Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 1012 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentlewoman from California (Mrs. Torres), pending which I yield myself such time as I may consume. During consideration of this resolution, all time yielded is for the purpose of debate only.

General Leave

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

Mr. Speaker, House Resolution 1012 provides for the consideration of an important bill to return control of healthcare spending and budgeting back where it belongs: with the patient.

H.R. 6199, the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018, would amend the Internal Revenue Code of 1986 to include certain over-the-counter medical products as qualified medical expenses for the purposes of spending one's own dollars within a health savings account.

Today's resolution provides for a rule to allow H.R. 6199, the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018, the standard practice for a tax-related measure on the House floor. The rule provides for 1 hour of debate equally divided and controlled between the chair and the ranking minority member of the Committee on Ways and Means. The rule does, however, provide the minority with the customary motion to recommit with or without instructions.

Also included in the resolution before us today are the standard provisions allowing the House of Representatives to continue to operate while Members are home, working with their constituents during the August district work period.

Mr. Speaker, I rise today to speak in support of the rule on H.R. 6199, the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018. This rule includes the work of various Members of Congress on the important issue of modernizing health savings accounts. While this legislation did not move through the Health Subcommittee of the Energy and Commerce Committee, my fellow members on the other Health Subcommittee, that of the Ways and Means Committee, have done quality work in moving this package. Each bill was reported favorably out of the Ways and Means Committee.

Mr. Speaker, I have long been a supporter of increasing flexibility within our healthcare system, especially through the use of health savings accounts. Health savings accounts allow patients to feel more involved and to have more control over their healthcare spending. As someone who has personally had a health savings account in the past, I believe it to be a powerful tool but that qualified expenses have been limited for too long.

This package will give more power to consumers by allowing them to use their hard-earned savings that they put into their health savings accounts on an expanded number of healthcare goods and services.

The first bill in this package, Promoting High-Value Healthcare Through Flexibility for High-Deductible Health Plans Act, introduced by Chairman Roskam, allows for first-dollar coverage flexibility for high- deductible health plans. Many individuals, especially in the post- Affordable Care Act world, have chosen to purchase high-deductible health plans. While this is a reasonable choice for many consumers, there are some who are faced with high out-of-pocket costs.

H.R. 6199 allows health plans to provide coverage for up to $250 per year for individuals or $500 per year for families before they meet their deductible. The goal of this provision is to incentivize services that could reduce future healthcare costs, such as primary care visits and telehealth services.

Additionally, under current law, individuals are unable to contribute to an HSA if they participate in a direct primary care service arrangement. Representative Erik Paulsen's Primary Care Enhancement Act, which is included in this rule, enables patients to be able to participate in a direct primary care service arrangement and remain qualified to contribute to a health savings account. It also includes direct primary care service arrangement fees as medical expenses.

Some individuals are fortunate enough to receive certain healthcare services at or nearby their workplace through their employer. Representative Mike Kelly's bipartisan Health

Savings Account Improvement Act of 2018, which is included in this package, addresses this issue.

While it is convenient and helpful to have access to such services, these individuals should not be barred from having a health savings account. This package creates a special rule that individuals can receive free or discounted services offered by their employers onsite or at retail medical clinics. These services may include physical exams, immunizations, nonprescription drugs, treatment of employment- related injuries, drug testing if required as a condition of employment, hearing or vision screenings, or other services that are not considered significant benefits in the nature of medical care.

Mr. Speaker, the post-Affordable Care Act world is riddled with flaws, but one of the biggest problems is its failure to promote consumer-driven healthcare. Expanding the use of health savings accounts could go a long way to reverse this trend. Health savings accounts give consumers incentives to manage their own healthcare costs by coupling a tax-favored savings account used to pay medical expenses with a high-deductible health plan that meets certain requirements for deductibles and out-of-pocket expense limits. The funds in a health savings account are owned by the individual and may be rolled over from year to year.

Health savings accounts are not a novel idea. They have been around since 2004, but current health savings account policy is extraordinarily restrictive, making it harder for consumers to take advantage of it.

I have spent several years in developing extensive reforms to increase the potential for health savings accounts for consumers, and H.R. 6199 includes meaningful improvements that we can, in fact, get across the finish line now to help families now.

