Veterans Healthcare Improvement Act

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

Mr. Speaker, today we are considering a bill that purports to make it easier for small businesses to obtain coverage, and tomorrow we will vote on a bill that will take away health insurance coverage for 24 million Americans and force everyone else to pay more for less. So not only are we considering a bill today that will make things worse, we are considering it a day before we vote on ruining health security for working families in order to provide tax cuts for the wealthy.

As we debate the possible replacement of the Affordable Care Act, I think it is instructive that we look back at what the situation was before the ACA passed.

Listening to some, you would think that the costs weren't going up at all. In fact, costs were going through the roof before the ACA, and small businesses, particularly, were having spectacular cost increases--and that is until somebody got sick. At that point, you were unlikely to be able to afford any insurance at all.

Every year before the ACA, small businesses were dropping insurance right and left, particularly after somebody got sick. Also, before the Affordable Care Act, people with preexisting conditions couldn't get insurance. Women were paying more than men. Millions of people were losing their insurance every year.

Since then, the costs have continued to go up, but at the lowest rate in the last 50 years. People with preexisting conditions can get insurance at the standard rate. Small businesses can cover their employees through the Affordable Care Act at the average cost, whether or not anybody in their small business has cancer or diabetes. Women are not paying more than men. Instead of millions of people losing their insurance every year, 20 million more people have insurance.

In addition to that, families now enjoy strong consumer protections. The full name of the Affordable Care Act is the Patient Protection and Affordable Care Act. Now there are no caps on what an insurance company pays, and they can't cancel your policy for anything other than nonpayment. Preventive services such as cancer screenings are available with no copay or deductible. Those up to 26 can stay on their parents' policy, and the doughnut hole is being closed.

The ACA did not cure every problem, but it went a long way to making Americans healthier and giving them some economic security. It could have gone further if, in the past 7 years, Republicans would have been willing to work with Democrats to build on the progress instead of forcing over 60 votes to repeal all parts of the Affordable Care Act.

If we do anything now, we ought to improve the situation, not make it worse. The Republican plan makes things worse. The CBO analysis concluded that 24 million fewer people will have insurance, and most of those that get insurance in the future will be paying more for policies that don't deliver as much.

For seniors, particularly, the costs will skyrocket. And, in fact, the prediction that the rates will go down in

the future are a result of the conclusion that so few seniors will be able to buy insurance that they will no longer be in the insurance pool.

The insurance pool would be younger, and, therefore, the costs would go down. But that is only because seniors won't be able to afford the insurance. Therefore, the insurance pool will be younger and cheaper for those who can actually afford it, but that is not a good thing for seniors who need the insurance and can't afford it.

So today we are considering another failed policy. The association plan ideas have been studied for years, and it has been concluded that it is a bad idea. Under the Affordable Care Act, essentially everybody pays average. If you change that arithmetic so some can pay a little less, then arithmetic matters. Everybody else is going to pay a little more.

In the association plans, quite frankly, I will admit, they will always work for the few that can get into them. That is because, if you can draw out your own group, if they are healthier than average and can pay less, they will pay less and the association will work. But if you pull out a group and it turns out they are a little sicker than average and the bids come in above average, then the association will dissolve and everybody will go back into the insurance pool.

So if you can pull out a group, they will always pay less until somebody gets sick, and then everybody jumps back into the insurance pool. The higher cost groups will be left behind. The lower cost groups will segment out, and then the rates will go down for a few and up for everybody else.

This is exactly why the American Academy of Actuaries has said that expanding association plans ``could result in unintended consequences such as market segmentation that could threaten . . . viability and make it more difficult for high-cost individuals and groups to obtain coverage.''

One of the other problems is a lack of regulation. If a group is allowed to circumvent State regulations, that policy may be cheaper because the policy is not as good.

There are a lot of ways that you can save money. You can pull out a group of just young men and save on maternity benefits. That would be cheaper for them but more expensive for everybody else.

And what happens when a new spouse needs coverage and tries to get it as an optional benefit? They won't be able to afford it.

Workers and businessowners are likely to get fewer benefits under the association approach and will be disadvantaged compared to those in the regular pool getting comprehensive benefits.

This is exactly why Consumers Union has stated that the legislation is ``likely . . . to provide minimal and nonuniform benefits.''

Mr. Speaker, this bill will make it easier to set up these kinds of associations and let them avoid State regulations, which could require solvency, nice solvency requirements, and consumer protections. The protections in this bill are not sufficient to protect consumers, and most States would require stronger capital requirements than the bill requires.

