Making further continuing appropriations for fiscal year 2017, and for other purposes.

Mr. Speaker, I thank the gentleman from Texas (Mr. Sessions), my good friend, the chairman of the Rules Committee for yielding me the customary 30 minutes, and I yield myself such time as I may consume.

(Mr. McGOVERN asked and was given permission to revise and extend his remarks.)

Mr. Speaker, I want to begin with some good news for my colleagues here in the House and for the American people, and that is my Republican colleagues have decided to pull their abysmal repeal and replace bill with regard to the Affordable Care Act from consideration this week. We can all breathe a sigh of relief. The American people dodged another Republican bullet here.

Their bill, as my colleagues all know, would have caused 24 million Americans to lose their health care. It would have cut Medicaid by over $800 billion, and then they would have given a trillion-dollar tax break to the richest people in the country. It would have compromised Medicare. It would have

basically denied Americans essential health protections that they currently are guaranteed in their health insurance; things like emergency room care, maternity care, mental health care. I can go on and on.

Then with their latest addition to their abysmal bill, they would have even allowed insurance companies to once again discriminate against Americans with preexisting conditions; something that they said that they wanted to protect, yet their adjustments to their abysmal healthcare bill would have allowed Americans with preexisting conditions to be discriminated against.

I mean, when we talk about essential health benefits, I want to stress the word ``essential.'' They are important, yet they are going down a road that I think is disastrous for millions of American people.

Let us begin by being thankful that we are not going to do great harm to our country this week. Now, there is always next week--we have to worry about that--but at least this week they had the common sense to pull this terrible healthcare bill that they have been working on for so long. Let's hope that we never ever see the bill. I think it is important for people to understand what is at stake. There is an awful lot at stake for tens of millions of Americans here today all across the country.

Mr. Speaker, that brings us to today. Let us be clear about why we are here again with yet another continuing resolution, the 29th--yes, you heard that right, the 29th--continuing resolution since Republicans have taken control of the House.

Republicans have nobody to blame for this mess but themselves. They control the White House, they control the Senate, and, unfortunately, they control this House. They were even the ones who set this artificial deadline of April 28 in the first place. That was after Republicans gave themselves a 2-month extension and then a 5-month extension.

Mr. Speaker, this should have all been sorted out last fall, but for 7 months Republicans have played games and delayed and bickered amongst themselves about government funding and health care and other priorities.

What do they have to show for it?

Nothing.

Now, maybe the delay was caused by this obsession from the Republican Conference with repealing the Affordable Care Act and ripping health care away from 24 million Americans. Maybe Republicans have been too busy trying to defund Planned Parenthood, trying to undo important consumer protections put in place by Democrats, trying to tear down commonsense rules to protect public safety and the environment.

Perhaps if Republicans had been responsibly working with Democratic leaders during the past 7 months, we could have already funded our government and we could be getting to work on other things that our constituents sent us here to do, like creating jobs and repairing our crumbling infrastructure.

We could have avoided events that have transpired during the past 48 hours: an emergency Rules Committee meeting, another Republican martial law rule, and threats of a Saturday session.

Mr. Speaker, to put it bluntly, this is about Republican dysfunction and incompetence, plain and simple. If Congress could be sued by the American people for malpractice, we would be in big trouble. This is indefensible. I am sure people who are watching these proceedings are scratching their heads saying: What the hell is going on in the people's House?

For the life of me, I cannot understand why we are constantly at the edge of a cliff. This Republican leadership jumps from one manufactured crisis to the next, and has proven ineffective at carrying out even its most basic responsibilities, like keeping the government's lights on and funding programs that help our constituents.

But don't take it from me. Listen to what some of my Republican colleagues are saying about the priorities of their own leadership. Representative Rooney, a Republican from Florida, said:

``I have been in this job 8 years, and I am wracking my brain to think of one thing our party has done that has been something positive, that has been something other than stopping something else from happening.''

Representative Mario Diaz Balart from Florida commented:

``It is pretty evident that we don't have the votes among Republicans to, in essence, do anything that is real.''

Mr. Speaker, when you have members of your own party making these kinds of statements, you really have to question the capacity of the Speaker and his leadership team to govern effectively.

Mr. Speaker, I very much regret that we are here today to consider another short-term CR. One week--that is all this bill does, keeps the government running for one additional week. Our constituents expect and deserve better from their elected officials.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield myself such time as I may consume.

I have a number of the day for my colleagues. I feel like I am on Sesame Street. This is the 29th closed rule this year. This is the 29th CR of this Republican majority. And the government is about to shut down when the calendar flips after midnight, and it is the 29th. So 29 must be the number of the day.

I want to wish the gentleman from Oklahoma (Mr. Cole) a happy birthday. Maybe he is 29, so it all kind of fits together.

I would just say to my colleagues, as an indication of how dysfunctional this place is: How do you get 29 closed rules in 4 months? How do we run a place in such a closed manner?

This is supposed to be a deliberative body. We are supposed to be debating issues. People are supposed to have a give-and-take on matters of importance. We have had 29 closed rules in the first 4 months of this year. It is unprecedented.

As I have been saying time and time again, when you have a lousy process, you usually end up with lousy legislation. I think that is the case with regard to the repeal and replace of the Affordable Care Act.

Here we are at the last minute trying to keep the government open for a week so we could have more time to keep it open for the rest of the year. I mean, this is not the way this place should be run.

Mr. Speaker, I yield 4 minutes to the gentlewoman from Florida (Ms. Castor), a former member of the Rules Committee.

I yield an additional 1 minute to the gentlewoman from Florida.

Mr. Speaker, I yield myself the balance of my time to close.

Mr. Speaker, I think it is clear that there is a lot of frustration on our side because of what is obviously a dysfunctional House. The fact that we are here again at the last minute trying to just keep the government running really is unfortunate. It is sad because it is not like we didn't know about this date. We have known about it for a long time.

My Republicans friends set this date. They have had months and months to figure out a way to keep the government running. They, again, are in control of the House. They are in control of the Senate. They are in control of the White House. Once again, we have a manufactured crisis where we are right at the edge of a cliff, and the best we could do today is kick the can down the road for a week and we will have this little debate again next week.

Perhaps if the leadership of this House actually focused on the people's business instead of on legislation that is about messaging or press releases, perhaps if they focused on the people's business rather than trying to undermine basic healthcare protections for people, we wouldn't have these crises all the time.

I said at the beginning of my remarks that we can breathe a sigh of relief today because my friends on the Republican side are not bringing up their abysmal repeal and replace of the Affordable Care Act bill.

They have been changing it and changing it, and there was some rumor, President Trump was saying that they would probably bring a bill up to pass it in his first 100 days because somehow it is more important to do something in 100 days than it is to get it right. But, nonetheless, they added another provision which they claim makes it more palatable to their Members. But I want my colleagues to understand that what they have done is made a bad bill worse.

The American College of Physicians sent us a letter to all Members, Democrats and Republicans, and I will just read one sentence from it. ``This amendment'' that my Republican friends added to their healthcare bill ``would make the harmful AHCA even worse by creating new coverage barriers for patients with preexisting conditions and weakening requirements that insurers cover essential benefits.''

I include in the Record the letter from the American College of Physicians.

American College of Physicians,

April 24, 2017.

