Workforce Development Tax Credit Act of 2017

Mr. Speaker, I yield 3 minutes to the gentleman from California (Mr. Ruiz).

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

Mr. Speaker, I rise in opposition to H.R. 849, the IPAB repeal.

Mr. Speaker, Republicans have spent the last 9 months trying to repeal the Affordable Care Act and they have failed, but instead of working with Democrats to improve the ACA, they will stop at nothing to repeal the law piece by piece.

The Republicans' partisan bill to reauthorize CHIP, community health centers, and other public health extenders is paid for on the back of Medicaid recipients, Medicare, low- and middle-income families with the Affordable Care Act health coverage, and the Prevention Fund, but yet they will not bother to pay for the $17.5 billion it will cost to repeal IPAB.

IPAB was enacted as a backstop to the other cost-saving and quality- improvement efforts in the ACA, such as accountable care organizations, patient-centered care models like Medical Homes, programs that pay for quality, not quantity and value-based purchasing.

Because of the Affordable Care Act and these programs, Medicare spending growth has slowed and Medicare solvency has been extended.

According to the CMS actuary, IPAB will not be triggered until 2021, so the

timing of today's repeal is premature and politically motivated.

IPAB repeal would increase the deficit by $17.5 billion. This is fiscally irresponsible of Republicans, especially as they prepare to announce a tax package that will saddle our country with $1.5 trillion of debt in order to give tax cuts to the wealthy and corporations.

IPAB repeal is not about helping seniors. Don't let the Republicans kid you. Contrary to what the Republicans say, IPAB is prohibited from sending recommendations to Congress that would harm seniors by increasing their out-of-pocket costs or cutting their benefits. In fact, it is the Republican ACA repeal efforts that would cut nearly a trillion dollars from Medicaid and Medicare, harming seniors and other vulnerable Americans, which would have truly led to the rationing of healthcare.

So for all these reasons, I urge my colleagues to vote ``no'' on H.R. 849, the IPAB repeal.

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

Mr. Speaker, I yield 4 minutes to the gentleman from Vermont (Mr. Welch), a member of our committee.

Mr. Speaker, I yield an additional 2 minutes to the gentleman from Vermont.

Mr. Speaker, may I inquire as to how much time remains?

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

Mr. Speaker, I can't help but put what is happening today in terms of the Republicans putting up this bill on the IPAB and what is happening tomorrow with the Republicans putting up a CHIP and community health centers bill but point out that collectively what they are trying to do is what they were not able to do in the first 9 months of this session when they sought very hard and pushed very hard to repeal the Affordable Care Act.

What is going on here today and tomorrow with the IPAB and community health centers and CHIP is essentially an effort to repeal the Affordable Care Act piece by piece, in my opinion.

What do we do?

We see the IPAB, which is part of the Affordable Care Act. We see the pay-fors for community health centers and the CHIP tomorrow, taking away money from the Prevention Fund from the Affordable Care Act, limiting the grace period when people will lose their insurance that they have under the Affordable Care Act.

This goes along also with what is happening with the President as well. The President has, in the last month or so, said that he is not going to pay the cost-sharing subsidies. He has cut back on the outreach so that people don't know what is in the Affordable Care Act. He has cut back on the period when people can sign up and get their insurance in half.

What we are seeing, in my opinion, is the Republicans sabotaging the Affordable Care Act. They couldn't repeal it, so now they are doing whatever they can to sabotage it. It is really ironic or inconsistent, however you want to put it. On the one hand they are insisting that when it comes to kids and community health centers, which is a group of people you would think they would be most concerned about, they insist on paying for it by taking money from other healthcare programs. We are asked to take money from the Prevention Fund, which pays for vaccines for children, which pays for the children's lead poisoning program, which is a major part of our opiate prevention program. This is the money that comes from the Prevention Fund. Basically, they are taking that money and using it to pay for the community health centers and the Children's Health Initiative, which means that that money is lost. That money is lost for those other purposes.

