Stop Junk Health Plans 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, 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.

Mr. Speaker, premiums are skyrocketing across the country, caused by this administration's sabotage of the Affordable Care Act. Just listen to the insurance company CEOs who are directly stating that not funding cost-sharing reductions for point of care for patients who are struggling to pay their bills will increase premiums. And also, by not outreaching to more people and low-risk individuals to come into the insurance pool, they are also increasing the premiums for everybody else.

But rather than making healthcare more affordable for all middle class families, this Congress is focusing on making healthcare more affordable for the wealthy few.

Instead of protecting the 130 million Americans with preexisting conditions, this Congress is sitting idly by as this administration once again allows insurance companies to sell junk plans that don't even cover basic healthcare services.

At a time when we should be stabilizing premiums by supporting risk- adjustment transfers and ACA enrollment outreach, the majority is refusing to act, simply ignoring the anticipated 18 percent increase in premiums for hardworking Americans throughout our country because, rather than help the American people, the majority would rather sabotage the Affordable Care Act for their own political gain.

This is wrong. So I offer the majority and all the Members of the House this choice: Members can support the previous question, ignore the people who will be priced out of healthcare, and ignore all the politically motivated actions by this administration to undermine access to affordable healthcare in our Nation; or Members can defeat the previous question so that we can bring up my bill, H.R. 6479, the Stop Junk Health Plans Act, which will lower costs and will ensure that Americans continue to have access to high-quality, affordable health plans. It is that simple.

You see, in general, there are three out-of-pocket or more than three out-of-pocket costs; in fact, one is the premiums, two is the deductibles, three is the co-pays, and four is the out-of-pocket costs Americans will have to pay if their health insurance doesn't cover those specific services.

So only focusing on premiums is a message deception. You see, with junk plans, that will increase out-of-pocket costs for patients because these junk plans may offer Americans a less expensive premium; however, the deductibles will be too expensive.

Also, if the majority goes after the essential health benefits and allows insurance companies not to cover things like emergency care, mental health, or prescription drugs, then they will be responsible for those out-of-pocket costs.

Also, if the majority does not defend the protections of people with preexisting illness--and insurance companies are now able to discriminate against those with diabetes, heart conditions, asthma, et cetera--then those individuals will have to pay more overall out-of- pocket costs either because they were denied or because health insurance companies will be able to charge them an exorbitant amount of money.

So this is why it is so important to keep patient out-of-pocket costs in perspective and not just focus on the political messaging tools of narrowly focusing on premiums, because someone can buy a low-cost premium health insurance, but, again, if it doesn't cover mental health, prescription drugs, emergency care, or other forms of guaranteed coverage under the Affordable Care Act, then they are going to have to pay that completely out of pocket.

If the majority doesn't protect patients with preexisting illness, then that is 180 million people in this country who have preexisting illnesses who are going to have to pay more out of pocket.

So, therefore, we must focus and stabilize the health insurance market; we must lower insurance costs by increasing enrollees into the insurance market by low-risk individuals; we must protect essential coverage and protect people with preexisting illness; and we must lower drug prices and the cost of overall care.

I urge all my colleagues to make the right choice--the only choice-- that supports the American people, in this case, the out-of-pocket costs.

Mr. Speaker, I urge Members to defeat the previous question. I urge Members to do the right thing, to think strategically, and to think about the overall out-of-pocket costs.

Mr. Speaker, I was unable to be present during rollcall vote No. 368 on July 24, 2018. Had I been present, on rollcall vote No. 368, I would have voted ``no.''