Much like the Republican replacement bill, this bill goes in the wrong direction, so I urge my colleagues to vote ``no.''

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

Mr. Speaker, I yield 4 minutes to the gentleman from New York (Mr. Espaillat).

Mr. Speaker, I yield 4 minutes to the gentleman from Connecticut (Mr. Courtney).

Mr. Speaker, I yield an additional 1 minute to the gentleman.

Mr. Speaker, would the Chair advise us how much time is available on both sides?

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

Mr. Speaker, I just wanted to point out a few letters that we have received, one from the Diabetes Association, which includes, in part: ``The Association has serious concerns that AHPs would lead to a two- tiered market, in which AHPs offer inadequate coverage to healthy groups only, while State-regulated plans provide adequate coverage with consumer protections but at an increasingly higher premiums. For these reasons, we urge you to oppose the Small Business Health Fairness Act of 2017, H.R. 1101.''

We have also received a letter, Mr. Speaker, from the National Association of Insurance Commissioners. They said in their letter: ``The legislation as written would eliminate all State consumer protections and solvency standards that ensure consumers receive the coverage for which they pay their monthly premium. These protections are the very core of a State regulatory system that has protected consumers for nearly 150 years . . . history has demonstrated that AHP- type entities have done more harm than good to small businesses.''

Mr. Speaker, we also received a letter from The Main Street Alliance, which said: ``In short, H.R. 1101 would result in higher premiums and poorer coverage for the most vulnerable small-business owners, would destabilize the small group market, and would lead small-business owners and employees to assume unnecessary financial risks.''

We also heard from the Consumers Union: ``Consumer's Union has long raised the inadequacies of AHPs . . . and urges Congress to reject them as likely to fragment the insurance risk pool and provide minimal and nonuniform benefits exempt from State benefit mandates.''

We also heard from a long coalition of consumer groups, providers, and labor unions which said that this bill would just move backward to a two-tiered system that makes it harder to purchase comprehensible, affordable coverage for all but a minority of small businesses.

Mr. Speaker, I include in the Record these letters.

American Diabetes Association,

March 21, 2017.

Hon. Paul Ryan,

Speaker, House of Representatives,

Washington, DC.

Hon. Nancy Pelosi,

Democratic Leader, House of Representatives,

Washington, DC.

Dear Speaker Ryan and Leader Pelosi: On behalf of the

nearly 30 million Americans living with diabetes and the 86

million more with prediabetes, the American Diabetes

Association (Association) is writing to express our strong

opposition to the Small Business Health Fairness Act (H.R.

1101). This legislation is nearly identical to legislation

considered by previous Congresses and that last passed the

House of Representatives in 2003. The Association opposed

that legislation and writes now to express our strong

concerns with this bill and the impact it will have for

people with, and at risk for, diabetes.

The legislation would create federally certified

association health plans (AHPs) with the goal of making

coverage more affordable for small businesses by allowing

them to band together to purchase coverage on behalf of a

larger insurance pool. We share the goal of making coverage

more affordable, but not at the expense of required consumer

protections, signed into law in 47 states, which ensure

people with diabetes have access to the services and

financial protection they need.

H.R. 1101 would broadly exempt AHPs from critical state

benefit standards, solvency rules, and consumer protections,

including requirements to cover health services essential to

those with diabetes. Specifically, H.R. 1101 would confer on

AHPs wide authority to:

Determine benefits to be covered: Other than requiring AHPs

to meet limited federal requirements for ERISA-governed

plans, H.R. 1101 would give AHPs broad discretion to omit

important health benefits.

Determine eligibility for coverage: While H.R. 1101 would

require AHPs to comply with ERISA non-discrimination

provisions, the AHP board would retain sole discretion to

approve applications for participation in the plan and to set

premiums based on an employer's health care claims

experience.

Maintain inadequate reserves: H.R. 1101 applies federally

determined solvency standards that are weaker than state

standards, exposing plan members to the risk of insolvency

and unpaid medical bills.

Because AHPs would compete with state-regulated plans on an

uneven playing field, they would likely cherry-pick healthy

small employer groups, making the risk pool in the state-

regulated market less healthy and more costly. In addition,

those who obtain coverage through an AHP would likely have

benefits that lack coverage for essential services and would

expose them to higher out-of-pocket costs and potential plan

insolvencies. In fact, numerous AHPs offered in the past have

gone insolvent and left consumers uninsured and with unpaid

medical bills.

