Providing for consideration of the bill (H.R. 184) to amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and providing for consideration of 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.

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 for debate.

Mr. Speaker, I rise to debate this rule, but I would urge my colleague from Texas to be mindful that this ain't going nowhere, so we really are, when all is said and done, wasting our time. This is not likely to be taken up by the Senate in August, and why we are not doing other things, I simply cannot understand.

The Protect Medical Innovation Act and the Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act are worth considering. The gentleman from Texas certainly is an expert in this area and is most sincere. It is regrettable that the legislation, ultimately, that will pass the House of Representatives ain't going nowhere.

Taken together, these measures do nothing to ameliorate the Republican attempt to eviscerate the Affordable Care Act, do nothing to curb rising drug costs, and do nothing to curtail skyrocketing premium hikes. Instead, H.R. 6311 continues the Republican majority's destructive path of undermining and destabilizing our health insurance markets.

This package of six bills will likely lead to fewer choices and competition for moderate- and low-income families who do not have the disposable income to pay premium costs up front.

In bringing up the second measure, H.R. 184, my friends across the aisle seem intent on ignoring the pressing issues facing our country, like passing sensible legislation that will address the country's ongoing gun violence epidemic, passing legislation that will protect our election infrastructure from hostile foreign hacking, or passing legislation that will help reunite the more than 2,500 separated children with their families. Rather, the Republican majority wants to waste valuable legislative time in repealing a tax that won't even be active until 2020.

This is the last week before we go on a 5-week recess and we are doing nothing. Even worse, these bills are not offset and, taken together with tomorrow's bills, will add up to $90 billion to our deficit. They are not paid for. And I challenge my colleague on the floor handling this rule to tell me where the pay-fors are and, if there are none, why are they not paid for--$90 billion.

Mr. Speaker, I strongly believe that the epidemic of gun violence that plagues our communities must be addressed in a comprehensive manner and without further delay. Unfortunately, our Nation has witnessed far too many senseless deaths caused each day by firearms, and that continues to rise.

Under a Republican majority, many commonsense reforms, such as the assault weapons ban--and somebody please tell me why anyone other than the military and law enforcement needs an assault weapon; I just, for the life of me, cannot understand it--were allowed to expire. I might add, flood insurance is getting ready to expire. We are not taking that measure up.

Providing nearly unfettered access to a variety of firearms does not make any sense. Someone said to me, well, there are 103 kinds of automatic weapons; and I say ban them all because they don't have any business in the hands of people in the streets at all.

While we need to preserve the rights of responsible gun owners--and I am one of them; I believe in the Second Amendment--we must focus more of our attention and efforts on keeping weapons out of the hands of dangerous individuals instead of attacking and undermining the healthcare for millions of hardworking Americans.

While the present administration works to further the majority's aim of dismantling the most popular aspects of the Affordable Care Act, like keeping children on their parents' health insurance until the age of 26 and protecting people with preexisting conditions, these bills continue to balloon Federal spending and deficits.

While we were promised increased revenue from the GOP tax cuts of 2017, with the GOP falling back on tired talking points like tax cuts paying for themselves, we now have the Congressional Budget Office projecting over $1 trillion in budget deficits in 2020, even before legislation like this passes.

Whatever happened to the conservative Republicans? Where did the fiscal conservative Republicans go, who are blowing up the deficit in this country? The amount of fiscal irresponsibility demonstrated by my friends across the aisle is shocking and will be a great detriment to all Americans in the future.

Moreover, these pieces of legislation do nothing to holistically solve the most pressing concerns hardworking Americans have with healthcare: ever-increasing premiums, unstable health markets, and exploding drug costs. In fact, in the last year and a half, the majority has gone out of their way to destabilize health markets as much as they can.

Instead of encouraging Americans to enroll in health insurance, the Department of Health and Human Services has created an advertising campaign explicitly undermining the individual insurance markets created under the Affordable Care Act. Republicans have cut the Department's budget for those grassroots organizations whose sole purpose is to assist folks in signing up for health insurance. How much of the budget did they cut? 92 percent.

In addition to this, HHS has threatened States that try to lower premiums, and the Trump administration has even canceled cost-sharing reduction payments to insurers, which the CBO projects will leave 1 million more people uninsured, raise premiums by 20 to 25 percent over the next 2 years, and increase the Federal deficit by $200 billion.

