Mr. Speaker, I yield myself such time as I may consume. (Mr. McGOVERN asked and was given permission to revise and extend his remarks.) I thank the gentleman from Georgia (Mr. Collins) for the…
Mr. Speaker, I yield myself such time as I may consume.
(Mr. McGOVERN asked and was given permission to revise and extend his remarks.)
I thank the gentleman from Georgia (Mr. Collins) for the customary 30 minutes.
Mr. Speaker, pathetic, that is the word to describe this process and this bill. If the American people could sue Congress for malpractice, my Republican friends would be in deep trouble.
How could you do this? How could you do this to the American people? How can you do this to the people you represent?
You are taking away essential healthcare protections. You are allowing insurance companies to discriminate against people with preexisting conditions. You are supporting a bill that will throw 24 million people off of their health care and cut Medicaid by $880 billion to give a $1 trillion tax break to the wealthiest people in this country.
What is wrong with you guys?
Today's rule self-executes three of the newest Republican amendments to the Republican health plan. This means, without any sort of debate or discussion whatsoever, the Palmer, MacArthur, and Upton amendments will magically pass the House.
What I find so hard to believe about this latest backroom deal is that they actually make this bill worse. I didn't think that was possible, Mr. Speaker.
To shore up support amongst this Chamber's most conservative faction, Representative MacArthur and others made a deal with President Trump to gut protections for individuals with preexisting conditions and to eliminate essential health benefits like maternity care, mental health treatment, and prescription drug coverage, just to name a few. These are among the most popular provisions of the Affordable Care Act.
The American people were justifiably outraged, and they showed up by the thousands to townhalls to express their anger. And there were some on the Republican side who actually got it. They listened to their constituents and they had the courage to stand up and say no.
But when Republican leaders came up short in their whip count, Representative Upton ran to the White House and concocted a deal with President Trump to try to win back votes. His amendment adds a measly $8 billion spread out over 5 years in a futile attempt to soften the devastating effect that this bill will have on millions and millions of Americans with preexisting conditions.
Now, $8 billion over 5 years sounds like a lot, but when we are talking about an entire country, it really isn't. Don't take it from me. Robert Graboyes from the conservative Mercatus Center said:
``The $8 billion amount is a pittance. Spread over 5 years, it's a fifth of a pittance.''
This is not a leftwing organization. This is an organization funded by Koch Industries, the Koch brothers. My friends love the Koch brothers.
What's more, some analysts have already estimated that an additional $200 billion will be needed over a decade to adequately fund high-risk pools. So this amendment is billions upon billions upon billions of dollars short. And as the Center for American Progress points out, the Upton amendment ``will have almost no effect.''
Now, my colleagues who have been won over by this should be ashamed of themselves. We are supposed to fix problems and help people, not merely settle for political cover that can be used in a press release. $8 billion to cover a $200 billion shortfall? Back where I come from, we call that being a cheap date. I guarantee you, your constituents are going to figure this out, and they will not be happy.
So to so-called moderate Republicans who have contorted themselves this week to try to find a fix to the damage being done to the people with preexisting conditions, I have breaking news: I have a magic bullet fix if Republicans really want to protect people with preexisting conditions. Are you ready? Brace yourselves. Don't change the law. Everyone is already protected by the Affordable Care Act, including people with preexisting conditions and those who struggle to find affordable care. Let me say to my colleagues that to claim or imply that this Republican plan covers preexisting conditions is a lie, plain and simple.
Now, let me say a few words about the process that has been used to bring this bill to the floor. It has been a disaster from start to finish, with secret negotiations, backroom deals, and bribes to buy off factions within the Republican Conference. There have been no hearings on this bill whatsoever. And the Republican leadership couldn't even slow down long enough to receive a score from the CBO.
I have one simple question: What is the rush? Wait a week and get a CBO score. Why is that such a radical idea?
Mr. Speaker, are Republican leaders jamming this bill through to appease Donald Trump?
Are they concerned that a new CBO score will confirm what we already know is true, that this bill will be devastating to the people of this country, force even more people to lose their health care, especially to older, sick, and low-income Americans.
Or maybe, Mr. Speaker, Republican leaders are worried that their colleagues will go home over this weeklong break and actually hear from their constituents who overwhelmingly oppose this effort to repeal the Affordable Care Act.
Honestly, I don't know how my Republicans friends can defend this terrible, closed, authoritarian process. It is an absolute disgrace.
I urge my colleagues to vote ``no'' on this bill, or, better yet, I urge my Republicans colleagues to do what they did a couple of weeks ago and pull this disastrous bill.
I reserve the balance of my time.
Mr. Speaker, I yield 1 minute to the gentleman from Kentucky (Mr. Yarmuth), the distinguished ranking member of the Committee on the Budget.
Mr. Speaker, I am not sure if my colleagues are aware of this since we are moving so quickly here, but I want to flag for everyone an important op-ed in The Hill by the executive director of the Boston Area Rape Crisis Center. She points out that in the latest version of this legislation, rape can once again be categorized as a preexisting condition as it often was before the Affordable Care Act.
I include her column, entitled ``Health `reform' will make sexual assault survivors sick,'' in the Record.
Health `Reform' Will Make Sexual Assault Survivors Sick
(By Gina Scaramella)
So far, we know that about 24 million Americans stand to
lose their health insurance coverage if the Affordable Care
Act (ACA) is replaced with the American Health Care Act
(AHCA). We know that most of those 24 million people will be
low-income.
We also know that groups of people who experience
significant health care disparities, such as lesbian, gay,
bisexual and transgender (LGBT) people, and Black and Latino
people, will be among those who risk losing the most if the
ACA is repealed. To that list, we must add survivors of
sexual violence.
Before passage of the ACA in 2010, sexual assault survivors
who had sought medical care for their injuries could be
denied health insurance coverage at a later date. The reason?
Health insurers often categorized rape as a pre-existing
health condition.
In one widely reported case, a 45-year-old woman met two
men at a bar in Florida who bought her a drink. Hours later,
she found herself lying by the side of the road with injuries
indicating that she had been raped and that the men had
spiked her drink. Her doctor prescribed a treatment of anti-
viral, post-HIV exposure drugs to protect against HIV
transmission.
When the woman lost her health insurance several months
after the attack, she was unable to obtain new insurance due
to the health care treatment she had received for the
assault. She went without health insurance for three years.
Stories like these prompted the National Women's Law Center
to launch a campaign called ``Being a Woman Is Not a Pre-
Existing Condition.'' It was so popular that then-House
Speaker Nancy Pelosi adopted the phrase in her pro-health
reform talking points with media, and the New York Times ran
an explainer on the ways in which health insurers treated
women as if they were just one giant pre-existing condition.
The AHCA initially retained the ACA's ban on discrimination
against people with pre-existing conditions. But an amendment
to the AHCA bill offered last week by New Jersey Congressman
Tom MacArthur and North Carolina Congressman Mark Meadows
would make it easier for health insurers to deny coverage to
people with pre-existing conditions.
By letting states waive the ACA prohibition on charging
people with pre-existing health conditions higher premiums,
protections for those who've previously been medically
treated for sexual assault would be gutted.
Perhaps more alarming, though, is the MacArthur-Meadows
amendment's provision allowing states to also seek waivers
from the ACA's requirement that essential health benefits be
covered by health insurance plans. Essential health benefits
include preventive health care services that most of us take
for granted. These include tests for blood pressure and
cholesterol, mammograms, and vaccinations. Essential health
benefits also include coverage for mental health care and
substance abuse treatment.
Sexual violence survivors face acute treatment needs in the
aftermath of an assault such as care for gynecological
injuries, other physical trauma, sexually-transmitted
diseases, and pregnancy. But sexual violence takes many
forms: incest: ongoing sexual abuse outside of the family,
sexual assault, sexual harassment or exploitation, and rape.
Each of these types of assault puts the survivor at risk for
various potential negative physical health and mental health
outcomes.
For example, an adult survivor of childhood sexual abuse is
at a higher risk for psychiatric disorders. Women and men who
have survived rape as adults are at higher risk of post-
traumatic stress disorder, depression, anxiety, and substance
abuse--any of which can significantly interfere with daily
living. No one can deny that there is a direct line between
having survived sexual violence, and an increased risk of
physical and mental health problems.
The mental health impacts of sexual violence are deep and
often longstanding. Survivors need long-term access to
nonjudgmental health and mental health services to reduce
their suffering and mitigate as much as possible the stress
that recovery from sexual violence puts on intimate family
relationships, and obligations related to school and work.
It is hard to see any good coming from this latest attempt
to repeal the ACA and all of the care it has brought to
survivors of sexual violence.
Mr. Speaker, I yield 1 minute to the gentlewoman from Washington (Ms. DelBene).
Mr. Speaker, I yield 1 minute to the gentleman from Texas (Mr. Castro).
Mr. Speaker, wow. I yield myself such time as I may consume, and to rebut the gentleman from Texas, let me include in the Record a letter from the American Cancer Society, the American Diabetes Association, the American Heart Association, the American Lung Association, the Cystic Fibrosis Foundation, the Juvenile Diabetes Foundation, the March of Dimes, the National Multiple Sclerosis Society, the National Organization for Rare Disorders, and the National Coalition for Women with Heart Disease.
Leading Patient Advocacy Groups Remain Opposed to the American Health
Care Act
Eight Organizations Issue Statement Criticizing Upton Agreement
Washington, May 3, 2017.--Earlier today, House Energy and
Commerce Committee Chairman Greg Walden (R-OR) issued a press
release stating that an amendment proposed by Representative
Fred Upton (R-MI) to the American Health Care Act (AHCA)
provides ``protection and certainty for patients with pre-
existing conditions.'' Eight leading patient groups, listed
below, issued the following statement in response:
Despite the Upton amendment, we remain strongly opposed to
the American Health Care Act and urge Congress to consider
the people at the heart of this decision. The various
patchwork solutions offered by lawmakers would still leave
the millions of patients we represent, who have serious and
chronic health conditions, at risk of not being able to
access life-saving treatments and care.
There is no substitute for fundamental, unequivocal
protections for people with pre-existing conditions.
The AHCA, including the potential amendment, would
undermine vital safeguards against being charged more for
insurance based on health status. Increasing funding for risk
sharing programs and consumer financial assistance does not
address the legitimate challenges built into these proposals.