The Association has serious concerns that AHPs would lead

to a two-tiered market, in which AHPs offer inadequate

coverage to healthy groups only, while state-regulated plans

provide adequate coverage with consumer protections but at

increasingly higher premiums. For these reasons, we urge you

to oppose the Small Business Health Fairness Act of 2017,

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

Mr. Speaker, the bad idea in this plan has been exposed in one of the letters that I mentioned. I said there are a lot of consumer groups, and I just want to name the groups that signed the letter. The American Nurses Association; the Alliance for Retired Americans; the American Cancer Society Cancer Action Network; the American Diabetes Association; the American Federation

of State, County and Municipal Employees; the Association of Reproductive Health Professionals; Bazelon Center for Mental Health Law; Community Catalyst; Consumers Union; Families USA; International Union, United Automobile, Aerospace and Agricultural Implement Workers of America--the UAW; NARAL Pro-Choice America; the National Council of La Raza; the National Education Association; the National Institute for Reproductive Health; National Partnership for Women and Families; National Women's Health Network; Raising Women's Voices for the Health Care We Need; and the Service Employees International Union all oppose this legislation.

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

Mr. Speaker, I just want to quote from another letter that we received from Blue Cross Blue Shield Association. They say: ``We have very serious concerns that H.R. 1101 would create preferential rules that would allow an AHP to be entirely exempt from State regulation by being self-insured or follow the rules of a single State nationwide. Research clearly shows that creating special rules for AHPs and exempting them from State regulation would lead to major problems, including . . . increased insolvency risk . . . increased costs for older, sicker workers.'' Therefore, they are also in opposition to this legislation.

I include in the Record the entire letter.

BlueCross BlueShield Association,

Washington, DC, March 7, 2017.

Hon. Virginia Foxx,

Chair, Committee on Education and the Workforce, House of

Representatives, Washington, DC.

Hon. Robert C. Scott,

Ranking Member, Committee on Education and the Workforce,

House of Representatives, Washington, DC.

Dear Madam Chairwoman and Mr. Ranking Member: The Blue

Cross and Blue Shield Association shares your commitment to

ensuring small employers are able to provide their employees

with high quality, affordable health coverage. However, we

are concerned that H.R. 1101, the ``Small Business Health

Fairness Act'' would not accomplish this critical goal, as it

does not reflect key principles that are essential to

ensuring a viable private health insurance market: (1) all

competitors should abide by the same set of rules; and (2)

states should have clear authority to regulate.

Today, small businesses are able to join together to

purchase coverage through association health plans (AHPs).

AHPs are currently regulated by the states, just like other

insurance in the small group market, and can be a good option

for small employers who want to provide their employees with

affordable coverage.

We have very serious concerns that H.R. 1101 would create

preferential rules that would allow an AHP to be entirely

exempt from state regulation by being self-insured or follow

the rules of a single state nationwide. Research clearly

shows that creating special rules for AHPs and exempting them

from state regulation would lead to major problems,

including:

Increased insolvency risk: The legislation as drafted would

allow for some AHPs to be entirely exempt from state

regulation, and instead operate under very limited federal

rules and oversight. Past experiences with these kinds of

arrangements left millions without health coverage and unpaid

claims due to insolvencies.

Increased costs for older, sicker workers: Ultimately, H.R.

1101 would make it much harder for small employers with

older, sicker workers to obtain coverage. This is because

lower-cost groups would move to a more loosely regulated AHP

with fewer benefit and rating rules, while older and/or high-

cost groups would remain in traditional insurance plans.

Attached is a compendium of research findings, which

provides overwhelming evidence that AHP legislation would

make health insurance less accessible, less affordable and

less secure for small employers and individual consumers.

We look forward to working with you on solutions that can

be taken to improve access and affordability for small

employers.

Sincerely,

Alissa Fox,

Senior Vice President.

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

Mr. Speaker, association plans will help the fortunate few who can get in so long as the members of that association remain healthier than average. But everybody else will pay more. Furthermore, these plans, when they are formed under the bill, will evade important State regulations that could improve solvency and provide important consumer protections.

This is not unlike the philosophy, I guess, on the other replace bill where 24 million fewer people will have insurance; the rest will pay more and get less; while millionaires benefit with huge tax cuts. In this, the fortunate few benefit to the expense of everybody else.