One of these improvements is the ability for spouses to contribute to a health savings account under certain circumstances even if their spouse has a flexible spending account. Under current law, one spouse can reimburse expenses for their spouses' and other dependents' medical expenses; therefore, the other spouse is considered to be ineligible for an HSA.

This provision enables the spouse without the flexible spending account to reimburse for medical expenses, with certain restrictions. This is critical, as it gives individuals increased flexibility to save for their own healthcare expenses that a shared flexible spending account for the whole family may not provide.

Additionally, this bill allows for individuals to terminate or convert their flexible spending account and health reimbursement accounts into a health savings account under certain circumstances. Employers would be able to allow their employees to convert their flexible spending account and health reimbursement account balances into health savings account funds if they enroll in a high-deductible health plan with an HSA. This is critical in empowering patients and allowing them the flexibility to change health plans without losing their savings.

There is a dollar limitation of $2,650 for conversions for individuals, $5,300 for families, and the funds transferred into the HSA would count toward the enrollee's HSA contribution for that taxable year.

H.R. 6199, the bill introduced by Representative Lynn Jenkins from Kansas, makes commonsense, patient-centered reforms to help defray costs for individuals. Over-the-counter medications, allergy and cold medicines, antibiotic ointment, and pain relievers are historically ineligible expenditures for HSA and other tax-favored healthcare accounts. The ACA created a requirement in Federal law that forced account holders to go to their doctor to obtain a prescription for over-the-counter medications before purchasing them with their health savings account or flexible spending account. Individuals who fail to jump through these hoops and purchase over-the-counter medications without a prescription, in fact, face a tax penalty for making a nonqualified distribution.

This policy drives unnecessary utilization of doctor services, decreases access to over-the-counter medications, and discourages people from taking control of saving for their healthcare needs. H.R. 6199 repeals this harmful provision, puts consumers back in the driver's seat, and allows them efficient access to appropriate medications.

Lastly, this legislation permits individuals to invest their hard- earned health savings account dollars into their physical fitness and well-being. In many ways, income is a hurdle for individuals and families who would like to participate in a physical activity, whether they would like to pay for a membership at a fitness facility or pay for their children to join a youth sports league. This legislation opens the door for paying for such activities with health savings account dollars.

Known originally as a standalone bill, the Personal Health Investment Today Act, introduced by Representative Jason Smith, allows qualified sports and fitness expenses to count as qualified medical expenses. These particular expenses are capped at $500 a year for individuals and $1,000 on a joint return.

Passage of this provision will assist individuals and families across the Nation in investing in their physical fitness, which can lead them to healthier lives and stave off conditions such as diabetes and obesity. These bills are an important example of the work we are doing right now to advance Member-driven solutions that will improve healthcare for all Americans.

Deductibles, out-of-pocket limitations have been steadily growing. Congress should be taking steps to make it easier for Americans to save, not restricting their options. The rule and the underlying bills included in this package strengthen consumer power and increase flexibility for patients in paying for their medical expenses.

I appreciate all of the work that the Members have put into the provisions of this bill. I urge my colleagues to support today's rule and the underlying legislation, and I reserve the balance of my time.

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

Mr. Speaker, once again, I want to draw attention to an opinion article in today's Wall Street Journal. The title of the article is ``TrumpCare Beats ObamaCare,'' July 23, 2018, penned by James Freeman.

``By prioritizing economic growth and reducing the tax and regulatory burdens on U.S. business, Mr. Trump has helped to create an economy with more job openings than ever before. As if by magic, the invisible hand of a freer marketplace is now generating new benefits as employers compete to fill all those open positions.''

``For the first time in 6 years, the share of U.S. workers offered health insurance through their employer has risen, a sign a tighter labor market is prompting businesses to offer more generous benefits. . . .''

``The Trump plan is repairing at least some of the damage caused by ObamaCare. Notes the Journal:

``Among all private-sector workers offered medical benefits, 72 percent opted to take them,'' which is up from the 17 percent in 2010 when it began to decline.

Again, Mr. Speaker, this is to point out that this is all occurring without a new government program. This is because of the strength of the economy. This is what happens when you put the focus on creating good jobs for American workers. This is the benefit that results.

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

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

Mr. Speaker, I was serving in the United States House of Representatives when the congressional Democrats passed the Affordable Care Act. I was serving in the House of Representatives when the implementation of ObamaCare happened at the end of calendar year 2013.