The other equally important problems with the AHCA remain,
including:
Allowing states to waive the guarantee of essential health
benefits, which would:
Segment the market into plans for sick people and plans for
healthy people, driving up the cost of plans for people with
serious health care needs
Undermine the protection against annual and lifetime
coverage caps, a critical safeguard for patients
Eliminating Medicaid expansion coverage for millions of
Americans and altering the program's financing structure in a
way that jeopardizes coverage of new and innovative
treatments
Increasing out-of-pocket costs for many Americans,
including some of the sickest and elderly among us
Given the numerous shortcomings of the American Health Care
Act in serving the patients we represent, our organizations
have no choice but to oppose this legislation and urge all
Representatives to vote against it, with or without the Upton
and MacArthur amendments.
Patient Advocacy Groups
American Cancer Society Cancer Action Network
American Heart Association
American Lung Association
Cystic Fibrosis Foundation
March of Dimes
National Organization for Rare Disorders
National MS Society
WomenHeart: The National Coalition for Women with Heart
Disease
Media Contacts
American Cancer Society Cancer Action Network, Alissa
Crispino.
American Heart Association, Abbey Dively.
American Lung Association, Allison MacMunn.
Cystic Fibrosis Foundation, Jessica Rowlands.
March of Dimes, Cindy Pellegrini.
National Organization for Rare Disorders, Jennifer Huron.
National MS Society, Eileen Curran.
WomenHeart: The National Coalition for Women with Heart
Disease, Tom Murphy.
Mr. Speaker, I also include in the Record a statement from the American Medical Association in opposition to this bill.
[From the American Medical Association, May 3, 2017]
AMA Warns that Proposed Changes to the American Health Care Act Do Not
Remedy Bill's Shortcomings
Despite amendments to bill, millions of Americans would still lose
health insurance coverage
Chicago.--American Medical Association (AMA) President
Andrew W. Gurman, M.D., issued the following statement today
about proposed changes to the American Health Care Act
(AHCA):
``None of the legislative tweaks under consideration
changes the serious harm to patients and the health care
delivery system if AHCA passes. Proposed changes to the bill
tinker at the edges without remedying the fundamental failing
of the bill--that millions of Americans will lose their
health insurance as a direct result of this proposal.
``High-risk pools are not a new idea. Prior to the
enactment of the Affordable Care Act, 35 states operated
high-risk pools, and they were not a panacea for Americans
with pre-existing medical conditions. The history of high-
risk pools demonstrates that Americans with pre-existing
conditions will be stuck in second-class health care
coverage--if they are able to obtain coverage at all.
``Not only would the AHCA eliminate health insurance
coverage for millions of Americans, the legislation would, in
many cases, eliminate the ban against charging those with
underlying medical conditions vastly more for their
coverage.''
``America should not go backward to the time when our
fellow citizens with pre-existing health conditions faced
high costs for limited coverage, if they were able to obtain
coverage at all. The AMA urges congressional leaders and the
Administration to pursue a bipartisan dialogue on alternative
policies that provide patients with access and coverage to
high quality care and preserve the safety net for vulnerable
populations.''
Background on high-risk pools
A January report from the American Academy of Actuaries
notes that ``enrollment has generally been low, coverage has
been limited and expensive, they require external funding,
and they have typically operated at a loss . . . Removing
high-risk individuals from the insured risk pools reduces
costs in the private market only temporarily. Over time, even
lower-cost individuals in the individual market can incur
high health care costs, which would put upward pressure on
premiums.''
According to the Kaiser Family Foundation:
State high-risk pools featured premiums above standard non-
group market rates--with most states capping them at 150%-
200% of standard rates. Many also featured high deductibles,
some $5,000 or more.
Despite the fact that many individuals were forced into
high-risk pools because of a pre-existing condition, nearly
all states excluded coverage for these conditions for 6-12
months.
Almost all high-risk pools imposed lifetime limits on
covered services, and some imposed annual limits.
Some states capped or closed enrollment.
Combined net losses for the state high-risk pools totaled
more than $1.2 billion for 2011, or $5,510 per enrollee, on
average.
Furthermore, a 2010 paper by James Capretta and Tom Miller
that appeared in National Affairs estimated that the cost of
adequately funded high risk pools would be $15 billion to $20
billion per year.
Mr. Speaker, I also include in the Record a letter from the American Academy of Family Physicians in opposition to this bill.
American Academy of
Family Physicians,
May 3, 2017.
Jim McGovern,
Representative, House of Representatives, Washington, DC.
Dear Rep. Jim McGovern: Despite recent activities and
amendments, the American Health Care Act (H.R. 1628) remains
a highly flawed proposal that will destabilize our health
care system, cause significant loss of coverage, and allow
for the discrimination against patients based on their
gender, age, and health status. For these reasons, the
American Academy of Family Physicians (AAFP) continues to
oppose the AHCA and
encourages the House of Representatives to reject this failed
policy.
The fact remains that the AHCA will:
Cause more than 24 million people to lose their health care
coverage, including more than 7 million with employer-
sponsored coverage.
Destabilize the individual health insurance market.
Create a race to the bottom by eliminating any standards
with respect to minimum insurance benefits.
Enact draconian cuts in the Medicaid program that will have
an immediate negative impact on low-income individuals,
children, and millions of senior citizens who rely on the
program.
Eliminate community rating and return to medical
underwriting, thus allowing insurers to discriminate against
individuals based on their gender, age, and health status.
Deny individuals protection against annual and lifetime
spending caps, thus threatening the financial stability of
millions of individuals and families in the future.
Over the past few days there has been an effort to advance
policies that seek to protect individuals with pre-existing
conditions from facing discrimination in insurance
underwriting as a result of their health status. Despite a
willingness to spend more money on these proposals, the
current efforts on pre-existing conditions fail to accomplish
their goal. High-risk pools are inherently flawed and
expensive. The proposals under consideration provide
inadequate funding for an inadequate period of time, thus
creating an under-funded and temporary solution for the
millions of Americans with pre-existing conditions. We find
it regrettable that Congress would seek to relegate
individuals with high health care needs to a program that has
a questionable history and would face uncertain financial
stability in the future.
By removing critical consumer protections that collectively
ensure that the millions of individuals with pre-existing
conditions can continue to purchase affordable health care
coverage, the AHCA would result in higher premiums and higher
deductibles for millions. Additionally, the negative impact
of the AHCA is not limited to the individual insurance
market. These policies also may impact the more than 130
million people with employer-sponsored insurance.
Thank you.
Mr. Speaker, I also include in the Record a statement from the AARP in strong opposition to this bill.
Mr. Speaker, if this bill were so great, these organizations would be supporting the Republican bill, not opposing it; and they are strongly opposing it.
Mr. Speaker, I yield 1 minute to the gentleman from Texas (Mr. Doggett).
Mr. Speaker, I yield 3 minutes to the distinguished gentlewoman from New York (Ms. Slaughter), the ranking member of the Rules Committee.
Mr. Speaker, I feel bad for the gentleman because it appears as if he only has one speaker supporting this rule and the bill, and nearly our entire caucus wants to speak on this against the Republican healthcare repeal bill. So I was wondering whether the gentleman might consider sharing some time with us?
I yield to the gentleman from Georgia.
It looks kind of lonely over there. It speaks volumes about how much support there is for this bill.
Mr. Speaker, I yield 1 minute to the gentleman from New Jersey (Mr. Pascrell).
Mr. Speaker, I include in the Record a letter from the
American College of Physicians in opposition to the bill.
American College of Physicians,
April 24, 2017.
Hon. Paul Ryan,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives,
Washington, DC.
Hon. Mitch McConnell,
Majority Leader, Washington, DC.
Hon. Charles Schumer,
Minority Leader, U.S. Senate,
Washington, DC.
Dear Speaker Ryan, Minority Leader Pelosi, Majority Leader
McConnell, and Minority Leader Schumer: On behalf of the
American College of Physicians (ACP), I am writing to urge
Congress to move away from the harmful changes to patient
care that would occur if the American Health Care Act (AHCA)
were to become law, and to instead work for bipartisan
solutions to improve the Affordable Care Act (ACA) rather
than repealing and replacing it. We believe that the AHCA,
which would repeal and replace the most important coverage
and consumer protections created by the ACA, is so
fundamentally flawed that it cannot be made acceptable. We
understand that the leadership in the House of
Representatives continues to explore ways to bring a modified
version of the AHCA to a vote, based on a draft amendment
reportedly being developed by Representatives MacArthur and
Meadows, a summary of which was made available to the public
through news organizations. This amendment would make the
harmful AHCA even worse by creating new coverage barriers for
patients with pre-existing conditions and weakening
requirements that insurers cover essential benefits.
The American College of Physicians is the largest medical
specialty organization and the second-largest physician group
in the United States. ACP members include 148,000 internal
medicine physicians (internists), related subspecialists, and
medical students. Internal medicine physicians are
specialists who apply scientific knowledge and clinical
expertise to the diagnosis, treatment, and compassionate care
of adults across the spectrum from health to complex illness.
The draft MacArthur-Meadows amendment would create what is
known as the ``Limited Waiver Option'' that would allow
states to eliminate or severely weaken vital ACA Title I
consumer protections--specifically, community rating and
essential health benefits (EHBs)--returning the country to
the pre-ACA days when persons with pre-existing
``declinable'' medical conditions in most states were priced
out of the market and the insurance products available in the
individual market did not cover medically necessary services.
Specifically:
The MacArthur-Meadows amendment would create an option for
states to obtain Limited Waivers from certain federal
standards that would gut existing law consumer protections.
Based on a summary of the draft amendment, states could seek
Limited Waivers for:
Essential Health Benefits (EHBs)
Community-rating rules, except for the following
categories, which are not waivable: Gender or Age (except for
reductions of the 5:1 age ratio previously established) or
Health Status (unless the state has established a high-risk
pool or is participating in a federal high-risk pool)
To obtain the waiver, states would only need to ``attest
that the purpose of their requested waiver is to reduce
premium costs, increase the number of persons with healthcare
coverage, or advance another benefit to the public interest
in the state, including the guarantee of coverage for persons
with preexisting medical conditions. The Secretary shall
approve applications within 90 days of determining that an
application is complete.'' [Emphasis added in italics].
In other words, as long as a state attested that there was
a ``benefit to the public,'' insurers would be once again
allowed to charge more to people with pre-existing
conditions, or decline to cover needed benefits like
physician and hospital visits, maternity care and
contraception, mental health and substance use disorder
treatments, preventive services, and prescription drugs.