I would hope we would defeat the legislation.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I ask unanimous consent to claim the time in opposition, although I am not opposed to the amendment.

Mr. Speaker, I appreciate the intent of the amendment offered by the gentlewoman from Washington, which seems to allow health association plans that are currently in existence to continue to operate under existing State and Federal law. In fact, giving States the ability to regulate association plans is very important. That is why I oppose the underlying bill.

The amendment also points out another interesting fact, and that is associations currently exist under current law, and the underlying bill simply unravels most of the regulations that apply to them, and this amendment would at least maintain State regulations.

We know that this bill creates winners and losers. The winners are those who are young and healthy enough to be invited into an association. The losers are small businesses and employers who are older, sicker, or just have more costly health bills. There is no guarantee that plans under this legislation will have the standard level of benefits or consumer protections, and that is why I am disappointed that the majority failed to rule any Democratic amendments submitted to the Rules Committee in order, although each and every one was germane.

The gentleman from New York (Mr. Espaillat), who is a member of the committee, offered an amendment that

would have protected the ability of the States to regulate any association health plan, including regulation related to benefits, consumer protections, and rating restrictions. Representative Torres from California offered an amendment to ensure that association plans cover 10 essential health benefits under the Patient Protection and Affordable Care Act.

One amendment was offered by Representatives Susan Davis of California and Suzanne Bonamici from Oregon--both committee members-- would have required association plans to provide for women's health benefits, including maternity care.

Representatives Bonamici, Davis, and Wilson also offered an amendment to prevent this legislation from taking effect if it would lead to increased premiums for older workers. These older workers will not be able to get into the associations because they would increase average costs of the association, and the point of the association is to get away from high-cost enrollees like older Americans. So these older people will be left out of the pool with other older and sicker workers where they will necessarily be paying more.

It is simple arithmetic. Their amendment would have been particularly important because we know that the Republican replacement plan contains an age tax that will severely disadvantage older populations.

None of the Democratic amendments, although germane, were allowed under the rule, and there does not seem to be any earnest attempt to look to try to correct the shortcomings of the bill. So while I do not intend to oppose this amendment, I do not think the amendment is enough of an improvement of the bill, nor does it change the underlying fact that the legislation does not adequately protect small businesses, workers, and their families, nor does it help those left behind who are not invited into the association who will necessarily be paying more.

Mr. Speaker, if those on the other side of the aisle want to go on a rescue mission, they ought to improve things, not make things worse. For most Americans, this bill will make things worse, and, tomorrow, 24 million Americans will be left out while many others will be paying more for less while millionaires get huge tax cuts. That is not an improvement.

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

Mr. Speaker, I would point out that when one size fits all, everybody can benefit; but when you start picking and choosing winners and losers, some will benefit and many others will lose. Under this bill, a fortunate few who get into association plans will benefit; everybody else loses.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I demand a recorded vote.

Mr. Speaker, pursuant to House Resolution 210, I call up the bill (H.R. 1101) to amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees, and ask for its immediate consideration.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material on H.R. 1101.

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

I rise today in support of H.R. 1101, the Small Business Health Fairness Act of 2017.

Mr. Speaker, this week marks 7 years since ObamaCare was signed into law. We all remember the promises former President Obama and Washington Democrats made at the time.

Families were promised that their healthcare costs would go down. They were promised more choices and more competition. Small businesses and their employees were promised greater access to affordable health care.

But for 7 years, we have watched as all of those promises were broken. For 7 years, we have heard from families and small businesses across the country that have seen their healthcare costs skyrocket and their choices diminish.

Members of the House Education and the Workforce Committee recently heard from Scott Bollenbacher, an Indiana small-business owner with 11 full-time employees. The company has been forced to switch healthcare plans twice now under ObamaCare, and their only viable option this year was a plan with a 78 percent premium increase.

Mr. Bollenbacher is one of countless small-business owners struggling to make ends meet under a failed government takeover of health care. Because of ObamaCare, 300,000 small-business jobs have been destroyed, including nearly 8,000 in my home State of North Carolina.

Additionally, an estimated 10,000 small businesses nationwide have closed their doors, and small business employees have lost $19 billion each year in wages.

It should come as no surprise that, since 2008, the share of small businesses with fewer than 10 employees offering health coverage has dropped 36 percent. It is not that they don't want to; it is that onerous mandates and regulations have made it simply unaffordable to do so.