Hon. Paul Ryan,

Speaker, House of Representatives,

Washington, DC.

Hon. Mitch McConnell,

Majority Leader, U.S. Senate,

Washington, DC.

Hon. Nancy Pelosi,

Minority Leader, House of Representatives,

Washington, DC.

Hon. Charles Schumer,

Minority Leader, U.S. Senate,

Washington, DC.

Dear Speaker Ryan, Minority Leader Pelosi, Majority Leader

McConnell, and Minority Leader Schumer: On behalf of the

American College of Physicians (ACP), I am writing to urge

Congress to move away from the harmful changes to patient

care that would occur if the American Health Care Act (AHCA)

were to become law, and to instead work for bipartisan

solutions to improve the Affordable Care Act (ACA) rather

than repealing and replacing it. We believe that the AHCA,

which would repeal and replace the most important coverage

and consumer protections created by the ACA, is so

fundamentally flawed that it cannot be made acceptable. We

understand that the leadership in the House of

Representatives continues to explore ways to bring a modified

version of the AHCA to a vote, based on a draft amendment

reportedly being developed by Representatives MacArthur and

Meadows, a summary of which was made available to the public

through news organizations. This amendment would make the

harmful AHCA even worse by creating new coverage barriers for

patients with pre-existing conditions and weakening

requirements that insurers cover essential benefits.

The American College of Physicians is the largest medical

specialty organization and the second-largest physician group

in the United States. ACP members include 148,000 internal

medicine physicians (internists), related subspecialists, and

medical students. Internal medicine physicians are

specialists who apply scientific knowledge and clinical

expertise to the diagnosis, treatment, and compassionate care

of adults across the spectrum from health to complex illness.

The draft MacArthur-Meadows amendment would create what is

known as the ``Limited Waiver Option'' that would allow

states to eliminate or severely weaken vital ACA Title I

consumer protections--specifically, community rating and

essential health benefits (EHBs)--returning the country to

the pre-ACA days when persons with pre-existing

``declinable'' medical conditions in most states were priced

out of the market and the insurance products available in the

individual market did not cover medically necessary services.

Specifically;

The MacArthur-Meadows amendment would create an option for

states to obtain Limited Waivers from certain federal

standards that would gut existing law consumer protections.

Based on a summary of the draft amendment, states could seek

Limited Waivers for:

Essential Health Benefits (EHBs)

Community-rating rules, except for the following

categories, which are not waivable: Gender or Age (except for

reductions of the 5:1 age ratio previously established) or

Health Status (unless the state has established a high-risk

pool or is participating in a federal high-risk pool)

To obtain the waiver, states would only need to ``attest

that the purpose of their requested waiver is to reduce

premium costs,

increase the number of persons with healthcare coverage, or

advance another benefit to the public interest in the state,

including the guarantee of coverage for persons with

preexisting medical conditions. The Secretary shall approve

applications within 90 days of determining that an

application is complete.'' [Emphasis added in italics].

In other words, as long as a state attested that there was

a ``benefit to the public,'' insurers would be once again

allowed to charge more to people with pre-existing

conditions, or decline to cover needed benefits like

physician and hospital visits, maternity care and

contraception, mental health and substance use disorder

treatments, preventive services, and prescription drugs.

This would take us back to the days when people had to fill

out intrusive insurance company applications to document

their previous health history, even before being advised what

the premium would be based on their individual health risk.

Unlike community rating, which bases premiums based on the

expected costs associated with all persons in the insurance

pool (adjusted only by age, tobacco use, and family size),

the Limited Waiver would again allow insurers in states that

obtain a waiver to again charge people exorbitant and

unaffordable premiums for their pre-existing conditions.

Before the ACA, insurance plans sold in the individual

insurance market in all but five states typically maintained

lists of so-called ``declinable'' medical conditions--

including asthma, diabetes, arthritis, obesity, stroke, or

pregnancy, or having been diagnosed with cancer in the past

10 years. Even if a revised bill would not explicitly repeal

the current law's guaranteed-issue requirement--which

requires insurers to offer coverage to persons with pre-

existing conditions like these--guaranteed issue without

community rating allows insurers to charge as much as they

believe a patient's treatment will cost. The result would be

that many patients with pre-existing conditions would be

offered coverage that costs them thousands of dollars more

for the care that they need, and in the case of patients with

expensive conditions like cancer, even hundreds of thousands

more.

An amendment to the AHCA reported out of the Rules

Committee on April 6th to establish a ``Federal Invisible

Risk Sharing Program,'' which would create a fund that states

could use to reimburse insurers for some of the costs

associated with insuring sicker patients, would not offset

the harm done to patients with pre-existing conditions by

allowing the Limited Waiver of community rating and essential

benefit protections. The pre-ACA experience with high-risk

pools was that many had long waiting lists, and offered

inadequate coverage with high deductibles and insufficient

benefits. Unless a national high-risk pool is supported with

a massive infusion of funding it will not be sufficient to

cover the millions of people with pre-existing conditions

that would be denied or charged more for coverage under the

AHCA. One paper estimates that a national high-risk pool

would cost $178.1 billion a year, roughly $176.4 billion more

than the annual funding provided to the Invisible Risk

Sharing Program. Also, shifting people out of the existing

health insurance marketplace to a high-risk pool would

undermine the assurance that enrollees could keep their

existing coverage.

The Limited Waiver Option will also allow states to seek

waivers from the essential health benefits required of all

plans sold in the individual insurance market, with the

result that millions of patients will be at risk of losing

coverage for essential services like maternity care, cancer

screening tests and treatments, prescription drugs,

preventive services, mental health and substance use disorder

treatments, and even physician visits, prescription drugs and

hospitalizations.

Prior to passage of the ACA, 62% of individual market

enrollees did not have coverage of maternity services, 34%

did not have substance-use disorder-services, 18% did not

have mental-health services and 9% did not have coverage for

prescription drugs. A recent independent analysis found that

the AHCA's repeal of current law required benefits would

result in patients on average paying $1,952 more for cancer

drugs; $1,807 for drugs for heart disease; $1,127 for drugs

to treat lung diseases; $1,607 for drugs to treat mental

illnesses; $4,940 for inpatient admission for mental health;

$4,555 for inpatient admission for substance use treatment;

and $8,501 for maternity care. Such increased costs would

make it practically impossible for many patients to avail

themselves of the care they need. The result will be delays

in getting treatment until their illnesses present at a more

advanced, less treatable, and more expensive stage, or not

keeping up with life-saving medications prescribed by their

physicians.

Allowing states to eliminate the EHB will threaten our

nation's fight against the opioid epidemic. A study concluded

that with repeal of the ACA, ``approximately 1,253,000 people

with serious mental disorders and about 2.8 million Americans

with a substance use disorder, of whom about 222,000 have an

opioid disorder, would lose some or all of their insurance

coverage.'' Finally, allowing states to drop important

benefits like maternity, substance use disorder treatment,

and preventive services will do little to reduce premiums. A

report by Milliman found that the main drivers of premium

costs were ambulatory patient services, hospitalization, and

prescription drugs. These are crucial services that form the

core of any health insurance plan.

