ASC Payment Transparency Act of 2018

Mr. Speaker, pursuant to House Resolution 1011, I call up the bill (H.R. 6311) to amend the Internal Revenue Code of 1986 and the Patient Protection and Affordable Care Act to modify the definition of qualified health plan for purposes of the health insurance premium tax credit and to allow individuals purchasing health insurance in the individual market to purchase a lower premium copper plan, and ask for its immediate consideration.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material on the bill currently under consideration.

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

Mr. Speaker, I chair the Health Subcommittee at the Ways and Means Committee, and I have had the opportunity, like many of my colleagues, to hear from physicians, hospitals, and patient advocates. I have heard a lot of stories about increased costs, which are exacerbating the coverage and access challenges that we currently face.

There is a broad consensus that healthcare in the United States needs to move towards a system that provides greater access to affordable care. The question is: How do we get that done?

The ACA government-approved, government-mandated one-size-fits-all insurance has dramatically decreased choice and increased premiums in the individual market. We will hear a lot of debate about this today.

But here is what is happening close to home. Mr. Speaker, in my home State, the Department of Health and Human Services released a report that shows, between 2013 and 2017, the average monthly premium for coverage in the individual market, in Illinois, increased 108 percent, or by $3,228 a year.

I have five counties in my constituency. In two of those five counties, there is only one insurer offering plans on the individual exchange. That is not a choice. That is a government mandate. That is a government monopoly.

It is time to drive a discussion around empowering individuals and their families to make healthcare decisions for themselves based on their needs and based on their budgets.

The policies that are included in H.R. 6311 expand access to consumer-directed health plans with tax favored accounts, like health savings accounts, HSAs. This bill increases choice, lowers premiums, and let's more families save more money to pay for their healthcare costs.

Now, my friends across the aisle will, without question, get up this afternoon and say that this bill doesn't do anything to help people. That instead of these policies, we should drop everything and work to fix the very broken, flawed plan that is the ACA. Well, here is the thing.

There are twice as many people who have an HSA than those who are covered under the exchanges. Let me say that again. Twice as many Americans are covered under HSAs than under the Affordable Care Act: 21.8 million people, Mr. Speaker, had a health savings account in 2017, and there is only 10.6 million who are enrolled in the exchanges in 2018--2 to 1.

The bill makes smart changes to help families save more money pre-tax for their healthcare. It changes the so-called use-it-or-lose-it nature of flexible spending arrangements, FSAs, by allowing balances to roll over to the next year. It doubles the amount of money people can put into a health savings account so that they can save enough to cover their exposure to out-of-pocket costs, and they are increasingly vulnerable to these out-of-pocket costs.

Now, my friends on the other side may say they want to talk about and distract from some of these commonsense solutions and say that somehow some subpar insurance is being promoted. Well, even after canceling millions of healthcare plans that people had and that people liked, notwithstanding the President's promise that if you like your coverage, you get to keep your coverage--you remember that, Mr. Speaker-- notwithstanding that, Democrats, God bless them, they still think they know what type of healthcare is best for everyone. They haven't learned yet that individuals and families are the best ones to make these decisions, not politicians and not bureaucrats in Washington.

We think people should be able to purchase the type of coverage they want and the type of coverage they can afford. One of the provisions in this bill allows everyone to purchase a catastrophic plan, a plan that was designed by ObamaCare. These plans offer the lowest premiums, and we think everyone should have access to them.

Even better, because these plans have average deductibles of $6,000, we think we should allow catastrophic and bronze plans to qualify for an HSA as well. This means people can get a break in taxes for the money that they save for their huge ObamaCare deductibles. This is real savings to real people who are struggling under the current healthcare law.

It allows working seniors with HSA-eligible coverage who are enrolled in Medicare part A to contribute to an HSA, which can provide an added benefit for seniors and an incentive for them to stay on their employer-sponsored plan over Medicare, if they choose. It makes perfect sense.

It increases utility and flexibility through allowing both spouses to make

catch-up contributions into the same HSA if they are over age 55.

Finally, it delays ObamaCare's health insurance tax for an additional 2 years, which would otherwise increase the cost of insurance premiums through a nearly $27 billion excise tax. This is a flawed tax that gets passed on to American families who are purchasing in the individual market; it gets passed on to seniors in Medicare Advantage; it gets passed on to small businesses; and it gets passed on in Medicaid programs.