I have got to tell you something. The President told me I had a junk insurance plan. I was covered by a health savings account in those years. Then-President Obama told me I had a junk insurance plan and that I was going to get something better.

I have got to tell you something. I didn't get something better. I went through healthcare.gov. I bought an unsubsidized ObamaCare policy, the bronze plan. I am like any other consumer. I bought on price.

What is the cheapest thing I could afford? That was the bronze plan. The premium was unbelievable. It was three times what I had paid for a premium before for my so-called junk insurance which I had had for years, which had covered every medical contingency that had occurred in my family's life for a number of years. But now I have to buy this policy that the premium was unbelievably high. But that wasn't the worst part, Mr. Speaker. The worst part was the deductible.

Now, look, I had a health savings account. I bought one as soon as the old medical savings accounts were allowed with the passage of the Kennedy-Kassebaum bill in, I think it was, July of 1996. The rules got written the next year. People were allowed to buy medical savings accounts. I bought one. I converted to a health savings account in 2004.

I thought I knew what a high deductible was. That was the whole purpose, after all, of having that medical savings account and, now, health savings account. You have a higher deductible so your premiums are going to be a little bit lower.

My premium certainly wasn't lower, but that deductible was something unlike anything I had ever seen. I went from a $3,500 deductible in my old health savings account with what then-President Obama said was a junk insurance policy. I went from a $3,500 premium to a $6,800 premium for just an individual. This is not a family policy, just for an individual.

Now, let me tell you something, Mr. Speaker. Someone wakes up at 3 in the morning with a kidney stone, the worst pain they have ever had in their life. They go to the emergency room basically to get a shot of morphine and an appointment with a urologist the next day and hopefully pass the darn thing. That exercise can cost in excess of $4,000. If you have a $6,800 deductible, guess what. That is all on you. Your coverage is meaningless at that point. And at the same time, you are having to pay a very expensive premium for coverage that is not there when you need it.

I am not an expert on this, Mr. Speaker, but I would call that junk insurance. That is what then-President Obama and the Congressional Democrats brought us with the passage of the so-called Affordable Care Act. I would far rather go back to those days before.

Most people don't understand why it is they have less coverage now and it costs them more money. Yeah, they heard the argument, if you like your doctor, you can keep your doctor; if you like your coverage, you can keep your coverage. They recognize that perhaps that was political hyperbole. But what they do not understand is: Why am I having to pay so much more now to get so much less?

Mr. Speaker, I submit that the ability for individuals to buy health savings accounts is not junk insurance. That is coverage that people can use. That is help for right now.

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

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

First off, Mr. Speaker, let me reference an article from the Investor's Business Daily from April 10 of this year. I am quoting Investor's Business Daily:

``When the Congressional Budget Office released its updated budget forecast, everyone focused on the deficit number. But buried in the report was the Congressional Budget Office's tacit admission that it vastly overestimated the cost of the Trump tax cuts because it didn't account for the strong economic growth they would generate.

``Among the many details in the report, the one reporters focused on was the Congressional Budget Office's forecast that the Federal deficit would top $1 trillion in 2020. . . .''

Most of the news accounts blame the tax cuts.

I am continuing to quote here:

``But there's more to the story that the media overlooked.

``First, the CBO revised its economic forecast sharply upward this year and next.

``Last June, the CBO said GDP growth for 2018 would be just 2 percent. Now it figures growth will be 3.3 percent''--this was last April, Mr. Speaker; I suspect it is probably going to be higher at the end of this quarter--``a significant upward revision. It also boosted its forecast for 2019 from a meager 1.5 percent to a respectable 2.4 percent.''

Mr. Speaker, the tax cuts are working to boost economic growth. Obviously, the story is far from completed, but the revenue generated by that increased growth is more than enough to offset the tax cuts that were passed by this body last December.

Mr. Speaker, today's rule allows the House to take another step in fixing the problems created by the Affordable Care Act and returning control of healthcare spending back to patients, where it belongs.

H.R. 6199, the Restoring Access to Medication Act of 2018, will allow those Americans with health savings accounts to use those accounts to pay for over-the-counter medications, the practice which existed up until the Democrats took away that ability in the Affordable Care Act. This is the right thing to do.

I want to thank Representative Jenkins for her leadership on this legislation and the Members who contributed to the package that is before us today. I urge my colleagues to support today's rule and support the underlying bills.