To be clear: while some younger and healthier persons might

be offered lower premiums in states that obtained a ``Limited

Waiver'' of community-rating and essential health benefits,

it would be at the expense of making coverage unaffordable

for those who need it most, older and sicker persons, and

result in skimpy ``bare-bones'' insurance for many others

that does not cover the medical care they would need if and

when they get sick.

Finally, even without the Limited Waiver Amendment, ACP

continues to believe that the AHCA has numerous other

provisions and policies that that will do great harm to

patients including:

The phase-out of the higher federal match in states that

have opted to expand Medicaid and the ban on non-expansion

states being able to access the higher federal contribution

if they choose to expand Medicaid;

Converting the shared federal-state financing structure for

Medicaid to one that would cap the federal contribution per

enrollee;

Providing states with a Medicaid block grant financing

option;

Eliminating EHBs for Medicaid expansion enrollees;

Imposing work or job search requirements on certain

Medicaid enrollees;

Regressive age-based tax credits, combined with changes

that will allow insurers to charge older people much higher

premiums than allowed under current law;

Continuous coverage requirements for patients with pre-

existing conditions;

Legislative or regulatory restrictions that would deny or

result in discrimination in the awarding of federal grant

funds and/or Medicaid and Children's Health Insurance Program

funding to women's health clinics that are qualified under

existing federal law for the provision of evidence-based

services including, but not limited to, provision of

contraception, preventive health screenings, sexually

transmitted infection testing and treatment, vaccines,

counseling, rehabilitation, and referrals, and;

Elimination of the Prevention and Public Health Fund, which

provides billions in dollars to the enters for Disease

Control and Prevention to prevent and control the spread of

infectious diseases.

The College strongly believes in the first, do no harm

principle. Therefore, we continue to urge that Congress move

away from the fundamentally flawed and harmful policies that

would result from the American Health Care Act and from the

changes under consideration--including the proposed ``Limited

Waiver'' amendment--that would make the bill even worse for

patients. We urge Congress to instead start over and seek

agreement on bipartisan ways to improve and build on the ACA.

The College welcomes the opportunity to share our ideas for

bipartisan solutions that would help make health care better,

more accessible, and more affordable for patients rather than

imposing great harm on them as the AHCA would do.

Sincerely,

Jack Ende, MD, MACP,

President.

Mr. Speaker, we have a press release from the American Hospital Association. Their line here is: ``Our top concern is what this change could mean for older and sicker patients, including those with preexisting conditions such as cancer patients and those with chronic conditions'' could suffer. ``This amendment proposed this week would dramatically worsen the bill.''

I include in the Record the American Hospital Association press release.

[From the American Hospital Association--April 27, 2017]

Statement on the American Health Care Act

(By Rick Pollack, President and CEO, American Hospital Association)

The latest version of the AHCA continues to put health

coverage in jeopardy for many Americans. Our top concern is

what this change could mean for older and sicker patients,

including those with pre-existing conditions, such as cancer

patients and those with chronic conditions. For these

reasons, along with our previously stated concerns about the

AHCA, we cannot support the bill. However, we urge Congress

to continue to work with stakeholders on a solution that

provides meaningful coverage.

The amendment proposed this week would dramatically worsen

the bill. The changes included put consumer protections at

greater risk by allowing states to waive the essential health

benefit standards, which could leave patients without access

to critical health services and increase out-of-pocket

spending. This could allow plans to set premium prices based

on individual risk for some consumers, which could

significantly raise costs for those with pre-existing

conditions.

Additionally, the Congressional Budget Office has not yet

scored the amendment. However, CBO previously projected that

the AHCA would result in 24 million fewer people covered in

2026. It is unlikely this amendment would improve these

coverage estimates.

As the backbone of America's health safety-net, hospitals

and health systems must protect access to care for those who

need it and ensure that the most vulnerable patients are not

left behind. The AHCA continues to fall far short of that

goal.

Mr. Speaker, the AARP issued yet another statement saying: ``This harmful legislation still puts an age tax on older Americans and puts vulnerable populations at risk through a series of backdoor deals that attempts to shift responsibility to States.''

I include in the Record the statement from the AARP.

AARP Maintains Opposition to Amended Health Bill

Age Tax, Weakening Medicare, Backdoor Cuts to Preexisting Condition

Population Would Harm American Families

Washington, DC.--AARP Executive Vice President Nancy

LeaMond released the following statement today in response to

the amended House bill that would create an ``Age Tax,''

increase premiums, eliminate protections for pre-existing

conditions, cut the life of Medicare, and give sweetheart

deals to big drug and insurance companies. In a letter sent

to all 435 members of the U.S. House of Representatives, AARP

restated its strong opposition to the bill and urged each

Representative to vote `No' on the proposed legislation. AARP

believes this legislation will have a significant harmful

impact on the health of millions of older Americans ages 50

to 64, as well as other vulnerable groups, including poor

seniors and disabled children and adults:

``This harmful legislation still puts an Age Tax on older

Americans and puts vulnerable populations at risk through a

series of backdoor deals that attempts to shift

responsibility to states. Older Americans need affordable

health care services and prescriptions. This legislation

still goes in the opposite direction, increasing insurance

premiums for older Americans and not doing anything to lower

drug costs.

``AARP continues to oppose legislation that would impose an

Age Tax, eliminate protections for preexisting conditions,

weaken Medicare, erode seniors' ability to live independently

because of billions of dollars in Medicaid cuts, and give

sweetheart deals to drug and insurance companies while doing

nothing to lower the cost of health care or prescription

drugs.

``We intend to let all 38 million of our members know

exactly how their Representative votes on this bill in

newsletters, in our publications, on social media and in

other formats. Our members care deeply about their health

care and have told us repeatedly that they want to know where

their elected officials stand.''

Past statements and releases about this bill can be found

here, here, here, and here. Public policy fact sheets about

the Age Tax and other harmful policies can be found here.

AARP's full letter to the House of Representatives can be

found below:

April 26, 2017.

Dear Representative: AARP, with its nearly 38 million

members in all 50 States and the District of Columbia, Puerto

Rico, and U.S. Virgin Islands, is a nonpartisan, nonprofit,

nationwide organization that helps people turn their goals

and dreams into real possibilities, strengthens communities

and fights for the issues that matter most to consumers and

families such as healthcare, employment and income security,

retirement planning, affordable utilities and protection from

financial abuse.

We write to again share our opposition to the pending

American Health Care Act (AHCA) and urge you to vote NO.

Throughout consideration of the AHCA, we have been expressing

serious concerns about the impact that this legislation will

have on older Americans. The Congressional Budget Office

(CBO)'s last estimate further demonstrates the harmful impact

of this bill on older Americans and some of our most

vulnerable. Specifically, we are concerned that the American

Health Care Act will weaken the fiscal sustainability of

Medicare; dramatically increase premium and out-of-pocket

costs for 50-64 year olds purchasing coverage on the

individual insurance market; substantially increase the

number of Americans without insurance; and put at risk

millions of children and adults with disabilities and poor

seniors who depend on the Medicaid program to access long-

term services and supports and other benefits. In addition,

changes under consideration that would allow states to waive

important consumer protections--such as allowing insurance

companies to once again charge Americans with pre-existing

conditions more because they've had cancer, diabetes or heart

disease--would make this bad bill even worse.