With regard to the grace period, they are saying, well, if you fail to pay your insurance, it used to be 90 days before you lost it. Now it would be 30 days before you lost it, which means that you end up with about 500,000 or 600,000 people who have insurance now under the Affordable Care Act that would lose it, according to the CBO.

Yet, at the same time, with the IPAB repeal, which we are considering now, which costs $17.5 billion, and which, as my colleague from Vermont said, is a mechanism to try to save costs, they are saying: Well, we don't have to pay for that. We can just repeal it. We will forego those additional costs, which become part of the deficit.

Mr. Speaker, for all these reasons, the bottom line is, what the Republicans are doing is not fair. It is not fair to the kids. It is not fair to the people who are going to lose their health insurance.

I will say as the last thing that this is going nowhere. One of the reasons why Democrats have been urging the Republicans with regard to the CHIP and community health centers to work with us on a bipartisan basis is because we know if this bill passes today on a partisan vote, because we can't support it for the reasons I explained, then that means that it is going to go to the Senate and it is going to die because there is no reason to believe that the Senate is going to take up this partisan bill.

I think it is just a huge mistake on the part of Republicans. Basically, what they are signaling today is that they don't really care about this. They wanted to stick around until the end of year, which means the community health centers and CHIP just basically wither on the vine for lack of funds. That is not fair. It is not fair to the kids. It is not fair to those who use community health centers.

Mr. Speaker, for all these reasons, I would urge a ``no'' vote on the bill today, the IPAB repeal; and I will also ask for a ``no'' vote tomorrow on the CHIP and the community health centers legislation.

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

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

Mr. Speaker, I thank my friend for yielding me this time.

Mr. Speaker, I rise today in opposition of the repeal of the Independent Payment Advisory Board.

This is another classic example of a solution in search of a problem. Of all the things that we should be working on in Congress in a bipartisan fashion to improve and to fix the problems that exist within our healthcare system, we have legislation on the floor before us today that calls for the repeal of a nonexisting commission, based on nonconsistent spending cuts being proposed for Medicare, based on a nonconsistent cost of rate of increase in spending under the Medicare program, all of which is going to add $17.5 billion to the deficit over the next 10 years because this bill isn't paid for. And the irony is they are coming forward with this legislation, which will add another $18 billion to the debt, on the same day they release a tax bill that calls for an additional $1.5 trillion worth of deficit spending because the tax bill hasn't been offset. At some point and at some time, we have got to take a bipartisan stand on fiscal responsibility in this place again because it is not happening today.

Instead, we should be working on short-term, practical solutions to stabilize and bring more certainty to the health insurance marketplace, in light of what the administration is doing to completely undermine the marketplaces today. We ought to be working on delivery system reform proposals that will emphasize the establishment of accountable care organizations and medical homes and value-based purchasing and bundling arrangements and different alternative payment models to get us to a system of value, quality, and outcomes, and away from the fee- for-service payment for the volume of services, regardless of results.

Let's be honest, the real cost driver in our Federal budget--and it is true at the State and local level--has been healthcare costs because we have an aging population. That is the work that we should be working on together, is the delivery system reform and the payment reform, so we are aligning the incentives in the right direction where we are telling our healthcare providers: You will be compensated based on good results, not on how much you do.

There is a lot within the Affordable Care Act giving our providers the very tools in order to accomplish that, and we ought to be enhancing that here today. Instead, we are wasting time on a commission that, according to the CMS's own actuary, says, at the very earliest, it might be comprised in 2021. But, even then, it warrants us, with the mission that we have given it, that: Hey, you have got healthcare spending within the healthcare system that, Congress, you need to deal with. And then come back with recommendations. And then it is up to us to make corrective action at that time.