Fortunately, relief is on the way. This week we are not only moving to repeal ObamaCare, we are also advancing positive reforms that promote affordable coverage for working families, including the Small Business Health Fairness Act.

As its title implies, this important legislation is about fairness for small businesses and their employees. Today, small businesses are on an unfair playing field with larger companies and unions when it comes to health care. Large businesses have the ability to negotiate for more affordable healthcare costs for their employees, but small businesses do not have the same advantage. Because of their size, small businesses have limited bargaining power, which means their employees can end up paying more for health insurance.

With millions of Americans employed by a small business, it is long past time to level the playing field. That is exactly what this commonsense legislation is about. This bill would empower small businesses to band together through association health plans, or AHPs, to purchase high-quality health care at a lower cost for workers.

This bill represents a first step toward a more competitive health insurance market that crosses State lines. Under H.R. 1101, small businesses in different States could join together through a group health plan. These plans would have strong protections and solvency requirements to ensure workers can count on healthcare coverage when they and their families need it.

What does all of this mean: more choices, more freedom, and more affordable health care for working families and small-business owners like Scott Bollenbacher. This is a better way, one that stands in stark contrast to ObamaCare's failed approach. Instead of more mandates, this bill empowers individuals to access the high-quality, affordable healthcare plan that meets their needs.

I want to thank my colleague Representative Sam Johnson for championing, for years, the positive reforms in this bill.

I urge Members to vote ``yes'' on H.R. 1101 so we can level the playing field for small businesses and expand affordable health coverage for working families.

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

Mr. Speaker, I yield 6 minutes to the gentleman from Texas (Mr. Sam Johnson), the author of the bill.

Mr. Speaker, I yield 2 minutes to the gentleman from Michigan (Mr. Walberg), the chairman of the Subcommittee on Health, Employment, Labor, and Pensions.

Mr. Speaker, I yield an additional 15 seconds to the gentleman.

Mr. Speaker, I yield 2 minutes to the gentleman from Tennessee (Mr. Roe), a distinguished colleague, a member of the committee, and the chair of the Veterans' Affairs Committee.

Mr. Speaker, I now yield 1\1/2\ minutes to the gentleman from Ohio (Mr. Chabot), the distinguished chairman of the Small Business Committee.

Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Georgia (Mr. Allen), a member of our committee.

Mr. Speaker, I now yield 2 minutes to the distinguished gentleman from Michigan (Mr. Mitchell), a member of the committee.

Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Minnesota (Mr. Lewis), a member of our committee.

Mr. Speaker, I have no further speakers, and I reserve the balance of my time.

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

Mr. Speaker, some of our colleagues on the other side of the aisle have spent a lot of their time extolling ObamaCare and indicating that we should just stay with what we have, but we all know that ObamaCare is failing.

Republicans are on a rescue mission. We truly do have a better way. As some of my colleagues have stated, we will be passing the American Health Care Act tomorrow. What we are doing here with this bill is something we could not include in that legislation that will round out what it is we want to do with keeping our promise in what we promised last year in our program called A Better Way.

Let me just talk a little bit about the failures of ObamaCare. As my colleagues have said, all the promises were broken: if you wanted to keep your doctor, you could keep your doctor; if you wanted to keep your healthcare plan, you could keep your healthcare plan. Those promises were the most obvious ones that went away. The cost of health care would be going down, and none of that happened.

Mr. Speaker, in addition to that, there is a 25 percent average increase in premiums this year for millions of Americans trapped in ObamaCare, healthcare.gov exchanges. Nearly one-third of U.S. counties have only one insurer offering exchange plans; 4.7 million Americans were kicked off their healthcare plans by ObamaCare. There was $1 trillion in new taxes, mostly falling on families and job creators; 18 failed ObamaCare co-ops out of 23, which my colleague from Tennessee so eloquently pointed out.

These were established as an alternative to the public option. Those healthcare co-ops collapsed, costing

taxpayers nearly 1.9 billion and forcing patients to find new insurance; $53 billion in new regulations requiring more than 176,800,000 hours of paperwork. ObamaCare regulations are driving up healthcare premiums and costing small-business employees at least $19 billion annually.

As I said in the hearing that we had on this bill, the Democrats want a coercive system. Republicans want a system based on freedom.

Today we have an opportunity to make a real difference in the lives of hardworking men and women who are employed by small business. We have an opportunity to deliver much-needed relief to small-business owners who are trying to do the right thing and provide high-quality healthcare coverage for their employees. This legislation represents a truly positive reform that will help lower healthcare costs for working families and put small businesses on a fair and level playing field.