Our members and others 50 years of age and older care

deeply about health care and want to know where their elected

leaders stand. Recognizing the importance of the upcoming

vote on the American Health Care Act, AARP intends to inform

our members, and others over age 50, how their elected

officials voted. We'll communicate the results of the vote in

our widely-circulated publications, in email alerts, in our

online channels, and through the media. Again, we urge all

Representatives to vote NO on the American Health Care Act in

its current form.

Medicare

Our members and older Americans believe that Medicare must

be protected and strengthened for today's seniors and future

generations. We strongly oppose any changes to current law

that could result in cuts to benefits, increased costs, or

reduced coverage for older Americans. According to the 2016

Medicare Trustees report, the Medicare Part A Trust Fund is

solvent until 2028 (11 years longer than pre-Affordable Care

Act (ACA)), due in large part to changes made in the ACA. We

have serious concerns that the American Health Care Act

repeals provisions in current law that have strengthened

Medicare's fiscal outlook, specifically, the repeal of the

additional 0.9 percent payroll tax on higher-income workers.

Repealing this provision would remove $117.3 billion from the

Hospital Insurance trust fund over the next ten years, would

hasten the insolvency of Medicare by up to four years, and

diminish Medicare's ability to pay for services in the

future.

Prescription Drugs

Older Americans use prescription drugs more than any other

segment of the U.S. population, typically on a chronic basis.

We are pleased that the bill maintains the Medicare Part D

coverage gap (``donut hole'') protections created under the

ACA. Since the enactment of the law, more than 11.8 million

Medicare beneficiaries who have fallen into the coverage gap

have saved over $26.8 billion on the improved coverage for

prescription drug costs due to closure of the donut hole. We

do have strong concerns that the fee on manufacturers and

importers of branded prescription drugs, which currently is

projected to add $24.8 billion to the Medicare Part B trust

fund between 2017 and 2026, will be repealed by the American

Health Care Act. Rather than repeal this fee for Medicare,

AARP believes Congress must do more to reduce the burden of

high prescription drug costs on consumers and taxpayers, and

we would be willing to work with you on bipartisan solutions.

Individual Private Insurance Market

About 6.1 million Americans age 50-64 currently purchase

insurance in the non-group market, and nearly 3.2 million are

currently eligible to receive subsidies for health insurance

coverage through either the federal health benefits exchange

or a state-based exchange (exchange). We have seen a

significant reduction in the number of uninsured since

passage of the ACA, with the number of 50-64 year old

Americans who are uninsured dropping by half. We are deeply

concerned that the AHCA would be a significant step backwards

and result in millions of older Americans who cannot afford

their health care, including many simply losing their health

care.

Based on CBO estimates, approximately 14 million Americans

will lose coverage next year, while a total of 24 million

Americans would lose coverage over the next 10 years. This is

especially troubling given that in the CBO and Joint

Committee on Taxation's (JCT) assessment ``the non-group

(individual) market would probably be stable in most areas

. . . under current law.''

Affordability of both premiums and cost-sharing is critical

to older Americans and their ability to obtain and access

health care. A typical 50-64 year old seeking coverage

through an exchange has a median annual income of under

$25,000 and already pays significant out-of-pocket costs for

health care. We have serious concerns--reinforced by the CBO

estimate--that the bill under consideration will dramatically

increase health care costs for 50-64 year olds who purchase

health care through an exchange due both to the changes in

age rating from 3:1 (already a compromise that requires

uninsured older Americans to pay three times more than

younger individuals) to 5:1 and reductions in current tax

credits for older Americans. CBO concluded that the bill will

substantially raise premiums for older people and force many

into lower quality plans.

Age rating plus reduced tax credits equal an unaffordable

age tax. Our previous estimates on the age-rating change

showed that premiums for current coverage could increase by

up to $3,200 for a 64 year old, while reducing premiums by

only about $700 for a younger enrollee. Significant premium

increases for older consumers will make insurance less

affordable, will not address their expressed concern about

rising premiums, and only encourage a small increase in the

enrollment numbers for younger persons.

In addition to increasing premiums from the age rating

change, the bill reduced the tax credits available for older

Americans to help purchase insurance. We estimate that the

bill's changes to current law's tax credits alone could

increase premium costs for a 55-year old earning $25,000 by

more than $2,300 a year. For a 64-year old earning $25,000,

that increased premium rises to more than $4,400 a year, and

more than $5,800 for a 64-year old earning $15,000.

Overall, both the bill's tax credit changes and 5:1 age

rating would result in skyrocketing cost increases for older

Americans. In their analysis, CBO found that a 64 year old

earning $26,500 a year would see their premiums increase by

$12,900--758 percent--from $1,700 to $14,600 a year. In

addition, older workers could also face higher out-of-pocket

costs because the bill eliminates cost-sharing subsidies

which help lower-income Americans with their co-pays and

deductibles. It cannot be overstated how much this bill would

erase recent gains in health care coverage and affordability

for 50-64 year olds, leading to large spikes in the number of

uninsured and financial hardship for millions of older

Americans.

Current law prohibits insurance companies from

discriminating against individuals due to a preexisting

condition. We are extremely concerned that the bill may now

repeal pre-

existing condition protections and would once again allow

insurance companies to charge Americans more due to a pre-

existing condition. We estimate that 40 percent of 50- to 64-

year-olds (or about 25 million people in this age group) have

a deniable pre-existing condition and risk losing access to

affordable coverage. We strongly oppose any weakening of the

law's pre-existing condition protections which benefit

millions of Americans.

Medicaid and Long-Term Services and Supports

AARP opposes the provisions of the American Health Care Act

that create a per capita cap financing structure in the

Medicaid program. We are concerned that these provisions

could endanger the health, safety, and care of millions of

individuals who depend on the essential services provided

through Medicaid. CBO found that the bill would cut Medicaid

funding by $880 billion over 2017-2026. By 2026, CBO expects

Medicaid spending to be about 25 percent less than what it

projects under current law. Medicaid is a vital safety net

and intergenerational lifeline for millions of individuals,

including over 17.4 million low-income seniors and children

and adults with disabilities who rely on the program for

critical health care and long-term services and supports

(LTSS, i.e., assistance with daily activities such as eating,

bathing, dressing, managing medications, and transportation).

Older adults and people with disabilities now account for

over sixty percent of Medicaid spending, and cuts of this

magnitude will result in loss of benefits and services for

this vulnerable population.

Of these 17.4 million individuals: 6.9 million are ages 65

and older (which equals more than 1 in every 7 elderly

Medicare beneficiaries); 10.5 million are children and adults

living with disabilities; and about 10.8 million are so poor

or have a disability that they qualify for both Medicare and

Medicaid (dual eligibles). Dual eligibles account for almost

33 percent of Medicaid spending. While they comprise a

relatively small percentage of enrollees, they account for a

disproportionate share of total Medicare and Medicaid

spending.

Individuals with disabilities of all ages and older adults

rely on critical Medicaid services, including home and

community-based services (HCBS) for assistance with daily

activities such as eating, bathing, dressing, and home

modifications; nursing home care; and other benefits such as

hearing aids and eyeglasses. People with disabilities of all

ages also rely on Medicaid for access to comprehensive acute

health care services. For working adults, Medicaid can help

them continue to work; for children, it allows them to stay

with their families and receive the help they need at home or

in their community. Individuals may have low incomes, face

high medical costs, or have already spent through their

resources paying out-of-pocket for LTSS, and need these

critical services. For these individuals, Medicaid is a

program of last resort.

