Providing for consideration of the bill (H.R. 372) to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers.

Mr. Speaker, I yield myself such time as I may consume, and I thank the gentleman from Georgia (Mr. Collins) for yielding me the customary 30 minutes.

Mr. Speaker, I rise in opposition to this rule today, one that provides for consideration of H.R. 372, the Competitive Health Insurance Reform Act of 2017, a good bill that I support.

Mr. Speaker, the Competitive Health Insurance Reform Act amends the McCarran-Ferguson Act so that the health insurance companies would no longer be exempt from Federal antitrust regulation.

Currently, unfortunately, most types of insurance, including property or life insurance, are exempt from Federal antitrust regulations and statutes. The McCarran-Ferguson Act makes it clear that the insurance industry heretofore has been regulated only by States. Additionally, the Department of Justice and the Federal Trade Commission have retained authority for antitrust enforcement involving mergers and acquisitions of insurance companies, but not dominations of markets and competition.

As a result of this exemption, the health insurance industry does not

have to share pricing information, and actually can currently communicate with one another to fix prices. Now, that doesn't make sense.

I firmly believe that the more transparency in our healthcare system, the better off consumers will be. Repealing the health insurance exemption of the McCarran-Ferguson Act may improve competition, but it would almost also result in more transparency in health insurance. It is something that we sorely need. So I intend to join many of my colleagues on both sides of the aisle in supporting the underlying bill because it increases transparency.

The reality is that this bill does nothing to replace the protections of the Affordable Care Act. It doesn't even make a dent in addressing the many problems created by the Republican healthcare legislation, the American Health Care Act.

Mr. Speaker, so I don't want anybody listening to this to be distracted by a bipartisan bill that we hope becomes law. In any way, shape, or form, this bill does nothing when, in 2 days, we are considering a bill that threatens the health care for 24 million Americans, increases prices for Americans who are currently insured by 15 to 20 percent, and throws millions off of the rolls of the insured.

The Republican healthcare bill that is coming to the floor Thursday will cause a huge disruption in coverage for millions of Americans. It creates an entirely new entitlement program. It would throw 24 million people who currently have insurance out of insurance. And for anybody who still has insurance, their rates go up 15 to 20 percent.

How is that a good idea? It is not.

This bill today does nothing. Nothing. I don't even think the advocates of it would say it does anything to address those increases in costs for consumers or 24 million people losing their health care or the creation of a brand-new costly entitlement program in a time of record deficits.

For constituents--and we all represent people from our districts--for people like Greg and Nikita, Coloradoans who have shared their stories with me, the passage of the American Health Care Act, the Republican healthcare bill, would devastate their lives.

Greg was diagnosed with a rare form of cancer in 2014, in his midforties. After several surgeries, his doctors told him his condition is inoperable and could only be treated chronically by medication. It is a very expensive injection that has so far been successful, thank goodness, at keeping the tumor from growing and allowing Greg to live an ordinary life.

Now, Greg needs this shot every 3 weeks. It is thousands of dollars each time. And despite working at least two jobs, it is not something that Greg could afford to have--Greg would not have health care without the Affordable Care Act. He would have to quit his jobs and become destitute and go on Medicaid.

The Republicans are basically saying to people like Greg: We want you to be lazy. We want you to quit your job so you could have health care. We want you to live off the government dole of this brand-new entitlement program that we created to hand you money rather than work for yourself and pay for your own insurance.

That is the message the Republicans are sending to people like Greg across the country.

Nikita lives in Boulder and has spent much of her life battling endometriosis. In 2014, she was having trouble walking because of her condition and she missed work for a few weeks. After the passage of the Affordable Care Act, she was able to afford the surgery that she needed to improve her mobility and manage her pain.

In her message to me, Nikita emphasized that affordable health care is what allows her to work and to be a citizen that pays taxes and contributes to society rather than somebody who is shut in at home, living off the government dole like Republicans are trying to force her to do with the new entitlement program that they are creating.

If Nikita didn't have the healthcare coverage she obtained through the Accordable Care Act, she said that she would be on disability and Medicaid, costing the government far more money and preventing her the dignity of holding a job and working to support herself and paying taxes.

Both Greg and Nikita expressed fear that the benefits they receive under the Affordable Care Act would disappear if the Affordable Care Act is dismantled in favor of this new Republican entitlement program that encourages people not to work. The American Health Care Act threatens to pull the rug out from so many of my constituents and millions across the country while simultaneously raising rates by 15 to 20 percent for people who are currently insured and paying for their own insurance.

Look, H.R. 372 is a fine bill. Republicans are using it as a talking point, claiming that somehow it addresses costs in some meaningful way. And given how complicated the healthcare system is and the critical role that we all have to play in it and every little piece plays, it is important to lay out the facts of the Republican plan, which H.R. 372 does nothing to address.

It is a fact fewer people will be covered under the Republican plan. The Congressional Budget Office says 24 million people will lose their healthcare coverage over the next decade.

It is a fact that middle-aged Americans will pay five times more in premiums. The age tax is a big part of the Republican healthcare bill. Americans ages 55 to 64 will see their cost increase by over $8,000. Most of my constituents in that age group simply can't afford that every year.

It is a fact that those currently enrolled in Medicaid programs are at risk of losing their coverage. The Republicans' concern that Medicaid expansion to the Affordable Care Act was coercive, they should be equally concerned about the per capita cap in the Republican plan. It is the flip side of the same coin.

Those are just some of the many troubling facts about the Republican healthcare bill.

H.R. 372, removing the antitrust exemption, is a fine bill. It does nothing to address any of those problems or change any of those facts and figures that I cited as to why this bill doesn't fix health care.

In fact, frankly, this bill is a distraction from the real topic we should be discussing--how to improve health care in this country. I don't think we should improve it by giving tax cuts to millionaires and billionaires, forcing people like Greg and Nikita not to work and to be destitute in order to get health care and go on the government dole, creating a brand-new entitlement program that States administer, increasing the costs of insurance for people who are already insured by 15 to 20 percent.

Mr. Speaker, if those are the answers, what is the question? Is it how to make health care cost more and how to have less people covered?