Listen, people, when we started this business of the Affordable Care Act--as much as my friends on the other side who have the prerogative, in the majority, to be in disagreement with this measure as well as any others and to offer this thing that ain't going nowhere here today--the simple fact of the matter is, some few years back, we had 42 million Americans who were uninsured. We now have more than 42 million Americans uninsured, and that is wrong.

I said yesterday in the Rules Committee, all of us, 535--the Senate and the House--and the six delegates, ought to be locked up up here until we come up with a sensible solution for the American people with reference to a crisis.

It was said yesterday by the chair of this committee that the plan that is going to be offered--that we did offer and then they voted against--would be the best healthcare plan in the world. Well, it ain't the best healthcare plan

in the world. The best healthcare plans in the world are in Denmark, Sweden, Switzerland, Australia, and a whole bunch of other places other than America.

And while the Trump administration has pushed junk healthcare plans, even the organizations that originally lobbied the administration for access to these plans now say they no longer want to use them.

All in all, as a result of these policies, as I have indicated, 4 million fewer Americans have health insurance than when Donald John Trump took office, and healthcare costs continue to rise unabated.

I need not remind my colleagues that people in the United States pay far more for healthcare than in any other industrialized nation on Earth, and, in most cases, they get far less. We spend over 18 percent of our gross domestic product on healthcare, compared to most other countries, which spend less than 10 percent, with much of the disparity occurring thanks to higher drug prices and administrative overhead.

Despite the money we pour into our healthcare, the United States has the shortest life expectancy and highest infant mortality of any modern industrialized nation--let me repeat that--the shortest life expectancy, and the highest infant mortality of any modern industrialized nation.

We have far fewer physicians--and we had better do something about that; not in this measure, not in the Affordable Healthcare Act. We had better get busy trying to figure out how to provide more physicians, more nurses, more research for a variety of measures that are oncoming that our Nation is going to be confronted with.

We have fewer hospital beds and, in perhaps what is the most depressing statistic of all of U.S. healthcare, the United States is one of only 13 countries in the world where the rate of maternal mortality, defined as the death of a mother in the year after she gives birth, is now worse than it was 25 years ago.

And here we are, continuing to jaw jack about something that ain't going nowhere, and we have situations in our country that all of us know something about, all of us care about. There is no Republican in the House or Democrat in the House that doesn't care about their constituents and their healthcare. And at the very same time, what we are winding up doing is arguing with each other and nothing is getting done, and that is just dead wrong for this country.

Black women, in particular, are three times more likely to die from health-related issues to their pregnancy. How can we seemingly pay for more healthcare now than at any point in our Nation's history and, yet, at the same time, be getting worse care than we were decades ago?

We have a fundamentally broken system. The majority doesn't seem to have any way of fixing it, and I am not even sure that they want to fix it. Indeed, they seem to be going out of their way making it somehow worse.

Now I hear all of the voices out there. I had a constituent call the other day to tell me that I wasn't as liberal as his people were, liberal, and that I didn't understand this whole healthcare system.

And I told him: Listen, man, in 1992, when I ran for office, I ran on the premise of universal healthcare for every American, period. And when we did the Affordable Healthcare Act, it ultimately got called the ObamaCare Act.

I have said in the Rules Committee repeatedly, it probably should have been called the Hastings/ObamaCare Act, or perhaps we would have done what Dr. Burgess asked us to do and it would be called the Burgess Healthcare Act.

I don't care what it is called. It needs to be called something that is going to help every American, and not just a handful, and certainly not the richest people in this country who don't even need any healthcare. They have been at the socialized healthcare business for all of their lives and, therefore, people like Donald John Trump don't need to worry about this kind of thing.

It is those people that are vulnerable. It is those people on Medicaid in Florida and other States that didn't expand Medicaid, 900,000 of them in my State, that are left to the mercies of the system.

And what do they do? All of us know what they do. When they have healthcare, they go to the hospital, to the emergency room, generally speaking, they are treated, and then those taxpayers in those respective jurisdictions wind up paying for it.

So why don't we get our act together and try to do something about it now?

