to enter into arrangements with the tion of a State is approved for a year, with cable block grant category’ means with re- State to help stabilize premiums for health respect to a purpose described in section spect to a State for a 10-fiscal-year period, insurance coverage in the individual market, 2202, such application shall be treated as ap- either of the following as specified by the as such markets are defined by the State. proved, with respect to such purpose, for State for such period in its plan under para- ‘‘(3) Reducing the cost for providing health each subsequent year through 2026. graph (2)(A)(i): insurance coverage in the individual market ‘‘(4) TREATMENT AS A STATE HEALTH CARE ‘‘(A) 2 ENROLLEE CATEGORIES.—Both of the and small group market, as such markets are PROGRAM.—Any program receiving funds following 1903A enrollee categories: defined by the State, to individuals who from an allocation for a State under this ‘‘(i) CHILDREN.—The 1903A enrollee cat- have, or are projected to have, a high rate of title, including pursuant to subsection (b), egory specified in subparagraph (C) of sub- utilization of health services (as measured shall be considered to be a ‘State health care section (e)(2). by cost) and to individuals who have high program’ for purposes of sections 1128, 1128A, ‘‘(ii) OTHER NONELDERLY, NONDISABLED, costs of health insurance coverage due to the and 1128B. NON-EXPANSION ADULTS.—The 1903A enrollee low density population of the State in which ‘‘(b) DEFAULT FEDERAL SAFEGUARD.— category specified in subparagraph (E) of they reside. ‘‘(1) IN GENERAL.— such subsection. ‘‘(4) Promoting participation in the indi- ‘‘(A) 2018.—For allocations made under this ‘‘(B) OTHER NONELDERLY, NONDISABLED, vidual market and small group market in title for 2018, in the case of a State that does NON-EXPANSION ADULTS.—Only the 1903A en- the State and increasing health insurance not submit an application under subsection rollee category specified in subparagraph (E) options available through such market. (a) by the 45-day submission date applicable of subsection (e)(2). ‘‘(5) Promoting access to preventive serv- to such year under subsection (a)(1) and in ‘‘(7) BLOCK GRANT HEALTH CARE ASSIST- ices; dental care services (whether preven- the case of a State that does submit such an ANCE.—In this subsection, the term ‘block tive or medically necessary); vision care application by such date that is not ap- grant health care assistance’ means assist- services (whether preventive or medically proved, subject to section 2204(e), the Admin- ance for health-care-related items and med- necessary); or any combination of such serv- istrator, in consultation with the State in- ical services for block grant individuals ices. surance commissioner, shall use the alloca- within the applicable block grant category ‘‘(6) Maternity coverage and newborn care. tion that would otherwise be provided to the for the State and 10-fiscal-year period in- ‘‘(7) Prevention, treatment, or recovery State under this title for such year, in ac- volved who are low-income individuals (as support services for individuals with mental cordance with paragraph (2), for such State. defined by the State). or substance use disorders, focused on either ‘‘(B) 2019 THROUGH 2026.—In the case of a ‘‘(8) AUDITING.—As a condition of receiving or both of the following: State that does not have in effect an ap- funds under this subsection, a State shall ‘‘(A) Direct inpatient or outpatient clinical proved application under this section for 2019 contract with an independent entity to con- care for treatment of addiction and mental or a subsequent year beginning during the duct audits of its expenditures made with re- illness. period described in section 2201, subject to

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00027 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.001 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2400 CONGRESSIONAL RECORD — HOUSE March 24, 2017 section 2204(e), the Administrator, in con- ‘‘(II) the relative State incurred claims ‘‘(ii) is established after consultation with sultation with the State insurance commis- proportion described in clause (iii) for such health care consumers, health insurance sioner, shall use the allocation that would State and year. issuers, State insurance commissioners, and otherwise be provided to the State under this ‘‘(iii) RELATIVE STATE INCURRED CLAIMS other stakeholders and after taking into con- title for such year, in accordance with para- PROPORTION.—The relative State incurred sideration additional cost and risk factors graph (2), for such State. claims proportion described in this clause for that may inhibit health care consumer and ‘‘(2) REQUIRED USE FOR MARKET STABILIZA- a State and year is the amount equal to the health insurance issuer participation; and TION PAYMENTS TO ISSUERS.—Subject to sec- ratio of— ‘‘(iii) reflects the goals of improving the tion 2204(a), an allocation for a State made ‘‘(I) the adjusted incurred claims by the health insurance risk pool, promoting a pursuant to paragraph (1) for a year shall be State, as reported through the medical loss more competitive health insurance market, used to carry out the purpose described in ratio annual reporting under section 2718 of and increasing choice for health care con- section 2202(2) in such State by providing the Public Health Service Act for the third sumers. payments to appropriate entities described previous year; to ‘‘(c) ANNUAL DISTRIBUTION OF PREVIOUS in such section with respect to claims that ‘‘(II) the sum of such adjusted incurred YEAR’S REMAINING FUNDS.— In carrying out exceed $50,000 (or, with respect to allocations claims for all States, as so reported, for such subsection (b), the Administrator shall, with made under this title for 2020 or a subsequent third previous year. respect to a year (beginning with 2020 and year during the period specified in section ‘‘(iv) RELATIVE UNINSURED AND ISSUER PAR- ending with 2027), not later than March 31 of 2201, such dollar amount specified by the Ad- TICIPATION AMOUNT.—For purposes of clause such year— ministrator), but do not exceed $350,000 (or, (i), the relative uninsured and issuer partici- ‘‘(1) determine the amount of funds, if any, with respect to allocations made under this pation amount described in this clause for a from the amounts appropriated under sub- title for 2020 or a subsequent year during State for 2018 and 2019 is the product of— section (a) for the previous year but not allo- such period, such dollar amount specified by ‘‘(I) 15 percent of the amount appropriated cated for such previous year; and the Administrator), in an amount equal to 75 under subsection (a) for the year; and ‘‘(2) if the Administrator determines that percent (or, with respect to allocations made ‘‘(II) the relative State uninsured and any funds were not so allocated for such pre- under this title for 2020 or a subsequent year issuer participation proportion described in vious year, allocate such remaining funds, in during such period, such percentage specified clause (v) for such State and year. accordance with the allocation methodology by the Administrator) of the amount of such ‘‘(v) RELATIVE STATE UNINSURED AND ISSUER specified pursuant to subsection (b)(2)(B)— claims. PARTICIPATION PROPORTION.—The relative ‘‘(A) to States that have submitted an ap- State uninsured and issuer participation pro- plication approved under section 2203(a) for ‘‘SEC. 2204. ALLOCATIONS. portion described in this clause for a State such previous year for any purpose for which ‘‘(a) APPROPRIATION.—For the purpose of and year is— such an application was approved; and providing allocations for States (including ‘‘(I) in the case of a State not described in ‘‘(B) for States for which allocations were pursuant to section 2203(b)) under this title clause (vi) for such year, 0; and made pursuant to section 2203(b) for such there is appropriated, out of any money in ‘‘(II) in the case of a State described in previous year, to be used by the Adminis- the Treasury not otherwise appropriated— clause (vi) for such year, the amount equal trator for such States, to carry out the pur- ‘‘(1) for 2018, $15,000,000,000; to the ratio of— pose described in section 2202(2) in such ‘‘(2) for 2019, $15,000,000,000; ‘‘(aa) the number of individuals residing in States by providing payments to appropriate ‘‘(3) for 2020, $10,000,000,000; such State who for the third preceding year entities described in such section with re- ‘‘(4) for 2021, $10,000,000,000; were not enrolled in a health plan or other- spect to claims that exceed $1,000,000; ‘‘(5) for 2022, $10,000,000,000; wise did not have health insurance coverage with, respect to a year before 2027, any re- ‘‘(6) for 2023, $10,000,000,000; (including through a Federal or State health maining funds being made available for allo- ‘‘(7) for 2024, $10,000,000,000; program) and whose income is below 100 per- cations to States for the subsequent year. ‘‘(8) for 2025, $10,000,000,000; and cent of the poverty line applicable to a fam- ‘‘(d) AVAILABILITY.—Amounts appropriated ‘‘(9) for 2026, $10,000,000,000. ily of the size involved; to under subsection (a) for a year and allocated The amount otherwise appropriated under ‘‘(bb) the sum of the number of such indi- to States in accordance with this section the previous sentence for 2020 shall be in- viduals for all States described in clause (vi) shall remain available for expenditure creased by $15,000,000,000, to be used and for the third preceding year. through December 31, 2027. available under subsection (d) only for the ‘‘(vi) STATES DESCRIBED.—For purposes of ‘‘(e) CONDITIONS FOR AND LIMITATIONS ON purposes described in paragraphs (6) and (7) clause (v), a State is described in this clause, RECEIPT OF FUNDS.—The Secretary may not of section 2202(a). with respect to 2018 and 2019, if the State sat- make an allocation under this title for a ‘‘(b) ALLOCATIONS.— isfies either of the following criterion: State, with respect to a purpose described in ‘‘(1) PAYMENT.— ‘‘(I) The ratio described in subclause (II) of section 2202— ‘‘(A) IN GENERAL.—From amounts appro- clause (v) that would be determined for such ‘‘(1) in the case of an allocation that would priated under subsection (a) for a year, the State by substituting ‘2015’ for each ref- be made to a State pursuant to section Administrator shall, with respect to a State erence in such subclause to ‘the third pre- 2203(a), if the State does not agree that the and not later than the date specified under ceding year’ and by substituting ‘all such State will make available non-Federal con- subparagraph (B) for such year, allocate, States’ for the reference in item (bb) of such tributions towards such purpose in an subject to subsection (e), for such State (in- subclause to ‘all States described in clause amount equal to— cluding pursuant to section 2203(b)) the (vi)’ is greater than the ratio described in ‘‘(A) for 2020, 7 percent of the amount allo- amount determined for such State and year such subclause that would be determined for cated under this subsection to such State for under paragraph (2). such State by substituting ‘2013’ for each ref- such year and purpose; ‘‘(B) SPECIFIED DATE.—For purposes of sub- erence in such subclause to ‘the third pre- ‘‘(B) for 2021, 14 percent of the amount allo- paragraph (A), the date specified in this sub- ceding year’ and by substituting ‘all such cated under this subsection to such State for paragraph is— States’ for the reference in item (bb) of such such year and purpose; ‘‘(i) for 2018, the date that is 45 days after subclause to ‘all States described in clause ‘‘(C) for 2022, 21 percent of the amount allo- the date of the enactment of this title; and (vi)’. cated under this subsection to such State for ‘‘(ii) for 2019 and subsequent years, Janu- ‘‘(II) The State has fewer than three health such year and purpose; ary 1 of the respective year. insurance issuers offering qualified health ‘‘(D) for 2023, 28 percent of the amount allo- ‘‘(2) ALLOCATION AMOUNT DETERMINA- plans through the Exchange for 2017. cated under this subsection to such State for TIONS.— ‘‘(B) FOR 2020 THROUGH 2026.—For purposes of such year and purpose; ‘‘(A) FOR 2018 AND 2019.— paragraph (1), the amount determined under ‘‘(E) for 2024, 35 percent of the amount allo- ‘‘(i) IN GENERAL.—For purposes of para- this paragraph for a year (beginning with cated under this subsection to such State for graph (1), the amount determined under this 2020) during the period described in section such year and purpose; paragraph for 2018 and 2019 for a State is an 2201 for a State is an amount determined in ‘‘(F) for 2025, 42 percent of the amount allo- amount equal to the sum of— accordance with an allocation methodology cated under this subsection to such State for ‘‘(I) the relative incurred claims amount specified by the Administrator which— such year and purpose; and described in clause (ii) for such State and ‘‘(i) takes into consideration the adjusted ‘‘(G) for 2026, 50 percent of the amount allo- year; and incurred claims of such State, the number of cated under this subsection to such State for ‘‘(II) the relative uninsured and issuer par- residents of such State who for the previous such year and purpose; ticipation amount described in clause (iv) for year were not enrolled in a health plan or ‘‘(2) in the case of an allocation that would such State and year. otherwise did not have health insurance cov- be made for a State pursuant to section ‘‘(ii) RELATIVE INCURRED CLAIMS AMOUNT.— erage (including through a Federal or State 2203(b), if the State does not agree that the For purposes of clause (i), the relative in- health program) and whose income is below State will make available non-Federal con- curred claims amount described in this 100 percent of the poverty line applicable to tributions towards such purpose in an clause for a State for 2018 and 2019 is the a family of the size involved, and the number amount equal to— product of— of health insurance issuers participating in ‘‘(A) for 2020, 10 percent of the amount allo- ‘‘(I) 85 percent of the amount appropriated the insurance market in such State for such cated under this subsection to such State for under subsection (a) for the year; and year; such year and purpose;

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00028 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.001 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2401 ‘‘(B) for 2021, 20 percent of the amount allo- under a group health plan or health insur- Subtitle E—Implementation Funding cated under this subsection to such State for ance coverage by reason of section 2714 and SEC. 141. AMERICAN HEALTH CARE IMPLEMEN- such year and purpose; and such dependent coverage of such individual TATION FUND. ‘‘(C) for 2022, 30 percent of the amount allo- ceased because of the age of such individual, (a) IN GENERAL.—There is hereby estab- cated under this subsection to such State for is not enrolling during the first open enroll- lished an American Health Care Implementa- such year and purpose; ment period following the date on which tion Fund (referred to in this section as the ‘‘(D) for 2023, 40 percent of the amount allo- such coverage so ceased. ‘‘Fund’’) within the Department of Health cated under this subsection to such State for ‘‘(2) LOOK-BACK PERIOD.—The term ‘look- and Human Services to carry out sections such year and purpose; back period’ means, with respect to an en- 121, 132, 202, and 214 (including the amend- ‘‘(E) for 2024, 50 percent of the amount allo- forcement period applicable to an enrollment ments made by such sections). cated under this subsection to such State for of an individual for a plan year beginning (b) FUNDING.—There is appropriated to the such year and purpose; with plan year 2019 (or, in the case of an en- Fund, out of any funds in the Treasury not ‘‘(F) for 2025, 50 percent of the amount allo- rollment of an individual during a special en- otherwise appropriated, $1,000,000,000 for Fed- cated under this subsection to such State for rollment period, beginning with plan year eral administrative expenses to carry out the such year and purpose; and 2018) in health insurance coverage described sections described in subsection (a) (includ- ‘‘(G) for 2026, 50 percent of the amount allo- in subsection (a)(1), the 12-month period end- ing the amendments made by such sections). cated under this subsection to such State for ing on the date the individual enrolls in such TITLE II—COMMITTEE ON WAYS AND such year and purpose; or coverage for such plan year. MEANS ‘‘(3) if such an allocation for such purpose ‘‘(3) ENFORCEMENT PERIOD.—The term ‘en- Subtitle A—Repeal and Replace of Health- would not be permitted under subsection forcement period’ means— Related Tax Policy (c)(7) of section 2105 if such allocation were ‘‘(A) with respect to enrollments during a payment made under such section.’’. SEC. 201. RECAPTURE EXCESS ADVANCE PAY- special enrollment period for plan year 2018, MENTS OF PREMIUM TAX CREDITS. SEC. 133. CONTINUOUS HEALTH INSURANCE COV- the period beginning with the first month Subparagraph (B) of section 36B(f)(2) of the ERAGE INCENTIVE. that is during such plan year and that begins Subpart I of part A of title XXVII of the Internal Revenue Code of 1986 is amended by subsequent to such date of enrollment, and adding at the end the following new clause: Public Health Service Act is amended— ending with the last month of such plan (1) in section 2701(a)(1)(B), by striking ‘‘(iii) NONAPPLICABILITY OF LIMITATION.— year; and This subparagraph shall not apply to taxable ‘‘such rate’’ and inserting ‘‘subject to section ‘‘(B) with respect to enrollments for plan 2710A, such rate’’; years beginning after December 31, 2017, and year 2019 or a subsequent plan year, the 12- before January 1, 2020.’’. (2) by redesignating the second section 2709 month period beginning on the first day of as section 2710; and SEC. 202. ADDITIONAL MODIFICATIONS TO PRE- the respective plan year.’’. (3) by adding at the end the following new MIUM TAX CREDIT. section: SEC. 134. INCREASING COVERAGE OPTIONS. (a) MODIFICATION OF DEFINITION OF QUALI- ‘‘SEC. 2710A. ENCOURAGING CONTINUOUS Section 1302 of the Patient Protection and FIED HEALTH PLAN.— HEALTH INSURANCE COVERAGE. Affordable Care Act (42 U.S.C. 18022) is (1) IN GENERAL.—Section 36B(c)(3)(A) of the ‘‘(a) PENALTY APPLIED.— amended— Internal Revenue Code of 1986 is amended— ‘‘(1) IN GENERAL.—Notwithstanding section (1) in subsection (a)(3), by inserting ‘‘and (A) by inserting ‘‘(determined without re- 2701, subject to the succeeding provisions of with respect to a plan year before plan year gard to subparagraphs (A), (C)(ii), and (C)(iv) this section, a health insurance issuer offer- 2020’’ after ‘‘subsection (e)’’; and of paragraph (1) thereof and without regard ing health insurance coverage in the indi- (2) in subsection (d), by adding at the end to whether the plan is offered on an Ex- vidual market shall, in the case of an indi- the following: change)’’ after ‘‘1301(a) of the Patient Pro- vidual who is an applicable policyholder of ‘‘(5) SUNSET.—The provisions of this sub- tection and Affordable Care Act’’, and such coverage with respect to an enforce- section shall not apply after December 31, (B) by striking ‘‘shall not include’’ and all ment period applicable to enrollments for a 2019, and after such date any reference to that follows and inserting ‘‘shall not include plan year beginning with plan year 2019 (or, this subsection or level of coverage or plan any health plan that— in the case of enrollments during a special described in this subsection and any require- ‘‘(i) is a grandfathered health plan or a enrollment period, beginning with plan year ment under law applying such a level of cov- grandmothered health plan, or 2018), increase the monthly premium rate erage or plan shall have no force or effect ‘‘(ii) includes coverage for abortions (other otherwise applicable to such individual for (and such a requirement shall be applied as if than any abortion necessary to save the life such coverage during each month of such pe- this section had been repealed).’’. of the mother or any abortion with respect riod, by an amount determined under para- to a pregnancy that is the result of an act of SEC. 135. CHANGE IN PERMISSIBLE AGE VARI- rape or incest).’’. graph (2). ATION IN HEALTH INSURANCE PRE- ‘‘(2) AMOUNT OF PENALTY.—The amount de- MIUM RATES. (2) DEFINITION OF GRANDMOTHERED HEALTH termined under this paragraph for an appli- PLAN.—Section 36B(c)(3) of such Code is Section 2701(a)(1)(A)(iii) of the Public cable policyholder enrolling in health insur- amended by adding at the end the following Health Service Act (42 U.S.C. ance coverage described in paragraph (1) for new subparagraph: 300gg(a)(1)(A)(iii)), as inserted by section a plan year, with respect to each month dur- ‘‘(C) GRANDMOTHERED HEALTH PLAN.— 1201(4) of the Patient Protection and Afford- ing the enforcement period applicable to en- ‘‘(i) IN GENERAL.—The term able Care Act, is amended by inserting after rollments for such plan year, is the amount ‘grandmothered health plan’ means health ‘‘(consistent with section 2707(c))’’ the fol- that is equal to 30 percent of the monthly insurance coverage which is offered in the in- lowing: ‘‘or, for plan years beginning on or premium rate otherwise applicable to such dividual health insurance market as of Octo- after January 1, 2018, as the Secretary may applicable policyholder for such coverage ber 1, 2013, and is permitted to be offered in implement through interim final regulation, during such month. such market after January 1, 2014, as a result 5 to 1 for adults (consistent with section ‘‘(b) DEFINITIONS.—For purposes of this sec- of CCIIO guidance. 2707(c)) or such other ratio for adults (con- tion: ‘‘(ii) CCIIO GUIDANCE DEFINED.—The term sistent with section 2707(c)) as the State in- ‘‘(1) APPLICABLE POLICYHOLDER.—The term ‘CCIIO guidance’ means the letter issued by ‘applicable policyholder’ means, with respect volved may provide’’. the Centers for Medicare & Medicaid Serv- to months of an enforcement period and SEC. 136. ESSENTIAL HEALTH BENEFITS DE- ices on November 14, 2013, to the State Insur- health insurance coverage, an individual FINED BY THE STATES. ance Commissioners outlining a transitional who— Section 1302 of the Patient Protection and policy for non-grandfathered coverage in the ‘‘(A) is a policyholder of such coverage for Affordable Care Act (42 U.S.C. 18022) is individual health insurance market, as sub- such months; amended— sequently extended and modified (including ‘‘(B) cannot demonstrate that (through (1) in subsection (a)(1), by striking ‘‘by the by a communication entitled ‘Insurance presentation of certifications described in Secretary’’; and Standards Bulletin Series—INFORMATION— section 2704(e) or in such other manner as (2) in subsection (b)— Extension of Transitional Policy through may be specified in regulations, such as a re- (A) in paragraph (1), by striking ‘‘para- Calendar Year 2017’ issued on February 29, turn or statement made under section 6055(d) graph (2)’’ and inserting ‘‘paragraphs (2) and 2016, by the Director of the Center for Con- or 36B of the Internal Revenue Code of 1986), (6)’’; and sumer Information & Insurance Oversight of during the look-back period that is with re- (B) by adding at the end the following new such Centers). spect to such enforcement period, there was paragraph: ‘‘(iii) INDIVIDUAL HEALTH INSURANCE MAR- not a period of at least 63 continuous days ‘‘(6) ESSENTIAL HEALTH BENEFITS FOR PLAN KET.—The term ‘individual health insurance during which the individual did not have AND TAXABLE YEARS BEGINNING ON OR AFTER market’ means the market for health insur- creditable coverage (as defined in paragraph JANUARY 1, 2018.—For plan years and taxable ance coverage (as defined in section 9832(b)) (1) of section 2704(c) and credited in accord- years beginning on or after January 1, 2018, offered to individuals other than in connec- ance with paragraphs (2) and (3) of such sec- each State shall define the essential health tion with a group health plan (within the tion); and benefits with respect to health plans offered meaning of section 5000(b)(1)).’’. ‘‘(C) in the case of an individual who had in such State, for the purposes of section 36B (3) CONFORMING AMENDMENT RELATED TO been enrolled under dependent coverage of the Internal Revenue Code of 1986.’’. ABORTION COVERAGE.—Section 36B(c)(3) of

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such Code, as amended by paragraph (2), is (A) ADVANCE PAYMENT NOT APPLICABLE.— defined in section 36B(b)(3)) for each such amended by adding at the end the following Section 1412 of the Patient Protection and month with respect to such individual, and new subparagraph: Affordable Care Act is amended by adding at ‘‘(E) such other information as the Sec- ‘‘(D) CERTAIN RULES RELATED TO ABOR- the end the following new subsection: retary may prescribe.’’. TION.— ‘‘(f) EXCLUSION OF OFF-EXCHANGE COV- (C) OTHER CONFORMING AMENDMENTS.— ‘‘(i) OPTION TO PURCHASE SEPARATE COV- ERAGE.—Advance payments under this sec- (i) Section 36B(b)(2)(A) of such Code is ERAGE OR PLAN.—Nothing in subparagraph tion, and advance determinations under sec- amended by striking ‘‘and which were en- (A) shall be construed as prohibiting any in- tion 1411, with respect to any credit allowed rolled’’ and all that follows and inserting ‘‘, dividual from purchasing separate coverage under section 36B shall not be made with re- or’’. for abortions described in such subpara- spect to any health plan which is not en- (ii) Section 36B(b)(3)(B)(i) of such Code is graph, or a health plan that includes such rolled in through an Exchange.’’. amended by striking ‘‘the same Exchange’’ abortions, so long as no credit is allowed (B) REPORTING.—Section 6055(b) of the In- and all that follows and inserting ‘‘the Ex- under this section with respect to the pre- ternal Revenue Code of 1986 is amended by change through which such taxpayer is per- miums for such coverage or plan. adding at the end the following new para- mitted to obtain coverage, and’’. ‘‘(ii) OPTION TO OFFER COVERAGE OR PLAN.— graph: (iii) Section 36B(c)(2)(A)(i) of such Code is Nothing in subparagraph (A) shall restrict ‘‘(3) INFORMATION RELATING TO OFF-EX- amended by striking ‘‘that was enrolled in any health insurance issuer offering a health CHANGE PREMIUM CREDIT ELIGIBLE COV- through an Exchange established by the plan from offering separate coverage for ERAGE.—If minimum essential coverage pro- State under section 1311 of the Patient Pro- abortions described in such subparagraph, or vided to an individual under subsection (a) tection and Affordable Care Act’’. a plan that includes such abortions, so long consists of a qualified health plan (as defined as premiums for such separate coverage or in section 36B(c)(3)) which is not enrolled in (b) MODIFICATION OF APPLICABLE PERCENT- plan are not paid for with any amount at- through an Exchange established under title AGE.—Section 36B(b)(3)(A) of such Code is tributable to the credit allowed under this I of the Patient Protection and Affordable amended to read as follows: section (or the amount of any advance pay- Care Act, a return described in this sub- ‘‘(A) APPLICABLE PERCENTAGE.— ment of the credit under section 1412 of the section shall include— ‘‘(i) IN GENERAL.—The applicable percent- Patient Protection and Affordable Care Act). ‘‘(A) a statement that such plan is a quali- age for any taxable year shall be the percent- ‘‘(iii) OTHER TREATMENTS.—The treatment fied health plan (as defined in section age such that the applicable percentage for of any infection, injury, disease, or disorder 36B(c)(3)), any taxpayer whose household income is that has been caused by or exacerbated by ‘‘(B) the premiums paid with respect to within an income tier specified in the fol- the performance of an abortion shall not be such coverage, lowing table shall increase, on a sliding scale treated as an abortion for purposes of sub- ‘‘(C) the months during which such cov- in a linear manner, from the initial percent- paragraph (A).’’. erage is provided to the individual, age to the final percentage specified in such (4) CONFORMING AMENDMENTS RELATED TO ‘‘(D) the adjusted monthly premium for the table for such income tier with respect to a OFF-EXCHANGE COVERAGE.— applicable second lowest cost silver plan (as taxpayer of the age involved:

‘‘In the case of house- Up to Age 29 Age 30-39 Age 40-49 Age 50-59 Over Age 59 hold income (expressed as a per- cent of the poverty Initial Final Initial Final Initial Final Initial Final Initial Final line) within the fol- % % % % % % % % % % lowing income tier:

Up to 133% 2 2 2 2 2 2 2 2 2 2 133%-150% 3 4 3 4 3 4 3 4 3 4 150%-200% 4 4.3 4 5.3 4 6.3 4 7.3 4 8.3 200%-250% 4.3 4.3 5.3 5.9 6.3 8.05 7.3 9 8.3 10 250%-300% 4.3 4.3 5.9 5.9 8.05 8.35 9 10.5 10 11.5 300%-400% 4.3 4.3 5.9 5.9 8.35 8.35 10.5 10.5 11.5 11.5

‘‘(ii) AGE DETERMINATIONS.— (2) ADVANCE PAYMENT NOT APPLICABLE TO to a pregnancy that is the result of an act of ‘‘(I) IN GENERAL.—For purposes of clause OFF-EXCHANGE COVERAGE.—The amendment rape or incest) . (i), the age of the taxpayer taken into ac- made by subsection (a)(4)(A) shall take effect ‘‘(B) CERTAIN RULES RELATED TO ABOR- count under clause (i) with respect to any on January 1, 2018. TION.— taxable year is the age attained by such tax- (3) REPORTING.—The amendment made by ‘‘(i) OPTION TO PURCHASE SEPARATE COV- payer before the close of such taxable year. subsection (a)(4)(B) shall apply to coverage ERAGE OR PLAN.—Nothing in subparagraph ‘‘(II) JOINT RETURNS.—In the case of a joint provided for months beginning after Decem- (A) shall be construed as prohibiting any em- return, the age of the older spouse shall be ber 31, 2017. ployer from purchasing for its employees taken into account under clause (i). (4) MODIFICATION OF APPLICABLE PERCENT- separate coverage for abortions described in ‘‘(iii) INDEXING.—In the case of any taxable AGE.—The amendment made by subsection such subparagraph, or a health plan that in- year beginning in calendar year 2019, the ini- (b) shall apply to taxable years beginning cludes such abortions, so long as no credit is tial and final percentages contained in after December 31, 2018. allowed under this section with respect to clause (i) shall be adjusted to reflect— SEC. 203. SMALL BUSINESS TAX CREDIT. the employer contributions for such cov- ‘‘(I) the excess (if any) of the rate of pre- (a) IN GENERAL.—Section 45R of the Inter- erage or plan. mium growth for the period beginning with nal Revenue Code of 1986 is amended by add- ‘‘(ii) OPTION TO OFFER COVERAGE OR PLAN.— calendar year 2013 and ending with calendar ing at the end the following new subsection: Nothing in subparagraph (A) shall restrict year 2018, over the rate of income growth for ‘‘(j) SHALL NOT APPLY.—This section shall any health insurance issuer offering a health such period, and not apply with respect to amounts paid or plan from offering separate coverage for abortions described in such subparagraph, or ‘‘(II) in addition to any adjustment under incurred in taxable years beginning after De- a plan that includes such abortions, so long subclause (I), the excess (if any) of the rate cember 31, 2019.’’. as such separate coverage or plan is not paid of premium growth for calendar year 2018, (b) DISALLOWANCE OF SMALL EMPLOYER for with any employer contribution eligible over the rate of growth in the consumer HEALTH INSURANCE EXPENSE CREDIT FOR for the credit allowed under this section. price index for calendar year 2018. PLAN WHICH INCLUDES COVERAGE FOR ABOR- ‘‘(iii) OTHER TREATMENTS.—The treatment ‘‘(iv) FAILSAFE.—Clause (iii)(II) shall apply TION.—Subsection (h) of section 45R of the Internal Revenue Code of 1986 is amended— of any infection, injury, disease, or disorder only if the aggregate amount of premium tax that has been caused by or exacerbated by credits under this section and cost-sharing (1) by striking ‘‘Any term’’ and inserting the following: the performance of an abortion shall not be reductions under section 1402 of the Patient treated as an abortion for purposes of sub- Protection and Affordable Care Act for cal- ‘‘(1) IN GENERAL.—Any term’’; and (2) by adding at the end the following new paragraph (A).’’. endar year 2018 exceeds an amount equal to paragraph: (c) EFFECTIVE DATES.— 0.504 percent of the gross domestic product ‘‘(2) EXCLUSION OF HEALTH PLANS INCLUDING (1) IN GENERAL.—The amendment made by for such calendar year.’’. COVERAGE FOR ABORTION.— subsection (a) shall apply to taxable years (c) EFFECTIVE DATE.— ‘‘(A) IN GENERAL.—The term ‘qualified beginning after December 31, 2019. (1) IN GENERAL.—Except as otherwise pro- health plan’ does not include any health plan (2) DISALLOWANCE OF SMALL EMPLOYER vided in this subsection, the amendments that includes coverage for abortions (other HEALTH INSURANCE EXPENSE CREDIT FOR PLAN made by this section shall apply to taxable than any abortion necessary to save the life WHICH INCLUDES COVERAGE FOR ABORTION.— years beginning after December 31, 2017. of the mother or any abortion with respect The amendments made by subsection (b)

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shall apply to taxable years beginning after SEC. 210. REPEAL OF MEDICAL DEVICE EXCISE ‘‘(2) ELIGIBLE COVERAGE MONTH REQUIRE- December 31, 2017. TAX. MENT.—No amount shall be taken into ac- SEC. 204. INDIVIDUAL MANDATE. Section 4191 of the Internal Revenue Code count under subparagraph (A) or (B) of para- of 1986 is amended by adding at the end the (a) IN GENERAL.—Section 5000A(c) of the In- graph (1) with respect to any individual for ternal Revenue Code of 1986 is amended— following new subsection: any month unless such month is an eligible ‘‘(d) APPLICABILITY.—The tax imposed (1) in paragraph (2)(B)(iii), by striking ‘‘2.5 coverage month with respect to such indi- under subsection (a) shall not apply to sales percent’’ and inserting ‘‘Zero percent’’, and vidual. after December 31, 2016.’’. ‘‘(c) MONTHLY LIMITATION AMOUNTS.— (2) in paragraph (3)— ‘‘(1) IN GENERAL.—The monthly limitation (A) by striking ‘‘$695’’ in subparagraph (A) SEC. 211. REPEAL OF ELIMINATION OF DEDUC- amount with respect to any individual for and inserting ‘‘$0’’, and TION FOR EXPENSES ALLOCABLE TO MEDICARE PART D SUBSIDY. any eligible coverage month during any tax- (B) by striking subparagraph (D). (a) IN GENERAL.—Section 139A of the Inter- able year is 1⁄12 of— (b) EFFECTIVE DATE.—The amendments nal Revenue Code of 1986 is amended by add- ‘‘(A) $2,000 in the case of an individual who made by this section shall apply to months ing at the end the following new sentence: has not attained age 30 as of the beginning of beginning after December 31, 2015. ‘‘This section shall not be taken into ac- such taxable year, SEC. 205. EMPLOYER MANDATE. count for purposes of determining whether ‘‘(B) $2,500 in the case of an individual who (a) IN GENERAL.— any deduction is allowable with respect to has attained age 30 but who has not attained (1) Paragraph (1) of section 4980H(c) of the any cost taken into account in determining age 40 as of such time, Internal Revenue Code of 1986 is amended by such payment.’’. ‘‘(C) $3,000 in the case of an individual who inserting ‘‘($0 in the case of months begin- (b) EFFECTIVE DATE.—The amendment has attained age 40 but who has not attained ning after December 31, 2015)’’ after ‘‘$2,000’’. made by this section shall apply to taxable age 50 as of such time, (2) Paragraph (1) of section 4980H(b) of the years beginning after December 31, 2016. ‘‘(D) $3,500 in the case of an individual who Internal Revenue Code of 1986 is amended by SEC. 212. REDUCTION OF INCOME THRESHOLD has attained age 50 but who has not attained inserting ‘‘($0 in the case of months begin- FOR DETERMINING MEDICAL CARE age 60 as of such time, and ning after December 31, 2015)’’ after ‘‘$3,000’’. DEDUCTION. ‘‘(E) $4,000 in the case of an individual who (b) EFFECTIVE DATE.—The amendments (a) IN GENERAL.—Subsection (a) of section has attained age 60 as of such time. made by this section shall apply to months 213 of the Internal Revenue Code of 1986 is ‘‘(2) LIMITATION BASED ON MODIFIED AD- beginning after December 31, 2015. amended by striking ‘‘10 percent’’ and insert- JUSTED GROSS INCOME.—The credit allowed SEC. 206. REPEAL OF THE TAX ON EMPLOYEE ing ‘‘5.8 percent’’. under subsection (a) with respect to any tax- HEALTH INSURANCE PREMIUMS (b) EFFECTIVE DATE.—The amendment payer for any taxable year shall be reduced AND HEALTH PLAN BENEFITS. made by this section shall apply to taxable (but not below zero) by 10 percent of the ex- Section 4980I of the Internal Revenue Code years beginning after December 31, 2016. cess (if any) of— of 1986 is amended by adding at the end the SEC. 213. REPEAL OF MEDICARE TAX INCREASE. ‘‘(A) the taxpayer’s modified adjusted gross income (as defined in section 36B(d)(2)(B), as following new subsection: (a) IN GENERAL.—Subsection (b) of section ‘‘(h) SHALL NOT APPLY.—No tax shall be 3101 of the Internal Revenue Code of 1986 is in effect for taxable years beginning before imposed under this section with respect to amended to read as follows: January 1, 2020) for such taxable year, over ‘‘(B) $75,000 (twice such amount in the case any taxable period beginning after December ‘‘(b) HOSPITAL INSURANCE.—In addition to 31, 2019, and before January 1, 2026.’’. the tax imposed by the preceding subsection, of a joint return). SEC. 207. REPEAL OF TAX ON OVER-THE- there is hereby imposed on the income of ‘‘(3) OTHER LIMITATIONS.— COUNTER MEDICATIONS. every individual a tax equal to 1.45 percent ‘‘(A) AGGREGATE DOLLAR LIMITATION.—The (a) HSAS.—Subparagraph (A) of section of the wages (as defined in section 3121(a)) re- sum of the monthly limitation amounts 223(d)(2) of the Internal Revenue Code of 1986 ceived by such individual with respect to em- taken into account under this section with is amended by striking ‘‘Such term’’ and all ployment (as defined in section 3121(b)).’’. respect to any taxpayer for any taxable year that follows through the period. (b) SECA.—Subsection (b) of section 1401 of shall not exceed $14,000. (b) ARCHER MSAS.—Subparagraph (A) of the Internal Revenue Code of 1986 is amended ‘‘(B) MAXIMUM NUMBER OF INDIVIDUALS section 220(d)(2) of the Internal Revenue to read as follows: TAKEN INTO ACCOUNT.—With respect to any taxpayer for any month, monthly limitation Code of 1986 is amended by striking ‘‘Such ‘‘(b) HOSPITAL INSURANCE.—In addition to term’’ and all that follows through the pe- the tax imposed by the preceding subsection, amounts shall be taken into account under riod. there shall be imposed for each taxable year, this section only with respect to the 5 oldest (c) HEALTH FLEXIBLE SPENDING ARRANGE- on the self-employment income of every in- individuals with respect to whom monthly MENTS AND HEALTH REIMBURSEMENT AR- dividual, a tax equal to 2.9 percent of the limitation amounts could (without regard to RANGEMENTS.—Section 106 of the Internal amount of the self-employment income for this subparagraph) otherwise be so taken Revenue Code of 1986 is amended by striking such taxable year.’’. into account. ‘‘(d) ELIGIBLE COVERAGE MONTH.—For pur- subsection (f) and by redesignating sub- (c) EFFECTIVE DATE.—The amendments poses of this section, the term ‘eligible cov- section (g) as subsection (f). made by this section shall apply with respect erage month’ means, with respect to any in- (d) EFFECTIVE DATES.— to remuneration received after, and taxable dividual, any month if, as of the first day of (1) DISTRIBUTIONS FROM SAVINGS AC- years beginning after, December 31, 2022. such month, the individual meets the fol- COUNTS.—The amendments made by sub- SEC. 214. REFUNDABLE TAX CREDIT FOR HEALTH lowing requirements: sections (a) and (b) shall apply to amounts INSURANCE COVERAGE. ‘‘(1) The individual is covered by a health paid with respect to taxable years beginning (a) IN GENERAL.—Section 36B of the Inter- insurance coverage which is certified by the after December 31, 2016. nal Revenue Code of 1986 is amended to read State in which such insurance is offered as (2) REIMBURSEMENTS.—The amendment as follows: coverage that meets the requirements for made by subsection (c) shall apply to ex- ‘‘SEC. 36B. REFUNDABLE CREDIT FOR COVERAGE qualified health plans under subsection (f). penses incurred with respect to taxable years UNDER A QUALIFIED HEALTH PLAN. ‘‘(2) The individual is not eligible for— beginning after December 31, 2016. ‘‘(a) ALLOWANCE OF PREMIUM TAX CREDIT.— ‘‘(A) coverage under a group health plan SEC. 208. REPEAL OF INCREASE OF TAX ON In the case of an individual, there shall be al- (within the meaning of section 5000(b)(1)) HEALTH SAVINGS ACCOUNTS. lowed as a credit against the tax imposed by other than coverage under a plan substan- (a) HSAS.—Section 223(f)(4)(A) of the Inter- this subtitle for the taxable year the sum of tially all of the coverage of which is of ex- nal Revenue Code of 1986 is amended by the monthly credit amounts with respect to cepted benefits described in section 9832(c), striking ‘‘20 percent’’ and inserting ‘‘10 per- such taxpayer for calendar months during or cent’’. such taxable year which are eligible cov- ‘‘(B) coverage described in section (b) ARCHER MSAS.—Section 220(f)(4)(A) of erage months appropriately taken into ac- 5000A(f)(1)(A). the Internal Revenue Code of 1986 is amended count under subsection (b)(2) with respect to ‘‘(3) The individual is either— by striking ‘‘20 percent’’ and inserting ‘‘15 the taxpayer or any qualifying family mem- ‘‘(A) a citizen or national of the United percent’’. ber of the taxpayer. States, or (c) EFFECTIVE DATE.—The amendments ‘‘(b) MONTHLY CREDIT AMOUNTS.— ‘‘(B) a qualified alien (within the meaning made by this section shall apply to distribu- ‘‘(1) IN GENERAL.—The monthly credit of section 431 of the Personal Responsibility tions made after December 31, 2016. amount with respect to any taxpayer for any and Work Opportunity Reconciliation Act of SEC. 209. REPEAL OF LIMITATIONS ON CON- calendar month is the lesser of— 1996 (8 U.S.C. 1641)). TRIBUTIONS TO FLEXIBLE SPEND- ‘‘(A) the sum of the monthly limitation ‘‘(4) The individual is not incarcerated, ING ACCOUNTS. amounts determined under subsection (c) other than incarceration pending the disposi- (a) IN GENERAL.—Section 125 of the Inter- with respect to the taxpayer and the tax- tion of charges. nal Revenue Code of 1986 is amended by payer’s qualifying family members for such ‘‘(e) QUALIFYING FAMILY MEMBER.—For striking subsection (i). month, or purposes of this section, the term ‘qualifying (b) EFFECTIVE DATE.—The amendment ‘‘(B) the amount paid for a qualified health family member’ means— made by this section shall apply to taxable plan for the taxpayer and the taxpayer’s ‘‘(1) in the case of a joint return, the tax- years beginning after December 31, 2016. qualifying family members for such month. payer’s spouse,

