Providing for consideration of the bill (H.R. 1101) to amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees.

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

Mr. Speaker, I rise in opposition to this rule today that provides for consideration of H.R. 1101, the so-called Small Business Health Fairness Act of 2017.

This bill, first of all, from a procedural basis, did not allow even a discussion of the amendments that my Democratic colleagues brought forward to improve the bill. This rule has something called the structured amendment process, which basically means that Democrats are locked out from presenting our ideas for improving this bill. We are not even allowed a 10-minute debate or a vote on any of the ideas that many of my colleagues brought forward.

The gentlewoman from Oregon (Ms. Bonamici) proposed an amendment to require the legislation only take effect if the Congressional Budget Office determined premiums for older workers wouldn't increase. Sounds like a reasonable idea to at least debate for an hour, 10 minutes. It is important to do.

The gentlewoman from California (Mrs. Torres) offered an amendment that would have required all association health plans to continue the 10 essential health benefits of the Patient Protection and Affordable Care Act to obtain State certification--again, not even allowed to vote on her amendment.

The gentleman from New York (Mr. Espaillat) offered an amendment to allow States to continue regulating any association health plan, including regulations related to benefits, consumer protections, and rating restrictions--not allowed.

These amendments would have improved the underlying legislation. They should have been allowed to proceed to the floor. Unfortunately, the only amendment that made it in was from the Republican side of the aisle, and all of the great ideas that Members on my side of the aisle offered were prevented from being even allowed to be debated under this restrictive rule.

I find it very troubling that my colleagues on the other side seem to prefer a partisan vote to collaboration and to considering valuable proposals that might help improve the quality of health care just because they happen to come from Democrats.

But there is a bigger issue here. Of course, in addition to the faulty process, the bill is simply a bad bill and does nothing to address the problems with the repeal of the Affordable Care Act, which is pending before this body.

One of the issues raised under this bill is it could lure away young and healthy workers, creating a distortion in the market. The ACA changed that practice by requiring health insurance sold through an association to meet the same insurance standards of coverage sold to the individual and small group market, preventing cherry-picking and providing a basic level of protection for consumers. This bill would roll back that progress, creating a separate set of rules for association health plans, essentially exempting them from complying with State regulations.

There is also little evidence that it has even been effective to expand coverage. That is why many consumer and advocacy groups, including, for instance, the National Association of Insurance Commissioners, have come out opposed to this bill.

But even more disturbing is the fact that we are considering a bill that even its proponents would agree does not in any way, shape, or form replace the protections of the Affordable Care Act. This is a bill that is narrow in scope. In fact, when we marked it up in our committee, the Education and the Workforce Committee, that very same day, the Energy and Commerce and Ways and Means Committees were marking up a bill to create a brand-new entitlement program, remove health care

from 24 million Americans who have it today, and increase costs by 15 to 20 percent for those who are paying for their insurance today.

At that time, the Republican healthcare bill had only been public for 24 hours. When the committees marked it up, we didn't even know how much the bill cost or how many people would lose coverage as a result. That information only came later, after committee members voted to amend or not amend the bill.

Frankly, it is unconscionable to deny people healthcare insurance. It may be a life-or-death proposition, and we need to do a better job understanding bills before we vote on them, which is one of the reasons that we need to make sure we know the cost of this so-called manager's amendment, these midnight changes to the repeal of the Affordable Care Act.

What is interesting with this proposed American Health Care Act the Republicans plan to bring to the floor, it was just reported--and I will be submitting the article for the Record--that the Republican bill actually results in more people being uninsured than if ObamaCare were simply repealed outright.

So rather than repealing it outright, what Republicans are doing is giving a tax break to billionaires, creating a brand-new entitlement program, throwing 24 million people off the insurance rolls, and increasing costs by 15 to 20 percent. It would actually throw less people off insurance if they simply repealed ObamaCare.

Mr. Speaker, I include in the Record an article from The New York Times.

[From The New York Times, Mar. 21, 2017]

The Upshot--Public Health

Fewer Americans Would Be Insured With G.O.P. Plan Than With Simple

Repeal

(By Margot Sanger-Katz)

The Congressional Budget Office recently said that around

24 million fewer Americans would have health insurance in

2026 under the Republican repeal plan than if the current law

stayed in place.