So I want to thank the Ways and Means Committee members who took that effort seriously. I look forward to this afternoon's debate.

I want to thank Chairman Brady for his leadership in driving this discussion, and I reserve the balance of my time.

House of Representatives,

Committee on Ways and Means,

Washington, DC, July 13, 2018.

Hon. Greg Walden,

Chairman, Committee on Energy and Commerce,

Washington, DC.

Dear Chairman Walden: I write to you regarding H.R. 6311,

to amend the Internal Revenue Code of 1986 and the Patient

Protection and Affordable Care Act to modify the definition

of the qualified health plan for purposes of the health

insurance premium tax credit and to allow individuals

purchasing health insurance in the individual market to

purchase a lower premium copper plan.

The Committee on Ways and Means ordered favorably reported

this bill which was also referred to the Committee on Energy

and Commerce. I ask that the Committee on Energy and Commerce

waive formal consideration of the bill so that it may proceed

expeditiously to the House Floor.

I acknowledge that by waiving formal consideration of the

bill, the Committee on Energy and Commerce is in no way

waiving its jurisdiction over the subject matter contained in

those provisions of the bills that fall within your Rule X

jurisdiction. I would support your effort to seek appointment

of an appropriate number of conferees on any House-Senate

conference involving this legislation.

I will include a copy of our letters in the Congressional

Record during consideration of this legislation on the House

floor.

Sincerely,

Kevin Brady,

Chairman.

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

The gentleman from Michigan asked the rhetorical question: Why are we here?

I will tell you one reason why we are here. One reason why we are here is I have an independent recollection of being in my car on Michigan Avenue in Chicago, listening then to President Obama give a speech to, I think it was the American Medical Association. I was listening on the radio and he said, I think--I may be conflating here. But he said: If you like your coverage, you can keep your coverage. If you like your doctor, you get to keep your doctor.

I think, during the course of the healthcare discussion, the Obama administration made this explicit promise to the American people: You are going to save $2,500 per family. And it was going to be great. It was going to solve all the problems. Yet, that didn't happen. That is why we are here.

I have a constituency where two counties have one insurer. That is why we are here.

Mr. Speaker, I yield 2 minutes to the gentleman from Minnesota (Mr. Paulsen) to tell us why we are here.

Mr. Speaker, I yield 2 minutes to the gentlewoman from Indiana (Mrs. Walorski).

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

Mr. Speaker, every time today we hear the phrase ``junk coverage,'' think ObamaCare. And I am not trying to be facetious, because there is nothing in this bill that makes any change to any coverage. I could only assume that the gentlewoman from California (Ms. Judy Chu) is referring to the catastrophic coverage that was part of the ACA.

All we are doing today is saying, with that coverage, they ought not be alone. They ought not just be out on an ice floe all by themselves. People who have that type of catastrophic coverage that our friends, when they were in the majority, created, those people should simply have access to a health savings account.

What is not to love about that?

So when you hear ``junk coverage,'' just be dismissive of that. It is a talking point, and it is not particularly persuasive. Who is persuasive is the gentleman from Nebraska.

Mr. Speaker, I yield 2 minutes to the gentleman from Nebraska (Mr. Smith).

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

Mr. Speaker, let's talk about the 5 percent solution. So, if you are in the 5 percent, you need a solution. Five percent of this country is millions of people who are in HSAs.

And the characterization of something as a tax shelter, as the gentleman from Texas just characterized, is a completely loaded and pejorative term.

So where do we go for some level of clarity? Let's go to the Joint Committee on Taxation, and the question that was posed to them was: Show us the tax returns of people who take advantage or who are in a health savings account.

In 2015, 71 percent of returns reported an income of $200,000 or less. Are those rich people? I don't think so. And, in addition, 28 percent reported income of $75,000 or less.

So the hyperbole, the overstatement, the mischaracterization, I think is ``rich.''

And did you notice something, Mr. Speaker? I laid out the President's promise: You like your coverage, you get to keep your coverage. You like your doctor, you get to keep your doctor. And we are going to save $2,500 per year per family.

There has been silence on the other side of the aisle, and I predict that that won't be answered all afternoon. Do you want to know why? Because there is no answer.