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‘‘(2) any dependent of the taxpayer, and exceed the amount described in subsection ‘‘(C) ROUNDING.—Any increase determined ‘‘(3) with respect to any eligible coverage (b)(1)(A) with respect to such month. under subparagraph (A) shall be rounded to month, any child (as defined in section ‘‘(4) COORDINATION WITH ADVANCE PAYMENTS the nearest multiple of $50. 152(f)(1)) of the taxpayer who as of the end of OF CREDIT.—With respect to any taxable ‘‘(8) RULES RELATED TO STATE CERTIFI- the taxable year has not attained age 27 if year— CATION OF QUALIFIED HEALTH PLANS.—A cer- such child is covered for such month under a ‘‘(A) the amount which would (but for this tification shall not be taken into account qualified health plan which also covers the subsection) be allowed as a credit to the tax- under subsection (d)(1) unless such certifi- taxpayer (in the case of a joint return, either payer under subsection (a) shall be reduced cation is made available to the public and spouse). (but not below zero) by the aggregate meets such other requirements as the Sec- ‘‘(f) QUALIFIED HEALTH PLAN.—For pur- amount paid on behalf of such taxpayer retary may provide. poses of this section, the term ‘qualified under section 1412 of the Patient Protection ‘‘(9) REGULATIONS.—The Secretary may health plan’ means any health insurance and Affordable Care Act for months begin- prescribe such regulations and other guid- coverage (as defined in section 9832(b)) if— ance as may be necessary or appropriate to ‘‘(1) such coverage is offered in the indi- ning in such taxable year, and ‘‘(B) the tax imposed by section 1 for such carry out this section and section 1412 of the vidual health insurance market within a Patient Protection and Affordable Care State (within the meaning of section taxable year shall be increased by the excess (if any) of— Act.’’. 5000A(f)(1)(C)), (b) ADVANCE PAYMENT OF CREDIT.—Section ‘‘(i) the aggregate amount paid on behalf of ‘‘(2) substantially all of such coverage is 1412 of the Patient Protection and Affordable such taxpayer under such section 1412 for not of excepted benefits described in section Care Act is amended by adding at the end months beginning in such taxable year, over 9832(c), the following new subsection: ‘‘(3) such coverage does not consist of ‘‘(ii) the amount which would (but for this ‘‘(f) APPLICATION TO CERTAIN PLANS.—The short-term limited duration insurance (with- subsection) be allowed as a credit to the tax- Secretary and the Secretary of the Treasury in the meaning of section 2791(b)(5) of the payer under subsection (a). shall prescribe such regulations as each re- Public Health Service Act), ‘‘(5) SPECIAL RULES FOR QUALIFIED SMALL spective Secretary may deem necessary in ‘‘(4) such coverage is not a grandfathered EMPLOYER HEALTH REIMBURSEMENT ARRANGE- order to establish and operate the advance health plan (as defined in section 1251 of the MENTS.— payment program established under this sec- Patient Protection and Affordable Care Act) ‘‘(A) IN GENERAL.—If the taxpayer or any tion for individuals covered under qualified or a grandmothered health plan (as defined qualifying family member of the taxpayer is health plans (whether enrolled in through an in section 36B(c)(3)(C) as in effect for taxable provided a qualified small employer health Exchange or otherwise) in such a manner years beginning before January 1, 2020), and reimbursement arrangement for an eligible that protects taxpayer information (includ- ‘‘(5) such coverage does not include cov- coverage month, the sum determined under ing names, taxpayer identification numbers, erage for abortions (other than any abortion subsection (b)(1)(A) with respect to the tax- and other confidential information), provides necessary to save the life of the mother or payer shall be reduced (but not below zero) robust verification of all information nec- any abortion with respect to a pregnancy by 1⁄12 of the permitted benefit (as defined in essary to establish eligibility of taxpayer for that is the result of an act of rape or incest). section 9831(d)(3)(C)) under such arrangement advance payments under this section, en- ‘‘(g) SPECIAL RULES.— for each such month such arrangement is sures proper and timely payments to appro- ‘‘(1) MARRIED COUPLES MUST FILE JOINT RE- provided to such taxpayer. priate health providers, and protects pro- TURN.— ‘‘(B) QUALIFIED SMALL EMPLOYER HEALTH gram integrity to the maximum extent fea- ‘‘(A) IN GENERAL.—Except as provided in REIMBURSEMENT ARRANGEMENT.—For pur- sible.’’. subparagraph (B), if the taxpayer is married poses of this paragraph, the term ‘qualified (c) INCREASED PENALTY ON ERRONEOUS (within the meaning of section 7703) at the small employer health reimbursement ar- CLAIMS OF CREDIT.—Section 6676(a) of the In- close of the taxable year, no credit shall be rangement’ has the meaning given such term ternal Revenue Code of 1986 is amended by allowed under this section to such taxpayer by section 9831(d)(2). inserting ‘‘(25 percent in the case of a claim unless such taxpayer and the taxpayer’s ‘‘(C) COVERAGE FOR LESS THAN ENTIRE for refund or credit relating to the health in- spouse file a joint return for such taxable YEAR.—In the case of an employee who is surance coverage credit under section 36B)’’. year. provided a qualified small employer health (d) REPORTING BY EMPLOYERS.—Section ‘‘(B) EXCEPTION FOR CERTAIN TAXPAYERS.— reimbursement arrangement for less than an 6051(a) of such Code is amended by striking Subparagraph (A) shall not apply to any entire year, subparagraph (A) shall be ap- ‘‘and’’ at the end of paragraph (14), by strik- married taxpayer who— plied by substituting ‘the number of months ing the period at the end of paragraph (15) ‘‘(i) is living apart from the taxpayer’s during the year for which such arrangement and inserting ‘‘, and’’, and by inserting after spouse at the time the taxpayer files the tax paragraph (15) the following new paragraph: was provided’ for ‘12’. return, ‘‘(16) each month with respect to which the ‘‘(6) CERTAIN RULES RELATED TO NON- ‘‘(ii) is unable to file a joint return because employee is eligible for coverage described in QUALIFIED HEALTH PLANS.—The rules of sec- such taxpayer is a victim of domestic abuse section 36B(d)(2) in connection with employ- tion 36B(c)(3)(D), as in effect for taxable or spousal abandonment, ment with the employer.’’. years beginning before January 1, 2020, shall ‘‘(iii) certifies on the tax return that such (e) COORDINATION WITH OTHER TAX BENE- apply with respect to subsection (f)(5). taxpayer meets the requirements of clauses FITS.— ‘‘(7) INFLATION ADJUSTMENT.— (i) and (ii), and (1) CREDIT FOR HEALTH INSURANCE COSTS OF N GENERAL ‘‘(iv) has not met the requirements of ‘‘(A) I .—In the case of any tax- ELIGIBLE INDIVIDUALS.—Section 35(g) of such clauses (i), (ii), and (iii) for each of the 3 pre- able year beginning in a calendar year after Code is amended by adding at the end the ceding taxable years. 2020, each dollar amount in subsection (c)(1), following new paragraph: ‘‘(2) DENIAL OF CREDIT TO DEPENDENTS.— the $75,000 amount in subsection (c)(2)(B), ‘‘(14) COORDINATION WITH HEALTH INSURANCE ‘‘(A) IN GENERAL.—No credit shall be al- and the dollar amount in subsection COVERAGE CREDIT.— lowed under this section to any individual (c)(3)(A), shall be increased by an amount ‘‘(A) IN GENERAL.—An eligible coverage who is a dependent with respect to another equal to— month to which the election under para- taxpayer for a taxable year beginning in the ‘‘(i) such dollar amount, multiplied by graph (11) applies shall not be treated as an calendar year in which such individual’s tax- ‘‘(ii) the cost-of-living adjustment deter- eligible coverage month (as defined in sec- able year begins. mined under section 1(f)(3) for the calendar tion 36B(d)) for purposes of section 36B with ‘‘(B) COORDINATION WITH RULE FOR OLDER year in which the taxable year begins, deter- respect to the taxpayer or any of the tax- CHILDREN.—In the case of any individual who mined— payer’s qualifying family members (as de- is a qualifying family member described in ‘‘(I) by substituting ‘calendar year 2019’ for fined in section 36B(e)). subsection (e)(3) with respect to another tax- ‘calendar year 1992’ in subparagraph (B) ‘‘(B) COORDINATION WITH ADVANCE PAY- payer for any month, in determining the thereof, and MENTS OF HEALTH INSURANCE COVERAGE CRED- amount of any credit allowable to such indi- ‘‘(II) by substituting for the CPI referred to IT.—In the case of a taxpayer who makes the vidual under this section for any taxable section 1(f)(3)(A) the amount that such CPI election under paragraph (11) with respect to year of such individual which includes such would have been if the annual percentage in- any eligible coverage month in a taxable month, the monthly limitation amount with crease in CPI with respect to each year after year or on behalf of whom any advance pay- respect to such individual for such month 2019 had been one percentage point greater. ment is made under section 7527 with respect shall be zero and no amount paid for any ‘‘(B) TERMS RELATED TO CPI.— to any month in such taxable year— qualified health plan with respect to such in- ‘‘(i) ANNUAL PERCENTAGE INCREASE.—For ‘‘(i) the tax imposed by this chapter for the dividual for such month shall be taken into purposes of subparagraph (A)(ii)(II), the term taxable year shall be increased by the excess, account. ‘annual percentage increase’ means the per- if any, of— ‘‘(3) COORDINATION WITH MEDICAL EXPENSE centage (if any) by which CPI for any year ‘‘(I) the sum of any advance payments DEDUCTION.—Amounts described in sub- exceeds CPI for the prior year. made on behalf of the taxpayer under section section (b)(1)(B) with respect to any month ‘‘(ii) OTHER TERMS.—Terms used in this 7527 and section 1412 of the Patient Protec- shall not be taken into account in deter- paragraph which are also used in section tion and Affordable Care Act, over mining the deduction allowed under section 1(f)(3) shall have the same meanings as when ‘‘(II) the sum of the credits allowed under 213 except to the extent that such amounts used in such section. this section (determined without regard to

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00032 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.001 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2405 paragraph (1)) and section 36B (determined graph (3) shall not be taken into account The Chair recognizes the gentle- without regard to subsection (g)(4)(A) there- under subparagraph (A)(iii) and shall not be woman from Tennessee. of) for such taxable year, and subject to division between the spouses.’’. GENERAL LEAVE ‘‘(ii) section 36B(g)(4)(B) shall not apply (b) EFFECTIVE DATE.—The amendment with respect to such taxpayer for such tax- made by this section shall apply to taxable Mrs. BLACK. Mr. Speaker, I ask able year.’’. years beginning after December 31, 2017. unanimous consent that all Members (2) TRADE OR BUSINESS DEDUCTION.—Section SEC. 217. SPECIAL RULE FOR CERTAIN MEDICAL have 7 legislative days in which to re- 162(l) of such Code is amended by adding at EXPENSES INCURRED BEFORE ES- vise and extend their remarks on H.R. the end the following new paragraph: TABLISHMENT OF HEALTH SAVINGS 1628, the American Health Care Act of ‘‘(6) COORDINATION WITH HEALTH INSURANCE ACCOUNT. 2017. COVERAGE CREDIT.—The deduction otherwise (a) IN GENERAL.—Section 223(d)(2) of the In- ternal Revenue Code of 1986 is amended by The SPEAKER pro tempore. Is there allowable to a taxpayer under paragraph (1) objection to the request of the gentle- for any taxable year shall be reduced (but adding at the end the following new subpara- not below zero) by the amount of the credit graph: woman from Tennessee? allowable to such taxpayer under section 36B ‘‘(D) TREATMENT OF CERTAIN MEDICAL EX- There was no objection. (determined without regard to subsection PENSES INCURRED BEFORE ESTABLISHMENT OF Mrs. BLACK. Mr. Speaker, I yield (g)(4)(A) thereof) for such taxable year.’’. ACCOUNT.—If a health savings account is es- myself such time as I may consume. (f) EFFECTIVE DATE.—The amendments tablished during the 60-day period beginning I rise today to speak in favor of the made by this section shall apply to months on the date that coverage of the account American Health Care Act, a bill that beginning after December 31, 2019, in taxable beneficiary under a high deductible health repeals many of the worst aspects of years ending after such date. plan begins, then, solely for purposes of de- termining whether an amount paid is used ObamaCare, and begins to repair the SEC. 215. MAXIMUM CONTRIBUTION LIMIT TO damage caused by the law by bringing HEALTH SAVINGS ACCOUNT IN- for a qualified medical expense, such account CREASED TO AMOUNT OF DEDUCT- shall be treated as having been established choice, competition, and patient-cen- IBLE AND OUT-OF-POCKET LIMITA- on the date that such coverage begins.’’. tered solutions back into our TION. (b) EFFECTIVE DATE.—The amendment healthcare system. (a) SELF-ONLY COVERAGE.—Section made by this section shall apply with respect Standing here today in the House de- 223(b)(2)(A) of the Internal Revenue Code of to coverage beginning after December 31, bating this bill is a proud moment for 1986 is amended by striking ‘‘$2,250’’ and in- 2017. me. I was working as a nurse in Nash- serting ‘‘the amount in effect under sub- Subtitle B—Repeal of Certain Consumer ville in the 1990s when, fresh off of the section (c)(2)(A)(ii)(I)’’. Taxes (b) FAMILY COVERAGE.—Section 223(b)(2)(B) failure of HillaryCare, the Clinton ad- of such Code is amended by striking ‘‘$4,500’’ SEC. 221. REPEAL OF TAX ON PRESCRIPTION ministration pushed out a single-payer MEDICATIONS. and inserting ‘‘the amount in effect under Subsection (j) of section 9008 of the Patient pilot program in Tennessee called subsection (c)(2)(A)(ii)(II)’’. Protection and Affordable Care Act is TennCare. (c) CONFORMING AMENDMENTS.—Section amended to read as follows: As the story goes, Vice President 223(g)(1) of such Code is amended— ‘‘(j) REPEAL.—This section shall apply to Gore and the Democratic Governor (1) by striking ‘‘subsections (b)(2) and’’ calendar years beginning after December 31, sketched out a program on a napkin both places it appears and inserting ‘‘sub- 2010, and ending before January 1, 2017.’’. section’’, and while sitting in a local bar. I saw first- (2) in subparagraph (B), by striking ‘‘deter- SEC. 222. REPEAL OF HEALTH INSURANCE TAX. hand the negative impact of govern- Subsection (j) of section 9010 of the Patient mined by’’ and all that follows through ment-run health care on patient care. I Protection and Affordable Care Act is ‘‘ ‘calendar year 2003’.’’ and inserting ‘‘deter- saw the costs rise, and the quality of amended to read as follows: mined by substituting ‘calendar year 2003’ ‘‘(j) REPEAL.—This section shall apply to care fall. I saw the burdens being for ‘calendar year 1992’ in subparagraph (B) calendar years beginning after December 31, placed on doctors, patients, hospitals, thereof .’’. 2013, and ending before January 1, 2017.’’. and care providers. I saw patients faced (d) EFFECTIVE DATE.—The amendments made by this section shall apply to taxable Subtitle C—Repeal of Tanning Tax with fewer choices and more regula- years beginning after December 31, 2017. SEC. 231. REPEAL OF TANNING TAX. tion. And I saw the devastating impact SEC. 216. ALLOW BOTH SPOUSES TO MAKE (a) IN GENERAL.—The Internal Revenue that TennCare was having on our CATCH-UP CONTRIBUTIONS TO THE Code of 1986 is amended by striking chapter State’s budget, gobbling up so much SAME HEALTH SAVINGS ACCOUNT. 49. State spending that other priorities (a) IN GENERAL.—Section 223(b)(5) of the In- (b) EFFECTIVE DATE.—The amendment like education and infrastructure were ternal Revenue Code of 1986 is amended to made by this section shall apply to services getting squeezed. read as follows: performed after June 30, 2017. I couldn’t sit idly by while this was ‘‘(5) SPECIAL RULE FOR MARRIED INDIVID- Subtitle D—Remuneration From Certain happening in my State, so I decided to UALS WITH FAMILY COVERAGE.— Insurers ‘‘(A) IN GENERAL.—In the case of individ- get involved in public service, and it is SEC. 241. REMUNERATION FROM CERTAIN INSUR- what inspired me to run for office at uals who are married to each other, if both ERS. spouses are eligible individuals and either Paragraph (6) of section 162(m) of the In- the very beginning. And when, in 2009 spouse has family coverage under a high de- ternal Revenue Code of 1986 is amended by and 2010, I saw the same principles ductible health plan as of the first day of any adding at the end the following new subpara- being debated and eventually imple- month— graph: mented on the national level, I thought ‘‘(i) the limitation under paragraph (1) ‘‘(I) TERMINATION.—This paragraph shall shall be applied by not taking into account my experience in Tennessee would be not apply to taxable years beginning after valuable to the national debate. I told any other high deductible health plan cov- December 31, 2016.’’. erage of either spouse (and if such spouses the people in my district that, if elect- both have family coverage under separate Subtitle E—Repeal of Net Investment Income ed to Congress, I would fight to repeal high deductible health plans, only one such Tax and replace ObamaCare. coverage shall be taken into account), SEC. 251. REPEAL OF NET INVESTMENT INCOME In 2011, I sponsored the first piece of ‘‘(ii) such limitation (after application of TAX. legislation that repealed a part of clause (i)) shall be reduced by the aggregate (a) IN GENERAL.—Subtitle A of the Internal Revenue Code of 1986 is amended by striking ObamaCare. And today, we take the amount paid to Archer MSAs of such spouses largest step yet in rescuing the Amer- for the taxable year, and chapter 2A. ‘‘(iii) such limitation (after application of (b) EFFECTIVE DATE.—The amendment ican people from the damage that has clauses (i) and (ii)) shall be divided equally made by this section shall apply to taxable been done by ObamaCare. between such spouses unless they agree on a years beginning after December 31, 2016. We are united in our goal to repeal different division. The SPEAKER pro tempore. The bill ObamaCare and replace it with patient- ‘‘(B) TREATMENT OF ADDITIONAL CONTRIBU- shall be debatable for 4 hours equally centered health care. Right now, TION AMOUNTS.—If both spouses referred to in divided and controlled by the chair and ObamaCare is imploding. We were subparagraph (A) have attained age 55 before ranking minority member of the Com- promised premiums that would de- the close of the taxable year, the limitation mittee on the Budget or their respec- crease by $2,500; instead, average fam- referred to in subparagraph (A)(iii) which is subject to division between the spouses shall tive designees. ily premiums in the employer market include the additional contribution amounts The gentlewoman from Tennessee have soared by $4,300. determined under paragraph (3) for both (Mrs. BLACK) and the gentleman from We were promised healthcare costs spouses. In any other case, any additional Kentucky (Mr. YARMUTH) each will would go down; instead, deductibles contribution amount determined under para- control 2 hours. have skyrocketed.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00033 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.001 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2406 CONGRESSIONAL RECORD — HOUSE March 24, 2017 We were promised we could keep our sition as Secretary of Health and of how much coverage and care will be doctor, and keep our health insurance Human Services to address some of the lost by their backroom deal that ends plans; instead, millions of Americans regulatory burden of ObamaCare consumer protections? have lost their insurance and the doc- through administrative action. We I get it. I wouldn’t want to, nor tors that they liked. have voted already and will continue to would I know how to justify giving In short, the Affordable Care Act was vote on individual pieces of legislation nearly $1 trillion in tax cuts to cor- neither affordable, nor did it provide to implement even more patient-cen- porations and the wealthy paid for by the quality of care that the American tered, free market reforms that we can- threatening the health and well-being people deserve. not address through reconciliation. of millions of American families. The American Health Care Act is a In fact, we just passed two bills al- Who is getting these huge windfalls? first step in our efforts to deliver pa- ready this week. One would allow small Companies like Amgen, with annual tient-centered healthcare reform. This businesses to join together to purchase profits of more than $3 million; bill returns to the American people insurance, and the other would in- Medtronic, with annual profits of more freedom and choice in their healthcare crease competition by tearing down than $6 billion; and Gilead Sciences, decisions. It gets government out of antitrust regulations. That bill re- with $13 billion in profits in 2016 alone. the relationship between patients and ceived 416 votes. This shows that these When the CBO released its report last their doctors—where it has never be- bills are commonsense measures that week showing that 24 million hard- longed—and puts people back in charge include bipartisan support. working Americans will be left without of their own health care. It brings the The day is finally here where we have healthcare coverage by 2026 if we pass free market principle of competition to an opportunity to fulfill that promise this bill, that premiums will rise 15 to an industry that has long been domi- that we have made to the American 20 percent next year, that people will nated by government intervention. people. I, for one, cannot sit idly by pay thousands of dollars more in Today we are faced with a stark and let this opportunity go to waste. deductibles and out-of-pocket costs, choice: Do we vote to continue the Campaigning is easy compared to gov- and that older Americans will be priced damage ObamaCare is doing to our erning, but our constituents did not out of the market by an age tax, I country and our constituents, or do we elect us to do what is easy. They elect- thought for sure it was dead on arrival, vote to go down another path, a better ed us to do what is right. that there was no way my Republican way of doing health care in this coun- I urge my colleagues to join me in colleagues would walk this plank. But try? here they are, and they are trying to While no legislation is perfect, this voting ‘‘yes’’ on the American Health take millions of American families bill does accomplish some important Care Act, to rescue the American peo- ple from ObamaCare. with them. reforms. It zeros out the mandates. It Fourteen million Americans will lose repeals taxes. It repeals the subsidies. Mr. Speaker, I reserve the balance of health coverage next year if this bill is It allows people to choose health insur- my time. approved. Twenty-one million Ameri- ance plans that are unique to their Mr. YARMUTH. Mr. Speaker, I yield cans will lose coverage in the next 3 families, instead of purchasing a one- myself such time as I may consume. years alone, wiping out all of the cov- size-fits-all plan that is mandated by Mr. Speaker, after 7 years of cam- erage gains from the ACA in just 3 some Washington bureaucrat, and it paigning against the Affordable Care years. For pretty much everyone else modernizes Medicaid, a once-in-a-life- Act, congressional Republicans have fi- in the individual market, deductibles time entitlement reform. nally produced what they cynically de- Ending Medicaid’s open-ended fund- scribe as a replacement plan. and other costs will be higher. And for ing structure will play an important Sadly, however, this bill will unravel lower-income individuals, out-of-pock- role in addressing the future budget all of the progress we made under the et costs will be much higher. deficits and our growing national debt. ACA, including expanding access to Insurance companies will again be I applaud my colleagues who have health insurance to 22 million Ameri- able to sell plans that offer much less stayed in this fight and continue to cans and improving the quality of cov- financial protection, and we will return make this bill better. erage and care for tens of millions to the days when millions of people in The members of the Budget Com- more. this country will live in fear that they mittee, which I chair, outlined four It nearly doubles the amount of unin- are always one serious illness or acci- principles they believed would improve sured people in this country, guts Med- dent away from bankruptcy. the bill. Those principles led to signifi- icaid by almost $900 billion, and weak- This bill will result in the largest cant changes to allow more State flexi- ens the Medicare trust fund. transfer of wealth from struggling fam- ilies to the well-off in our Nation’s his- bility in Medicaid and ensure that tax b 1130 credits truly served the people they are tory, giving $1 trillion in tax breaks to meant to serve. That was bad enough. But the last- millionaires, billionaires, and corpora- Others fought to eliminate Federal minute changes to this bill are aston- tions. It is Robin Hood in reverse, but ObamaCare regulations that drive up ishing and appalling. This legislation this is far worse because access to life- the cost of health care for all Ameri- now allows insurers to end coverage for saving care is being stolen. cans and give those powers back to the prescription drugs, mental health, ma- I don’t say that casually. I have met States. At the same time, we also en- ternity and newborn care, preventive people, constituents of mine, whose sure that States have the resources to care, emergency room visits, hos- lives have been saved because of the provide maternity and newborn care pitalizations, outpatient care, rehab Affordable Care Act. and treatment for mental health and visits, lab services, and pediatric care. This is from one of my constituents: substance abuse. That is not progress. That is not a fix. ‘‘My name is Kevin Schweitzer. I am I agree with these changes, and I ap- That is a potential health crisis for 62 years old and I’m a lifelong resident plaud my colleagues for the work to every American. of Louisville, Kentucky. make sure that we truly reverse the My Republican colleagues are well ‘‘I worked hard, took risks and built damage ObamaCare is doing to our aware of this. Why else would they a successful small business that I sold healthcare system and our economy. have drafted this bill and these last- at age 59. My wife and I were excited ObamaCare’s legacy is clear: more minute changes in secret? Why else about our prospects as we headed into government, less choice, and higher would complicated legislation affecting early retirement. As a retiree too costs. Our vision for health care in the lives of millions be sent to the floor young for Medicare, I purchased health America is the opposite: more freedom, just 2 weeks after it was introduced insurance on the open market. Less more choice, and lower costs. Put sim- with no congressional hearings, not a than a year later, I was diagnosed with ply, the American Health Care Act is a single one, on a bill that impacts the lymphoma. I have undergone multiple good first step, but it is only a first health care of nearly every American scans and 2 cycles of chemo. I am win- step. family? Why else would they rush the ning the battle so far, but since this My good friend and our former col- bill to the floor without an updated disease is in my blood I will be fighting league, Dr. Tom Price, will use his po- Congressional Budget Office estimate it for the rest of my life.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00034 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.034 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2407 ‘‘A cancer diagnosis is a life-changing vider. Soon, we are warned, some re- Let me tell you, as a woman of faith, event that not only attacks the body, gions will have no providers at all. Pre- I am appalled and I am saddened by the but the mental stress is just as tough miums soared an average of 25 percent hypocrisy displayed in this bill by peo- to deal with. Thanks to ObamaCare, last year, and this year we are warned ple who say they are religious. I want I’ve been able to rest easier knowing it could be 40 percent or more. to remind you—in the Scriptures, the that my illness wouldn’t bankrupt my Critics cite the CBO estimate that 24 Book of Mark, chapter 12:31, we are re- family and that I’ll be able to provide million Americans will lose their cov- minded to love your neighbor as your- for my wife even after I’m gone.’’ erage. It is important to understand self. I also heard from a young woman their reasoning there. The CBO be- This bill shows disdain for the most named Sarah Adkins. She suffers from lieves that people won’t buy health in- vulnerable and would lead to death and chronic kidney disease. Sarah was able surance unless we force them to buy destruction and disease for millions of to get health insurance because of the health insurance. In fact, people won’t Americans. ACA. On January 9, 2011, it saved her buy health insurance that is not a good I hope Republicans remember to love life. One of her kidneys shut down and value for them, and, clearly, their neighbor as themselves today and almost went septic. If she didn’t have ObamaCare isn’t. vote ‘‘no’’ on this mean-spirited bill. coverage, she would have waited or not We replace it with a vigorous buyer’s Let’s defeat this harmful and morally gone to the hospital at all. The doctor market where plans across the country bankrupt bill. This is a matter of life told her that if she had arrived at the will compete to offer consumers better and death, and the American people de- ER an hour later, she would have died. services at lower prices tailored to serve better. Mr. Speaker, the health of my con- their own needs and wants. And we as- Mrs. BLACK. Mr. Speaker, I yield 2 stituents Kevin Schweitzer and Sarah sure these plans are within their finan- minutes to the gentleman from Ohio Adkins is at stake in this debate. They, cial reach with $90 billion of additional (Mr. JOHNSON), a member of the Budget and the hundreds of other constituents support that the CBO simply ignores. Committee. I have heard from who have serious and The AHCA’s biggest achievement is Mr. JOHNSON of Ohio. Mr. Speaker, chronic health conditions, will need to replace coercion with choice for the American people spoke loudly and high-quality, affordable health cov- every American. It ends the individual clearly last November. In fact, they erage for the rest of their lives. Under mandate that forces Americans to buy have been speaking loudly and clearly this bill, they will get less coverage, it products they don’t want. It ends the ever since this fatally flawed bill called will cost more, and eventually they employer mandate that has trapped ObamaCare was signed into law. And will be priced out of the market, leav- many low-income workers in part-time now we are hours away from the vote ing them nowhere to turn for the care jobs. It begins to restore consumers’ that the American people have been they need. freedom of choice, the best guarantee waiting years for. And that is not all. Because of the of quality and value in any market. It This vote can be distilled down to last-minute changes to this bill, insur- allows Americans to meet more of simply this, and each Member of this ers will be able to sell stripped-down their healthcare needs with pretax dol- body must ask themselves this simple coverage to weed out people with pre- lars. It relieves the premium base of question: Are they willing to allow existing conditions. They will be able the enormous cost of preexisting condi- ObamaCare to remain the law of the to refuse, for example, to offer cov- tions by moving them to a block-grant- land? Or are we going to begin to re- erage for chemotherapy drugs and can- ed assigned risk pool. store healthcare decisions to the Amer- cer treatments, insulin pumps, hospital Mr. Speaker, ObamaCare is col- ican people and their doctors? stays, and prescription drugs that treat lapsing, premiums are skyrocketing, Those who choose to vote against the chronic conditions across the board. and providers are fleeing. This may American Health Care Act, regardless Basically, if you have a serious health well be our last off-ramp on this road of how they attempt to justify it, will problem, the care you need may not be to ruin. be voting to keep ObamaCare in place. available to you at all. Mr. YARMUTH. Mr. Speaker, I re- This is an inescapable fact that will re- When the American people were mind my colleague that his vote for main long after the smoke and spin and promised by President Trump and Re- this bill will result in 38,200 people handwringing from political pundits publican congressional leadership that from his congressional district in Cali- following this vote has gone and dis- their existing coverage would be pre- fornia losing health care and coverage. appeared, regardless of how the votes served and that everybody would have Mr. Speaker, I yield 11⁄2 minutes to go. insurance and it would be less expen- the gentlewoman from California (Ms. There is no such thing as perfect leg- sive and much better, they, under- LEE), a distinguished member of the islation in a body of 435 men and standably, believed they would be Budget Committee. women representing 435 different parts treated much better than this. None of Ms. LEE. Mr. Speaker, I rise in of the Nation. those promises are in this bill. In fact, strong opposition to H.R. 1628, which is There is consensus among the Amer- the opposite of every one of those a bill to take away health care from 24 ican people that this law should be re- promises is what is in this bill. Those million Americans. pealed and replaced, and today the peo- were promises made to every family in Whether you believe it or not, health ple’s House will either acknowledge the our congressional districts, and this care is a basic right. This shameful bill will of the people or we will defy it. bill fails them at every turn. steals from those who can least afford Mr. YARMUTH. Mr. Speaker, I re- Mr. Speaker, I urge my colleagues to it, including seniors, veterans, people mind my colleague that his vote for oppose this legislation, and I reserve living with HIV, children, and the dis- this bill will result in 40,500 people the balance of my time. abled. It would, yes, rip away health from his congressional district in Ohio Mrs. BLACK. Mr. Speaker, I yield 2 care from 24 million people. It would losing health coverage and care. minutes to the gentleman from Cali- reduce benefits, make families pay Mr. Speaker, I yield 11⁄2 minutes to fornia (Mr. MCCLINTOCK). more for less, and transfer $600 billion the gentleman from Massachusetts Mr. MCCLINTOCK. Mr. Speaker, I re- in tax cuts to the very wealthy. This is (Mr. MOULTON), a distinguished mem- mind the gentleman from Kentucky outrageous. ber of the Budget Committee. that every promise made to the Amer- Access to women’s health is denied Mr. MOULTON. Mr. Speaker, I would ican people in support of ObamaCare by defunding Planned Parenthood. also like to remind the gentleman from was rapidly broken. We are now, at this Medicaid, as we know it, will end. Ohio that the latest poll put the will of moment in time, watching the death Healthcare costs for working families the American people at 17 percent in throes of ObamaCare. and seniors will skyrocket. And now it favor of this bill. More people are paying the State tax eliminates essential health benefits I would like to read a message from penalty or claiming hardship exemp- like maternity, mental health, and my Republican constituent: tions than are buying ObamaCare poli- emergency care. ‘‘The American Health Care Act cies. In a third of our counties, there is This is not a health bill. It is a tax would strain the fiscal resources nec- no choice left at all. You get one pro- giveaway to the wealthy. essary to support the Commonwealth’s