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

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 am pleased to be here with Ms. Jenkins, moving forward on this legislation. It represents an opportunity for us to deal with a series of, as she mentioned, bipartisan ideas, relatively simple, to enhance service delivery.

I state from the outset that I am troubled that we were not able to provide opportunities to pay for these. They carry a cost. In committee, even though I thought they were a good idea, I voted against some of them because they were rather expensive.

In the aggregate, these are things, moving forward, that will improve healthcare, and I am hopeful that, as we move along the process, we can find some ways to offset the costs involved.

Some of us have philosophical questions about the role of HSAs and how it fits overall, but this legislation will make key consumer- friendly improvements to our existing system. Direct primary care medical homes are an important example of successful delivery reforms that will become easier to access under this legislation.

DPC arrangements offer individuals access to comprehensive primary care and prevention services in a medical home setting for a flat monthly fee, as opposed to concierge services that some people have in mind. Most of these practices typically charge a low monthly fee, perhaps $50 to $100, in most cases, and they serve low- and

moderate-income patients. These fees support the delivery of high- quality, coordinated care by providing better healthcare upfront in primary care settings.

DPC practices reduce unnecessary hospital and specialty care, as well as administrative expenses. This empowers the doctor-patient relationship, enabling providers to resist financial incentives that distort the decisionmaking process in primary care.

It also reduces the conveyor belt process, where people are typically shuttled into the office in 8-minute increments. This is not the case in direct primary care. It is not uncommon for appointments to last half an hour or even an hour. So they build a better relationship with patients, and they are able to better understand and address healthcare needs.

By offering a high level of access to primary care, evidence shows that direct primary care medical homes improve health outcomes and reduce costs. Today, DPC medical homes serve individuals of all ages and income in at least 47 States.

This legislation simplifies existing IRS regulations and clarifies that direct primary care medical homes are qualified health expenses-- medical services--and not health plans.

I personally question the IRS ruling. We have debated with them, but we have lost that. We fix it with this legislation.

As more individuals and employers seek to utilize the direct primary care delivery model, it is important that this outdated tax barrier not get in the way of patients accessing this successful model.

The legislation will allow HSA plans to cover onsite employee clinics. Think for a moment about the nursing stations that we have here in the House of Representatives to provide that service. They can offer physical exams, immunization, over-the-counter drugs, drug testing, hearing and vision screening, and other minor primary care preventive services to help employers assemble a benefits package for their employees that is both practical and can give them a competitive edge.

Allowing employees to access this basic healthcare service at work means it doesn't disrupt the worksite. It is more convenient for them; it is better for the employer.

Another key consumer change made by this bill is to recognize that employees change jobs. This bill allows individuals to streamline the conversion of a medical savings account, flexible savings account, or HSA so they won't lose savings when they change jobs. These reasonable changes will help consumers make the most of their employer-sponsored coverage.

Now--make no mistake--while this legislation will certainly help some consumers, it doesn't atone for the systematic sabotage that we have seen of the Affordable Care Act by the administration and some of my Republican colleagues. By zeroing out the mandate penalty, estimates are that insurance premiums will rise 15 percent. None of these bills before us today undo that premium hike that is visited upon our constituents unnecessarily.

These premium increases are coming after Republicans gave insurance companies billions in tax cuts in their tax bills. Republican attempts to expand HSAs is no replacement for the Affordable Care Act's financial assistance. Attempts to expand HSAs are a continuation of a platform of shifting families into health plans which provide fewer health benefits and higher out-of-pocket costs, while providing greater tax benefits for those who need them least.

HSAs and high-deductible healthcare plans shift costs to consumers without bending the cost curve or addressing underlying costs of medical care in the United States. I think we can and should do better.

For instance, the President has promised action on lowering prescription drug costs. These bills today do nothing to lower the cost of drugs consumers buy, and seek to move more people into plans that provide only catastrophic coverage, exposing more people to pay the full freight of drug price hikes.

Now, we have legislation before our committees that could move forward to do something about this, and I am saddened, despite Trump's talking about it, that we have really not taken action to do so. And we could, on a bipartisan basis, if we were enabled to do so.