For real answers, I yield 3 minutes to the gentleman from Tennessee (Mr. Roe).

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

Mr. Speaker, I yield 3 minutes to the gentleman from Ohio (Mr. Stivers).

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

Mr. Speaker, there is nothing in this bill that is destructive at all. The entire structure of the bill is invitational. The bill presumes the status quo in terms of the Affordable Care Act, and it allows people to get in sync with the Affordable Care Act, and it allows them to save money in a tax-free manner.

I am really surprised at the hyperbole, the overstatement, and the over characterization. Nobody has answered either, Mr. Speaker, if you will notice, my admonition about the characterization of junk insurance. To attribute that claim, which we have heard from a couple of speakers this afternoon, against this bill is to attribute that claim and that criticism against the ACA, because the underlying bill matches exactly what the ACA purports, that is, catastrophic coverage. It simply says, if you have that coverage and your deductibles take your breath away, good news; you can save on a tax-free basis.

So I think, with all due respect to the talking point writers and all due respect to the critics of this bill, I think the entire debate would be uplifted somewhat if we were debating the actual bill that is before us instead of tweets and news feeds and so forth.

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

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

Mr. Speaker, I served on the Ways and Means Committee when the ACA was passed, and I recall then-minority ranking member Dave Camp from Michigan, who went on to become the chairman later, offered an alternative to the ACA.

He inquired of then-chairman Rangel: When are we going to get to the Republican alternative? When are we going to get to the Republican alternative?

I remember this because I was sitting--I think I had the same seat that Mr. Higgins from New York has--down in front on the left side of the dais.

Charlie Rangel evoked an old gospel song. He said: Soon and very soon, which is why I remember.

Now, soon and very soon never came for that amendment. Soon and very soon never came for the Republican alternative to be considered in the Ways and Means Committee.

Now what we are dealing with is the reality of the Affordable Care Act. Mr. Speaker, what we are proposing is to say: Look, we have got some suggestions; we think we can make this better.

Is this reckless? I think not. I fundamentally reject that. When you accept the entire premise of the current structure of the Affordable Care Act, and you take something that pre-existed within the Affordable Care Act, that is health savings accounts, and you attach it and you expand it, where is the defensiveness?

This is what is amazing to me about this debate. This is why our country is stuck. Our friends on the other side of the aisle have created the Affordable Care Act, and it is orthodoxy. To take it on and to try to make improvements--they say they want improvements.

They say: Oh, let's work together.

All afternoon with Ms. Jenkins here on the House floor, she was managing time of bills that were bipartisan in nature, bipartisan as they went through the committee, but you got none of that veneer of bipartisanship as they were discussed on the floor. They were perceived as a direct attack at what? Orthodoxy.

So notwithstanding the invitation to work on both sides of the aisle, the other side is making it very clear that they are unwilling to take the structure of the ACA, to take favorable tax treatment and help more people save their own money and spare themselves the results of a law that our friends on the other side of the aisle said that you could keep your doctor, you could keep your coverage, and you would save $2,500 per person--and, again, I reiterate, Mr. Speaker, did you notice there was no answer to that charge this afternoon?

I laid it out twice and now a third time; and absolute silence.

Why? Because they oversold. Now when they have got friends on this side of the aisle who are saying: Look, we can improve this. Let's work here. No, we don't like the ACA, but we can work through some of these things, then, all of a sudden, it is stiff-arm. Then, all of a sudden, it is insincere. Then, all of a sudden, it is political.

This is good work, this is serious work, and it is work that is designed to bring relief to people who are suffering, who have no interest in the nature of a donkeys-and-elephants debate on the House floor. Most people's eyes glaze over.

Most people say they want remedies. This is a remedy that makes sense. This is a remedy in sync with the ACA in some ways. The responses we have heard from the other side I don't think are persuasive.

Mr. Speaker, I urge the passage of H.R. 6311, and I yield back the balance of my time.

Mr. Speaker, I claim the time in opposition.

Mr. Speaker, I urge us to reject this motion to recommit.

The hospital insurance trust fund isn't going to be insolvent purely because we are freeing Americans from the individual mandate. This crisis has been going on for decades.

Mr. Speaker, I urge a ``no'' vote, and I yield back the balance of my time.