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00035 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.036 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2408 CONGRESSIONAL RECORD — HOUSE March 24, 2017 continued commitment to universal Deductibles, copays—I had a deduct- right direction. It repeals the mandates health coverage.’’ ible on my own individual policy, a and restores freedom to individuals and This constituent is the Republican skyrocketing deductible. There are markets. Governor of Massachusetts, who knows deductibles of $13,000. That is not It repeals about $1 trillion of taxes. It that TrumpCare destroys our ability to health care. That is not even access. reduces deficit spending by over $100 ensure access to quality, affordable Drug formularies being tightened to billion, making it the largest entitle- healthcare coverage. save money, so people are denied pre- ment reform since the 1960s. It rolls Another Republican in my State, scription drugs, a prescription drug back regulations, gives maximum flexi- Governor Mitt Romney, worked with tax; thousands of Minnesotans losing bility to States, and begins to the Democratic legislature to create their plans, 100,000 when a big insurer defederalize health care. the Nation’s first system to provide af- dropped out; 1,000 counties with one in- For 7 years now, Republicans have fordable, comprehensive health care. surer—that is what you are trying to promised the American people that if RomneyCare wasn’t perfect, but Re- preserve on the other side, people vot- we were given control of the Presi- publicans and Democrats worked to- ing ‘‘no’’ on this bill? dency and the House and the Senate, gether to improve it, and they created Emergency State legislation trying then we would repeal and replace a system with higher approval ratings to prop up MNsure in my home State ObamaCare. And now that we are given than TrumpCare or even ObamaCare. because it is failing, and $1 trillion in the opportunity to govern and to keep We can do this. Health care should taxes and spending that is bankrupting our promises and to deliver results for not be partisan. It should be about in- the country—that is what the other the American people, we can’t let per- vesting in our people, in our families, side is trying to preserve. fect be the enemy of good. and in our future so that Americans Those voting ‘‘no’’ on this bill, we The debate is now closing. We have can live healthy, productive lives. But have a choice today. You can embrace two choices. We either pass a good but that is not what this Republican the status quo and see the markets spi- imperfect bill, or we leave ObamaCare TrumpCare bill does. Michael is a constituent from ral out of control completely, or you in place. That is an unacceptable alter- Gloucester, the old fishing city. He was can vote for change and do the right native. prescribed OxyContin by his doctors, thing. As leaders, we have a moral obliga- and then became addicted. But he was Mr. YARMUTH. Mr. Speaker, I re- tion to do something, to not stand idly able to enter a treatment program mind my colleague that his vote for by while the people suffer under a sys- through Medicaid, the kind of program this bill will result in 50,200 people tem that is failing them. that will be cut by TrumpCare. He is from his congressional district in Min- If we are going to restore the great- now back at work as an electrician, nesota losing health coverage and care. ness of America and transfer power 1 and he says that the Affordable Care I yield 1 ⁄2 minutes to the gentleman back to the people, we need more than Act saved his life. from New York (Mr. JEFFRIES), a dis- policy solutions, even perfect policy so- I am a veteran, and I get my health tinguished member of the Budget Com- lutions. We need the political will and care at the VA. Sometimes it takes me mittee. the courage to lead. weeks to get an appointment. If this Mr. JEFFRIES. Mr. Speaker, the This is a rescue mission, Mr. Speak- Republican bill passes, it will throw 8 Trump Presidency has been character- er, and it isn’t without risk; but I have million veterans off private health ized by chaos, crisis, and confusion, faith in the President and his team. I care, forcing them into the VA, and and this Republican healthcare debacle have faith in our States and the free creating even longer wait times. That has been no different. markets, and, above all, Mr. Speaker, I is no way to treat those who have put The American people clearly under- have faith in the American people. their lives on the line for our country. stand that TrumpCare will be an un- Mr. YARMUTH. Mr. Speaker, I re- Perhaps it’s no surprise that this bill is being mitigated disaster. Under TrumpCare, mind my colleague that his vote for jammed down the throats of Congress and the working families will pay more and get this bill will result in 60,400 people American people like a dead fish. less. Under TrumpCare, premiums will from his congressional district in Nobody wants it and it will make a lot of increase. Under TrumpCare, copays Texas losing health coverage and care. people sick. will increase. Under TrumpCare, I yield 2 minutes to the gentleman What we should be doing here in Wash- deductibles will increase. Under from New York (Mr. HIGGINS), a distin- ington is coming together as Republicans and TrumpCare, out-of-pocket expenses guished member of the Budget Com- Democrats to have an open, honest debate, will increase. mittee and the Ways and Means Com- and improve the health care system. Under TrumpCare, 24 million hard- mittee. Everyone says Congress doesn’t work— working Americans will lose their Mr. HIGGINS of New York. Mr. don’t prove them right. health coverage. Under TrumpCare, in- Speaker, this never needed to be an I urge my colleagues to vote no on this ter- dividuals between the age of 50 and 64 ideological fist fight. Democrats were rible bill and to instead come to the table like will pay a regressive age tax. always willing to take into account se- we did in Massachusetts. Health care is a matter of life and rious and constructive alternatives to Mrs. BLACK. Mr. Speaker, I yield 2 death; that is why we take it so seri- the law that we have today that make minutes to the gentleman from Min- ously. TrumpCare will lead to in- it better, to make it affordable, more nesota (Mr. LEWIS), who is a distin- creased death, disease, and destitution, affordable for the American people. guished member of the Budget Com- and that is why we oppose this horrible But this bill is a blatant takeaway mittee. piece of legislation. from the American people of money b 1145 Mrs. BLACK. Mr. Speaker, I yield 2 and protection. If you are 50 to 64 years Mr. LEWIS of Minnesota. Mr. Speak- minutes to the gentleman from Texas old, you get clobbered. If you are 64 er, I rise today in support of the Amer- (Mr. ARRINGTON) who is a member of years old, you make $26,000 a year, ac- ican Health Care Act, and I ask the the Budget Committee. cording to the Republican-led Congres- other side: Just what is it you are try- Mr. ARRINGTON. Mr. Speaker, sional Budget Office, your premiums go ing to preserve by voting ‘‘no?’’ ObamaCare’s disastrous effects over from $1,700 a year to $14,000 a year. Premiums rising double digits for the last several years have wreaked Fact: UnitedHealthcare is one of the years for the last 7 years? In my home havoc on our small businesses, broken largest private health insurers in State of Minnesota, back-to-back pre- the backs of middle and working class America. mium increases of 50 to 67 percent? families, and have had a disproportion- Fact: UnitedHealthcare will have $200 Young, healthy people being priced ately negative impact on rural Amer- billion in revenues this year, and they out of the insurance market, 8 million ica. Those are the folks who I represent paid their chief executive officer $66 in 2014, choosing to pay the penalty in- in west Texas. million in compensation in 2014. stead of buying insurance? While the current bill before us is far Fact: UnitedHealthcare is under in- That is the genesis of the death spi- from perfect—and let’s be honest, there vestigation today by the Department ral in the insurance markets. That is is no such thing as perfect legislation— of Justice for stealing billions of dol- what this bill is trying to correct. it reverses course and takes us in the lars from the Medicare program.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00036 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.038 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2409 Fact: The Republican health bill, on I yield 2 minutes to the gentlewoman cuts, $1.15 trillion in spending cuts, page 67, in 7 words, gives from Washington (Ms. DELBENE), a dis- $150 billion in deficit reduction; UnitedHealthcare, their high-paid ex- tinguished member of the Budget Com- defunding Planned Parenthood. ecutives, and all of their cronies, a mittee and the Ways and Means Com- How long have we been fighting to massive tax cut to continue to screw mittee. defund Planned Parenthood? the American people. Ms. DELBENE. Mr. Speaker, if Re- Close the illegal alien loophole that Mr. Speaker, we can do much better. publicans crafted legislation that lived allows people to enroll in ObamaCare, We are prepared to do much better. But up to the promise of insurance for ev- only to check their status in this coun- this is a financial assault on good, erybody, they would have broad bipar- try subsequently. hardworking Americans who want to tisan support. But that is not what We install work requirements. I don’t do one thing at the end of the day, they did. think people that are able to work but after paying too much money for This bill threatens massive disrup- choose not to should expect us to go health care throughout the year, and tion and chaos, not only to our borrow money from China to pay for that is, when they need their health healthcare system, but to middle class their health care. Installing those work care, it is available to them and their families, families who sit at their requirements is fundamental to bold family. kitchen table trying to figure out how conservative reform. Mrs. BLACK. Mr. Speaker, I yield 2 to pay their mortgage, buy groceries, Block grants for States so that fi- minutes to the gentleman from New and also get health coverage for their nally they can be liberated from the York (Mr. FASO), a distinguished mem- kids. This Republican bill does nothing oppressive hand of the Federal Govern- ber of the Budget Committee. to help them. ment, and also blocking States from Mr. FASO. Mr. Speaker, I wanted to In their rush to check a political box, additional Medicaid expansion. point out to my colleagues that a fun- Republicans have crafted legislation We have been engaging in these con- damental change is being made with that does nothing but hurt working servative fights for years, and finally, the new health law we have before us, Americans, and, in the last 24 hours, it today, we have got the chance to put a and that is, we are, for the first time, has gone from bad to worse. win on the board; and so I am joining equalizing the treatment of people who Make no mistake, the changes made our President, our Speaker, and many do not have employer-provided health in the 11th hour to appease the most conservatives in this Congress in vot- care. extreme Members of Congress have put ing for the American Health Care Act. When we win, when we do this, not Those of us who have employer-pro- lifesaving care even further out of only do we enhance our economy, not vided health care, 170 million Ameri- reach. only do we free up opportunities for cans, that is not a taxable event for Some may use alternative facts, but broader prosperity in America, but we them. It is not a taxable event where this is reality, and the reality is that allow people to be in charge of health they have to pay tax at the end of the their bill robs $75 billion from Medi- care, and we move from a government- year on the value of that employer-pro- care, forces older Americans to pay five centered system to a patient-centered vided health care. times more than others, and shifts $312 And yet, if you are the person who billion in out-of-pocket costs onto mid- system. That was the promise we made does not have employer-provided dle class families. in the elections, and that is the prom- health care, if you are the husband and But this is about more than numbers. ise I intend to keep by voting for this wife with two kids making 45 or $50,000, It is about people like Rachel, from bill. Mr. YARMUTH. Mr. Speaker, I re- and your employer does not provide Kirkland, Washington, who suffered a mind my colleague that his vote for health care, you receive absolutely no heart attack and blood clot at the age this bill will result in 56,000 people tax subsidy through the Tax Code. of 35. She now depends on frequent from his congressional district in Flor- This bill, through the advance re- tests, medications and doctors’ visits ida losing health coverage and care. fundable tax credits, will, for the first to stay healthy. Thankfully, it is all I yield 13⁄4 minutes to the gentle- time, give someone the choice to buy covered by her insurance. woman from Florida (Ms. WASSERMAN health care and give them the oppor- Rachel told me: ‘‘I’m horrified by the SCHULTZ), a distinguished member of tunity and the means to buy health talking point that equates repealing the Budget Committee. care that they previously have not had. the Affordable Care Act with getting It is not a markedly important distinc- freedom back. For me, the loss of the b 1200 tion, frankly, from the Affordable Care ACA gives me nothing but the freedom Ms. WASSERMAN SCHULTZ. Mr. Act, where you only could buy the to die sooner and worry more.’’ Speaker, I stand in opposition to the health care through an exchange-ap- I am not voting against this bill be- Republican pay more for less care act, proved policy. cause it is a Republican bill. I am vot- under which Americans will suffer from This policy, under this legislation ing ‘‘no’’ for families like Rachel’s. higher healthcare costs, less coverage, today, will allow someone the flexi- Health care doesn’t need to be a par- a crushing age tax, and a ransacking of bility and the freedom to buy a policy tisan issue, and I stand ready and will- the Medicare trust fund, which our sen- of their choosing, not one dictated by ing to work on commonsense solutions iors depend on for long-term care. Washington. So that is a fundamental that expand coverage and reduce costs. Under the age tax, Americans aged 50 important distinction between the sta- But I was sent here to make my con- to 64 will be forced to pay five times tus quo and what this legislation would stituents’ lives better. This bill does higher premiums than others, no mat- offer. not do that. I encourage my colleagues ter how healthy they are. Under Mr. Speaker, and my colleagues, I to vote ‘‘no.’’ TrumpCare, a 64-year-old with an in- urge support for the bill. It is not per- Mrs. BLACK. Mr. Speaker, I yield 2 come of $26,500 in the individual mar- fect, as we all know, but it is some- minutes to the gentleman from Florida ket will pay $12,900 more in their pre- thing that is long overdue. (Mr. GAETZ) who is a distinguished miums every year under this bill. I would also point out that the num- member of our Budget Committee. In addition, TrumpCare will take bers that my colleague from Kentucky Mr. GAETZ. Mr. Speaker, I rise to re- away health care from 24 million hard- uses are really based upon fantasy. peal the disaster that is ObamaCare. working Americans and will force fam- Those numbers are simply incorrect, ObamaCare functions as a wet blanket ilies to pay higher premiums and and the people of our State and our over the American economy, stopping deductibles. In fact, for families en- country will have health care under businesses from growing, and impairing rolled in the ACA marketplace, pre- the provisions of this bill, and we will the rights of individuals to make their miums are expected to increase by 15 work hard to ensure that they do. own decisions about health care. to 20 percent. Mr. YARMUTH. Mr. Speaker, I re- Mr. Speaker, I specifically implore It will also punish millions of people mind my colleague that his vote for my conservative colleagues to vote for who experience a lapse in coverage by this bill will result in 65,800 people this bill and give us a chance to get out forcing them to pay a 30 percent higher from his congressional district in New from under this disastrous law. This premium each month in order to re- York losing health coverage and care. legislation represents $1 trillion in tax ceive care.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00037 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.041 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2410 CONGRESSIONAL RECORD — HOUSE March 24, 2017 Tell that to Suzanne Boyd from Sun- vote for this bill will result in 37,900 The Affordable Care Act, known as rise, Florida, who, with two daughters people from his congressional district ObamaCare, is 8,000 pages—8,000 heading to college, lost her husband to losing health coverage and care. pages—of regulation and taxation. lung cancer and then lost the insurance Mr. Speaker, I yield 11⁄2 minutes to There is not a man or a woman coverage she had through her em- the gentleman from Pennsylvania (Mr. amongst us, from sea to shining sea, ployer. Thankfully, she was able to ob- BRENDAN F. BOYLE), who is a distin- who believes this body can produce tain coverage under the ACA for $192 a guished member of the Budget Com- 8,000 pages of freedom. The American month with subsidies rather than a 30 mittee. Health Care Act is 124 pages of reason- percent Republican sick tax for getting Mr. BRENDAN F. BOYLE of Pennsyl- able legislation based upon the best a life-threatening illness. vania. Mr. Speaker, I rise today in op- input of free market principles. Yet this bill apparently isn’t harmful position to TrumpCare, the Republican A vote against the American Health enough for the far-right extremists in plan to cut Medicare and Medicaid, in- Care Act is a vote against freedom. It the Republican Party, whom Repub- crease healthcare costs, and take is a vote against 124 pages of reason- lican leadership has tried to appease by health care away from tens of millions able legislation, and it is a vote for cutting the ACA essential health bene- of Americans, all while providing the 8,000 pages of ObamaCare. fits like mental health, maternity, and largest transfer of wealth from work- Mr. Speaker, I urge my colleagues to emergency services. ing families to our Nation’s richest, vote ‘‘yes’’ for the American Health Mr. Speaker, this bill is like taking a and all of this in the name of choice Care Act. sledgehammer to a clock that is mov- and freedom. But we all know that, Mr. YARMUTH. Mr. Speaker, I re- ing a little slow rather than working under this bill, that is just code for mind my colleague that the gentle- on precision fine tuning instead. It is survival of the fittest, economic Dar- man’s vote for this bill will result in an immoral piece of legislation. As a winism. 50,100 people from his congressional breast cancer survivor, I urge every Mr. Speaker, let me bring this a lit- district in Louisiana losing health cov- Member to stand with my sister sur- tle closer to home for me. Thanks to erage and care. vivors all across the country, who TrumpCare, 36,700 of my constituents Mr. Speaker, I yield 11⁄2 minutes to number in the millions, to make sure covered by the ACA’s Medicaid expan- the gentlewoman from Washington that you don’t devastate our health sion now stand to lose this lifesaving (Ms. JAYAPAL), who is the distin- and make sure that we don’t have our coverage. Here is one of them, con- guished vice ranking member of the lives threatened. stituent Maura McGrath, a 17-year-old Budget Committee. Mrs. BLACK. Mr. Speaker, I yield 2 with Down syndrome. Ms. JAYAPAL. Mr. Speaker, I thank minutes to the gentleman from Indiana Maura’s parents, Joe and Rita, know the distinguished gentleman for yield- (Mr. ROKITA), who is the vice chair of firsthand why Medicaid is so impor- ing and for his tremendous leadership. the Budget Committee. tant. Medicaid has been critical to Mr. Speaker, this reckless Repub- Mr. ROKITA. Mr. Speaker, I thank keeping their daughter alive and sav- lican plan is a betrayal of the Amer- the chairwoman. ing their family from bankruptcy. ican people. How is it a betrayal? I am really proud, Mr. Speaker, of Callously stripping 24 million people the Budget Committee. We did great Even though Joe and Rita both work, the cost of Maura’s care is too expen- of health care is a betrayal. work last week, and everyone was Putting an age tax on people aged 50 sive to afford on their own, not to men- heard: six motions on the Republican to 64 who will pay up to $14,000 more in tion that Rita is a breast cancer sur- side, six motions on the Democratic annual premiums is a betrayal. side, and the debate was civil. Tones vivor and Joe suffers from Parkinson’s Gutting essential benefits like ma- weren’t raised; theatrics, by and large, disease. Medicaid provides the ternity care, prescription drug cov- weren’t employed; and we made the bill McGraths peace of mind knowing erage, emergency services, and fun- better. That was the process the week Maura will receive the care that she damentally destroying protections for before that when the committees of ju- needs and they aren’t alone to fend for Americans with preexisting conditions risdiction had this legislation. themselves, given the tough hand they is a betrayal. It is my hope that, as we pass this have been dealt. Slashing Medicaid by $880 billion and bill off the floor of the House—and it is Mr. Speaker, for Maura and everyone stripping the safety net for our seniors, a bill being passed off the floor of the in my district, say ‘‘no’’ to TrumpCare. our kids, and people with disabilities is House and not into law right now—and Mrs. BLACK. Mr. Speaker, I yield 2 a betrayal. as it goes to the Senate, that the bill minutes to the gentleman from Lou- The burden of all of this, Mr. Speak- will continue to be improved. That is isiana (Mr. HIGGINS). er, will fall on the States, who will the legislative process. Mr. HIGGINS of Louisiana. Mr. have to come up with billions of dol- I am very proud of the members of Speaker, I rise unscripted and in pas- lars. the staff of the Budget Committee for sionate support of freedom. I have Mr. Speaker, this bill is not about being a major part of that process and heard many statements with words freedom or choice. This bill is a trav- starting that process. We did good like ‘‘fact’’ and details of the minutia esty, and the American people will pay work. You don’t have to pass this bill of these plans. I will share with you a the price. to find out what is in it as we had to fact. This is not a healthcare bill. The with ObamaCare. This process will con- Two hundred years ago, my ancestral only people who benefit are million- tinue. forefather was born. He was a young, aires, billionaires, and insurance com- I am very pleased, also, that we have poor Irishman born into indentured panies, who will get $1 trillion in tax Medicaid block grants, or lump sum servitude. He heard a whisper of a land benefits while working Americans pay payments to the States, that are avail- born across the sea, a land where a more and get nothing. able now to cover at least our able-bod- man could own his own property, a Mr. Speaker, this bill is pure greed, ied children and adults. It is a huge land where a man could keep the toil of and real people will suffer and die from step forward in letting States have the his labor. So he garnered his courage, it. Vote ‘‘no,’’ and protect our care. flexibility they need to decide who he saved his money, and he booked pas- Mrs. BLACK. Mr. Speaker, I yield really needs this assistance, how they sage on a cargo vessel converted to myself such time as I may consume. should get it, and what they should get carry human beings. According to the Mr. Speaker, I want to recognize that in terms of health care. letter unearthed by my sainted moth- our Members on the other side of the This is good legislation. This is what er, his sleeping berth measured 2 by 2 aisle are sharing some data on the cov- we were sent to do, and we are keeping by 5. erage of per congressional district our promises to the American people What could have driven my ancestral based on a study that was conducted by by passing this legislation. forefather—and yours, Mr. Speaker— the Center for American Progress, Mr. Speaker, I urge all my colleagues indeed, all of America? What drove our which is a left-leaning organization to to vote ‘‘yes.’’ ancestral forefathers to come to this begin with. The Center for American Mr. YARMUTH. Mr. Speaker, I re- land? Freedom. Freedom drove us, and Progress employs a flawed method- mind my friend from Indiana that his it is freedom for which I stand. ology for estimating this coverage. In

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fact, their foundational numbers are fore the Affordable Care Act was signed Mr. Speaker, I yield 13⁄4 minutes to actually based on CBO’s coverage esti- into law. Since the Affordable Care the gentlewoman from Texas (Ms. mates, estimates that the CBO itself Act, I saw firsthand the direct and JACKSON LEE). has established are not infallible. positive impact of this legislation over Ms. JACKSON LEE. Mr. Speaker, I These coverage numbers only take the past 7 years to communities and thank the distinguished gentleman of into account plans that they consider families across the central coast. the Budget Committee for his leader- comprehensive major medical policies. The Affordable Care Act meant ship. This is a term that is used in the very Sarah, from Lompoc, could open her Our mothers and our doctors have law that we are trying to dismantle small business and afford insurance warned us about poison pills. Well, let today. These coverage estimates do not coverage for her two children. me say that, this morning, the Repub- account for things that we have in our It meant that Kathleen, in San Luis licans are giving to the American peo- bill, such as HSA plans that allow pur- Obispo, who was diagnosed with ovar- ple a poison meal that would affect my chase with tax credits, and many med- ian and breast cancer, that her $500,000 friend, the senior citizen, with $175 bil- ical plans. medical bill was covered by her lion being taken away from Medicare; So the AHCA increases freedom for healthcare plan. a poison meal that will affect a young Americans to purchase the kind of cov- It meant that Adrienne, from child who is being seen by a doctor. erage that works for them, not the nar- Buellton, now could afford to pay for The Children’s Hospital Association, rowly defined coverage that we see her husband’s nursing facility, as his including the Texas Children’s Hos- that the Federal Government likes. debilitating disease prevents her from pital, has said to vote ‘‘no’’ on this bill Mr. Speaker, I yield 11⁄2 minutes to being able to physically care for him. because 30 million children will have the gentleman from California (Mr. Repealing legislation that has im- no health insurance. MCCLINTOCK), who is a member of our proved the quality of life not only for This will impact working families committee. Sarah, Kathleen, and Adrienne, but for making $31,000 a year. They will have Mr. MCCLINTOCK. Mr. Speaker, I the over 20 million Americans who to pay $4,000 more out of pocket. In simply want to underscore what the have gained health insurance under the 2026, under pay more for less, $52 mil- chairwoman has already laid out. Affordable Care Act, would be callous, lion Americans will be uninsured. When my friend from Kentucky says cruel, and irresponsible. This poison meal is getting worse and that his constituents will lose cov- Instead of taking away health care worse. erage, he is basing it on two premises. from 24 million Americans, let’s work Then, in the dark of night, what did He is ignoring the $90 billion of addi- together to create a more equitable, af- they do? tional funds that we freed up in the fordable, and accessible healthcare sys- They took away hospitalization. Budget Committee to assure that no- tem for all. They took away pregnancy, maternity, body will face sticker shock as we b 1215 and newborn care. They took away make this transition. Mrs. BLACK. Mr. Speaker, I yield 1 mental health and substance abuse Second, he assumes that the only minute to the gentleman from South care. reason that people buy insurance is if Those States that are experiencing Carolina (Mr. SANFORD). we force them to buy it. The reality is Mr. SANFORD. Mr. Speaker, I want the opioid abuse and epidemic, what many are refusing to buy ObamaCare to make clear that I agree with what are they going to do? policies even when they are faced with every Republican speaker has said thus They have threatened community these crushing tax policies. The AHCA far on the need to repeal and replace health centers. They are closing rural replaces this heavyhanded and failing the Affordable Care Act. I want to say hospitals. bureaucratic nightmare. how much I admire the Speaker and What is this disaster of TrumpCare? Ultimately, we are going to be judged the leadership team, President Trump It is injuring my good friend who is not on polls or fairy tales, but on sitting there in the hospital room. It is and his team, Chairwoman BLACK, and whether the vast majority of Ameri- others on the Budget Committee for injuring Anna Nunez. It is injuring cans have a better experience with this what they have brought to bear. small businesses who say that they can new consumer-driven market than they My simple question is one of timing. live better under the Affordable Care had with the bureaucratized, one-size- What I tell my boys consistently is: If Act, and the youngster that is a junior fits-all ObamaCare system. That sys- you don’t know, you don’t go. in college who said she would not be tem has already been weighed in the One of the things that I think we alive had it not been for the Affordable balance and found wanting by the have to really look at in this bill is one Care Act. American people, and I am here to of process. It does do a lot of good More than half of the American peo- stake my reputation on the prediction things, as has been pointed out by the ple—and it is growing—are against this that they will find better policies with Republican speakers, but it still leaves bill done in the dark of night. It is the better services at lower costs when in place community rating. It leaves in poison meal that is keeping those who they are restored the freedom to be place the architecture, I think, of a need health insurance away from consumers in a marketplace with a flawed bill that came with the Afford- health insurance. supportive tax structure that assures able Care Act. I ask my colleagues to vote ‘‘no.’’ that these policies are within the fi- The question is: Can we build on top Don’t feed the American people a poi- nancial reach of every American fam- of that to do the very good things that son meal. ily. are talked about in this bill, or do we Mr. Speaker, as a member of the Budget Mr. YARMUTH. Mr. Speaker, I re- take just a little bit more time to Committee and the representative of a con- mind my colleague that his vote for make certain that we have it right? gressional district that has benefited enor- this bill will result in 38,200 people I think that when you look at this mously from the Affordable Care Act, I rise in from his congressional district in Cali- notion of lowering premiums, look at it strong and unyielding opposition to H.R. 1628, fornia losing health coverage and care. like rent control in New York. Rent the so-called ‘‘American Health Care Act,’’ Mr. Speaker, I yield 11⁄2 minutes to control in New York has done a lot of which more accurately should be called the gentleman from California (Mr. good for some folks, but it has hurt a ‘‘Trumpcare, the Pay More For Less Act.’’ CARBAJAL), who is a distinguished lot of others in the process. Seven years ago yesterday, March 23, member of the Budget Committee. The question we fundamentally have 2010, President Barack Obama signed into Mr. CARBAJAL. Mr. Speaker, before to ask ourselves is: At this juncture, law the landmark Affordable Care Act passed I came to Congress, I worked in local can we make the changes necessary? by the Democratic controlled 111th Congress. government as a county supervisor. Mr. YARMUTH. Mr. Speaker, I men- Seven years later, the verdict is in on the One of my proudest achievements dur- tion to my colleague that his vote Affordable Care Act; the American people ing that time was working in a bipar- against this bill will result in 56,600 have judged it a success and are adamantly tisan way to create a program that re- people from his congressional district opposed to any effort to repeal a law that has duced the rate of uninsured children in in South Carolina losing health cov- brought to more than 20 million Americans the our county by over 90 percent—all be- erage and care. peace of mind and security that comes with

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00039 Fmt 0636 Sfmt 9920 E:\CR\FM\K24MR7.044 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2412 CONGRESSIONAL RECORD — HOUSE March 24, 2017 knowing they have access to affordable, high In addition to terminating the ACA Medicaid The claim of our Republican friends that quality health care. expansion, the bill converts Medicaid to a per- Trumpcare provides more freedom to all Before the passage of the Affordable Care capita cap that is not guaranteed to keep pace Americans calls to mind the words of Anatole Act, 17.1 of Americans lacked health insur- with health costs starting in 2020. France: ance; today nearly nine of ten (89.1%) are in- The combined effect of these policies is to ‘‘The law, in its majestic equality, forbids the sured, which is the highest rate since Gallup slash $880 billion in federal Medicaid funding rich as well as the poor to sleep under began tracking insurance coverage in 2008. over the next decade. bridges, to beg in the streets, and to steal Because of the Affordable Healthcare Act: The cuts get deeper with each passing year, bread from the market.’’ 1. insurance companies are banned from reaching 25% of Medicaid spending in 2026. Trumpcare raises costs for Americans near- discriminating against anyone, including 17 These steep cuts will force states to drop ing retirement, essentially imposing an ‘‘Age million children, with a preexisting condition, or people from Medicaid entirely or ration care Tax.’’ charging higher rates based on gender or for those who most need access to com- The bill allows insurance companies to health status; prehensive coverage. charge older enrollees higher premiums than 2. 6.6 million young-adults up to age 26 can The Pay-More-For-Less plan undermines allowed under current law, while reducing the stay on their parents’ health insurance plans; the health care safety net for vulnerable popu- size of premium tax credits provided. 3. 100 million Americans no longer have an- lations. Again, these changes hit low-income older nual or life-time limits on healthcare coverage; Currently, Medicaid provides coverage to persons the hardest. 4. 6.3 million seniors in the ‘‘donut hole’’ more than 70 million Americans, including chil- A 64-year-old with an income of $26,500 have saved $6.1 billion on their prescription dren, pregnant women, seniors in Medicare, buying coverage in the individual market will drugs; people who are too disabled to work, and par- pay $12,900 more toward their premiums in 5. 3.2 million seniors now get free annual ents struggling to get by on poverty-level 2026, on average. wellness visits under Medicare, and wages. Trumpcare raises costs for individuals and 6. 360,000 Small Businesses are using the In addition to doctor and hospital visits, families with modest incomes, particularly Health Care Tax Credit to help them provide Medicaid covers long-term services like nurs- older Americans. health insurance to their workers; ing homes and home and community-based A recent analysis found that in 2020, individ- 7. Pregnancy is no longer a pre-existing services that allow people with chronic health uals with incomes of about $31,000 would pay condition and women can no longer be conditions and disabilities to live independ- on average $4,000 more out of pocket for charged a higher rate just because they are ently. health care—which is like getting a 13% pay women. To date, 31 states and D.C. have expanded cut. We are becoming a nation of equals when Medicaid eligibility to low-income adults, And the older you are, the worse it gets. it comes to access to affordable healthcare in- which, when combined with the ACA’s other An analysis by the Urban Institute estimates surance. that for Americans in their 50s and 60s, the The President and congressional Repub- coverage provisions, has helped to reduce the tax credits alone would only be sufficient to licans call this enviable record of success a nation’s uninsured rate to the lowest in history. Trumpcare throws 24 million Americans off buy plans with major holes in them, such as ‘‘disaster.’’ The American people do not agree and that their health insurance by 2026 according to a $30,000 deductible for family coverage and is why they reject overwhelmingly (56%–17%) the Congressional Budget Office. no coverage at all of brand-name drugs or this Republican attempt to repeal the Afford- Low-income people will be hit especially many therapy services. able Care Act according to the latest hard because 14 million people will lose ac- Another reason I oppose the Trumpcare bill Quinnipiac poll. cess to Medicaid by 2026 according to CBO. before us is because its draconian cuts in Americans know a disaster when they see Trumpcare massively shifts who gets in- Medicaid funding and phase-out of Medicaid one and they see one in the making: it is sured in the nongroup market. expansion put community health centers at called ‘‘Trumpcare,’’ masquerading as the According to CBO, ‘‘fewer lower-income risk. ‘‘American Health Care Act,’’ which will force people would obtain coverage through the Community health centers are consumer- Americans to ‘‘pay more for less.’’ nongroup market under the legislation than driven and patient-centered organizations that And they are right to be alarmed at what current law,’’ and, ‘‘a larger share of enrollees serve as a comprehensive and cost effective they see. in the nongroup market would be younger primary health care option for America’s most This ‘‘Pay-More-For-Less’’ bill is a massive people and a smaller share would be older underserved communities. $900 billion tax cut for the wealthy, paid for on people.’’ Community health centers serve as the backs of America’s seniors, the vulnerable, The projected 10% reduction in premiums is the health care home for more than 25 the poor, and working class households. not the result of better care or efficiency—it is million patients in nearly 10,000 com- This ‘‘Robin Hood in reverse’’ bill is unprec- in large part the result of higher-cost and older munities across the country. edented and breathtaking in its audacity—no people being pushed out of a market that is Across the country, 550 new clinics bill ever tried to give so much to the rich while also selling plans that provide less financial have opened to receive 5 million new taking so much from the poor and working protection. patients since 2009. class. People with low incomes suffer the greatest Community health centers serve ev- Trumpcare represents the largest transfer of losses in coverage. eryone regardless of ability to pay or wealth from the bottom 99% to the top 1% in CBO projects the uninsured rate for people insurance status: American history. in their 30s and 40s with incomes below 200% 1. 71% of health center patients have This callous Republican scheme gives gi- of poverty will reach 38% in 2026 under this incomes at or below 100% of poverty gantic tax cuts to the rich, and pays for it by bill, nearly twice the rate projected under cur- and 92% have incomes less than 200% of taking insurance away from 24 million people, rent law. poverty; leaving 52 million uninsured, and raising costs Among people aged 50–64, CBO projects 2. 49% of health center patients are for the poor and middle class. 30% of those with incomes below 200% of on Medicaid; and In addition, Republicans are giving the phar- poverty will be uninsured in 2026. 3. 24% are uninsured; maceutical industry a big tax repeal, worth Under current law, CBO projects the unin- 4. Community health centers annu- nearly $25 billion over a decade without de- sured rate would only be 12 percent. ally serve on average 1.2 million home- manding in return any reduction in the cost of Being uninsured is not about ‘‘freedom.’’ less patients and more than 300,000 vet- prescription and brand-name drugs. Speaker Ryan has argued that people will erans. To paraphrase Winston Churchill, of this bill, happily forgo insurance coverage because this Community health centers reduce it can truly be said that ‘‘never has so much bill gives them that ‘‘freedom.’’ health care costs and produce savings— been taken from so many to benefit so few.’’ The argument makes as much sense as the on average, health centers save 24% per The Pay-More-For-Less plan destroys the foolish claim that slaves came to America as Medicaid patient when compared to Medicaid program under the cover of repeal- ‘‘immigrants’’ seeking a better life. other providers. ing the Affordable Care Act Medicaid expan- The freedom to be uninsured is no freedom Community health centers integrate sion. at all to people in their 50s and 60s with mod- critical medical and social services CBO estimates 14 million Americans will est incomes who simply cannot afford to pay such as oral health, mental health, lose Medicaid coverage by 2026 under the thousands of dollars toward premiums. substance abuse, case management, Republican plan. They do not really have a choice. and translation, under one roof.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00040 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.029 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2413 Community health centers employ your costs climb so right now, the by millions of Americans as nearly 190,000 people and generate over most I personally have to pay out of ‘‘Obamacare.’’ $45 billion in total economic activity in pocket is $1,000 per year.’’ MARCH 24, 2017. some of the nation’s most distressed Brian Norgaard: ‘‘I am a small busi- Re Changes to the Affordable Healthcare communities. ness owner and leadership trainer who Act. Community health centers serve on Obamacare has helped tremendously.’’ THE PRESIDENT OF THE UNITED STATES OF the front lines of public health crises Brian Norgaard, a Dallas, Texas resi- AMERICA, such as the Zika virus and the opioid dent, called my office to express his op- The White House, epidemic. position to Trumpcare and to offer Washington, DC. Mr. Speaker, community health cen- share how the Affordable Care Act has GREETINGS MR. PRESIDENT: Today is a very ters are on the front lines of every crucial and important day for the residents helped small business owners like him- of the City of Houston’s District D, where I major health crisis our country faces, self: serve as the elected City Council Member, from providing access to care (and em- ‘‘I am a small business owner and which also falls under Congressional Dis- ployment) to veterans to addressing leadership trainer who Obamacare has tricts 18 and 7. As a local elected official the opioid epidemic to responding to helped tremendously. whose mother is on a fixed income, this will public health threats like the Zika ‘‘My wife and I both own small busi- not only impact her but many other senior virus. nesses in the Dallas, Texas area and as citizens who I represent. We should be providing more support a result of the huge savings we received In the news, we see how the Affordable and funding to community health cen- Healthcare Act is proposed to be changed. after paying lower [healthcare] pre- Under the new revisions to the healthcare ters, not making it more difficult for miums under Obamacare, we were able bill, which is called The American Health them to serve the communities that to reinvest those saving into both of Care Act, about $337 Billion will be cut from desperately need them by slashing our businesses and the community. the current plan over a 10 year period caus- Medicaid funding. ‘‘And the healthcare we received was ing 24 million Americans, including Demo- Trumpcare Republican plan leaves quality, at that.’’ crats, Republicans, Independents, poor and rural Americans worse off. Ashley Walton: ‘‘For cancer sur- the middle class, to lose their healthcare. Mr. Speaker, health insurance has vivors, we literally live and die by in- This proposed health care bill is receiving historically been more expensive in criticism from the health care providers, surance’’ some conservatives and a united Democratic rural areas because services cost more Ashley Walton was 25 when a mole on and it is hard to have a stable indi- Party. The Congressional Budget Office even her back turned out to be melanoma. showed how this current proposed plan will vidual market with a small population. She had it removed, but three years negatively impact everyone. What is most Under the Affordable Care Act, pre- later she discovered a lump in her ab- concerning to me in regards to this program mium subsidies are tied to local costs, domen. is the impact that it will have on our senior which helps keeps premium costs down. She was then unemployed and unin- citizens. But they are not under the Repub- sured, and so she put off going to a doc- 52% of my District is made up of Senior Citizens who are on fixed incomes. These lican plan. tor. So, under the Republican plan resi- senior’s will have to pay more for their She tried to buy health insurance. dents in rural areas, who tend to be health care under this proposed American Every company rejected her. older and poorer, will pay much more Health Care Act. In no way is this accept- Ashley eventually became eligible for able. I am an advocate for my seniors and I and get much less health insurance. California’s Medicaid program, which refuse to quietly sit back while this is being At the end of the day, Mr. Speaker, had been expanded under the Afford- considered. the powerful and compelling reasons to able Care Act. I have encouraged everyone to reach out to reject Trumpcare lies in the real world The 32-year-old Oakland resident their Members of Congress to let them know experiences of the American people. that this isn’t something that we stand for credits her survival to the ACA. Let me briefly share with you the and to work on their behalf to vote this item Without it, ‘‘I would likely be dead, positive, life affirming difference made down today. and my family would likely be bank- by the Affordable Care Act in the lives Sincerely, rupt from trying to save me.’’ of just three of the millions of Ameri- DWIGHT BOYKINS, Before any of our Republican col- Houston City Counsel, cans it has helped. District D. Joan Fanwick: ‘‘If Obamacare is re- leagues supporting this bill cast their pealed, I don’t know if I’ll live to see vote, I urge them to reflect on the tes- Mrs. BLACK. Mr. Speaker, I yield 2 the next President’’ timony of Joan, Brian, and Ashley, and minutes to the gentleman from Wis- ‘‘After nearly a decade of mysterious to on this question posed by a con- consin (Mr. GROTHMAN), who is also a health scares, I was diagnosed with an stituent to Sen. COTTON of Arkansas at member of the Budget Committee. autoimmune disorder called Sjogren’s a recent town hall: Mr. GROTHMAN. Mr. Speaker, I Syndrome last year, when I was a jun- ‘‘I’ve got a husband dying and we would encourage my colleagues to vote ior at Temple University. can’t afford—let me tell you some- for the bill. The reason I ask you to ‘‘It’s a chronic illness with no known thing. vote for the bill is kind of like the re- cause or cure, and without close med- ‘‘If you can get us better coverage verse: What is going to happen if this ical surveillance and care, it can lead than this [Obamacare], go for it. bill fails? to life-threatening complications (like ‘‘Let me tell you what we have, plus If this bill fails, you won’t be able to the blood infections I frequently expe- a lot of benefits that we need. have the huge increase in funding in rience). ‘‘We have $29 per month for my hus- HSAs, a free-market, patient-centered ‘‘For me, having this disorder means band. Can you beat that? Can you? tax provision which is going to help waking up every morning and taking 10 With all the congestive heart fail- many people and particularly allow different medications. ures, and open heart surgeries, we’re flexibility for older married couples. ‘‘It also means a nurse visiting my trying. $29 per month. And he’s a hard If this bill doesn’t pass, we are going apartment every Saturday to insert a worker. to continue to levy fines on young peo- needle into the port in my chest, so I $39 for me.’’ ple who don’t want health insurance, can give myself IV fluids throughout I urge all Members to reject as so many people have not had when the week. Trumpcare, one of the most mon- they are young. We will continue to ‘‘Without insurance, my medical ex- strously cruel and morally bankrupt levy fines on small business that can’t penses would cost me about $1,000 per legislative proposals ever to be consid- afford health insurance. week—more than $50,000 per year. And ered in this chamber. If this bill fails to pass, we are not that doesn’t even include hospitaliza- To paraphrase a famous former re- going to allow States to put work re- tions. ality television personality, ‘‘believe quirements on Medicaid. Quite frankly, ‘‘My medical bills aren’t cheap under me, Trumpcare is a disaster.’’ Medicaid, in many ways, is a more gen- Obamacare, but I can afford them. We should reject it and keep instead erous policy than the one that people ‘‘Under Obamacare, insurance compa- ‘‘something terrific’’ and that is the who do work are able to afford through nies aren’t allowed to cut you off when Affordable Care Act, regarded lovingly their insurers.