I have proudly advocated for multiple pieces of legislation that will improve and strengthen the Medicare system, including H.R. 676, the Expanded and Improved Medicare for All Act, which will provide all individuals residing in the United States and the United States territories, with affordable healthcare, including that which is medically most necessary, such as primary and preventative care, dietary and nutritional therapies, prescription drugs, emergency care, long-term care, mental health services, dental services, and vision care. Underscore preventative care. And if we did more in that arena, we wouldn't have as much of a problem as we do today.

Medicare for All will save taxpayers hundreds of dollars a month. Now, I firmly believe that we must focus priorities in the interest of the American people to ensure that our citizens have continued access to healthcare services.

So when we come back here in September, when we finish all of our fighting in November, and we have somebody that is going to get elected, 435 of us will return here and be sworn in in January. Let's all make a commitment that we are going to work together, together, to get all of the resources, the tremendous minds, the incredible staffs that work here in this institution together, and try to make sure that we do the right thing by the American people and pass a measure that will cause everyone to have affordable care.

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 am going to offer an amendment to the rule that would change the rules of the House to prevent any legislation from being considered that would reduce the guaranteed benefits for individuals enrolled in either Medicare or Medicaid programs.

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 urge my colleagues to vote ``no'' and defeat

the previous question so that we may protect these critical programs for this generation and the next.

Mr. Speaker, I would be prepared now to advise my colleague from Texas that I have no further speakers, and I am prepared to close when, and if, he is.

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

Mr. Speaker, in closing, this place, the people's House, should be about approaching our congressional responsibilities and daily activities in a manner that is fair and respectful to all Americans; in a manner where the appropriate committee of jurisdiction holds hearings and markups; in a manner where experts in the field are respected and consulted; in a manner where Members of both political parties have the ability to offer amendments and debate the contents of bills that come to the House floor.

Unfortunately, in this historically closed-off, Republican run House, that is not the case. And let me make it very clear. Even though in the Ways and Means and the Appropriations Committee, as a matter of practice, we allow for closed rules, we now have, with these three rules that are likely to be finished today, we have 95 closed rules. This is 2018, and not in the history of the people's House has the process been as closed.

When the Speaker of the House of Representatives began this session, he indicated that it would be the most open session that we would have. And yet, it is not the case.

I spoke earlier about immigration, and I saw this morning where the majority leader has determined, even though having promised his own conference that he would have a vote on immigration, he ain't gonna do it.

Now, something is wrong with this process and it needs to be corrected, and we can correct it going forward. We will make 100, and then we will be historically referenced as the most closed Congress in the history of the United States of America.

What we see are my friends across the aisle, bending over backwards to reward a very specific and elite constituency. Week after week, the powerful gun lobby is rewarded as Republican leadership refuses to bring up even the most commonsense gun violence prevention legislation.

The next week, like today, the powerful medical insurance lobby chalks up a win as this Republican-led Congress votes in favor of special interests over the interests of hardworking Americans.

Some other people that make out like bandits that we never talk about are the insurance companies. I could spend a whole hour talking about how they are benefiting while we are about the business of tying each other in knots with verbiage rather than with substantive legislation.

Mr. Speaker, while there is no quick fix to any of these measures, not to gun violence, opioid addiction, the immigration problems, and ongoing foreign cyber attacks on our election system's infrastructure, we simply must engage in the complicated and difficult process of improving our country's current policies.

I, as well as my colleagues on this side of the aisle, stand ready to work with Members of Congress to bring commonsense legislation to the floor that will benefit all Americans and not just the rarified few.

Mr. Speaker, I am going to urge a ``no'' vote on the rule and a ``no'' vote on the previous question. This measure we are debating here today ain't going nowhere, and I yield back the balance of my time.

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

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, by direction of the Committee on Rules, I call up House Resolution 1011 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Florida (Mr. Hastings), 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 1011 provides for the consideration of two bills aimed at removing some of the most burdensome aspects of the Affordable Care Act, and, as a result, moving toward lowering healthcare costs for the millions of Americans who are confronted daily with rising premiums, rising deductibles, and rising drug prices.

With each bill, we take one step closer to ultimately eliminating the Affordable Care Act's government-run approach to healthcare and return to a market-driven solution that puts patients first.

