Providing for consideration of the bill (H.R. 6199) to amend the Internal Revenue Code of 1986 to include certain over-the-counter medical products as qualified medical expenses, and providing for proceedings during the period from July 27, 2018, through September 3, 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Speaker, I yield myself such time as I may consume, 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, pursuant to House Resolution 1012, I call up the bill (H.R. 6199) to amend the Internal Revenue Code of 1986 to include certain over-the-counter medical products as qualified medical expenses, 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 materials on the bill under consideration.

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

Mr. Speaker, I am pleased to come to the floor today to speak in support of the Restoring Access to Medication and Modernizing Health Savings Account Act of 2018.

This legislation makes a variety of simple but much-need changes to health savings accounts, or HSAs, rules to ensure that folks have more access and choice when using their HSAs.

This bill contains five separate bipartisan pieces of legislation that passed the Ways and Means Committee earlier this month. It includes a bipartisan policy by Mr. Roskam and Mr. Thompson that would allow HSA-eligible plans to offer a certain amount of first-dollar coverage in their plan design without losing their HSA-eligibility. This allows HSA plans to offer coverage for valuable services like telehealth or primary care appointments without a deductible.

The bill permits patients with HSAs to access the innovative and patient-centered direct primary care arrangements with HSA plans, provisions championed by the bipartisan team of Mr. Paulsen and Mr. Blumenauer.

The bill also allows coverage for certain medical services from a retail or onsite clinic and permits contributions to an HSA if their spouse has a health FSA, which is prohibited today.

Another commonsense provision in the bill allows rollovers from other tax-advantaged health accounts to be able to fund HSAs. These proposals were included in Mr. Kelly and Mr. Blumenauer's bipartisan legislation.

Additionally, this bill contains the PHIT Act, introduced in a bipartisan manner by Mr. Jason Smith and Mr. Kind, that would allow certain qualified fitness expenses to be eligible items that can be paid for with tax-advantaged dollars, offsetting a portion of their costs and promoting healthy activity.

Lastly, this legislation repeals the Affordable Care Act's unnecessary barriers when it comes to using tax-advantaged health accounts to purchase over-the-counter medicines, something that I have been pleased to work on with my good friend Congressman Kind for the last several years, and I am encouraged that the bipartisan duo of Representatives Meng and Paulsen have also joined us in introducing the underlying legislation.

In addition to expanding access for over-the-counter medication, the bill also allows for feminine hygiene products to be considered a qualified medical expense.

Since the passage of the Affordable Care Act, Americans have had to seek prescriptions in order to use their health savings and flexible spending accounts on safe and effective over-the-counter medicines. This legislation would end the need for those prescriptions.

It doesn't make any sense to require the millions of American families that use HSAs and FSAs to manage their healthcare needs to go to the doctor in order to access over-the-counter medicines for things like basic pain management and cold and allergy symptoms.

Nobody benefits from this nonsensical policy that requires consumers to jump through unnecessary hoops and increases the burdens on the healthcare system, all while providing no medical benefit. Over-the- counter medicines are often the frontline treatment for many common illnesses and for maintenance of chronic diseases, and they should be treated as medically reimbursable healthcare therapies, just as prescription medications.

Mr. Speaker, I am pleased the House is considering H.R. 6199, which gives individuals and families more control over their healthcare spending and increases their options when it comes to health savings accounts.

Today marks a nice opportunity to pass bipartisan legislation to simply make it easier for consumers to meet their basic medical needs. These are commonsense, simple, bipartisan solutions, and I urge my colleagues to support this legislation.

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

Mr. Speaker, I yield 3 minutes to the gentleman from South Carolina (Mr. Rice), a distinguished member of the House Ways and Means Committee.

Mr. Speaker, I appreciate my friend's point of view on the other side of the aisle. Mr. Kind and I have worked really hard on this legislation for many years. I want to, for the Record, just remind folks that this bill is simply allowing people to keep more of their hard-earned money.

Letting people keep their own money is not government spending that needs to be offset. Each of these bills contained in this package were authored with our Democratic colleagues without an offset. Each of these bills went through committee, with bipartisan support, without an offset. It is ironic that Democrats want to, all of a sudden, claim to be fiscally conservative.

This is the same Democratic Party that passed the stimulus in 2009. Remember, that bill added nearly $800 billion to the deficit.

Mr. Speaker, I yield 3 minutes to the gentleman from Pennsylvania (Mr. Kelly), a real leader on these issues on the House Committee on Ways and Means.

Mr. Speaker, I yield 3 minutes to the gentleman from Kansas (Mr. Estes), my friend and colleague.

Mr. Speaker, I yield 2 minutes to the gentleman from Illinois (Mr. Roskam), who has provided great leadership in this area.

Mr. Speaker, I yield 2 minutes to the gentleman from Minnesota (Mr. Paulsen), who has worked tirelessly in this area.

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

Mr. Speaker, we have heard my friends on the other side of the aisle suggest here, this afternoon, this bill might, in some way, hurt people with preexisting conditions. However, we know that is simply not true. This bill doesn't touch preexisting conditions. It doesn't raise costs or premiums on families. And it doesn't take away anyone's choice of a healthcare plan.