So all this talk about unelected bureaucrats making these decisions belies what the legislation actually calls for in the establishment of the IPAB. This was, however, another important cost containment tool that was put into the Affordable Care Act to try to restrain the growth of healthcare spending. We need more of those type of ideas, rather than efforts today to remove those tools and then possibly see just unbridled healthcare spending in the future.

What is really disturbing is I know there is a lot of common ground in this area, yet the American people wouldn't know it, with this political ping-pong ball on healthcare reform going back and forth and the chaos and the confusion that it is causing, and that is unfortunate.

So, instead, today, we ought to first take steps to stabilize the insurance exchanges, rather than an administration that is doing everything they can to limit the enrollment during the signup period, which actually started yesterday and lasts until December 15. They have cut by 90 percent funding for marketing of the exchanges. They have cut by almost 50 percent the funding for our navigators back home who are trying to help people get affordable healthcare coverage in their lives. They ended the cost-share payments, which only increases the cost for healthcare for everyone else because of the risk that the insurance plans now face.

The other segment of the population that we should be focused on in helping is that 5 or 6 percent of the population that are in the individual market who don't qualify for premium tax credits because they are getting hammered today. You would think that would be another area of bipartisan commonality that we can come together on

to provide relief for those individuals who are in the individual market experiencing these higher premiums, part of it being done because of the elimination of the cost-sharing reduction payments, but, instead, nothing is being done on that front.

My friend from Michigan also pointed out that we should be having hearings about the cost of prescription drugs in committee. That is one of the main cost drivers within the healthcare system, yet there is deafening silence in the Halls of Congress when it comes to taking measure on that front, even though President Trump promised during the course of his campaign and even earlier this year to try to take some action in a bipartisan way to address drug costs.

It was an initiative that the President was even interested in trying to address. Yet, again, nothing is being done.

So this legislation is much ado about nothing because there is nothing pending. In fact, nothing would be pending, according to the CMS actuary, until, at the earliest, 2021. Instead, we are wasting time and opportunity to address the real problems and finding the real fixes that are needed in the healthcare system. There I am confident there is a lot of bipartisan overlap, having worked with many of my colleagues on the committee and across the aisle, on many of these measures that I just mentioned here today.

So I encourage my colleagues to vote ``no'' and allow this to go forward, because it does keep an eye on rising costs and it keeps the pressure where it belongs--right here in Congress--to take future action if the rate of growth starts spinning out of control.

Mr. Speaker, pursuant to House Resolution 600, I call up the bill (H.R. 849) to repeal the provisions of the Patient Protection and Affordable Care Act providing for the Independent Payment Advisory Board, and ask for its immediate consideration.

Mr. Speaker, I ask unanimous consent that all Members have 5 legislative days to revise and extend their remarks and insert extraneous material on the bill into the Record.

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

I rise today in support of H.R. 849, the Protecting Seniors' Access to Medicare Act. This discussion is not new. Republicans and Democrats came together to pass this same bill back in 2015. This year there is, once again, strong bipartisan support with 45 Democratic Members and 225 Republican cosponsors. It passed out of the Ways and Means Committee last month with bipartisan support, too.

This bill will repeal the Independent Payment Advisory Board, or IPAB, created in ObamaCare, the Affordable Care Act. The IPAB puts 15 unelected bureaucrats in charge of Medicare spending with significant unilateral powers to slash payments to providers, forcing them to stop seeing Medicare patients without any accountability, judicial review, or transparency.

The board's unprecedented authority to alter Medicare policy could ultimately reduce seniors' access to healthcare and put the government, rather than the patient, at the center of the healthcare system.

Putting Medicare on a sustainable financial footing is a top priority for all of us here in Congress, but passing the buck to a handful of unaccountable bureaucrats is not the right approach.

Last year, the Medicare Trustees Report stated that this was to be the year that the IPAB's authority to make cuts would be triggered. Fortunately, this year's Medicare Trustees Report has given us slightly more time, but next year, they can come back and move that date up once again. This is a cloud that will hang over providers and beneficiaries, unless we act and pass this bill today.