If that is the question, the Republican bill is a good answer.

That is not the question my constituents are asking me, and I don't think it is a question their constituents are asking my Republican colleagues.

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

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

Two weeks ago, the Republicans pushed ahead with their healthcare bill, despite not knowing the impact of the legislation. A week later, the nonpartisan Congressional Budget Office announced that the bill would take health insurance away from 24 million people and increase costs by 15 to 20 percent for those who currently have insurance.

Mr. Speaker, late last night the Republicans introduced a major manager's amendment that changes the bill, frankly.

Mr. Speaker, just as it was irresponsible to move forward without knowing the full effects of the original bill, it is completely reckless to even know whether this manager's amendment makes it better or worse and the impact that it has on health care for American families. It is reckless to consider and vote on their amended bill before the Congressional Budget Office even says how much it costs, or how much it will increase insurance by, or whether it throws people off insurance rolls.

Mr. Speaker, if we defeat the previous question, I will offer an amendment to the rule that would require a CBO cost estimate that analyzes the impact of any legislation amending or repealing the Affordable Care Act, as well as the impact of any manager's amendment to that legislation to be made publicly available before the bill may be considered on the House floor.

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 am proud to yield 4 minutes to the distinguished gentleman from Kentucky (Mr. Yarmuth), the ranking member on the Committee on the Budget, to discuss our proposal.

I yield an additional 1 minute to the gentleman.

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

Mr. Speaker, I am awaiting the graphic presentation about some of what is at stake in this debate about the Affordable Care Act, the fundamental debate about whether we try to fix health care in this country, make insurance cost less, or whether we move backwards under this Republican healthcare proposal.

The Republican healthcare proposal would create an entirely new entitlement program administered by the States. In creating this program, it would throw 24 million people who have healthcare insurance today off of the insurance rolls. They would become uninsured Americans.

It would add an age tax on older Americans. It would also increase the cost of health care for people who have health care today and pay for it, by 15 to 20 percent. Now, they wouldn't be getting more for that 15 to 20 percent.

Mr. Speaker, if you can believe it, they would actually be getting less insurance for that 15 to 20 percent because many of the requirements that insurance has to have are rolled back, the Federal protections under this Republican healthcare bill.

Somehow, at the same time it does all these things, the same time it costs 24 million Americans their insurance, the same time it increases rates by 15 to 20 percent--and, by the way, these figures are from the nonpartisan Congressional Budget Office, the head of which was appointed by Republicans.

These are solid predictions that are done by people who were appointed by Republicans. We are not citing any outside group or naysayers who don't like the bill. These are the objective Congressional Budget Office numbers that we are citing here in their entirety.

So, in addition to costing people 15 to 20 percent more, this bill also, for reasons unknown, gives an enormous multibillion-dollar tax break to millionaires and billionaires in New York and California. That is where most of them live. Now, there are a few in other places, of course, too.

But it is just unclear why, at the same time Republicans are trying to change the healthcare law, they want to go back to giving enormous tax cuts to the wealthiest Americans. We are not even talking the wealthiest 1 percent. We are talking, like, one-tenth of a percent who are going to see the bulk of the benefit from these tax cuts, at the same time that health care is being taken away from 24 million people who have insurance today, and at the same time those who are fortunate enough to be able to continue to have it will have to pay 15 to 20 percent more.

That is why, Mr. Speaker, this bill is so unpopular. If you are going to go through the trouble of creating an entirely new entitlement program, at least do it in a way where it actually helps people afford coverage versus hurts their ability to afford coverage.

Now, I gave the example in my remarks of Greg, and that is far from unique because people today, who rely on the subsidies to be able to get health insurance within the Affordable Care Act, if the Republican bill passes, would have to quit their jobs and rely on Medicaid instead, or they would have to take a lower-wage job. Instead of earning $40,000 or $50,000 a year, they would have to quit that job and try to take a minimum-wage job so they could qualify for Medicaid.

Essentially, this Republican healthcare bill is telling Americans, you need to be lazy and not work if you want health care because, if you want to work a job, we are going to take it away. We are only going to provide it if you quit your job or take a minimum-wage job under Medicaid.

So that is not the message or the incentives that we want to send to the American people. One of the great aspects of the Affordable Care Act is it actually, for the first time, provided an incentive for people to get increases in their wages, to get better jobs, to work additional hours.

Before the Affordable Care Act, we were locked into a scenario where people who were on Medicaid lost their Medicaid benefits if they got a raise at work, depending on the size of their family. It could have been a raise from, let's say, $14 an hour to $16 an hour. They couldn't work overtime. They couldn't work a second job, as so many people do to escape from poverty because they would lose their health care.

The Affordable Care Act said: You know what? We are going to allow you and encourage you to work that second job, to get a raise and support your health care as you make your way out of poverty into the middle class. What a great idea.

The Republican proposal creates a brand new entitlement program, but rolls back those affordability protections that help people work their way out of poverty, and leaves no alternative for people like Nikita and Greg, other than you have to quit your job or work a minimum-wage job because, otherwise, we are going to take your health care away from you.

That is the reason that the projections came back--no surprise--that 24 million people will lose their healthcare insurance. It is the reason that healthcare insurance rates will increase 15 to 20 percent.

We don't know the reason that they are also giving a tax cut to billionaires in the same bill. We know they want to do that, but they should do that in a tax bill. There is an effort at tax reform. I think they are talking about giving an additional tax cut to billionaires in that bill. That will be debated separately. But it is unclear how--or it is more than unclear as to why it would help make health care more affordable to give a tax cut to billionaires. It just doesn't make any sense. Let's debate that under a different bill.

I am happy to do that. As part of a broader tax proposal, we will see what else is in it. We know Republicans want to do that, but they shouldn't do that under the guise of health care.

So, again, Mr. Speaker, what you have here in this Republican bill, which this current bill does nothing to change--and this bill will pass, it has passed before, and we hope the Senate acts on it to remove the antitrust exemption. This bill does nothing to change the facts on the ground that the Republican healthcare bill that creates a brand new entitlement program would make Americans pay more for less, 24 million people would lose their insurance, there is an age tax on older Americans, guts Medicaid, huge tax cuts for millionaires and billionaires, increases of 15 to 20 percent for Americans who are lucky enough to retain their insurance, and discourages work and encourages people to be lazy at home to get health care.