The first bill in today's rule, H.R. 184, the Protect Medical Innovation Act of 2017, would repeal the excise tax on medical devices imposed on American companies by the previously mentioned Affordable Care Act.

The second bill in today's rule, H.R. 6311, the Increasing Access to Lower Premium Plans and Expanding Health

Savings Accounts Act of 2018, expands the availability and the use of health savings accounts to allow individuals and their families to save their own money and budget for the healthcare needs they have that otherwise would not be part of their budget.

Today's resolution provides for a closed rule for H.R. 184, the Protect Medical Innovation Act of 2017. This is the standard practice for a tax-related measure on the House floor. The rule provides for 1 hour of debate, equally divided and controlled by the chair and the ranking minority member on the Committee on Ways and Means. The rule does provide the minority with the customary motion to recommit with or without instructions.

The second part of today's resolution provides for a closed rule for H.R. 6311, the Increasing Access to Lower Premium Plans and Expanding Health Savings Accounts Act of 2018. The rule provides for 1 hour of debate equally divided and controlled by the chair and the ranking minority member of the Committee on Ways and Means. The customary motion to recommit with or without instructions is provided to the minority.

This week, Republicans in the House continue our efforts to increase more healthcare options while driving down premiums in the individual market. According to the Office of the Assistant Secretary for Planning and Evaluation at the Department of Health and Human Services, premiums on the exchange are 105 percent higher, on average, in calendar year 2017, compared to premiums in the individual market in calendar year 2013, which was the last year before the Affordable Care Act took effect.

It is important that we continue to address the negative impact that the Affordable Care Act has had on the individual market and to help Americans across the country be more in charge of their healthcare purchases.

Thus far, the Republican Congress has been successful in nullifying the individual mandate, repealing the Independent Payment Advisory Board, and delaying many of the harmful taxes on American businesses and American consumers. I am also encouraged by the actions of the administration in permitting more low-cost limited duration insurance plans and allowing access to association health plans for more small businesses.

These are choices that are provided to the American people so that they, the American people, can be in the driver's seat, not the other way around with the ACA's government-approved one-size-fits-all healthcare model.

With that in mind, two bills we are considering this week seek to expand and improve health savings accounts. Under the current rule, H.R. 6311, the Increasing Access to Lower Premium Plan and Expanding Health Savings Accounts Act of 2018, will enhance the benefit of tax- preferred health accounts so that individuals can better plan and save for their healthcare needs, and, also, these individuals will see lower premiums on their healthcare plans.

For the last several Congresses, I have argued to improve the utility of health savings accounts, and so I am pleased to see that these important policies are being advanced through the House this week.

In addition to offering health insurance, many employers often arrange to reimburse their employees and their dependants some of their medical expenses that are not covered by health insurance. Health flexible spending accounts and health reimbursement arrangements are two of the more common arrangements offered by employers.

I have heard the frustration of employees, many of whom are my constituents in north Texas, over forfeiting the remaining amounts in their flexible spending account at the end of each plan year. We can all agree that the healthcare needs and purchases vary from year to year, where one year a person may have more medical expenses than the next or the other way around.

One of the provisions in H.R. 6311 eliminates the arbitrary ``use it or lose it'' rule and allows flexible spending account balances to be carried over to the next plan year within a reasonable annual flexible spending account contribution limit.

Another provision allows working seniors that are covered under an HSA-eligible high deductible health plan and enrolled in Medicare part A to continue to contribute to their health savings account. Just because someone becomes eligible for Medicare because of age, they should not be prohibited from continuing to contribute to a health savings account.

Under current law, there are annual health savings account contribution limits. In 2018, the limit for an individual was $3,450. For families, that amount was $6,900. While these limits are updated annually for inflation, they are significantly less than the combined limit on annual out-of-pocket deductible expenses.

H.R. 6311 would allow individuals to increase their contributions to equal to the combined annual limit on the out-of-pocket and deductible expenses under their HSA-qualified insurance plan. That would be $6,550 for an individual and $13,300 for a family this year.

The Affordable Care Act limits the option of individuals enrolled in bronze and so-called copper, or catastrophic, plans to make HSA contributions. Also, only those under 30 or those that qualify for a hardship exemption are actually able to purchase the so-called copper health plan. That is a 50 percent actuarial value health plan.