In providing a fixed amount of federal funding per person,

this approach to financing would likely result in

overwhelming cost shifts to states, state taxpayers, and

families unable to shoulder the costs of care without

sufficient federal support. This would result in cuts to

program eligibility, services, or both--ultimately harming

some of our nation's most vulnerable citizens. In terms of

seniors, we have serious concerns about setting caps at a

time when per-beneficiary spending for poor seniors is likely

to increase in future years. By 2026, when Boomers start to

turn age 80 and older, they will likely need much higher

levels of service--including HCBS and nursing home--moving

them into the highest cost group of all seniors. As this

group continues to age, their level of need will increase as

well as their overall costs. We are also concerned that caps

will not accurately reflect the cost of care for individuals

in each state, including for children and adults with

disabilities and seniors, especially those living with the

most severe disabling conditions. CBO estimates that Medicaid

spending on a per-enrollee basis would grow at a faster rate

than the consumer price index for medical care services (CPI-

M)--3.7 percent for CPI-M versus an average annual growth

rate of 4.4 percent for Medicaid over the 2017-2026 period.

Over time, the difference in the growth rate under the per

capita cap (CPI-M) and the actual cost of care would further

shift costs to states, which could result in even greater

potential harm to some of the most vulnerable individuals.

AARP is also opposed to the repeal of the six percent

enhanced federal Medicaid match for states that take up the

Community First Choice (CFC) Option. CFC provides states with

a financial incentive to offer HCBS to help older adults and

people with disabilities live in their homes and communities

where they want to be. About 90 percent of older adults want

to remain in their own homes and communities for as long as

possible. HCBS are also cost effective. On average, in

Medicaid, the cost of HCBS per person is one-third the cost

of institutional care. Taking away the enhanced match could

disrupt services for older adults and people with

disabilities in the states that are already providing

services under CFC and would result in a loss of about $12

billion for HCBS over ten years.

AARP also has concerns with the removal of the state option

in Medicaid to increase the home equity limit above the

federal minimum. This provision would take away flexibility

for states to adjust a Medicaid eligibility criterion based

on the specific circumstances of each state and its residents

beyond a federal minimum standard. AARP continues to support

critical consumer protections included in current law,

including guaranteed issue, prohibitions on preexisting

condition exclusions, bans on annual and lifetime coverage

limits and allowing families to keep children on their

policies until the age of 26. Also, AARP continues to support

restoring the 7.5 percent threshold for the medical expense

deduction which will directly help older Americans struggling

to pay for health care, particularly the high cost of nursing

homes and other long-term services and supports.

We look forward to working with you to ensure that we

maintain a strong health care system that ensures robust

insurance market protections, controls costs, improves

quality, and provides affordable coverage to all Americans.

Sincerely,

Nancy A. LeaMond,

Executive Vice President and

Chief Advocacy and Engagement Officer.

Mr. Speaker, the American Medical Association sent letters to Speaker Ryan and Minority Leader Pelosi saying that ``We are deeply concerned that the AHCA would result in millions of Americans losing their current health insurance coverage. Nothing in the'' so- called ``MacArthur amendment remedies the shortcomings of the underlying bill.''

And then they say that, basically, this addition that the Republicans added to the healthcare bill ``could effectively make coverage completely unaffordable for people with preexisting conditions.''

I include in the Record the letter from the American Medical Association.

American Medical Association,

Chicago, IL, April 27, 2017.

Hon. Paul Ryan,

Speaker, House of Representatives,

Washington, DC.

Hon. Nancy Pelosi,

Democratic Leader, House of Representatives,

Washington, DC.

Dear Speaker Ryan and Leader Pelosi: After reviewing the

MacArthur Amendment to H.R. 1628, the American Health Care

Act (AHCA), the American Medical Association (AMA) remains

opposed to passage of this legislation. As we have previously

stated, we are deeply concerned that the AHCA would result in

millions of Americans losing their current health insurance

coverage. Nothing in the MacArthur amendment remedies the

shortcomings of the underlying bill. The amendment does not

offer a clear long-term framework for stabilizing and

strengthening the individual health insurance market to

ensure that low and moderate income patients are able to

secure affordable and adequate coverage, nor does it ensure

that Medicaid and other critical safety net programs are

maintained and adequately funded.

The MacArthur Amendment would allow states to apply for

waivers from critical consumer protections provided in the

Affordable Care Act (ACA), including the age rating ratio of

3 to 1, the requirements that health insurers must cover

certain essential health benefits, and the ban on health

status underwriting. The current ban on health status

underwriting protects individuals from being discriminated

against by virtue of their medical conditions. Prior to the

passage of the ACA, such individuals were routinely denied

coverage and/or priced out of affordable coverage. We are

particularly concerned about allowing states to waive this

requirement because it will likely lead to patients losing

their coverage. Although the MacArthur Amendment states that

the ban on preexisting conditions remains intact, this

assurance may be illusory as health status underwriting could

effectively make coverage completely unaffordable to people

with preexisting conditions. There is also no certainty that

the requirement for states to have some kind of reinsurance

or high-risk pool mechanism to help such individuals will be

sufficient to provide for affordable health insurance or

prevent discrimination against individuals with certain high-

cost medical conditions.

We continue to strongly urge Congress to engage in a

bipartisan, bicameral dialogue with stakeholders to work on

policies that enhance coverage, choice, and affordability.

Sincerely,

James L. Madara, MD.

Mr. Speaker, I find all this particularly puzzling because my friends have said over and over and over and over again that they agree with Democrats when it comes to protecting people with preexisting conditions. They said that they do not want insurance companies to have the ability to discriminate against people with preexisting conditions. And yet what they have done is they have created a repeal-and-replacement bill that does just that and then goes after essential benefits.

Again, we have been talking about essential benefits over and over and over again. And again, I want to remind my colleagues what the word ``essential'' means. Go to the dictionary.

Look up the word ``essential.'' It says, absolutely necessary, extremely important. That is the definition of essential. And so when we talk about essential health benefits, that is what we are talking about.

I have one additional speaker. I was going to close, but I would ask indulgence.

Mr. Speaker, I yield 2 minutes to the gentlewoman from Texas (Ms. Jackson Lee).

I yield the gentlewoman from Texas an additional 1 minute.

Mr. Speaker, I yield myself such time as I may consume.

I thank the gentlewoman for her remarks. I thank the chairman of the Rules Committee for his indulgence.

I would just close by saying I think it is sad that we are here at the last minute trying to kick the can down the road to keep the government running again for 1 additional week. This could have been avoided and, again, it could have been avoided if, instead of trying to take away people's health insurance, instead of trying to take away people's essential health benefits, instead of trying to cut Medicaid by $800 billion and taking that money and giving a tax break of close to $1 trillion to the richest people in the country, that we actually focused on our job, which is keeping this government running.

But my colleagues on the Republican side are in charge. We are where we are. We have to keep the government running.

Having said all of that, I yield back the balance of my time.

