Department of Homeland Security Acquisition Innovation Act

Mr. Speaker, 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 thank the gentleman from Texas (Mr. Sessions), my friend, for yielding me the customary 30 minutes.

Mr. Speaker, the majority is rushing to congratulate itself for finally having a bill to repeal the Affordable Care Act. For 7 years, Republicans had nothing to actually replace the law with, but that didn't stop them from making one empty political promise after another.

And after all that, what do we have in front of us today? This bill will take away health care from 24 million hardworking Americans. It forces families to pay higher premiums and deductibles, increasing out- of-pocket costs. It is a crushing age tax, forcing Americans age 50 to 64 to pay premiums five times higher than what others pay for health coverage, no matter how healthy they are. Not to mention the $880 billion cut to Medicaid or the fact that it steals from Medicare, shortening the life of the Medicare trust fund by 3 years and ransacking funds that seniors depend on to get the long-term care they need.

I don't see anything there to be excited about. But then again, I come from the old-fashioned school of thought that we should actually take care of our fellow citizens as they grow older, rather than tossing them off the ship without a life preserver.

It is no wonder that after developing such an ill-conceived and far- reaching bill on the fly, the majority has had to try and jam this legislation through our Chamber.

First, they rushed this bill through the committee process without holding a single hearing, and without the benefit of a nonpartisan Congressional Budget Office score outlining its costs and impacts.

Then the majority came out of a back room somewhere and filed four managers' amendments in the dark of

night to try to appease the conservative and moderate holdouts, including the infamous Buffalo bribe. The Republican leadership has been trying to strong-arm their conference into voting for this bill all week, and nobody knows how today's vote will go. The only thing we do know is that this is a terrible bill that is only getting worse, not better.

This thing has been a mess from beginning to end. Now, I know our President prides himself on his negotiating skills, but this seems more like the art of no deal to me, no matter what the final vote tally looks like.

That brings us to this early morning, when we met at 7 a.m. in the Rules Committee to report out this rule, which rewrites the bill to make it far worse.

Last night, we were presented with a provision, concocted in some back room, that boggles the mind with its cynicism. So what is this mysterious grand bargain that will appease the Republican Conference and finally buy Speaker Ryan enough votes to pass this disaster of a bill? Well, Mr. Speaker, it is so cartoonishly malicious that I can picture someone twirling their mustache as they drafted it in their secret Capitol lair last night.

Republicans are killing the requirements that insurance plans cover essential health benefits--essential health benefits. Now, perhaps you are wondering: What are these so-called essential benefits? Well, I will give you a partial list: emergency room trips, maternity care, mental health care and substance abuse treatment, and prescription drugs. These are the types of exotic, extravagant benefits that Republicans apparently don't think are important for working Americans to be able to afford.

It would be literally unbelievable if we weren't here considering it right now, Mr. Speaker. Now, I have been awake since before dawn-- thanks to our Rules Committee meeting--so I know that this isn't a nightmare. We are actually voting on a bill with a backroom deal, made in the dark of night, that would take away any guarantee that plans would cover these basic essential benefits.

And, of course, we have no idea what the costs will be or how many people it will affect. We can't know those things until we get an analysis from the nonpartisan Congressional Budget Office, which, obviously, we will not have before we vote on this reckless legislation.

And that is the real problem. Because every time you come out of a back room, this bill gets worse. For the sake of our country, maybe we should consider putting locks on the back rooms you huddle in.

President Trump keeps talking about crowd size. My colleagues across the aisle keep talking about page size. This morning, in the Rules Committee, Republicans kept saying that the fifth manager's amendment is only 4 pages long. How bad could it be?

Well, they need to stop worrying about size and pay more attention to how this bill will affect regular, working Americans. These 4 pages are the worse 4 pages on this planet because of the terrible consequences it will have on real people. It will be devastating for millions and millions of Americans.

So, Mr. Speaker, instead of rushing this horrendous bill, patched together with backroom deals, to the floor and voting on it just hours after seeing the final product, we should be working together in a bipartisan way to improve people's lives, and certainly not putting them at risk. My colleagues seem too concerned about winning at any cost to stop and think about the consequences for millions upon millions of Americans. This is a lousy bill.

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

Mr. Speaker, I include in the Record a letter from the AARP; a letter from the National Rural Health Association; a letter from the American Society of Addiction Medicine; and a letter from the American Medical Association--all strongly opposed to the Republican bill.

Mr. Speaker, I just want to say to my colleague from Texas, he said this bill was talked to death. It was talked to death by politicians. There were no hearings on this bill, so no experts came to testify, and none of these people who are now writing to us in opposition had the opportunity to be able to come before us and tell us how awful this bill is.

Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr. Hastings), a distinguished member of the Rules Committee.

Mr. Speaker, I yield an additional 30 seconds to the gentleman from Florida.

Mr. Speaker, I hear my friend talking about what came out of the Ways and Means Committee. I will tell you what came out of Ways and Means Committee: a $1 trillion tax cut for the wealthy.

Mr. Speaker, I yield 2 minutes to the gentleman from Colorado (Mr. Polis), a distinguished member of the Rules Committee.

Mr. Speaker, I would respond to the gentleman from Alabama with the words of another Alabama Member, Congressman Mo Brooks, who this morning said:

This is one of the worst bills I've seen in my 30 years in

Congress.