So, today, I am pleased that a bill that I introduced with Representative Roskam, H.R. 6314, the Health Savings Act of 2018, to expand the eligibility and the access to health savings accounts by allowing plans categorized as catastrophic and bronze plans in the individual and small group markets to qualify for HSA contributions. That is included in this bill.

Lastly, I appreciate working with the Ways and Means Health Subcommittee Chairman Peter Roskam on H.R. 6311. One of the key provisions of the bill is to provide an off-ramp from ObamaCare's rising premiums and limited choices by allowing the premium tax credit to be used for qualified plans offered outside of the law's exchanges and healthcare.gov.

In addition, it expands access to the lowest premium plans available, so-called copper or catastrophic plans, for all individuals purchasing coverage in the individual market and allows the premium tax credit to be used to offset the cost of such plans.

I recognize not everyone will choose to have a health savings account, but they should have the option because HSAs represent a powerful tool to lower prices and improve access to quality care for everyone, and those are goals that we can all share.

Now, it is well documented that many of the provisions contained within the Affordable Care Act have negative consequences on patients, both in access to care and in affordability. One of the provisions that has been universally criticized is that, on a large, bipartisan nature, its repeal was called for almost immediately after the passage of the Affordable Care Act. This is the tax on medical device manufacturers, or more commonly referred to as the medical device tax.

It seems illogical that within a piece of legislation that was purported to make medical care available, more accessible to all Americans, the Federal Government would want to tax the very providers of medical innovation that create devices to improve the delivery of healthcare, but, nevertheless, that is exactly what happened when ObamaCare passed in 2010, and it was done as a means to pay for the astronomical price tag that accompanied the Affordable Care Act.

This tax burden is unfair, and it actually increases costs that consumers pay at their doctors' offices. The tax has also been cited by dozens of medical device manufacturers who have or are considering moving their operations overseas so that they can continue to innovate without the heavy burden of this tax stifling their growth. This tax slows the creation of new techniques and devices, which will make the delivery of medicine more efficient, and it puts at risk the jobs that were created by the creation of such devices.

For anyone who thinks that we are merely talking about the largest and most expensive pieces of technology found within a hospital-- basically, your MRI, CAT scans, and some surgical equipment--let's be clear that

this tax covers every piece of medical equipment, from those large machines to the smallest of items, including syringes used to deliver lifesaving antibiotics and vaccines. It continues to negatively impact a number of constituents in my district and, I am certain, in districts around the country, and it does continue to create a burden on a number of companies.

The medical device tax has led to the elimination of thousands of good-paying jobs, and repealing it would be the first step to bringing those jobs back and stem the loss of future jobs within this vital industry that is helping to mitigate rising costs of healthcare due to the burdensome provisions within the Affordable Care Act.

This is a tax on business, a tax on consumers, and a tax on innovation. To date, 33,000 jobs have been lost in the medical device industry since the passage of the Affordable Care Act, and it is projected that over 130,000 additional jobs are on the chopping block.

Why would anyone be surprised about this? Excise taxes--and that is what this is, an excise tax--are meant to lead to a reduction in the consumption of the goods being taxed. We place an excise tax on cigarettes. We want to discourage people from smoking. We make it burdensome to afford a smoking habit.

Did we really intend, with the passage of the Affordable Care Act by congressional Democrats in 2010, to make it more burdensome to use more efficient medical devices?

H.R. 184 has bipartisan, bicameral support, with currently 277 cosponsors. Republican leadership in the House has heard this request and heard the calls from many Members within this body and is moving this bill in a responsible way to put Americans back to work and lower healthcare costs for all.

Mr. Speaker, I urge my colleagues to support today's rule and the underlying bill, and I reserve the balance of my time.

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

The gentleman is quite correct in identifying the other body as sometimes an obstacle to good public policy, for it was 1 year ago that the other body blocked a health care reform that this body had passed the previous May.

But, Mr. Speaker, I want to draw the House's attention to an article in today's Wall Street Journal. The title of the article is ``TrumpCare beats ObamaCare.'' And I just want to quote a little bit from this article.