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

Mr. Speaker, I think we need to ask ourselves: What is this bill all about? Why are we here today?

H.R. 6311 is the final of three bills regarding health savings accounts and health taxes that we will be considering this week. I find it sad we are not spending our time today addressing the most pressing concerns of Americans struggling to make ends meet because of the Republican sabotage of healthcare coverage.

Nothing in H.R. 6311, or any other bill we have considered this week, undoes the ongoing harm caused by the actions of the Trump administration or this Republican Congress.

For example, earlier this month, the administration created needless confusion by refusing to make legally required risk adjustment payments until, when there was major protest, it reversed course last night under public pressure. But in June, the Justice Department refused to defend protection for the 130 million Americans living with preexisting health conditions.

Last fall, the President terminated cost-sharing reduction payments for Americans earning 100 to 250 percent of the Federal poverty level. The GOP tax bill gutted the individual responsibility requirement, causing a 15 percent spike in premiums, according to CBO.

Recently, the administration again cut funding for navigator organizations to just $10 million for the upcoming open enrollment period. I saw at home what these navigator provisions meant to nonprofit organizations that were reaching out to people who wanted information and healthcare.

Cut, cut, cut is the administration's answer. And this Congress' response to that administration action is zero, silence, silence, silence.

These and so many other actions by Republicans have led to direct increases in premiums and out-of-pocket costs for middle class families.

Expanding HSAs and shifting more Americans into catastrophic coverage, as H.R. 6311 does, will not meaningfully help middle class families harmed by Republican sabotage of ACA. Instead, it will primarily benefit wealthy Americans and large insurance companies.

According to data from the Joint Committee on Taxation, more than 80 percent of the tax benefit for health savings accounts goes to individuals earning more than $100,000 annually. We pointed that out in committee.

What was the response? Obfuscation, obfuscation. That is a fact and analysis given to us by the Joint Committee on Taxation. So all these crocodile tears for mainly middle class families, I think, are shown for what they are.

Very few families with modest incomes can afford the high, out-of- pocket expenses required in order to participate in a HSA. Doubling the amount that individuals can contribute tax-free--tax-free--as this bill does, will make no difference to the millions of working families who don't have thousands of dollars available to contribute to an HSA in the first place.

I suggest that everybody go home and talk to the general public.

In addition, a 2-year delay of the health insurance provider fee will have only a minimal impact on premiums. Indeed, this provision will mainly benefit insurance companies, while adding more than $25 billion to the deficit.

Not only do the bills we have considered this week not address these pressing issues, they also recklessly add to the deficit. Republicans have failed to produce even $1 for the enormous cost of these bills. So I said to the chairman of the committee that I once chaired, I was sometimes asked that question: Will you pay for it? And I said yes.

I asked the chairman: Will you pay for this? At first, it was said: Well, we don't have to do that in committee. So I said: Will you do it on the floor, yes or no? He said no.

So here we are. Although we do not yet have a final analysis from the Congressional Budget Office or the Joint Committee on Taxation, past estimates of similar provisions have shown us this:

H.R. 184, which would repeal the medical device tax, will cost about $20 billion over 10 years.

H.R. 6199, which would expand HSAs to include over-the-counter medications and gym memberships, will cost roughly $20 billion.

And this bill, which expands HSAs and delays a tax on the health insurance industry, would increase the deficit the most. This is, in a few words, a Risky Roskam bill that would cost up to $50 billion, $50 billion.

When all is said and done, our actions this week could add up to $90 billion to our Nation's debt, increasing pressure to cut vital programs like Medicare. This comes just months after a tax cut bill that would add an additional $2 billion to the debt.

So, look, we need to come and ask ourselves: Why are we here?

These bills will not likely pass the Senate or become law, so here we are. We are going to recess, adjourn tomorrow for 5 weeks or so. I think the reality is that these bills, which will not likely pass the Senate, will not ever become law.

I think it is likely that they have a different purpose, and I think that was described in a recent article in The Hill. I read it because I want the public to question what we do, and I quote:

``The bills on the House floor next week could give victories to the bill

sponsors who are also vulnerable in November.'' The chairman of the subcommittee, where I am ranking member, is facing, this article says, ``a tough reelection race in his suburban . . . district.''