The collection of bills on the floor this week will reduce Federal revenues by about $90 billion and will do nothing to reduce the number of uninsured people that will increase as a result of policy changes my Republican friends have done in this Congress. Their sabotage efforts under the Trump administration have caused millions of people to lose coverage, and millions more will do so in the future.

Now we are seeing, in the budget proposal, my Republican friends proposing to cut Medicare and Medicaid by nearly $1 trillion to try and pay for the deficits that have been exaggerated by tax cuts they have enacted. The bills that we will be considering, especially the next one, will only add fuel to that fire.

So, I am pleased that we have got some bipartisan pieces that we can move forward. I am hopeful that we don't abandon a sense of fiscal responsibility to be able to work together to pay for them, and I hope that we can encourage some of my friends on the other side of the aisle to dial back the assault on the Affordable Care Act, especially by the administration, so that we don't destabilize the system further, drive up costs, and increase the number of uninsured.

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

Mr. Speaker, I yield 4 minutes to the gentleman from Wisconsin (Mr. Kind), a senior member of the Committee on Ways and Means, author of several of these reform provisions, and a champion of value over volume in healthcare, as well as fiscal restraint.

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

Mr. Speaker, I yield myself 1 minute just to respond briefly.

Mr. Speaker, I was here in 2009. The very month President Obama took office, there were 700,000 jobs lost. There was great fear that we were going to have a complete collapse of the auto industry. There was a whole range of things that we were in an emergency situation on, and the worst economic crisis since the Great Depression.

As it was, a major portion of that bill was tax cuts to try and stimulate the economy. I do point out that as we move forward, our healthcare bill was entirely paid for, and that is what we need to get back to.

Mr. Speaker, I yield 3 minutes to the gentleman from Illinois (Mr. Danny K. Davis), a champion of healthcare, dealing with disparities in the healthcare system, a champion for balance and vision, and I appreciate him being here.

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

Mr. Speaker, I take modest exception to the notion that somehow the Affordable Care Act failed. It represents the largest expansion of healthcare that we have seen in decades. It is so popular and important that, when my Republican friends attempted to repeal it, something they have been working on for 7 years, it blew up in their face. Even President Trump said their bill was mean. And it continues, even though they are working to dismantle it bolt by bolt.

I would hope that we will return to sanity to be able to work to be able to move forward on things like some of the elements in this bill here today that we agree upon that could move us forward rather than the continued battle over the notion that the Affordable Care Act is something that needs to be destroyed. The American people deserve better.

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

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

Mr. Speaker, I appreciate the opportunity for us to have this discussion. It has been fun working with the gentleman from Minnesota (Mr. Paulsen) on this notion of direct primary care. It is a simple notion that runs athwart IRS regulations. I still don't fully understand why these should be classified as ``health plan'' rather than ``payment for service.''

But, nonetheless, we were able to work together on a bipartisan basis to move this forward. It is not expensive. The score is less than $2 billion out of $90 billion that we are tossing around here, and I personally believe that it will result in substantial savings in order to provide more efficient coverage.

But I must say that I am a little troubled by the continuing assault on what we are doing with the fiscal future of this country.

We just saw the latest reports that because of what my Republican friends have done with the budget and with the tax bill, we have doubled the deficit this year. It is doubled.

Now, there were complaints from my friend from Kansas about deficit spending when President Obama took office. Remember, he was only President for one-third of that month and lost 700,000 jobs. The economy was in free fall. Absolutely we took steps: cutting taxes and moving in areas to try and strengthen parts of the economy that was posing huge problems for people across the board. And this was broadly supported by people in business. Economic experts actually agree that probably we didn't do enough, and that slowed the economic recovery. But the economy has recovered.

We have seen 9 consecutive years of private sector job growth. That is what Trump inherited: over 7 years of job growth. The economy was strong. It wasn't in free fall. Yet, in that strong position, we are doubling the deficit this year. We are looking at trillion dollar deficits as far as the eye can see.

And we just had the President announce that he wants to spend $12 billion more, not because we are in economic free fall, but because his ruinous trade policies have resulted in losses to the farming sector. They are going to provide extra government bailout, not because farmers want it, but because they are being injured by these ruinous trade policies.

There was a time when most of my Republican friends would rise up in opposition. It is certain that if these were offered by Bill Clinton or Barack Obama, they would be screaming at the top of their lungs. Most of them are strangely silent now, but it is another $12 billion to try to fix a problem that Trump has created by starting trade wars with our friends, trying to punish China, and, in fact, we are punishing our allies. And somehow auto imports are national security.