Mr. Speaker, I yield 1 minute to the gentleman from Michigan (Mr. Kildee).

Mr. Speaker, I notice the gentleman from Georgia relied on a tweet from Donald Trump for his facts in explaining the bill. I might suggest a more scholarly source, maybe, like, beginning with the Congressional Budget Office, which says that 24 million people will lose their health coverage as a result of the bill.

I will also point to the Quinnipiac poll that says only 17 percent of the American people approve of what my Republicans friends are doing. Seventeen percent is lower than Trump's rating. That is quite an accomplishment.

Mr. Speaker, I yield 1 minute to the gentlewoman from California (Mrs. Davis).

Mr. Speaker, I include in the Record a statement from NETWORK, the lobby for Catholic Social Justice; a letter from the National Alliance on Mental Illness; a letter from the Mental Health Liaison Group; and an article in the New York Times entitled ``Late GOP Proposal Could Mean Plans That Cover Aromatherapy but Not Chemotherapy.''

Dear Representative: NETWORK Lobby for Catholic Social

Justice urges you to vote NO on the American Health Care Act

(AHCA). This legislation fails to protect access to quality,

affordable healthcare for vulnerable communities. It would

widen the gaps in our society by making massive cuts to

Medicaid, giving large tax breaks to the very wealthiest

families and corporations, and threatening the health

security of American families.

Our faith teaches that access to healthcare is an essential

human right that is necessary to protect the life and dignity

of every person. The bill would drastically increase the

number of people without health insurance--and I know that

behind those numbers are millions of stories of families

facing medical bankruptcy, forgoing treatment, and losing

loved ones who could have been saved by preventative care.

The AHCA cuts Medicaid spending--an essential source of

care for millions of children, seniors, people with

disabilities, and people experiencing poverty in our nation--

and a per-capita cap would force states to ration care. The

legislation would also increase costs for older and sicker

patients and burden low- and moderate-income families with

much higher premiums by cutting $312 billion of financial

assistance for people purchasing health insurance on the

individual market. This is far from the Gospel mandate to

care for our most vulnerable sisters and brothers.

For any replacement to the ACA to be sufficient, it must

meet these 10 conditions--a Ten Commandments of Healthcare if

you will--and the AHCA breaks nine of 10 commandments:

1. Thou shalt provide affordable insurance and the same

benefits to all currently covered under the Affordable Care

Act. AHCA fails.

2. Thou shalt continue to allow children under the age of

26 to be covered by their parents' insurance.

3. Thou shalt ensure that insurance premiums and cost

sharing are truly affordable to all. AHCA fails.

4. Thou shalt expand Medicaid to better serve vulnerable

people in our nation. AHCA fails.

5. Thou shalt not undercut the structure or undermine the

purpose of Medicaid, Children's Health Insurance Program

(CHIP), and Medicare funding. AHCA fails.

6. Thou shalt create effective mechanisms of accountability

for insurance companies and not allow them to have annual or

lifetime caps on expenditures. AHCA partial fail.

7. Thou shalt not allow insurance companies to discriminate

against those with pre-existing conditions. AHCA partial

fail.

8. Thou shalt not allow insurance companies to discriminate

against women, the elderly, and people in poverty. AHCA

fails.

9. Thou shalt provide adequate assistance for people

enrolling and using their health coverage. AHCA fails.

10. Thou shalt continue to ensure reasonable revenue is in

the federal budget to pay for life-sustaining healthcare for

all. AHCA fails.

At its heart, this bill has lost sight of community and the

common good. Its biggest problem is that it lacks the

awareness that it is community which makes healthcare

effective. Healthcare is not just about the individual--it is

a communal good. The hyper individualism evident in the AHCA

is sucking the life out of our nation. Just focusing on one's

individual self is contrary to our Catholic faith and

contrary to our Constitution. We will track the vote and

score it in our 2017 voting record.

This dangerous legislation is not the faithful way forward

and must be rejected. Stand by Gospel principles and vote NO

on the AHCA.

Sincerely,

Sr. Simone Campbell, SSS,

Executive Director, NETWORK Lobby

for Catholic Social Justice.

Mr. Speaker, I yield 1 minute to the gentleman from Indiana (Mr. Visclosky).

Mr. Speaker, I yield 1 minute to the gentlewoman from California (Ms. Matsui).

Mr. Speaker, I just want to take a second to summarize this rule because people have been asking about it.

It is a closed rule. The only amendments allowed are amendments offered by people who wrote the bill. Those amendments are fixes to fixes to fixes to fixes in their bill and, in the words of Trump, sad.

I would just say, you know, usually when you have a lousy process you have a lousy bill, and that is why only 17 percent of the American people support what my Republican friends are doing.

I yield 1 minute to the gentleman from Texas (Mr. Castro).

Mr. Speaker, I yield 1 minute to the gentleman from Colorado (Mr. Perlmutter).

Mr. Speaker, I would like to inquire of the gentleman from Texas, if I can.

I know he has a few more speakers than he did yesterday, but we have a ton over here, and if there is additional time that he could share with us, we would appreciate it.

Mr. Speaker, I yield 1 minute to the gentlewoman from Illinois (Ms. Kelly).

Mr. Speaker, I yield 1 minute to the gentleman from North Carolina (Mr. Price).