VerDate Sep 11 2014 06:05 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00041 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.030 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2414 CONGRESSIONAL RECORD — HOUSE March 24, 2017 If this bill doesn’t pass, we won’t be Your bill would increase their pre- We are not the only ones opposing able to stop the bleeding on Medicaid miums an average of $8,000 a year. Ac- this legislation. It is opposed by an funding. We are approaching a $20 tril- cording to the Congressional Budget amazing array of American organiza- lion debt. Of course, the bulk of that Office, within 10 years, nearly 30 per- tions and individuals, including the spiraling debt is caused by mandatory cent of those 50-to 64-year-olds would American Medical Association, the spending, of which Medicaid is one of be without any insurance. American Hospital Association, the the worst parts. Did you really come to Congress to American Nurses Association, the Na- Finally, for the first time in years, take nursing home and home care away tional Rural Health Association, we are passing a law that will make a from the elderly and the disabled? AARP, the National Disability Rights significant dent in that mandatory Did you get elected in order to take Network, the American Diabetes Asso- spending. health care from mothers? ciation, American Cancer Society, and If this bill isn’t passed, we prevent Your bill would kick them off of Easterseals, virtually every healthcare putting a provision in here requiring Medicaid if they don’t find a job 60 and consumer advocacy group, Gov- documentation of citizenship for Med- days after they give birth. ernors from both sides of the aisle, and icaid. Right now, we are becoming the We have heard over and over that pa- a growing list of our Republican col- healthcare provider for the world. We tients need choices and should be em- leagues. cannot afford to become the healthcare powered to choose the care that they Mr. Speaker, I thank the Budget provider of the world. want. But, apparently, that doesn’t Committee staff for the incredible job Under this bill, we are providing apply to women. The bill would block they have done throughout this proc- funds, seed money for high-risk pools millions of women from choosing ess. for States, which will hold down insur- Planned Parenthood, a trusted Mr. Speaker, I reserve the balance of ance costs, which is the underlying healthcare provider to 2.5 million pa- my time, and I ask unanimous consent problem we have here. tients every year. that the gentleman from New Jersey If this bill doesn’t pass, we continue The American people are not clam- (Mr. PALLONE), chairman of the Energy to fund abortion providers. I think this oring for you to repeal ObamaCare. and Commerce Committee, control the is the best bill in decades for those of Only 17 percent of Americans say that balance of my time. us who wish we would stop funding you should vote to repeal ObamaCare. The SPEAKER pro tempore. Is there these organizations. The average American overwhelmingly objection to the request of the gen- We are providing assistance for peo- wants you to vote ‘‘no.’’ tleman from Kentucky? ple who can’t get insurance through Mrs. BLACK. Mr. Speaker, I yield 2 There was no objection. their employer. It is high time the Tax minutes to the gentleman from Kansas Mrs. BLACK. Mr. Speaker, I yield myself such time as I may consume. Code provided equality for people who (Mr. MARSHALL), who is a physician. Mr. Speaker, I want to remind my get insurance from their employer and Mr. MARSHALL. Mr. Speaker, Kan- fellow colleagues that, currently, when those who don’t. sas voters sent me to fix health care. we look at the access to care for peo- Finally, if we don’t pass this bill, we Doing nothing is not an option. I can- ple, one-third of our counties only have don’t end ObamaCare. not sit here idly while the ACA de- one provider; two-thirds of our coun- The SPEAKER pro tempore. The stroys and bankrupts America’s ties only have two providers. In my time of the gentleman has expired. healthcare system. Mrs. BLACK. Mr. Speaker, I yield an State of Tennessee, there are 14 coun- This bill eliminates nearly a trillion additional 30 seconds to the gentleman. ties where they will have no insurance dollars of taxes. This bill eliminates Mr. GROTHMAN. Already a third of provider on the marketplace. So when funding for Planned Parenthood. This the counties only have one provider. If we talk about people losing their insur- bill will save many hospitals in Kansas we don’t pass this bill now, we are ance, they are losing their insurance from closing by increasing funding for going to go into the next year and we by not having access to even purchase Medicare patients. This bill allots $100 are going find a lot of people who think the insurance. they have ObamaCare but have nothing billion for high-risk pools. This bill One of my former colleagues, the because there will be no providers left. specifies another $15 billion specifically gentleman from Minnesota, asked: We have got to step in to save those for maternity coverage, which is near What are my colleagues on the other people and provide insurance in those and dear to my heart; newborn care; side of the aisle trying to preserve? counties in which ObamaCare will mental health care; and substance I want to point to this chart here to leave no insurance companies remain- abuse disorders. ask that question, because these are ing. Mr. Speaker, this is the best bill that the broken promises of ObamaCare. Mr. YARMUTH. Mr. Speaker, I re- we can get through this process. I am Why are you trying to preserve some- mind my colleague that his vote for excited to be part of it. This is the first thing where they say premiums will de- this bill will result in 44,600 people chapter of a new book, with many more crease by $2,500, and we see the average from his congressional district in Wis- chapters to come. We will fix health family premiums have soared by $4,300, consin losing health coverage and care. care. making insurance unaffordable for Mr. Speaker, I yield 2 minutes to the Mr. YARMUTH. Mr. Speaker, I re- many families? gentlewoman from Illinois (Ms. SCHA- mind my colleague that his vote for Another broken promise: the cost of KOWSKY), a distinguished member of this bill will result in 50,000 people health care will go down. the Budget Committee and the Energy from his congressional district in Kan- We see some deductibles that have and Commerce Committee. sas losing health coverage and care. gone up as much as 60 percent. In my Ms. SCHAKOWSKY. Mr. Speaker, I Mr. Speaker, I yield myself 2 min- own State, they have gone up by 63 per- sincerely ask my Republican col- utes. cent, making coverage unaffordable. leagues: Did you really come here to Mr. Speaker, in concluding the pres- You can keep your doctor—70 percent take health care away from 24 million entation from the Budget Committee, I of the plans consist of narrow net- people? just have to say that the bill we are works, which means they cannot keep Over 40,000 people in my district will considering today is a mess. It is not a their doctor. I cannot tell you the lose their coverage. healthcare bill at all. number of people who have called me Did you come to Congress to make This bill is driven by a desire to cut because their doctor was not on their insurance more expensive for my con- taxes for the wealthiest Americans and inept plan. stituent, Mary, who has a preexisting many wealthy corporations by nearly Finally, ‘‘middle class Americans condition and now pays half of what $1 trillion in all. It is paid for by mak- won’t see a tax increase.’’ This was a she used to pay for insurance because ing health care unaffordable for mil- promise by former President Obama. of the tax credits she got from lions of people. ObamaCare penalties were put in place, ObamaCare? This is irresponsible. It is not what so people are receiving a tax penalty. Did you come to Congress to impose the American people want, it is not These are the broken promises that a crippling age tax on Americans 50 to what they deserve, and it is certainly the other side of the aisle wants to con- 60 years old? not what they can afford. tinue to protect. As opposed to that, we

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00042 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.047 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2415 want a system that is going to be open most substantive reform to the Med- There is a reason this bill was with patient care and give affordability icaid program since its creation and hatched up in the back rooms only to so people can get the services that they will restore power to our States and be finalized last night, and that is be- want with a cost that they can afford. local communities and governments cause congressional Republicans did I also thank the Budget Committee where they can make better decisions not want the American people to see for the work that they have done, and than a one-size-fits-all here in Wash- what was in it. all the staff that have worked endless ington. We want to give our States TrumpCare provides less coverage, hours to make it possible for this to be more control in how they manage these fewer protections, and higher costs. here on the floor today. people that they are closest to. TrumpCare is Robin Hood in reverse, Mr. Speaker, I yield 30 minutes to In closing, I want to thank our col- taking benefits and financial assist- the gentleman from Oregon (Mr. WAL- leagues and the President of the United ance from hardworking, middle class DEN), and I ask unanimous consent States and the Vice President and Sec- Americans and our most vulnerable in that he may control that time. retary Price. They have worked day in order to give tax breaks to the wealthi- The SPEAKER pro tempore. Is there and day out, tirelessly, without hesi- est and the corporations. objection to the request of the gentle- tation, to help get to the best policy TrumpCare cuts a combined $1 tril- woman from Tennessee? possible here and to work and listen to lion from Medicare and Medicaid. There was no objection. our colleagues, as we have all done, to These cuts are devastating, Mr. Speak- Mr. WALDEN. Mr. Speaker, I yield craft the best bill we can, given the er. myself such time as I may consume. constraints under which we must oper- TrumpCare will ration care for the 76 After 7 years, we have heard the sto- ate. million Americans who rely on Med- ries of our constituents, patients, The end result highlights the diverse icaid, including seniors with long-term friends, and family who have suffered ideas of our Conference that come from care needs, Americans with disabil- under ObamaCare. We have heard from the American people and the deter- ities, pregnant women, and vulnerable those who have benefited in some re- mination that we share to save this children. spects. market and make it work again. I fear for seniors, Mr. Speaker, those I think of the struggles of constitu- Remember, we are talking about a in nursing homes. When States get less ents like Indra from Bend, Oregon. She narrow slice of the insurance market, money, what will they do? They will lost her private insurance and her pre- that driven by ObamaCare, that, last give less money to nursing homes. We ferred doctor. When she went to look year, there were 225 counties in Amer- will go back to the days that I remem- for a new plan under ObamaCare, she ica where, if you were looking for in- ber in New Jersey when nursing homes found the plans were too expensive, and surance on that exchange, you had one were terrible places, where there she went without insurance for almost option. This year, it is 1,022 counties. weren’t enough nurses, where there 2 years. See, her story should not be That is one out of every three in Amer- were fires because of lack of mainte- lost in this debate either. ica. And that was before Humana nance of the nursing home. Working families are going to pay b 1230 pulled out and other companies said this market is about gone. more for less. They will see their pre- Then there is April. Last fall, she We need to fix this market. That is miums and deductibles skyrocket. My found out her insurer would not be of- what this legislation seeks to do. GOP colleagues talk about high fering her plan this year. The most Mr. Speaker, I want to thank our ter- deductibles and copays. Well, you ain’t comparable plan available would raise rific staff that has worked day and seen nothing yet. her monthly premium by $564 per night to get us to this point. We know You are going to see that this repeal month, bringing her total monthly pre- there is a lot more work to do. This repeals the limits on deductibles and mium to $1,503. should not be taken in isolation as the copays that exist under the current You see, there is a whole other group only healthcare reform on our list. We law. Out-of-pocket costs are going to of Americans out there who are suf- are going to go after the cost drivers. go through the roof. The deductibles fering these effects of ObamaCare. The We are going to go after prescription will go even higher. The copays will go American Health Care Act represents a costs. We are going to go after hospital even higher. The out-of-pocket costs better way for patients like Indra and costs. will go even higher. April all across our country. Our plan Wherever it is in the health system, And the bottom line is Americans be- will rescue and revitalize the market if you have nothing to hide, you won’t tween the ages of 50 and 64 will pay an and lower costs and increase flexibility have to fear our investigations. But we age tax and be forced to pay premiums for patients to choose. They will have are going to get costs down. We are five times higher than what younger more choices for health care and keep going to get costs down. people pay for their coverage. a health insurance plan that works for The American Health Care Act is just I have heard my colleagues on the them and for their family. the first step in our mission to rescue other side say, well, that is only fair. This legislation creates the Patient the American people from the failures Well, I don’t think it is fair that sen- and State Stability Fund. Now, this is of the underlying law. We know they iors should have to pay a lot more, an innovative approach to give States are there. We are going to fix this. We that those between 50 and 64 should the financing and flexibility to repair are committed to it. have to pay a lot more. the damage done to the insurance mar- Mr. Speaker, I reserve the balance of Also, TrumpCare leaves the sickest kets by ObamaCare and meet the my time. and vulnerable Americans at the mercy unique needs of their citizens. More Mr. PALLONE. Mr. Speaker, I yield of insurance companies, allowing them importantly, we provide an additional myself such time as I may consume. to charge a 30 percent penalty or sick $15 billion, Mr. Speaker, to States de- Mr. Speaker, I remind my colleague, tax to those who are unable to main- voted for maternity coverage. We heard my chairman, GREG WALDEN, that his tain continuous coverage. So if you fail from people who said we need to do vote for this bill will result in 64,300 to pay your insurance for a month and more in this area: newborn care, men- people from his congressional district then you want to get it again, even if tal health, and substance disorders. in Oregon losing health coverage and you have a preexisting condition, We are also taking action to care. which is often the case, you are going strengthen Medicaid. We want to put Mr. Speaker, President Trump and to pay a 30 percent penalty, or sick tax. Medicaid on a sustainable path so it congressional Republicans are not lev- I don’t think that is very fair. can better care for those it was in- eling with the American people when Last night, in order to garner votes tended to serve, a path through this per they say no one will be worse off under from the extreme right in their party, capita program for States that, frank- this repeal bill. TrumpCare dismantles House Republicans added a provision ly, was at one time embraced by Demo- the health and economic security that that eliminates protections for essen- crats, including President Clinton. millions of hardworking Americans tial health benefits. Now, maybe people The most vulnerable in our commu- have gained over the last 7 years, and don’t understand that, but let me ex- nities need this help. It represents the it should be defeated. plain it.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00043 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.048 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2416 CONGRESSIONAL RECORD — HOUSE March 24, 2017 The ACA ensured that, when a con- health benefit. But there will also be Mr. WALDEN. Mr. Speaker, I yield sumer purchased health insurance on plans that provide for specific markets myself 10 seconds before I yield to the the individual market or gained cov- of young people without children or el- gentleman from Michigan. erage through Medicaid expansion, derly couples or whatever it is. I would just suggest that the Amer- their plan would cover 10 critical, es- Mr. Speaker, markets work, and you ican people are very smart. Unfortu- sential benefits. don’t have to mandate benefits for nately, under ObamaCare, 19.2 million TrumpCare eliminates this guar- those markets to work. Americans said: I am not going to buy antee, meaning that unscrupulous in- The SPEAKER pro tempore. The ObamaCare. I am going to pay a pen- surance companies can sell skeletal time of the gentleman has expired. alty to the IRS instead. plans, junk insurance, without benefits Mr. WALDEN. Mr. Speaker, I yield You see, we are trying to fix it so for hospitalization, maternity care, an additional 15 seconds to the gen- they will want to buy it. mental health, drug treatment serv- tleman from Texas. I yield 2 minutes to the gentleman Mr. BARTON. Mr. Speaker, we al- ices, and Americans won’t even know from Michigan (Mr. UPTON). ways want to score a touchdown. what they are getting. They won’t real- Mr. UPTON. Mr. Speaker, you know, Sometimes we take a field goal. What ize that they have worthless insurance there is an old Upton family quote that we don’t want to do today is take a my grandfather would always say: Was until they get sick and it is too late. safety. The bottom line is this bill should be Vote for this bill. Let’s send it to the you always perfect? No, none of us are. defeated for so many reasons because other body and continue to work to im- And you know what? This is not a so many more people will not have prove it. It is a good bill. Please vote perfect bill. That is for sure. But health insurance, because their costs ‘‘yes.’’ ObamaCare is broken. One out of three are going to go up, and because they Mr. PALLONE. Mr. Speaker, I re- counties has only one provider, and it won’t even know what insurance they mind my colleague that, in Mr. BAR- looks like it is going to get worse as are buying. We are going go to back to TON’s case, his vote for this bill will re- other major insurance companies are the old days of the Wild West when in- sult in 64,900 people from his congres- on the verge of pulling the plug. surance companies could sell whatever sional district in Texas losing health Nearly two dozen of the nonprofit junk insurance they want and the pub- coverage and care. CO-OPS have already gone belly up. In lic won’t even know what they are get- I yield 2 minutes to the gentlewoman my home State, folks saw their pre- ting. It is a disaster for the American from California (Ms. ESHOO). miums increase by nearly 17 percent. people. Ms. ESHOO. Mr. Speaker, I thank the Some States have had premium in- I urge my colleagues to vote ‘‘no,’’ gentleman for yielding me time. creases of more than 100 percent. Most and I reserve the balance of my time. Mr. Speaker, the American people had double-digit increases, many over Mr. WALDEN. Mr. Speaker, I yield are very smart. They listen up. They 20 percent, and some forecast 40 to 50 myself 20 seconds. kind of knit their eyebrows together. percent increases come fall if nothing The irony of that argument is it was They listen to the debate. They want happens. just a year or so ago that every Mem- the facts, and then they make up their The calls on both sides of the aisle ber of this House who was here at the mind. What our colleagues on the other have often used the R word—on this time and the Senate, by a unanimous side of the aisle have brought forward side, ‘‘replace’’; on your side, the vote, agreed to waive the essential ben- today is a disaster for the American Democratic side, ‘‘repair.’’ Let’s both efits he just listed off for the employ- people, and the American people know agree. The status quo is not acceptable. ment market between 51 and 100—and, it. But this, this bill, is the only train You have 17 percent of the American by the way, those essential benefits leaving the station. Is it going to im- people that are for your plan, and the don’t apply to the large group mar- prove if it gets to the Senate? Of course reason why? They know there are ket—so this has already been done. it will. We should all work for that going to be higher costs. Families are I yield 11⁄2 minutes to the gentleman goal. going to have to pay more and get from Texas (Mr. BARTON), the vice For me, I worked with Medicaid ex- less—pay more for their premiums, chairman of the full committee. pansion States like Michigan providing more for their deductibles, and more in Mr. BARTON. Mr. Speaker, I sup- a reasonable transition until 2020 and ported this bill when it came out of the their out-of-pocket costs. You are taking health care away then grandfathering all those folks Energy and Commerce Committee 2 or until they are off. Some of my col- 3 weeks ago, and I want to thank from 24 million Americans. That is more than the entire population of leagues called to end Medicaid expan- Chairman WALDEN for his excellent Australia. Who comes to Congress to sion even this year. They want total leadership. repeal. As he knows, I had some concerns hurt people? The promise of the Affordable Care about the bill at the time. I didn’t b 1245 Act was no one—no one ever again— think it addressed all the problems What would total repeal mean? Total will be able to take away your insur- that we needed to address. repeal would mean taking away the ance the way the insurance companies At the start of this week, I was a ability of HHS to provide flexibility to did 7-plus years ago. Now it is only the ‘‘no’’ vote—a friendly ‘‘no’’ vote, but I the States to administer this critical Republican Party that can take away was a ‘‘no’’ vote. Our Republican lead- program. It would mean taking away Americans’ insurance. ership in the House and the President There isn’t one developed country in insurance for young kids on their par- and his senior advisers continued to in- the world that has your plan. It is a ents’ policies. It would reinstall a cap volve themselves in constructive dis- combination of all kinds of things to on insurance. And, yes, it would allow cussions with people like myself. Yes- get votes. insurance companies to discriminate terday they agreed to put back in the What free markets? What are you against those with preexisting ill- repeal of the essential health benefits talking about? There is hypocrisy here nesses. provision, and that is a big win for con- because you all have the Affordable This bill still allows all of those im- servative values, so I am now a ‘‘yes’’ Care Act insurance. Every single Mem- portant protections to stay in place. A vote. ber of Congress does. So I guess it is number of us will continue to work My friends on the left seem to think good enough for you but it is not good with HHS to provide even more flexi- the only way to get a benefit is to have enough for your constituents. bility to States like Michigan. This has the Federal Government mandate it This is a matter of life and death. to be a key component of moving for- and then have the Federal Government You are playing with people’s lives. It ward. pay for it. I am here to tell you, Mr. is a profound issue. This doesn’t de- At the end of the day, I would like to Speaker, that markets work. If we cre- serve one vote in the House of Rep- think that we could work together on a ate a healthcare market where people resentatives. Vote it down. bipartisan basis. High premiums and a can choose their insurance that fits The SPEAKER pro tempore. The lack of access impact us all. Let’s work their needs, there will be plans that Chair would remind all Members to di- together. You can’t get to second base provide for every so-called essential rect their remarks to the Chair. unless you get to first.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00044 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.050 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2417 Mr. PALLONE. Mr. Speaker, I re- By giving States more tools to ad- overstate how terrible TrumpCare will mind my colleague from Michigan that dress costs, this bill will allow States be for the American people. his vote for this bill will result in 43,500 to explore ways to make accepting This is a dangerous bill. It is opposed people from his congressional district Medicaid more attractive to providers, by physician groups and hospital asso- in Michigan losing health coverage and leading to better health outcomes. ciations. care. Without addressing the current prob- I urge my colleagues to vote ‘‘no.’’ Mr. Speaker, I yield 1 minute to the lems facing the Medicaid program, it Mr. WALDEN. Mr. Speaker, I yield gentleman from New York (Mr. ENGEL). will not survive. This bill puts Med- 11⁄2 minutes to the gentleman from Mr. ENGEL. Mr. Speaker, when peo- icaid on a path to sustainability. An Kentucky (Mr. GUTHRIE), the former ple look at these bills, they want to insolvent safety net will harm those it head of the Medicaid task force. know what they are going to pay. What intends to help. Mr. GUTHRIE. Mr. Speaker, about 7 this bill does is simple—you pay more This is our moment. We have a his- years ago, I was on the floor talking on and you get less. That is the bottom toric opportunity to enact the biggest the Affordable Care Act. And I remem- line—pay more and get less. entitlement reform in our lifetime. We ber talking about, I had just left the The President promised better health have a chance to save Medicaid. State Senate, and bringing up that my care for more people at a lesser cost. I urge my colleagues to vote for this colleagues are in Frankfort and they But my Republican colleagues can no bill. are doing work on the budget; and, in longer claim with any credibility that Mr. PALLONE. Mr. Speaker, I re- the future, it is going to make it more their plan achieves these goals. mind my colleague from Mississippi difficult for them to pass budgets be- Twenty-four million people will lose that his vote for this bill will result in cause of the expansion in Medicaid, and coverage. People 50 to 64 will be hit 69,600 people from his congressional that is coming to pass. It will be in the with an age tax and pay premiums five district losing health coverage and next budget session they have to deal times higher than everybody else. care. with moving forward, if we don’t ad- Deductibles will go up. And protections Mr. Speaker, I yield 2 minutes to the dress this situation. that make sure insurance companies gentleman from Texas (Mr. GENE So people keep talking about a rush offer minimum value will be thrown GREEN), the ranking member of the process. Over a year ago, we put to- out. Health Subcommittee. gether a Medicaid task force, met with Again, the Republican bill, Mr. GENE GREEN of Texas. Mr. groups of people, met with Governors, TrumpCare—pay more, get less—but it Speaker, this is outrageous. we took a lot of information, and put gives billionaires a tax break. That is TrumpCare will rip health insurance together a plan that addresses the really important; isn’t it? With the Af- from 24 million Americans, almost as needs of Medicaid. Medicaid is growing. fordable Care Act, we set out to give many people who live in the State of It will be over a $1 trillion program Americans more affordable, higher Texas. within 10 years if we don’t deal with it. quality health care. TrumpCare is a direct assault on the It is going to implode. So we actually Is the law perfect? No. We should be President’s promise to the American worked to put it on a sustainable budg- working together to tweak the law. We people. It will saddle families across et. It is growing. People talk about should be working together to improve the country with massive health costs. cuts to Medicaid. Only in Washington, the law, not putting in a clunker like It will lead to higher premiums, less D.C., is slowing the growth of a pro- this bill, which will roll back the time benefits, and more people uninsured. gram looked at as a cut. So we have on people’s coverage. Roll back the Under this bill, premiums increase 15 worked hard to move that forward. time, give people less coverage, and let to 20 percent in each of the next 2 The other thing I want to talk about them pay more. That is not what the years. It will particularly be terrible is, last year, small businesses were American people want. I urge my col- for the near-elderly Americans because going to be hit by the minimum essen- leagues to vote ‘‘no.’’ TrumpCare allows insurance compa- tial benefits. Small businesses were Mr. WALDEN. Mr. Speaker, I yield nies to charge them five times higher saying: We like our plans, and we want 11⁄2 minutes to the gentleman from Mis- than what others would pay for cov- to keep it. We are going to have our sissippi (Mr. HARPER), the chairman of erage. It destroys protections for prices go up, and we are not going to be the House Administration Committee, Americans with preexisting conditions. able to afford to provide coverage. and a valuable member of the Energy It guts the essential benefits so con- So we all came together, bipartisan, and Commerce Committee. sumers won’t know what coverage they to address that to exempt the small- Mr. HARPER. Mr. Speaker, have. Plans would not have to cover business plans for those programs. It ObamaCare has failed. Contrary to things like emergency care, hos- passed by voice vote in the House, what was promised, premiums have pitalization, or even prescription unanimous consent in the Senate, and gone up and there are fewer health in- drugs. signed by then-President Obama. surance options. This bill addresses a What do you do when you leave peo- So the question is, if small businesses crisis that before now had no end in ple with that? Junk plans that are in- can design and keep their own plans, I sight. surance in name only. What is the think individuals can, too. Not only does this bill work to solve point of having insurance if it doesn’t I agree with my friend from Cali- the problems we see in the private in- cover anything? fornia that the American people are surance market, it addresses one of our For those who aren’t one of the 24 smart. I disagree with my other col- Nation’s most vital programs—Med- million who lose insurance, many will league who says: They will buy things, icaid. This program is a critical lifeline be left with plans that are more expen- and they won’t even know what is in it. for hundreds of thousands of Mississip- sive but don’t have to cover things like They are smart, and I urge support pians. prescription drugs or mental health for this bill. Medicaid is a safety net program that and substance abuse. Mr. PALLONE. Mr. Speaker, I re- was designed for children, the elderly, This bill will make it harder for peo- mind my friend from Kentucky that pregnant mothers, and the disabled. ple to get treatment. It will destroy his vote for this bill will result in 44,000 This bill will refocus attention back on the Medicaid program, the bedrock of people from his congressional district the program’s initial goals, but will our social safety net that insures 74 losing health coverage and care. modernize it to better serve these pa- million Americans, including children, Mr. Speaker, I yield 2 minutes to the tients. pregnant women, and one in seven sen- gentlewoman from Colorado (Ms. We should move decisionmaking au- iors on Medicare. DEGETTE). thority down to those who are best po- TrumpCare harms Medicare. It will Ms. DEGETTE. Mr. Speaker, Presi- sitioned to address these problems. A make the program insolvent 3 years dent Trump promised his healthcare program run primarily by the States earlier, directly causes part B pre- plan would be ‘‘much better health with assistance from the Federal Gov- miums to go up $8.7 billion, and takes care at a much lower cost.’’ Secretary ernment will best be able to help those away funds that seniors depend on for of Health and Human Services Tom who need it most. long-term care. It is impossible to Price even promised ‘‘nobody will be

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00045 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.052 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2418 CONGRESSIONAL RECORD — HOUSE March 24, 2017 worse off financially.’’ In reality, of In that time, those same Americans million more people have health care course, the TrumpCare bill will leave who fought against passage of and then the people who are out there just about everybody worse off, with ObamaCare have delivered Republicans busting it, sometimes 60 hours a week, less care at a higher cost. majorities in the House, in the Senate, wind up with their premiums doubled This bad bill would rip health insur- and put a Republican in the White and their coverage cut in half. It’s the ance money away from millions of peo- House. They did so, in part, based on craziest thing in the world.’’ ple—24 million over 10 years, and 14 our promises to repeal and replace Mr. Speaker, hardworking American million next year alone. ObamaCare. families in my district, they don’t Americans who are lucky enough to And here we stand, 7 years after want crazy. They want the American hold on to coverage if this bill becomes ObamaCare passed, with the oppor- Health Care Act, a sane plan that gives law will pay more for it in premiums, tunity to finally deliver on that prom- them their freedom back. deductibles, and other out-of-pocket ise, and to bring relief to patients In a few minutes, Mr. Speaker, you costs, especially people age 50 and up. across this country who haven’t been are going to hear somebody from the Mr. Speaker, the deals that were cut able to find the care they were prom- other side say that a bunch of my con- last night to win more Republican ised at a cost they can afford. stituents are going to lose coverage. votes for TrumpCare would be even It is an opportunity for us to fulfill That is absolutely false. Those con- more devastating. Trips to the emer- our promise to our constituents. Let’s stituents are getting their freedom gency room, mental health and sub- be clear: a vote against this bill today back to choose whether or not they stance abuse treatment, maternity is a vote for preservation of the want healthcare coverage and what care both before and after birth, pre- ObamaCare disaster, a vote to keep kind of healthcare coverage they want. scription drugs, lab tests, and more es- critical healthcare decisions in the I say vote ‘‘yes.’’ sential services could be cut. hands of bureaucrats in Washington, Mr. PALLONE. Mr. Speaker, I re- Apparently, some people don’t think D.C., and a vote against the largest en- mind my colleague from Texas that his these services deserve guaranteed titlement reform in a generation. vote for this bill will result in 61,900 health insurance. They would let insur- I urge all of my colleagues to do the people from his congressional district ers sell skimpy plans that don’t even cover patients’ basic needs. right thing and vote for this bill. losing health coverage and care. Democrats believe we can, and Mr. PALLONE. Mr. Speaker, I re- Mr. Speaker, I yield 1 minute to the should, work together to improve the mind my colleague from Indiana that gentleman from North Carolina (Mr. ACA, not to work on a misguided bill his vote for this bill will result in 37,800 BUTTERFIELD). that would gut it. people from his congressional district Mr. BUTTERFIELD. Mr. Speaker, We owe this to folks like Amanda losing health coverage and care. over the last few days, 110 organiza- Miller of Denver. Amanda changed jobs Mr. Speaker, I yield 1 minute to the tions have written to me in opposition last year. During her period of unem- gentleman from Pennsylvania (Mr. MI- to TrumpCare. You know who they are: ployment, she and her husband decided CHAEL F. DOYLE). AARP, American Hospital Association, the smart thing to do was to get cov- Mr. MICHAEL F. DOYLE of Pennsyl- American Heart Association, American erage to fill the gap. Thank God they vania. Mr. Speaker, for the last 71⁄2 Medical Association, American Acad- did. years, Republicans have promised emy of Physicians, American Academy Shortly after that, she and her hus- Americans something better than the of Pediatrics, American Psychiatric band got into a serious car accident. ACA. Instead, today, they are giving us Association, National Association of Amanda walked away unscathed, but something much worse. School Nurses, Alliance for Retired her husband was badly injured. She Twenty-four million people lose their Americans, American Federation of could see more of his skull than she insurance? Stripping away guaranteed Teachers, National Association of could see of his scalp. Luckily, there benefits? Putting maternity, mental School Psychologists, National School were some nurses in a car behind them, health, and pediatric care at risk? Boards Association, National Edu- and they stabilized him and took him Shame on you. cation Association, the Children’s De- to the emergency room. Pitting the elderly against children, fense Fund, March of Dimes, the Na- Their hospital bill of $16,000 was paid the disabled, and the mentally ill in tional Committee to Preserve Social in full, thanks to Amanda’s coverage the Medicaid program? Placing a tax Security and Medicare, the American through the ACA. What do we say to penalty on veterans? Charging a crush- College of Physicians North Carolina Amanda? Can we guarantee her better ing age tax on 50- to 64-year-olds, forc- Chapter, North Carolina Society of Ad- insurance and a better financial situa- ing them to pay five times more than diction Medicine, Consumers Union, tion? I don’t think so. what others pay? Shame on you. United Steelworkers, AFL–CIO, Fami- Let’s defeat this bill, and let’s start This isn’t a healthcare bill. This is a lies USA, Center for American working towards a good one that will tax cut bill masquerading as a Progress, National Association of Pedi- cover everybody. healthcare bill. This bill does nothing atric Nurse Practitioners, and the list Mr. WALDEN. Mr. Speaker, I yield to lower premiums, copays, or goes on and on. 11⁄2 minutes to the gentleman from In- deductibles. Mr. Speaker, I include in the RECORD diana (Mr. BUCSHON). You cut taxes by almost $1 trillion a list of entities opposing TrumpCare. Mr. BUCSHON. Mr. Speaker, when for corporations and the rich, while 1. AARP ObamaCare was debated 7 years ago, I ransacking Medicaid and the Medicare 2. American Hospital Association wrote my Member of Congress to urge trust fund. That is shameful. 3. American Heart Association him to vote against what I saw as a Americans will not forget who did 4. American Medical Association government takeover of our healthcare this to them today. 5. American Academy of Physicians system. Mr. WALDEN. Mr. Speaker, I yield 6. American Academy of Pediatrics 7. American Psychiatric Association At that time, I was a practicing phy- 11⁄2 minutes to the gentleman from sician, and I could foresee the disas- 8. National Association of School Nurses Texas (Mr. FLORES), a real leader on 9. Alliance for Retired Americans trous consequences of this law and the Energy and Commerce Committee. 10. American Federation of Teachers what it would do to patients across this b 1300 11. National Association of School Psy- country, including my own. And I chologists wasn’t alone. Mr. FLORES. Mr. Speaker, we have 12. National School Boards Association Citizens from every corner of Amer- heard numerous comments from the 13. National Education Association ica stood up and demanded that Con- left extolling the virtues of 14. Children’s Defense Fund gress reject the ObamaCare bill, but we ObamaCare, and I think it is instruc- 15. March of Dimes were ignored. Since then, out-of-pocket tive to hear the words of a former 16. National Committee to Preserve Social Security and Medicare costs for families have skyrocketed, Democratic President that is beloved 17. American College of Physicians North patient-choice has evaporated, and by the left. Here is what he said less Carolina Chapter ObamaCare has inched closer to the than 6 months ago: ‘‘So you’ve got this 18. North Carolina Society of Addiction brink of collapse. crazy system where all of a sudden 25 Medicine

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00046 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.053 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2419 19. North Carolina AIDS Action Network 89. Health and Education Alliance of Lou- with other Governors from around the 20. Consumers Union isiana country who support this bill, he, too, 21. SEIU 90. Healthy Schools Campaign believes it is in the best interest of 22. United Steelworkers 91. Higher Education Consortium for Spe- Hoosiers. I agree and I urge my col- 23. AFL–CIO cial Education 24. Families USA 92. Judge David L. Bazelon Center for Men- leagues to join me in support of the 25. Center for American Progress tal Health Law American Health Care Act. 26. Southern HIV/AIDS Strategy Initiative 93. LEAnet, a national coalition of local Mr. PALLONE. Mr. Speaker, I re- 27. National Association of Pediatric Nurse education agencies mind my colleague from Indiana that Practitioners 94. Learning Disabilities Association of her vote for this bill will result in 28. Children’s Hospital Association America 37,700 people from her congressional 29. National Rural Health Association 95. Lutheran Services in America Dis- district losing health coverage and 30. American Lung Association ability Network 31. ACLU care. 96. Michigan Association of Intermediate Mr. Speaker, I yield 2 minutes to the 32. National Urban League School Administrators 33. Black Women’s Health Imperative 97. Michigan Association of School Admin- gentlewoman from Florida (Ms. CAS- 34. Communications Workers of America istrators TOR), the vice ranking member of our 35. International Brotherhood of Teamsters 98. National Association of Pediatric Nurse committee. 36. National Rural Education Association Practitioners Ms. CASTOR of Florida. Mr. Speaker, 37. National Association of Social Workers 99. National Association of State Directors my neighbors back home in Florida 38. National Association of Pediatric Nurse of Special Education (NASDSE) work very hard for their health cov- Practitioners 100. National Association of State Head In- erage. When they pay their hard-earned 39. Lutheran Services in America jury Administrators copayments and premiums, they expect 40. NETWORK Lobby for Catholic Social 101. National Black Justice Coalition Justice 102. National Center for Learning Disabil- something meaningful in return: real 41. Children’s Dental Health Project ities health care. That is what the Afford- 42. Family Voices 103. National Disability Rights Network able Care Act provided; not just a piece 43. First Focus Campign for Children 104. National Down Syndrome Congress of paper, but real health services, an 44. American Psychological Association 105. National Health Law Program end to discrimination against pre- 45. National Council for Behavioral Health 106. National Respite Coalition existing conditions, and all sorts of 46. National Hemophilia Foundation 107. Paradigm Healthcare Services other consumer protections. 47. American Congress of Obstetriticians 108. School Social Work Association of and Gynecologists But in the middle of the night last America night, the Republicans turned back the 48. American Sexual Health Association 109. School-Based Health Alliance 49. Big Cities Health Coalition 110. Society for Public Health Education clock. They have eliminated from the 50. National Women’s Law Center 111. Teacher Education Division of the basic health insurance policy coverage 51. Human Rights Campaign Council for Exceptional Children for emergency room visits, hospitaliza- 52. Partnership for America’s Children tion, prescription drugs, and more. 53. Friends Committee on National Legis- Mr. BUTTERFIELD. What is it about this, Mr. Speaker, that you don’t un- They have really embraced the mon- lation iker of pay more for less. And on top of 54. National Partnership for Women & derstand? Families You are wrong on this. Don’t let your it, remember, this bill rips health in- 55. Planned Parenthood Action Fund base push you over the cliff on this bill. surance away from millions of our 56. National Center for Learning Disabil- Mr. WALDEN. Mr. Speaker, I yield neighbors back home. It raises costs on ities hardworking Americans, especially our 11⁄2 minutes to the gentlewoman from 57. Save Medicaid in Schools Coalition older neighbors. It is practically an age Indiana (Mrs. BROOKS). 58. HIV Medicine Association tax, if you are over 50 years old. It Mrs. BROOKS of Indiana. Mr. Speak- 59. Drug Policy Alliance breaks that fundamental guarantee 60. League of Conservation Voters er, I appreciate the passion I have that has existed for 50 years, that if 61. Natural Resources Defense Council heard from colleagues on both sides of your family is struck with an Alz- 62. Green Latinos the aisle and from Hoosiers on all sides heimer’s diagnosis, a child with a com- 63. Green For All of this issue. The issue of health care is 64. Safe Climate Campaign plex condition, a handicap, that you personal for people, and it should be. 65. Climate Reality Project are not going to live your remaining But today, health care isn’t personal. 66. Center for Reproductive Rights years in poverty, all the while, taking Under ObamaCare, healthcare coverage 67. Interfaith Disability Advocacy Collabo- your tax dollars and shifting it to mil- rative has been a one-size-fits-all approach. lionaires and billionaires and corpora- 68. International Federation of Profes- I have heard from so many of my sional and Technical Engineers tions. constituents in my more than 4 years TrumpCare is a recipe for disaster. It 69. Trust for America’s Health in Congress about how ObamaCare has 70. AIDS United is a fundamental violation of the val- 71. AFSCME cost them and their families—lost doc- ues we share as Americans, and it 72. Cystic Fibrosis Foundation tors, higher premiums and deductibles, should meet its demise today. 73. AASA, The School Superintendents As- and a lack of options for coverage. Mr. WALDEN. Mr. Speaker, I yield sociation As an example of just one of those 11⁄2 minutes to the gentleman from New 74. Accelify Hoosiers, Lon told me his premiums York (Mr. COLLINS), a real leader on 75. American Foundation for the Blind and deductibles doubled last year when our committee. 76. Association of Assistive Technology he lost his healthcare plan. He has had Act Mr. COLLINS of New York. Mr. 77. Programs Association of Educational to change his insurance 3 times in 3 Speaker, today is a historic day, make Service Agencies years. That is not how healthcare cov- no mistake about it. The American 78. Association of School Business Officials erage should work. Health Care Act changes the trajectory International The American Health Care Act of health policy in this country. Here 79. Association of University Centers on makes healthcare coverage more per- are just a few of the highlights: Disabilities sonal for every American. This bill em- This bill eliminates the individual 80. Autistic Self Advocacy Network powers you, and every American, to mandate penalty; eliminates the em- 81. Center for American Progress Center for Public Representation choose the best health care for you and ployer mandate penalty; eliminates the 82. Clearinghouse on Women’s Issues your family. It empowers our Gov- ObamaCare subsidies in 2020; elimi- 83. Colorado School Medicaid Consortium ernors and our State legislatures to nates ObamaCare tax increases; elimi- 84. Conference of Educational Administra- meet the individual healthcare needs of nates insurance mandates so we can tors of Schools and Programs for the Deaf their citizens, including the people lower premiums; provides refundable 85. Council for Exceptional Children struggling to make ends meet and the tax credits for individuals and families 86. Council of Administrators of Special most vulnerable: the elderly, pregnant who do not get their health insurance Education 87. Disability Rights Education & Defense moms, kids, and people with disabil- through their employer or the govern- Fund ities. ment, and allows them to choose the 88. Division for Early Childhood of the I applaud our Hoosier Governor Hol- health care that works for them; al- Council for Exceptional Children (DEC) comb, who wrote a letter to Congress most doubles the contribution limits