Mr. Speaker, as the gentleman from Massachusetts was speaking, I rushed to the floor because he was making such eloquent and important statements, and I wanted to make sure to join him on recognizing that, though we are pushing the can down the road, we know what the mindset of the administration is in terms of funding this country. As a member of the Budget Committee, we received the skinny budget, and, to my dismay, it was a budget that harmed and hurt and undermined the governance of this Nation.

I think it is important to match the Affordable Care Act with the outside needs of living and thriving in this Nation. So my Houston Housing Authority has now stopped vouchers for families in Section 8 housing for fear of not having the money. They had breaking news 2 days ago telling those families, don't show up because we have no money to house you--similar to no money and no room at the inn.

The zeroing out of the community development dollars, which ends our opportunities for parks and sidewalks and housing and fixing those hurricane roofs of senior citizens who are living in devastation from Hurricane Ike.

It is not realizing the importance of the National Endowment for the Arts or recognizing the EPA and clean air and clean water for those of us who live near the Gulf or near the border.

It is not recognizing that you are not the President of the 10 percent that may approve of what you are doing, but you are the President of the United States of America.

And then, for those who work in health care, in a meeting I just had with the National Institutes of Health, $6 billion cut. Do you realize that one of the institutes sends 88 percent of their moneys out for grants so that researchers, young scientists who live here in the United States, can thrive and provide new kinds of research?

There are 27 institutes in the National Institutes of Health. One of them happens to deal with diabetes. The number one is cancer. And for those of us who have experienced it, and for African- American women and others who have the triple negative trait, breast cancer, the research of the NIH is crucial.

Or Dr. Fauci's National Institute of Allergy and Infectious Diseases. Dr. Peter Hotez, in Houston, head of Baylor Infectious Diseases, understands Ebola and Zika. We need these resources. What an outrage to cut, in the skinny budget, $6 billion.

So we may push this to another 7 days, but I can tell you that we are pushing the hearts and minds of Americans. We are creating a disaster.

And I can't appreciate the fact that law enforcement will be losing funding. The Department of Justice and the Civil Rights Division, in spite of who is leading that Department, it is a Department for the vulnerable.

So I thank the gentleman for providing me with this time, but I wanted to make sure that we added this long litany of those who will be negatively impacted and that America is not about that. America is about serving all of the people of the United States.

Mr. Speaker, I rise to speak about H.J. Res. 99, ``Making Further Continuing Appropriations for Fiscal Year 2017.''

This resolution is an imperfect vehicle for appropriations for FY 2017, because it does not fully fund the government for the entire fiscal year and it keeps in place sequestration.

H.J. Res. 99 goes against sound fiscal practice by including the budget gimmickry known as sequestration, a fiscal bludgeon that makes across the board cuts in funding for the valuable services depended upon by American children, seniors, workers, veterans, students, and small businesses.

Mr. Speaker, the Continuing Resolution before us extends current Fiscal Year 2017 government funding by seven days, through May 5, 2017, at its current rate, which means a continuation of the across-the-board cut of .19% for all accounts, defense and non-defense, contained in the expiring continuing resolution that was approved December 8, 2016.

Mr. Speaker, I am disappointed that we have again been placed in the position of having to fund the government through the device of a continuing resolution rather than through the normal appropriations process of considering and voting on the twelve separate spending bills reported by the Committee on Appropriations.

H.J. Res. 99 is far from perfect, but it is a modest and positive step since it ensures that funding for appropriated entitlements will continue at a rate maintaining program levels under current law and, for a week at least, prevents congressional Republicans from shutting down the government again and manufacturing a crisis that only harms our economy, destroys jobs, and weakens our middle class.

The government shutdown of 2013, which was manufactured by the Republican majority lasted 16 days and cost taxpayers $24 billion.

The enormous harm and disruption of the lives of federal employees and the people they serve, however, was irreparable.

As I stated, Mr. Speaker, this Continuing Resolution is not perfect and it only funds the government until May 5, 2017.

As veteran and seasoned Members of Congress, we have been in this challenging position before.

But working together--in a spirit of goodwill, bipartisanship, and realism, I believe we can reach a long-term agreement that will avert a shutdown of government operations and the disruption a shutdown causes to the lives of millions of Americans who depend upon federal programs to do their jobs, educate their kids, care for their parents, and contribute to their communities.

Our constituents look to the Congress and the President to make responsible choices and decisions to keep the nation safe, the economy prosperous, and to make necessary and prudent investments in education, healthcare and research, transportation and infrastructure, economic development, science, the arts and humanities, and the environment.

This is, after all, just another way of saying that the American people expect their leaders in Washington be guided by the Constitution's Preamble and pursue policies and provide the resources that will:

``establish justice, ensure domestic tranquility, provide for the common defense, promote the general welfare, and secure the blessings of liberty.''

The funding priorities that have been floated by the Trump Administration fail this essential test of leadership because they are irresponsible, impracticable, unrealistic, and, in many respects, insensitive or indifferent to the deleterious impact they will have on the lives of real people living in the real world.

They do not command majority support in the Congress or of the public.

To win such support, I believe that it is essential that any subsequent continuing resolution or omnibus appropriations bill achieves the following goals and objectives:

``To establish justice'' and ``To promote the general welfare'':

1. Full funding for the U.S. Department of Justice Civil Rights Division and the Department of Education Office of Civil Rights so that they have funds needed to enforce laws protecting civil rights, voting rights, and prosecuting hate crimes.

2. Fully funds community development block grants and low income housing programs in urban and rural communities.

3. Fully funds the Legal Services Corporation so that working and low-income persons who lack an army of lobbyists to represent them in Washington will at least have the assistance of counsel to defend their legal rights in courts of law.

4. Fully funds programs providing food assistance to housebound seniors, such as Meals on Wheels.

5. Fully funds programs that provide students from low and moderate- income families access to affordable higher education and provides students with special needs the support needed to receive the free appropriate public education (FAPE) in the least restrictive environment (LRE) guaranteed by the Individuals with Disabilities Education Act (IDEA Act).

6. Fully funds before and after school programs and other student enrichment programs that help students succeed.

7. Fully funds programs that make federal housing safer through energy efficient heating and cooling systems.

8. Preserves tax credit programs that help revitalize low income communities.

9. Fully funds the Environmental Protection Agency and Department of Energy programs developing the next generation of clean energy and transportation technologies.

``Provide for the common defense'':

1. Provides robust funding for the Department of State and USAID to advance national security interests in places like Iraq and Afghanistan and to end violent conflicts in trouble spots which could threaten the security interests of the United States.

2. Provides adequate funding for United Nations peacekeeping missions throughout the world and distribution of food aid to people in developing and famine stricken countries, such as South Sudan, Somalia, Yemen, and Nigeria.

``To ensure domestic tranquility'':

1. Fully funds cost-sharing reduction subsidies, or CSRs, to compensate insurers for reducing deductibles and out-of-pocket maximums for low-income customers on the Affordable Care Act exchanges.

2. Protects the adequacy, solvency, and integrity of the Medicare and Medicaid programs, which provide health sustaining support for 70 million Americans.

3. Fully funds the National Institutes of Health research programs so that patient access to lifesaving treatments is not delayed.

4. Does not convert funding for the Centers for Disease Control and Prevention into block grants which would hinder the nation's ability to respond swiftly and effectively to public health crises like Ebola, Zika, and HIV/AIDS.