Mr. Speaker, I yield 1 minute to the gentleman from Rhode Island (Mr. Langevin).

Mr. Speaker, I yield 1 minute to the gentlewoman from Hawaii (Ms. Gabbard).

Mr. Speaker, I include in the Record the CBO score for the underlying bill and the first four manager's amendments. We just got it last night, and it is already out-of-date given the fifth manager's amendment that was just submitted late last night.

U.S. Congress,

Congressional Budget Office,

Washington, DC, March 23, 2017.

Hon. Paul Ryan,

Speaker of the House, House of Representatives, Washington,

This analysis confirms that the Republicans will give a trillion-dollar tax break to the wealthiest people in this country, and they will kick 24 million Americans off their health insurance.

I will say that is why we are packed with speakers on this side, and there is probably only a couple of people on the gentleman's side, because we are standing with the American people who are outraged by this bill.

Mr. Speaker, I yield 1 minute to the gentleman from Rhode Island (Mr. Cicilline).

Mr. Speaker, I yield 2 minutes to the gentlewoman from Connecticut (Ms. DeLauro).

Mr. Speaker, I yield 30 seconds to the gentlewoman from New Hampshire (Ms. Kuster).

Mr. Speaker, I yield 1 minute to the gentleman from Virginia (Mr. Connolly).

Mr. Speaker, I yield 30 seconds to the gentleman from Florida (Mr. Crist).

Mr. Speaker, I yield 30 seconds to the gentleman from California (Mr. Panetta).

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

Mr. Speaker, I include in the Record a letter from 87 patient and provider organizations, including the Cystic Fibrosis Foundation, which is strongly opposed to this bill.

March 20, 2017.

Hon. Mitch McConnell,

Senate Majority Leader,

Washington, DC.

Hon. Paul Ryan,

Speaker of the House,

Washington, DC.

Dear Leader McConnell and Speaker Ryan: The undersigned

organizations write to express grave concern about proposals

put forth in the American Health Care Act (AHCA) to alter the

fundamental structure and purpose of Medicaid, a vital source

of health care for patients with ongoing health needs.

We feel compelled to speak out against proposals to phase

out Medicaid expansion and implement per capita caps, which

threaten the ability of Medicaid to provide critical health

care services to many of our most vulnerable citizens. These

proposals aim to achieve cost savings of approximately $880

billion, according to the Congressional Budget Office, at the

expense of tens of millions of patients who rely on Medicaid

for life-sustaining care. While we appreciate the

opportunities we have had to work with your staff, we cannot

support the Medicaid provisions in this bill and cannot

accept policies that prioritize cutting costs by limiting

patients' access to care.

Medicaid is Critical for Patients

Medicaid is a crucial source of coverage for patients with

serious and chronic health care needs. Pregnant women depend

on Medicaid, which covers roughly 50 percent of all births

including many high-risk pregnancies. Medicaid covers cancer

patients: nearly one-third of pediatric cancer patients were

enrolled in Medicaid in 2013 and approximately 1.52 million

adults with a history of cancer were covered by Medicaid in

2015. Over fifty percent of children and one-third of adults

living with cystic fibrosis rely on Medicaid to get the

treatments and therapies they need to preserve their health.

Nearly half of children with asthma are covered by Medicaid

or CHIP and adults with diabetes are disproportionally

covered by Medicaid as well. The patients we represent are

eligible for Medicaid through various pathways, including

through income-related and disability criteria.

Reject Per Capita Caps

The proposal to convert federal financing of Medicaid to a

per capita cap system is deeply troubling. This policy is

designed to reduce federal funding for Medicaid, forcing

states to either make up the difference with their own funds

or cut their programs by reducing the number of people they

serve and the health benefits they provide.

For patients with ongoing health care needs, this means

that Medicaid may no longer cover the care and treatments

they need, including breakthrough therapies and technology.

In order to save money, the per capita caps are set to grow

more slowly than expected Medicaid costs under current law.

As the gap between the capped allotment and actual costs

increases over time, states will be forced to constrain

eligibility, reduce benefits, lower provider payments, or

increase cost-sharing. Moreover, by capping the federal

government's contribution to Medicaid in this manner, states

will be less able to cover the cost of new treatments. This

could be devastating for people with serious diseases, for

whom groundbreaking treatments represent a new lease on life.

For people with cystic fibrosis, cancer, and other diseases,

new therapies can be game changers that improve quality of

life and increase life expectancy. In fact, we have already

seen Medicaid programs respond to current budget constraints

by using clinically inappropriate criteria to restrict access

to therapies old and new. A per capita cap will only

exacerbate the downward pressure on Medicaid budgets and will

further reduce access to these therapies for patients.

Pairing financing reforms with increased flexibility, as

has often been proposed, would further undermine Medicaid's

role as a safety net for patients. Without current guardrails

provided by federal requirements--coupled with reduced

federal funding--states will have the authority to reduce

benefits and eligibility as they see fit and to impose other

restrictions, such as waiting periods and enrollment caps.

These policies have serious implications for patients--for a

person with cancer, enrollment freezes and waiting lists

could mean a later-stage diagnosis when treatment costs are

higher and survival is less likely. For a person with

diabetes, this would risk the ability to adequately manage

the disease. Many of our patients rely on costly services

that will be quickly targeted for cuts if states are given

such flexibility, so it is imperative that current federal

safeguards remain in place.