It is the opposite of what we want to do. It is contrary to the American work ethic, and it is contrary to all incentives around cost containment. I hope--I really hope, Mr. Speaker--that the House defeats this awful bill to replace the Affordable Care Act, even as we pass some of these commonsense bipartisan measures like the one before us today that, around the edges, could potentially affect antitrust within insurance companies.

Mr. Speaker, the bill under consideration today is a commonsense piece of legislation. It has passed the House before. Ultimately, however, it distracts from the elephant in the room. The American Health Care Act is the Republican bill to roll back and change the Affordable Care Act and create a brand new entitlement program while increasing the insurance rates for American families, providing tax cuts to billionaires, and throwing 24 million people off of the insurance rolls.

My colleagues across the aisle had 7 years to work with us to improve the Affordable Care Act, but they refused to work with us to make health care more affordable and to expand coverage. Instead, they have drafted a bill that does the exact opposite. No wonder we were unable to find common ground when our goals were different.

The goals of myself and Democrats have always been to reduce costs and expand coverage. Reading into what the Republican goals must be if this bill meets them, it seems like they are working to decrease coverage and increase costs--the opposite of what we are working for.

How will my colleagues look into the eyes of a former veteran or a small-business owner or a middle class family or my constituents like Greg or Nikita and somehow tell them that they would be better off under a plan that forces them to quit their jobs and become destitute? How will Republicans defend the vote to senior citizens when the age tax in this bill will force most seniors to pay premiums five times higher than what others pay for healthcare coverage? What will my colleagues say to 24 million people who lose healthcare coverage entirely under this bill?

The Republican healthcare bill that this body will consider on Thursday will do extraordinary damage to the healthcare system and leave millions of Americans guessing as to how much healthcare costs will cost and what will be covered. The American healthcare bill threatens to roll back important protections in coverage gains delivered by the ACA, and discussion of anything else at this point is a diversionary tactic, plain and simple.

Mr. Speaker, let's defeat the previous question and figure out how much this mysterious manager's amendment even changes the bill for better or worse. My colleague, Mr. Yarmuth, made a very compelling argument about how we need to know the actual costs and benefits of any bill we vote on; yet, this body is being forced to vote blind on a manager's amendment that we saw for the first time today and could even change by tomorrow, and we won't even know how it affects the costs of this bill or how it affects the lives of Americans who have health care today or aspire to it.

Mr. Speaker, I encourage my colleagues to defeat the previous question and vote ``no'' on the rule, to vote ``yes'' on this commonsense bill to modify our antitrust statutes which Democrats and Republicans have supported overwhelmingly in the past, but never, not once, to take our eye away from the ball of trying to decrease costs rather than increase costs and trying to expand coverage rather than retract coverage.

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

Mr. Speaker, I demand a recorded vote.

Mr. Speaker, let me thank the gentleman very much for his leadership. I acknowledge the chairman of the committee for his, as well.

I thank the gentleman for yielding to me, and although I will make the points that I think are important, I wanted to take the time to thank Mr. Conyers for the thoughtful legislation that he has introduced over the years.

This leads me to call this the Conyers bill because of the important contributions it makes to ensuring that our health care is competitive, our health insurance is competitive, and his thoughtfulness in this legislation. As it comes to the floor, I am reminded of Mr. Conyers' influence on this legislation. It is an interesting time at which it comes, Mr. Speaker.

Mr. Speaker, I rise to acknowledge the importance of H.R. 372, the Competitive Health Insurance Reform Act of 2017, a proposal to remove the antitrust exemption in the McCarran-Ferguson Act as it applies to health insurance.

Overall, the proposed legislation, as well as previous attempts by the Judiciary Committee to repeal the McCarran-Ferguson Act's antitrust exemption for health insurance, does not raise new or pressing issues.

Opponents of repeal assume problems that cannot be documented, unlike the very tangible and real economic and competitive costs that will be incurred if the exemption is allowed to continue.

As the Justice Department has explained, where there is effective competition, coupled with transparency, in a consumer-friendly regulatory framework, insurers will compete against each other by offering plans with lower premiums, reducing copayments, lowering or eliminating deductibles, lowering annual out-of-pocket maximum costs, managing care, improving drug coverage, offering desirable benefits, and making their provider networks more attractive to potential members.

That sounds, of course, like the Affordable Care Act, which we will celebrate tomorrow, for that was the day it was signed. That is what health insurance should be for the American people.

This legislation is a very thoughtful legislative initiative, and I am hoping that its coming to the floor is not like trying to put lipstick on a pig. That, of course, is the latest configuration of the meaningless TrumpCare, and which the amendment that will be coming forward will, again, in essence, throw people off health insurance. It will take away all that we are intending it to do, but this legislation has reason.

Other current enforcement tools and regulatory policies already in place address competition issues at the State and Federal level to police health insurance competition. In this and numerous other ways, effective regulation can promote improved healthcare delivery and improved cost control by ensuring that all insurance companies are required to follow certain basic consumer-friendly rules of the road.

Again, wouldn't it be great to have this very thoughtful legislation with all of the points of the Affordable Care Act: it eliminates preexisting conditions, has lowered premiums and continues to lower premiums, and is lowering or eliminating deductibles. All of those were thoughtful of Mr. Conyers, and they would have been the right complement to the Affordable Care Act.

However, the additional risks of adding new regulatory uncertainty, increasing boundary-testing litigation, and distracting policymakers from more important ways to reduce healthcare costs and improve healthcare competition suggest that further caution and delay on this front is inadvisable, given present circumstances and conditions.

But let us not fool ourselves into thinking that the legislation before us is a panacea that will lead to affordable, accessible, high- quality health care for all Americans. If that worthy goal is the objective sought, the best way to achieve it is to retain and strengthen the Affordable Care Act and abandon the misguided effort of House Republicans to repeal this landmark legislation and replace it with the pay more for less act masquerading as a healthcare bill.