This would take us back to the days when people had to fill
out intrusive insurance company applications to document
their previous health history, even before being advised what
the premium would be based on their individual health risk.
Unlike community rating, which bases premiums based on the
expected costs associated with all persons in the insurance
pool (adjusted only by age, tobacco use, and family size),
the Limited Waiver would again allow insurers in states that
obtain a waiver to again charge people exorbitant and
unaffordable premiums for their pre-existing conditions.
Before the ACA, insurance plans sold in the individual
insurance market in all but five states typically maintained
lists of so-called ``declinable'' medical conditions
including asthma, diabetes, arthritis, obesity, stroke, or
pregnancy, or having been diagnosed with cancer in the past
10 years. Even if a revised bill would not explicitly repeal
the current law's guaranteed-issue requirement which requires
insurers to offer coverage to persons with pre-existing
conditions like these guaranteed issue without community
rating allows insurers to charge as much as they believe a
patient's treatment will cost. The result would be that many
patients with pre-existing conditions would be offered
coverage that costs them thousands of dollars more for the
care that they need, and in the case of patients with
expensive conditions like cancer, even hundreds of thousands
more.
An amendment to the AHCA reported out of the Rules
Committee on April 6th to establish a ``Federal Invisible
Risk Sharing Program,'' which would create a fund that states
could use to reimburse insurers for some of the costs
associated with insuring sicker patients, would not offset
the harm done to patients with pre-existing conditions by
allowing the Limited Waiver of community rating and essential
benefit protections. The pre-ACA experience with high-risk
pools was that many had long waiting lists, and offered
inadequate coverage with high deductibles and insufficient
benefits. Unless a national high-risk pool is supported with
a massive infusion of funding it will not be sufficient to
cover the millions of people with pre-existing conditions
that would be denied or charged more for coverage under
the AHCA. One paper estimates that a national high-risk
pool would cost $178.1 billion a year, roughly $176.4
billion more than the annual funding provided to the
Invisible Risk Sharing Program. Also, shifting people out
of the existing health insurance marketplace to a high-
risk pool would undermine the assurance that enrollees
could keep their existing coverage.
The Limited Waiver Option will also allow states to seek
waivers from the essential health benefits required of all
plans sold in the individual insurance market, with the
result that millions of patients will be at risk of losing
coverage for essential services like maternity care, cancer
screening tests and treatments, prescription drugs,
preventive services, mental health and substance use disorder
treatments, and even physician visits, prescription drugs and
hospitalizations.
Prior to passage of the ACA, 62% of individual market
enrollees did not have coverage of maternity services, 34 did
not have substance-use disorder-services, 18% did not have
mental-health services and 9% did not have coverage for
prescription drugs. A recent independent analysis found that
the AHCA's repeal of current law required benefits would
result in patients on average paying $1,952 more for cancer
drugs; $1,807 for drugs for heart disease; $1,127 for drugs
to treat lung diseases; $1,607 for drugs to treat mental
illnesses; $4,940 for inpatient admission for mental health;
$4,555 for inpatient admission for substance use treatment;
and $8,501 for maternity care. Such increased costs would
make it practically impossible for many patients to avail
themselves of the care they need. The result will be delays
in getting treatment until their illnesses present at a more
advanced, less treatable, and more expensive stage, or not
keeping up with life-saving medications prescribed by their
physicians.
Allowing states to eliminate the EHB will threaten our
nation's fight against the opioid epidemic. A study concluded
that with repeal of the ACA, ``approximately 1,253,000 people
with serious mental disorders and about 2.8 million Americans
with a substance use disorder, of whom about 222,000 have an
opioid disorder, would lose some or all of their insurance
coverage.'' Finally, allowing states to drop important
benefits like maternity, substance use disorder treatment,
and preventive services will do little to reduce premiums. A
report by Milliman found that the main drivers of premium
costs were ambulatory patient services, hospitalization, and
prescription drugs. These are crucial services that form the
core of any health insurance plan.
To be clear: while some younger and healthier persons might
be offered lower premiums in states that obtained a ``Limited
Waiver'' of community-rating and essential health benefits,
it would be at the expense of making coverage unaffordable
for those who need it most, older and sicker persons, and
result in skimpy ``bare-bones'' insurance for many others
that does not cover the medical care they would need if and
when they get sick.
Finally, even without the Limited Waiver Amendment, ACP
continues to believe that the AHCA has numerous other
provisions and policies that that will do great harm to
patients including:
The phase-out of the higher federal match in states that
have opted to expand Medicaid and the ban on non-expansion
states being able to access the higher federal contribution
if they choose to expand Medicaid;
Converting the shared federal-state financing structure for
Medicaid to one that would cap the federal contribution per
enrollee;
Providing states with a Medicaid block grant financing
option;
Eliminating EHBs for Medicaid expansion enrollees;
Imposing work or job search requirements on certain
Medicaid enrollees;
Regressive age-based tax credits, combined with changes
that will allow insurers to charge older people much higher
premiums than allowed under current law;
Continuous coverage requirements for patients with pre-
existing conditions;
Legislative or regulatory restrictions that would deny or
result in discrimination in the awarding of federal grant
funds and/or Medicaid and Children's Health Insurance Program
funding to women's health clinics that are qualified under
existing federal law for
the provision of evidence-based services including, but not
limited to, provision of contraception, preventive health
screenings, sexually transmitted infection testing and
treatment, vaccines, counseling, rehabilitation, and
referrals, and;
Elimination of the Prevention and Public Health Fund, which
provides billions in dollars to the Centers for Disease
Control and Prevention to prevent and control the spread of
infectious diseases.
The College strongly believes in the first, do no harm
principle. Therefore, we continue to urge that Congress move
away from the fundamentally flawed and harmful policies that
would result from the American Health Care Act and from the
changes under consideration--including the proposed ``Limited
Waiver'' amendment--that would make the bill even worse for
patients. We urge Congress to instead start over and seek
agreement on bipartisan ways to improve and build on the ACA.
The College welcomes the opportunity to share our ideas for
bipartisan solutions that would help make health care better,
more accessible, and more affordable for patients rather than
imposing great harm on them as the AHCA would do.
Sincerely,
Jack Ende, MD, MACP,
President.
Mr. Speaker, I include in the Record a letter from the Cancer Action Network against this bill.
Cancer Action Network,
American Cancer Society,
May 3, 2017.
Hon. Paul Ryan,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives,
Washington, DC.
Dear Speaker Ryan and Minority Leader Pelosi: The American
Cancer Society Cancer Action Network (ACS CAN) is deeply
concerned about the reports of additional amendments to the
American Health Care Act (AHCA), including one that would
allegedly add $8 billion in new spending for state high-risk
pools. This amendment is particularly egregious because it
would further incent states to apply for waivers from
current-law market rules that protect patients with pre-
existing conditions.
Historically, state high-risk pools have fallen short of
providing coverage of prevention, treatment and follow-up
care for cancer patients and survivors. Segmenting people
with cancer and other serious illnesses away from the private
marketplace and into high-risk pools absent an adequate and
permanent source of public funding has never been an adequate
solution.
Between 1976 and 2010, 35 states created high-risk pools to
cover individuals who could not otherwise purchase insurance
in the private market, usually because of a pre-existing
condition. Every one of those risk pools experienced net
operating losses year after year. Furthermore, high-risk
pools did not result in lower premiums. All of them set
premiums above the non-group market average or standard rate
in the state, usually by 150-200 percent. Only a few states
provided additional premium assistance for low-income
individuals, leaving many who could not afford premiums
priced out of the program. Most states also imposed waiting
periods before covering preexisting conditions. An individual
with a prior cancer diagnosis often had to wait 6-12 months
before the high-risk pool would cover the costs associated
with cancer treatment or follow-up survivorship care. Most
states imposed limitations on coverage with either lifetime
or annual limits. And most plans offered deductibles of
$1,000 or higher. Neither AHCA, nor the new amendment would
fully protect patients from any of those conditions.
Cancer patients and survivors need insurance coverage that
is affordable, readily accessible, and protects them from
pre-existing condition exclusions, annual and lifetime caps
on coverage and extraordinary out-of-pocket costs. Past
experience has shown that high-risk pools failed to meet
these basic needs, yet still were a drain on state budgets.
As we have indicated in our earlier letters, there are
reasonable fixes that could be made to the current law. We
stand ready to work with you to develop policies that improve
the law and encourage a robust health insurance market that
provides affordable and comprehensive coverage options.
Sincerely,
Christopher W. Hansen,
President.
Mr. Speaker, I include in the Record a letter from the American Society of Clinical Oncology against this bill.
American Society of
Clinical Oncology,
April 27, 2017.
Hon. Paul Ryan,
Speaker, House of Representatives,
Washington, DC.
Dear Speaker Ryan, On behalf of the American Society of
Clinical Oncology (ASCO), I write to express our strong
opposition to the American Health Care Act (AHCA), as
currently amended. As the leading professional society
representing more than 42,000 physicians worldwide who care
for people with cancer, ASCO has a unique perspective on the
law's potential impact on cancer patients. Our core mission
is to ensure every patient with cancer has meaningful access
to high quality care. We believe Congress shares this goal
and our comments today are in the spirit of advancing that
common purpose.
In January 2017, as Congress embarked upon the repeal and
replacement of the Affordable Care Act, ASCO shared a set of
guiding principles that support improvements to the current
health care system. We also put forth specific areas where
people with cancer need protections. Our principles rest on
the belief that any health system reform must ensure all
people affected by cancer receive high-quality care. ASCO's
first principle states, ``all Americans should have access to
affordable and sufficient healthcare coverage regardless of
their income or health status. To ensure protected access,
the current ban on preexisting condition limitations,
elimination of annual and lifetime coverage caps, and
maintenance of guaranteed renewability should be preserved.''
We take the position that ``any efforts to reform the
healthcare system at the national, state, or local levels
should ensure that individuals with healthcare insurance can
continue to access affordable insurance without
interruption.'' The amended AHCA violates these principles.
Studies show that when cancer patients do not have adequate
insurance they receive less care, receive it later, and have
worse outcomes than those with better insurance coverage.
Uninsured and under-insured families facing a cancer
diagnosis experience significant stress. They often are
unable to meet out-of-pocket expenses and even forgo cancer
care in order to pay for necessities of daily living. The
AHCA as currently constructed will create or worsen these
barriers to care. It will add costs to the system, decrease
access to appropriate treatment and increase existing
disparities in care.