Maintain Medicaid Expansion

While the AHCA has been described as preserving Medicaid

expansion for those already enrolled in coverage, we are

concerned that estimates show that eliminating the enhanced

match for any enrollee with even a small gap in coverage

would actually result in millions of people losing

coverage. By eliminating the enhanced federal match for

any enrollee with a gap in coverage, eventually states

will be on the hook for billions of dollars to continue

covering this population--an insurmountable financial

hurdle. Additionally, seven states have laws that would

effectively end Medicaid expansion immediately or soon

thereafter when the expansion match rate is eliminated.

Nearly half of adults covered by the Medicaid expansion

are permanently disabled, have serious physical or mental

conditions--such as cancer, stroke, heart disease,

arthritis, pregnancy, or diabetes--or are in fair or poor

health. Repealing Medicaid expansion will leave these

patients without coverage they depend upon to maintain

their health.

The proposed financing reforms are a fundamental shift away

from Medicaid's role as a safety-net for some of the most

vulnerable members of our society. Repealing Medicaid

expansion would leave millions without the health care they

rely on. Our organizations represent and provide care for

millions of Americans living with ongoing health care needs

who rely on Medicaid and we cannot support policies that pose

such a grave risk to patients.

We hope that we can continue our dialogue as you move

forward in this process to arrive at solutions that provide

all Americans with high-quality, affordable care regardless

of an individual's income, employment status, health status,

or geographic location.

Sincerely,

ADAP Advocacy Association; AIDS Action Baltimore; The AIDS

Institute; Alpha-1 Foundation; Alport Syndrome Foundation;

ALS Association; American Academy of Pediatrics; American

Behcet's Disease Association; American Congress of

Obstetricians and Gynecologists; American Diabetes

Association; American Lung Association; American Parkinson

Disease Association; American Society of Hematology; American

Thoracic Society; Amyloidosis Support Groups Inc.; ARPKD/CHF

Alliance; Arthritis Foundation; Batten Disease Support &

Research Association; Bladder Cancer Advocacy Network.

Bridge the Gap--SYNGAP Education and Research Foundation;

Bronx Lebanon Hospital Center Department of Family Medicine;

CADASIL Together We Have Hope Non-Profit; Cancer Support

Community; Child Neurology Foundation; Children's Cause for

Cancer Advocacy; Children's Dental Health Project; Chronic

Illness and Disability Partnership; Community Access National

Network; Congenital Adrenal Hyperplasia Research Education &

Support Foundation, Inc.; COPD Foundation; Cure HHT;

Cutaneous Lymphoma Foundation; Cystic Fibrosis Foundation;

Cystinosis Research Network; debra of America; Endocrine

Society; Fibrous Dysplasia Foundation; First Focus Campaign

for Children.

FORCE: Facing Our Risk of Cancer Empowered; Foundation for

Prader-Willi Research; Friedreich's Ataxia Research Alliance

(FARA); Genetic Alliance; Hannah's Hope Fund; Hide & Seek

Foundation for Lysosomal Disease Research; Hispanic Health

Network; Hope for Hypothalamic Hamartomas; Huntington's

Disease Society of America; Immune Deficiency Foundation; The

International Pemphigus and Pemphigoid Foundation; Kids v

Cancer; Latino Commission on AIDS; LFS Association (Li-

Fraumeni Syndrome Association); Liver Health Connection;

March of Dimes; Medicare Rights Center; MLD Foundation.

Moebius Syndrome Foundation; Muscular Dystrophy Association

(MDA); NASTAD (National Alliance of State & Territorial AIDS

Directors); National Alliance on Mental Illness; National

Coalition for Cancer Survivorship; National Health Law

Program; National Hemophilia Foundation; National Multiple

Sclerosis Society; National Organization for Rare Disorders;

National Patient Advocate Foundation; National Tay-Sachs &

Allied Diseases Association (NTSAD); National Urea Cycle

Disorders Foundation; National Viral Hepatitis Roundtable;

NBIA Disorders Association; Needle Exchange Emergency

Distribution (NEED); Parent Project Muscular Dystrophy

(PPMD); Parkinson Alliance; The PCD (Primary Ciliary

Dyskinesia) Foundation; Polycystic Kidney Disease Foundation;

Pulmonary Fibrosis Foundation.

PXE International; Rett Syndrome Research Trust;

Scleroderma Foundation; The

Sudden Arrhythmia Death Syndromes Foundation; T1D Exchange;

Trisomy 18 Foundation; Tuberous Sclerosis Alliance; United

Way Worldwide; VHL Alliance; Wilson Disease Association;

Wishes for Elliott: Advancing SCN8A Research.

Mr. Speaker, I would say to my colleagues that this is a sad day for this institution. This process has been awful. But this is even a sadder day for the American people.

I remind my colleagues that we are supposed to care about one another, especially the most vulnerable in our society. In this era of Trump, Washington has become a mean place. It is a place where it has become unfashionable to worry about the poor, about older Americans, and about those who struggle.

There is absolutely no justification for giving huge tax breaks to billionaires--$1 trillion in tax breaks to millionaires and billionaires, and at the same time throwing 24 million people off of health care and denying millions more essential healthcare protections.