To set the stage, in December, with the repeal of the individual mandate, and quoting here: ``But while many people didn't realize it at the time, it turns out that Mr. Trump has been helping to improve an important source of insurance coverage since virtually the moment he took office.''

Continuing to quote here: ``By prioritizing economic growth and reducing the tax and regulatory burdens on U.S. business, Mr. Trump has helped 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.''

Continuing to quote here: ``For the first time in six 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.''

So, Mr. Speaker, I simply submit that the activities of the Trump administration have, indeed, improved the healthcare landscape in this country. That is something we should acknowledge and embrace.

I reserve the balance of my time.

Mr. Speaker, I am prepared to close as well.

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

The gentleman from Florida is making a point about open rules, and I do feel obligated to point out in the 111th Congress--that was the Congress that was the first 2 years of President Obama's administration--in the 111th Congress, under Speaker Pelosi, the majority had zero open rules. That is zero open rules in the 2 years in which we saw the passage of the Affordable Care Act, the passage of Dodd-Frank; the House-passed Waxman/Markey, which was a cap-and-trade global warming bill, so significant pieces of legislation passed the floor of this House, all under closed rules.

But, Mr. Speaker, today's rule brings forward two pieces of legislation that will have a meaningful impact on Americans' healthcare costs, including the premiums and the prices they pay for medicines.

H.R. 184, the Protect Medical Innovation Act of 2017, which will repeal the Affordable Care Act's ill-conceived medical device tax, and H.R. 6311, the Increasing Access to Lower Premium Plans and Expanding Health Savings Account Act of 2018, which will provide greater freedom for Americans to use their own money to pay for medical expenses out of their health savings accounts, both of these build on the House's work over the past 2 years to make healthcare a more patient-centered market.

Mr. Speaker, I certainly want to thank Representatives Paulsen and Roskam for their work on these measures. I urge my colleagues to support today's rule and move the debate forward on this legislation.

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. 184) to amend the Internal Revenue Code of 1986 to repeal the excise tax on medical devices, and ask for its immediate consideration.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days within which to revise and extend their remarks and include extraneous material on the bill H.R. 184, currently under consideration.

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

Mr. Speaker, today, the House will vote on H.R. 184, the Protect Medical Innovation Act, which will finally repeal the medical device excise tax and eliminate a burden on patients and the companies that create and produce lifesaving medical devices for people all over the world.

The medical device industry is truly an American success story, directly employing more than 400,000 people. In Minnesota alone, more than 35,000 people are employed at almost 700 companies, mostly small companies that you have never heard of. Many of them were started by a doctor or an engineer or an entrepreneur in the garage or in the backyard with an idea to improve or help save someone's life. In fact, 80

percent of all medical device companies have less than 50 employees, and 93 percent have less than 500 employees. The jobs they provide are good, rewarding jobs that pay above-average salaries.

Mr. Speaker, America is a net exporter in medical devices, one of the other reasons why it is an American success story. But back in 2013, the Affordable Care Act imposed a new 2.3 percent excise tax on all medical devices.

Mr. Speaker, 2.3 percent may not sound like much, but it wasn't a tax on profits; it was a tax on sales, on revenue. Usually the government puts an excise tax on things we want to discourage, like tobacco, alcohol, or gas-guzzling automobiles.

Why would we want to discourage medical innovation? Only in Washington would you impose a tax on lifesaving medical devices and then think you are going to help reduce healthcare costs.

Guess what? The device tax caused the loss of over 29,000 jobs. Now, with strong bipartisan support, we have been able to eliminate this onerous tax with suspensions. The last time we suspended this tax, companies responded by hiring more engineers and more technicians and putting more money into research and development projects for these new, lifesaving technologies.

But these innovators need certainty. They need predictability. And a permanent repeal is needed to especially help startup companies from where the next generation of inventions and innovation will come.

Investors will hold back capital in new companies when there is a threat of an excise tax starting back up because it already takes 8 to 10 years, Mr. Speaker, for these companies to become profitable in the first place. This tax raises the bar and makes it even more difficult for them to become profitable.