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00047 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.026 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2420 CONGRESSIONAL RECORD — HOUSE March 24, 2017 for health savings accounts; provides Now they will have a choice. Those What is our plan going to do? $115 billion for the Patient and State thousands of people will not walk It is going to give affordability. It is Stability Fund to lower patient cost away. They will choose something bet- going to give competition. We are and stabilize the insurance market; ter for them. There will be thousands going to have choices. and enacts the most significant re- of people that have insurance that cov- And what else? forms to Medicaid in history, ensuring ers their needs, and not what, Mr. It is going to remove red tape. It is that Medicaid is sustainable and avail- Speaker, my colleague says they will going to remove the barriers between able for the most vulnerable among us do. They are not that stupid. They healthcare professionals and patients. for generations to come. won’t walk away. It is going to empower patients. That The American Health Care Act is a Mr. PALLONE. Mr. Speaker, I re- is what health care in America is monumental step toward freedom, mind my colleague from Michigan that about: people making healthcare deci- choice, and individual responsibility in his vote for this bill will result in 39,500 sions with their healthcare practi- health care. people from his congressional district tioners. That is what we are going to Mr. Speaker, I will proudly vote for losing health coverage and care. do. That is what this does. this bill today, and I urge all of my col- Mr. Speaker, I yield 1 minute to the The two worst things that leagues to do the same. gentleman from California (Mr. ObamaCare did to the healthcare sys- Mr. PALLONE. Mr. Speaker, I re- MCNERNEY). tem in America, first of all, is it took mind my colleague from New York Mr. MCNERNEY. Mr. Speaker, since the free market out of America. It took that his vote for this bill will result in the implementation of the ACA, over the free market out of health care in 58,000 people from his congressional 3.9 million women age 18 to 64 have America. It also expanded Medicaid, a district losing healthcare coverage and gained health coverage through Med- safety net program that was intended care. icaid. The ACA ended gender rating, for the aged, the blind, the disabled, Mr. Speaker, I yield 1 minute to the meaning that the insurance companies children, and mothers, and extended it cannot charge women more than they gentleman from Maryland (Mr. SAR- to able-bodied adults—something that charge men for the same coverage. BANES). it was never intended to do. TrumpCare also eliminates Medicaid Mr. SARBANES. Mr. Speaker, this is Mr. Speaker, I look forward to hear- funding for Planned Parenthood, reduc- a terrible bill. It is a terrible bill. It is ing how many people in my district are ing access to health care for women. wrong for the country. going to be empowered now from the Millions of women rely on Planned Why would the President, why would gentleman from New Jersey. Parenthood for both routine and life- the leadership on the Republican side Mr. PALLONE. Mr. Speaker, I re- saving care, such as preventative serv- here in Congress, why would they mind my colleague from Georgia that ices, family planning, and preventing choose as the first order of business his vote for this bill will result in 62,800 unwanted pregnancies. When the GPO taking healthcare coverage away from people from his congressional district strips Planned Parenthood funding, 24 million Americans? losing health coverage and care. It is wrongheaded. It is immoral. It is health care of women will suffer. TrumpCare and its Medicare cuts Mr. Speaker, I yield 1 minute to the inhumane. It makes no sense. It is also hurts seniors. Older Americans ac- gentleman from Vermont (Mr. WELCH). wrong for America. count for over 60 percent of Medicare Mr. WELCH. Mr. Speaker, those of us In the people’s House, we need to spending. Insurance companies will who support the Affordable Care Act vote it down. now be able to charge more based on know that the work of improving Mr. WALDEN. Mr. Speaker, I yield their age, which will increase pre- health care and making it more afford- 11⁄2 minutes to the gentleman from miums by thousands. able and accessible is never done. It Michigan (Mr. WALBERG). Mr. Speaker, watching Republicans matters. It really matters to the moth- Mr. WALBERG. Mr. Speaker, for 7 sell this bill is like buying a used car ers and fathers we represent and to the years, I have heard story after story from a guy with a crooked smile, even children that they love. But this bill, from people in my district about how they don’t believe in it. I ask my Re- stripping 24 million Americans of the Affordable Care Act is anything publican colleagues to withdraw this health care, a $1 trillion tax cut to the but affordable. horrible bill and work with Democrats wealthiest among us, making people 50 Families and small businesses are to improve the ACA instead of trying to 64 pay five times as much as other paying more for less, and insurers are to sell this atrocity. Americans, obviously, is a giant step dropping out of the marketplaces, leav- Mr. WALDEN. Mr. Speaker, I yield backwards. ing behind fewer options. Government- 11⁄2 minutes to the gentleman from One of those Americans is Linda from run health care isn’t working, and we Georgia (Mr. CARTER), our resident Burlington. She left an abusive mar- are repealing and replacing ObamaCare pharmacist on the committee. riage, but had to leave her health care like we promised our constituents we Mr. CARTER of Georgia. Mr. Speak- behind. The Affordable Care Act res- would do. er, I am joyous to be here today on cued her, and she has gone on to revive The American Health Care Act is the such a historical day. You see, for the her life and her future. first step of a three-step process to re- past 7 years, I have practiced in b 1315 pair our broken healthcare system. ObamaCare, I have practiced under This bill moves power away from Wash- ObamaCare, and I have practiced in Our community hospitals that do so ington and puts doctors and patients at that setting; and I can tell you that much good in our communities have the center of their healthcare deci- what it promised, it has not delivered gone from red ink to black ink by the sions. It reforms and strengthens Med- on. help that the Medicare expansion pro- icaid and gives States the flexibility to There has not been increased accessi- vided. innovate and best meet the needs of bility, no. Instead of that, we have got It is a sad day for this institution. their citizens. five States in our country that only We did all of this without hearing from This patient-centered approach will have one plan to offer. We have a third a single patient, a single doctor, a sin- bring costs down, increase choice and of the counties in our country that gle person. We had no hearings. competition, and provide important only have one plan to offer. We have 16 Mr. Speaker, can we do better than protections for patients with pre- counties in Tennessee that don’t even that? existing conditions. have a plan, and now we are going to Mr. WALDEN. Mr. Speaker, I yield 2 Mr. Speaker, these are the types of have the opportunity to have access. minutes to the gentlewoman from things we promised, and doing nothing Now we are going to have choice. North Carolina (Ms. FOXX), the chair- is not an option. May I remind my col- We have also been told about afford- woman of the Education and the Work- league from the other side of the aisle: ability. Well, let’s talk about afford- force Committee. I have seen those numbers. My con- ability. We see what ObamaCare did. It Ms. FOXX. Mr. Speaker, sky- stituents will not simply walk away increased premiums 25 percent this rocketing cost, diminished choices for and do nothing just because the other year alone; 50 percent in seven States. patients, small businesses destroyed, side says that they will be uncovered. That is unsustainable. fewer jobs, and lower wages, that is

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00048 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.056 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2421 ObamaCare’s legacy. That is what Republicans in Congress promised I yield 1 minute to the gentleman Democrats imposed on our country. they would lower costs, but this mess from New York (Mr. TONKO). We believe the American people de- raises costs on families. Not only does Mr. TONKO. Mr. Speaker, a resound- serve a better way, and that is what the CBO tell us premiums will increase ing ‘‘no’’ to TrumpCare, President this legislation will deliver. The Amer- 15 to 20 percent, but TrumpCare will Trump’s broken promise to our great ican Health Care Act puts the Amer- allow insurance companies to increase America. There is no disputing the dev- ican people back in control of their deductibles and out-of-pocket costs. astation this bill will cause for Amer- health care. It restores choices, pro- Under the guise of State flexibility, ica’s working families. tects the most vulnerable, encourages Republicans say they are shifting re- TrumpCare will rip health insurance lower healthcare costs, empowers sponsibilities to States. Here is what away from 24 million people. States, and frees families and small that means: TrumpCare will force It will raise costs for consumers and businesses from costly taxes and man- States to raise taxes and ration care. It lower standards of care, with premiums dates. will repeal the requirement for insur- rising and deductibles increasing by an Let’s keep our promise to provide a ance plans to cover doctor visits, emer- average of $1,500. better way on health care by voting gency room care, prescription drug TrumpCare will eliminate required ‘‘yes’’ on the American Health Care coverage, and even mental health serv- mental health and addiction benefits, Act. ices. jeopardizing recovery for millions of Mr. Speaker, I ask the gentleman Everyone is entitled to their own Americans in the midst of this opioid from Oregon (Mr. WALDEN) to engage in opinions but not their own facts. The epidemic. a brief colloquy. fact is TrumpCare will raise your pre- It imposes a crushing new age tax on Health sharing ministries play an in- miums, raise your deductibles, and seniors and those approaching retire- creasingly important role in the lives hurt millions of hardworking families. ment, amounting to tens of thousands of many Americans, particularly in the I urge my colleagues to vote ‘‘no.’’ of dollars. devastating wake of ObamaCare. In re- Mr. WALDEN. Mr. Speaker, I yield 2 TrumpCare steals from Medicare, and minutes to the gentleman from Penn- cent days, constituents have expressed it cuts Medicaid by $839 billion, merci- sylvania (Mr. MURPHY), our resident concerns about the future of these lessly putting children, the elderly, the psychologist who does a remarkable healthcare plans, particularly as it re- disabled, and our most vulnerable at job on mental health care issues and lates to whether they would be consid- risk. ered credible coverage under the bill’s all of these healthcare issues. Mr. MURPHY of Pennsylvania. Mr. It does all this to give a $1 trillion continuous coverage provisions. tax cut to millionaires, billionaires, Will Chairman WALDEN work with Speaker, in my district over the time and corporations. me, as the bill moves forward, to en- span since the Affordable Care Act, The American people overwhelm- sure we address the concerns of those ObamaCare, was passed, I fielded many, ingly reject this bill. who benefit from health sharing min- many a call from persons who said they could not afford health care. In some of Defeat TrumpCare. Vote ‘‘no.’’ istries? Mr. WALDEN. Mr. Speaker, I reserve Mr. WALDEN. Will the gentlewoman those instances, even though a person the balance of my time. yield? was able to afford the premium, they Ms. FOXX. I yield to the gentleman could not afford the deductible. Mr. PALLONE. Mr. Speaker, I yield 1 from Oregon. A gentleman aged 55 and his wife said minute to the gentlewoman from New Mr. WALDEN. Mr. Speaker, I would they would have to pay $27,000 out of York (Ms. CLARKE). be delighted to work with the gentle- pocket between premium deductibles Ms. CLARKE of New York. Mr. woman from North Carolina. and copays before they could use their Speaker, I rise today in strong opposi- Health care sharing ministries are a first benefits. He was one of the 19.2 tion to this sham American Health vital part of our healthcare system. million Americans who chose to pay Care Act. They are a shining example of how the fine rather than get on the Afford- I am from Brooklyn, and in Brooklyn communities can come together with- able Care Act, ObamaCare. We suspect we know: Men lie; women lie; the num- out government mandates or dictates that many more will continue on with bers don’t. Here are the numbers: to provide innovative healthcare solu- saying they would rather pay a fine or This reckless and destructive bill tions. find a way out rather than continue to leaves 24 million Americans without I look forward to working with pay for it if this continues on as is. coverage. It will cause the uninsured Chairwoman FOXX on these concerns In the past, we have been battling rate for my district to skyrocket over that have been raised and will work many things under this with regard to 12 percent and leave over 400,000 with the Senate to get repeal and re- mental health care. The past adminis- Brooklynites without coverage. placement of ObamaCare to the Presi- tration attempted to strip the pro- Because of age discrimination in this dent’s desk. tected drug class status for lifesaving bill, the age tax, it will put our seniors Mr. PALLONE. Mr. Speaker, I re- psychiatric medications. We fought in the terrible position of having to mind my colleague from North Caro- back on that. We also worked together, choose between eating, visiting their lina that her vote for this bill will re- however, in a bipartisan way to make doctors, or purchasing medication. sult in 80,600 people from her congres- sure we had assured things for mental Which one do you, Mr. Speaker, sug- sional district losing health coverage health care. gest they choose? and care. This bill has several provisions which I also vehemently oppose the Empire I yield 1 minute to the gentleman are extremely important. It has $100 State kickback language put in this from New Mexico (Mr. BEN RAY LUJA´ N). billion which States may use to help in bill as an attempt to get Republican Mr. BEN RAY LUJA´ N of New Mexico. their stabilization fund to fund mental votes. This language is a dressed up Mr. Speaker, my Republican colleagues health care. There is another $15 bil- earmark that specifically targets New have called TrumpCare everything lion focused on mental health care. York City. It targets my home. from an act of mercy to a rescue mis- There is $500 billion for substance This would further reduce Medicaid sion. Now, I might live at the end of a abuse. Funding will be in there. funds for New York by an additional $2 long dirt road, but I didn’t fall off the My hope is that States make a deci- billion. The trade-off, raising city turnip truck yesterday and neither did sion. It is in their hands with the pas- taxes to cover the gap. the American people. sage of this bill so they can make the For most Americans, Medicaid benefits are Congressional Republicans are jam- right choice to continue mental health not the end goal but rather [provides] tem- ming their catastrophic bill that will care, and I trust they will do that. porary support, but for our seniors Medicaid take health insurance away from 24 Mr. PALLONE. Mr. Speaker, I re- can mean the difference between nursing million Americans, raise your pre- mind my colleague from Pennsylvania home care, family home care and dying alone. miums, raise your deductibles, raise that his vote for this bill will result in I urge my colleagues to consider the harm- your out-of-pocket costs, and will slap 37,100 people from his congressional ful real life impact of this legislation and to op- a crushing age tax on those over the district losing health coverage and pose it. Brooklyn Resists . . . America must age of 50. care. resist.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00049 Fmt 0636 Sfmt 9920 E:\CR\FM\K24MR7.058 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2422 CONGRESSIONAL RECORD — HOUSE March 24, 2017 Thank you and I yield the balance of my maining for the minority. So that is Fortunately, we were among the time. the total time we are working back off lucky ones. Lauren was okay. Most Mr. WALDEN. Mr. Speaker, I reserve of. The Chair will consult with the gen- critically, our health coverage gave us the balance of my time. tleman on the committee time. the support that we needed to be able Mr. PALLONE. Mr. Speaker, may I The gentleman from Oregon has 91⁄2 to focus on the one thing that inquire how much time remains on minutes remaining in the Energy and mattered most, her recovery. both sides? Commerce time. For families in America, that is the The SPEAKER pro tempore (Mr. COL- Mr. PALLONE. What is the total simple expectation of our country’s LINS of Georgia). The gentleman from time remaining currently? healthcare system, a commitment that New Jersey has 68 minutes remaining, The SPEAKER pro tempore. There our society makes to care for one an- and the gentleman from Oregon has are 67 minutes remaining for the gen- other in our time of deepest need be- 651⁄2 minutes remaining. tleman from New Jersey as the des- cause our health is our great equalizer. Mr. PALLONE. Mr. Speaker, what ignee of the gentleman from Kentucky. No matter your power or privilege, did the Chair say? That is 1 hour and 7 minutes. no one among us escapes our time here The SPEAKER pro tempore. One Mr. WALDEN. Mr. Speaker, I reserve on Earth without watching someone we hour and eight minutes remaining. the balance of my time. love fight for their life. So we fortify Mr. PALLONE. Mr. Speaker, I yield 1 Mr. PALLONE. Mr. Speaker, I yield 1 this social contract, not just out of minute to the gentleman from Iowa minute to the gentleman from Oregon sympathy for the suffering, but so that (Mr. LOEBSACK). (Mr. SCHRADER). it is there for us, too, when we need its Mr. LOEBSACK. Mr. Speaker, I am Mr. SCHRADER. Mr. Speaker, after sturdy brace. disheartened by what Congress is doing all these late nights and backroom ‘‘Blessed are the merciful, for they here today. deals, here we are. This version of the shall be shown mercy.’’ My number one goal has always been bill was just dropped on our lap this Mr. WALDEN. Mr. Speaker, I reserve to ensure Iowans have access to qual- morning, so we ought to take a careful the balance of my time. ity, affordable care. This legislation look at what is in front of us. Mr. PALLONE. Mr. Speaker, I yield does not do that. It implements an age First of all, the bill defunds access to to the gentlewoman from California tax, raising costs on older Americans. preventative health care and wellness. (Ms. LOFGREN) for a unanimous consent It cuts nearly $900 billion from the el- All the programs that we made request. derly, nursing homes, and disabled progress on will be gone. (Ms. LOFGREN asked and was given children. It shortchanges the Medicare trust permission to revise and extend her re- This is unacceptable. Exactly those fund. Seniors might be paying thou- marks.) who need health coverage the most— sands more than they are now to get Ms. LOFGREN. Mr. Speaker, I rise in middle class families, people with dis- the care they need. opposition to this terrible bill that will abilities, and those who are less fortu- It returns us to a system with hurt my constituents in California. nate—are the ones who lose out in this skimpy benefits without serious cov- Mr. Speaker, each one of us was elected by Republican bill. erage for maternity care and mental our constituents to stand up for them here in I remain committed to working to health. Washington. Today, I will stand up for people Most dramatically, the bill disman- improve healthcare coverage so it who live in the 19th Congressional District by tles the Medicaid system as we know works better for Iowans and all Ameri- voting no on this terrible bill. it, which has been a success across cans. We cannot go back to a time It’s small wonder that polling shows only 19 much of the country. when Iowa families had to choose be- percent of Americans are in favor of this bill. In Oregon, children and families fi- tween putting food on the table and With the bill, 24 million fewer Americans will nally have access to care that fits their getting medical care for their children. have health care insurance. Families will pay needs. People living with disabilities Unfortunately, that is just what this increased out of pocket costs with higher are leading productive lives now. Hos- bill does. deductibles. pitalizations and emergency room vis- I urge my colleagues to vote this bill Incredibly, it allows insurance companies to its have been cut in half, and costs are down. penalize people older than 50 by allowing down. Mr. WALDEN. Mr. Speaker, if I could We are all going to do this—take them to charge 5 times more for insurance get an indication in terms of the health care away from 24 million than younger Americans. amount we are down on each side here? It hurts Seniors in other ways too.... by Americans, 14 million just this next I think we were allocated a half an shortening the life of the medicare trust funds, year—and not going to save any more hour. by increasing costs for medicine for medicare money than under the original ACA? The SPEAKER pro tempore. Is the Look, I know there are parts of the recipients and by smashing the safety net for gentleman referring to the time in ACA that need fixing. While millions of nursing home care which the Medicaid pro- which he is acting as the designee of people got coverage for the first time, gram provides. the gentlewoman from Tennessee on premiums are still too high in the indi- Incredibly, it also has a special penalty for behalf of the Committee on Energy and vidual market. That is only 5 percent. veterans, by barring veterans from receiving Commerce? Vote ‘‘no’’ on this bill, and let’s tax credits if they are nominally eligible for VA Mr. WALDEN. Yes. make the system better. care, even if there is no room for them at the The SPEAKER pro tempore. The gen- VA. tleman from Oregon has 91⁄2 minutes re- b 1330 Let’s stand together for our hardworking maining in the Energy and Commerce Mr. WALDEN. Mr. Speaker, I don’t Americans all over our country and in our own portion of this debate. believe I have any other speakers, so I districts by voting no on this poorly crafted bill Mr. WALDEN. Mr. Speaker, and the will continue to reserve the balance of that cuts taxes for the richest Americans and minority side? Or is that what is re- my time. leaves regular Americans on the short end of maining split equal? Mr. PALLONE. Mr. Speaker, I yield 1 the stick when it comes to health care. The SPEAKER pro tempore. The gen- minute to the gentleman from Massa- Mr. PALLONE. Mr. Speaker, I yield 1 tleman will suspend. chusetts (Mr. KENNEDY). minute to the gentleman from Cali- The gentleman from Kentucky has Mr. KENNEDY. Mr. Speaker, 5 years fornia (Mr. CA´ RDENAS). not assigned designees on the basis of ago, I got the phone call everyone Mr. CA´ RDENAS. Mr. Speaker, I rise committee affiliation. The rule pro- dreads. My wife had collapsed at work today to urge my colleagues to own up vides for four total hours of debate. and was being rushed to an emergency to their bad bill. It is clear this is not Mr. PALLONE. Mr. Speaker, could room. It is a moment that is painfully what the American people deserve or we just ask the total because then familiar to far too many. Time stops. what the American people are asking maybe we can figure it out on the mi- You fight to push your breath down for. nority side? your throat. Your brain gets stuck in This legislation guts Medicaid. It The SPEAKER pro tempore. The that highlight reel of worst-case sce- steals from Medicare. It crushes our Chair has provided the total time re- narios. You are terrified. seniors and our working families. And

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00050 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.027 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2423 just when you thought it couldn’t get they would be higher in 2016 than they That is why we are left with a bill that worse, they went after veterans and would have otherwise been. So we are is opposed by doctors, nurses, hos- their children. taking that, using that and saying: pitals, and just about everyone because What’s more, this bill means insur- let’s drive them down; let’s get pre- it makes the problems in our ance companies won’t cover new moth- miums down. healthcare systems worse, not better. ers, newborn babies, and prescription It is unfortunate that you were will- That is what happens when you never drugs. The Republicans are making ing to do that 2 years ago. It was bipar- even reach out to the other side. health care for Americans worse and tisan. Today, it is some extraordinary Whether this bill dies today, or in the worse and worse. thing we are doing that is bad. It is Senate, I hope we can get to work to- The Republicans have secretly not. We want to get lower premiums. gether, Republicans and Democrats, to wheeled and dealed in back rooms at Mr. Speaker, I reserve the balance of do better for the American people. the expense of millions of Americans in my time. Mr. WALDEN. Mr. Speaker, I yield our great country, while giving tax Mr. PALLONE. Mr. Speaker, Chair- myself 30 seconds. breaks to millionaires and billionaires. man WALDEN is completely Actually, we did reach out to Demo- Mr. Speaker, I urge my colleagues to mischaracterizing the bill that was led crats. We have always reached out to own up to this bill and oppose it for the by Mr. CA´ RDENAS. Democrats. The vice chair of the Com- sake of the American people. I yield 1 minute to the gentleman mittee held lunches with Democrats to God bless us. from California (Mr. RUIZ). say: How can we work together on this? Mr. WALDEN. Mr. Speaker, I yield Mr. RUIZ. Mr. Speaker, the majority And we were told: No, we can’t work myself such time as I may consume. of my patients in the emergency de- with you on this particular measure. I One of the great tragedies of this de- partment are age 50 and older. This hope we can. I agree, there is a lot we bate is some of the scare tactics we bill’s age tax will devastate Americans need to do together. It is what the have heard. And to listen to the gen- ages 50 to 64 who have worked their American people expect. We have had these individual con- tleman from California talk about how whole lives, planned for retirement, removing essential benefits from the versations out of the bright lights of and now are wondering how they will the cameras. Let’s get together. Let’s Federal mandate from the law is going make ends meet. get this done. A lot hangs in the bal- to cause all that to happen is tragic be- The age tax will force older Ameri- ance. cause he, on March 25 of 2015, cospon- cans to pay premiums up to five times Mr. Speaker, I reserve the balance of sored legislation that did precisely higher than others, no matter how my time. that, removed the same Federal man- healthy they are, no matter how re- Mr. PALLONE. Mr. Speaker, I yield 1 dates for workers in the 51–100 pool of sponsibly they have lived, making cov- minute to the gentlewoman from employees for employers. He said it erage too expensive, and forcing them Michigan (Mrs. DINGELL). was too much of a mandate then on to be uninsured. Mrs. DINGELL. Mr. Speaker, today, those businesses, when they provide in- For example, Rex, from my district, the House will vote on a bill that will surance. wrote me that he was worried about take us back in our Nation’s history. So every Member of the House who choosing between affordable insurance My family has worked for decades for was here then, and every Senator, in- or saving for his retirement. Insurance affordable quality health care for every cluding the Democrat leader of the for older Americans like Rex will be American. It took a long time to Senate at the time, voted for that, too expensive, leaving them uninsured achieve the progress we have made passed unanimously. when they need coverage the most. today. By the way, the Congressional Budg- Under this bill, a 64-year-old like We began with Social Security, then et Office said that those regulations Rex, with an income of $26,500, in the we created Medicare, developed the Na- that we are pulling back here would individual market, will pay up to tional Institutes of Health, the chil- have made nongroup premiums 27 per- $14,000 for health insurance. That is dren’s healthcare program, and many cent to 30 percent higher in 2016, than more than half of their income on pre- other efforts that have helped every they otherwise would have been. So we miums alone, leaving little for food, for single one of our communities across are basically taking what CBO said is a medicine, rent, and other basic neces- this country. good policy and implementing it here sities. Hearing after hearing, amendment once again. I stand with our older Americans, after amendment, the Affordable Care Last time, in 2015, that was bipar- and I urge everyone, Democrats and Act was eventually developed. Cov- tisan. It was a voice vote. Today, you Republicans, to stand with older Amer- erage was expanded. Costs were low- would think the world was falling icans. Put ideology, partisanship, and ered. Certainty was brought to uncer- around us, the sky was falling. Yet, ev- politics aside and do the right thing. tainty. Let me remind you that before the erybody who was here in 2015 said, that Mr. WALDEN. Mr. Speaker, I reserve Affordable Care Act, many had to de- is okay, it is the right thing to do be- the balance of my time. cide between bankruptcy and death. cause it will lower premiums, like CBO Mr. PALLONE. Mr. Speaker, I yield 1 Children hit lifetime caps. Cancer and said, by 27 to 30 percent. minute to the gentleman from Cali- being a woman were preexisting condi- So we thought what was good for fornia (Mr. PETERS). tions where it costs too much money those in the work world, for everybody Mr. PETERS. Mr. Speaker, I came to for premiums, or you couldn’t get them who is insured through a large group Congress ready to help improve our at all. plan, which is about 155 million Ameri- healthcare system. And as our col- Millions now have coverage who cans—they don’t live under this man- leagues on Chairman WALDEN’s side didn’t, lifesaving screenings, preventa- date, yet they have all those services have pointed out, there are some insur- tive care, and, today, we are talking and benefits—that that would make ance markets that aren’t providing the about taking it back by eliminating es- sense to lower premiums for individ- choice and the low cost that consumers sential services. Please vote ‘‘no’’ for uals on the ObamaCare exchange, be- want, so let’s fix them. America’s heart and soul. cause what I hear is, premiums are too But that is not what this bill does. Mr. WALDEN. Mr. Speaker, I reserve high, deductibles go up. This bill takes away health insurance the balance of my time. Nobody sees this thing coming down. from 24 million Americans, including Mr. PALLONE. Mr. Speaker, I yield We are making changes here because 37,000 people in my district in San myself 1 minute. those exchanges are collapsing. We Diego. And the last-minute changes Mr. Speaker, I think it is very telling want to bring the premiums down. We made will cost the Federal Government that the gentleman from Oregon has no want to make the changes that will even more money, without increasing more speakers on his side for what bring them down. CBO says doing this coverage or reducing premiums. Is that they claim to be a very significant bill, on essential benefits would have re- really the best we can do? and it certainly is significant; but the sulted in nongroup premiums 27 to 30 The only reason we are in this mess reason for that, in my opinion, is be- percent lower than they would have is because the Speaker of the House cause this Republican bill is hurting otherwise been. They basically say only ever sought 218 Republican votes. real people.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00051 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.062 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2424 CONGRESSIONAL RECORD — HOUSE March 24, 2017 Don’t tell the real people, don’t tell what you are selling and I can’t afford Mr. Speaker, last month, President the Americans in my district or the what you are selling. I will even pay Trump stood right here in this room rest of the country who are coming to the IRS $600 or $700 not to take and said to Congress: ObamaCare is your doors and going to your legisla- ObamaCare. collapsing. He called on us to take de- tive offices and calling you by the Meanwhile, Mr. Speaker, the insurers cisive action to protect all Americans. thousands to tell you not to pass this have said that the way the Democrats Today we have a choice to make: will bill, don’t tell them your answer that I created the insurance markets all over we answer the President’s call to ac- hear over and over again: Well, trust the country, we can stay in them. We tion and pass this legislation to repeal us. Trust us. are losing too much money, and we are and replace ObamaCare? Or will we The problem is we have to look at out. allow ObamaCare to remain fully in the bill that is before us today. This is That is why in one out of three coun- place and deny our constituents the re- a terrible bill. Millions of people, 24 ties today in America you only have lief they urgently need? million people, are going to lose their one choice, and that is called a monop- I, for one, refuse to allow my con- insurance. Many more are going to pay oly. We are trying to fix this market so stituents in Texas to suffer a lot more out of pocket with higher people will have choices that are af- ObamaCare’s impacts any longer. For fordable. We are trying to make sure deductibles and higher copays. the past 7 years, we have watched people have access to coverage they And the worst part of all is you are ObamaCare fail Americans on every want and can afford. This is the first allowing the insurance companies to single promise, and throughout this step, not the last step, toward fixing sell junk insurance that doesn’t even time, as the Obama administration this market. turned a deaf ear to the American peo- cover their care; it doesn’t even nec- I look at it like we have poured the ple, House Republicans were listening. essarily provide any coverage. foundation. Construction projects are a So I ask my colleagues on the other little messy when you are just pouring We were listening to all those facing side, think of the people. Think about the foundation. Now we are going to severe premium increases, people like your heart. Think about what this real- put up the walls, we are going to put Lauren in my district, in my home- ly means. And if you look at it, you the roof on, and we are going to build town of The Woodlands. Lauren re- will know that this is a bad bill and this out in multiple steps throughout cently emailed me to say that her pre- should be defeated. this year and next. miums this year have gone up by near- Vote ‘‘no.’’ I urge my colleagues to Meanwhile, we provide complete cov- ly 70 percent. Now they are $900 a vote ‘‘no.’’ erage. We do all the protections month. Mr. Speaker, I reserve the balance of ObamaCare continues in its support for We were listening to all those who my time. people while we fix the market and can no longer see the doctor of their Mr. WALDEN. Mr. Speaker, I yield allow it to come back. We have timed choice or access the care they need at myself such time as I may consume. this out. I know there are some on my an affordable price, people like Eliza- Mr. Speaker, here is what I would side of the aisle who wanted to get rid beth from Conroe, Texas, another con- say: What you have heard from the of those protections, and we brought stituent of my mine. Her family pays other side is everything is working per- them around or they are going to vote about $800 a month in healthcare pre- fectly; leave it alone. ‘‘no.’’ But we said: No; we have to have miums, yet they can no longer see any Democrats created ObamaCare. those protections in place—existing of the doctors they know and trust. Democrats created the exchange. They conditions, no more lifetime caps, This includes the primary care doctor said: We are going to tell you the kind keeping your kids on until they are 26. that Elizabeth and her husband have of insurance you have to buy; we are We have a product here that needs to been seeing for over a decade. It in- going to force you to buy it, or you will go to the next step. We will all work on cludes her children’s longtime pediatri- answer to the IRS and pay a penalty. it and continue to make it better as we cian. All of these doctors are now out They mandated that. go forward. But if we do nothing and of reach, thanks to ObamaCare. Then they came back and said: Well, let it fail today, these markets are That is the thing with this law. It that didn’t work so well, so we had bet- going to get worse and worse under the has helped some, no doubt, but far ter get rid of the essential benefits for Democrats’ ObamaCare plans, and peo- more people have been hurt, people the workers and employers, 51–100 em- ple won’t have a choice in States and like Lauren and Elizabeth, who are ployees in a company; we are going to counties all over America. paying significantly more for signifi- take that off because that will drive up I wish we could join together today cantly less access to health care. premiums. And they voted unani- and put forward a bipartisan vote to It doesn’t have to be this way. After mously to do that. Today, they come save these markets and help our con- 7 years of listening carefully to the back and say: Oh, that would be hor- stituents going forward. Mr. Speaker, American people, we have now arrived rible. But they did it before, so they we owe it to them. They have asked for at this moment of decisive action. were for it before they were against it. it for 7 years. Let’s get it done. With the American Health Care Act, Mr. Speaker, I urge support for this But let me talk about what really we have the best opportunity since legislation, and I reserve the balance of matters here. First of all, there is lot ObamaCare’s enactment to repeal this my time. harmful law, clear the deck, and begin of scare tactics out there by a lot of Mr. PALLONE. Mr. Speaker, I yield high-paid organizations. The first is, over with a step-by-step process to de- the balance of my time to the gen- liver a healthcare system based on we preserve your right as a citizen to tleman from Massachusetts (Mr. what patients and families truly want acquire health insurance regardless of NEAL), and I ask unanimous consent and need, not what Washington thinks your health condition. that he be allowed to control that is best. b 1345 time. This bill gets us off to an excellent The SPEAKER pro tempore. Is there So here is the deal: preexisting condi- start. First, it delivers swift relief to objection to the request of the gen- tions, we protect that; lifetime caps, the American people by immediately tleman from New Jersey? we protect that so that insurance com- There was no objection. repealing ObamaCare’s most harmful panies can’t go over the top of you; Mrs. BLACK. Mr. Speaker, I yield 30 provisions. The individual mandate— keep your kids on until they are 26, we minutes to the gentleman from Texas the tax penalty—is gone. The employer protect that. Those were good things. (Mr. BRADY), and I ask unanimous con- mandate tax penalty is gone. Nearly We agree in a bipartisan way those sent that he may control that time. $900 billion in ObamaCare tax hikes should be protected. We do that. The SPEAKER pro tempore. Is there that have driven up costs and reduced But we also recognize that 19.2 mil- objection to the request of the gentle- access to care for families, patients, lion Americans looked at the Demo- woman from Tennessee? and jobs, those tax hikes are gone. crats’ healthcare exchanges and plans, There was no objection. From here, the American Health went the other direction, and said no. Mr. BRADY of Texas. Mr. Speaker, I Care Act takes significant action to re- They have walked with their wallets yield myself such time as I may con- place ObamaCare with patient-focused and their feet and said: I don’t like sume. solutions that expand choice, lower