Twenty-four million people--my Republican colleagues have lost their human ability to feel what that means. That is the entire population of Australia.

Mr. Speaker, I have a great deal of respect for my colleagues, but when I look at this bill and I read this bill, I have to wonder: What are you thinking? How could you do this?

I have come to the conclusion there are only two reasons--there are only two ways you can vote for this bill. One is you don't know what is in the bill; or two is you have to have a heart of stone, because this bill is shameful. It is going to hurt people. It is going to hurt your constituents.

Withdraw this bill or vote ``no'' on this bill, but this bill cannot become law. The health care and healthcare protections for the American people are too important.

Mr. Speaker, I urge all my colleagues--both Democrats and Republicans--reject this. Vote ``no.''

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

Mr. Speaker, I demand a recorded vote.

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 228 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, pending which I yield myself such time as I may consume. During consideration of this resolution, all time yielded is for the purpose of debate only.

General Leave

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

Mr. Speaker, I rise in support of this rule and the underlying legislation.

This rule is a fair rule that adequately provides both sides of the aisle with ample time to debate the merits of the underlying legislation. In fact, the Rules Committee thought it was so important that ample time be provided to this debate, that we are provided 4 hours of general debate on the underlying bill.

Mr. Speaker, in honor of our former President, Ronald Reagan, I wear brown today. The former President, when he was President, believed that wearing brown was good luck to him and good luck for the things which he was undertaking. So, in honor of Ronald Reagan, I, too, wear my brown jacket today.

Mr. Speaker, it has become abundantly clear that ObamaCare has failed the American people. Our Nation's healthcare system today is broken and only getting worse under the current law, known as the Affordable Care Act, or ObamaCare.

Simply put, ObamaCare is collapsing, and it is collapsing fast. Options and choices are disappearing for consumers, and an anticompetitive marketplace has been created that firmly harms patients.

How bad is it? Nearly one-third of all U.S. counties currently have only one insurer offering plans on their State's exchanges. That is a government-created monopoly, Mr. Speaker, and that kills the free market, meaning no choices for the American people and higher costs are what the American consumer and the healthcare market are finding.

And it is only continuing to get worse. As more and more insurers leave the marketplace, prices will continue to rise, forcing healthy individuals to make economic decisions not to purchase health care, creating a self-defeating spiral of rising costs and less options. That is why we must act, and act today, which is what we are doing.

It is no wonder that in such a government-controlled system that premiums have increased by an average of 25 percent on the ObamaCare exchanges this year alone. And it is no wonder that some 19.2 million taxpayers chose to outright pay the individual mandate penalty or claimed an exemption. What this means is that ObamaCare is not a good option to these 19.2 million people.

Mr. Speaker, the American people, I believe, sent us to Washington, D.C., to fix this issue. They are telling us directly: this must be fixed now. And people certainly outside of Washington resent the Federal Government telling them how to purchase health care and what that healthcare marketplace would look like. But we really do not have to tolerate this. We do not have to agree that we will accept the status quo.

Mr. Speaker, I believe the American people are smart. I believe the American people want independence, they love freedom, and they want to know that they can make their own choices, because they believe they make better choices than a one-size-fits-all plan out of Washington,

Mr. Speaker, I yield 10 minutes to the gentleman from Lewisville, Texas (Mr. Burgess), a distinguished member of the Rules Committee, a gentleman who sits on both the Energy and Commerce and the Rules Committee. He is quite literally the most knowledgeable person on health care in the United States Congress.

Mr. Speaker, I yield myself such time as I may consume, and I thank the gentleman from Florida very much. In fact, the gentleman is correct. We had an opportunity to quote the Bible, Janis Joplin, and ZZ Top when we were doing our hearings. We had so much time with each other, and I enjoyed the hours and hours that we had to debate these essential items.

But the other side of the story is essential health benefits are not being done away with. They are being transferred entirely to States. States have asked for the ability to manage their own money, and manage their own people's benefits of what would be required in the States. So in no way should a person take away, well, we just did away with it. In fact, we transferred the authority and the responsibility of essential health benefits to the States because Governors have been asking for this.

Mr. Speaker, I want to take just a moment to explain what I believe is at the heart of the legislation and really, in reality, the key to fixing health care. It is the second part of this.

We heard the gentleman from Lewisville, Texas, Dr. Burgess, speak about the Energy and Commerce portions. I now would like to take a minute to talk about the portions that come directly out of the Ways and Means Committee.

The gentleman, Mr. Brady, from The Woodlands, Texas, today, spoke about many of these; but at the heart of it, 170 million Americans currently receive their health care through an employee-employer tax advantage or tax benefits, an untaxed benefit whereby people who have an employer who can provide their health care, it is not taxed-- pretaxed to the employee, allowing them to have a good healthcare system. Well, all the while, millions of Americans pay higher premiums out of their pockets in the individual market. Those are people that do not have an employer who is able to help them. So that is not fair. That does not help these people.

What we are doing here is putting together an addition of, really, a great Republican idea; and it takes the important step to provide the same tax-free benefits for those employer-sponsored plans that we will give to regular employees, and it is called a tax credit. This tax credit is going to work because it allows every single American that does not receive the tax benefit at work to get it for themselves.