Millions of Americans use tax-advantage healthcare accounts to save and pay for healthcare expenses. In fact, there are twice as many Americans with an HSA than those who get coverage on the Affordable Care Act's exchanges. Almost 22 million people had an HSA in 2017, and there is only about 10 million people enrolled on the exchanges in 2018. Forty-four percent of all civilian workers had access to a health flexible spending arrangement in 2017.

The provisions in this bill allow more things to be paid for out of these accounts, like over-the-counter drugs, feminine products, and fitness activities. This means people are paying less because they are able to use pre-tax dollars or take a deduction for their contribution.

As a reminder, the policies in the bill are all bipartisan. We have worked together to write and advance them.

This bill helps middle class families afford their healthcare expenses, and I hope my colleagues will continue to support this legislation.

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

Mr. Speaker, I thank my friend and colleague from Oregon for yielding me this time. I agree with my colleague.

Mr. Speaker, I rise in opposition to this legislation, not because of the policy initiatives underlying these bills, but because of how fiscally irresponsible it is being done.

This week, out of the Ways and Means Committee, we have 10 bills to be debated and voted on on the House floor, at a total cost of roughly $90 billion. There was no effort made to try to find an offset or a pay-for in order to maintain some fiscal discipline in this place. That is problematic, because we keep digging the hole deeper.

But my name is on a few of these bills. Yesterday we had the repeal of the medical device tax, legislation that I had authored with my friend from Minnesota, Erik Paulsen. But that came at a cost of $20 billion. No offset. No pay-for. Just borrow more money from China and let future generations wrestle with it.

But it made sense policy-wise to try to repeal that in a fiscally responsible manner, because we were taxing these manufacturers whether they were making a profit or not. In fact, the pre-revenue companies were getting hit by the same tax. Policy-wise, it didn't make a lot of sense.

Today, I was happy to introduce legislation from our friend and colleague, Ms. Jenkins, on the Restoring Access to Medication Act. This will make it easier for patients to purchase over-the-counter medicine with their HSA and FSA account money without having to first run to their doctor to get a prescription. Just for the sake of efficiency and the cost savings, policy-wise, that makes sense; but the legislation comes with a cost, and there was no effort to pay for that.

Also part of this package is legislation I have introduced with our colleague, Mr. Smith, called the Personal Health Investment Today Act, or the PHIT Act. This would allow HSA and FSA dollars to be used for physical exercise, for gym memberships, so that we are investing in the front end of wellness and keeping people healthy in their lives rather than the hundreds of billions of dollars we spend at the back end dealing with chronic disease management.

Policy-wise that makes sense, but the legislation, again, comes with a cost. No attempt to pay for it. I think that is fiscally irresponsible.

At the time when we worked on and passed the Affordable Care Act, President Obama had one major request, that all of it had to be paid for, all of it had to be offset. We worked hard to accomplish it, and, in fact, we did, and then some. We did not add one nickel to our budget deficit or to future budget debt forecasts because of how we dealt with that in a fiscally responsible manner.

All we are asking is that our colleagues on the other side who are in charge now and running this place try to practice some semblance of that fiscal discipline that we showed with the passage of the Affordable Care Act.

We ought to be working together, finding out what is working with the healthcare system and fixing what isn't.

What is not working is the elimination of cost-sharing reduction payments that help health insurance providers spread the risk in the health insurance exchanges. That is one of the reasons why premiums are being driven up right now.

What is not working is refusing to provide funding to the navigators, who help people make the choices with the health plans that they have available, or undercutting funding for any education outreach with patients, or the elimination of the individual responsibility component so that young and healthy people don't get to sit around and wait until they get sick or injured and then go out and acquire health insurance. That is not how insurance markets work.

What also doesn't work is an administration that is trying to undermine the protections that are in place under the Affordable Care Act for people with preexisting conditions. There is a lawsuit pending right now. This administration should be defending that preexisting condition exclusion, and they are refusing to do so. That will implicate millions of lives throughout our country.

There is a lot that we can and should be working on together to improve the healthcare system, to reduce healthcare costs for all Americans. This approach, this piecemeal approach, while policy-wise there is a lot of justification and explanation for what is happening, is being done in a very fiscally irresponsible manner, just piling on the debt.

Mr. Speaker, this comes, by the way, on the heels, in this session of Congress, of the passage of a major tax cut last year that will add over $2 trillion to our national debt over the next 10 years because, again, there was no attempt to pay for it. It comes on the heels of the passage of a 2-year budget that will increase spending by over half a trillion dollars, none of it paid for, none of it offset.

Just yesterday, President Trump just announced a $12 billion subsidy bailout program for our family farmers because of the adverse effects that they are feeling due to his tariffs. And that is going to be borrowed money from China, again, to pay our farmers because they can't now sell their product--guess where--into the Chinese market.

How crazy is this? I hope we are not in an era now where budget deficits and debt only matters when there is a Democrat in the White House. Over the last year and a half, that certainly seems to be the case in this Congress.