VerDate Sep 11 2014 03:26 Jun 16, 2017 Jkt 079060 PO 00000 Frm 00052 Fmt 0636 Sfmt 0634 E:\RECORD17\MARCH\H24MR7.REC H24MR7 March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2425 costs, and enhance competition. This is I would like to give a special thanks Here is the point: it is a $1 trillion where we reclaim control of health to Emily Murry, Stephanie Parks, and tax cut so that they can change the care from Washington and put it back all of our hardworking staff on the baseline for their tax cuts that are where it belongs—with patients, fami- Ways and Means Committee. coming down the road. That is what lies, and States. At the end of the day, on this day, we this is about. We expand health savings accounts, will have our first true vote to repeal Now, the President said he wanted an making them more flexible and more ObamaCare. History will record where insurance plan that covered all mem- user-friendly. We protect health cov- we stand. This is a clear choice. We can bers of the American family. What erage for the more than 150 million stand with President Trump and more they are offering up today is a plan Americans who receive it through their freedom for Americans to buy health that cuts health insurance for 24 mil- job. We deliver the largest entitlement care they choose, or stand with lion American family members. It does reform in decades, giving power to ObamaCare and more government that not increase coverage, it does not lower States to improve and streamline Med- gets in the way. I proudly stand with costs, and it does not strengthen con- icaid so they can better serve the needs President Trump and more freedom for sumer protections. of local patients and families. the American people. So what does it do? For low- and middle-income Ameri- Mr. Speaker, I reserve the balance of Sadly enough, back to the old argu- cans who don’t receive coverage my time. ment that we have had in this institu- through work or a Federal program, we Mr. NEAL. Mr. Speaker, I yield my- tion for years: a $1 trillion tax cut for offer an advanceable, refundable tax self such time as I may consume. the people at the top and special inter- credit that people can use immediately Recently, President Trump said: Who ests. to help purchase coverage that is tai- knew that health care could be so com- The former speaker here a minute lored to their needs. These tax credits plicated? ago, the chairman of the Energy and provide a conservative, free-market al- Well, 70 years ago, Harry Truman Commerce Committee, spoke about ternative to inefficient ObamaCare knew how complicated it could be when perfection. I was here when this legis- subsidies that exist today. They deliver he first proposed national health insur- lation was authored, and I helped to support to low- and middle-income ance. Lyndon Johnson knew more than write it. I can tell you this right now: Americans. At the same time, they will 50 years ago when he proposed, success- we knew it was not about perfection, encourage real competition and choice fully, Medicare and Medicaid. Richard but we subscribed to the idea, as was in the health insurance market. Nixon knew when he proposed the indi- the case with Social Security, Medi- Finally, as a committed pro-life con- vidual mandate. Bob Dole knew when care, and Medicaid, that we would im- servative, I am pleased to say this bill he proposed the individual mandate. In prove it as time went on. We would fix defunds Planned Parenthood while Massachusetts, Mitt Romney knew it so that all members of the American funding the community health centers when he proposed the individual man- family might benefit from the basic no- for women’s truly needed health care, date. tion of access and affordability as it re- and takes vital action to protect the Mr. Speaker, recently, within the lates to health care. right to life. No Federal funding can be last week, the great on-the-street writ- So what do we have here? $839 billion of cuts to Medicaid, used for elective abortions. The lan- er, Jimmy Breslin, died. Amongst the which is now long-term care for mem- guage is crystal clear. great columns and the great books he bers of the American family. The American Health Care Act rep- wrote, one of them that he wrote that resents a critical first step in our mul- Do you know why? will be with us in a timeless manner Sixty percent of Medicaid dollars go tiphase effort to tear down ObamaCare was ‘‘The Gang That Couldn’t Shoot and reinstate patient-focused solutions to nursing home care, and they want to Straight.’’ cut $839 billion to provide a $1 trillion that help all Americans. But we know That is what this institution has there is more work to do. ObamaCare tax cut. Let me tell you, members of been like for the last 10 days. There the American family can understand was a massive government takeover of were caucuses and there were con- health care. To fully uproot the law, it that. ferences. People were running back and In Massachusetts, where proudly I is going to take a sustained, coordi- forth with new CBO scores and coming can say 100 percent of the children in nated, and relentless effort from both back to the floor with new proposals. our State are covered, 97 percent of the Congress and the administration. For- Members are put in the position of adults in Massachusetts are covered. tunately, we have incredible partners being offered special arrangements so And guess what? It polls regularly in in President Trump and Secretary that they might be brought over the the high seventies as to consumer sat- Price at the Department of Health and goal line—that, after 61 times they isfaction. A Republican Governor of Human Services. They are already be- have voted in this House to try to re- Massachusetts has advised them to go ginning work on the next phases of the peal the Affordable Care Act. slowly and to go carefully, that this is process, stripping away ObamaCare’s Well, here is what we have in front of not the path that they want to travel regulations so we can enact additional us this afternoon: a CBO score says down, as well as other Governors free-market solutions. These include that 24 million Americans will see ei- across the country who happen to be a consensus conservative proposals, such ther an increase in premiums or they Republican. as allowing insurance to be sold across will lose their insurance, there will be State lines. an imposition of an age tax on older b 1400 But to see success in the next phases, Americans, and a tax cut of $1 trillion. The hard truth here today is they are we have to take the first step today. This bill has gone from bad to worse. asking the American family to pay We have to pass the American Health If that wasn’t enough, to get the more to get less. Dozens of Republicans Care Act, deliver immediate relief to votes to pass the bill, they want to cut have said so today. the American people, and provide a prescription drug benefits, mental Secretary Mnuchin recently said that conservative path forward. health benefits, hospital benefits, and ‘‘there will be no absolute tax cut for In closing, I thank all the leaders in maternity care; and, yes, every one of the upper class.’’ I hope that the Re- the House who worked hard to craft the us in this institution knows a family publican Conference confers with Sec- bill before us today: Chairman GREG who is struggling with a loved one’s ad- retary Mnuchin so that they might get WALDEN, Chairman DIANE BLACK, and diction, and they want to roll back their facts straight on this issue. so many others. that benefit. Mr. Speaker, I reserve the balance of I also want to offer my gratitude to Recently, the conservative columnist my time. everyone from the Congressional Budg- Bill Kristol tweeted: Mr. BRADY of Texas. Mr. Speaker, I et Office, the Joint Committee on Tax- yield 3 minutes to the gentleman from The healthcare bill doesn’t, A, lower costs ation, and the House Office of Legisla- that they have; B, it doesn’t improve insur- Ohio (Mr. TIBERI), the chairman of the tive Counsel who provided analysis and ance; C, it doesn’t increase liberty; D, it Health Subcommittee, who played an support as we developed this legisla- doesn’t make health care better. So what is invaluable role in solutions to lower tion. the point? healthcare costs for Americans.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00053 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.065 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2426 CONGRESSIONAL RECORD — HOUSE March 24, 2017 Mr. TIBERI. Mr. Speaker, I thank Washington’s hands. Today, it is time wasn’t long before 18 more followed the gentleman for his leadership in this for us to deliver. suit, closing their doors and leaving important matter, and I echo his words Mr. NEAL. Mr. Speaker, I would re- hundreds of thousands more without with respect to the staff, Emily Murry mind my friend—and he is my friend— health insurance. Only 4 of the 23 CO– and her team, as well as Whitney from Ohio that his vote will result in OPs created under ObamaCare actually Daffner and Abby Finn in my office. 39,500 people losing their healthcare remain, and these remaining 4 will Mr. Speaker, like the chairman, I had coverage if this legislation prevails. likely face the same fate as they con- a front row seat in 2009 and 2010 to the Mr. Speaker, I yield 2 minutes to the tinue to struggle with dire financial passage of the Affordable Care Act and gentleman from Michigan (Mr. LEVIN), challenges. a front row seat to all the promises who was a substantive and major play- Americans were falsely promised, if made about this wonderful bill called er in the development of the ACA when they liked their insurance, they could the Affordable Care Act. it was passed. keep it. After complying with Then, over the last 6 years, like the (Mr. LEVIN asked and was given per- ObamaCare’s mandates, many Nebras- chairman, I heard from my constitu- mission to revise and extend his re- kans could not even keep the insurance ents and fellow Ohioans. I heard about marks.) this law created. their sad ObamaCare stories of a road Mr. LEVIN. Mr. Speaker, I thank Mr. One of my constituents in western of broken ObamaCare promises. NEAL for his work and that of all of us Nebraska, Pam, who is self-employed, There was a lady east of Columbus on the committee on the Democratic lost her insurance four times under who had cancer. She was a survivor. side. ObamaCare. Prior to ObamaCare’s im- As CBO has said, under this bill, 24 Fast-forward to a few years ago. She plementation, she had a plan she liked million Americans would lose their gets cancer again and finds out that and that actually covered her pre- health insurance next year, and 24 mil- the oncologist that she had, she could existing condition. She was forced off no longer have. He was not in the net- lion over the next decade. Today, most are invisible, but they of that original plan when ObamaCare work. She could not go to the hospital would become seen and heard at emer- began and then lost her coverage three in her community. She had to go 60 gency rooms, with no other place to go more times through no fault of her miles away. with more serious illnesses because of own. Or there is the small-business owner For Pam and millions of others no preventive care. and his wife and family on the indi- They are people 50 to 64 with far across the country, ObamaCare has se- vidual market and now on the ex- higher premiums; mothers without ac- verely limited options for affordable change not getting employer-provided cess to affordable maternity care; el- care. This is simply unsustainable. health care and, therefore, not getting derly evicted from nursing homes, los- Constituents in rural districts like the benefit. They saw their plan price ing coverage from Medicaid, the larg- mine are being hit the hardest by quadruple in the last several years. Mr. est source of long-term care in our Na- ObamaCare’s dwindling insurance mar- Speaker, we are going to take care of tion; and lives lost that could have kets. Because of ObamaCare, Nebras- that person and give them a tax credit been saved. I repeat: lives lost that kans are down to only two insurers so they have the ability, just like em- could have been saved. from which to choose, and other rural ployer-provided employee’s health I remember some time ago I met a areas are down to only one or even zero care. woman who had health insurance providers on their exchanges. In Ohio, last year, our CO-OP col- through her job. She contracted breast Adding insult to injury, according to lapsed. We had 20,000 people without cancer and received treatment but then the Obama administration’s own report health care. Many saw bills not being lost her job and insurance. Then the on the individual market, 2017 pre- paid. Twenty counties in my State had ACA covered her. She looked straight miums in Nebraska increased by 51 per- one provider and fewer choices. at us and said that, without further cent. Broken promises. Constituents can’t treatments, she would not be alive The SPEAKER pro tempore. The keep their doctor, can’t keep their hos- today. time of the gentleman has expired. pital. Constituents saw emergency Under this bill, a trillion dollars is Mr. BRADY of Texas. Mr. Speaker, I room visits go up. It was supposed to lost for health care, and there will be a yield the gentleman an additional 30 go down under the Affordable Care Act. trillion dollars in tax cuts, mostly for seconds. Premiums and deductibles are going the very wealthy and corporations. Mr. SMITH of Nebraska. Mr. Speak- up, not down, in my district. This is not America. I repeat: This is er, places like Oklahoma are experi- One promise wasn’t broken, and that not America. encing premium increases of 69 per- is a government-mandated, one-size- Mr. BRADY of Texas. Mr. Speaker, I cent, and it is only projected to get fits-all Washington plan that many of yield 2 minutes to the gentleman from worse if we do not act. my constituents didn’t want and others Nebraska (Mr. SMITH), the chairman of Doing nothing is certainly not an op- couldn’t afford. That was their the Human Resources Subcommittee. tion. We must come together to rescue ObamaCare. Mr. SMITH of Nebraska. Mr. Speak- this rapidly collapsing healthcare sys- We can do better, and in this bill we er, I rise today in support of H.R. 1628, tem. Let’s come together to do right by do. In one step, in the first step, more the American Health Care Act of 2017. the American people. steps to come, we begin creating a pa- This legislation is the first step in a I urge passage of this bill. tient-centered healthcare system that process to unravel ObamaCare’s taxes Mr. NEAL. Mr. Speaker, I would re- will not only put more power in the and mandates and provide relief to the mind my colleague that his vote for hands of our constituents, but it will American people. this bill will result in 50,000 people in also drive down healthcare costs. To understand the extent of his congressional district in Nebraska Remember what they said in Ohio ObamaCare’s failures and their impact losing their health coverage and care. newspapers in my State about on hardworking Americans and their Mr. Speaker, I yield 2 minutes to the ObamaCare: a tough pill to swallow, a families, just look at the rapid collapse gentleman from Georgia (Mr. LEWIS), a nightmare, very taxing, just more red of ObamaCare’s Consumer-Operated giant in terms of the morality of our tape. These aren’t my words, Mr. and Oriented Plans, or CO-OPs. time and a good friend and individual Speaker; these are hardworking Ohio- The story of these failed ObamaCare who helped write the Affordable Care ans’ words. They deserve better. They CO-OPs began in my home State of Ne- Act, as well. deserve more choices. They deserve braska, with the abrupt collapse of Mr. LEWIS of Georgia. Mr. Speaker, better access, the access and the CoOportunity Health, which left 120,000 I want to thank my friend for yielding. choices they want for them and their Nebraskans and Iowans without health Mr. Speaker, I rise to oppose this families. insurance. I repeat: It left 120,000 Ne- bill. We begin, Mr. Speaker, with this bill. braskans and Iowans without health As elected Representatives, we have We don’t end here. There is much more insurance. a mission, an obligation, and a man- to do. We are putting the people’s CoOportunity Health was the first date to fight for each and every Amer- power back in their hands, not in ObamaCare CO-OP to collapse, but it ican.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00054 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.067 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2427 I ask you, Mr. Speaker: Who will opment, and we have new investments mate does not address 1115 waiver payments stand for the American people? Who in facilities coming online. that we believe this bill would put at risk. will speak up for those who have been We need to permanently repeal this By FY22, the Commonwealth estimates an left out and left behind? onerous tax or it is going to start up additional $425–475 million per year of re- duced federal revenue in potential elimi- Mr. Speaker, I have said it time and again. Voting ‘‘yes’’ today means per- nation of 1115 payments not captured under time again: Health care is a right. It is manent repeal of the medical device the per capita targets, including federal not a privilege reserved for a wealthy tax. matching funds for a state-run few, for what does it profit this body to Mr. Speaker, I am also encouraged to ConnectorCare Wrap subsidy. pass this bill and lose our soul? see several provisions I have authored The actual experience for these and other This bill is a shame. It is a disgrace. to enhance and expand the use of factors is significantly dependent on how the Mr. Speaker, today my heart breaks health savings accounts and flexible U.S. Department of Health and Human Serv- for the disabled, for women, for seniors, spending accounts that are included in ices implements the legislation and unpre- dictable factors in the future (e.g., pharma- and for working families. My heart this legislation today. ceutical growth). aches for those who are living pay- HSAs and FSAs are now more pop- In addition to reduced federal revenue for check to paycheck. My heart mourns ular than ever and used by 20 million Medicaid, the CBO also projects a reduction for innocent little children whose very Americans. It is time to remove the re- in employer-sponsored health insurance of 7 lives depend on if their families can strictions on HSAs that were imposed million people nationwide as a result of the pay the bills. in ObamaCare so that we can make repeal of the federal Employer Mandate. This is the right and wrong of it. This them more accessible and easier to use This would exacerbate a trend that Massa- is the heart and soul of the matter. and empower Americans to take more chusetts has seen over the last several years. Massachusetts repealed the Chapter 58 Fair We cannot abandon our principles, control of their healthcare decisions. Share Contribution in 2013 in order to com- Mr. Speaker. We cannot forget our val- Expanding HSAs will help us also port with the ACA. My administration has ues. I have fought too hard and too begin to address the rising costs of proposed reinstating an employers’ shared long to back down now. health care. One recent study showed responsibility for the costs of health care. I will fight any bill that turns the that, when a large employer switched This would be increasingly important if the clock back to a darker time. I will their employees over to an HSA plan, federal Employer Mandate were repealed, as fight every single attempt to turn a it lowered their healthcare spending by the AHCA proposes. deaf ear, a blind eye, and a cold shoul- The Commonwealth does have certain pro- an average of $900 per employee over a tections in place that could mitigate the im- der to the sick, to our seniors, and to 5-year period. That is real savings, Mr. pact of some of these changes. Massachusetts working families. Speaker. retains its individual health insurance man- Mr. Speaker, I will fight every day, Let’s support a better way forward to date, reducing the likelihood that many peo- every hour, every minute, and every lower healthcare costs for patients and ple would drop out of the insurance market second. I oppose this bill with every put them back in control of their due to the repeal of the federal mandate. breath and every bone in my body. We healthcare decisions. Massachusetts also has protective insurance must not give up. We cannot—I will coverage laws that would not be superseded b 1415 not—give in, not today, not tomorrow, by the federal legislation. The AHCA includes a provision that would not never, ever. Mr. NEAL. Mr. Speaker, I remind my colleague that his vote for this bill will prevent Medicaid from reimbursing Planned On this bill, there is only one option, Parenthood for providing important health and that option is to vote ‘‘no.’’ We can result in 49,200 people in his congres- services such as cancer screenings. My ad- do better. Mr. Speaker, we must do bet- sional district in Minnesota losing ministration opposes this provision, and has ter. Vote ‘‘no’’ on this bill. their healthcare coverage and care. already committed to funding these services Mr. BRADY of Texas. Mr. Speaker, I Mr. Speaker, I include in the RECORD with state dollars if it should pass. first would remind my friend from a letter from Governor Charlie Baker During conversations with governors Georgia that nearly 700,000 Georgians of Massachusetts that relates to the across the country, the Trump Administra- debate we are having today. tion has expressed a general openness to pro- have chosen to either pay a fine or ex- viding greater state flexibility with respect empt themselves from ObamaCare be- OFFICE OF THE GOVERNOR, COMMON- to health care, including through a letter cause it has failed them so badly. WEALTH OF MASSACHUSETTS, issued by HHS Secretary Price on March 14 And to my friend from Michigan, STATE HOUSE, to states. Our administration will pursue ad- 420,000 Michiganders, more than half, Boston, MA, March 21, 2017. ditional flexibilities to stabilize our markets DEAR DELEGATION MEMBER: Health care is and ensure continued coverage for residents chose to exempt themselves from once again at the forefront of national and ObamaCare rather than accept that and we urge you to support these efforts by state policy discussions; I know we all share leading discussions in Congress to ensure the failed health care. the goal of ensuring access to quality, afford- Mr. Speaker, I yield 2 minutes to the people of Massachusetts continue to have ac- able health care coverage for the people of cess to a quality health care system. gentleman from Minnesota, (Mr. PAUL- Massachusetts. With Congress set to take up Overall, our analysis indicates that the SEN), a key member of the Ways and the American Health Care Act (AHCA) immi- AHCA would increasingly strain the fiscal Means Committee. nently, I wanted to share with you my ad- resources necessary to support the Common- Mr. PAULSEN. Mr. Speaker, today ministration’s analysis of the potential ef- wealth’s continued commitment to universal we are taking a very important step to fects this bill would have on our state. health care coverage. I hope this information The Congressional Budget Office (CBO) re- is helpful to you as Congress takes up the lift the burden of the Affordable Care leased its score of the AHCA on March 13. Act off of the backs of the American American Health Care Act. This analysis is broadly consistent with con- My administration and I will continue to people. A key component of this is re- cerns we have raised, with you and others, stay in touch with you as we work together pealing the burdensome mandates and regarding the bill’s impact on the state and to ensure access to quality, affordable health tax increases that were imposed to help its residents’ access to affordable healthcare. coverage for all Massachusetts residents. fund this failed law. This includes the Applying CBO’s assumptions to Massachu- Sincerely, medical device tax, a senseless policy setts results in at least $1 billion of reduced CHARLES D. BAKER, that placed an excise tax on lifesaving federal revenue beginning in 2020, and we es- Governor. timate reduced revenue of $1.3 billion in 2021, medical technology. and $1.5 billion in 2022, with likely a greater Mr. NEAL. Mr. Speaker, I yield 2 What did this achieve? A loss of 30,000 annual impact in the years that follow. minutes to the gentleman from Texas high-paying American jobs, less re- Specifically, our estimate extrapolated (Mr. DOGGETT), who played a major search and development, canceled from the CBO analysis of a $1.5 billion im- role in the substantive contribution he projects, and postponed expansions. pact for FY 2022 includes $1.3 billion of an- made to writing the ACA. Most importantly, it hurt patients. nual MassHealth federal revenue losses and Mr. DOGGETT. Mr. Speaker, There is good news. Just a few years $200 million in annual reduced federal sub- TrumpCare is big on Trump, but it is ago, in 2015, we came together on a bi- sidies for private insurance through the Con- weak on care. After falsely promising nector. partisan basis and suspended the tax Several key areas of concern for Massachu- that there would be coverage for every- for 2 years. We are seeing positive re- setts were not included in the CBO analysis one for less and better, TrumpCare sults. Companies are now hiring again, and could further impact the Common- only cares about huge tax breaks for we have increased research and devel- wealth’s budget. For example, the CBO esti- the superrich and special interests, like

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00055 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.068 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2428 CONGRESSIONAL RECORD — HOUSE March 24, 2017 the totally unjustified $28 billion wind- Chamber today, but I don’t forget their ObamaCare and given generous sub- fall for the pharmaceutical industry voice. I am not going to forget the sidies found a way to exempt them- that they grab right out of the Medi- voice of the constituents that came to selves because ObamaCare failed. care trust fund so that premiums will me as small-business owners saying: Mr. Speaker, I am proud to yield 3 go up. Those earning $1 million within You are putting me out of business minutes to the gentleman from Penn- a single year get 79 percent of a $230 with these insurance premiums. They sylvania (Mr. KELLY), a small-business- billion tax break, but there is no gen- are going through the roof. man and a key member of our com- uine relief for middle class taxpayers. I won’t forget the faces of the people mittee. Removing the essential health bene- who are saying: My copays are going Mr. KELLY of Pennsylvania. Mr. fits provisions will only enable insurers through the roof. My deductibles are Speaker, I am proud to stand today in to exclude the very healthcare protec- higher. I don’t have coverage that I had support of this bill. I have been told tions that folks thought they were get- 7 years, 8 years ago before ObamaCare. that this is a rookie mistake. I under- ting when they paid their premiums. Mr. Speaker, I implore all of us in stand that. We have been working 7 Insurance plans will not just be skinny, this Chamber to work together for the years to undo that rookie’s mistake. they will be a sham; a provision that at American people as a whole. The Amer- That is why we are here today. A rook- the very time you need the care, it ican people want freedom. They don’t ie who didn’t know what he was doing, won’t be there. Many certificates of in- want mandates. They want to choose but lectured to us, told us: This is what surance will become as worthless al- the insurance that works best for you have to do; and if you do this, you most as a diploma from Trump Univer- them. They want to access their doc- can keep your doctor, you can keep sity. tors that they select. They want to your health plan, you can just stay on This Republican bill targets our vet- have the promise that was made to board, and we are going to insure mil- erans by denying them tax credits. For them, that they could have their insur- lions of you. millions of people who are just a few ance and keep it going forward honored Nothing could be further from the years too young to qualify for Medi- and respected by this institution. That truth. The big thing was you are going care, their premiums will go through is what our legislation starts today. to save $2,300 on your premiums. He the roof. It will cost thousands of dol- Not a soul on our side of the aisle forgot to tell everybody but the people lars more in order to get insurance. says the issue of health care will go who were actually in that business. In- Yes, the Republicans have been divided away because of the first step we take credible. Incredible. and factionalized. They are divided be- today, because we have to do better for Now, this isn’t about me, and it is tween those who want nothing care and the American people when it comes not not about you. This is about people. We those who want little care. But, most- only to health insurance, but for are in the people’s House. Let me just ly, they don’t seem to care how many health care in America. I know we can, read to you a couple letters from the millions of people lose their health in- and I want to be a voice to say let us people who I represent back home. By surance. join together to get this done for the the way, out of the seven counties I Mr. President, this is not the art of American people. represent, five have one insurer, and the deal. It is the art of the steal, of Mr. NEAL. Mr. Speaker, I remind my the rest of them got out because they taking away insurance coverage from colleague that his vote for this bill couldn’t stand to try and work under families that really need it to provide today will result in 68,300 people from this onerous law. tax breaks for those at the very top. his congressional district losing their Let me tell you what Amanda says: I Those who understand health care, the health coverage and care. am very happy to hear that you are professionals, say reject this bill, and Mr. Speaker, I yield 1 minute to the working to repeal the Affordable Care it should be rejected. gentleman from California (Mr. THOMP- Act. I just got an up-close-and-personal Mr. BRADY of Texas. Mr. Speaker, I SON), a very thoughtful member of the look at how dysfunctional it is while remind my friend from Texas that 2 Committee on Ways and Means who trying to shop for my own plan. It is million Texans eligible, forced into also helped to write the ACA. hard enough to start a business in this ObamaCare and getting deep subsidies, Mr. THOMPSON of California. Mr. country due to so many rules, regula- have said: No thanks. ObamaCare has Speaker, I rise in opposition to this bad tions, and confounding taxes. This law failed me. Two out of three Texans eligible. bill. It is not a step toward fixing the makes it even harder. And I don’t Mr. Speaker, I yield 2 minutes to the ACA, this is a step toward destroying think the government should make me gentleman from New York (Mr. REED), health care. It was bad when it ripped buy coverages I simply don’t need. I a key member of our Committee on health care away from 24 million know my situation, and I should be Ways and Means. Americans. It was bad when it created able to buy whatever I want without Mr. REED. Mr. Speaker, I rise today an age tax, forcing seniors to pay five incurring four-figure tax penalties. in support of this legislation. I ask my times that of what other people pay. It Jason says to me: Dear MIKE, I am a colleagues on the other side of the was bad when it forced hardworking self-employed father of four feeling the aisle—as I stood in front of town halls Americans to pay higher premiums and hurtful effects of ObamaCare. For and I listened to thousands of folks deductibles while billionaires get a years there has been so much talk from across my district say what we should trillion dollars’ worth of tax cuts. And Republicans about repealing be working on is fixing the Affordable it was bad when it shortened the life of ObamaCare. I am paying yet more Care Act to a T, I have heard my col- Medicare. money for less coverage. We are really leagues on the other side of the aisle But today it got worse. Today Repub- feeling the effects of this in my family say: It is not perfect; we need to repair licans gutted coverage for emergency in our budget. My kids are going to bed it. services, prescription drugs, hos- hungry after dinner. We desperately Yet, today we take the first step in pitalization, mental health coverage, need relief and now, not next year. I this endeavor by the legislation that is and preventative coverage. This bill enthusiastically pulled the lever for before us, and all we hear is how bad also prevents millions of veterans from Donald Trump and for you, and we are this legislation is. All we hear today, getting health care. This is a truly bad counting on you to make some real Mr. Speaker, is how bad this first step bill. It will cost millions of Americans change in D.C. Please keep up the in this journey for the American people their health care. It will force them to fight, and do it quickly. we need to go on when it comes to pay more for fewer benefits, and it So this is not about MIKE, it is not American health care is. gives the richest Americans a huge tax about John, it is not about any of us. I don’t hear rhetoric saying let us cut. This is a tax-cut bill, not a What it is about is taking care of the talk about phase 2, let us talk about healthcare bill. The American people people that we were sent here to rep- phase 3, where we can come together as deserve much better. I urge everyone resent. They are Republicans and they Democrats and Republicans for the to vote ‘‘no’’ on this bad bill. are Democrats, who some people could people we represent. Mr. BRADY of Texas. Mr. Speaker, I care less about any of us, but they ex- The American people are lost in this remind my friend from California, 1.5 pected us to do something for them. We bickering that we have here in this million Californians forced into are sitting here today because this law

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00056 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.071 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2429 is so bad. If it was so good, we wouldn’t fer of wealth in this Chamber from peo- trillion of taxes that were put on have to worry, but it is bad, with a cap- ple who are begging and pleading and health care in order to pay for the bill, ital B. showing up at the townhalls and asking which will be eliminated as well. Now, I have got to tell you, growing for our help, and our answer is a trans- If left in place, the health insurance up, as a young kid, as it got toward fer of wealth in a tax bill. Everybody tax alone will raise costs on families up Christmas—and I say this to my wants to know why we are taking this to $5,000 over the next decade. friends, by the way, on our side—I used up first and not taxes. Because it is a Bipartisan congressional Members to make a list right before Christmas. tax bill, that is why. have repeatedly opposed taxpayer fund- ing of abortions, and that is fixed in I put on that list everything I wanted. b 1430 You know what, Mr. Speaker? Come this bill as well. Christmas morning, I never got every- Mr. BRADY of Texas. Mr. Speaker, I When we talk about health care, we thing I wanted, but I was so thankful would remind my friend from Con- are talking about something very per- for everything I got. necticut that 190,000 residents in Con- sonal, which is why I want patients put We have to deliver today. We have to necticut, two out of three eligible for back in control. Mr. NEAL. Mr. Speaker, I would re- keep a promise today to the American ObamaCare, believed it failed them so mind my colleague that her vote for people. We have to backtrack on a badly they paid a tax or exempted themselves. this bill will result in 63,000 people in rookie mistake 7 years ago and make it South Dakota losing their healthcare better for the American people, not Mr. Speaker, I yield 2 minutes to the gentlewoman from South Dakota (Mrs. coverage and care. just for Republicans, not just for Mr. Speaker, I yield 1 minute to the NOEM), who has weighed in in such a Democrats, not just for those who vote LU- key way on health care. gentleman from Oregon (Mr. B blue or red, but for those who expect us MENAUER), a visionary, certainly, a for- Mrs. NOEM. Mr. Speaker, it is no to do what we are supposed to do in the ward-looking individual who also surprise that the Democrats today are people’s House. This is not the Repub- helped to write the ACA. lican House or the Democrat House, upset, that they are complaining that Mr. BLUMENAUER. Mr. Speaker, it this is the people’s House. they don’t like this bill, because their has come to this: considering hope- Isn’t it time for all of us to come to- number one goal all along, and I have lessly flawed legislation that the Re- gether to get this done? heard them say it to me in conversa- publicans have had 7 years to prepare We have a marvelous opportunity, tions over the years, their number one for and still couldn’t do it right. It may but we could lose it. I ask you all and goal was to go to a single-payer sys- still pass, but it is never going to be I urge you all to please vote for this tem. They wanted government-run enacted because most people are fig- act. health care, and we are on the track to uring it out. They don’t like it and Mr. NEAL. Mr. Speaker, I remind my that today. they are being heard. That is why this colleague and my friend that with his In fact, in my home State of South bill has been stalled and the Repub- vote for this bill, 41,400 people from his Dakota, at one time, we had 17 options licans have been forced to twist the congressional district in Pennsylvania and companies that people could shop legislation in this fashion. will lose their healthcare coverage. for their healthcare policies from. But the bottom line remains: Mr. Speaker, I yield 2 minutes to the Today we have two. TrumpCare will cost more for people gentleman from Connecticut (Mr. LAR- We are well down our road now to who need it the most. It will hurt older SON), who is from an adjacent district giving them exactly what they want. and lower-income people in order to and a close friend and a long-time They hate this bill because it puts peo- create tax cuts for people who need member of the Committee on Ways and ple back in control of their own health them the least. TrumpCare will desta- Means and an individual who also con- care. It doesn’t let some bureaucrat in bilize health insurance and will slowly tributed mightily to the development Washington, D.C., decide what treat- but surely destroy Medicaid. and writing of the Affordable Care Act. ment they can get in the future. It lets It didn’t have to be that way, but as Mr. LARSON of Connecticut. Mr. people decide that with their doctors. long as people continue speaking out Speaker, I associate myself with Mr. This is a vote, today, for freedom for and fighting back with us, it won’t be NEAL’s remarks, and especially him people who have lived under the bu- in the future, and we can have a new framing this issue from the outside reaucracy of the Federal Government era in health care and in politics. about the arc of history. not giving them options on how to take With their help, it will be. As we have witnessed in this Cham- care of themselves and their families. Mr. BRADY of Texas. Mr. Speaker, I ber time and again, dating back to Rising costs, shrinking options, in- remind my dear friend from Oregon, Franklin Delano Roosevelt, when you creasing bureaucracy under ObamaCare 153,000 Oregonians eligible for look at the impact of 24 million people, has taken healthcare control away ObamaCare with generous subsidies you have to look at your colleagues on from patients, away from people, away said thank you, but no thank you. Mr. Speaker, I yield 2 minutes to the the other side of the aisle and say: Are from families struggling to pay their gentleman from South Carolina (Mr. you frozen in the ice of your indiffer- bills; and, against their best and own RICE), my good friend and a key mem- common sense and household budgets, ence to what impacts the daily lives of ber of the Ways and Means Committee. people who have showed up at our fo- they are forced to pay $10,000, $15,000, Mr. RICE of South Carolina. Mr. rums and the forums that you have $20,000 more per year for health cov- Speaker, I stand in strong support of conducted? erage, health coverage which has a de- the American Health Care Act and urge The sheer humanity of what is tak- ductible so high that they don’t even my colleagues to vote in favor of the ing place across this country cries out utilize it then because they can no way bill. for a solution. Yet all we have heard, meet the $6,500 deductible, $10,000 de- ObamaCare was built on broken as Mr. NEAL said, is the helter-skelter ductible, $12,000 deductible. So they promises. President Obama said you back and forth of who is winning politi- don’t even use it at all if they do have could keep your policy, keep your doc- cally, what is happening with the Free- it. Their stories are reflected in all the tor, and it would bring down the cost of dom Caucus, what is going to—if data that we have seen. the insurance for a family of four by Trump loses, is RYAN out? One hundred percent of the $2,500 per year. The American people don’t care healthcare options on healthcare.gov It is time for the lies to stop. Let me about that. They care about their fami- in South Dakota have seen double-digit share with Members the shameful re- lies. And this is the institution that we rate increases. Meanwhile, the number ality of ObamaCare in South Carolina. were sent to to work on their behalf. It of providers families have to choose It turns out you couldn’t keep your is up to us to come together and work from has gotten much, much worse. doctor. In fact, the Medical University on behalf of the American people. We have a responsibility to eliminate of South Carolina is not an accepted This is not a healthcare bill. This is ObamaCare’s individual and employer provider under ObamaCare in South a tax bill. We are going to work on that mandates, which today’s legislation Carolina. That is right. South Caro- later on, but we shouldn’t start by say- does. It also abolishes the taxes that linians cannot go to the Medical Uni- ing that we are going to have a trans- were included in ObamaCare, up to $1 versity of South Carolina if they are

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00057 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.072 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2430 CONGRESSIONAL RECORD — HOUSE March 24, 2017 covered by ObamaCare exchange poli- for the most wealthy in the guise of tion so no one has the rug pulled out cies. healthcare reform. That is unfortunate from underneath them. It turns out you couldn’t keep your because it is a missed opportunity of With the American Health Care Act, policy. It is hard to believe, but more fixing what isn’t currently working in we are delivering on our promise and South Carolinians had their plans can- the healthcare system. acting on the policies of President celed by ObamaCare than have enrolled If we wanted to be honest with the Trump. This bill is just the first step in in the exchanges. 237,000 South Caro- American people today, we would a three-part effort to repair our Na- linians’ policies were canceled in admit that there are important, good tion’s healthcare system. Coupled with ObamaCare. features of the Affordable Care Act administrative actions and additional It turns out South Carolinians did that should remain and we should not legislation, the AHCA will lower costs not see a $2,500 reduction in their end. But there are things that need to and build a marketplace with real healthcare premiums. In fact, pre- be fixed, and we have to stay focused choices instead of a one-size-fits-all miums have increased by double digits on reducing healthcare costs for all plan. every year since the exchange opened; Americans. Let’s continue to work on Mr. Speaker, 7 years of ObamaCare is and this year, premiums increased 28 delivery system reform and payment long enough. Seven years of families percent and deductibles 26 percent. reform so we get better results at a seeing their premiums rise, plans can- I submit to you that if you have a better price. celed, and doctors dropped is enough. health insurance policy with $6,000 in But a bill before us that increases the Today we can deliver on our promise deductibles and copays so high you uninsured by 24 million, that delivers and put our bold solutions into decisive can’t afford to use your policy, regard- huge tax breaks to the most wealthy, action. The AHCA is a bill 7 years in less of the fact that statistics say you that applies a new older American tax, the making. I urge my colleagues to are covered, you are not covered. especially in rural areas like mine in join me in supporting it. 206,000 South Carolinians have signed Wisconsin, and that robs money from Mr. NEAL. Mr. Speaker, I remind my up for ObamaCare—4 percent of the the Medicare trust fund is not only a colleague that her vote for this bill will population. Ninety-six percent of missed opportunity, it is bad legisla- result in 42,000 people in her congres- South Carolinians are not on tion. sional district in Indiana losing their ObamaCare. Three times as many peo- I encourage my colleagues to vote healthcare coverage and care. ple in South Carolina have chosen to ‘‘no.’’ We can do better. We must do I include in the RECORD a letter from pay the mandate penalty rather than better. Republican Governor Snyder of the to pick up ObamaCare policies. Mr. BRADY of Texas. Mr. Speaker, I State of Michigan raising his concerns Mr. Speaker, President Obama prom- remind my good and thoughtful friend about this legislation. ised South Carolinians we would have that 290,000 Wisconsinites that chose STATE OF MICHIGAN, many competitive plans to choose not to get ObamaCare were willing to EXECUTIVE OFFICE, from, but after only 3 years of Obama’s pay a tax to stay out of a failed Lansing, MI, March 21, 2017. Hon. SANDY LEVIN, damage to our healthcare system, only healthcare system. one provider remains, and they are House of Representatives, I am proud to yield 2 minutes to the Washington, DC. threatening to pull out. gentlewoman from Indiana (Mrs. DEAR REPRESENTATIVE LEVIN: As Congress The SPEAKER pro tempore. The WALORSKI), a new member of our com- considers legislation to repeal and replace time of the gentleman has expired. mittee who is doing tremendous things the Affordable Care Act and reform Med- Mr. BRADY of Texas. Mr. Speaker, I in health care. icaid, I want to ensure you are aware of the yield an additional 15 seconds to the Mrs. WALORSKI. Mr. Speaker, I rise impact that changes may have on bene- gentleman from South Carolina. today in strong support of the Amer- ficiaries in Michigan who rely on these pro- Mr. RICE of South Carolina. The CEO grams for access to care and overall health. ican Health Care Act. I also want to provide my perspective on pri- of a major hospital in South Carolina Yesterday marked 7 years since the stated, the way it is going right now, it orities for federal health reform and high- ObamaCare law was signed into law. light how they have been utilized at the is probably going to implode in the For 7 years, we have seen the same pat- state level to drive meaningful reform that next year or two. Our State’s director tern: rising premiums, dwindling op- has increased access to cost-effective care. of insurance, last year, said companies tions, broken promises, and a col- In its current form, the American Health have given their best shot and can’t lapsing system. Care Act (AHCA) shifts significant financial sustain this business model, can’t In the State of Indiana, four insurers risk and cost from the federal government to states without providing sufficient flexi- make a profit. The Affordable Care Act left the ObamaCare exchange just this has not worked, does not work, and bility to manage this additional responsi- year in the past 3 months, forcing bility. The proposed legislation reduces fed- cannot work under this structure in 68,000 Hoosiers to shop for a new plan, eral resources that our state relies on to as- South Carolina. making it even harder for them to sist 2.4 million Michiganders enrolled in tra- Mr. NEAL. Mr. Speaker, I would re- choose and keep their doctor. ditional Medicaid and the Healthy Michigan mind my colleague that his vote for But today we have the opportunity to Plan, our state’s innovative Medicaid expan- this bill will result in 70,000 people in repeal ObamaCare and replace it with a sion program. The current federal debate has largely fo- his congressional district in South patient-centered system, lowering Carolina losing their healthcare cov- cused on the Medicaid expansion population, costs, increasing choices, and providing including over 650,000 childless adults and erage. real protection. 1 parents that are enrolled in the Healthy Mr. Speaker, I now yield 1 ⁄2 minutes This legislation dismantles Michigan Plan. However, half of all children to the gentleman from Wisconsin (Mr. ObamaCare’s burdensome taxes, man- in Michigan are served by traditional Med- KIND), who is a thoughtful member of dates, and the job-killing medical de- icaid each year and roughly 67,000 of them the Ways and Means Committee and vice tax. currently reside in your district. Moreover, lucky enough to have been educated in It gives individuals and families ac- more than 338,000 individuals with disabil- the Commonwealth of Massachusetts. cess to quality, affordable health care ities receive their health care and support services through Medicaid and an estimated Mr. KIND. Mr. Speaker, we face a through refundable tax credits and ex- truly historic day today in the United 22,000 of these individuals reside in your dis- panded health savings accounts. trict. Altogether, there are 1.75 million chil- States Congress. For the first time in It provides resources for States to dren, seniors, pregnant women and disabled our Nation’s history, we have a Con- tailor solutions to the needs of their individuals served by traditional Medicaid in gress working with an administration citizens, protecting women’s health, Michigan, and roughly 119,000 of them reside offering the American people a addressing the opioid crisis. in your district. As you know, these are our healthcare reform bill that, instead of It gives States flexibility to imple- state’s most vulnerable citizens, friends and reducing the number of uninsured in ment innovative reforms. neighbors. The proposed AHCA will ad- versely impact them. this country, increases the uninsured It allows my home State to continue While reforming the nation’s health care by 24 million people, including 431,000 building on its patient-centered system is vital, it is imperative that gains in in my home State of Wisconsin. Healthy Indiana Plan. health coverage and access to care are main- And we understand why. It is a sim- It protects patients with preexisting tained. These ideas are not mutually exclu- ple explanation. This is a tax cut bill conditions and ensures a stable transi- sive.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00058 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.074 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2431 In Michigan, innovative approaches to im- Mr. Suber began seeking treatment I came to Congress to make a dif- proving quality and value are being utilized when New Jersey expanded its Medi- ference, to find solutions to the many to support each individuals’ personal respon- care program and provided more com- issues that vex our country. I came sibility for their health. This has resulted in prehensive access to treatment. here to reduce the size and scope of an significant reductions of nearly 50% in un- compensated care, a dramatic decrease in At least New Jersey got it half right. unwieldy government, to get govern- the number of individuals using the emer- Each morning Mr. Suber receives ment out of the way of everyday citi- gency room as a regular source of care, and treatment at Paterson Counseling Cen- zens. I came here to address spending, nearly 85% of enrollees taking part in annual ter, which allows him to go to work as a $20 trillion debt in this country, to primary or preventive care visits. As drafted, a cleaner at Well of Hope, another bring back free-market principles. I the AHCA would eliminate coverage from treatment center in Paterson serving came here to defend the Constitution the 49,000 individuals enrolled in the Healthy the homeless. and our founding principles, and turn Michigan Plan in your district, as Michigan Without the treatment he receives power back to the States and to the taxpayers assume responsibility over time for up to $800 million in additional costs. through Medicaid, he wouldn’t be people. This cost shift will trigger a provision in working. He would be using the emer- All that said, every single one of Michigan law ending the Healthy Michigan gency department at St. Joseph’s hos- these principles can be found in this program. pital, the most expensive part of the bill. The American Health Care Act re- I believe Medicaid reform is necessary, hospital. Or maybe he wouldn’t have duces spending and cuts the taxes that however, that reform must be approached de- survived. have strangled businesses and individ- liberately to ensure that state flexibility and So, Mr. Speaker, for the life of me, I uals for the last 7 years. It represents innovation are valued, Michigan providers don’t understand why we would jeop- the first real entitlement reform in the remain strong, and our most vulnerable citi- zens do not fall through the cracks. Ideally, ardize treatment for James and the 52-year history of Medicaid. It deletes this would be done by removing prescriptive millions of other Americans facing Federal mandates that rob citizens of program requirements that require states to similar challenges. What were they their individual liberty. seek waivers when implementing innovative thinking? Mr. Speaker, this bill may not be per- ideas. Instead, states would be given per- Will this bill improve Medicaid? fect, but it is a dramatic step in the formance based outcomes with federal in- Nope. right direction. And before I am lec- volvement only when performance is lack- Will this bill increase the number of tured as to unsubstantiated facts and ing. Americans with health coverage? Nope. fear tactics as to how this is going to If Congress moves forward in passing the proposed AHCA, which shifts financial risk Will it lower costs on the exchanges? impact my State, I would suggest to to state taxpayers, my administration and Nope. you that 420,000 Michiganders eligible the Michigan Legislature must possess the Will this bill bolster employer cov- for Medicare said ‘‘thanks, but no flexibility necessary to manage that risk. erage? No. thanks’’ to the broken promise of af- The Trump Administration may provide ad- Will coverage now provide more ac- fordable health care. ditional flexibility to states, however, I am cess to care, a promise time and time And that is why, Mr. Speaker, I am concerned that federal agencies may encoun- again by Mr. Trump, himself? No. going to vote for this bill, and I would ter limitations in federal statute. Ulti- Will it strengthen Medicare? No. ask my colleagues to support it. mately, Michigan cannot rely solely on the Mr. NEAL. Mr. Speaker, I would re- promise of future action without seeing all b 1445 mind my colleague that his vote for of the tools that will be at our disposal to Mr. Speaker, it is obvious. We know manage the program. this bill will result in 38,200 people In addition, under the proposed AHCA, I we are trying to change things and from his congressional district in remain concerned about the affordability of make them better. Michigan losing their healthcare cov- insurance coverage in the individual market. We changed Medicare. We did it to- erage, and 313,123 people in the State of I am particularly concerned about the im- gether. Michigan, indeed, did sign up for the pact this legislation may have on older We changed Medicaid. We did it to- Affordable Care Act. Michiganders who could see significant cost gether. Mr. Speaker, I yield 2 minutes to the increases. We changed a lot of things together, gentleman from New York (Mr. CROW- I welcome the opportunity to partner with but you chose the only lonely path. you to provide greater federal budget pre- LEY), a long-time friend, a very sound dictability and improve health outcomes of Mr. BRADY of Texas. Mr. Speaker, I member of the committee, and also the Michiganders, which in turn relieves pres- remind my good friend from New Jer- well-regarded chairman of the Demo- sure on other social programs. I have worked sey that 314,000 residents of New Jersey cratic Caucus. with other Governors to develop a proposal said ‘‘no thank you’’ to ObamaCare be- Mr. CROWLEY. Mr. Speaker, this bill to accomplish these objectives while also cause it failed them. is a bad policy built on horrible proc- preserving coverage for Michiganders, and I I yield 2 minutes to the gentleman ess. Twenty-four million Americans hope this can serve as a blueprint for you as from Michigan (Mr. BISHOP), a new will lose their coverage if this bill be- we work together to accomplish these goals. member of the committee, who dove I look forward to continuing our partner- comes law. Premiums and out-of-pock- ship to help Michiganders lead healthy and into this issue with great thoughtful et expenses will skyrocket, especially productive lives. and conscientious work. for older Americans because of the age Sincerely, Mr. BISHOP of Michigan. Mr. Speak- tax, as hardworking Americans are RICK SNYDER, er, I rise today in support of the Amer- forced to subsidize tax cuts for the Governor. ican Health Care Act, and I want to wealthy. Mr. NEAL. Mr. Speaker, I yield 2 thank the chairman for his leadership It is no wonder this bill was crafted minutes to the gentleman from New on this measure. in the dead of night behind closed Jersey (Mr. PASCRELL), who is a well- Mr. Speaker, I came to Washington, doors. It is so bad, even Members of the regarded member of the Ways and D.C., to make a difference. When it Republican Party are rejecting this Means Committee. I think it is fair to comes to health care, it is readily ap- bill, but President Trump and Repub- say that everybody in this institution parent that ObamaCare does not work lican leadership insisted they need to looks forward to his time when he gets for most Americans. We know for a repeal ObamaCare at any cost, even if up to speak. fact, as we are standing here today, the price will be making health care Mr. PASCRELL. Mr. Speaker, the that the current system is collapsing out of reach for veterans, for seniors, question I get asked is: What the heck upon itself. and many of the hardest-working were they thinking about? Our Nation has endured 7 long years Americans. Let me tell you what they are think- of this mess, and today we have the ob- So the majority made it worse, and ing about. Medicaid is the source of 25 ligation and the responsibility to act. I then they made it worse again. Now percent of all projected public and pri- have heard many critics of this pro- they have taken away the bare min- vate spending for drug abuse treat- posal, but I was raised to do what is imum requirements for insurance like ment. It is about $8 billion. right, to be a part of the solution, and covering emergency room visits or pre- Let’s consider James Suber from my not sit idly by on my hands as a spec- scription drugs. It will crush any pro- hometown of Paterson, New Jersey. tator and watch Rome burn. tections for preexisting conditions.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00059 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.033 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2432 CONGRESSIONAL RECORD — HOUSE March 24, 2017 There is no guarantee the treatment healthcare coverage. I also want to Heaven forbid if you need prenatal or you need for your condition will even thank the gentleman for being the first pediatric care, too. Basically, under be covered under this bill. Image that: speaker on the Republican side to ac- this plan, one illness is enough to healthcare coverage that doesn’t cover knowledge that this is a tax cut. bankrupt a family for a lifetime. If you your health. Insurance that insures ab- Mr. Speaker, I yield 1 minute to the asked anyone on the street, no one in solutely no peace of mind for what life gentleman from Chicago, Illinois (Mr. America would call this health insur- may bring you. DANNY K. DAVIS), a distinguished mem- ance. Yet, my Republican colleagues This body blow to critical health pro- ber of the Ways and Means Committee hail this as choice—the choice to go tections was done just to win votes, and my friend. bankrupt if you get sick or, God forbid, like so many of the other provisions Mr. DANNY K. DAVIS of Illinois. Mr. have an accident. and political favors, like the Empire Speaker, I rise in strong opposition to So, Mr. Speaker, I have to ask: How State kickback, the Buffalo bribe, and this draconian, Dracula-inspired health many Republicans are left who actu- the Syracuse sellout. I call it simply a bill. It is not really a health bill at all. ally support the bill? Who wants to political ploy. As a matter of fact, it is a tax cut for kick thousands of people off of Med- That provision, which will cut $2 bil- the wealthiest individuals in our coun- icaid, reduce care for the disabled, and lion from only New York State, has try. This bill will decimate all of the strip children of their health care be- been blasted by newspapers from The public health gains that professional cause that is exactly what you are Buffalo News to Newsday on Long Is- health personnel and activists have going to do if you vote for this bill. It land. They have called it a train wreck. fought for the last 50 years. does the exact opposite of what you, They have called it bloody money. This bill will take out the oppor- your party, and President Trump have Like everything else in this bill, it rep- tunity for those low- and moderate-in- promised the American people. resents the worst kind of backroom, come individuals who fall between the This bill doesn’t provide better, shady maneuvering. gap created by Medicaid and nothing. cheaper health care for everyone. And This bill is bad for New York, bad for They are the least of those in our soci- guess what? Everybody knows that. By the democratic system, and bad for ety. And when you take away health voting for this bill, you will literally America. My colleagues on the other care for that group of individuals, his- force millions of Americans to pay side of the aisle should be ashamed of tory will not regard you well. more for less and jeopardize the health themselves. I know many of you are. I believe that the best way to meas- of our country for generations. But this bill is appalling, and I urge ev- ure the effectiveness of a society is by So if you vote to break all of the eryone in this Chamber to vote it how well it treats its young, how well promises you made to the American down. And, Mr. Chairman, I know that it treats its old, and how well it treats people, then you are going to own it, 2.7 million New Yorkers will lose their those who have difficulty caring for and you are going to be responsible for health care if this bill becomes law. themselves. whatever happens. Vote down this bill. Mr. BRADY of Texas. I remind my I will vote ‘‘no.’’ I urge us all to do Mr. BRADY of Texas. Mr. Speaker, I friend from New York, nearly four out so. reserve the balance of my time. of five New Yorkers said no to Mr. BRADY of Texas. Mr. Speaker, I Mr. NEAL. Mr. Speaker, I yield 1 ObamaCare because it failed them. remind my good friend from Illinois, minute to the gentlewoman from Ala- Mr. Speaker, I yield 1 minute to the half a million Illinoisans have said no bama (Ms. SEWELL), a valued member gentleman from Iowa (Mr. KING), my to ObamaCare because it failed them. of the Ways and Means Committee. dear friend. Mr. Speaker, I reserve the balance of Ms. SEWELL of Alabama. Mr. Speak- Mr. KING of Iowa. Mr. Speaker, I my time. er, for 7 years, our Republican col- want to thank the chairman for yield- Mr. NEAL. Mr. Speaker, I yield 2 leagues have railed against the Afford- ing to me. minutes to the gentlewoman from Cali- able Care Act, but is this the best they Seven years ago today, I brought the fornia (Ms. SA´ NCHEZ), the vice chair of can offer now: TrumpCare? The Repub- first repeal of ObamaCare here to this the Democratic Caucus, and a very lican bill, TrumpCare, is a bad deal for Congress. Forty words, to rip it out by strong performer on the Ways and Americans, and it is a bad deal for Ala- the roots as if such act had never been Means Committee. bamians. enacted. I would like to be here today Ms. SA´ NCHEZ. Mr. Speaker, I rise By every matrix, cost, coverage, and passing the full repeal of ObamaCare. today in opposition to the Republican’s care, it is a bad deal. On cost, We are not, but this is the first bite at so-called healthcare bill. TrumpCare will cost more and give us the repeal apple in a process to hope- It pains me to even call it a less. For Alabama hospitals, fully get all of this thing done in one healthcare bill because it is actually a TrumpCare will mean a $97 million in- day. massive tax cut for insurance CEOs crease in uncompensated cost care, and If I thought we could do it all in one that provides nearly zero healthcare it is an age tax for seniors. Seniors will bite, I would stand for that, but in- benefits for the American people. pay five times more than the young for stead, here is what we have got. We In fact, TrumpCare ensures that 24 their health insurance. have got a $1 trillion tax cut. We have million Americans will lose their On coverage, TrumpCare will mean 24 got a $1.15 trillion spending cut. We health insurance coverage. Seniors will million Americans and 243,000 Alabam- have got a $150 billion deficit reduc- be charged more, and insurance compa- ians will lose their healthcare cov- tion. We have got a bill that eliminates nies will once again dictate the health erage. On quality of care, TrumpCare the employer mandate, eliminates the of the American people. On the very will mean that essential benefits will individual mandate, and it eliminates day that the majority tax cuts for the be lost: essential benefits like rehabili- Federal mandates in the essential rich come into effect, on January 1, tative care, mental health, and preven- health benefits package of those 10 2018, at least 40,000 of my own constitu- tive services. mandates—that I despise, by the way. ents would immediately lose their Mr. Speaker, what is clear, It expands health savings accounts— health care. TrumpCare is not a healthcare bill. It doubles them—it allows for us to pass But that is not all. The Republican is a tax-cut-for-the-wealthy bill—$600 selling insurance across State lines, idea of health coverage will leave mil- billion in tax cuts. So I say to you, my and it enables catastrophic health in- lions of Americans without the basic Republican colleagues know what they surance. That is a pretty good list, and health services that they expect and are against, the Affordable Care Act. that is the list of things that I am that they deserve. That means that the But what are they for? What are they going to support here when this goes up monthly premium you pay won’t cover for? I ask all of you. for a vote. all of the services you will need to get Mr. BRADY of Texas. Mr. Speaker, I Mr. Speaker, I urge its adoption. better if you get sick. The Republican reserve the balance of my time. Mr. NEAL. Mr. Speaker, I remind my healthcare plan won’t cover your emer- Mr. NEAL. Mr. Speaker, might I in- colleague that his vote for this bill will gency room visit, the X-rays, or even quire as to how much time remains? result in 40,900 people from his congres- the prescription drugs you need to re- The SPEAKER pro tempore. The gen- sional district in Iowa losing cover. tleman from Massachusetts has 53⁄4