We are especially concerned with provisions allowing state
waivers that could erode important protections for patients
with cancer, including pre-existing condition safeguards,
coverage of essential services, and access to affordable
health insurance. Removing these protections from current
federal law allows for a weakening of these critical
provisions in some states and establishes a system of
inequitable protections across state lines for cancer
patients. We urge policymakers to ensure that robust
requirements are in place to ensure that all insurance
products cover the full scope of services and therapies that
cancer patients require.
ASCO strongly opposes passage of the AHCA in its current
form. We welcome the opportunity to address these issues--and
to work toward a better proposal--with you and your staff.
Sincerely,
Daniel F. Hayes, MD, FASCO, FACP,
President, American Society of Clinical
Oncology.
Mr. Speaker, I include in the Record a letter from the American Congress of Rehabilitation Medicine against this bill.
American Congress of
Rehabilitation Medicine,
May 2, 2017.
Re Deep Concerns with the American Health Care Act and
Related Amendments.
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: The American Congress
of Rehabilitation Medicine (ACRM) writes in reference to the
American Health Care Act (AHCA), H.R. 1628, and the MacArthur
Amendment to the bill. ACRM is an organization of
rehabilitation professionals dedicated to serving people with
disabling conditions by supporting research and services that
promote health, independence, productivity, and quality of
life; and meet the needs of rehabilitation clinicians and
individuals with disabilities.
ACRM is seriously concerned that current House proposals
will undercut the federal coverage standard for
rehabilitation and habilitation services and devices
established under the Affordable Care Act (ACA). Access to
rehabilitation enables individuals experiencing injuries,
illnesses, and disabilities to maximize their quality of life
by enhancing their health, function, and independence. We
believe that any ACA repeal and replace bill that advances in
the House and Senate must maintain access to rehabilitation
and habilitation services and devices.
In particular, the AHCA (H.R. 1628, as amended) includes a
provision that would allow states to apply for waivers
exempting them from compliance with important patient
protections that are required by the Affordable Care Act
(ACA), including premium rating ratios based on age,
protections for consumers disallowing medical status
underwriting (i.e., community rating), and requirements for
insurers to cover a defined package of essential health
benefits (EHBs), which include rehabilitative and
habilitative services and devices. We are deeply concerned
these EHB changes will curtail access for both children and
adults in Medicaid expansion states, as well as private ACA
health plans. ACRM believes that these provisions will
significantly undermine the health insurance coverage that
patients need.
ACRM urges Congress to work in a bipartisan manner to
improve access to affordable, comprehensive care for all
Americans,
including those with disabilities and chronic conditions
needing rehabilitation and habilitation services and devices.
Douglas Katz, MD, FACRM, FAAN,
ACRM President.
Mr. Speaker, I include in the Record a letter from the Consortium for Citizens with Disabilities in strong opposition to this bill.
Consortium for Citizens
With Disabilities,
April 28, 2017.
Dear Member of Congress: The Consortium for Citizens with
Disabilities (CCD) is strongly opposed to the amended
American Health Care Act. The amended American Health Care
Act retains the original bill's proposals to dramatically cut
Medicaid services that are vital to people with disabilities
and seniors through per capita caps, which CCD has opposed.
The new amendments--including permitting states to seek
waivers from the protections for people with pre-existing
conditions and from the requirement to provide essential
health benefits--makes the amended AHCA even more harmful to
people with disabilities. We urge you to oppose this
legislation.
Medicaid provides services and supports that maintain the
health, function, independence, and well-being of 10 million
enrollees living with disabilities. For many people with
disabilities, being able to access timely needed care is a
life or death matter. The American Health Care Act changes
the way that the Federal Government funds Medicaid--rather
than paying states based on the actual costs of healthcare
for people in Medicaid, it sets a cap on the amount of
federal support, a cap that is totally unrelated to the
actual costs of needed care for enrollees. This cap is
designed to cut Medicaid, and the bill uses those cuts to pay
for unrelated tax cuts. Slashing federal support for
Medicaid, which is already a lean program, will force states
to cut services and eligibility that put the health and
wellbeing of people with disabilities at significant risk.
The newest amendments to the American Health Care Act make
the bill even more harmful to people with disabilities. The
new amendments would allow states to easily obtain waivers
that would allow them to charge higher premiums to people
with pre-existing conditions, including people with
disabilities. They also would allow states to seek waivers
from the Affordable Care Act's requirement to provide
essential health benefits, including crucial services for
people with disabilities such as mental health and substance
use disorder services, prescription drugs, rehabilitative and
habilitative services and devices, preventative and wellness
services and chronic disease management, and pediatric
services. These waivers jeopardize the Affordable Care Act's
protections for people with pre-existing conditions,
including people with disabilities, and CCD opposes any roll-
back of those protections.
The ACA helped millions of people with disabilities and
others to gain access to affordable and comprehensive health
insurance. The amended American Health Care Act is
insufficient to help people with disabilities meet their
healthcare needs, and we urge you to oppose the bill should
it come to a vote.
Sincerely,
Health Task Force Co-chairs: Bethany Lilly, Bazelon Center
for Mental Health Law; Dave Machledt, National Health Law
Program; Peter Thomas, Brain Injury Association of America;
and Julie Ward, The Arc of the United States.
Long Term Services and Supports Co-chairs: Alison Barkoff,
Center for Public Representation; Nicole Jorwic, The Arc of
the United States; Sarah Meek, Lutheran Services in America
Disability Network; and Laura Weidner, National Multiple
Sclerosis Society.
Mr. Speaker, I yield 1 minute to the gentleman from Massachusetts (Mr. Moulton.)
Mr. Speaker, I include in the Record a letter from Children's Leadership Council opposed to this bill.
Children's Leadership Council,
May 1, 2017.
Dear Representative: The Children's Leadership Council
opposes the American Health Care Act (AHCA) because it would
jeopardize health care for millions of babies, children,
youth and families. We urge you to vote NO on this
legislation.
The Children's Leadership Council (CLC) is a coalition of
organizations dedicated to improving the lives and
opportunities of America's children. Nationwide, CLC members
work to advance the health, education and well-being of
babies, children and youth in order to prepare them for
school, work, and life. The CLC is the only national
children's coalition solely dedicated to supporting
investments in our nation's children and youth; and
collectively, CLC's members have affiliates, partners, and
members in every state in the nation.
The Affordable Care Act and Medicaid play a crucial role in
the lives of children, including those facing the greatest
challenges such as children in poverty; children suffering
abuse and neglect; children in foster care, and children with
disabilities. Medicaid, for example, provides coverage for
approximately 37 million children, including children with
disabilities, children in foster care and children from low-
income families. Children are the largest group of Medicaid
recipients, and nearly 40 percent of all the nation's
children rely on Medicaid and CHIP for their healthcare.
Medicaid provides health care treatment and preventive
services, mental health care, case management and
transportation services to and from medical appointments for
children who are low-income or disabled. The AHCA's changes
to Medicaid would radically restructure a program that has
worked for more than 50 years to support children's health.
The Medicaid cap would shift $839 billion to stages, forcing
them to cut eligibility, benefits, or provider rates that
could have disastrous health consequences.
There is no question that the massive cuts to Medicaid,
increased premiums likely for millions of families, and
eliminating the Essential Health Benefits requirements under
current law will seriously harm children and families.
Maternity benefits would be among the many medical services
no longer guaranteed if this bill were to become law. The
massive Medicaid reductions in substance abuse treatment will
add to the increases nationwide in the need for child welfare
services because of the surge in opioid addiction. Families
caring for children with disabilities will find supports for
care at home jeopardized.
With a record 95% of children with health coverage in our
country, the AHCA would turn back the clock on progress for
children. And recent proposed changes to the bill would
further undermine consumer protections that make health care
out of reach for low-income children and their families--thus
making the already harmful bill worse for children. Polling
conducted by the Children's Leadership Council found 71
percent of parents, including 67 percent of Independent
parents (of children under the age of 18), want increased
investments in programs that help children in the areas of
education, health and nutrition, not less as proposed by the
Mr. Speaker, I include in the Record a letter from the Paralyzed Veterans of America against this bill.
Paralyzed Veterans of America,
Washington, DC, May 3, 2017.
Hon. Paul Ryan,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives,
Washington, DC.
Dear Speaker Ryan and Leader Pelosi: Paralyzed Veterans of
America (PVA) urges
rejection of the latest version of the American Health Care
Act (AHCA). PVA is the nation's only Congressionally-
chartered veterans' service organization solely dedicated to
representing veterans with spinal cord injury and/or disease.
Consequently, we are very concerned about the conflicting
information circulating about this legislation and the
adverse impact it could have on our members and millions of
other people with disabilities.
As we understand it, the AHCA cuts $880 billion out of the
Medicaid program in order to finance tax cuts that will
explode the deficit and largely assist upper income
individuals, corporations, and providers. The Medicaid
changes are particularly devastating to people with
disabilities. Under the cap and cut proposal, the federal
government would no longer share in the costs of providing
health care services and community services beyond the capped
amount. This would eliminate the enhanced federal match for
the Community First Choice Option under Medicaid that
provides attendant care services in the community. Thanks to
this program, many poor veterans with serious non-service-
connected disabilities have been able to move from nursing
homes into their communities. The AHCA also weakens Medicaid
by ending the Medicaid expansion earlier and offering
Medicaid block grants to states. Data from the Robert Wood
Johnson Foundation shows expansion has helped thousands of
veterans and their caregivers.
For veterans and PVA members in particular, the AHCA
continues several problematic policies of the ACA as well as
troubling new provisions that could affect the ability of
many veterans and their family members to afford health
insurance in the private market. The underlying AHCA bill:
Continues to exclude CHAMPVA beneficiaries--dependents of
the most catastrophically disabled veterans--from the
dependents' coverage policy up to age 26.
Fails to remove the prohibition on enrollment into the VA
health care system for Priority Group 8 veterans, thus
denying these veterans access to the principal health care
system for veterans.
Denies access to tax credits making health insurance
affordable to anyone eligible for a host of other federal
health programs, including those ``eligible'' for coverage
under Title 38 health care programs. This would prevent many
veterans who may be ``eligible for'' but not enrolled in the
VA health care system from accessing these tax credits
intended to help people buy insurance.