That loss was bigger than most experts anticipated, and led

to a round of predictable laments from congressional

Democrats--and less predictable ones from Republican

senators, including Bill Cassidy of Louisiana and John Thune

of South Dakota, who told reporters that the bill needed to

be ``more helpful'' to low-income people who wanted

insurance.

But one piece of context has gone little noticed: The

Republican bill would actually result in more people being

uninsured than if Obamacare were simply repealed. Getting rid

of the major coverage provisions and regulations of Obamacare

would cost 23 million Americans their health insurance,

according to another recent C.B.O. report. In other words, 1

million more Americans would have health insurance with a

clean repeal than with the Republican replacement plan,

according to C.B.O. estimates.

The C.B.O. estimated what would happen after a simple

repeal when it considered a bill that Congress passed last

year. (President Obama later vetoed that bill.) The bill left

parts of Obamacare in place, so the 23 million estimate

didn't come with the kind of detailed analysis that

accompanied last week's score of the American Health Care

Act. But the similarity of the two estimates highlights some

of the difficulties of the current proposal, both for

Democrats, who are strongly criticizing potential coverage

losses, and for the repeal-or-die crowd, who hate the

structure of this new bill.

``It's reaffirmed how exceedingly complicated and

convoluted the approach the House leadership took,'' said Dan

Holler, the vice president for communications and government

relations at Heritage Action, an advocacy group firmly in the

repeal-or-die camp.

Late Monday, House leadership revealed a set of amendments

to the bill, which will be considered when the bill comes up

for a vote. But, if they are adopted, the changes are

unlikely to have major effects on overall coverage numbers.

If anything, the changes might lead to a larger increase in

the number of Americans without health insurance.

The people who would end up without health insurance are

slightly different in the two cases. The current bill would

cause more people to lose employer insurance, while a

straight repeal bill would most likely cause more people who

buy their own coverage to become uninsured. A simple repeal

would be worse for Americans with pre-existing conditions,

but the current bill would be worse for older Americans who

are relatively healthy. Both approaches would lead to major

reductions in the number of Americans covered by Medicaid.

The bill that Congress passed in 2016 is the third

scenario. It would have kept Obamacare's major insurance

regulations on the books, including its rule that health

insurers need to sell insurance at the same price to healthy

and sick customers of the same age. It would have removed

funding for the expansion of Medicaid, dropped subsidies to

help people buy health coverage, and eliminated the

individual and employer mandates in the law.

The results of those changes would be drastic: In a decade,

32 million more people would be without health insurance,

according to the estimates. The C.B.O. essentially said it

was a policy combination that would break the insurance

market, resulting in substantially more people losing

coverage than gained it under Obamacare.

The kind of full repeal that some Republicans are calling

for would, of course, be hard to pass. Even if every member

of their caucus supported the approach, most experts believe

that repealing Obamacare's major insurance provisions would

require a type of legislation that would be vulnerable to a

Senate filibuster, and would thus require at least eight

Democratic votes.

All three approaches would result in meaningful reductions

in the number of Americans with health coverage. But, in the

end, it appears that the long-term effects of the current

Republican plan don't look that different from full repeal.

Mr. Speaker, Margo Sanger-Katz said, in part: ``But one piece of context has gone little noticed: The Republican bill would actually result in more people being uninsured than if ObamaCare were simply repealed. Getting rid of the major coverage provisions and regulations of ObamaCare would cost 23 million Americans their health insurance. . . . In other words, 1 million more Americans would have health insurance with a clean repeal than with the Republican replacement plan, according to CBO estimates.''

So it is just unclear what the Republicans are trying to do here. If the goal was to come up with something worse than repealing the Affordable Care Act, they certainly reached that goal: less people will have coverage, more tax breaks for billionaires, higher rate increases for most Americans. On every account, it actually underperforms a cleaner repeal.

What Democrats wanted to do is improve the Affordable Care Act. And I want to be clear, none of us have ever argued the Affordable Care Act is perfect. I pushed for fixes. So many of my Democratic and Republican colleagues have pushed for fixes to strengthen the law, like repealing the medical device tax, which adds cost to health care, and altering the Cadillac tax on insurance premiums.