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00060 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.078 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2433 minutes remaining under this com- alarmed at the real consequences this struggling with a family member who mittee time allocation. bill will have on rural Arizona and has an opiate addiction, which is the Mr. NEAL. Mr. Speaker, I yield 1 rural America. crisis of our time. minute to the gentlewoman from Cali- These communities will be dispropor- This is more of the same: tax cuts for fornia (Ms. CHU), a new member on the tionately harmed by this bill. In the wealthiest amongst us and Ways and Means Committee, and a Coconino County, a 40-year-old making healthcare cuts for everyone else. very thoughtful Member of Congress. $30,000 a year will go from a $2,400 pay- Mr. Speaker, I reserve the balance of my time. b 1500 ment to a $6,000 payment. Getting away from my script for a Mr. BRADY of Texas. Mr. Speaker, I Ms. JUDY CHU of California. Mr. second, I spent many years on the west yield myself the balance of my time to Speaker, my constituent Patty never side of Chicago looking at what the close. had to worry about health care. Her core side of poverty looks like night Mr. Speaker, do you want to know husband had insurance through his job. after night, family after family, in our how bad ObamaCare is? But last year, Patty’s husband passed cities and our towns in this wonderful Twice as many Americans have ex- away suddenly. Overnight, Patty found America. I know a little bit about empted themselves, have paid a fine, or herself without health coverage for math, and I know that 20 million peo- found another way out of ObamaCare herself and her 20-year-old son, who ple insured is better than 24 million for everyone who took it. I am a conservative, and I am proud had a preexisting condition. people uninsured. of the conservative win in this bill. I Even though she was grieving over Please vote ‘‘no.’’ am proud of the $1 trillion in tax relief the sudden loss of her husband, Patty Mr. BRADY of Texas. Mr. Speaker, I on our small businesses, our patients, couldn’t afford COBRA and had less reserve the balance of my time. than a month to find health care for Mr. NEAL. Mr. Speaker, I yield 30 and our families. I am proud of the her family. Thank goodness she was seconds to the gentleman from Ten- more than $1 trillion of spending cuts that Washington cannot afford nor sus- able to get coverage through the ACA. nessee (Mr. COHEN). Under TrumpCare, Patty could have Mr. COHEN. Mr. Speaker, this is not tain. I am proud of the first reforms in her life upended all over again. Patty is a healthcare bill. This is a wealth care Medicaid since the program was cre- 62 years old, and TrumpCare would bill. ated in giving States back control of cause premiums for people over 60 to Unfortunately, President Trump, that plan, including the option of a increase by more than $6,000 a year, when he spoke in Louisville, said we work requirement. I am proud to repeal ObamaCare making insurance unaffordable. And had to pass this bill to get the big tax mandates that have forced Americans under the age tax created in this bill, cuts. It is about wealth care. It is the into health care they can’t afford and insurance companies could charge Ebenezer Scrooge law of this Congress. Patty five times as much as a young The insurance you will get with the don’t want. I am proud to defund person. She could see skyrocketing amendments made will be as worthless Planned Parenthood once and for all. costs for her hypertension and doctor’s as the degree from Trump University. And I am proud of the $150 billion of visits. We do not need wealth care, but we deficit reduction. This is a clear choice, and we will TrumpCare is a bad deal for Ameri- need health care. stand where we stand today: the choice cans like Patty. Mr. BRADY of Texas. Mr. Speaker, I between President Trump and more Mr. Speaker, I urge my colleagues to reserve the balance of my time. freedom or ObamaCare and less free- vote a resounding ‘‘no’’ to this down- Mr. NEAL. Mr. Speaker, I yield my- right cruel bill. dom. I stand with President Trump. self the balance of my time. Mr. Speaker, I yield back the balance Mr. BRADY of Texas. Mr. Speaker, I In closing, I want to make sure the of my time. reserve the balance of my time. people of America understand what we Mrs. BLACK. Mr. Speaker, I yield Mr. NEAL. Mr. Speaker, I yield 1 are doing here in about 1 hour. We myself such time as I may consume. minute to the gentleman from Oregon heard during the course of a Presi- I include in the RECORD a letter dated (Mr. DEFAZIO). dential campaign the promise that ev- March 7, 2017, from Dr. Thomas Price, Mr. DEFAZIO. Mr. Speaker, this so- erything was going to be covered and the Secretary of Health and Human called health bill is actually just most- we would be tired of winning. Services, who sent a letter of support ly targeted for tax cuts for the wealthi- If winning means that 24 million for the American Health Care Act to est among us. Americans are going to lose their Chairmen Walden and Brady. Let’s look at it this way: a million- healthcare coverage, if winning means THE SECRETARY OF aire will get a $30,000-a-year tax cut. A imposing an age tax on seniors, if win- HEALTH AND HUMAN SERVICES, 64-year-old senior who earns $30,000 a ning means higher out-of-pocket costs Washington, DC, March 7, 2017. year—that is all he earns, just the tax for working Americans, and if winning Hon. GREG WALDEN, cut the millionaire gets—they will see means robbing $75 billion from the Chairman, Committee on Energy & Commerce, their premium go from $1,700 a year, to Medicare trust fund, we don’t want to Washington, DC. $15,000 a year. That is half their in- be part of that victory lap. Hon. KEVIN BRADY, come. This isn’t about one person making Chairman, Committee on Ways & Means, They are going to have a choice: give up alternative facts. Our statements Washington, DC. DEAR CHAIRMAN WALDEN AND CHAIRMAN up their house so they can buy health today have been based upon the CBO, BRADY: On behalf of the Trump Administra- insurance or don’t buy health insur- the National Rural Health Association, tion, I am writing in support of the reconcili- ance, pray you don’t have a health the American Medical Association, the ation recommendations recently released for emergency, and go bankrupt or die. American Association of Retired Per- consideration by your Committees. To- Those are great choices. sons, and the March of Dimes. gether, they align with the President’s goal This says a lot about the values of This bill has fewer covered, weaker of rescuing Americans from the failures of the Republican leadership and their ob- protections, and higher costs. Let’s call the Affordable Care Act. These proposals offer patient-centered solutions that will session. Instead of fixing the problems this what it is today; it is a $1 trillion provide all Americans with access to afford- with the Affordable Care Act, they tax cut for the richest amongst us. able, quality healthcare, promote innova- want to kill it. It says a lot about their The Republicans are now facing the tion, and offer peace of mind for those with values. They are pathetic. art of the ordeal. They have a bad plan, pre-existing conditions. Mr. BRADY of Texas. Mr. Speaker, I and they know it. They have scrambled Your legislative proposals are consistent reserve the balance of my time. for the last week to try to figure out with the President’s commitment to repeal Mr. NEAL. Mr. Speaker, I yield 1 how to stitch it together, and it hasn’t the Affordable Care Act; provide minute to the gentleman from Arizona worked. advanceable, refundable tax credits for Americans who do not already receive such (Mr. O’HALLERAN). For those across this country, think tax benefits through health insurance offered Mr. O’HALLERAN. Mr. Speaker, I of the following: no maternity care, by their employers; put Medicaid on a sus- rise in strong opposition to the so- fewer hospital visits, no mental health tainable path and remove burdensome re- called American Health Care Act. I am services for those families who are quirements in the program to better target

VerDate Sep 11 2014 03:26 Jun 16, 2017 Jkt 079060 PO 00000 Frm 00061 Fmt 0636 Sfmt 0634 E:\RECORD17\MARCH\H24MR7.REC H24MR7 H2434 CONGRESSIONAL RECORD — HOUSE March 24, 2017 resources to those most in need; empower pa- essentially no choices, while they watch Mrs. BLACK. Mr. Speaker, I include tients and put healthcare dollars and deci- their premiums rise dramatically. The Con- in the RECORD a list of groups sup- sions back into their hands by expanding the gressional Budget Office estimates that 28 portive of the American Health Care use of health savings accounts; ensure a sta- million Americans will lose coverage over Act. We have many groups, from con- ble transition away from the Affordable Care the next decade if changes are not made to Act; and protect people with pre-existing the Affordable Care Act. servative groups to pro-life groups, to conditions. As the Affordable Care Act continues to industry groups; and among those Achieving all of the President’s goals to re- deteriorate, and as insurance premiums sky- would be several insurance providers, form healthcare will require more than what rocket across the nation, opposition to this such as Blue Cross Blue Shield, An- is possible in a budget reconciliation bill, as failed policy grows. Governor Mark Dayton them, and others. procedural rules on this type of legislation (D–MN) said, ‘‘the Affordable Care Act is no GROUPS SUPPORTIVE OF THE AMERICAN prevent inclusion of key policies such as sell- longer affordable.’’ Similarly, Bill Clinton HEALTH CARE ACT ing insurance across state lines, lowering called ObamaCare, ‘‘. . . the craziest thing in drug costs for patients, providing additional the world.’’, adding that people ‘‘wind up CONSERVATIVES flexibility in Medicaid for states to manage with their premiums doubled and their cov- American Legislative Exchange Council their programs in a way that best serves erage cut in half.’’ The President and Con- Americans for Tax Reform their most vulnerable citizens, or medical gress must act now to repeal the Affordable Association of Mature American Citizens legal reforms. Your proposals represent a Care Act to protect the citizens we serve in Center of the American Experiment necessary and important first step toward the states. Citizens Against Government Waste Independent Women’s Voice fulfilling our promises to the American peo- WE SUPPORT EFFORTS TO REPLACE OBAMACARE ple. We look forward to working with you Institute for Liberty Most Americans receive their health insur- Log Cabin Republicans throughout the legislative process, making ance coverage through their employer or necessary technical and appropriate changes, Market Institute through Medicare. These individuals will not National Taxpayers Union—Key Vote and ensuring eventual arrival of this impor- see a direct change from the repeal of Obamacare Repeal Coalition tant bill on the President’s desk. Obamacare. For those Americans who do not Six Degrees Project Yours truly, receive coverage through their employer, Small Business & Entrepreneurship Coun- THOMAS E. PRICE, M.D., Medicare or Medicaid, we support a refund- cil Secretary. able tax credit they can use to obtain afford- Taxpayers Protection Alliance Mrs. BLACK. Mr. Speaker, I include able health care coverage within the market- PRO-LIFE GROUPS place. in the RECORD a letter that comes from American Center for Law and Justice 24 of our Governors in support of the WE SUPPORT EFFORTS TO REFORM THE SYSTEM Catholic Medical Association repeal of ObamaCare, and I would like To provide access to affordable and quality Concerned Women for America to read just two quick paragraphs out health care, we must reform the system. We Faith & Freedom Coalition—Key Vote of the letter: support a plan that gives state governments National Right to Life—Key Vote ‘‘We support efforts to Reform the maximum flexibility to reform Medicaid and Susan B. Anthony List system. the system surrounding it. The states are INDUSTRY ‘‘To provide access to affordable and more effective, more efficient and more ac- Advanced Medical Technology Association quality health care, we must reform countable to the people. What works in one (AdvaMed) state may not work in another location, and America’s Health Insurance Plans (AHIP) the system. We support a plan that true reform will allow states to recognize gives state governments maximum American Benefits Council and meet the unique needs of people all American Builders and Contractors flexibility to reform Medicaid and the across America. American College of Cardiology system surrounding it. The states are We recognize that a vote in the House of American Supply Association more effective, more efficient and more Representatives is the first step in the Re- Anthem Insurance accountable to the people. What works peal, Replace and Reform process. The mem- Associated General Contractors of Amer- in one state may not work in another bers of the United States Senate will un- ica—Key Vote doubtedly make additional improvements location, and true reform will allow Blue Cross Blue Shield before final approval by the President. We Consumer Healthcare Products Association states to recognize and meet the also recognize that the Secretary of Health Corporate Health Care Coalition unique needs of the people all across and Human Services is committed to work- Employers Council on Flexible Compensa- America. ing with state leaders to provide maximum tion ‘‘We recognize that a vote in the flexibility for true reform. ERISA Industry Committee (ERIC) House of Representatives is the first Governors are pleased to have an adminis- Food Marketing Institute step in the Repeal, Replace and Reform tration and a Congress willing to collaborate Health Leadership Council process. The members of the United with the states to address the legitimate HSA Council needs of our people. We have compassion for International Franchise Association (IFA) States Senate will undoubtedly make those concerned about the uncertainty sur- Medical Device Manufacturers Association additional improvements before final rounding the changes. This is why it is im- (MDMA) approval by the President. We also rec- perative that the Congress act quickly on National Association of Manufacturers ognize that the Secretary of Health Repeal, Replace and Reform. (NAM) and Human Services is committed to This is a multi-stage process. There is National Association of Wholesale working with state leaders to provide much more work to be done, and process can Distributers (NAW)—Key Vote National Business Group on Health maximum flexibility for true reform.’’ only begin with a vote in the House of Rep- resentatives. With this in mind, we humbly National Club Association MARCH 24, 2017. request that you vote to repeal and replace National Council of Chain Restaurants Hon. MITCH MCCONNELL, Obamacare and to reform the system going National Federation of Independent Busi- Majority Leader, U.S. Senate, forward. Thank you. nesses—Key Vote Washington, DC. Sincerely, National Grocers Association Hon. PAUL D. RYAN, Governor Scott Walker, Wisconsin; Gov- National Restaurants Association Speaker, House of Representatives, ernor Robert Bentley, Alabama; Governor National Retail Federation—Key Vote Washington, DC. Rick Scott, Florida; Governor C.L. ‘‘Butch’’ National Roofing Contractors Association DEAR LEADER MCCONNELL AND SPEAKER Otter, Idaho; Governor Eric Holcomb, Indi- One Nation Health RYAN: Thank you for your service to our ana; Governor Terry E. Branstad, Iowa; Gov- Self-Insurance Institute of America, Inc. country. Please allow us to offer our ernor Sam Brownback, Kansas; Governor The Association of Chief Human Resource thoughts about the pending vote on the Matt Bevin, Kentucky; Governor Paul R. Officers (HR Policy) American Health Care Act. Americans want LePage, Maine; Governor Phil Bryant, Mis- US Chamber of Commerce—Key Vote personalized, patient-centered healthcare sissippi; Governor Eric R. Greitens, Missouri; Mrs. BLACK. Mr. Speaker, I yield 2 that treats them as individuals not a sta- Governor Pete Ricketts, Nebraska; Governor minutes to the gentleman from Texas tistic, and that demands we repeal Christopher T. Sununu, New Hampshire; (Mr. HENSARLING), the chair of the Fi- Obamacare, replace it, and reform the sys- Governor Doug Burgum, North Dakota; Gov- tem. nancial Services Committee. ernor Ralph Torres, Northern Mariana Is- Mr. HENSARLING. Mr. Speaker, WE SUPPORT THE REPEAL OF OBAMACARE lands; Governor Mary Fallin, Oklahoma; tragically, I receive correspondence Obamacare is collapsing. If we do nothing, Governor Henry McMaster, South Carolina; people will lose access to health care cov- Governor Dennis Daugaard, South Dakota; every week like this. I heard from Rita erage. As it stands now, one-third of the Governor Bill Haslam, Tennessee; Governor in east Texas, who writes me: counties nationwide have only a single insur- Gary R. Herbert, Utah; Governor Matthew H. Since ObamaCare took effect, my insur- ance carrier. Americans in these areas have Mead, Wyoming. ance no longer covers my colonoscopies as

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00062 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.032 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2435 preventative care. I now pay $1,000 and more Now your coverage can’t be canceled band’s medical treatment. She told me: out of pocket versus $100 outpatient fee. if your insurance company decides that ‘‘So I will now have to pay the fine, I heard from Frances in the Dallas it has paid too much. Preventive serv- drop my insurance, and hope I do not area near where I live. A few years ago ices, such as cancer screenings, are free get sick.’’ she was tragically diagnosed with ton- with no copays and deductibles. We are I told Kay I would vote to repeal and sil cancer. The good news is she had a closing the doughnut hole. Those under replace ObamaCare. good policy; $600-a-month premium and 26 can stay on their parents’ policies. A nurse from Warren County wrote a maximum out of pocket of $3,500. But We also funded community health to me: ‘‘The care that I give my pa- thanks to ObamaCare, her insurance centers, made investments in edu- tients is founded on their ability to company dropped her twice, and she cation to produce more doctors, nurses, choose their course of care. We advo- wrote: and other professionals. Through all of cate every day for our patients to have They dropped me again because they are that, the Medicare trust fund is more more choices in their care, and it will leaving the Dallas market. solvent than it was before. be very painful for us to deny them Her premiums and deductibles dou- Still, the law is not perfect. But if we those options and to deny them care.’’ bled. She lost her oncologist, and she are going to make any changes, we She asked me to stand against writes that this is all because of ought to improve the law, not make it ObamaCare, and I told her I would. ObamaCare, the Affordable Care Act. worse. Susan, from Bedford County, told me I heard from Tonya in Van Zandt Incredibly this bill makes it worse. her health insurance premium in- County, in my district: Now, the CBO has separated promises creased 156 percent and her deductible We had five family members covered by in- and press releases from reality. Twen- increased 766 percent in just 2 years. surance at around $800 a month until ty-four million fewer people will have She asked how we could make her pay ObamaCare. Our insurance premiums sky- insurance, and the Republicans call such high rates. I told Susan I would rocketed to $1,500 a month, equivalent to a this choice in freedom to be uninsured. vote to repeal ObamaCare. house payment, with a $15,000 deductible, Most everybody else will pay more and Mr. Speaker, I told my constituents and we cannot see the doctors that know our that I would stand for them to repeal medical history. Repeal it. I should not be get fewer benefits. All of those con- forced to pay for something I cannot use. sequences will occur if the proposal ac- this law that has hurt their ability to This has been a nightmare. tually works. get the affordable care they want and need. Passing the American Health Mr. Speaker, ObamaCare has been a b 1515 nightmare. It is collapsing as we speak. Care Act is the first step in repealing A number of States have done what ObamaCare and replacing it with solu- People are losing their coverages. In- this bill tries to do, and that is cover surance plans are pulling out of States tions that put patients first. I urge my people with preexisting conditions fellow Members to support this bill. and counties. Tens of millions of our without universal coverage. All of fellow countrymen have been forced to ObamaCare has failed far too many those attempts failed. in the Sixth District of Virginia. The buy health insurance plans they cannot So the question we must ask is: Who afford, they do not want, and that do status quo cannot continue. will be better off if this bill passes? Mr. SCOTT of Virginia. Mr. Speaker, not work for them. Certainly not older people who will Right here, right now, we have a I remind my distinguished colleague face the bill’s age tax. Certainly not choice: failed ObamaCare or the Amer- from Virginia that his vote for this bill veterans who will lose benefits. Cer- ican Health Care Act that begins the will result in 56,100 more people from tainly not senior citizens in nursing process of providing Americans with his congressional district in Virginia homes and people with disabilities be- guaranteed access to quality, afford- losing health care. cause Medicaid is cut. Even the sol- able, patient-centered health care. Mr. Speaker, I yield 1 minute to the It clearly advances the cause of free- vency of the Medicare trust fund will gentleman from the Mariana Islands dom, and all Members should support it be worse. (Mr. SABLAN). and end the nightmare of ObamaCare. But millionaires will get tax cuts. Mr. SABLAN. Mr. Speaker, I oppose Mr. SCOTT of Virginia. Mr. Speaker, Mr. Speaker, we have been hearing a the American Health Care Act because I ask unanimous consent that I be al- lot of complaints and shortcomings it fails to increase coverage for 3.8 mil- lowed to manage the balance of the about the Affordable Care Act, but if lion Americans in the insular areas: time remaining. we are going to make any changes, we American Samoa, Guam, the U.S. Vir- The SPEAKER pro tempore. Is there should improve it. Unfortunately, this gin Islands, Puerto Rico, and my own objection to the request of the gen- bill makes things worse: 24 million will district, the Mariana Islands. tleman from Virginia? lose their insurance, most everybody President Trump promised, There was no objection. else will pay more and get less. This ‘‘Everybody’s going to be taken care of Mr. SCOTT of Virginia. Mr. Speaker, bill should be defeated. much better than they’re taken care of I yield myself such time as I may con- Mr. Speaker, I reserve the balance of now,’’ but that is not happening. In- sume. my time. stead of taking the opportunity to take Mr. Speaker, as we talk about the Af- Mrs. BLACK. Mr. Speaker, it is now care of all Americans, the American fordable Care Act, I think it is impor- my honor to yield 2 minutes to the Health Care Act ignores the insular tant to remind ourselves of the situa- gentleman from Virginia (Mr. GOOD- areas: tion before it passed: costs were going LATTE), the distinguished chairman of We are not included in the new Med- through the roof, those with pre- the Judiciary Committee. icaid per capita funding proposal. As a existing conditions could not get insur- Mr. GOODLATTE. Mr. Speaker, I matter of fact, in a year, we would see ance, women were paying more than want to tell you why I am supporting our Medicare funding reduced by 68 men, and every year millions of people this legislation, the American Health percent. were losing their insurance. Care Act. We are not included in the new Pa- We passed the Affordable Care Act. Kaye, from Roanoke, contacted me tient and State Stability Fund. And Since then, the costs have continued to about President Obama’s promise that the new tax credit for insurance pre- go up, but at the lowest rate in 50 she could keep her health care. She miums is actually a new cost, an un- years. Those with preexisting condi- shared that she received a letter from funded Federal mandate, imposed by tions can get insurance at the standard her insurer stating that her policy was Congress on territorial governments. rate. Women are no longer paying more going to increase by $600 per month— Everyone in this Chamber wants af- than men. Instead of millions of people increase by $600 per month. Since she fordable, quality health care for all losing their insurance every year, more wasn’t of age to be on Medicare but Americans. This bill fails to do that. than 20 million more people now have wasn’t working because she was at So let us begin again. Let us work to- insurance. home caring for her sick husband, she gether on legislation to reach the goal The full name of the Affordable Care was frustrated with her situation. the President has set and many of us Act is the Patient Protection and Af- Kaye couldn’t afford the extra money share: insurance for everyone, not just fordable Care Act. she owed on top of the bills for her hus- the rich.

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Mrs. BLACK. Mr. Speaker, I yield 11⁄2 interest or, rather, feckless special in- physician leaders of our organizations, rep- minutes to the distinguished gen- terests. resenting over 500,000 physicians and medical tleman from Florida (Mr. DUNN). Show the Nation that we care more students, visited with members of the House Mr. DUNN. Mr. Speaker, I rise to re- about people than politics, that we of Representatives to urge that they ‘‘First, do no harm’’ to our patients by rolling back peal ObamaCare by supporting the care more about the long arc of Amer- key coverage, benefits and consumer protec- American Health Care Act. We are here ican history toward justice rather than tions as required under current law, includ- to take health care back from the bu- the short news cycle of who is up and ing the Affordable Care Act. We are con- reaucrats and give it to the people. who is down in Washington. cerned that by rushing to a mark-up tomor- The previous administration enacted Make no mistake: History is watch- row in the Energy and Commerce and Ways ObamaCare, and we saw its effects: ing this vote. Vote ‘‘no.’’ and Means Committees, there will be insuffi- 1 cient time to obtain non-partisan estimates higher premiums, less choice, lost cov- Mrs. BLACK. Mr. Speaker, I yield 1 ⁄2 minutes to the gentleman from Lou- of this legislation’s impact by the Congres- erage, and broken promises. The sional Budget Office, or for medical organi- isiana (Mr. ABRAHAM), who is a family deductibles are so high it is like not zations like ours and other key stakeholders having insurance at all. practitioner and knows a little about in the health care community to offer sub- The people who sent me to Congress medicine. stantive input on the bill. sent me with strict orders: End this Mr. ABRAHAM. Mr. Speaker, as a During our meetings with members of the law. And on the American Health Care practicing physician in the Louisiana House of Representatives today, we shared Act, I can report, it does. and Mississippi delta, I have some of our joint principles for health care reform. They reflect our collective expertise, and With this bill, the Federal Govern- the best patients, but some of the poor- est. They can’t afford to see me be- represent the health care needs patients ment no longer forces you to buy a present to our members every day. We urge product you can’t use and don’t want. cause they can’t afford ObamaCare, in- Representatives to utilize these principles to The individual mandate is gone, so is creased costs, skyrocketing premiums, evaluate any legislation to modify current the job-killing employer mandate. high deductibles. I can’t cure a disease law, and ensure that patients and providers Gone are a host of taxes on prescrip- if I can’t see the patient. The cost is are not adversely affected. While each of our tion meds, over-the-counter drugs, in- just too high for ObamaCare. organizations individually are still reviewing surance premiums, and lifesaving med- We have heard about Medicaid expan- the changes proposed by the American Health Care Act, released just hours ago, we ical devices. sion here today. That is a second-class insurance for first-class people. I can’t share a concern that it will not meet our It ends ObamaCare’s Medicaid expan- principles because it will likely result in less sion, and it puts Medicaid on a budget get my patients to see a specialist. access to coverage and higher costs for mil- and focuses State efforts on those peo- They have to go to the hospital. They lions of patients. ple truly in need. This is the biggest have to go to the emergency room. We urge House Speaker Paul Ryan (R–WI) entitlement reform in a generation. Prices go through the roof. and the chairs of these two committees to Of course the bill is not perfect. I have heard my colleagues on the reconsider the decision to move forward with mark-up, and instead allow the time needed There is more to do. But I spent 30 other side of the aisle reference the Hippocratic Oath. With all due respect, for a thorough review of the bill to ensure years as a surgeon. In medicine, as in that it meets our overarching principle, life, you do not get to choose the per- I don’t think they would know what ‘‘First, do no harm’’ to patients. the Hippocratic Oath says if their life fect option. You learn not to make per- ABOUT THE AMERICAN ACADEMY OF FAMILY fect the enemy of great. depended on it. Guess what? It does. PHYSICIANS With this vote we decide whether Google it. Founded in 1947, the AAFP represents ObamaCare is our healthcare future or Let me educate you. Let me educate 124,900 physicians and medical students na- not. We can live with its failures and our colleagues. It says I will always tionwide. It is the only medical society de- broken promises or create a market- seek a path to a cure for all diseases. voted solely to primary care. Family physi- based system that actually lowers the ObamaCare will not let me do that. cians conduct approximately one in five of- fice visits—that’s 192 million visits annually cost of health care and serves patients, We have got to do better. We cannot cram people into a healthcare system or 48 percent more than the next most vis- not bureaucrats. ited medical specialty. Today, family physi- So I support the American Health that has failed just so politicians can thump their chest and have some type cians provide more care for America’s under- Care Act, Mr. Speaker, and I urge that served and rural populations than any other all Members do the same. of mysterious victory that is hollow medical specialty. Family medicine’s corner- Mr. SCOTT of Virginia. Mr. Speaker, and very, very small. stone is an ongoing, personal patient-physi- I remind my colleague that his vote for We need to pass this American cian relationship focused on integrated care. this bill will result in 63,900 people Health Care Act. ObamaCare has failed. To learn more about the specialty of family from his congressional district in Flor- It is a sham of an insurance. Americans medicine, the AAFP’s positions (5 page PDF) deserve better. We deserve better as on issues and clinical care, and for ida losing healthcare coverage and downloadable multi-media highlighting fam- care. Americans. My patients deserve better. Mr. SCOTT of Virginia. Mr. Speaker, ily medicine, visit www.aafp.org/media. For I yield 1 minute to the gentleman I remind my colleague that his vote for information about health care, health condi- from Connecticut (Mr. COURTNEY). tions and wellness, please visit the AAFP’s this bill will result in 51,700 people in Mr. COURTNEY. Mr. Speaker, in a award-winning consumer website, few minutes, the American people will his district losing their coverage and www.FamilyDoctor.org (www.family see clearly what each and every Mem- care. doctor.org). Mr. Speaker, I include in the RECORD ber of this House is made of. Will we ABOUT THE AMERICAN ACADEMY OF PEDIATRICS a letter from the American Academy of vote to willfully strip healthcare cov- The American Academy of Pediatrics is an Family Physicians, the American erage for 24 million Americans, older organization of 66,000 primary care pediatri- Academy of Pediatrics, the American Americans, working Americans, Ameri- cians, pediatric medical subspecialists and College of Physicians, the American pediatric surgical specialists dedicated to cans with chronic illness and develop- Congress of Obstetricians and Gyne- the health, safety and well-being of infants, mental disabilities and now, incred- cologists, and the American Osteo- children, adolescents and young adults. For ibly, we even know, Americans who pathic Association in opposition to the more information, visit www.aap.org and fol- wore the uniform of this Nation? low us on Twitter @AmerAcadPeds. legislation. In a few minutes, we will see who will ABOUT THE AMERICAN COLLEGE OF PHYSICIANS vote to raid the Medicare trust fund in [From the American Academy of Family The American College of Physicians is the order to cut Medicare taxes for the Physicians, American Academy of Pediat- largest medical specialty organization in the rich, and we will see who will vote to rics, American College of Physicians, The United States. ACP members include 148,000 American Congress of Obstetricians and cut Medicaid’s coverage for patients internal medicine physicians (internists), re- Gynecologists, American Osteopathic As- lated subspecialists, and medical students. struggling with the curse of opioid ad- sociation, Mar. 7, 2017] diction. Internal medicine physicians are specialists AMERICA’S FRONT LINE PHYSICIANS EXPRESS who apply scientific knowledge and clinical Mr. Speaker, this is not just a vote. SERIOUS CONCERNS WITH THE AMERICAN expertise to the diagnosis, treatment, and This is a gut check of who we are as HEALTH CARE ACT compassionate care of adults across the spec- people and whether our purpose, as WASHINGTON, DC—After the release of the trum from health to complex illness. Follow elected officials, is to serve the public two budget reconciliation bills today, the ACP on Twitter and Facebook.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00064 Fmt 0636 Sfmt 0634 E:\CR\FM\K24MR7.086 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2437 ABOUT THE AMERICAN CONGRESS OF direction. This isn’t about health care, off the insurance roll, and that is a OBSTETRICIANS AND GYNECOLOGISTS per se; this is about how do you pay for shame. They will suffer, and their fam- The American College of Obstetricians and it. ilies will suffer. Gynecologists (The College), a 501(c)(3) orga- Insurance is not a magic bullet any- I have health insurance, and so does nization, is the nation’s leading group of where across the spectrum. Insurance every Member of Congress. We even physicians providing health care for women. is simply a scheme in which we risk- have a clinic and doctors at our dis- As a private, voluntary, nonprofit member- ship organization of more than 57,000 mem- manage together. We put a certain posal right here in this Capitol. bers. The College strongly advocates for amount of money into a bucket, as- Doesn’t every American deserve the quality health care for women, maintains suming not all of us will suffer the same treatment as Members of Con- the highest standards of clinical practice and risks that we want to cover. If we do, gress? continuing education of its members, pro- we have got to put more money in; if Instead of moving backwards, Repub- motes patient education, and increases we don’t, then the system works. licans should partner with Democrats awareness among its members and the public This is about having to confront that to amend and strengthen the existing of the changing issues facing women’s health choice that there is way too much cost law. By working together, we can cre- care. The American Congress of Obstetri- for the amount of resources that are ate a plan that works for all Ameri- cians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion. available in any of these cir- cans, not just the Members of Con- cumstances, and it is hard. gress. Vote ‘‘no.’’ Vote ‘‘no.’’ ABOUT THE AMERICAN OSTEOPATHIC ASSOCIATION Many of my constituents ask: Why Ms. KAPTUR. Mr. Speaker, the Affordable did Republicans spend 6 years railing The American Osteopathic Association Care Act needs to be repaired, not repealed. (AOA) represents more than 129,000 osteo- against ObamaCare and not have the In 2010, Democrats passed health care reform pathic physicians (DOs) and osteopathic fix available on Inauguration Day? in an effort to move toward health insurance medical students; promotes public health; Well, this is Exhibit A. This is hard for all Americans. Though we have made encourages scientific research; serves as the stuff. Even among Republicans, we progress and more work to do, we cannot primary certifying body for DOs; and is the have got more than 218 votes among us, move America backward. Tens of thousands accrediting agency for osteopathic medical and we can’t agree among ourselves of people in northern Ohio and millions across schools. Visit DoctorsThatDo.org to learn necessarily what ought to go forward. America will lose insurance if TrumpCare be- more about osteopathic medicine. But I do know this, that we are down comes law. Mr. SCOTT of Virginia. Mr. Speaker, to the final choice: Do we keep This bill is cruel. It will take away care from I yield 1 minute to the gentlewoman ObamaCare and the failure that is con- some of our most vulnerable citizens like from Ohio (Ms. FUDGE). fronting us and will continue to be those who suffer from opioid addiction, mental Ms. FUDGE. Mr. Speaker, what is a there, or do we take a chance on mov- illness or have disabilities. This bill will under- life worth? What does it cost to save ing toward something different, mov- mine Medicare and cut $28 billion from Ohio’s the life of a sick child or a senior cit- ing toward freedom, moving toward Medicaid program, the majority of which is izen? choice, giving States back the oppor- spent on nursing home care. If Republicans For all of the rhetoric about freedom tunity to decide for their indigent pop- succeed in repealing the Medicaid expansion, and choices, this bill sends a clear mes- ulation how they should take care of one in four Ohio hospitals would close accord- sage to every American as to where Re- them? ing to the Ohio Hospital Association. publican priorities lie. Tax breaks to I don’t think anybody in Washington, Our goal should be to make our health care the wealthy have been deemed more D.C., can come up with a plan that system better, not worse. This merciless bill is valuable than lifesaving care. fixes that for all 50 States. I trust my not a health care bill. This bill is an $800 bil- They are telling hardworking fami- colleagues in Austin to make that hap- lion tax cut for corporations and the very rich. lies that insurance that only benefits pen far better than anybody I would How that giveaway provides better health care the wealthy, the healthy, and the trust in D.C., and this bill moves that to working and middle-class families is beyond young is more important than access direction, and that is the right direc- me. to nursing homes, to pediatric care, tion for us to go. For Lent I gave up chocolate, I recommend mental health services, substance This is a hard choice, but for me it is the Republicans try giving up tax cuts to the abuse treatment, and the overall peace relatively straightforward. You keep rich! of mind that, if you get sick, you can ObamaCare with a ‘‘no’’ vote. You Let me share a story about a young man in afford care. move toward a brighter future for Ohio who was diagnosed with an extremely Speaker RYAN calls this ‘‘an act of health care in this country and the way rare form of cancer one month before his 26th mercy.’’ This is by no means merciful, we pay for it, who pays for it, and how birthday. Mr. Speaker. Mercy is caring for the we get that done by a ‘‘yes’’ vote. I en- Once he turned 26 he lost coverage under sick, the poor, for our elders. Mercy is courage my colleagues to vote ‘‘yes’’ his parent’s health care policy. extending a hand to those in need. This on this bill. But after visiting an Ohio Jobs and Family is heartless. Mr. SCOTT of Virginia. Mr. Speaker, Services office, he learned about his eligibility Human decency demands a ‘‘no’’ vote I remind my colleague that his vote for for the Ohio Medicaid expansion, which al- on TrumpCare. Vote ‘‘no.’’ this bill will result in making things lowed him to receive the cancer treatment he Mrs. BLACK. Mr. Speaker, I yield 2 worse by 58,600 people in his district needed to survive. minutes to the gentleman from Texas losing their healthcare coverage and Frankly, without the Affordable Care Act’s (Mr. CONAWAY), the chairman of the care. multi-layered protections, he would be dead. Agriculture Committee. Mr. Speaker, I yield 1 minute to the The Affordable Care Act and its Medicaid Mr. CONAWAY. Mr. Speaker, we are gentlewoman from Florida (Ms. WIL- expansion has allowed him to return to finish faced with an unenviable choice of the SON). law school. fact that there is infinite demand for Ms. WILSON of Florida. Mr. Speaker, This bill shifts the burden of health costs to health care. There is no top on the I would like to begin by asking my Re- the working and middle class, all so the rich amount of healthcare cost necessary to publican colleagues one simple ques- can have a trillion dollar tax cut. A tax cut for provide all the health care that we tion: Don’t you have constituents who the super rich doesn’t help working people want for everybody in this country, get sick and need insurance? and seniors pay for health care. Astoundingly, and we have limited resources within Everyone gets sick, rich and poor, the falsely labeled, so called ‘‘health’’ bill actu- which to do that. Black and White, men, women, and ally rewards billionaires and corporations with The real question is: Does children. hundreds of billions in tax giveaways. ObamaCare take up that task by ask- Having insurance gives us peace of This bill does nothing to control costs for ing government to make those hard mind. It helps ensure that a medical health insurance. Millions will lose coverage. It choices, or do we as individuals and crisis is not exacerbated by a financial will actually result in higher costs too all while families and caregivers make those crisis. It often makes a difference be- undermining Medicare and slashing Medicaid. harder choices for ourselves? tween life and death. If the Affordable Congress ought to repair not repeal the I believe that the bill that we will get Care Act is repealed, your constituents ACA. We cannot move backward. This GOP to vote on today moves us toward that and millions of people will be kicked bill is cruel and some of our most challenged