Not only do the changes made to the original version of the
AHCA continue its failure to protect veterans and people with
disabilities, they make these circumstances worse. The latest
changes would allow states to seek waivers that would allow
insurers to charge higher premiums to people with pre-
existing conditions, including people with disabilities. The
new amendments also would allow states to seek waivers from
the ACA's requirement that certain essential health benefits
must be provided, including crucial services for people with
disabilities such as prescription drugs, rehabilitative and
habilitative services and devices, preventative and wellness
services and chronic disease management. The combination of
these changes would make it nearly impossible for people with
pre-existing conditions to find affordable plans that cover
basic health care services.
Throughout these past few months, the American people have
been calling for a bipartisan effort to improve the nation's
health care system. Congress should heed these voices, stop
its pursuit of the flawed American Health Care Act and work
together through regular order to strengthen all Americans'
access to affordable, high quality health care.
Sincerely,
Carl Blake,
Associate Executive Director.
Mr. Speaker, I include in the Record a letter from the March of Dimes opposed to this bill.
[From the march of dimes]
Under AHCA, Over 6 Million Women of Childbearing Age Will Lose Health
Coverage
Dear Representative: Prior to 2010, low-income adult women
could generally only obtain Medicaid coverage after they were
pregnant. By the time they enrolled in this coverage, many of
the best opportunities for guaranteeing a healthy pregnancy
and healthy baby had already been missed.
Today, states that have expanded Medicaid can extend
Medicaid coverage to low-income women of childbearing age,
giving them the chance to get healthy before they get
pregnant. The March of Dimes estimates that approximately 6.5
million low income women of childbearing age are currently
covered under Medicaid expansion, giving them access to
treatment for tobacco use, obesity, substance abuse, and
other conditions that can have a major impact on future
pregnancies. Between 2012 and 2015, the rate of uninsurance
among women of childbearing age dropped by 40%, with much of
that decline attributable to Medicaid expansion.
The American Health Care Act (AHCA) would do away with
these advances by rolling back Medicaid expansion. Its
fundamental restructuring of the traditional Medicaid program
would also likely lead to significant coverage losses or
restriction of services to beneficiaries, including pregnant
women. These changes do a serious disservice to low-income
women and families by denying them access to the care they
need to lead healthy lives and, ultimately, have healthy
pregnancies and give birth to healthy infants.
The MacArthur amendment and other proposed changes to the
AHCA do not address these issues. Women, infants, families,
and communities will bear the longterm cost if health care
for women of childbearing age and pregnant women is
shortchanged and more babies are born sick as a result. The
March of Dimes urges all Representatives to oppose the
American Health Care Act.
Sincerely,
Stacey D. Stewart,
President.
Mr. Speaker, I include in the Record a letter from AFSCME in strong opposition to this bill.
Mr. Speaker, I include in the Record a letter from the National Farmers Union in strong opposition to this bill.
National Farmers Union,
May 3, 2017.
Dear Member of Congress: I write on behalf of nearly
200,000 members of the National Farmers Union (NFU) who are
engaged in all forms of farming and ranching. NFU has already
spoken in opposition of the American Health Care Act (AHCA)
because of the estimated 24 million Americans who would lose
coverage as a result. The most recent amendment to the AHCA
only moves further away from NFU's member-driven policy of
affirming ``the right of all Americans to have access to
affordable, quality health care.''
Farming is a dangerous occupation, ranking 6th in
occupational fatality rates. The injury rate for agricultural
workers is also 40% higher than the rate of all workers.
Finally, the average age of farmers in the United States is
over 58 years. U.S. health care policy must take into account
the unique needs of the men and women who provide food and
fiber for our country and much of the world.
Our current health care system is not without its problems,
but progress has been
made since the passage of the Affordable Care Act (ACA). The
current structure of tax credits and premium subsidies help
farmers maintain consistent coverage, especially during
downturns in the farm economy. The expansion of Medicaid has
proven beneficial to rural communities, where the rate of
enrollment is higher than in urban America. The Health
Insurance Marketplace, while certainly in need of stabilizing
measures, makes coverage more accessible for many farm
families.
The correlation between a strong Medicaid program and the
success of rural hospitals has become evident during the
influx of rural hospital closures over the last six years.
Seventy-eight rural hospitals have closed since 2010 with
over 80% of those located in states that opted out of the
Medicaid expansion. With another 673 hospitals at risk of
closure, the AHCA's proposed Medicaid cap could have
devastating consequences for rural communities.
In 2012, 75 percent of farms sold less than $50,000 in
agricultural products and 57% had sales less than $10,000.
Young farm families that don't receive additional income or
health benefits from off-farm jobs would find it extremely
difficult to purchase health insurance. The proposed
legislation would also hurt older farmers. Easing
restrictions on what insurance companies can charge older
customers will leave older farmers facing increased premiums
of thousands of dollars, despite the larger subsidies some
would receive.
The modified AHCA bill also has a significant negative
impact on those with pre-existing conditions. It's estimated
that 40 percent of 50- to 64-year-olds would be denied
coverage in the individual market without the Affordable Care
Act's protections for those with preexisting conditions. The
waiver option would mean that a large number of farmers in
many states would be forced into high-risk pools. This
legislation is woefully short in funding for those high-risk
pools, leaving individuals with preexisting conditions to
contend with increased premiums, higher deductibles and
longer waiting periods for coverage.
Affordable access to quality health coverage is a high
priority for all Americans. As you consider how to best
improve our health care system, we ask that you give serious
consideration to the needs of farmers and ranchers. While
there is certainly room for improvement in current policy,
the American Health Care Act will only hurt family farmers
and rural communities across the country. NFU requests that
you oppose the proposed legislation.
We appreciate your efforts to provide all Americans with
high-quality comprehensive health insurance. Thank you for
your consideration.
Sincerely,
Roger Johnson,
President.
Mr. Speaker, I yield 1 minute to the distinguished gentleman from Massachusetts (Mr. Neal), the distinguished ranking member of the Committee on Ways and Means.
Mr. Speaker, I yield 1 minute to the gentleman from New York (Mr. Crowley), the chairman of the Democratic Caucus.
Mr. Speaker, I include in the Record a letter from the National Education Association in strong opposition to this bill.
May 3, 2017.
Hon. James P. McGovern,
House of Representatives, House Office Building, Washington,
Mr. Speaker, I include a letter from the American Academy of Pediatrics, American College of Nurse-Midwives, American College of Physicians, American Congress of Obstetricians and Gynecologists, National Association of Nurse Practitioners in Women's Health, National Partnership for Women & Families, and Planned Parenthood Federation of America.
May 1, 2017.
Hon. Paul Ryan,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives,
Washington, DC.
Dear Speaker Ryan and Leader Pelosi: On behalf of
physicians, certified nurse-midwives/certified midwives, and
nurse practitioners who provide care for the women of
America, along with our patient partners, we stand together
for women and families and against House passage of the
MacArthur (R-NJ) Amendment to the American Health Care Act
(AHCA, H.R. 1628). Rather than support recent gains in
women's access to healthcare and coverage, the MacArthur
Amendment and AHCA turn back the clock and reverse hard-won
progress. We stand ready to continue work with Congress to
advance legislation that promotes women's health, healthcare
and coverage.
In our letter of March 22, 2017, we expressed opposition to
the AHCA because it threatened women's access to care
protected by Essential Health Benefits (EHBs) requirements,
eliminated the Medicaid expansion, cut qualified providers at
Planned Parenthood from the Medicaid program, and made severe
reductions to Medicaid and other programs critical to women
and newborns. We said that important health initiatives for
women and newborns should be built upon and improved--not
rolled back.
However, the MacArthur Amendment to AHCA places women's
health and coverage at even greater risk. The MacArthur
Amendment would enable states to waive EHBs including those
for maternity and newborn care, preventive services, and
services for mental health and substance use disorders; to
waive community rating rules; and to shunt patients with
costly healthcare conditions or illnesses into unproven
government high risk pools. Supporters of the bill claim this
bill maintains protections for those with preexisting
conditions, but allowing states to waive coverage of EHB and
charge people more based on their health status renders the
promise of coverage for preexisting conditions to be
meaningless. If all that the Secretary may require of a state
waiver application is an un-validated attestation that the
purpose of their requested waiver is to reduce premium costs,
increase the number of persons with healthcare coverage, or
advance another benefit to the public interest in the state,
including the guarantee of coverage for persons with pre-
existing medical conditions, it is meaningless in protecting
health, quality healthcare and coverage. Women and families
must not be made to suffer, lose access to care and coverage,
and pay higher healthcare costs.
EHB is a critical protection that ensures women have
guaranteed access to a robust set of health care services.
Making certain categories of coverage optional--such as
maternity care--would not substantially lower the premiums
that people pay for health coverage. For example, the
requirement for maternity care as an EHB is not a source of
health cost growth. Rather, by sharing risk across a broad
population of beneficiaries it provides vital protection for
women and families from the risk of tens of thousands of
dollars of out-of-pocket costs associated with normal
physiologic labor and delivery, cesarean section, and birth
complications. In exchange for monthly premium costs of just
$8-14 according to one recent analysis, the maternity care
EHB provides significant security for people wishing to grow
their families in the U.S. Furthermore, since everyone is at
some point a newborn, childbirth affects all of us. Enabling
exclusion of maternity care from health coverage denies
people access to the care that everyone deserves for the best
start in life.
Congress should move to protect and advance health, quality
care and coverage, particularly for women and newborns, and
not to endanger them as the AHCA and the MacArthur Amendment
would do. Americans of both parties agree. A recent Kaiser
Family Foundation poll found ``relatively few Americans want
to see the president and Congress decrease funding for a
variety of different health priorities--including spending
for reproductive health services for lower-income women (21
percent).''
When women have access to quality, evidence-based,
affordable care throughout their lives, they enrich our
workforce, achieve higher levels of education, reach their
goals, and actively contribute to the success of their
families and their communities. We urge the U.S. House in the
strongest possible terms to get it right, not fast. The AHCA
and the MacArthur Amendment turn the clock back on women's
health and should not move forward.
We stand ready to continue assisting Congress in advancing
health policy that supports women's access to high quality
healthcare and coverage, and is effective at controlling and
reducing the costs that people pay for their healthcare.
Sincerely,
American Academy of Pediatrics, American College of Nurse-
Midwives, American College of Physicians, American Congress
of Obstetricians and Gynecologists, National Association of
Nurse Practitioners in Women's Health, National Partnership
for Women & Families, Planned Parenthood Federation of
America.
Mr. Speaker, I yield 1 minute to the gentlewoman from Texas (Ms. Jackson Lee).
Mr. Speaker, I include in the Record a letter from the National Rural Health Association opposed to this bill.