The Affordable Care Act works. I think we in the Judiciary Committee know it full well. We held hearings and briefings; we heard from the victims of those who did not have insurance, who had lost insurance, did not have enough insurance, or the insurance would not cover them.

I am reminded of a very emotional story of an 8-year-old girl in the office of an insurance company where her family was begging for coverage because she had leukemia; obviously, a preexisting condition. It is sad to say, but I understand that she lost her life.

The Affordable Care Act has significantly improved the availability, affordability, and quality of health care

for tens of millions of Americans, including millions who previously had no health insurance at all.

Americans are rightly frightened by Republican attempts to repeal the ACA without having in place a superior new plan that maintains comparable coverages and comparable consumer choices and protections, not throwing off 24 million Americans who will have no insurance.

It is beyond dispute that the pay more for less plan proposed by Republicans fails this test miserably. The Republican pay more for less act is a massive tax cut for the rich, paid for on the backs of America's most vulnerable: those who work and who happen to be of low income. This Robin-Hood-in-reverse bill is unprecedented and breathtaking in its audacity. No bill has ever tried to give so much to the rich while taking so much from the poor.

One number comes to mind: $880 billion taken away from Medicaid insurance covering nursing homes, patients, the blind, the disabled; again, then giving a great plus and a great refund in tax credits to the richest in America. They will be happy. It won't be health care. They have got private health insurance. But it certainly will be a big check that they get in the mail.

This pay more for less bill represents the largest transfer of wealth from the bottom 99 percent to the top 1 percent in American history. This Republic scheme gives gigantic tax cuts to the rich, and pays for it by taking insurance away from 24 million.

In addition, Republicans are giving the pharmaceutical industry a big tax repeal, worth nearly $25 billion over a decade, without demanding in return any reduction in the cost of prescription and brand-name drugs. That is very important.

To paraphrase Winston Churchill, of this bill, it can truly be said that never has so much been taken from so many to benefit so few.

The pay more for less plan destroys the Medicaid program. CBO estimates 14 million will lose Medicaid. In 2026, 52 million Americans will be uninsured.

We know that these combined policies will not help to cure some of the thoughtful deliberations that went into the underlying bill. We want more competition. We want the insurance products to be the kind of products that we can be sure provide health care.

In short, the Republican pay more get less plan represents a clear and present danger to the financial and health security of American families and to the very stability of our Nation's healthcare system.

Mr. Speaker, the healthcare marketplace is complex in how it operates and how it motivates providers, insurers, and consumers.

If I can quote the 45th President, he said: ``I didn't know how difficult this would be.'' Well, we know how difficult it can be, and was.

Mr. Speaker, Democrats held some 79-plus hearings. We had 181 witnesses-plus. We had hundreds of hours of hearings. We held thousands, I might imagine, of townhall meetings. We didn't hold one here and one there. I myself held 11 townhall meetings.

We continue to hear from not only the consumers, but the rural hospitals, the major hospitals, the senior citizens, and particularly those senior citizens on dealing with the cost of prescription drugs.

I am proud to say that we saved the dastardly Medicare part D by closing the doughnut hole, which is closed today, so that seniors under the Affordable Care Act do not fall into an abyss, a deep ocean, and have to, in essence, not take their drugs because they don't have enough money.

An effective regulatory framework is needed to shape this complex environment--and this is a word to the administration--to help safeguard consumers, help keep costs under control, and help make a full range of healthcare services. But our country's long experience shows that we cannot expect a healthcare system to run effectively on market competition alone. Markets can and do fail when proper regulation is lacking.

So the goodness of this bill has to go along with--a good example is recognizing what happens in the ACA's provision, banning insurance companies from denying coverage of preexisting disease--we had to help them along--preexisting conditions. We had to help them along. You have to help them along to be a good steward of the insurance that the American people need.

This is a key consumer protection that the free market demonstrates time and time again that it could produce and needed to do. That is where regulation and the antitrust laws come in to protect consumer choice. Let me go back and say that it could not produce on its own. It is a per se violation of antitrust laws for competing companies to agree to divide markets or to fix prices. The other sectors in the healthcare supply chain are already subject to antitrust laws, and it will be beneficial to the healthcare marketplace and to consumers if the healthcare industry joins them. That is why I said this bill is a thoughtful, important bill to dealing with the complex issues of insurance and health care.

I am sad to say that tomorrow, as we celebrate the Affordable Care Act, we will be looking toward Thursday, where we will be, in essence, debating a bill that takes 24 million people off of health insurance, period. 24 million will lose their coverage. Tax giveaways will continue again to the top 1 percent. That will be $600 billion in tax breaks to the rich and big corporations. In fact, the Republican bill gives $2.8 billion to 400 of the richest families in America.

Then to add to the downside, the Affordable Care Act was known to create more jobs. Unfortunately, this will see 2 million jobs destroyed and lost. Families will be paying more for less. Young people will be hit with a millennial penalty. And we don't know if this formula that they have still stops the 50- to 64-year-olds from paying higher premiums. Women lose comprehensive care, middle-aged Americans pay the age tax, seniors see Medicaid and Medicare weakened, preexisting conditions and disabilities may suffer, and it does not reduce the deficit as the ACA does.

My final point, if I can, we are glad to come to the floor and honor Mr. Conyers for this important bill and support H.R. 372. I believe this legislation before us does a lot more good than it does harm, but I hope that we can, in a bipartisan manner--maybe even in a nonpartisan manner--reflect on what is needed to really insure the American people and we can work with the Affordable Care Act, which has all of these positive elements, and move this country forward through competition and health care that saves lives.

Mr. Speaker, overall, the proposed legislation, as well as previous attempts by the Judiciary Committee to repeal the McCarran-Ferguson Act's antitrust exemption for health insurance, does not raise new or pressing issues.

Opponents of repeal assume problems that cannot be documented, unlike the very tangible and real economic and competitive costs that will be incurred if the exemption is allowed to continue.

As the Justice Department has explained, where there is effective competition, coupled with transparency, in a consumer-friendly regulatory framework, insurers will compete against each other by offering plans with lower premiums, reducing copayments, lowering or eliminating deductibles, lowering annual out-of-pocket maximum costs, managing care, improving drug coverage, offering desirable benefits, and making their provider networks more attractive to potential members.