In the Education and the Workforce Committee, I actually offered three amendments to show some of the ideas that I and some of my colleagues had to improve the Affordable Care Act. They offered an amendment to establish a public option in the exchange, to provide a baseline of competition in every ZIP Code in this country--defeated on a partisan vote. I should add that my proposal for a public option--and I am a cosponsor of the bill to do the same--would actually reduce the budget deficit by over $50 billion.

I also offered an amendment for pricing transparency to help make the market in health care work. One of the major market fallacies in health care is a Byzantine pricing structure where, frequently, different entities and people are paying different amounts for the same thing. If we had simple pricing transparency and quality transparency, we would go a long way towards making markets work in health care--defeated on a party vote.

Finally, I offered an amendment that would have allowed reimportation of prescription drugs. When you have a situation where--we have a popular example of this in the EpiPen, costing Americans who need access to the EpiPen over $400, and yet in neighboring countries-- Canada, Australia--EpiPens cost $40 or $50, one-tenth as much.

It is not unique to the EpiPen. By no means is that an exception to the rule. In fact, it is the rule. By allowing reimportation of prescription drugs, a proposal that was backed in the Senate in a bipartisan way by many of my Democratic and Republican colleagues as a budget amendment, we could actually reduce costs in health care, making the goal of expanding coverage even easier with those reduced costs.

You know, when I think about health care, I think it is important to think about who in our districts and States it most affects. I think of Pat Hayward, a constituent in my district who lives in Loveland.

Pat has so many family members who would be directly impacted by the repeal of the ACA. For instance, her husband has melanoma and over the years has needed several procedures to remove cancerous cells from his skin.

Had those procedures not been done in a timely and efficient manner, it could cause major complications, including premature death for Pat's husband.

Prior to the Affordable Care Act, when they tried to change insurance carriers, her husband was told that any coverage would exclude coverage of cancers, the very type of coverage he needed, because it was a preexisting condition. They literally would have had to choose between bankruptcy or being forced out of their home and into destitution or not getting the lifesaving melanoma treatments that he needed.

But it is not just Pat's husband who has benefited and perhaps is alive and thriving today because of the protections of the Affordable Care Act. Pat's eldest son took advantage of a provision that allowed him to stay on his parents' plan until he got a job with health insurance at age 25.

Their younger son has struggled with anxiety and panic attacks, but thanks to comprehensive mental health treatment and the protections of the mental health parity that are in the Affordable Care Act--and being rolled back under the American Health Care Act, the Republican bill to replace it--their son is now back in college and thriving.

Pat, herself, expressed gratitude. The Affordable Care Act covers wellness visits and tests like mammograms, which can detect problems early, reduce costs, and save lives.

I share this story--and Pat wanted me to share her story--because families like the Haywards are like families in every State, in every county, in every ZIP Code in the country. American families have faced their share of medical challenges, as have mine, and I am sure that yours has as well, Mr. Speaker. Medical challenges crop up unexpectedly. They don't have any bias toward a political party. They affect Democrats and Republicans and Independents and Greens and apathetic voters and diligent participants in our civic system. They make no distinction.

But the Affordable Care Act is there to make it easier for families across our country to stay healthy, to get better, to save their lives so that kids can grow up with their parents healthy, kids can grow up and be able to go to school and get good jobs.

And like so many of my constituents, Pat told me she would rather see the current system improved than thrown out entirely, and I agree. That is why I offered the pricing transparency amendment, the public option amendment, and the reimportation of prescription drug amendment; and there are dozens of other ideas to improve the Affordable Care Act from my side of the aisle. I offered amendments in committee that would have codified these provisions into law.

I plan to continue to fight to improve access and lower healthcare costs, but dismantling the Affordable Care Act is simply counterproductive towards that end.

The Republican proposal to create a brand-new entitlement program would cause 24 million Americans to lose their insurance--over 1 million more than repealing the Affordable Care Act. For those who are lucky enough to still have their insurance, it would increase rates by 15 to 20 percent.