[From the National Rural Health Association]
Vote NO to the American Health Care Act
The National Rural Health Association urges a NO vote on
the American Health Care Act (AHCA).
Rural Americans are older, poorer and sicker than other
populations. In fact, a January 2017 CDC report pronounced
that life expectancies for rural Americans have declined and
the top five chronic diseases are worse in rural America. The
AHCA does nothing to improve the health care crisis in rural
America, and will lead to poorer rural health outcomes, more
uninsured and an increase in the rural hospital closure
crisis.
Though some provisions in the modified AHCA bill improve
the base bill, NRHA is concerned that the bill still falls
woefully short in making health care affordable and
accessible to rural Americans. For example, the modified bill
contains a decrease in the Medical Expense Deduction
threshold from 10% to 5.8% in an attempt to assist Americans
between the ages of 50 and 64 who would see their premiums
skyrocket under the current plan. However, this deduction is
not a credit and therefore would be of little use to low
income seniors that are in very low tax brackets or do not
pay income tax at all. Additionally, the new amendments to
freeze Medicaid expansion enrollment as of Jan. 1, 2018, and
reduce the Medicaid per-capita growth rate will
disproportionately harm rural Americans.
The AHCA will hurt vulnerable populations in rural
Americans, leaving millions of the sickest, most underserved
populations in our nation without coverage, and further
escalating the rural hospital closure crisis. According to
the Wall Street Journal, the ``GOP health plan would hit
rural areas hard . . . Poor, older Americans would see the
largest increase in insurance-coverage costs.'' The LA Times
reports ``Americans who swept President Trump to victory--
lower-income, older voters in conservative, rural parts of
the country--stand to lose the most in federal healthcare aid
under a Republican plan to repeal and replace the Affordable
Care Act.'' Let's be clear--many provisions in the ACA failed
rural America. The lack of plan competition in rural markets,
exorbitant premiums, deductibles and co-pays, the co-op
collapses, lack of Medicaid expansion, and devastating
Medicare cuts to rural providers--all collided to create a
health care crisis in rural America. However, it's beyond
frustrating that an opportunity to fix these problems is
squandered, and instead, a greater health care crisis will be
created in rural America.
Congress has long recognized the importance of the rural
health care safety net and has steadfastly worked to protect
it. And now, much of the protections created to maintain
access to care for the 62 million who live in rural America
are in jeopardy. We implore Congress to continue its fight to
protect rural patients' access to care. Three improvements
are critical for rural patients and providers:
1. Medicaid--Though most rural residents are in non-
expansion states, a higher proportion of rural residents are
covered by Medicaid (21% vs. 16%).
Congress and the states have long recognized that rural is
different and thus requires different programs to succeed.
Rural payment programs for hospitals and providers are not
`bonus' payments, but rather alternative, cost-effective and
targeted payment formulas that maintain access to care for
millions of rural patients and financial stability for
thousands of rural providers across the country. Any federal
health care reform must protect a state's ability to protect
its rural safety net providers. The federal government must
not abdicate its moral, legal, and financial responsibilities
to rural, Medicaid eligible populations by ensuring access to
care.
Any federal health care reform proposal must protect access
to care in Rural America, and must provide an option to a
state to receive an enhanced reimbursement included in a
matching rate or a per capita cap, specifically targeted to
create stability among rural providers to maintain access to
care for rural communities. Enhancements must be equivalent
to the cost of providing care for rural safety net providers,
a safeguard that ensures the enhanced reimbursement is
provided to the safety net provider to allow for continued
access to care. Rural safety net providers include, but not
limited to, Critical Access Hospitals, Rural Prospective
Payment Hospitals, Rural Health Clinics, Indian Health.
Service providers, and individual rural providers.
2. Market Reform--Forty-one percent of rural marketplace
enrollees have only a single option of insurer, representing
70 percent of counties that have only one option. This lack
of competition in the marketplace means higher premiums.
Rural residents average per month cost exceeds urban ($569.34
for small town rural vs. $415.85 for metropolitan).
Rural Americans are more likely to have obesity, diabetes,
cancer, and traumatic injury; they are more likely to
participate in high risk health behaviors including smoking,
poor diet, physical inactivity, and substance abuse. Rural
Americans are more likely to be uninsured or underinsured and
less likely to receive employer sponsored health insurance.
Rural communities have fewer health care providers for
insurers to contract with to provide an adequate network to
serve the community.
Any federal health care reform proposal must address the
fact that insurance providers are withdrawing from rural
markets. Despite record profit levels, insurance companies
are permitted to cherry pick profitable markets for
participation and are currently not obliged to provide
service to markets with less advantageous risk pools.
Demographic realities of the rural population make the market
less profitable, and thus less desirable for an insurance
company with no incentive to take on such exposure. In the
same way that financial service institutions are required to
provide services to underserved neighborhoods, profitable
insurance companies should be required to provide services in
underserved communities.
3. Stop Bad Debt Cuts to Rural Hospitals--Rural hospitals
serve more Medicare patients (46% rural vs. 40.9% urban),
thus across-the-board Medicare cuts do not have across the
board impacts. A goal of the ACA was to have hospital bad
debt decrease significantly. However, because of unaffordable
health plans in rural areas, rural patients still cannot
afford health care. Bad debt among rural hospitals has
actually increased 50% since the ACA was passed. According to
MedPAC ``Average Medicare margins are negative, and under
current law they are expected to decline in 2016'' has led to
7% gains in median profit margins for urban providers while
rural providers have experienced a median loss of 6%.
If Congress does not act, all the decades of efforts to
protect rural patients' access to care, could rapidly be
undone. The National Rural Health Association implores
Congress to act now to protect rural health care across the
nation.
Mr. Speaker, I include in the Record a letter from the American Thoracic Society opposed to this bill.
American Thoracic Society,
April 27, 2017.
Dear Representative: On behalf of the 16,000 members of the
American Thoracic Society (ATS), I want to voice my grave
concerns with the latest legislative proposal developed to
repeal and replace the Affordable Care Act (ACA). While CBO
estimates are not yet available for the most recent
legislation proposal being considered in the House, we remain
concerned that the bill, if enacted, will result in a loss of
health insurance for millions of Americans. Should the
proposal come up for a vote in the near future, we urge you
to vote ``NO'' on the American Health Care Act.
The ATS opposes any legislation that does not ensure
affordable health insurance coverage for Americans currently
insured under
the ACA. We are concerned that allowing states to waive
important insurance reforms in the Affordable Care Act will
lead to reduced coverage for many Americans and significant
price increases for patients with pre-existing conditions.
Further, we are concerned that reliance on ``high risk
pools'' will not adequately meet the health insurance needs
of many Americans with pre-existing conditions. We note that
previous attempts at implementing state-based high risk pools
have been largely unsuccessful. Members of the ATS serve a
large and diverse patient population, including patients with
respiratory diseases, critical illnesses and sleep disorders
such as asthma, COPD, pneumonia, sepsis and obstructive sleep
apnea. Our patients cannot afford to lose affordable health
insurance coverage for any period of time.
The ATS looks forward to working with Congress to improve
our health care system and ensure health insurance coverage
for all Americans. If you have questions or need additional
information, please contact Nuala S. Moore, Associate
Director of Government Relations.
Sincerely,
David Gozal, MD, MBA,
President.
Mr. Speaker, I include in the Record a letter from the Academy of Nutrition and Dietetics opposed to this bill.
Academy of Nutrition
and Dietetics,
Washington, DC, May 2, 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: Nutrition services
save money, improve chronic disease outcomes and save lives.
For this reason, the Academy of Nutrition and Dietetics, the
nation's largest organization of food and nutrition
professionals, remains opposed to H.R. 1628, the American
Health Care Act (AHCA) as amended by the MacArthur amendment.
The Academy and our 75,000-plus members believe that all
Americans should have both coverage and access to high-
quality health care. The Academy urges Congress to support
measures that include nutrition services and prevention that
reduces the cost of health care and improve patients' lives.
The new proposal set forth in the AHCA not only fails to
improve the health of all Americans, but it will worsen
patient care and public health by removing vital resources
that are currently effective in improving health across the
country.
This legislation continues to eliminate investments in
prevention and public health, reverse advancements made in
disease prevention and chronic care management, and according
to the Congressional Budget Office, would result in the loss
of health care coverage for at least 24 million Americans
Allowing states to waive pre-existing conditions and
essential health benefits will lead to decreased coverage and
utilization of vital nutrition services.
Individuals with chronic disease such as diabetes and
hypertension benefit from medical nutrition therapy and
nutrition services to lower their blood sugar and blood
pressure, while reducing reliance on expensive medications.
The cost of these services is inexpensive and replaces more
costly interventions that are necessary as chronic disease
progresses with many complications.
The Academy holds five key tenets for analyzing any
legislation to reform health care:
1. The health of all Americans should improve as a result
of our health policy choices. Sufficient resources must be
made available to ensure optimal health.
2. Access to quality health care is a right that must be
extended to all Americans.
3. Nutrition services, from pre-conception through end of
life, are an essential component of comprehensive health
care.
4. Stable, sufficient and reliable funding is necessary for
our health care system to provide everyone access to a core
package of benefits.
5. Health care must be patient-centered.
Affordable access to care is an ongoing challenge that any
reform legislation should address. Although this legislation
purports to provide access, it fails to make coverage more
affordable; unaffordable access to coverage is really not
coverage at all. The proposal fails to maintain a core
package of benefits that improve the health of Americans, by
removing a basic floor of services that should be provided
without cost-sharing to the Medicaid population.
Additionally, the new proposal would allow states to opt
out of requiring that health plans cover the Essential Health
Benefits which help reduce longer term health care costs,
allow insurers to charge people higher premiums based on pre-
existing conditions like nutrition related diseases like
diabetes and heart disease and increase out-of-pocket costs
for vulnerable older adults.
By repealing the Prevention and Public Health Fund, the
proposal eliminates the sole federal investment in
prevention, which will harm our state and local communities
that depend on these effective public-private partnerships to
improve the health of their communities.
The AHCA as currently drafted fails to meet the Academy's
five tenets, and therefore we cannot support the passage of
these proposals.
The Academy urges Congress to not hold future votes without
an evaluation of the proposed amendments from the
Congressional Budget Office estimating the budgetary impact
of the amended legislation and the anticipated effect on
coverage for Americans. We look forward to continued
collaboration to improve the health and nutrition for all
Americans.