``But overall, the measures slated for consideration are minor and won't make a major dent in premiums, according to Joe Antos, a healthcare expert at the right-leaning American Enterprise Institute.''

I want to quote that again: ``These measures slated for consideration are minor and won't make a major dent in premiums, according to Joe Antos, a healthcare expert at the right-leaning American Enterprise Institute.''

So I think that is really what this is all about. It is a political exercise. It is aimed to help people who are in a vulnerable political position. But that is not a reason to bring up these bills today, when, as I described earlier, there are so many issues relating to healthcare coverage.

The Republicans have undertaken these last months under this administration to do everything they can to sabotage healthcare for Americans. As a result, 3 million people less have healthcare insurance. But ACA works so well that 20 million people received healthcare coverage they did not have.

So, this is kind of a sad moment. We are turning this place into a campaign entity. We should not be doing that when it comes to healthcare coverage. We tried, in recent times, to say to the Republicans, if you want to improve ACA, we are ready. Never has there been any offer to do that. Instead, it was repeal, repeal, repeal. I won't say that 55 times, but that is how often it happened. More recently, it was sabotage, sabotage, sabotage. That isn't what we should be doing for what is so dear to Americans, healthcare coverage.

It is a sad day, as I said earlier, that, here we are, when so much needs to be done, and this, essentially, is a political exercise.

I reserve the balance of my time.

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

Mr. Speaker, I have heard the so-called fact that more people have HSAs than those who are covered by ObamaCare. That simply is not true.

ObamaCare includes expanded Medicaid. So if you want to talk about more than in the exchanges, we can discuss that and argue it, but don't come here and minimize the impact of ACA.

We worked hard on it. We meet so many people who have benefited from what we Democrats did, and the public, more and more, is expressing that. You were on the wrong side of history, and you are now on the wrong side of public opinion.

Mr. Speaker, I yield 2 minutes, or more if he would like, to the gentleman from New York (Mr. Higgins), an active member of our committee.

Mr. Speaker, I yield 3 minutes to the gentlewoman from California (Ms. Judy Chu), who is so active and there all the time.

Mr. Speaker, I yield 5 minutes to the gentleman from Texas (Mr. Doggett), a true fighter.

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

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

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

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

Mr. Speaker, I yield 2 minutes to the gentlewoman from Michigan (Mrs. Lawrence), my colleague.

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

Mr. Speaker, as I close, I think back some years ago when we were working on ACA. It was one of our proudest achievements. The Republicans, from day one, were determined to destroy it. ACA can be made better, but destruction is not improvement.

This bill, when you put it together, is not only unpaid for, but would be a step to try to undermine the basic thrust of the ACA, to replace these basic provisions with something much less.

In a word, the Republicans are on the wrong side of history, and the clock is ticking.

These bills, when you put them all together, essentially say, these are another way to undercut ACA. This is a very, very weak--and I think worse than a weak set of alternatives. They have never been able to come up with a comprehensive bill, and this effort is the opposite. As we have mentioned, relatively few people with lower income can access these. So many of the people who access HSAs are people who can afford it.

We can make it better. But don't come here when you have had no alternative to say that this is something that could replace ACA. You don't pay for it. You are reckless. This, as I said earlier, is a reckless bill of the chairman of our subcommittee.

So I urge my colleagues to reject this and to not be fooled. We Democrats come to the floor with a sense of being on the right side of history. What is happening in this country is that more and more of the public acknowledge it. Compared to when we first started, I remember going back home, there was so much opposition, so much misguided. But when people--20 million--for the first time, in most cases, had healthcare, the clock began to tick in the direction of universal care.

You are trying to turn back the clock, you Republicans, but it is ticking more and more towards universality. That is what is happening in this country. And this is becoming part of the bedrock, the foundations of care and of provisions for the benefit of the American people as Social Security was, as Medicare was, and as Medicaid was.

You are going to pay the price for your blind opposition. The public is more and more aware, as their eyes have been opened and as their health has been protected, what this has meant to millions of families in this country--millions. I run into it every day I go home, people who come and say: Without healthcare coverage,

where would I be? Not only financially, but where would I be and what is so dear to me, my health and the health of our families and the health of our kids?

I urge we Democrats to stand up tall and say to the American public: The ACA was a major historic step in the right direction. The Republicans continue to try to destroy it. History is showing that, once again, they were moving in the wrong discretion.