I have had many conversations with companies that I represent in my community about what this excise tax means to them. I remember having a conversation with a medium-sized company owner who said that without this tax they would be able to have a few more projects online, which meant they would hire two more engineers and two more technicians. Other companies to which I have spoken said they would be able to directly invest more in research and development, creating more high- paying jobs, invent better products. Ultimately, it is about helping more patients.

The good news, Mr. Speaker, is there is strong recognition that we need to eliminate this tax on a bipartisan basis, because it is such bad policy. In fact, very few bills have such strong bipartisan support: 277 cosponsors. Mr. Speaker, 44 of those cosponsors are Democrats across the aisle.

I pledge that I will continue working with Senator Klobuchar in the Senate across the aisle, and my colleagues, to get this over the finish line, because there are very few issues that would unite an Elizabeth Warren and a Ted Cruz, but this, Mr. Speaker, is one of them.

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

Mr. Speaker, I yield 2 minutes to the gentleman from Indiana (Mr. Banks), someone who represents a State that is steeped in medical technology jobs and has been a leader in championing the repeal of this tax.

Mr. Speaker, contrary to some of the claims we heard a little bit before about the bill doing nothing to help everyday, average Americans, I will just remind Members that this bill reverses a harmful tax that is hurting job growth and innovation across the country.

Access to good-paying jobs and innovative medical products is critically important, and I would argue that that is really important for everyday Americans.

I would agree, also, with what was said earlier. Americans need certainty. This is an industry that needs certainty if we are going to be able to invest in new innovations, new inventions, to keep patients at the forefront of lifesaving and life-improving technology, to make sure their healthcare is the model of the rest of the world.

Mr. Speaker, I yield 3 minutes to the gentlewoman from Utah (Mrs. Love), who has been a strong voice for innovation, not only in her State but within our conference here in the House of Representatives, in repealing the device tax.

Mr. Speaker, I yield an additional 1 minute to the gentlewoman from Utah.

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

Mr. Speaker, I thank the gentleman for sharing his perspective from California. I think of Minnesota and California and Massachusetts and some other States that have a propensity of strong ecosystems of medical technology, and those jobs, we know, are very, very important. We want to see those continue.

I just want to mention, Mr. Speaker, what we don't want to go back to, because these are the stories we were hearing prior to our suspension, why we need to permanently repeal this tax.

I remember speaking to a company in Plymouth, Minnesota. They were pretty clear. They said: Instead of 10 projects, we are only going to have 6 projects funded with this tax in place. That means too few engineers, too few technicians while that device tax was in effect.

I talked to another company that was actually in Texas. They had laid off an employee that had been employed for 22 years, and then they had laid off 25 people, deferring the hiring of another 15 employees because of that tax being put in place.

Another medical company in Shoreview, Minnesota, told me they had to borrow $100,000 a month from the bank just to pay the device tax because the tax was on sales and revenue, not on profits. That is a high-risk tragedy, Mr. Speaker, in order to keep these companies alive.

There is a company in New York that was trying to finance a new cancer therapy using gamma radiation, and they struggled to raise the necessary funds that were necessary to complete the project because the medical device tax was discouraging investment in lifesaving innovation.

And then, Mr. Speaker, I remember having a conversation with an employee, someone from my district, and he came up to me and said: Mr. Paulsen, I have been employed at this medical device company for 21 years, a strong medical device manufacturer, but because of the tax, I have lost my job. Now his family struggled at his new job because his wages were $40,000 less than where he was before he was laid off, all because of that device tax. His vacation time was cut in half, and his healthcare costs also went up.

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

Mr. Speaker, I yield myself such time as I may consume while we wait for one additional speaker.

Mr. Speaker, let me just remind folks where we are right now. Think back to 2013, 2014 when this tax was first put in place. We heard earlier from one of our colleagues who had said: Do you know what? The medical device industry was a part of putting together the Affordable Care Act, and they agreed to this.

Actually, that is a myth. It is not true. I have talked to numerous medical device manufacturers, small, medium, and large, as well as the associations, that said they had no part in agreeing to that. In fact, when this dollar amount came up as a part of the Affordable Care Act, they backed into it. There was some dollar amount assigned, and that is how he backed into a 2.3 percent excise tax.

And, again, just a reminder, an excise tax is a tax on your sales and revenue, not on your profits. For companies that take 8 to 10 years to become profitable in the first place, that is a high hurdle when you are trying to attract new capital, new investors in order to take the risk that this new technology is going to be successful.