Sincerely,
Lucille Beseler,
President.
Mr. Speaker, I include in the Record a letter from The Jewish Federations of North America opposed to this bill.
The Jewish Federations
of North America,
Washington, DC, May 2, 2017.
Hon. Paul Ryan,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives,
Washington, DC.
Dear Speaker Ryan and Leader Pelosi: The Jewish Federations
of North America (JFNA) remains staunchly opposed to the
American Health Care Act of 2017 (AHCA), even with the
recently released amendment proposed by Representative Tom
MacArthur (R-NJ). We are disappointed that AHCA retains the
devastating cuts to Medicaid included in the earlier version
of the legislation, cuts which are the result of the
legislation's proposal to dramatically restructure Medicaid's
federal financing structure and roll back coverage for 14
million people covered by the state Medicaid expansions. The
amendment does nothing to alleviate these concerns.
JFNA represents 148 Jewish federations and 300 network
communities that together support 15 leading academic medical
centers/health systems, 100 Jewish nursing homes, and 125
Jewish family & children's agencies, providing health care
for more than one million clients, Jewish and non-Jewish
alike. Medicaid is a lifeline for more than 80 million
people, including low-income children, older adults, and
people with disabilities nationwide. Medicaid is a vital
program for Jewish federations throughout the country and
particularly for our communal health and long-term care
partners that care for the most vulnerable in our
communities.
JFNA is deeply troubled by the findings of the
Congressional Budget Office (CBO) that AHCA will cause $839
billion in reductions--about 25 percent--to federal Medicaid
funding and a loss in coverage for more than 14 million
Medicaid beneficiaries. We believe that converting Medicaid
to a block grant or per capita cap will cause irreparable
harm not only to the millions who depend on the program, but
also to our large network of providers who care for them.
AHCA would convert the long-standing and fundamental
federal-state partnership of the Medicaid program to a block
grant or per capita cap system. Under either approach, states
would receive a limited amount of federal money for their
Medicaid programs. As CBO found, even under a per capita cap
system, the federal share is lower than the average annual
increase in Medicaid spending and will not be sufficiently
flexible to address a variety of key factors affecting
Medicaid spending, including major disasters, economic
downturns, unexpected health care cost increases, and
demographic changes, such as the rapidly aging baby boomer
generation. CBO projected that AHCA's $839 billion cut in
federal Medicaid funding will shift substantial costs to
state and local governments, our providers, and our patients,
thus exacerbating the existing strain on the program. We
agree with CBO's conclusion that, due to these reductions in
funding, states will be left with no choice but to reduce
Medicaid enrollment, eligibility for Medicaid benefits, and
payment rates. Many people who now qualify for Medicaid could
end up uninsured or losing access to critical health and
long-term care services.
JFNA is concerned by many of the unintended consequences of
this legislation, such as:
People who desperately need Medicaid and who are currently
eligible will become uninsured;
States will be forced to cut back on crucial Medicaid
services, such as home and community-based services,
effectively forcing people who are capable of living in the
community with proper home and community-based services into
nursing homes;
States will be forced to reduce already low provider
payment rates, thus further decreasing the pool of providers
serving Medicaid beneficiaries and increasing waiting times
for services; and,
Health care providers and entities that care for these
vulnerable populations will suffer additional financial
strain. As a result, these agencies will be forced to lay off
staff or close their doors altogether, resulting in
significant job losses and further hurting state economies.
For these reasons, we must oppose the legislation as
currently written and urge the House of Representatives to
reconsider moving forward with it. We stand ready to work
with you, in tandem with our Jewish communal health and long-
term care providers, to promote more targeted ways to reduce
Medicaid spending and develop a new framework of policies to
improve Medicaid quality, efficiency, and sustainability.
Sincerely,
William C. Daroff,
Senior Vice President for Public Policy & Director of the
Washington Office.
Mr. Speaker, I include in the Record an article in The Wall Street Journal today stating: ``. . . employers looking to lower their costs could impose lifetime limits and eliminate the out-of- pocket cost cap from their plans under the GOP legislation.''
[From the Wall Street Journal]
Little-Noted Provision of GOP Health Bill Could Alter Employer Plans
Last-minute amendment would allow states to obtain waivers from
certain Affordable Care Act requirements
(By Stephanie Armour and Michelle Hackman)
Many people who obtain health insurance through their
employers--about half of the country--could be at risk of
losing protections that limit out-of-pocket costs for
catastrophic illnesses, due to a little-noticed provision of
the House Republican health-care bill to be considered
Thursday, health-policy experts say.
The provision, part of a last-minute amendment, lets states
obtain waivers from certain Affordable Care Act insurance
regulations. Insurers in states that obtain the waivers could
be freed from a regulation mandating that they cover 10
particular types of health services, among them maternity
care, prescription drugs, mental health treatment and
hospitalization.
That could also affect plans offered by large employers,
health analysts said.
The ACA prevents employer plans from putting annual limits
on the amount of care they will cover, and it bars lifetime
limits on the 10 essential benefits. But in 2011, the Obama
administration issued guidance stating that employers aren't
bound by the benefits mandated by their state and can pick
from another state's list of required benefits. That guidance
was mostly meaningless because the ACA established a national
set of essential benefits.
Under the House bill, large employers could choose the
benefit requirements from any state--including those that are
allowed to lower their benchmarks under a waiver, health
analysts said. By choosing a waiver state, employers looking
to lower their costs could impose lifetime limits and
eliminate the out-of-pocket cost cap from their plans under
the GOP legislation.
The measure would give employers added flexibility to take
steps that could lower costs by limiting more-expensive
coverage areas. And it would lessen the federal regulation of
insurers, a goal of GOP lawmakers who believe the ACA is an
example of government overreach.
The impact on employer plans expands the scope of the
health bill to affect, potentially, everyone not insured by
Medicare or small-business plans, since the bill also
includes cuts to Medicaid and changes to the individual
market. Employer health plans are the single largest source
of health insurance in the country, with about 159 million
Americans receiving coverage through their jobs.
``It's huge,'' said Andy Slavitt, former acting
administrator of the Centers for Medicare and Medicaid
Services under President Barack Obama. ``They're creating a
backdoor way to gut employer plans, too.''
But some experts say the impact could be less.
``The real question is, would employers do this? Many
wouldn't,'' said Larry Levitt, a senior vice president at the
Kaiser Family Foundation. ``Many employers offer quality
benefits to attract employees. But employers are always
looking for ways to lower costs.''
Fifty-nine percent of employers had a lifetime limit on how
much their insurance plans would cover before the ACA, Mr.
Levitt said.
The potential impact on large-employer plans was picked up
on by health analysts including Matthew Fiedler, a fellow at
the Brookings Institution. It is possible the Trump
administration could minimize the impact by barring employers
from picking plans across state lines, he said, but there is
no sign that that would occur.
``The core goal of insurance is to ensure that people are
protected if the worst happens, and these protections are
crucial to achieving that goal,'' Mr. Fiedler said.
Potentially, the new provision could play out this way: If
a state did away with a requirement to provide mental health
and substance abuse services, employer plans using that
benchmark could impose lifetime caps on the amount of mental
health coverage they are willing to pay for.
One trade group representing employers said the amendment's
effects on people with employer-sponsored health coverage
would be minimal. Most large employers didn't impose annual
or lifetime limits before the ACA was implemented, according
to James Gelfand, senior vice president of health policy at
the Erisa Industry Committee.
``Even if self-insured health plans are no longer banned
from imposing annual or lifetime limits, they're unlikely to
attempt to squeeze the toothpaste back into the tube,'' he
said. ``The benefits of reimposing limits are questionable.''
Mr. Speaker, I yield 1 minute to the distinguished gentleman from Michigan (Mr. Levin).
(Mr. LEVIN asked and was given permission to revise and extend his remarks.)
Mr. Speaker, I include in the Record a statement from the Children's Hospital Association in opposition to this bill.
[From Children's Hospital Association,
Apr. 27, 2017]
Children's Hospitals Urge House to Vote Against Amended AHCA
Lawmakers should know bill is bad for kids
Washington, DC.--On behalf of our nation's children's
hospitals and the patients and families they serve,
Children's Hospital Association (CHA) continues to oppose the
newly modified American Health Care Act (AHCA) and strongly
urges the House of Representatives to reject the bill.
Recently adopted changes only worsen the AHCA by putting
children with preexisting conditions at increased risk of
losing health care coverage and failing to correct the
Medicaid cuts that would impact over 30 million kids.
The legislation the House might consider for a vote as
early as the weekend would impose over $800 billion in cuts
on states by fundamentally changing Medicaid--a program over
40 percent of the children across the country depend on for
their health care coverage and access to medical care. Under
the bill, Medicaid would no longer be able to flex with the
needs of enrollees, instead becoming a severely restricted
system of per capita caps or block grants.
The block grant option in particular would be devastating
to children as it eliminates Medicaid's EPSDT (Early and
Periodic Screening, Diagnostic, and Treatment) benefit which
ensures children receive immunizations, mental health
assessments and vision, eye and hearing exams as well as
other medical services they might need. A block grant would
also remove cost-sharing protections for children,
essentially creating new barriers to care for low-income,
working families.
CHA urgently asks members of Congress to vote against the
AHCA. Medicaid must be maintained to ensure children receive
the coverage and medical care that return lifelong benefits
into adulthood. Investing in children's health advances a
better future for our nation.
Mr. Speaker, I include a statement from Families USA in opposition to this bill.
[From FAMILIESUSA]
Latest House GOP Proposal--``Upton Amendment''--Still Leaves People
with Pre-Existing Conditions Out in the Cold
Washington, DC.--Republicans in the House today are
discussing a so-called compromise that ostensibly adds $8
billion to their Affordable Care Act (ACA) repeal bill in an
attempt to appease members worried that the bill strips
coverage guarantees for people with pre-existing conditions.
Below is a statement from Families USA Executive Director
Frederick Isasi.
``Despite today's wheeling and dealing, the GOP repeal bill
still drops the coverage guarantee for people with pre-
existing conditions, strips coverage from millions, and
drives up costs for millions more. A measly $8 billion
handout isn't going to change that. The bill also decimates
Medicaid--more than $800 billion in cuts. That hurts seniors,
people with disabilities, and children like Jimmy Kimmel's
son who he so eloquently spoke of Monday night. Remember,
half of the births in America are reimbursed through
Medicaid.