Small businesses are the backbone of our Nation's economy, and there is no reason why they should be at a disadvantage when it comes to finding an affordable healthcare plan. They should be treated in the same fashion as larger businesses and have the ability to craft healthcare plans that meet the needs of their employees. If we want to encourage small businesses to offer health care at a lower cost to workers, this is one commonsense step we can make.

Again, I thank our colleague, Congressman Sam Johnson, a true patriot and servant of this country, for his longtime support of this legislation.

I urge my colleagues to vote ``yes'' on H.R. 1101, the Small Business Health Fairness Act, which will help more Americans access high- quality, affordable health care.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I rise in opposition to the motion to recommit.

Mr. Speaker, this motion is nothing more than a last-ditch attempt to defeat a commonsense bill that will help expand access to affordable healthcare coverage for working families. In fact, this motion represents the same failed approach to health care we have experienced in recent years.

We have seen what happens when the Federal Government dictates the kind of health insurance individuals can and cannot buy. Healthcare costs skyrocket and patients have fewer choices.

While our Democrat colleagues offer a motion that doubles down on a failed approach to health care, my Republican colleagues and I are offering the American people a better way.

The Small Business Health Fairness Act is about empowering individuals, families, and small-business owners so more Americans have access to affordable healthcare coverage. By rejecting this motion and supporting the underlying bill, we can take an important step in keeping our promise to deliver free-market, patient-centered healthcare solutions.

I urge my colleagues to vote ``no'' on the motion to recommit and ``yes'' on the Small Business Health Fairness Act.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I have an amendment at the desk.

Mr. Speaker, I thank Chairwoman Foxx and the Committee on Education and the Workforce for their work on this important bill that will benefit small businesses and the families who work for them.

My amendment to the Small Business Health Fairness Act provides a straightforward clarification to ensure that existing association health plans can continue to operate and provide high-quality, affordable care to as many people as possible.

This amendment safeguards association health plans that have been successfully operating under State and Federal law--many of them for decades. We will be making certain that they would not inadvertently be disadvantaged by new Federal legislation or regulation or vulnerable to efforts to restrict access and limit choices.

Why do we need this amendment?

Because I fear what happened in my State will happen in others, where the insurance commissioner attempted to reject 42 out of about 60 association health plans. His office interpreted ObamaCare as giving him a mandate as justification for attempting to eliminate virtually all of these popular plans. By adopting my amendment, it will make crystal clear in the underlying bill that this won't be tolerated, and it will support both existing and future association health plans.

Talk to one of the nearly 400,000 individuals in my home State of Washington who get their care from an association plan, and you will find out why so many Washington businesses renew their plans every year.

Our State has been fortunate to have a robust AHP market that has become essential to providing cost-effective choices to small-business employers, thanks to bipartisan legislation enacted in the mid-1990s. In the case of one association plan operating in my State, roughly 40 percent of participating small-business employers did not previously offer health coverage.

My amendment is supported by the U.S. Chamber of Commerce. In its letter to me, which I include in the Record, the U.S. Chamber indicated that it shares my interest in making sure that State-based association health plans that currently exist are able to continue operating in accordance with existing State and Federal law. My amendment is also supported by the Association of Washington Business.

Chamber of Commerce of the

United States of America,

Washington, DC, March 20, 2017.

Hon. Jaime Herrera Beutler,

House of Representatives,

Washington, DC.

Dear Congresswoman Herrera Beutler: Thank you for your

attention to the concerns raised by the Association of

Washington Businesses regarding H.R. 1101, the ``Small

Business Health Fairness Act.'' The U.S. Chamber of Commerce

has several state chambers of commerce members that provide

state-based quality health care coverage to their member

companies. The Chamber shares your interest in making sure

that the state-based Association Health Plans that currently

exist are able to continue to operate in accordance with

existing state and federal law without being disadvantaged by

this new federal legislation.

The Chamber appreciates your commitment to small businesses

and to ensuring that current affordable coverage options

continue to be available alongside new options in a

nondiscriminatory and fair environment. Thank you for your

dedication and efforts, and we look forward to continuing to

work with you to advance the priorities and interest of

business.

Sincerely,

Randel K. Johnson.