Mr. Speaker, I believe that if all members of the House and Senate work together, we can reach agreement on an appropriate budget framework that invests in the American people, preserves our national security, and keeps faith with the values that have served our nation well and made the United States the leading nation on earth.

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 289 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Massachusetts (Mr. McGovern), my friend, the ranking member of the committee, pending which I yield myself such time as I may consume.

General Leave

Mr. Speaker, I ask unanimous consent that all members have 5 legislative days to revise and extend their remarks.

Mr. Speaker, I rise today in support of the rule. It is a fair rule that enables this body to continue working in a bipartisan fashion to get our work done for the American people. Essentially, it is to fund the government for one more week as final preparations are made and as the Appropriations Committee finalizes its work. It enables us to continue to serve our constituents. It enables the American people to have confidence not only in what we are doing, but to provide the necessary resources so that this Nation can continue to protect itself also.

I also rise in support of the underlying legislation that is in this rule. This short-term CR, while being far from ideal, is exactly what we need to do so that we can allow our colleagues in the House, as well as the Appropriations Committee and this body, to move forth a bill that will find its way to the United States Senate and to the President's desk.

For months now, our colleagues on the Appropriations Committee, under the great work of our brand-new chairman, Chairman Frelinghuysen from New Jersey, have been working towards funding a government agreement while they are trying to reach a long-term bridge.

Yesterday at the Rules Committee, the young chairman, along with the ranking member, Mrs. Lowey from New York, came and spoke to the Rules Committee not only with great confidence about the work that they are doing, but with great confidence about how they worked well together. It was once again another opportunity for Members of Congress in the performance of their duties to have confidence not only in their working relationship, but in the product that they would wish to move forward.

The Rules Committee was quite blunt to them that, while we were pleased to see them, we wanted to see them get their work done a week from now. I think the American people feel the same way. I think they are willing to take the time to do it right, but it is now time to feel a little bit of pressure towards completing the work that needs to be done.

Mr. Speaker, today we are going to have one of the most distinguished members of the Rules Committee who will speak with us. He shares a role not only as vice chairman of our committee, but he also has an opportunity to sit on the Appropriations Committee; a person responsible as a cardinal for a massive part of not only the Federal Government spending, but the authority and responsibility for the Federal Government to deliver in so many areas in support of the American people.

I will be introducing the gentleman from Oklahoma (Mr. Cole) in just a few minutes, who will also provide detail and information not only in support of the great work that is being done, but why we are doing that for the American people.

Mr. Speaker, I am confident that my colleagues on the Appropriations Committee are going to continue their work. We are asking this body today to consider this rule to move forth legislation.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I appreciate the gentleman, my friend from Massachusetts, for his words of wisdom about the direction we ought to be going. That is what we are going to do; we are going to continue moving.

I find in my job, as I perform my duties, that I have a chance to really interact with a lot of people in government. Over Christmas, I had a chance to visit our troops around the world and look at them and give them the confidence that what we do in Washington will allow them to keep working for freedom and to represent us.

Dr. Francis Collins at the National Institutes of Health, an enormously brilliant man who helped with the genome project, who keeps NIH up and working; and at the National Eye Institute, Dr. Paul Sieving; and so many others who do count on us getting it right, whether it be the United States military, whether it is our border patrol, whether it is our health and human services, but the person who knows these characteristics of what it takes to get agreements is also on the Rules Committee. He is a valuable member of our Rules Committee. He is the gentleman from Oklahoma (Mr. Cole).

Mr. Speaker, I yield 10 minutes to the gentleman from Oklahoma (Mr. Cole), vice chairman of the Labor, Health and Human Services, Education, and Related Agencies Subcommittee.

Mr. Speaker, also I want to recognize the gentleman from Oklahoma (Mr. Cole) for another birthday today. The gentleman from Oklahoma was very silent last night at the Rules Committee. He didn't let us know, so we didn't say anything. But today is his birthday, and I congratulate him for that.

I reserve the balance of my time.

Mr. Speaker, last night at the Rules Committee, we had a debate where we focused our attention not only on the legislation, but also on the need to get this done.

I appreciate the gentlewoman from Florida (Ms. Castor), the gentleman from Oklahoma (Mr. Cole), and the gentleman from Massachusetts (Mr. McGovern) and their attention to the ideas that they have. They do have ideas, and they do have decisions that would help make this process even better. We are here today for the right reasons.

I would advise the gentleman from Massachusetts (Mr. McGovern) that I do not have any further speakers, and I reserve the balance of my time pending his close.

Mr. Speaker, I yield myself such time as I may consume.

I want to thank the gentleman from Massachusetts. I want to thank the gentlewoman from Florida and the gentlewoman from Texas for their comments about trying to focus us on the activities that perhaps they would want or not want.

Mr. Speaker, today we are here because Chairman Frelinghuysen and Ranking Member Lowey came to the Rules Committee yesterday and asked us to please consider the offer that they were laying on the table, and that is to fund the government for 1 more week, with an assurance that they needed 1 more week to complete their work.

You heard the gentleman, the Honorable Tom Cole, distinguished gentleman from not only Oklahoma, but a gentleman from the Appropriations Committee, reinforce how important the work is.

We have heard from our colleagues on the Democratic side how important the NIH is, Francis Collins, the work that he does there; the United States Military; Secretary of Defense Mattis; the men and women that protect us; those people that are in Homeland Security. That is what we are going to do, so that is what we are going to focus on, and that is just the way it is.

So, Mr. Speaker, I would urge all my colleagues to support this rule and the underlying legislation.

I yield back the balance of my time, and I move the previous question on the resolution.

The previous question was ordered.

Mr. Speaker, on that I demand the yeas and nays.

Mr. Speaker, I thank the chairman, my good friend, for yielding me the time and for those incredibly gracious and generous remarks.

Mr. Speaker, I certainly rise to support the rule and the underlying legislation. By the very nature of Rules debates, everything seems to be partisan because it seems to be sort of shirts and skins as it is on the rules. The reality is the legislation we are talking about has actually been requested by both parties. We had both the chairman and the ranking member in there requesting because they are working together in a bipartisan way to produce a major piece of legislation that will direct spending for the United States government in the range of about $1 trillion between now and September 30.

The important thing to note is that it is a very bipartisan negotiation between two very skillful legislators, Chairman Frelinghuysen and Ranking Member Nita Lowey. When they bring that legislation to the floor, as they will next week, it is going to have some pretty important and pretty major things on it.

We are not only going to adequately fund our military, we are going to increase that. We are going to give the President some things he has asked for in terms of supplemental money for defense to upgrade and improve our military.

We are going to give him some additional things for border security as well that, again, both parties have agreed on. I think we all want secure borders. We know there is always some debate about exactly how or what we should do, but, in this case, we have a bipartisan agreement.

We will actually give a very substantial increase to the National Institutes of Health, which, as the gentleman from Texas (Mr. Sessions) mentioned, great work is done on behalf of the American people in that institution. Frankly, it has been Republicans that first doubled that back in the late 1990s and early 2000s and now have reignited the biomedical research engine by putting additional resources in there. It is

something our friends support, but actually it was Republicans who took the initiative to achieve.