Now some have stated that this bill does not solve any immediate problem, and they have questioned the need to act on the bill today. I believe that our seniors and our healthcare providers are a priority. Why should we kick the can down the road when we can stop this today?

There are letters of support from over 700 bipartisan groups representing patients, employers, hospitals, doctors, nurses, and other healthcare professionals all voicing strong support for IPAB repeal.

They believe that the threat of this board is enough to warrant repeal and to place the decisionmaking back in the hands of elected Members of Congress, and I agree.

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

Mr. Speaker, I yield myself such time as I may consume, and let me just start by saying that some of my colleagues on the other side of the aisle have called on us to work with them over and over again to find common ground, to make fixes in the flaws in ObamaCare.

Today we have an opportunity to do exactly that. We should all be joining together. There is bipartisan support on this bill to eliminate this unnecessary and potentially very destructive body, one that I would define as a major flaw in the law. This is the exact process that we have been asking for--you have been asking for.

The bill has been through regular order. We have had countless hearings on this topic. We have actually voted not once, but twice, in past Congresses to repeal the IPAB to keep it from harming access to seniors' care.

So today we are bringing this bill forward--this legislation forward--as a stand-alone provision, not tied to any other policies, to once and for all allow Members to say whether they support or oppose this unaccountable board.

Mr. Speaker, I yield 4 minutes to the gentleman from Tennessee (Mr. Roe), who has been a tireless champion for seniors in Tennessee and, since day one, has been working on this legislation to repeal the IPAB.

Mr. Speaker, I yield 1 minute to the gentleman from Pennsylvania (Mr. Rothfus), who has been a tireless advocate working on Medicare issues as well.

Mr. Speaker, I yield 1 minute to the gentleman from Indiana (Mr. Messer), a member of our leadership team.

Mr. Speaker, I yield 1 minute to the gentleman from Georgia (Mr. Allen), who is an original cosponsor of this legislation.

Mr. Speaker, I have no more speakers.

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

Mr. Speaker, my colleagues on the other side of the aisle have supported this bill in the Ways and Means Committee in regular order last month and in a prior vote, I will add, back in 2015.

Rather than take control away from the American people and from our seniors, we should be expanding choice, expanding access, and expanding flexibility and competition in Medicare, and we can start that right now, today, by passing this legislation to terminate the IPAB once and for all.

Now, my colleagues on the other side of the aisle have also called on us to work with them to find common ground, to work with them to fix those flaws in the Affordable Care Act. Well, today, with this vote, we have the opportunity to do just that, to join together to eliminate this unnecessary

and potentially destructive provision--certainly, it is a major flaw in the law--and pass this bipartisan legislation.

Repealing IPAB is crucial to maintaining and expanding access to high-quality care for our Nation's seniors and ensuring that Medicare payment policy is not dictated to us and our constituents by a board of unelected and unaccountable bureaucrats.

Mr. Speaker, I want to thank Dr. Roe and I want to thank Dr. Ruiz on the other side of the aisle for their leadership on this bill, along with the Energy and Commerce and Ways and Means Committee members.

Mr. Speaker, I strongly urge my colleagues to support the passage of H.R. 849, and I yield back the balance of my time.

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

Mr. Speaker, this is really the question: Why in the world are we taking up a bill to terminate a board that does not exist? Why in the world are we doing so when premiums are rising and action should be taken to strengthen them? Why in the world are we passing a bill that would increase the deficit by $17.6 billion? Pay for CHIP, the Republicans say, but not this bill.

So however you feel about IPAB, this is the wrong time and the wrong bill for addressing it. The ACA enrollment period began yesterday, and because of actions of the Trump administration, consumers across the country face confusion and instability in the market.

Rather than addressing these urgent issues, we are engaged today in a political exercise to repeal IPAB, a board that has no members under a provision that has never taken effect and is not projected to be triggered before 2021, according to CMS actuaries.