Other current enforcement tools and regulatory policies already in place address competition issues at the state and federal level to police health insurance competition.

In this and numerous other ways, effective regulation can promote improved health care delivery and improved cost control, by ensuring that all insurance companies are required to follow certain basic consumer-friendly ``rules of the road.''

It might be argued that increasing the federal government's role in regulating health insurance, through expanded antitrust enforcement, would appear to conflict with proposed reforms to delegate more responsibility to state governments.

However, the additional risks of adding new regulatory uncertainty, increasing boundary-testing litigation, and distracting policymakers from more important ways to reduce health care costs and improve health care competition suggest that further caution and delay on this front is inadvisable given present circumstances and conditions.

But let us not fool ourselves into thinking that the legislation before us is a panacea that will lead to affordable, accessible, high quality health care for all Americans.

If that worthy goal is the objective sought, then the best way to achieve it is to retain and

strengthen the Affordable Care Act and abandon the misguided effort of House Republicans to repeal this landmark legislation and replace it with their Pay More For Less Act, masquerading as the American Health Care Act.

The Affordable Care Act has significantly improved the availability, affordability, and quality of health care for tens of millions of Americans, including millions who previously had no health insurance at all.

Americans are rightly frightened by Republican attempts to repeal the ACA without having in place a superior new plan that maintains comparable coverages and comparable consumer choices and protections.

It is beyond dispute that the ``Pay More For Less'' plan proposed by House Republicans fails this test miserably.

The Republican ``Pay More For Less Act'' is a massive tax cut for the wealthy, paid for on the backs of America's most vulnerable, the poor and working class households.

This ``Robin Hood in reverse'' bill is unprecedented and breathtaking in its audacity--no bill has ever tried to give so much to the rich while taking so much from the poor and working class.

This ``Pay More Get Less'' bill represents the largest transfer of wealth from the bottom 99% to the top 1% in American history.

This Republican scheme gives gigantic tax cuts to the rich, and pays for it by taking insurance away from 24 million people and raising costs for the poor and middle class.

In addition, Republicans are giving the pharmaceutical industry a big tax repeal, worth nearly $25 billion over a decade without demanding in return any reduction in the cost of prescription and brand-name drugs.

To paraphrase Winston Churchill, of this bill, it can truly be said that ``never has so much been taken from so many to benefit so few.''

The ``Pay More Get Less'' plan destroys the Medicaid program under the cover of repealing the Affordable Care Act Medicaid expansion.

CBO estimates 14 million Americans will lose Medicaid coverage by 2026 under the Republican plan.

In addition to terminating the ACA Medicaid expansion, the ``Pay More Get Less'' plan converts Medicaid to a per capita cap that is not guaranteed to keep pace with health costs starting in 2020.

The combined effect of these policies is to slash $880 billion in federal Medicaid funding over the next decade.

The cuts get deeper with each passing year, reaching 25% of Medicaid spending in 2026.

In short, the Republican ``Pay More Get Less Act'' represents a clear and present danger to the financial and health security of American families, and to the very stability of our nation's health care system overall.

Mr. Speaker, the health care marketplace is complex in how it operates and how it motivates providers, insurers, and consumers.

An effective regulatory framework is needed to shape that complex environment, to help safeguard consumers, help keep costs under control, and help make a full range of health care services available.

But our country's long experience shows that we cannot expect a health care system to run effectively on market competition alone; markets can and do fail when proper regulation is lacking.

A good example is the ACA's provision banning insurance companies from denying coverage of preexisting conditions.

This is a key consumer protection that the free market demonstrated time and again that it would not produce on its own.

And that is where regulation and the antitrust laws come in to protect consumer choice.

It is a per se violation of antitrust law for competing companies to agree to divide markets or to fix prices.

The other sectors in the health care supply chain are already subject to the antitrust laws, and it will be beneficial to the health care marketplace, and to consumers, if the health insurance industry joins them.

For these reasons, I believe the legislation before us does more good than harm and, accordingly, I urge my colleagues to join me in supporting H.R. 372.

Mr. Speaker, pursuant to House Resolution 209, I call up the bill (H.R. 372) to restore the application of the Federal antitrust laws to the business of health insurance to protect competition and consumers, 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 H.R. 372.

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

Mr. Speaker, I rise today in support of a bill that will move us a step closer towards restoring healthy competition in the health insurance industry. Today, the health insurance industry is besieged by dwindling competition and skyrocketing premiums. Insurance providers, States, and the public have been dealing with the disastrous repercussions of ObamaCare for the past 6 years and overregulation by States for much longer.

Congress finally has the opportunity to pass legislation to reverse the downward spiral of our health insurance industry. Any such legislation must encourage a robust and competitive health insurance market in which insurance providers actively compete for customers. Healthy competition ensures premiums are accurately priced and that customers are able to find a variety of policies to meet their specific needs and demands.

H.R. 372, the Competitive Health Insurance Reform Act of 2017, represents a step on that journey, repealing the McCarran-Ferguson Act as it applies to the business of health insurance. There is wide support for this bill, and the Judiciary Committee has favorably reported similar legislation in the past, including legislation that was passed by the House, 406-19 during the 111th Congress.

The stated goal of the bill is to help restore competition in the healthcare market. I support this goal and firmly believe this bill must be coupled with larger changes to the existing Federal and State healthcare regulatory schemes.

As Speaker Ryan has noted, States ``should be empowered to make the right tradeoffs between consumer protections and individual choice, not regulators in Washington.''

This bill does not impact the State's ability to regulate the insurance market. Rather, this legislation levels the playing field for all healthcare industry participants. While insurers have been exempt from Federal antitrust laws for the past 70 years, healthcare providers and other participants have not.

This bill removes this exemption, ensuring that health insurers are better able to compete to provide quality coverage, thereby benefiting hospitals, doctors, and, most importantly, patients.

In addition, if separate legislation is passed to allow for the more open sale of health insurance across State lines, the Competitive Health Insurance Reform Act will allow uniform Federal antitrust laws to be applied across the marketplace while allowing States to maintain authority as the primary regulators of the health insurance market outside of the antitrust sphere.