Mr. Speaker, I urge that we reject this bill and move proudly forward. We put together this step. We are going to continue to move forward.

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

Mr. Speaker, I demand a recorded vote.

Mr. Speaker, TrumpCare, that is what we are talking about today.

What is TrumpCare? Well, it is not much care. In fact, it is mainly indifference from people that don't really care or understand the plight of thousands of families across this country working to make ends meet, and suddenly somebody has an accident on the way home from work or suddenly a child is diagnosed with some dreaded disease, and they face, without access to affordable health insurance, a catastrophe.

We know that there are a significant number of American families that have said they couldn't meet a $400 or $500 emergency. Think about what happens to them when they face a $4,000 or a $40,000 healthcare bill. That is what the Affordable Care Act has been all about.

So today we see the chapter in the TrumpCare story that Mr. Roskam and his colleagues are offering for Trump and all of his cohorts. And what is it? It is the 5 percent solution, because we know that health savings accounts have been used by exactly 5 percent of those who earn less than $100,000.

So, as usual, the Trump approach is let's do more for the few, and to heck with the many, the many people who are out there for whom health savings accounts provide little or no protection.

Now, of course, it is a valuable tax shelter for some people who are a little bit more prosperous in our society, and that is fine, but I believe we need to make healthcare accessible to more people.

And then there is the additional problem that Mr. Roskam and his colleagues have decided to pay for their package of bills, $100 billion of bills, by borrowing just a little bit more. After all the trillions of dollars that they have borrowed from the Saudis and the Chinese and people here at home, wherever they can find somebody who will take their IOU, they want to borrow a little more money, $100 billion, almost, to finance this package of bills to help that 5 percent of the families who earn less than $100,000.

I offered an amendment, recognizing that it wouldn't correct all the flaws of TrumpCare, but that it would address one central problem, and that is the problem of preexisting conditions.

What is a preexisting condition? Well, it is whatever an insurance company wants to point to to deny you coverage before the Affordable Care Act.

I do think that our Republican colleagues are afflicted with a very serious preexisting condition. It is called amnesia. They have forgotten what healthcare was like for families before the Affordable Care Act came into existence and prohibited these preexisting conditions not only for those who went to the marketplace, but across the board, to prevent preexisting conditions from being used against someone to deny them coverage or to limit the coverage that they got.

The kind of people whom I came in contact with as we worked on the Affordable Care Act who were determined to have preexisting conditions were a victim of domestic violence, someone who was born with a disability, and someone who had an accident or an illness and found themselves with some lingering effects of that. They would either be denied coverage altogether, or they would find in the fine print of their insurance policy significant limitations on that insurance. The insurance would cover them for everything except what they needed insurance for.

Now, after the Republican attempt--and not just one, but 60 or 70 attempts--to repeal the Affordable Care Act failed in the United States Senate, thanks to the courage of a few there and of the many across this country who said, ``We don't want it repealed,''

now that it has failed, they have devoted the last year to doing everything in the book to try to sabotage the Affordable Care Act.

They won't stabilize health insurance markets. They won't focus on reducing premiums. They won't focus on strengthening and correcting any of the shortcomings within the Affordable Care Act, like the need to rein in the prescription drug price gouging.

So instead of expanding accessible coverage, what they do is to expand a healthcare tax shelter for a few people.

Having done so much harm, they tell us today that they are not advocating junk insurance. Well, let's talk about junk insurance, because I think they are right in the junkyard on it.

President Trump's administration is out there telling the courts that they cannot defend the protections in the Affordable Care Act.

Mr. Speaker, they can't defend, and they refuse to defend, the preexisting conditions provisions that protect, in Texas, it is almost half of the population who are said to have some type of preexisting condition.

So the administration won't protect those with preexisting conditions. They are hoping to erode that protection. And when I offered a one-paragraph amendment, Republicans refused it without any decent explanation in our committee to ensure that the preexisting condition provision was in any policy that would be purchased under this plan.

So what you will be left with, as my colleague from California explained, are junk insurance plans. They are the kind that promise great coverage, but down in the fine print of the policy, you don't have coverage when you need it. They are skinny insurance plans that aren't about the size of the person, but the size of the coverage, that it doesn't cover very much. And those kinds of plans are the kind that we will end up having.