We will see some really important increases in some education programs that give some of our less advantaged citizens opportunities to go: TRIO, GEAR UP. Both prepare individuals for higher education and then have a chance to exploit the opportunity when it comes.

So that bill will have a lot of good things in it that will be bipartisan. My good friend from Massachusetts (Mr. McGovern) mentioned--and I think appropriately so--that there is a certain amount of dysfunction in the appropriations process. Where we probably disagree is--I have got to tell you, it is not new. Since we passed the Budget Control Act over 40 years ago in 1974, budgets and appropriations have been completed on time exactly four times. It didn't matter who was in charge. So maybe we ought to go back and look at that defective process that was set in motion by our friends back when they controlled both Chambers in overwhelming numbers and rethink how we do this.

I do agree with the gentleman from Massachusetts (Mr. McGovern) that it is important to focus on first things first. And while tax reform is a very important goal that, I think, this Congress will achieve and while health care is a very important goal, which I certainly hope this Conference achieves and I think we are working toward, there is no question the most important thing we do around here is fund the government every day. We make sure that our military has what it needs to protect us and that our border control officials have what they need to make sure they are secure, that we do things like look for cures for Alzheimer's and cancer at the NIH. To me, that always is the most important thing it has to do.

So, in this bill and in the bill that will follow next week, we are actually doing what we should do. We are putting first things first. Let's make sure these basics are done for the American people, and then let's get about the important business of changing their Tax Code and making sure that they have the best health care in the world.

In my view, Congress could have--and to my friend's point--could have and should have done this months ago. It is important to note that the Appropriations Committee had reported out all 12 of the bills that fund the day-to-day operation of the budget. Five of them actually moved across the floor. We did run into problems in the United States Senate where there was a lot of obstruction, but the Appropriations Committee did its job. We just have to now, as a Congress, do our job and make sure those bills get to the floor in a timely manner, and that we do the right thing so that they pass.

The Appropriations Committee can only prepare them. They don't get to schedule them on the floor. They don't get to move them across the floor. That has to be done with all sides working together for the good of the American people.

Again, it is worth noting that we can do this process. Two years in a row, we have done all 12 bills. So I would hope in the future, as we make these decisions--and my friend is right, a decision was made in November or December. It is not one I agreed with--to wait and say let's let the new administration have some input on this. Now, there is certainly nothing wrong with that.

The new administration wants to come in, and there is a vehicle called a supplemental, where, if they want to tweak the budget, they can do that and they can bring it to the floor, and that is what we should have done. But we shouldn't ask them to write the budget for the very year in which they show up. They simply don't have their people in place. They are not ready to do that. They have got to get their Cabinet appointed. So I would hope, in the future, we remember that and do first things first.

Still, it is never too late to do the right thing, as my mom used to say. And the right thing to do today is to pass this rule, pass this bill, give our friends, the appropriators, the time that they need to negotiate a final bill. I am confident we will do that; I am confident we will do it on a bipartisan basis, Mr. Speaker; and I am confident we will be back here with a bill the American people can be proud of because that will have been negotiated in good faith, it will be bipartisan, and it will give us the stability that we need from now until September 30.

Mr. President, I wish to submit to the Senate the budget scorekeeping report for June 2017. The report compares current-law levels of spending and revenues with the amounts the Senate agreed to in the budget resolution for fiscal year 2017, S. Con. Res. 3. This information is necessary for the Senate Budget Committee to determine whether budget points of order lie against pending legislation. The Republican staff of the Senate Budget Committee and the Congressional Budget Office, CBO, prepared this report pursuant to section 308(b) of the Congressional Budget Act, CBA.

My last filing can be found in the Record on April 27, 2017. The information contained in this report captures

legislative activity since that filing through June 5, 2017.

Republican Budget Committee staff prepared Tables 1-3 of this report.

Table 1 gives the amount by which each Senate authorizing committee exceeds or is below its allocation for budget authority and outlays under the most recently adopted budget resolution. This information is used for enforcing committee allocations pursuant to section 302 of the CBA. For this reporting period, 13 of the 16 authorizing committees are in compliance with their allocations. Legislative activity involving the appropriations process, continuing resolution and omnibus, during the last reporting period includes provisions, such as changes to health benefits for miners and Medicaid funding, charged to the Committee on Finance that caused it to breach its allocation. The other two committees in breach, as previously reported, are the Committee on Veterans Affairs and the Committee on Commerce, Science, and Transportation. In total, authorizing committees are estimated to increase outlays by $292 million more than they were allocated over the fiscal year 2017-2026 period. Of that $292 million in violations, $91 million stems from the Finance Committee's violations during this reporting period.

Table 2 gives the amount by which the Senate Committee on Appropriations exceeds or is below the statutory spending limits for fiscal year 2017. This information is used to determine points of order related to the spending caps found in sections 312 and 314 of the CBA. H.R. 244, the Consolidated Appropriations Act, 2017, P.L. 115-31, provided full-year appropriations for the current fiscal year. These appropriations, $551.1 billion for defense and $518.5 billion for nondefense, were consistent with the statutory limits imposed by the Budget Control Act of 2011.

Table 3 tracks compliance with the fiscal year 2017 limit for overall changes in mandatory programs, CHIMPS, in appropriations bills, established in the fiscal year 2016 budget resolution. CHIMPS in the Consolidated Appropriations Act were consistent with this year's limit of $19.1 billion. This information is used for determining points of order under section 3103 of that resolution.

In addition to the tables provided by Budget Committee Republican staff, I am submitting CBO tables, which I will use to enforce budget totals approved by the Congress.

CBO provided a spending and revenue report for fiscal year 2017, which helps enforce aggregate spending levels in budget resolutions under CBA section 311. CBO's estimates show that current-law levels of spending for fiscal year 2017 are below the amounts assumed in the budget resolution by $303 million in budget authority and $6.4 billion in outlays. CBO also estimates that revenues are $1 million above assumed levels for fiscal year 2017, but $21 million below assumed levels for the fiscal year 2017-2026 period. Social Security levels are consistent with the budget resolution's fiscal year 2017 figures.

CBO's report also provides information needed to enforce the Senate pay-as-you-go, PAYGO, rule. The Senate's PAYGO scorecard currently shows increased deficits of $226 million over the fiscal year 2016-2021 and $227 million over fiscal year 2016-2026 periods. For both periods, outlays have increased by $201 million, while revenues decreased by $25 million over the 6-year period and $26 million over the 11-year period. Missing from these levels are the budgetary effects of divisions M-O of the Consolidated Appropriations Act, 2017 and the miners' health provisions of H.J. Res. 99, the short-term continuing resolution, P.L. 115-30, which are required to be excluded based on language in the acts. The consolidated appropriations bill, however, is recorded as reducing revenues by $24 million and $25 million over the fiscal year 2016-2021 and fiscal year 2016-2026 periods, respectively. That revenue loss is found in the appropriations section of the bill, not covered by the exclusion, which includes provisions related to visa-program extensions and insurance coverage of mammography. The Senate's PAYGO rule is enforced by section 201 of S. Con. Res. 21, the fiscal year 2008 budget resolution.

Finally, included in this submission is a table tracking the Senate's budget enforcement activity on the floor. No budget points of order have been raised since my last filing.

All years in the accompanying tables are fiscal years.

I ask unanimous consent that the accompanying tables be printed in the Record.