It would also, for reasons unknown, have an enormous tax cut for billionaires and millionaires. We know Republicans want to do that, but they should do that through a tax bill, not through something that is supposed to be a healthcare bill--enormous tax cuts. We are not even talking the wealthiest 1 percent. Most of those tax cuts go to the wealthiest one-tenth of 1 percent of Americans. That certainly doesn't help reduce the cost of health care.

Again, this bill can be debated, and, frankly, many of us feel it presents a problem in the risk pools that remove consumer protections. There is a solvency issue around some of these groups. There is a legitimate debate to be had, but we certainly haven't heard anybody present that somehow this bill is any kind of answer to making health care more affordable or expanding coverage.

What we have before us over the next couple of days is a bill that not only is the answer, but is a bill that creates an even bigger problem. The Republican healthcare bill would dig us in a deeper hole with regard to health care, leaving more Americans without coverage, creating a costly, brand-new entitlement program, and raising rates for those Americans who are lucky enough to still have their insurance after the Republicans remove it from tens of millions of people.

If that bill is the answer, what is the question?

Is the question, Mr. Speaker: How do we make health care cost more for American families?

Is the question, Mr. Speaker: How do we have less people covered and throw 20 million people off of health care insurance?

Is the question, Mr. Speaker: How do we make sure that, rather than work hard and try to get a raise or work two jobs, Americans are forced to quit their jobs and be lazy and not work just so that they can have Medicaid eligibility, which is what the brand-new Republican entitlement program would do?

Or, is the answer to move forward in a bipartisan way to improve the Affordable Care Act, a discussion that so many of us are excited to have.

I was disappointed that my three amendments were shut out in partisan votes in committee, and I am hopeful that by resetting this process, we can work together to reduce costs and expand coverage. Defeating the rule today will be the first step towards accomplishing that.

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

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

Mr. Speaker, first of all, amendments that were brought forward by Ms. Bonamici, germane. Republicans shut it down, didn't allow a debate.

Amendment brought forward by Norma Torres for this very bill, germane--not allowed to be debated for not even 10 minutes, not 5 minutes, not even 1 minute. Mrs. Torres wasn't even allowed to offer her amendment under this rule that only allowed Republican amendments.

Finally, Mr. Espaillat's amendment to this bill, yes, germane. He was, nevertheless, shut out in a party-line vote by the Rules Committee and not allowed to present his amendment before the floor that would simply allow States to continue protecting the benefits and consumer protections and rating restrictions in associated health plans, very simply.

Mr. Speaker, we are here considering the rule for H.R. 1101 and we still don't have a cost estimate from our nonpartisan experts at CBO. We certainly believe this legislation will increase premiums for the middle class and seniors, but we don't have any idea how much so. It is becoming a pattern, Mr. Speaker.

Two weeks ago, the Republican majority pushed ahead with their healthcare repeal bill without a cost estimate. A week later, it turned out it will cost 24 million Americans their insurance and 15 to 20 percent increases for those who would still have it.

Late last night, there was a backroom, secretive manager's amendment that was proposed which we don't know the cost of or how it would affect coverage, and it is irresponsible for the Republicans to move forward without knowing the effect of the bill as amended.

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 yield 3 minutes to the distinguished gentlewoman from California (Ms. Lee) to discuss our proposal to make sure we actually know the cost of what is before this body.

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

Mr. Speaker, first of all, over 150 amendments by Democrats were rejected to this healthcare bill before us today, contrary to the process of 8 years ago when over 120 Republican amendments were not only made in order, but were actually incorporated into the healthcare bill despite the fact that, for final passage, not a single Republican voted for it.

So when we talk about the record and the precedent, there couldn't more of a night-and-day difference between what is occurring today where Democrats are locked out and the effort 8 years ago where Republican ideas were welcomed in the process.

I also want to ask my colleague from Alabama--I was hoping that he would yield me the time to do so, and I will have to yield him time for an answer--he mentioned that this manager's amendment has already been posted and we will have 3 days to look at it. I just want to get his assurance that the version that we saw posted is the actual version that will be brought to the Rules Committee and presented on the floor and there will be no further changes to the manager's amendment, if the gentleman can assure me of that.