The McCarran-Ferguson Act was originally passed to leave the regulation of the business of insurance with the States and to allow insurers to engage in certain procompetitive collaborative activities.

This legislation limits significant uncertainty and unnecessary litigation that would likely result from a broader McCarran-Ferguson repeal, through the use of safe harbors for such historically procompetitive collaborative activities, specifically the collection and distribution of historical loss data, the determination of loss development factors, the performance of actuarial services that do not involve restraints of trade, and the use of common forms that are not coercive.

Absent these safeguards, insurers will likely disengage from certain proconsumer collaborative activities, eliminating or impeding smaller insurers from competing and disincentivizing larger insurers from exploring new products and markets. This will lead to further market consolidation and fewer product choices, the impact of which will eventually be borne by the consumer.

These narrow safe harbors create a presumption that certain procompetitive activities can continue while maintaining regulation and oversight to the extent any activity crosses over into a restraint of trade. As a result, insurers can continue to engage in proconsumer business practices and will be encouraged to provide a diverse range of offerings at fair and reasonable prices.

I thank Mr. Gosar for introducing this legislation, and I urge all of my colleagues to vote for the Competitive Health Insurance Reform Act.

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

Mr. Speaker, I yield 5 minutes to the gentleman from Arizona (Mr. Gosar), who is the chief sponsor of the legislation.

Mr. Speaker, I am prepared to close, so I reserve the balance of my time until the other side closes.

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

Our health insurance industry is in a dire situation. Premiums and deductibles are skyrocketing, hundreds of percent in some cases. In the State of the gentleman who is the chief sponsor of this bill, the State of Arizona, there has been a more than 100 percent increase in just the last year.

In 2017, the national State average of insurers participating in Federal exchanges dropped to four, down from six the previous year. Five States will only have one insurer providing plans on their Federal exchanges this year. It is time to reverse this trend. The Competitive Health Insurance Reform Act is an important step in restoring competition to the health insurance industry and will help to set the foundation for additional essential reforms that must follow.

I say to the gentleman from Michigan (Mr. Conyers), the ranking member of the committee and my friend, I appreciate very much working with him on this legislation, but I would also say to him that this legislation, as bipartisan as it is, cannot save the Affordable Care Act. It is drowning. It is denying people coverage. Its costs are going up so much that somebody who likes it this year will not be able to afford it next year.

The promise that if you like your health insurance you will be able to keep it was never true, and it is still not true with ObamaCare. The promise that if you like your doctor you can keep your doctor was never true. The promise that health insurance premiums would go down under ObamaCare has been proven to be totally false. Instead, what we have done is we have denied the American people the right to choose for themselves what access to health care that they need and can afford.

We have denied the American people the freedom to decide whether or not they want to purchase a product that is mandated upon them by the Federal Government. That is wrong. It has got to change. That is why we are taking action this week--including the Competitive Health Insurance Reform Act, but certainly not only the Competitive Health Insurance Reform Act--to return a patient-centered healthcare system to the American people, one that reconnects them with their healthcare providers, one that will make sure that they have the maximum amount of choice and the maximum amount of access to real, affordable health insurance and quality health care in America. I support this bipartisan legislation. I urge my colleagues to do the same.

Mr. Speaker, I include in the Record three letters in support of H.R. 372.

Small Business &

Entrepreneurship Council,

Vienna, VA, February 27, 2017.

Hon. Paul A. Gosar,

House of Representatives,

Washington, DC.

Dear Representative Gosar: The Small Business &

Entrepreneurship Council (SHE Council) and our nationwide

membership of small business owners and entrepreneurs support

the ``Competitive Health Insurance Reform Act of 2017'' (H.R.

372). Perhaps more than any other group, small business

owners understand the need for increased competition in the

health insurance marketplace. Indeed, it is the actions of

entrepreneurs that bring down costs, enhance innovation, and

boost quality in a competitive marketplace. H.R. 372 is a

common sense and long-overdue step to repeal special-interest

exemptions to federal antitrust laws for health insurance

companies.

These exemptions have existed for more than 70 years, and

were initially instituted to help newly formed insurance

companies deal with data sharing. Given the dramatic changes

in the industry over these past many decades, such special-

interest treatment is no longer warranted.

Considering the government-imposed distortions within the

health care industry as a result of the Affordable Care Act

and other regulatory restrictions, full-blown review and

reform of health care policies focused on expanding

competition, and consumer choice are needed. That includes

foundational changes, such as, in the case of H.R. 372,

removing special-interest treatment that could reduce or

retrain competition.

In order to bring down health insurance costs and utilize

the models and technologies of our modern economy to drive

value and innovation within this sector, entrepreneurs need a

system that allows for such freedom and creativity. Your bill

is an important step in bringing down artificial barriers

that are preventing much needed innovation and competition.

Thank you for your leadership on this important issue. Please

let SBE Council know how we can help you advance H.R. 372

into law.

Sincerely,

Karen Kerrigan,

President & CEO.

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

Mr. Speaker, I claim the time in opposition to the motion.

Mr. Speaker, the McCarran-Ferguson Act was originally passed to leave the regulation of the business of insurance with the States and to allow insurers to engage in certain procompetitive collaborative activities.

This legislation limits significant uncertainty and unnecessary litigation that would likely result from a broader McCarran-Ferguson repeal through the use of safe harbors for such historically procompetitive collaborative activities, specifically the collection and distribution of historical loss data, the determination of loss development factors, the performance of actuarial services that do not involve restraints of trade, and the use of common forms that are not coercive.

Absent these safeguards, insurers will likely disengage from certain proconsumer collaborative activities, eliminating or impeding smaller insurers from competing and disincentivizing larger insurers from exploring new products and markets. This will lead to further market consolidation and fewer product choices, the impact of which will eventually be borne by the consumer.

These narrow safe harbors create a presumption that certain procompetitive activities can continue while maintaining regulation and oversight to the extent any activity crosses over into a restraint of trade. As a result, insurers can continue to engage in proconsumer business practices, and will be encouraged to provide a diverse range of offerings at fair and reasonable prices.