Mr. Speaker, I am confident that the underlying legislation before us today will improve the ability of small businesses to access affordable, high-quality health coverage in every State across the country. However, first, this body should, as clearly as possible, ensure that those States that already have successfully operating association health plans are not disrupted, which is what my amendment would do.

I urge my colleagues to support this amendment, and I thank the chairwoman for her work on this.

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

Mr. Speaker, how much time do I have remaining?

Mr. Speaker, I would just like to say that part of the reason this underlying bill is so critical is because we just don't believe one size fits all. When it comes to health coverage, we need to make sure that there are many different options for families, individuals, and businesses. We are clarifying basically a technical change here that allows continued existing plans to operate.

Who can be opposed to existing plans operating and offering more options and more plans?

This is exactly what Republicans are doing right now. We are fighting to make sure that the families and the people we represent have those options and their choices, that they can keep their doctor, that their health premiums will come down, that they can maybe get a plan through their work, or maybe they will be able to get into the individual market and self-insure--options--because one size does not fit all, which is why this bill is crucial and why my amendment to this bill makes it better. That is why we are going to move forward and make sure that more Americans have access to care--not just on paper--but care that gets them to in to the doctor, that gets them the care that they need, whether it is a specialist or a primary care doctor.

Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, I thank the gentlewoman for yielding.

I would like to start off by thanking Chairwoman Foxx and Chairman Walberg for their strong support of my bill, the Small Business Health Fairness Act.

Mr. Speaker, the legislation before us today is on an issue that has long been near and dear to my heart: association health plans. Association health plans would allow small businesses to join together and provide healthcare coverage just like large corporations and unions do today.

Association health plans are also a central part of replacing ObamaCare with commonsense solutions.

You know, ObamaCare has been an absolute disaster. My constituents in Collin County, Texas, have shared with me their negative experiences with it since it became law nearly 7 years ago.

One of the groups hardest hit by ObamaCare is small businesses, the backbone of our economy. Since 2008, over one-third of businesses with fewer than 10 employees offering health insurance have dropped insurance; and, you know, that is just wrong.

Because ObamaCare is failing, we need to repeal it and replace it with better solutions for the American people. One of these solutions is my association health plan bill.

What my bill does is simply allow small businesses to join together through trade or professional organizations. As we all know, the basic rule of insurance is the bigger the risk pool, the lower the cost.

Furthermore, my bill allows small businesses to join together across State lines. My bill would also free small businesses from costly and burdensome State and Federal requirements. This isn't anything different from what large employers and unions already do. My bill is simply about leveling the playing field for small businesses and their hardworking employees.

This bill also has wide support from the business community, including the United States Chamber of Commerce, the National Federation of Independent Business, the National Retail Federation, and the International Franchise Association.

Not everyone knows this, but I was a small-business owner myself between my time in the Air Force and coming to Congress. In fact, I established a home building business in north Texas from scratch, so I can understand where small businesses are coming from.

For example, Bob Gibbons and his wife own a commercial real estate business in my hometown of Plano, Texas. They have had a tough time obtaining good, affordable health insurance, a problem that has gotten worse since ObamaCare.

Bob sums up this entire issue pretty well in two sentences: ``Why should someone's status as an employee give them preferential right to decent group health coverage? Entrepreneurs are penalized when they start a small business because they can't get comparable coverage.''

Bob's experience underscores the entire point behind the Small Business Health Fairness Act.

Mr. Speaker, I include Bob's letter in the Record, along with letters from the cities of Frisco, Richardson, and Anna in my district.

REATA Commercial Realty, Inc.,

Plano, TX, March 2, 2017.

Re Association Health Plans.

Hon. Sam Johnson,

House of Representatives,

Washington, DC.

Dear Representative Johnson: I would like to register my

support of your recently introduced bill, H.R. 1101, which

would provide for association health plans. I am a small

business owner in your district in Plano, Texas. My wife and

I have been on a roller coaster of health coverage over the

years. We were covered by employer plans when I was an

employee (pre-ACA). Then we had to negotiate for an

individual plan when I started my own business (pre-ACA).

Then we were again covered by an employer plan when my wife

went to work (post-ACA). And now that she works with me, we

must navigate the purchase of an individual plan again, but

in the post-ACA failure environment.

I have always thought it was ridiculous that the only

decent health coverage was available to employees of

companies that provided it. Why should someone's status as an

employee give them a preferential right to decent group

health coverage? Entrepreneurs are penalized when they start

a small business because they can't get comparable coverage.