We have a saboteur-in-chief, not only when it comes to our military alliances and our friends abroad but, with this President, with reference to healthcare. These bare-bones, junk insurance policies will not get the job done.

I think of the many people whom I represent in central Texas, and I am sure they are not unlike people in the suburbs of Chicago.

They are people like Colleen, who is a bookkeeper. She adopted her son through the foster care system when he was 18 months old. Unknown to her, he had a preexisting condition; and she learned that she had a preexisting condition. And as she said: ``The Affordable Care Act made my family possible.''

I think of people like Theresa in San Antonio, who says that, before the Affordable Care Act, she found herself repeatedly digging out of medical debt because of a preexisting condition.

I think of a constituent who called me during the debate of the Affordable Care Act because her sister could not get coverage for cancer.

Mr. Speaker, her sister could not get coverage. Though she had substantial chemotherapy coverage, it was not enough to cover the full amount of the treatment that she needed.

We cannot go back. These folks would drag us back along with the chief saboteur of healthcare in this country. We don't want to return to the fine print restrictions, to the clever caveats. We need comprehensive coverage.

The Affordable Care Act can be made better, and I believe we are going to have a Congress that will do just that if we defeat this effort.

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 4952) to direct the Secretary of Health and Human Services to conduct a study and submit a report on the effects of the inclusion of quality increases in the determination of blended benchmark amounts under part C of the Medicare program, as amended.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and include extraneous material on H.R. 4952, currently under consideration.

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

Mr. Speaker, this bill, H.R. 4952, the Improving Seniors Access to Quality Benefits Act, will allow us to take a deeper look at how the Medicare Advantage benchmark cap is affecting people across the Nation. I have been working with Mr. Kind and other Members to address this inequity that affects seniors in high-quality plans across the country.

The Medicare Advantage program was designed to give seniors a choice in their healthcare and utilize the private

sector to provide better care and benefits. Medicare Advantage plans receive a capitated payment rate to cover the patient's total cost of care. In order to encourage quality, seniors enrolled in high-quality plans receive a quality bonus payment that goes directly to seniors in the form of reduced cost sharing or extra benefits.

The Medicare Advantage program is very popular and has been working well for many years. In my district in western Pennsylvania, more than half of Medicare beneficiaries choose Medicare Advantage. Nationwide, Medicare Advantage enrollment has grown to 30 percent of Medicare beneficiaries. That number is even higher with 48 percent of the Hispanic and 38 percent of African American Medicare beneficiaries choosing Medicare Advantage.

Unfortunately, the Affordable Care Act implemented a cap on payments to Medicare Advantage plans. This misguided benchmark cap policy has penalized approximately 5.8 million American seniors being denied important benefits like care coordination, vision, dental, and wellness programs.

This issue has cost seniors in my district and across the country millions of dollars in benefits that they are entitled to. We talk often about paying for value in the Medicare program, and this policy undermines that goal.

The benchmark cap is clearly a problem, and we need more information on it. The Improving Seniors Access to Quality Benefits Act requires the Secretary of HHS to analyze and report to Congress on the impact of including quality bonus payments in the Medicare Advantage benchmark cap. It also establishes a sense of Congress that this issue undermines the goal of delivering high-quality care in the Medicare program.

It is my understanding that the Department of Health and Human Services has limited secretarial authority to make this change on its own. I hope to work together with the Secretary on policies such as this to encourage high-quality plans for seniors.

Mr. Speaker, this legislation has broad support from many stakeholders, including America's Health Insurance Plans, the Better Medicare Alliance, the Healthcare Leadership Council, Meals on Wheels America, the National Minority Quality Forum, the Alliance of Community Health Plans, and many others.

Mr. Speaker, I urge the adoption of this legislation, and I reserve the balance of my time.

Committee on Ways and Means,

House of Representatives,

Washington, DC, July 13, 2018.

Hon. Greg Walden,

Chairman, Committee on Energy and Commerce,

Washington, DC.

Dear Chairman Walden: I write to you regarding H.R. 4952,

the ``Improving Seniors Access to Quality Benefits Act'' the

Committee on Ways and Means ordered favorably reported that

was also referred to the Committee on Energy and Commerce.

I ask that the Committee on Energy and Commerce waive

formal consideration of the bill so that it may proceed

expeditiously to the House Floor.