This is embarrassing that we are in this situation. But it is not just embarrassing, it is dangerous. We are weakening ourselves economically, while we pick fights with our allies, like Canada and the European Union.

Mr. Speaker, on top of all of this, we are going to advance legislation today that have some nuggets of positive things. I have worked with my colleagues on some of them. There are important advances, but they are coming at a price of $90 billion added to the deficit, without even an attempt to work with us to offset. I think we could have offset the direct primary care piece that we are talking about here. It is relatively small potatoes compared to $90 billion, and compared to $12 billion for tariff relief for a trade war we didn't need.

Mr. Speaker, I enjoy the conversation about some of these items. I think it is important to spotlight them. But I am hopeful that we are able to return to fiscal stability, not having bailouts for farmers that they don't want and wouldn't need if we had a rational tariff policy. I am hopeful that we are not going to have a parade of other things that undermine the Affordable Care Act and add unnecessary costs to the deficit.

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

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

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, I yield myself such time as I may consume, and I thank the gentleman from Texas for yielding me the customary 30 minutes.

Mr. Speaker, $2 trillion, that is what this GOP Congress added to the debt last year when they passed their tax scam, $2 trillion that has been taken away from our children and grandchildren to give tax breaks to corporations and the very wealthy.

And today, we take up three bills which are estimated to add another $100 billion. I suppose in comparison to the tax scam, that may be small potatoes, but this is real spending with no offsets and no effort to even try to find an offset. When the 115th Congress finally ends, we will have to put trillions on the Nation's credit card--trillions.

Next year, those of us who may be lucky enough to be back will have the hard task of digging ourselves out of this hole, this wall of debt that will have been created by the 115th Congress. We will have new Members here who will need to deal with the decisions that we are making here today.

Let me tell you about my experience in having to deal with those very irresponsible decisions that put us and pushed us into debt.

In 2008, when I was first elected to the State legislature, I was elected with a wall of debt of $15 billion. My first 30 days in office, we passed four different budgets, and none of it added up. We simply couldn't pay our bills. We had charged ourselves to a place that we could no longer continue.

No one got paid for 6 or 7 months--no one, not the small contractors doing business with the State of California, not the big contractors, not our State employees, not even the members of the legislature. As a matter of fact, I don't come from money, so every month I took a loan to make my mortgage. And this is where the 115th Congress is leading us today. There are no easy choices.

Mr. Speaker, this rule makes in order H.R. 6199, the Restoring Access to Medication and Modernizing Health Savings Accounts Act of 2018. H.R. 6199 claims to restore access to medication and modernizes health savings accounts. This bill makes minor changes that largely favor higher income-earning individuals who can afford to set aside that extra money for things like gym memberships.

This is not, however, the worst bill we have voted on this year. And some

of us may end up even voting for it. After all, I support fixes to the Affordable Care Act. We all do. However, it does not address the destructive actions by President Trump that have disproportionately affected low-income families.

After nearly 70 unsuccessful repeal attempts by this Congress, this administration has, sadly, turned to chipping away at the Affordable Care Act. President Trump has resorted to undoing key provisions of the healthcare law without offering any working fixes, which ultimately puts in jeopardy access to healthcare.

He has eliminated the individual mandate, which alone will increase premiums by 9 or 10 percent, and he is expanding plans that offer slimmer benefits and reduce consumer protection, also known as junk plans, as they cover nothing.

Healthcare plans that can charge you more for being a woman or for being older or for having a preexisting condition, these plans can also outright deny coverage to anyone, putting 130 million Americans' healthcare at risk. Expanding these volatile health plans into the marketplace will also increase premiums between 1 and 4 percent.

Almost a year ago, the Trump administration announced that they were canceling cost-sharing reduction payments which helped nearly 6 million low-income Americans better afford medical services by lowering deductibles and copayments. This alone caused premiums in 2018 to increase by 20 percent, all while this majority won't even try to find a $100 billion offset. Cutting cost-sharing payments increased the deficit by $200 billion. The administration also recently cut additional outreach and consumer education dollars to local organizations by $10 million.