In September, every Democratic member of the Ways and Means Committee wrote to Chairman Brady urging bipartisan action to stabilize the insurance market. But after repeated requests, we never received a response from the chairman, and, to date, the House has taken no action on behalf of consumers.

In the meanwhile, the Trump administration has continued to work to undermine the law and access to healthcare by: one, cutting off funding for cost-sharing assistance for moderate-income enrollees; two, slashing funds to navigators that help consumers enroll in coverage-- the biggest navigator in Michigan had its funding cut by 90 percent; three, shortening the enrollment period; four, shutting down healthcare.gov on weekends; and five, proposing to chip away at consumer protections through executive fiat.

These actions have significantly contributed to insurers exiting the market and raising premiums. It is nothing less than direct and deliberate sabotage; so, instead, the Republicans today bring up a bill about a board that does not exist, and the latest is it would not until 2021, at the earliest.

There are simple actions that we can take today to repair some of the damage and, thereby, improve the insurance markets. Senators Lamar Alexander and Patty Murray recently came to a bipartisan agreement that would provide funding for the cost-sharing reductions and outreach and enrollment activities that strengthen the risk pool in the marketplace.

Unfortunately, as we see today, my Republican colleagues continue to ignore these and other important issues, while allowing an administration, obsessed with repeal of ACA, to do so through executive action what could not be done legislatively.

What is more, they are bringing to the floor today a bill that the Congressional Budget Office estimates will raise the deficit by $17.5 billion over the next decade. I repeat, raise the deficit by $17.5 billion over the next decade. And this is just a small preview of the coming GOP tax bill, which would increase our Nation's debt by $1.5 trillion according to the Republican's own budget resolution.

And whatever happened to the crocodile tears we used to hear from Republicans about the deficit? In terms of today's bill lacking any offset, how about at least starting to address the staggering cost of prescription drugs, a step that would save both senior citizens and the Medicare program money.

Mr. Speaker, the American people need Congress to take action to lower their healthcare costs and to stabilize the markets. They do not need today an irrelevant political bill such as H.R. 849. If you support real steps to lower health insurance premiums now, vote ``no'' on this bill.

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

Mr. Speaker, I yield 5 minutes to the gentleman from Wisconsin (Mr. Kind).

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

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

Mr. Speaker, I reserve the balance of my time, unless Mr. Paulsen is ready to close.

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

Mr. Speaker, I want to say this to my colleagues, whom I very much respect, who signed on to this bill, many of them early on this year. There have been three changes of circumstance:

First, right then, it appeared that IPAB might come into existence in 2017. Now the actuary has made clear that will not happen under these circumstances until 2021.

Secondly, since the bill was introduced, circumstances have changed. The administration has taken steps to undercut healthcare for Americans. So because of cost-sharing and other issues, premiums have been rising. That is a second change of circumstance why this is the wrong bill at the wrong time.

Third, the last time it came up, it was paid for. In the Committee on Ways and Means, when we raised this issue, we were told, as always: Well, we don't have to pay for it in the committee, but it can be paid for on the floor.

This is totally unpaid for, zero, no effort to pay for it, and it would add $17.5 billion to the national debt. Already, it is at its record level with, now, the threat of $1.5 trillion more.

So I really urge, no matter what were the circumstances when you signed on, in almost every case they have changed, and so there is such good reason why this is the wrong bill at the wrong time, and I think to vote for this is really the wrong vote.

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

Mr. Speaker, I rise in opposition to H.R. 849, the so-called ``Protecting Seniors' Access to Medicare Act of 2017,'' which repeals the Independent Payment Advisory Board (IPAB), that was established under the ACA in response to high rates of growth in Medicare expenditures and charged with developing proposals to ``reduce the per capita rate of growth in Medicare spending.''