You have already got to go through the FDA. You have got to go through a rigorous process, go through a gold standard, and then you have to make sure that you are going to potentially have CMS offer a reimbursement policy for your devices.

So there is a whole host of, or a multitude of, risk factors that go in already when companies are thinking of starting up to actually be a part of this strong ecosystem of providing medical technology and lifesaving innovation that goes out to help our patients.

The good news is, if we keep this industry strong in America, if we can repeal this tax permanently, we will not only be improving healthcare outcomes around the world; we will be keeping those jobs here. We will be keeping the headquarters here in the United States.

So it is not just some of the tax reforms you pass, Mr. Speaker. It is about giving more certainty and more predictability by repealing a tax that never should have been put in place in the first place.

And I think with strong bipartisan support, both on a vote today in the House and potentially once again in the Senate--I think the last time we had a vote leading up to President Obama signing a temporary suspension of the device tax, we had enough votes in the House to override a Presidential veto. That is what got the attention of the Senate. That is what got the attention of the President at that time, and we actually made it the law of the land, 2-year suspension. We renewed another 2-year suspension.

But now is the time, Mr. Speaker, to actually make this permanent, to put ourselves in a position to make this repeal permanent, to put ourselves in a position where we can guarantee that American innovation is going to be strong and steadfast for years and decades to come. We can keep this American success story alive.

We have got a host of other challenges, I know, as we look towards the medical device industry. We have a hearing going on right now on trade,

for instance. We don't need to do anything else with potential tariffs or quotas in different areas that put additional uncertainty on this industry, on these high-paying, high-quality jobs. So this is one initial effort that we can make today on the House floor, with a strong bipartisan vote, to make sure a permanent repeal is also the law of the land.

Mr. Speaker, I am looking around for my colleague from Indiana, who I think is on the way right now.

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

Announcement by the Speaker Pro Tempore

Mr. Speaker, I yield 2 minutes to the gentlewoman from Indiana (Mrs. Walorski), who has been a champion of not only repealing this tax, but fighting hard for the medical device industry in her home State.

Mr. Speaker, as I close, let me remind my colleague, because he had mentioned eliminating the individual mandate as a part of the tax reform that was enacted recently, according to the IRS, 79 percent of the 6.6 million people who paid the penalty in 2015 had incomes below $50,000. These are middle class people.

I yield to the gentleman from Massachusetts.

Mr. Speaker, reclaiming my time, on the individual mandate, 6.6 million people who paid the penalty had incomes below $50,000. These are middle class people who had to pay the fine instead of buying overpriced ObamaCare coverage that they could not afford. Now, starting in 2019, they are not going to have to do that anymore. Republicans think that is a good thing.

Let me close back on the bill, though, Mr. Speaker.

The good news is that both Republicans and Democrats here today agree and understand that the medical device excise tax does more harm than good, and it has to be repealed. We heard testimony and speakers today on both sides of the aisle. We will have a strong, bipartisan vote to repeal this tax permanently.

We have already had a suspension twice. But we need to give this industry certainty so that we can make sure that this American success story not only survives, but thrives.

It is about high-paying jobs with net exports around the world. This makes sure that patients not only in the United States are going to have access to new medical technology devices, for baby boomers, seniors, and those getting up in their elder years with new devices. This is really critical for the innovation that is going to help to make sure that we are protecting patients around the world, keeping headquarters here, keeping jobs here, and improving healthcare outcomes.

Today, we have an opportunity to help. It is helping those small startups that are part of the very ecosystem that has made this industry so strong in the United States that provides these jobs, and making sure that entrepreneurs, doctors, engineers, and folks who come up with an idea in the backyard or in the garage can see their idea come to fruition.

So let's remove this threat to innovation. Let's remove this job- killing tax once and for all. There are 277 cosponsors in the House. How many bills actually get that many cosponsors of Democrats and Republicans? Let's continue to show the American public that what we are doing here in Washington on this issue is results oriented, is solution oriented, and we are sensitive, and we understand that.

Mr. Speaker, I ask everyone to vote for the passage of H.R. 184, and I yield back the balance of my time.

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