Who is this? Well, quite honestly, it is small-business owners; it is low-income workers; it is entrepreneurs. It includes, really, a lot of real estate agents and people that work for a small business, maybe heating and air-conditioning systems like we have all across this country. It will give their families an opportunity.

How much money? Well, we will provide them between $2,000 and $14,000 a year for their families to be able to have these opportunities to purchase a nongovernment healthcare plan, meaning that, as they would go to the marketplace, we are going to help these people through a tax credit available January 1, providing them with an opportunity to purchase health care on a benefit basis.

Why is this important? It saves money because what it does, it creates two things: a family then has an insurance plan, including a healthcare component that goes to the hospitalization; and secondly, it gives them an opportunity to have their own doctor or healthcare plan that they choose. This is important because many of these people end up in the hospital in the most expensive kind of way we can provide health care: at the emergency room.

So this gives these families parity in the marketplace. We believe that that is important and is another part of this Republican healthcare plan.

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

Mr. Speaker, I yield 2 minutes to the gentleman from Alabama (Mr. Byrne), a distinguished member of the Rules Committee.

Mr. Speaker, I yield 5 minutes to the gentleman from Georgia (Mr. Woodall), who will be describing the third piece of this, and that is the putting together of the piece from the Budget Committee.

Mr. Speaker, I yield 2 minutes to the gentleman from Oklahoma (Mr. Cole), the vice chairman of the Rules Committee.

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

Mr. Speaker, we are going to keep moving on. We were allocated the same amount of time. I guess the answer would be no.

Mr. Speaker, I yield 1 minute to the gentlewoman from Wyoming (Ms. Cheney), who is the favorite daughter of Wyoming and serves on the Rules Committee.

Mr. Speaker, I yield 1 minute to the distinguished gentleman from Pasco, Washington (Mr. Newhouse), who is a member of the Rules Committee.

Mr. Speaker, I reserve the balance of my time, and I am prepared to close.

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

Mr. Speaker, I want to begin by thanking our colleagues, the gentleman from Massachusetts leading the Rules Committee, and his ranking members as they came from each of the committees, some 50 hours' worth of hearings and markups, including some 16 hours in the Rules Committee to not only talk about and vet, but to understand more clearly what we would be voting on.

Mr. Speaker, today is a bill that is a compromise bill, no doubt about it. I had my own plan and I had my own ideas. I took 2 years to get involved in this process. It is difficult to write a healthcare bill. But it didn't have to be my bill; it had to be a bill that we could all work together on.

President Trump has been a part of that. President Trump took time out of his schedule to do this. It is important to the American people. President Trump, more than any single Member of Congress, gave the message to the American people about what was necessary and what he would do. He is going to live up to that, and we should, too.

Mr. Speaker, the bottom line to this whole thing is we are going to present a Republican plan, and we are going to stand behind what we sell. It is better for the American people. But make no mistake about it: we are transferring power, authority, and responsibility not just to States, but also to the American people. It will be up to them to make determinations about their own health care because, for the first time, we will allow some 50 million Americans to have a tax equity, an opportunity to use tax credits that will be available to families anywhere from $2,000 for an individual to $14,000 for a family.

This will empower people who have not found a fair shot at the tax advantages it will give them: small-business owners; the American people; the average worker in this country, including those who work two or three different jobs; as well as those who are uninsured. We believe it is a better shot, an opportunity. We are willing to put our name on it and behind it.

For these reasons, Mr. Speaker, I urge us to move forward. There will be 4 hours of debate that remain in this opportunity. For that reason, I urge my colleagues to support this rule and the underlying bill.

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

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

Mr. Speaker, I thank the gentleman for yielding.

Mr. Speaker, we all know why we are here--the problems that exist within the Affordable Care Act. It is simply not working for the American people--limited choice, costs going up, and millions without access to care. Unfortunately, these are not just talking points, but real issues affecting real Americans.

The Affordable Care Act has damaged the individual market. It has driven insurers away from offering coverage. Now, we are seeing one- third of all United States counties with only one insurer. And among the plans that have chosen to remain in the markets, there have been widespread, double-digit premium increases.

The individual markets are a death spiral and are failing to live up to the promises made 7 years ago--that Americans would be able to receive affordable health care. As we knew then, and we know now, this was an empty promise that has left an estimated 19.2 million Americans without coverage. What is worse, these individuals are forced to pay the individual mandate penalty or seek a hardship exemption because of the costs to purchase and use health insurance.

Nine months ago, Mr. Speaker, we began our Better Way plan to save the Nation's healthcare system and to bring relief to the American people. This plan, which served as the blueprint for the American Health Care Act, laid out the policies to stabilize the collapsing insurance markets and to repeal the more burdensome Affordable Care Act taxes and mandates that have hindered innovation and limited access to care. So let's take a look at what the American Health Care Act does.

First and foremost, it provides immediate relief to the State insurance markets. As Republicans, we know that one-size-fits-all works for no one and certainly did not work for the individual markets. The States should have the flexibility to support their insurance markets and ensure that plans can continue to provide options for coverage.

To do this, we relaxed two of the egregious market regulations that were imposed under the Affordable Care Act: the mandate that premiums cannot vary for younger and older Americans by more than a 3-to-1 ratio, and the mandate creating fixed actuarial values for plans.