``The Upton $8 billion is a non-solution--money thrown at
`high-risk pools' that experts on both sides of the aisle
have warned lead to higher costs, fewer benefits, and waiting
lists rationing care for those with pre-existing conditions.
``Republicans in the House can do all the backroom vote-
trading they want; their bill will still harm millions and
millions of people in America and breaks President Trump's
promise to cover everybody and protect people with pre-
existing conditions. This isn't what people in America want.
It is time for the GOP to drop this deeply flawed legislation
and move on to efforts that will help, and not hurt,
America's families.''
Mr. Speaker, I include a statement from the Association of American Medical Colleges in opposition to this bill.
[From AAMC, May 2, 2017]
AAMC Statement on the MacArthur Amendment to the American Health Care
Act
AAMC (Association of American Medical Colleges) President
and CEO Darrell G. Kirch, MD, issued the following statement
regarding the amendment to the American Health Care Act
(AHCA) introduced by Rep. Tom MacArthur (R-N.J.):
``This week, the House could vote on a new version of the
American Health Care Act that includes the MacArthur
amendment. Unfortunately, the amendment does not address the
limitations in the original measure, such as making high-
quality, affordable health insurance available to all, and
maintaining programs to support the health care safety net--
at least at current levels--until other comparable coverage
expansions are available.
The amendment's treatment of essential health benefits and
health status underwriting dilutes protections for many
Americans and would leave individuals with preexisting
conditions facing higher premiums and reduced access to vital
care.
The shortcomings in the underlying bill remain the same.
The original analysis from the Congressional Budget Office
indicated that 14 million Americans would lose their health
insurance coverage as early as next year, and as many as 24
million by 2024. Nothing in the bill has changed that alters
the fact that this legislation would lead to fewer Americans
with quality insurance, less affordable coverage for those
who have it, and the destabilization of the current Medicaid
program.
We continue to urge members of Congress to engage with the
nation's medical schools and teaching hospitals and other
stakeholders to find ways to achieve high quality health care
for all Americans.''
Mr. Speaker, I yield 1 minute to the gentlewoman from California (Ms. Sanchez), the vice chair of the Democratic Caucus.
Mr. Speaker, I yield 1 minute to the gentlewoman from California (Ms. Judy Chu of California.)
Mr. Speaker, maybe the gentleman hasn't been listening to all the organizations and healthcare advocates who have come out strongly opposed to the Republican bill, that I have read into the Record, who know a lot more about health care than anybody in this House, who spend their lives protecting people and protecting people's healthcare rights. They are all in strong opposition to the Republican bill because you take away the protections for preexisting conditions, plain and simple.
Mr. Speaker, I yield 1 minute to the gentleman from Oregon (Mr. Blumenauer).
Mr. Speaker, I include in the Record a letter from the American Public Health Association in strong opposition to the Republican bill.
American Public Health Association,
May 4, 2017.
House of Representatives,
Washington, DC.
Dear Representative: On behalf of the American Public
Health Association, a diverse community of public health
professionals who champion the health of all people and
communities, I write to express our continued strong
opposition to H.R. 1628, the American Health Care Act of
2017, legislation to repeal the Affordable Care Act. The
amended bill would be even worse for the nation's health than
the original proposal and does nothing to improve the health
of the American public. Additionally, the bill would have the
greatest negative impact on the health of the most vulnerable
Americans.
According to the March Congressional Budget Office
analysis, the legislation would result in 14 million
Americans losing health insurance coverage in 2018. By 2026,
CBO estimates 24 million individuals would lose coverage,
taking the uninsured rate up to a staggering 52 million,
nearly double the number of Americans who would lack
insurance under existing law. The bill would cut critical
premium subsidies for low- and middle-income families and
phase out the ACA's Medicaid expansion. Under the proposal,
many, especially low-income and older Americans, would pay
higher premiums, receive lower subsidies and be subject to
higher out of pocket costs, including higher deductibles and
co-pays for plans that provide less coverage. Health
insurance coverage is critical to preventing disease,
ensuring health and well-being and driving down the use of
costlier providers of care. Unfortunately, this proposal will
result in a greater number of people losing coverage than the
number of people who have gained coverage under the
Affordable Care Act, putting many at risk of premature death
due to the lack of access to critical health services.
The amended bill would be even worse for public health than
the original bill that was pulled from the House floor in
late March. The amended bill would allow states to opt-out of
requiring health plans to cover the 10 essential health
benefits such as maternity care, mental health and substance
abuse disorder services and prescription drug coverage. It
would also allow insurers to charge significantly higher
premiums for people with pre-existing conditions and possibly
allow insurers to charge older adults even higher premiums.
The inclusion of a mere $8 billion over five years will do
little to help people with pre-existing conditions who could
see drastically higher premiums leaving millions in the
individual and small group market with no protections from
insurer discrimination.
The bill would also eliminate the Prevention and Public
Health Fund, the first and only mandatory funding stream
specifically dedicated to public health and prevention
activities. The fund has already provided more than $6
billion to support a variety of public health activities in
every state including tracking and preventing infectious
diseases like the Ebola and Zika viruses, community and
clinical prevention programs, preventing childhood lead
poisoning and expanding access to childhood immunizations.
Eliminating the fund would devastate the budget of the
Centers for Disease Control and Prevention. The fund
currently makes up 12 percent of CDC's budget and eliminating
this funding stream would force Congress to replace the
funding through the regular appropriations process where
resources for nondefense discretionary programs are already
too low.
Not only would the bill phase out the Medicaid expansion
under the ACA, it would also make other troubling changes to
the Medicaid program, converting it to a per capita program.
The most recent CBO analysis estimated the bill would cut
federal spending on Medicaid by $839 billion over the next
decade, drastically cutting resources to states, many of
which are already struggling with tight budgets. The bill
would also block Medicaid reimbursements to Planned
Parenthood for one year--which CBO estimates will lead to
less access to care, more unintended births and more costs
for the Medicaid program.
While the Affordable Care Act is not perfect, the law has
made progress in addressing the biggest challenges facing our
health system including the rising costs associated with our
health care system, uneven quality of care, deaths due to
medical errors, discriminatory practices by health insurance
providers and the shrinking ranks of the nation's primary
care providers. The ACA has made progress in shifting our
health system from one that focuses on treating the sick to
one that focuses on keeping people healthy. We ask you to
oppose this and future efforts to repeal or weaken the ACA.
Instead, we urge you to work on a bipartisan basis to improve
and build upon the successes of the ACA and to work to
provide health insurance coverage to the more than 28 million
who still lack coverage. We look forward to working with you
to create the healthiest nation in one generation.
Sincerely,
Georges C. Benjamin, MD,
Executive Director.
Mr. Speaker, I yield 1 minute to the gentlewoman from Connecticut (Ms. DeLauro).
Mr. Speaker, I yield 1 minute to the distinguished gentleman from Rhode Island (Mr. Langevin).
Mr. Speaker, I yield 30 seconds to the gentlewoman from Wisconsin (Ms. Moore).
Mr. Speaker, I yield 30 seconds to the gentleman from Vermont (Mr. Welch).
May I inquire of the gentleman how many more speakers he has?
Well, I am not really prepared to close because my side has a ton more to say, but I am out of time.
Mr. Speaker, I yield myself the balance of my time, and given the fact there were no hearings or anything else, it would have been nice to have a little bit more time.
Mr. Speaker, if we defeat the previous question, I will offer an amendment to the rule that would change the rules of the House to prevent this bill or any other healthcare-related legislation from being considered if it does not have a CBO cost estimate or if it would deny health coverage or require higher premiums due to preexisting conditions; impose lifetime limits on health coverage; prevent individuals under age 26 from being covered under their parents' plan; reduce the number of people receiving health care under the Affordable Care Act; increase costs to seniors by reopening the doughnut hole and raising prescription drug costs; require people to pay for preventive services, including cancer screenings; reduce Medicare solvency or change the Medicare guarantee; or reduce Federal taxes on the 1 percent of the population with the highest incomes or increase taxes on the 80 percent of hardworking Americans earning moderate to low incomes.
Mr. Speaker, I ask unanimous consent to insert the text of my amendment in the Record, along with extraneous materials, immediately prior to the vote on the previous question.
Mr. Speaker, none of us on this side are claiming that the Affordable Care Act is perfect. In fact, for 7 years, we have been prepared to work with our Republican colleagues in a bipartisan way to make it even better, to cover more people, to find ways to lower costs; but for 7 years, my Republican colleagues had no interest in doing that. All they wanted to do was repeal the bill, repeal the bill, repeal the bill and offer no alternative.
Now we see their alternative, and it is an awful alternative. It is a disaster. It is an alternative that came not out
of a deliberative process, but out of some back room somewhere. People haven't even read this bill. They don't even know what it does because we are not even waiting for a CBO score. This is a pathetic process that everybody should be ashamed of.
Let me just say, to claim or to imply that the Republican plan covers people with preexisting conditions, it is a lie. It is a lie. Let's be honest about it. This does not cover people with preexisting conditions. To come on the floor and say it does, to try to fool people, well, you may get away with it in the short term, you may get a headline, but I will tell you, people will figure out soon enough when they are denied healthcare coverage, when they see their costs rise and rise and rise.
To have a healthcare bill that throws 24 million Americans off of health insurance, you should be ashamed.
To have a healthcare bill that cuts Medicaid by $880 billion to give a tax cut to the wealthiest people in this country, you should be ashamed.
I spent a good deal of my time reading letters from organizations like the National Farmers Union, the AARP, the Cystic Fibrosis Foundation, Paralyzed Veterans of America, March of Dimes, the American Medical Association, on and on and on, organizations that have dedicated their lives to helping people in this country that know something about this subject.
And when it comes down to who do I trust, them or you, on whether or not your bill covers people with preexisting conditions, there is no contest. I trust them. They see what you are trying to do. They understand that this bill is a fraud.
It is unconscionable to not only me and to people on our side, but to people who are watching this debate--Democrats, Republicans, and independents alike--that we would be spending time debating a healthcare bill that will make life worse for people in this country. Any kind of healthcare bill that came to this floor ought to be about expanding coverage and lowering cost. We want to work with you on that. Instead, you come to a bill that is going to rip health care away from tens of millions of people.
How can you do this? How can you do this to the American people? How can you do this to your constituents?
This is a terrible bill. You should vote ``no'' on it or, better yet, pull it.
Mr. Speaker, I yield back the balance of my time.
Mr. Speaker, on that I demand the yeas and nays.
Mr. Speaker, I demand a recorded vote.