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00065 Fmt 0636 Sfmt 9920 E:\CR\FM\A24MR7.036 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2438 CONGRESSIONAL RECORD — HOUSE March 24, 2017 citizens like the mentally ill or disabled will Groups like the American Medical Association, Today, buying an insurance policy on the lose care. Premiums for those over 50 could the American College of Physicians, the Amer- exchanges with high premiums, high copays, increase by 5 fold. As the old saying goes; ican Academy of Pediatrics and the American and most importantly, exceedingly high ‘‘this dog won’t hunt.’’ Nurses Association, just to name a few, are deductibles make the actual utilization of Ohio embraced the ACA and 866,000 peo- urging Congress to stop TrumpCare. These health benefits far costlier than originally ad- ple were finally able to receive health care are the men and women who are out there on vertised. coverage. What will this poorly conceived Re- the front lines everyday treating and healing Americans were told repeatedly that the publican tax giveaway bill do to Ohio: our fellow Americans. ACA would save up to $2,500 in premium 1. About 47,000 people will lose health in- To make things worse, TrumpCare is being payments per family per year. President surance because they are insured through the rushed to the floor with minimal deliberation. It Obama said: ‘‘I will sign a universal health ACA in Ohio’s 9th district. was introduced less than three weeks ago and care bill into law by the end of my first term 2. The district’s uninsured rate has gone we have not held a single hearing or heard as president that will cover every American from 13.3% to 7.0% since the ACA was imple- from a single expert witness on it. Now we are and cut the cost of a typical family’s premium mented. This 6.3 percentage point drop in the being asked to vote on it despite receiving the by up to $2,500 a year.’’ uninsured rate could be reversed if the ACA is newest version of the manager’s amendment That didn’t happen—not even close. entirely or partially repealed. late last night. This is not the regular order Nationwide, since 2016, gross premiums be- 3. 318,900 individuals in the district who and transparency that the Republicans prom- fore subsidies in the Bronze-priced tier rose a now have health insurance that covers pre- ised. whopping 27 percent, silver 24 percent and ventive services like cancer screenings and flu Mr. Speaker, this bill pushes the cost of gold 32 percent. shots without any co-pays, coinsurance, or health care onto those who can least afford it That should come as no surprise. As early deductibles stand to lose this access if the Re- as August 2012, Politifact found President while providing massive tax cuts for the publican Congress eliminates ACA provisions Obama’s promise to be untrue and labeled the wealthy. I urge my fellow members to defeat requiring health insurers to cover important statement a ‘‘promise broken’’ in a Politifact this misguided bill and let us begin the serious preventive services without cost-sharing. report entitled: NO cut in premiums for typical work of making real improvements in the Af- 4. 370,700 individuals in the district with em- family. ployer-sponsored health insurance are at risk fordable Care Act for all Americans. Health insurance consumers were promised Mrs. BEATTY. Mr. Speaker, I rise today to of losing important consumer protections like they could keep their insurance plan if they the prohibition on annual and lifetime limits, express my opposition to TrumpCare and my liked it and keep their trusted doctors as well. protection against unfair policy rescissions, strong support for the Affordable Care Act. That didn’t happen either. Since the ACA was enacted seven years and coverage of preexisting health conditions, As a matter of fact, several million were ago, more than 20 million Americans have if the ACA is entirely or partially repealed. kicked off insurance plans they were very sat- This Republican bill, hastily prepared, gained access to affordable and high quality isfied with—like my wife and I—only to be should be defeated. It is cruel, will leave mil- health insurance, including nearly one million forced into an Obamacare plan that we didn’t lions of our fellow citizens bankrupt and des- Ohioans. want and was more expensive. titute, and if implemented, will be responsible We thought 129 million Americans with pre- Also, in New Jersey—like much of the na- for more death and illness coast to coast. Vote existing conditions would be able to keep their tion—insurance companies are pulling out of no on TrumpCare. health care coverage. We thought 105 million the exchanges. Insurers continue to exit the Mr. LYNCH. Mr. Speaker, I rise in strong Americans would no longer have to worry individual market and the exchange has expe- opposition to H.R. 1628, the American Health about annual or lifetime limits. Yet, we are rienced a net loss of 88 insurers. Today, five Care Act of 2017. here today winding back the clock on all the states only have one insurer option. At home, Mr. Speaker, I have received countless vis- progress we have made based on a bill that last year five insurance carriers offered plans its, calls, letters and emails from constituents wasn’t released to the public until last night. on the New Jersey exchange, today only two about this bill. I have heard from hospitals, What’s the rush to pass a bill that affects so remain. The exodus of insurance companies doctors, patients, nurses, parents of children many people without letting the public view it? from the individual market is an unsustainable with serious illnesses, researchers and the list What’s the rush to pass a bill that affects so and ominous trend. goes on. They have one thing in common: many people without a new CBO score? Mr. Speaker, almost twice as many Ameri- they are afraid of what TrumpCare could do to Mr. Speaker, we know that TrumpCare will cans have paid the financial penalty—pursuant their patients and to their families. cause Americans to pay more for less cov- to what is euphemistically called the ‘‘indi- H.R. 1628 will not bring down health care erage. We know that TrumpCare will provide vidual mandate’’—for not buying a health in- costs or improve access. Indeed, by slashing a massive tax cut to the super rich 400 fami- surance plan—or have received an exemption Medicaid by $880 billion, it will force States to lies and leave the other 99.9 percent of people from the individual mandate as those who ration care for our most vulnerable popu- behind. We know that TrumpCare will cause have actually purchased a plan through the lations. In Massachusetts, this cut will put the 24 million Americans to lose their health insur- exchange. By the numbers that means 19.2 health of 1.9 million people at risk, including ance, including tens of thousands of my con- million taxpayers either paid the individual 650,000 children, 170,000 seniors and stituents in the Third Congressional District of mandate penalty or claimed an exemption, 280,000 people with disabilities. My state is Ohio. We know that TrumpCare will slash compared to 10.3 million individuals who paid also being hit hard by the opiate addiction cri- Medicaid funding by $880 billion. We also for plans on the Obamacare exchanges. sis and cutting Medicaid will cripple our ability know that TrumpCare will put 13 million chil- Obamacare also increased taxes by about to address that problem. It is also a disgrace dren, people with disabilities and adults just one trillion dollars. that the funding being cut out of Medicaid is one emergency visit away from financial ca- For example, beginning in 2020, a new 40% being handed over to insurance companies tastrophe. excise tax on employer provided comprehen- and the wealthiest Americans in a $1 trillion Mr. Speaker, these cuts hurt people all sive health insurance plans is scheduled to tax break for the rich. across the country. TrumpCare will not make take effect. Any plan provided by an employer TrumpCare slashes $175 billion from the healthcare more affordable. exceeding $10,200 for individuals and $27,500 Medicare Trust Fund, cutting its solvency by Democrats believe healthcare is a right, not for families will be taxed at 40 percent for three years and hurts seniors by letting insur- a privilege. I join my colleagues in fighting for each dollar above those numbers. According ance companies charge older Americans five affordable healthcare for all Americans. I will to the Kaiser Family Foundation this so-called times more than they do young ones. The vote no, and urge all my colleagues to vote no Cadillac tax will hit 26 percent of employers by yearlong bar on reimbursements to Planned as well. 2020. Parenthood for non-abortion services means Mr. SMITH of New Jersey. Mr. Speaker, According to the IRS, approximately 10 mil- that women will have to go without health while the Affordable Care Act has been in ef- lion families took advantage of the chronic screenings, pre-natal care and well-woman fect since 2010, it has only provided actual ac- care tax deduction which is now been rede- visits. And according to the C.B.O., 24 million cess to health insurance benefits through the fined out of reach for many. New taxes com- Americans will no longer have health insur- exchange and Medicaid expansion for a little bined with skyrocketing premiums, copays and ance coverage. over 3 years—beginning in 2014. deductibles underscores the need for serious All this begs the question, how does this bill In that short period of time, however, seri- review, reevaluation and reform. provide better care for Americans? ous problems and flaws have been exposed, That said Mr. Speaker, I remain deeply con- But you do not have to take my word for it yet in recent months the law’s systemic prob- cerned—and will vote no today—largely be- when I say that this bill will hurt Americans. lems have been trivialized or ignored by many. cause the pending bill cuts Medicaid funding

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00066 Fmt 0636 Sfmt 9920 E:\CR\FM\A24MR7.037 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2439 by an estimated $839 billion over ten years or eligibility that puts the health and wellbeing families like Olivia’s, and millions of Americans according to the Congressional Budget Office of people with disabilities at significant risk. In across our country. (CBO), rolls back Medicaid expansion, cancels fact, people with disabilities are particularly at I urge my colleagues to vote no on behalf essential health benefits such as maternity risk because so many waiver and home- and of the American people. and newborn care, hospitalization, pediatric community-based services are optional Med- Ms. EDDIE BERNICE JOHNSON of Texas. services, and mental health and substance icaid services and will likely be the first serv- Mr. Speaker, I rise in strong opposition to H.R. use treatment, and includes ‘‘per capita ices cut when states are addressing budgetary 1628, the American Health Care Act, which caps’’—all of which will likely hurt disabled shortfalls. The health, functioning, independ- not only seeks to repeal the Patient Protection persons, the elderly and the working poor. ence, and wellbeing of 10 million enrollees liv- and Affordable Care Act, but reform entitle- For years, I have supported Medicaid ex- ing with disabilities and, often, their families, ments, redistribute wealth, and strip coverage pansion as a meaningful way of providing ac- depends on funding the services that Medicaid from millions of people. cess to health care for struggling individuals provides. Likewise, Medicaid Expansion pro- The American Health Care Act would re- and families living above the poverty line but vides coverage for millions of people with dis- duce coverage for Americans while increasing still poor despite being employed—80 percent abilities and their caregivers who previously out-of-pocket costs for the sickest and the el- of all Medicaid enrollees in New Jersey are fell into healthcare coverage gaps. For many derly. Health plans would fail to meet the families with at least one working adult in people with disabilities, being able to access needs of Americans with chronic or complex 2017. timely, needed care is a life or death matter. conditions. The bill also eliminates protections Although more than 800,000 children are The drastic cuts to Medicaid that will result against annual and lifetime caps. With a last- served by Medicaid in my state, the bulk of from per capita caps and the ultimate elimi- minute manager’s amendment to repeal the Medicaid funds are spent assisting the dis- nation of Medicaid Expansion will endanger Essential Health Benefits, the ten coverage abled and the elderly. In New Jersey approxi- millions.’’ rules set up by the Affordable Care Act, this mately 74 percent of all Medicaid spending Autism Speaks, a leading autism aware- ruthless bill has gotten even worse. goes directly to assist persons with disabilities ness, science, and advocacy group, further ar- The Affordable Care Act required insurers to and senior citizens. Two out of every five peo- ticulated another concern, that ‘‘the choice of cover ten ‘‘Essential Health Benefits’’ from ma- ple in nursing homes are on Medicaid. 2016 as a baseline year for per capita caps ternity care, mental health, and prescription According to the New Jersey Department of may prevent states from addressing the needs drugs, to hospitalization and outpatient care. If Human Services, in New Jersey total enroll- of children with autism. In July 2014 the Cen- this is repealed, comprehensive health insur- ment in Medicaid in February 2017 was 1.77 ter for Medicaid and CHIP Services issued an ance will become virtually unavailable in the million people. Of that a significant number are informational bulletin clarifying Medicaid cov- individual market. This means that individuals newly enrolled under Medicaid expansion— erage of services to children with autism, in- with pre-existing conditions would not be pro- 663,523 ‘‘newly eligible.’’ cluding benefit requirements for the Early and tected. Younger and healthier people benefit, These people are in need and deserve our Periodic Screening, Diagnostic, and Treatment older and sicker people suffer. support. Current law provides states that (EPSDT) program. Although EPSDT is a man- While the new additions to this measure are opted to embrace Medicaid Expansion—like datory Medicaid program, few states in 2016 startling, the original bill is just as shocking. New Jersey—95 percent of the costs for the funded autism services at the required stand- Slashing and capping the Medicaid program ‘‘newly enrolled.’’ The federal share drops to ard of care. Locking in 2016 as a baseline will ration care and give tax breaks to the 90 percent by 2020. year can only perpetuate this historic under- wealthy. This bill cuts $880 million from Med- The proposed American Health Care Act funding of EPSDT benefits.’’ icaid and then caps the program so that it continues Medicaid expansion however only Ms. ROYBAL-ALLARD. Mr. Speaker, for my cannot expand and contract as needed. By until 2020. Those enrolled before December constituents and all Americans, Trumpcare the end of 2019, the Medicaid expansion pro- 31, 2019 would be grandfathered in at the 90 would result in higher costs, less coverage, a gram will freeze and this bill will shift costs to percent match rate but the federal-state match crushing age tax for persons 50 to 64, a short- states for the elderly, children, individuals with formula would then be reduced to a range be- er Medicare life span, and the ransacking of disabilities, and low-income adults. tween 75 percent–25 percent to 50 percent– the Medicaid funds that enable seniors to get This bill will kick 24 million people off their 50 percent or any new enrollee. the long term care they need. And last night, health insurance by 2026, and 7 million people What does that mean? Republicans added a provision that would pro- will lose their employer-based coverage. While The United State Conference of Catholic hibit our veterans who are eligible to receive the Affordable Care Act subsidies were based Bishops wrote each of us on March 17th: VA care from receiving any tax credits to help on income and when premiums rose, the fed- ‘‘. . . it is our assessment that some provi- pay for their care outside the VA, even if they eral subsidy also rose to pay for premium sions are commendable (and they reference are not enrolled in the VA. costs, the American Health Care Act replaces the pro-life safeguards and other noteworthy In my congressional district, the uninsured those subsidies with a fixed credit amount. provisions in the bill) . . . while others present rate dropped from 31.7 to 17.5 percent due to The age-based tax credits are a refundable grave challenges that must be addressed be- Obamacare. tax credits that is larger for older individuals, fore passage . . . millions of people who Among my constituents who benefited are a however, it allows insurers to charge older en- would be eligible for Medicaid under current young mother from Bell Gardens, California, rollees five times more than a younger en- law will be negatively impacted due to reduced and her 15-month-old daughter, Olivia, who rollee. funding from the per capita cap system pro- was born with Down Syndrome. Mr. Speaker, the public has spoken about posed in the legislation, according to the CBO. Because of Obamacare’s Medicaid expan- this so-called ‘‘replacement’’ bill. People will Those struggling families who currently re- sion in California, Olivia was able to have her live or die as a result of this legislation. This ceive Medicaid coverage from the recent ex- congenital heart defect repaired shortly after bill will force Americans to pay more for their pansion will see dramatic changes through the birth. She is now being followed by a cardiolo- premiums, more for their care, more on out-of- AHCA as well, without clear indication of af- gist to ensure her ongoing care for a healthy pocket expenses and deductibles; all the while fordable, adequate coverage to replace their heart. giving tax breaks directly to the wealthy. The current options. Many states begin their legis- Obamacare’s Medicaid expansion also Republican leadership has rushed this bill to lative sessions every cycle by attempting to makes it possible for baby Olivia to receive the floor without any consideration and I urge overcome major deficits. State and local re- early intervention and physical therapy serv- you all to consider its harmful effects. Your sources are unlikely to be sufficient to cover ices to enhance and accelerate her develop- constituents are asking you to work with us to the gaps that will be created in the health care ment. repair the Affordable Care Act. Work with us. system as financial responsibility is further Olivia’s mom is terrified that if Trumpcare Mr. AL GREEN of Texas. Mr. Speaker, al- shifted to the states. Congress must rework passes, her daughter may not be able to re- though Trumpcare is a terrible Healthcare the Medicaid-related provisions of the AHCA ceive these services, which help her remain plan, it is a terrific Wealthcare plan. to fix these problems and ensure access for healthy and make it possible for her to reach Trumpcare is terrific Wealthcare because in all, and especially for those most in need.’’ critical developmental milestones. the final analysis, it allows the 400 richest A letter led by the Consortium For Citizens Republicans like to call Obamacare a failed families to get $7 million a year ad infinitum, with Disabilities, and signed by over 60 organi- disaster. That is simply one more example of $7 million a year forever. zations states: their ‘‘alternative facts.’’ In the final analysis, 79% of the cuts be- ‘‘Dramatic reductions in federal support for The Republican Trumpcare bill before us is come Wealthcare dollars for the very rich, not Medicaid will force states to cut services and/ the disaster waiting to unfold for countless healthcare dollars for the very poor.

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00067 Fmt 0636 Sfmt 9920 E:\CR\FM\A24MR7.043 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE H2440 CONGRESSIONAL RECORD — HOUSE March 24, 2017 In the final analysis, it sacrifices $1 trillion structure Medicaid funding through a simi- hard to see a reasonable federal purpose here from Medicare and Medicaid to enrich the lar legally authorized system. other than garnering more GOP votes for the lives of millionaires and billionaires. The Faso-Collins amendment specifies that struggling repeal bill.’’ (available at https:// any State that had an allotment of Dis- ballkin.blogspot. com/2017/03/ is-gop-aca- In the final analysis, it provides more money proportionate Share Hospital (DSH) funds repealer- unconstitutional- on.html?m=1) for Wealthcare and less money for Healthcare. that was more than 6 times the national av- Violation of Due Process and Equal Protec- Mr. Speaker, Trumpcare is more Wealthcare erage, and that requires subdivisions with tion—Under the Fifth Amendment, the Fed- and less Healthcare. populations of less than 5,000,000 to con- eral government is not permitted to deprive Mr. CONYERS. Mr. Speaker, I’ve been here tribute toward Medicaid costs, shall have its its citizens of equal protection or due process a while and it’s hard for me to recall a time reimbursement reduced by the amount of of law. Those clauses have been interpreted when we’ve voted on something so obviously contributions by such subdivisions. (This ef- on numerous occasions to prevent the gov- fectively limits the application to New York ernment from discriminating between the and willfully harmful to children, seniors and State, and carves out New York City.) Under treatment of the sovereign States absent a working Americans. the amendment, New York State is at risk of rational basis. For example, in Helvering v. This bill strips healthcare from 24 million losing $2.3 billion of its $32 billion in Federal David, 301 U.S. 619, 640 (1937), the Supreme people. Medicaid funds. Court warned that Congress does not possess It requires some seniors to pay 100 percent This provision is unconstitutional, and the right to demonstrate a ‘‘display of arbi- or more of their income in premiums. could be struck down for several reasons: trary power’’ in its treatment of the various This legislation dramatically cuts Medicaid, Violation of Limits on Spending Power— States. In this regard, in 2009, when an ear- Article I of the Constitution grants Congress directly contradicting President Trump’s claim lier Senate version of the Affordable Care spending power to ‘‘provide for the . . . gen- Act sought to provide special treatment for not to. eral Welfare.’’ In South Dakota v. Dole, 483 Nebraska with respect to Medicaid reim- In Michigan, HALF of all children rely on U.S. 203 (1987), the Supreme Court held that bursements, 13 Republican State attorneys Medicaid. any spending condition imposed on the general wrote to Congress (available at In my district alone, 56,000 people will lose States must be related to the Federal inter- http://www.law. columbia.edu/sites/ default/ coverage, including 16,000 children. est in that particular project or program and files/microsites/ career-servicesifiles/ Let’s be clear: if we pass this bill, children, that Congress cannot coerce the States into Letter%20to% 20the%20 Honorable%20Nancy compliance with the Federal government’s seniors, and working people will suffer and %20Pelosi%20 and%20the objectives. In NFIB v. Sebelius, 132 S. Ct. %20Honorable%20Harry %20Reid.pdf) assert- some will die, so that the wealthy can get a 2566 (2012), the Supreme Court found provi- ing the provision was unconstitutional (the tax cut. sions of the Affordable Care Act which re- provision was ultimately dropped). In the Healthcare is a right, not a privilege. That’s quired all States to comply with the law’s case of the Faso-Collins language, there is no why I support a single-payer, Medicare-for-All Medicaid expansion violated this spending legitimate policy justification for developing plan, and why I will be voting ‘‘no’’ on this authority, noting the ‘‘Constitution has a special rule limiting Medicaid funds for mean spirited legislation. never been understood to confer upon Con- New York as compared to all other States, Mr. Speaker, as Ranking Member on the gress the ability to require the States to including 15 States which have sharing House Judiciary Committee, I include in the govern according to Congress’ instructions.’’ agreements with their counties. Nor has a The Faso-Collins language does not appear justification been offered for why New York RECORD a legal analysis prepared by com- to be related to any Federal interest in the City should be excluded from the application mittee staff that concludes that the provision of use or allocation of Federal Medicaid funds: of the special rule. As such, it is clear that H.R. 1628 that requires New York State to it does not further Medicaid’s purposes and the provision is discriminatory, ‘‘arbitrary’’ change how its counties fund the State’s por- has nothing to do with ensuring the proper and has no rational basis. tion of Medicaid expenses is not related to a disbursement of Federal funds. Indeed, be- Abrogation of Tenth Amendment Prin- legitimate Federal interest, that no rational cause the provision applies to counties in a ciples—The Tenth Amendment provides in Federal purpose has been proffered for the single State—and leaves the very same sys- relevant part that powers not delegated to the Federal government or prohibited to the provision, and that it would severely intrude on tem undisturbed in 15 other States—it could not possibly be justified by any legitimate States are reserved for the States. This has traditional state prerogatives. As such, this Federal interest. been read to prevent the federal government provision would violate Constitutional limits on An additional line of Supreme Court cases, from ‘‘commandeering’’ the states to serve the Federal Spending Power, the Due Process including New York v. United States, 505 U.S. its own purposes. In Printz v. United States, and Equal Protection Clauses and the Tenth 144, 167, 172 (1992), has held that conditions 521 U.S. 898 (1997), the Supreme Court held Amendment (reserving all undelegated powers on Federal grants must be ‘‘reasonably re- that Congress cannot commandeer State of- to the States) and would likely be held uncon- lated to the purpose of the [Federal] expendi- ficers to implement Federal policy—in that stitutional if challenged in court. ture’’ because otherwise ‘‘the spending power case requiring criminal background checks could render academic the Constitution’s for handgun purchases pursuant to the Brady MEMORANDUM other grants and limits of Federal author- Handgun Violence Prevention Act. The Faso- To: Interested Members. ity.’’ Likewise, in Massachusetts v. United Collins language commandeers New York From: House Judiciary Committee Demo- States, 435 U.S. 444, 461 (1978), the Supreme State government to facilitate the partisan cratic Staff. Court noted that it has ‘‘repeatedly held political ends of a faction in the U.S. Con- Re: Constitutionality of Faso-Collins that the Federal Government may impose gress, which would seem well outside the Amendment. appropriate conditions on the use of Federal proscriptions of Printz. In fact, by essen- Date: March 24, 2017. property or privileges and may require that tially ordering New York to reorganize its The Faso-Collins amendment, incorporated State instrumentalities comply with condi- internal affairs, the Faso-Collins amendment into the Manager’s amendment, would vio- tions that are reasonably related to the Fed- may run even further afoul of Tenth Amend- late Constitutional limits on the Federal eral interest in particular national projects ment principles than was the case in Printz Spending Power, the Due Process and Equal or programs.’’ Under these precedents, the given the lack of a Federal purpose and the Protection Clauses and the Tenth Amend- Faso-Collins language would be held to be an interference with the core sovereign function ment (reserving all undelegated powers to arbitrary exercise of Federal power which in- of how a State chooses to use its taxing the States). Requiring New York State to trudes on only one particular State’s sov- power. change how its counties Fund its portion of ereign tax powers, and is unrelated to any It is of particular constitutional concern Medicaid expenses is not related to a legiti- Federal interest or purpose in the Medicaid that the Faso-Collins provision directly mate Federal interest, no rational Federal Program. interferes with New York’s internal deci- purpose has been proffered for the provision, As Yale Law School Professor Abbe Gluck sions about how to structure its own tax and and it would severely intrude on traditional wrote in a post on the Balkinzation blog spending policies, and how to allocate those state prerogatives. today, the Faso-Collins ‘‘amendment is like- responsibilities between the State and its If the Faso-Collins amendment were ever ly unconstitutional. The protection from fed- subdivisions—which is a core function of a enacted, it quickly would be invalidated by eral interference of the internal functions of sovereign entity protected by the Tenth the Federal courts. The irony of this a state government is one of the bedrocks of Amendment (and potentially Article IV § 4 of ‘‘buyout’’ is that the ‘‘payment’’ supposedly state sovereignty protected by the limita- the Constitution, which provides that the being delivered in exchange for votes—the tions on Congress’s powers in Article I of the ‘‘United States shall guarantee to every unconstitutional provision—is the legisla- Constitution and the reservation of power to State in this Union a Republican Form of tive equivalent of a check on a closed bank the states in the Tenth Amendment.’’ She Government.’’). This is constitutionally sig- account, which will never deliver the prom- further reasoned that ‘‘Even if one could nificant because in Reynolds v. Sims, 377 U.S. ised benefits. argue that this is an exercise of the federal 533, 575 (1964), the Supreme Court held that For the last 51 years, New York State has spending power under Article I, for Congress political subdivisions such as counties and chosen to fund a portion of its share of the to legally use that power, the conditions on cities ‘‘have been traditionally regarded as Medicaid Program by using funds from coun- a state’s use of federal funding have to be subordinate governmental instrumentalities ty property taxes. Fifteen other States tied to a reasonable federal propose . . . It is created by the State to assist in the carrying

VerDate Sep 11 2014 05:11 Mar 25, 2017 Jkt 069060 PO 00000 Frm 00068 Fmt 0636 Sfmt 0634 E:\CR\FM\A24MR7.040 H24MRPT1 SSpencer on DSK4SPTVN1PROD with HOUSE March 24, 2017 CONGRESSIONAL RECORD — HOUSE H2441 out of State governmental functions.’’ In legislation would require every state, except Medicaid funding. Compounding those cuts is Hunter v. City of Pittsburgh, 207 U.S. 161, 178 Nebraska, to shoulder its fair share of the in- a cynical so-called deal several upstate Mem- (1907), the Court noted that these subdivi- creased Medicaid costs the bill will generate. bers made to secure their votes on this bill. sions are ‘‘created as convenient agencies for The provision of the bill that relieves a sin- exercising such of the governmental powers gle state from this cost-sharing program ap- Under the bill, New York State, and ONLY of the state, as may be entrusted to them’’ pears to be not only unrelated, but also anti- New York State, will no longer be allowed to and that the ‘‘number, nature, and duration thetical to the legitimate federal interests in ask counties to provide a portion of state Med- of powers conferred upon these [entities] and the bill. icaid funding. the territory over which they shall be exer- The fundamental unfairness of H.R. 3590 Don’t be fooled—this is no deal at all for cised rests in the absolute discretion of the may also give rise to claims under the due New York and will actually gut the State’s state.’’ The Faso-Collins amendment pur- process, equal protection, privileges and im- Medicaid program, forcing hundreds of hos- ports to invoke Federal power to displace munities clauses and other provisions of the New York’s sovereign exercise of this ‘‘abso- Constitution. As a practical matter, the deal pitals to close and rationing health care for lute discretion’’ and, for that reason, vio- struck by the United States Senate on the millions of New Yorkers. lates the Constitution. As Chief Justice John ‘‘Nebraska Compromise’’ is a disadvantage But my colleagues who have traded their Marshall long ago explained in Gibbons v. to the citizens of 49 states. Every state’s tax vote for this provision have made an empty Ogden, 22 U.S. 1, 198–200 (1824), the States’ dollars, except Nebraska’s, will be devoted to bargain. This provision is flatly unconstitutional ‘‘power of taxation is indispensable to their cost-sharing required by the bill, and will be and will never be enacted. They are giving existence. . . . In imposing taxes for State therefore unavailable for other essential away health insurance for millions of New purposes, [States] are not doing what Con- state programs. Only the citizens of Ne- gress is empowered to do. Congress is not braska will be freed from this diminution in Yorkers for an empty promise. empowered to tax for those purposes which state resources for critical state services. My Republican colleagues claim we need to are within the exclusive province of the Since the only basis for the Nebraska pref- pass this bill to give people ‘‘freedom’’ to buy States.’’ erence is arbitrary and unrelated to the sub- health insurance. Let me tell you, freedom to stance of the legislation, it is unlikely that buy health insurance and actually being able OFFICE OF THE ATTORNEY GENERAL, the difference would survive even minimal to afford health insurance are two very dif- STATE OF SOUTH CAROLINA, scrutiny. We ask that Congress delete the Nebraska ferent things. December 30, 2009. They keep talking about ‘‘access’’ to health Hon. NANCY PELOSI, provision from the pending legislation, as we Speaker, House of Representatives, prefer to avoid litigation. Because this provi- care. Access is not coverage. When they talk Washington, DC. sion has serious implications for the country about access and freedom, they are con- Hon. HARRY REID, and the future of our nation’s legislative ceding that this bill does nothing to ensure Majority Leader, U.S. Senate, process, we urge you to take appropriate that Americans have affordable, comprehen- Washington, DC. steps to protect the Constitution and the sive health insurance to cover them no matter The undersigned state attorneys general, rights of the citizens of our nation. We be- what their health care needs are. lieve this issue is readily resolved by remov- in response to numerous inquiries, write to The Republicans so clearly believe that express our grave concern with the Senate ing the provision in question from the bill, version of the Patient Protection and Afford- and we ask that you do so. Americans just need freedom to buy insur- able Care Act (‘‘H.R. 3590’’). The current By singling out the particular provision re- ance, that when asked what a pregnant iteration of the bill contains a provision that lating to special treatment of Nebraska, we woman should do if her state no longer re- affords special treatment to the state of Ne- do not suggest there are no other legal or quires insurance companies to cover maternity braska under the federal Medicaid program. constitutional issues in the proposed health care, OMB Director Mick Mulvaney said she We believe this provision is constitutionally care legislation. can ‘‘figure out a way to change the state Please let us know if we can be of assist- flawed. As chief legal officers of our states [she] lives in.’’ How callous are my Republican we are contemplating a legal challenge to ance as you consider this matter. this provision and we ask you to take action Sincerely, colleagues to believe that is a real option for to render this challenge unnecessary by Henry McMaster, Attorney General, South Americans? striking that provision. Carolina; Rob McKenna, Attorney General, This bill is a cowardly, cynical effort to lower It has been reported that Nebraska Sen- Washington; Mike Cox, Attorney General, taxes on the rich and dismantle Medicare and ator Ben Nelson’s vote, for H.R. 3590, was se- Michigan; Greg Abbott, Attorney General, Medicaid as we know it. I urge my colleagues cured only after striking a deal that the fed- Texas; John Suthers, Attorney General, Col- to oppose this bill. eral government would bear the cost of orado; Troy King, Attorney General, Ala- newly eligible Nebraska Medicaid enrollees. bama; Wayne Stenehjem, Attorney General, The SPEAKER pro tempore. Pursu- In marked contrast all other states would North Dakota; Bill Mims, Attorney General, ant to clause 1(c) of rule XIX, further not be similarly treated, and instead would Virginia; Tom Corbett, Attorney General, consideration of H.R. 1628 is postponed. Pennsylvania; Mark Shurtleff, Attorney be required to allocate substantial sums, po- f tentially totaling billions of dollars, to ac- General, Utah; Bill McCollum, Attorney commodate H.R. 3590’s new Medicaid man- General, Florida; Lawrence Wasden, Attor- RECESS dates. In addition to violating the most basic ney General, Idaho; Marty Jackley, Attorney The SPEAKER pro tempore. Pursu- General, South Dakota. and universally held notions of what is fair ant to clause 12(a) of rule I, the Chair and just, we also believe this provision of Mr. NADLER. Mr. Speaker, for seven years, H.R. 3590 is inconsistent with protections af- declares the House in recess subject to the Republicans have tried and failed to repeal the call of the Chair. forded by the United States Constitution the Affordable Care Act. So now, with a Re- against arbitrary legislation. Accordingly (at 3 o’clock and 31 min- In Helvering v. Davis, 301 U.S 619, 640 (1937), publican-controlled House, a Republican-con- utes p.m.), the House stood in recess. the United States Supreme Court warned trolled Senate, and a Republican in the White f that Congress does not possess the right House, what have they presented us to vote under the Spending Power to demonstrate a on today? Republicans complained that pre- b 1630 ‘‘display of arbitrary power.’’ Congressional miums were skyrocketing, so they offer a bill AFTER RECESS spending cannot be arbitrary and capricious. that raises premiums. They complained that The spending power of Congress includes au- deductibles were too high, so they propose al- The recess having expired, the House thority to accomplish policy objectives by lowing insurance companies to charge more. was called to order by the Speaker pro conditioning receipt of federal funds on com- They complained that too many people were tempore (Mr. HOLDING) at 4 o’clock and pliance with statutory directives, as in the 30 minutes p.m. Medicaid program. However, the power is not losing their insurance, so they have embraced unlimited and ‘‘must be in pursuit of the a plan that will take away health care from 24 f ‘general welfare.’ ’’ South Dakota v. Dole, 483 million Americans. TERRORIST AND FOREIGN FIGHT- U.S. 203, 207 (1987). In Dole the Supreme This bill imposes a devastating age tax on ER TRAVEL EXERCISE ACT OF Court stated, ‘‘that conditions on federal older Americans and does next to nothing to 2017 grants might be illegitimate if they are un- protect Americans with pre-existing conditions. related to the federal interest in particular It gives nearly $900 billion in tax cuts to the The SPEAKER pro tempore. Pursu- national projects or programs.’’ Id. at 207. It insurance companies and the wealthy, while ant to clause 8 of rule XX, the unfin- seems axiomatic that the federal interest in ished business is the question on sus- H.R. 3590 is not simply requiring universal refusing coverage for services as basic as health care, but also ensuring that the states hospitalization. It’s simple: Americans will pay pending the rules and passing the bill share with the federal government the cost more and get less under this bill. (H.R. 1302) to require an exercise re- of providing such care to their citizens. This In New York, 2.7 million people will lose in- lated to terrorist and foreign fighter federal interest is evident from the fact this surance and the state will lose $4.6 billion in travel, and for other purposes.

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