The mandate limiting a plan's ability to set premiums by age has driven up the cost for coverage for younger and healthier Americans and has pushed away those seeking coverage by the millions. Of the 19.2 million Americans who have sidestepped the individual mandate, it estimated that as many as 45 percent of these individuals are under the age of 35. Without these younger Americans seeking coverage, the markets have further plunged into death spirals, as insurers hike up premiums year after year.

To change this, we are relaxing the ratio to 5-to-1. It will lower premium costs and provide necessary opportunities to stabilize the markets.

Additionally, we are repealing the actuarial values mandate to provide insurers with additional flexibility to offer more coverage options.

To further supplement these efforts, we are establishing the Patient and State Stability Fund. This fund provides States with $100 billion over 10 years to promote innovative solutions to lower cost and increase access to health care for unique patient populations in each State. The goal is simple: to provide States with maximum flexibility as to how they address the cost of care for their citizens.

The Congressional Budget Office estimated that a combination of the Stability Fund and other proposed changes to the market would reduce premiums by 10 percent by calendar year 2026. We all want patients to have access to high-quality, affordably priced coverage. The Patient and State Stability Fund can help to lower costs.

In Medicaid, in addition to supporting the insurance market, the American Health Care Act provides needed reforms to the Medicaid program. Without changes, the Medicaid expansion alone is expected to cost $1 trillion over the next decade. Medicaid desperately needs reform so that States can continue to provide coverage to children, people with disabilities, and other vulnerable groups.

To address these concerns, the American Health Care Act first phases out the Medicaid expansion, the expansion that has crippled State budgets and limited States' ability to ensure that

resources will continue to be available for those vulnerable populations.

Additionally, our bill helps further bend the Medicaid cost curve by shifting programs toward per capita allotments. The per capita allotments, an idea that originated during the Clinton administration, will set limits on the annual cost for growth for per capita expenditures for which the States will receive matching funds from the Federal Government.

The American Health Care Act increases the amount of flexibility that States have in managing their Medicaid programs. The bill scales back the Affordable Care Act mandates that have limited a State's ability to tailor their plans to the needs of their beneficiaries. States can and should be trusted to manage the needs of their beneficiaries, and this bill allows States to do that.

Additionally, the bill before us today furthers the goal of providing the States with greater flexibility in managing their Medicaid programs by providing States with the option to implement two additional opportunities: work requirement and block grants for Medicaid.

This time around we chose to engage our State counterparts in the discussion and listen--listen--to their input as we designed this bill. At the top of their list were the desire to see the work requirement built in and the opportunity to work with Medicaid as a block grant.

We don't tell them what to do. They are given the permission to do what they feel is best for their citizens. Republicans trust the States and trust the Governors and the elected leaders in those States.

Finally, the American Health Care Act provides additional resources to bolster State safety net providers. The bill provides increases in the community health center funding, offers enhanced funding to support safety net providers in States that did not expand Medicaid, and ends the cuts to the disproportionate share hospital payments.

We are committed, Mr. Speaker, to ensuring that our local providers can continue to deliver lifesaving care. The American Health Care Act turns this commitment into action. For millions of Americans in rural and medically underserved areas, these actions will provide needed relief that was undercut by the Affordable Care Act.

Let me just say, Mr. Speaker, it has been an interesting process. We had a 27\1/2\-hour markup in the Energy and Commerce Committee. We have had over 15 or 16 hours in the Rules Committee. This bill has been almost talked to death. I want to just acknowledge that I appreciate the input of the administration. I appreciate the fact that the directive to us last night was to put our pencils down and turn our papers in. It is time, Mr. Speaker.

This is a good bill. The rule deserves our support. The underlying bill deserves our support.

Mr. Speaker, I appreciate all the hard work the Rules Committee chairman has done in this bill. Mr. Speaker, I have the great pleasure of serving on the Rules Committee, but I am the designee to the Budget Committee.

This whole process that we are going through is a Budget Committee process. It is called reconciliation. And as folks have talked about it, they have talked about what the Ways and Means Committee has done and what the Energy and Commerce Committee did. But then those two bills come together in the Budget Committee, and we move the process forward.

I can't help but notice my colleagues' frustration with the amendments that have been made to this bill along the way. Generally, we celebrate amendments that are made along the way because they improve the work product. We do them together.

I point here, Mr. Speaker, to a tweet that the President sent out the day the healthcare bill was introduced. The President said:

``Our wonderful new HealthCare Bill is now out for review and negotiation.''

And that was true. It was out for review so everyone could read it, and it was out for negotiation so that everyone could improve it.

We did that in the Budget Committee. We had four motions to instruct that passed in the Budget Committee to provide Medicaid flexibility, to make sure the tax credits were targeted to the right populations, to ensure that able-bodied, working Americans had those incentives to both get health care and be able to go back to work.

Now, every committee didn't have that experience. As my colleagues have asked for a bipartisan process, you will remember that the Energy and Commerce Committee spent 10 hours debating the title of the bill. They spent 10 hours debating Democratic amendments to change the title of the bill. Folks, we have opportunity after opportunity to make things better, but it is incumbent upon us to choose that opportunity to make things better.

So often we get wrapped around the partisan action. Folks let that opportunity slip away. I am glad that we didn't do that.

Mr. Speaker, when I talk about what we did in the Budget Committee to make it better, I am talking about focusing on the real problems. There is not a member in this body that doesn't understand that what is contributing to the ObamaCare death spiral is that young people are not enrolling. Young people are not enrolling.