There is no reason to make an exception to these safe harbors. Therefore, I oppose the motion. I urge my colleagues to reject this motion to recommit and to support the underlying bill.

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

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 209 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Colorado (Mr. Polis), 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 and to include any extraneous material on House Resolution 209, currently under consideration.

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

Today I am pleased to bring forward this rule on behalf of the Rules Committee. The rule provides for consideration of H.R. 372, the Competitive Health Insurance Reform Act. The rule provides for 1 hour of debate for the bill, equally divided between the chairman and ranking member of the Judiciary Committee. The rule also provides for a motion to recommit.

Yesterday, the Rules Committee had the opportunity to hear from Judiciary Committee Chairman Bob Goodlatte and Congressman David Cicilline on behalf of the Judiciary Committee.

I thank Chairman Goodlatte and the Judiciary Committee staff for their work on this legislation. As a member of the Judiciary Committee, I had the opportunity to review this legislation at both a committee hearing and a markup.

We heard from several witnesses at the Judiciary Committee hearing, including the bill's primary sponsor, Congressman Paul Gosar of Arizona.

In addition to the bill's sponsor and the Judiciary Committee, I would also like to recognize one of my colleagues from Georgia, Representative Austin Scott, for his interest in this topic and leadership on this legislation. Congressman Austin Scott of Georgia testified before the Judiciary Committee on this bill and has worked actively to highlight this issue.

The issue of competition in the health insurance marketplace is not a new one, but it is one that deserves more attention. Legislation similar to the Competitive Health Insurance Reform Act passed the House under a Democrat-led Congress in 2010 and under a Republican Congress in 2012.

Mr. Speaker, much of our attention on the floor this week is focused on making health care more affordable and accessible to the American people. The Competitive Health Insurance Reform Act is part of that plan.

From shore to shore, we have seen and heard stories about the soaring costs of health care and the health insurance markets that have been hamstrung by ACA regulations. As a result, insurers have fled the exchanges while consumer choice and access to quality care have disappeared along with them.

Today, more than ever, we need to institute reforms that restore options for Americans by encouraging healthy competition in the health insurance market. The problem actually dates back to the 1940s, and the Competitive Health Insurance Reform Act helps address a problem that has increasingly demanded attention.

In 1944, Mr. Speaker, the Supreme Court held, for the first time, that insurance was part of interstate commerce and was, therefore, subject to Federal antitrust laws. Congress responded a year later by passing the McCarran-Ferguson Act, which established certain exemptions from the Federal antitrust regulations for the business of insurance. That law remains in place today, and reexamining it in the context of our health insurance market has received bipartisan support.

The Competitive Health Insurance Reform Act would amend the 1945 McCarran-Ferguson Act to apply our three main antitrust laws--the Clayton Act, the Sherman Act, and the FTC Act--to the health insurance industry.

To be clear, this bill does not impose new or radical regulations upon the health insurance industry. It merely applies longstanding antitrust laws to the business of health insurance, laws that have applied to the rest of the economy for decades. By restoring the application of our competition and antitrust laws to the health insurance industry, we strengthen the foundation for a competitive health insurance market.

The high prices and lack of choices that patients find in health insurance flow back from a lack of competition in the market and a barrage of regulations. So it is past time that we reestablish a basis for a system in which insurance providers compete for customers in a patient-driven marketplace.

While we work to bring common sense back to health care, we also have to look at the broad context of where the industry is and how it got there. In that spirit, this bill recognizes the importance of open and free competition across the economy, including the healthcare marketplace. Part of the government's role is to guard the American people rather than creating special interest exemptions that ultimately work against the hardworking citizens. H.R. 372 establishes that there is no basis for further exemption of the health insurance industry from the Federal antitrust law.

Importantly, however, H.R. 372 also contains narrowly defined safe harbors to protect historically procompetitive collaborative activities that are unique to the business of insurance, including the collection and distribution of historical loss data and the performance of actuarial services that do not involve a restraint of trade.

The Competitive Health Insurance Reform Act is not a magic pill or a silver bullet, but it is a key component of our broader plan to restore competition and common sense to the healthcare marketplace.

The principles captured by this bill are part of our House Republican Better Way plan and a part of our plan to address the harm done that ObamaCare has brought on our healthcare system and those who depend on it.

I look forward to the underlying legislation once again receiving broad support from both sides of the aisle.

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

Mr. Speaker, I yield such time as he may consume to the gentleman from Georgia (Mr. Austin Scott) to continue discussing the rule before us about the McCarran-Ferguson repeal.

Mr. Speaker, I have no other speakers, and I reserve the balance of my time.

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

I would just like to remind those from the House that if you do defeat this rule, you will not vote on this commonsense piece of legislation. So let's at least put the correct procedural order out there.

We need to vote ``yes'' on this rule and get on to the underlying piece of legislation, which is a piece that has passed this House not only unanimously by voice vote in the Republican Congress but also with an overwhelming vote just recently in the Democratic administration as well. So we are moving forward on this.

I think what is interesting here, and what I have worked on, and we are going to have a lot of discussion on for the next 2 days is repealing and replacing ObamaCare. I think it was interesting that my friend--we share many a night and day in the Rules Committee, we share different opinions, but he made mention of the elephant in the room. I will just make mention of the donkey in the room.

It is amazing to me now that we are actually concerned about people losing health care. We are actually concerned about prices going up. We are actually concerned about these issues that have been going on for 7 years. We are having an $800 billion tax because we have removed the taxes and impediments of ObamaCare. We are actually--instead of mandating the folks that they buy insurance that they can't afford and can't use, we are actually getting a marketplace that will actually give them better choices and results.

I think the interesting part here is not knowing the cost and benefits. Good gracious. All we have to do is look back over the last 7 years, Mr. Speaker. When we understand what is going on, let's also, as we throw out the discussion--it was made in comment by my friend, 7 years to fix. You can't fix broken in this regard. When he goes about it traditionally wrong, it is not fixing. When you take away the markets, when you take away the individual market, and when you are taking away the very incentives that actually are the underpinnings of our health care to enlarge and grow, if your goals were to reduce and expand, then you failed miserably. You have not reduced costs, they have gone up. You have not expanded choices, they have gone down.