And this is not the first time that they cut these critical dollars. From the very beginning of this administration, millions of dollars in outreach, customer assistance and other help and total enrollment time was cut out. Additionally, we are still waiting on a solution to combat the rising prescription drug crisis, which was promised by this administration.

The increasing cost of prescription drugs in combination with the forecasted increase in medical price inflation will also raise premiums between 5.7 and 6.5 percent next year.

Earlier this month, President Trump announced yet another sabotage: that he will not make the $10.4 billion in risk adjustment payments, which will also increase premiums. These risk adjustment payments protect consumers by ensuring insurance companies don't cherry-pick between the healthy and the sick.

It was very telling last week when the Ways and Means Committee chairman said that GOP lawmakers were exploring a possible legislative fix to restart the risk adjustment payments that President Trump abruptly suspended. The House GOP leadership knows the harm President Trump is causing. Why don't we do something about it today?

The common theme here is an administration consistently undoing key provisions in our healthcare system, putting Americans' health at risk, increasing premiums, which fall squarely on the shoulders of our families and will add billions of dollars to our deficit.

This isn't the Affordable Care Act. This is TrumpCare. This bill is more of the same. Instead of finding solutions for the families that need it the most, this bill will add $100 billion to the deficit.

We should be spending our time making positive, meaningful improvements to our existing healthcare system that ensures millions of Americans have access to affordable healthcare coverage.

We should be discussing legislation that puts downward pressure on premiums so families don't have to worry year after year if they will be able to afford healthcare coverage.

We should be helping to stabilize the marketplace so consumers can choose from a variety of options that meet their unique family needs.

Instead, today, we are, sadly, wasting time discussing a bill that fails to address the concerns of millions of Americans.

I am proud to be from California, a State that stands up for their residents to ensure that they have access to healthcare coverage. In fact, California's comprehensive outreach and marketing program was credited with lowering premiums by 6 to 8 percent--real money. California is proof that effective advertising and outreach can increase enrollment, expand coverage, stabilize risk pools, and lower premiums.

But this administration--and through inaction, this Congress--is driving up healthcare prices for every American, including Californians. So we will vote today on this bill, and it will probably pass, and then it will die in the Senate. And while we send the Senate more legislation that they will never take up, Americans will continue to suffer.

Like I said, this isn't a bad bill, but it only benefits 6 percent of Americans--6 percent, not the 14 percent who lack healthcare insurance at all.

We must do more. We must help those who are falling further and further behind while this Congress buries us in debt.

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

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

Mr. Speaker, if we defeat the previous question, I will offer an amendment to the rule to bring up Representative Ruiz's legislation, H.R. 6479, which will ban junk insurance plans.

Mr. Speaker, I ask unanimous consent to insert the text of my amendment in the Record, along with extraneous material, immediately prior to the vote on the previous question.

Mr. Speaker, I yield 4 minutes to the distinguished gentleman from California (Mr. Ruiz) to discuss our proposal.

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

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

Mr. Speaker, in the first 12 months of this administration, 3.2 million people have lost their healthcare because of the sabotage of this administration. As a matter of fact, last year, we had the highest increase in the number of uninsured since the ACA was passed.

When the ACA was passed, I was not in Congress. I was a State legislator in California, where we embraced the ACA, where we made it work for our families, and where we reached out to our constituents and asked: How can we make it better?

This is not the ceiling; this is the floor.

As State representatives, we felt that we had an urgency to act, to make it better and make it work for our constituents. That is what we did, and that is why the California exchange is so successful.

But that didn't happen in other States controlled by Republican legislators and Republican Governors. Unfortunately, they chose to do the opposite, and that has hurt their constituents.

Mr. Speaker, the bill we are considering today will add another $100 billion to our national debt. That is not a small thing.

When the bill comes due for this expenditure, how are we going to pay for it? What is the plan? Where is the budget? Where is the fiscal conservancy here?

Will the House GOP majority then go after the least fortunate Americans by cutting Medicaid? Or maybe they will go after American seniors and cut Medicare and Social Security.

These are the questions people will be asking themselves when they exercise their American civic duty this fall. Americans will have to decide: Are trillions in tax cuts for wealthy corporations worth it to me if it means that I can't go to the doctor?

That is why we have to offer real solutions, and we can start by paying for these bills today.

Mr. Speaker, I urge my colleagues to oppose the previous question and the rule because we owe it to our future generations who will have to answer for our actions here today.

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.