More Americans rejected ObamaCare and filed for an exemption or agreed to pay the penalty than enrolled in ObamaCare. I don't care how big your heart was when you passed the bill, you have to concede that wasn't what you intended. And we can do better.

My friends are talking about the essential health benefits plan today. Young people are particularly sensitive to that. They are price sensitive in that way. We are talking in the Budget Committee about how to preserve that flexibility for States to design plans that are right for them.

How many times today have we heard folks say that prices are going to increase for Americans between the age of 54 and 64?

I have heard it at least a dozen times. At the same time, my friends are demanding that every healthcare plan in the State of Georgia cover maternity benefits for those women between the age of 54 and 64. At the same time, my friends are demanding that every plan in Georgia cover pediatric benefits for those empty nesters between 54 and 64. That doesn't make sense. It doesn't make sense. We in Georgia know it doesn't make sense, and we can do better.

Mr. Speaker, 45 percent of the almost 20 million people who rejected the Affordable Care Act and agreed to pay the fine or file an exemption instead were under the age of 35. There is not a serious thinker in this room who believes we can solve the insurance crisis in this country without getting these folks back into the marketplace. And that is what we did in the Budget Committee. That is what we have done throughout this entire amendment process, and that is what the amendments we considered in the Rules Committee this morning did as well.

Mr. Speaker, since the passage of the Affordable Care Act, many States have had to pass a lot of legislation in order to conform their plans to new one-size-fits-all Federal mandates. But that is not the story. The story is that, at the same time, States were passing their own benefit mandates to serve their constituency better.

Mr. Speaker, Chairman Session's State of Texas passed a mandate that orally administered anticancer medication be covered. The gentleman from Texas has seen those groups in his office. He has seen those families struggling. And what Texas said is: To respond to our people, we are going to require every plan sold in the State of Texas cover these issues.

In my home State, Mr. Speaker, we created a commission to look at annually how to add more benefits, change those benefits, make sure we are being responsive to folks in the best way that we can.

The gentleman from Colorado, his State did the very same thing. They required coverage for acupuncture services. They required the selling of child-only plans. They required coverage for fetal alcohol syndrome. We do these things collaboratively, and we do these things together.

Mr. Speaker, I urge passage of the rule and passage of the underlying legislation.

Mr. Speaker, today is a sad day for this institution.

Why are we here? Well, after 13 hours at the Rules Committee on Wednesday,

did we report to the floor the Republicans' replacement to the Affordable Care Act? No.

And why not? Because the legislation was not extreme enough. It didn't hurt enough people. It didn't make enough people uninsured. It didn't give a large enough tax break to the wealthiest among us.

That 13-hour exercise yielded nothing except to reveal the callous depths of the Republican Party's attempt to deprive health care from 24 million people.

So after my friends on the other side of the aisle added yet another manager's amendment, bringing the total to five, and after stripping away essential health benefits, we are here this morning to push this extreme, dangerous, and callous bill under martial law.

But why are we really here? Is this bill actually about improving health care in this country? By my estimation, and by the analysis of virtually every healthcare group--Mr. McGovern has introduced some of them: hospitals, medical organizations, and the nonpartisan Congressional Budget Office--the answer is a flat-out, resounding no.

Premiums are going to rise. Millions upon millions of people will lose health coverage. Essential benefits will be stripped away, and 400 of the wealthiest Americans will get a substantial tax cut, while Medicaid is being cut by $880 billion.

Mr. Speaker, during that 13-hour marathon meeting that yielded nothing but a rule allowing Republicans to continue to ram this measure through Congress, I quoted from Scripture, from the King James Bible, Matthew 25:45. It says:

Then shall He answer them, saying, Verily, I say unto you,

inasmuch as you did it not to one of the least of these, you

did it not to me.

My friends on the other side of the aisle often cite Scripture in their legislative motivations. I ask them now: How does cutting the benefits from the least among us, while showering more wealth upon the wealthiest among us, square with these teachings?

In addition, Mr. Speaker, I noted to them that we hear from them all the time about liberty. So I noted that, in the Preamble to the Constitution, the document that guides our great Nation and that we all swear an oath to uphold, that we are entrusted to also, and I quote from the Preamble, ``promote the general welfare.'' I also note for you that this charge is placed before the first mention of the word ``liberty.''

Does stripping away of essential health benefits, which include maternity and newborn care, pediatric services, and emergency services, promote the general welfare?

Does cutting $880 billion from Medicaid promote the general welfare?

Does ensuring that, by 2026, 56 million people under the age of 64 will be left without coverage promote general welfare?

Finally, Mr. Speaker, in the debate at committee on this shameful bill, I answered the Republican charge that this bill was about freedom when I quoted a verse from Janis Joplin's ``Me and Bobby McGee.'' What she was saying is: ``Freedom's just another word for nothin' left to lose.''

Mr. Speaker, if this extreme bill becomes law, a bill which has been rushed through Congress, amended without care, brought before us without hearings, without a CBO score, without thoughtful consideration, without a Democratic amendment being approved, and without a clue, I fear--indeed, I know--that the American people will find themselves with nothing left to lose when it comes to their and their family's health care, which is the most perverse and wretched kind of freedom as you may have ever seen.