I have listened to it about as much as I can right now. We are going to have the next 2 days to give people health. It is why we are over here for the majority speaking because of the failure of the ACA in ObamaCare. When we understand that, then we can look at pieces of legislation like the Competitive Health Insurance Reform Act that should have been part of this a long time ago. Yet, we choose to begin discussions about a failure. It is about a failure.

Choose the status quo. Squint your eyes, look real hard, it is not getting worse, it is really okay, just help us tweak it, help it get better.

It is not getting any better. In fact, any insurance company is on a death spiral. ObamaCare is failing. Some of the CBO estimates about increased costs 10 years out are based on ObamaCare pricing. There wouldn't even be an ObamaCare plan in 10 years because it won't be there.

So we will have these arguments. We will have these discussions. But if you want to move forward a commonsense piece of legislation, if you want to move forward a bipartisan piece of legislation, if you want one that actually the American people sent us here to do to actually make things better, then vote ``yes'' on the rule and vote ``yes'' on the underlying bill because that is why we are here--real solutions from a real majority that will answer the questions and then gladly defend it to an American people who are tired of being told about and talked about and taking things away because we didn't read it to know what was in it. That is why, because you couldn't know what was in it.

Now we are going to tell you what is in it, and we are going to put back a

marketplace that actually works for Americans. When we do that, we will gladly put the market back there where they can actually have a plan they can afford and actually use. When we understand that, the health care and the plan we put forward will be one that works for the American people, not against them.

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

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

Mr. Speaker, I thank the gentleman for yielding and for his extraordinary leadership on this legislation.

Mr. Speaker, H.R. 372, the Competitive Health Insurance Reform Act of 2017, would partially repeal a longstanding antitrust exemption established by the McCarran-Ferguson Act with respect to the business of health and dental insurance.

To qualify for this limited antitrust exemption, an insurer must be engaged in the business of insurance regulated by a State that is not designed to boycott, coerce, or intimidate.

While these requirements somewhat constrain anticompetitive conduct, it is clear that they do not preclude the most egregious antitrust violations, such as price fixing, bid rigging, and market allocation, by health insurance providers.

Health insurers should not be immune from antitrust scrutiny, particularly when they collude to increase prices, reduce availability, or otherwise engage in anticompetitive behavior.

That is why House Democrats passed a measure that is substantively similar to H.R. 372, in 2010, by a vote of 406-19, and in 2009, as well. In 1988, 1992, and 1994, Judiciary Democrats likewise favorably reported legislation to completely repeal the McCarran-Ferguson Act.

While H.R. 372 is only a partial repeal of this exemption, I encourage my colleagues to support this measure. But let me be perfectly clear about three things:

First, promoting competition in health insurance markets cannot occur at the expense of the strong protections established by the Affordable Care Act to make health markets more efficient and prohibiting discriminatory insurance policies. These protections are ``textbook measures that help promote competition in the insurance marketplace,'' as Professor Tim Greaney, a leading antitrust expert, testified in 2015.

Second, contrary to President Trump's suggestions on Twitter, repealing McCarran-Ferguson's antitrust exemption for health insurance will not remove State barriers or create new pathways for insurance companies to compete and offer products across State lines.

This simplistic approach to healthcare policy overlooks the fact that the Affordable Care Act already allows States to establish healthcare choice compacts to provide for cross-State insurance sales, while five States have already enacted out-of-State purchasing laws. But these laws have done little to encourage cross-State insurance sales because health insurers are simply not interested in selling these products across State lines.

The barriers to entry into health insurance markets ``are not truly regulatory, they are financial and they are network,'' as Professor Sabrina Corlette of Georgetown University's Health Policy Institute has observed.

Notwithstanding President Trump's exaggerated claims to the contrary, it is also clear that enacting this legislation is not a precondition for Congress

authorizing cross-State insurance sales.

My Republican colleagues on the Judiciary Committee agree, noting in their report on the bill that ``the general consensus, including among witnesses at the most recent Judiciary hearing on the Competitive Health Insurance Reform Act, is that if Congress decides to allow insurers to sell across State lines, such action does not necessarily require a repeal of McCarran-Ferguson.''

And third, there is no evidence that enacting this bill alone will improve the affordability or availability of health insurance.

According to the Congressional Budget Office, the effect of H.R. 372 on health insurance premiums ``would probably be quite small,'' and enacting the bill will have ``no significant net effect on the premiums that private insurers would charge for health or dental insurance.''

Additionally, because the McCarran-Ferguson Act does not apply to mergers, H.R. 372 will not prevent further concentration in health insurance markets.

The truth is, Mr. Speaker, if Republicans were serious about actually enforcing the antitrust laws, they would fully fund the antitrust agencies. But as we know from the Trump administration's budget blueprint, Republicans plan to make deep cuts to the funding of enforcement agencies like the Justice Department, likely to the detriment of economic opportunity and fair competition.

In addition, President Trump has not even nominated heads to the antitrust agencies. According to the Partnership for Public Service, even though he has been in office for 60 days, President Trump has not picked a nominee for 497 of the 553 positions requiring Senate confirmation.

Worse still, President Trump is reportedly considering appointing a former lobbyist for a health insurance giant to run the Justice Department's antitrust division, which is tasked by Congress ``to protect economic freedom and opportunity by promoting free and fair competition in the marketplace.''

Citing lobbying reports, the International Business Times notes that this particular lobbyist participated in the ``antitrust issues associated with Anthem's proposed acquisition of Cigna,'' and his firm received $375,000 in lobbying fees.

Just last month, the Justice Department won an important lawsuit initiated under the Obama administration to block this merger, which, according to the Department of Justice, would have harmed consumers through increased health insurance prices, while stifling the exact innovation that is necessary to lower healthcare costs.

It is unsurprising that President Trump's corporate cabinet will probably include yet another lobbyist that will pursue an extreme agenda on behalf of special interests. But the significance of this potential appointment cannot be overstated and absolutely will not result in lower prices or more choices for the American people.

In closing, Mr. Speaker, while I support H.R. 372 as a complement to the Affordable Care Act, I agree with the ranking member that this bill is not a solution to improving the availability or affordability of health insurance.