I opposed this bill when it came to the floor as H.R. 1190 in the 114th Congress and I oppose it now because by repealing IPAB, the bill would eliminate an important safeguard that will help reduce the rate of Medicare cost growth responsibly while protecting Medicare beneficiaries.

Mr. Speaker, H.R. 849 is nothing but another attempt, in a long line of House Republican efforts to undermine both the Medicare guarantee and the Affordable Care Act.

Repealing IPAB would cost over $17.5 billion during the course of a ten year period according to the Congressional Budget Office (CBO).

Mr. Speaker, Republicans do not even make an attempt to find an offset for this $17.5 billion increase to the deficit resulting from repeal of the IPAB, while at the same time they plan to bring to the floor a partisan bill to reauthorize CHIP, Community Health Centers, and other public health extenders by cutting Medicare and slashing funding for programs relied upon by Medicaid recipients, low and middle income families with Affordable Care Act health coverage.

After more than seven years under the Affordable Care Act, more than 20 million Americans have gained health coverage; up to 129 million people who could have otherwise been denied or who faced discrimination now have access to coverage.

Mr. Speaker, given the real challenges facing our nation, it is irresponsible for the Republican majority to continue bringing to the floor unpaid for bills that would do serious harm to millions of Americans if they were to be enacted.

House Republicans have tried more than 65 times to undermine the Affordable Care Act, which has enabled more than 20 million previously uninsured Americans to know the peace of mind that comes from having access to affordable, accessible, high quality health care.

Their batting average to date is .000; they have struck out every time because the American people appreciate and strongly support the Affordable Care Act.

Mr. Speaker, I ask my colleagues to look at the facts and abandon this misguided effort to undermine the ACA and impose significant negative impacts on Americans currently insured.

The Independent Payment Advisory Board is to recommend to Congress policies that reduce the rate of Medicare growth and help Medicare provide better care at lower costs.

IPAB membership by law is to be made up of 15 members appointed by the President and confirmed by the Senate and been comprised of the non-partisan CBO, economists, and health policy experts as contributing to Medicare's long-term sustainability.

Mr. Speaker, the IPAB is already prohibited from recommending changes to Medicare that ration health care, restrict benefits, modify eligibility, increase cost sharing, or raise premiums or revenues.

Under current law, the Congress retains the authority to modify, reject, or enhance IPAB recommendations to strengthen Medicare, and IPAB recommendations would take effect only if the Congress does not act to slow Medicare cost growth.

Finally, Mr. Speaker, let me point out to our friends across the aisle that according to the CMS actuary, IPAB will not be triggered until 2021, so the timing of today's repeal is premature and politically motivated.

IPAB was enacted as a backstop to the other cost saving and quality improvement efforts in ACA, such as accountable care organizations, patient-centered care models like medical homes, programs that pay for quality not quantity, and value based purchasing.

Because of the ACA and these programs, Medicare spending growth has slowed and Medicare's solvency has been extended.

Increasing the deficit by $17.5 billion as a result of repealing the IPAB would is fiscally irresponsible, especially now that Republicans have introduced a tax package that will saddle our country with $1.5 trillion of debt in order to give tax cuts to the wealthy and corporations.

Mr. Speaker, despite the Supreme Court's upholding of the law's constitutionality, the reelection of President Obama, and Speaker Ryan's admission that ``Obamacare is the law of the land,'' Republicans refuse to stop wasting time and taxpayer money in their effort to take away the patient protections and benefits of the Affordable Care Act.

Mr. Speaker, I call upon House Republican leaders to stop wasting our time trying to take away healthcare protections that Americans depend on and to start addressing pressing national priorities.

And they should start with working with Democrats on a bipartisan and responsible plan to reauthorize the Children's Health Insurance Program (``SCHIP'') which insures more than 9 million kids and fully funding the relief efforts needed to help American communities recover from the devastating effects of Hurricanes Harvey, Irma, and Maria.

I urge my colleagues to join me in voting against H.R. 849.