I was thrilled when I ran into Gabi Pate at a Plano Chamber

of Commerce Public Policy Committee meeting yesterday and

heard you were trying to help. Association health plans would

be a step in the right direction. At least then I could get

in on a group plan through trade associations, a chamber of

commerce or another qualified group. I truly hope that the

bill will allow for portability of that health coverage,

however, so I can leave the association if I choose and still

have coverage.

Thank you for your leadership in this area. Please don't

hesitate to contact me if you have any questions.

Sincerely,

Bob Gibbons.

Mr. Speaker, by allowing small businesses to band together, they can collectively purchase more affordable health insurance for their employees.

Let's get this commonsense plan passed. Let's help those who power our economy be able to get the health care they want, need, and deserve for themselves and their workers.

Mr. Speaker, I urge all my colleagues to vote in favor of H.R. 1101.

Mr. Speaker, again, as someone who was a small-business employer for 27 years and provided health benefits for my staff, I am acutely aware of the challenges in the small-business market which long predate passage of the Affordable Care Act and which is still something that we can do better in terms of helping folks deal with this issue, which, again, is so important because small businesses are the job creators in the American economy.

What I want to sort of point out is that this legislation, in my opinion, is just a complete misfire. Let's, first of all, remind everyone that there are over 670 association health plans existing in America today.

The notion that the Affordable Care Act somehow is smothering or stifling association health plans is, in fact, just factually false. There are many that are in business, providing coverage, as has been said by some of the prior speakers, for people in industries like restaurants, et cetera. Again, we are not talking about some existential threat that is out there in terms of association health plans today.

The guts of this bill--and it is quite extraordinary coming from, again, the Republican Party--is to preempt State Governments from having any say over the solvency and the benefit design of plans that operate under association health plans.

Back in the 1990s, there was a spate of problems with association health plans going belly up because, again, there was no State insurance solvency standards to make sure that there were funds set aside to pay the bills of people who were employed in the businesses that these plans were set up to serve.

As a result, Congress acted. We basically said that the Federal Government was doing a lousy job in terms of protecting patients. And we gave States the ability, through their State insurance departments, to make sure that certain solvency standards were met and, as was stated earlier, that they weren't able to cherry-pick just the healthiest and leave the rest for the other segments of the health insurance industry.

As a result of the fact that we made this change, again, the State insurance commissioners all across America, Republican States and Democratic States, have weighed in. They sent a letter on February 28 pleading with Congress not to do this, not to pass this bill which eliminates their ability to protect the citizens of their States.

So this bill is actually an anti-states' rights bill because it is basically saying the Federal Government is just going to step in and wipe out the way in which these plans operate and just lead, again, a race to the bottom, the lowest threshold of protections for patients; and that is considered healthcare reform or somehow advancing the ball in terms of helping small businesses.

There are many other ways to deal with this issue, and this is not the right one. Again, this is not some new idea that we are debating. This has been back and forth over the years, in the 1990s and the early 2000s. It predates the Affordable Care Act by decades, and it is just an old chestnut that is being thrown out in the floor in the name of some idea to sound like we are doing something for small businesses.

Again, under the Affordable Care Act, we set up a 50 percent tax credit for businesses that qualify for it to make health insurance affordable.

I did two townhalls back in my district. I had a plumber from the next town over who, again, took advantage of that 50 percent tax credit. He saved thousands of dollars in terms of providing health benefits for his small business.

We can expand that tax credit to get a wider universe of small businesses, and that is what we should be doing. We should be building on what is successful, again, not watering down existing patient protection and consumer protection laws that ensure that plans are actually going to have enough funds to pay the bills when people get sick or go to the hospital and certainly not be able to cherry-pick what benefits are considered essential or not.

Mr. Speaker, we should not be allowing health plans to decide we are not going to cover maternity or that they can pick and choose what essential benefits that, again, the rest of the universe of businesses have to provide now under the Affordable Care Act, which are, again, based on sound medical research, not political decisions or not just the whims of people who are running health plans, like association health plans.

Again, this is the wrong approach. This is, again, turning the clock backwards. It is not going to provide any protections, and it certainly is not responding to some existential threat of association health plans. There are 672 in operation today. Let's help them with programs like tax credits. Let's not just sort of turn that whole sector of the health insurance marketplace into the Wild West because it is patients who are going to lose. Our citizens are going to lose. We can do better than that as a Congress.

Mr. Speaker, again, I strongly urge a ``no'' vote on this measure.