I acknowledge that by waiving formal consideration of the

bill, the Committee on Energy and Commerce is in no way

waiving its jurisdiction over the subject matter contained in

those provisions of the bills that fall within your Rule X

jurisdiction. I would support your effort to seek appointment

of an appropriate number of conferees on any House-Senate

conference involving this legislation.

I will include a copy of our letters in the Congressional

Record during consideration of this legislation on the House

floor.

Sincerely,

Kevin Brady,

Chairman.

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

Mr. Speaker, it is estimated that the ACA's benchmark cap negatively impacts more than 40 percent of counties across our country. The Improving Seniors Access to Quality Benefits Act will require the Secretary to fully evaluate the impact of including quality bonus payments under the benchmark cap on our seniors residing in these counties.

This bill was brought through the committee process in a bipartisan fashion. Now on the floor, I strongly recommend my colleagues on both sides of the aisle to vote in favor of H.R. 4952 to ensure seniors are not missing out on additional healthcare benefits or reduced cost sharing as a result of the ACA's benchmark cap.

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

Mr. Speaker, I move to suspend the rules and pass the bill (H.R. 6138) to amend title XVIII of the Social Security Act to provide for ambulatory surgical center representation during the review of hospital outpatient payment rates under part B of the Medicare program, and for other purposes, as amended.

Mr. Speaker, I ask unanimous consent that all Members have 5 legislative days in which to revise and extend their remarks and include extraneous material on H.R. 6138, currently under consideration.

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

Mr. Speaker, ambulatory surgery centers provide patients with high- quality, same-day surgical and preventive care. H.R. 6138, the Ambulatory Surgical Center Payment Transparency Act of 2018, makes two simple and straightforward ASC reforms.

The bill adds an ASC representative to the advisory panel on hospital outpatient payment, which will allow ASCs proper representation and a seat at the table for future CMS payment policy changes. This bill also requires the Centers for Medicare and Medicaid Services to disclose their criteria for inclusion or exclusion of procedures on the ASC approved list.

Currently, CMS does not fully provide explanations for their decisions, leading to a lack of transparency in the process. These simple changes will continue to protect patient access to cost- effective and high-quality services performed in the ASC setting.

I hope that this legislation marks the first of many steps in further bolstering ASC and patient access to these high-quality facilities.

I thank Chairman Brady, Ranking Member Neal, and the Ways and Means staff for working to provide transparency in this space. I also thank Mr. Larson for his work and partnership on this important bill.

Mr. Speaker, I encourage all Members to support this legislation, and I reserve the balance of my time.

Committee on Ways and Means,

House of Representatives,

Washington, DC, July 13, 2018.

Hon. Greg Walden,

Chairman, Committee on Energy and Commerce,

Washington, DC.

Dear Chairman Walden: I write to you regarding H.R. 6138,

the ``Ambulatory Surgical Center (ACS) Payment Transparency

Act of 2018'' the Committee on Ways and Means ordered

favorably reported which was also referred to the Committee

on Energy and Commerce.

I ask that the Committee on Energy and Commerce waive

formal consideration of the bill so that it may proceed

expeditiously to the House Floor.

I acknowledge that by waiving formal consideration of the

bill, the Committee on Energy and Commerce is in no way

waiving its jurisdiction over the subject matter contained in

those provisions of the bills that fall within your Rule X

jurisdiction. I would support your effort to seek appointment

of an appropriate number of conferees on any House-Senate

conference involving this legislation.

I will include a copy of our letters in the Congressional

Record during consideration of this legislation on the House

floor.

Sincerely,

Kevin Brady,

Chairman.

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

I want to reiterate the small but important step we are taking here today in passing this legislation. Ambulatory surgical centers provide excellent care at lower cost to patients and taxpayers.

While there is a much longer conversation that needs to happen regarding parity in reimbursement in outpatient settings, what we are doing here is simple. ASCs are an integral part of the healthcare system, and we are saying that, as stakeholders, they deserve a seat at the table when changes to payment policies are being debated and when decisions are being made by CMS on the services they are able to provide patients. We believe they should get a transparent explanation as to why those decisions were made.

Mr. Speaker, this is a commonsense bill. I urge all my colleagues to support it, and I yield back the balance of my time.