I yield to the gentleman from Alabama.

Reclaiming my time, Mr. Speaker, I also would like to ask if we are going to have a score from the Congressional Budget Office prior to the House having to vote on that manager's amendment?

I yield, for an answer, to the gentleman from Alabama.

Mr. Speaker, reclaiming my time, again, that simply confirms what our previous question would simply require, that before the bill is voted on we will simply know how much it costs and who it impacts. What could be more important than finding that out.

I think it is important to note that Democrats have been shut out of the process, at the committee level, in the amendments I offered. Even the germane amendments of this particular bill before us today, Democrats were locked out.

Rather than allow Members of both parties to participate in reducing the costs of health care and increasing coverage, Republicans have come up with a bill that actually increases costs and decreases coverage.

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

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

Mr. Speaker, the statistics we are talking about, the fact that it will cost Americans 15 to 20 percent more to get health care, the fact that it will cost 24 million Americans their insurance, these are not statistics that are made up by some group that wants to oppose the Republican effort. They are facts that are arrived upon by the Congressional Budget Office, the head of which was appointed by a Republican. They do diligent work to determine how much bills cost and what their effect is.

Now, of course, you know, those are best estimates. Maybe, instead of 24 million people who will lose coverage under the Republican healthcare bill, maybe it will be 25 million, maybe it will be 23 million. There is always a little bit of variation on what those predictions are.

But whether it is 23 million or 25.6 million, the fact that Americans--millions, tens of millions of Americans--will lose coverage under this Republican bill should be a flashing warning sign that it is time to slow down and work in a collaborative manner to improve the Affordable Care Act, rather than create a brand new entitlement program that throws 24 million people off the insurance rolls, and increases the cost for those who remain by 15 to 20 percent.

This bill immediately before us is a diversion from the real story in health care. In my home State alone, 600,000 Coloradans would likely lose coverage if the American Health Care Act is rammed through Congress, as my Republican colleagues intend to do.

The American Health Care Act would roll back important protections and coverage gains. It would create a brand new entitlement program, while delivering record tax breaks for billionaires in New York and California.

It is clear that this bill threatens the health and welfare of hundreds of thousands of families in Colorado alone, tens of millions across the country. It is time that we get this process right and slow down, rather than cramming a midnight bill through the House of Representatives that we don't even know the cost of, before we are voting on it.

This is simple, Mr. Speaker. Democrats are excited to roll up our sleeves and work together to create a plan that will reduce healthcare costs. If you don't like the amendment I offered for allowing reimportation of prescription drugs, let's talk about other options.

What about Medicare negotiating prescription drug rates? What about removing tax deductibility for the advertisements for pharmaceutical companies?

What about expediting approval process at the FDA, which President Trump himself mentioned in this very Chamber as a proposal that can reduce the cost of approving drugs from the $1.2 billion it costs today, which is passed along to consumers, to a much lower cost, thereby passing the savings along to consumers.

There are plenty of good ideas the Democrats and Republicans can work together on. None of them are this bill before us today. None of them are in the repeal of the Affordable Care Act. So let's just stop this ridiculous partisan process.

I don't want 24 million Americans to be victims of partisanship in Washington. I don't want other Americans who pay for their healthcare insurance to be victims of partisanship in Washington.

I want to make sure that people in my district who are working hard and only able to afford coverage under the Affordable Care Act because of the healthcare subsidies are not forced into medical bankruptcy and to give up their jobs and rely on Medicaid because of Republican efforts to ram through this brand new entitlement program.

Let's get this right. There is plenty of opportunity to work together to reduce costs and expand coverage. The American Health Care Act does the exact opposite. It increases costs and reduces coverage.

And instead of these incremental bills, like this so-called Small Business Health Fairness Act, which actually winds up removing protections and pushing more costs onto working families and seniors, we should improve upon and fix the Affordable Care Act that we put in place 7 years ago. We should support innovation to produce healthier outcomes, to reduce costs, and, yes, to expand coverage across our country.

We have a unique opportunity in this Congress to put partisanship behind us, to work together to make affordable health care a reality for every American family. Because you know what? When you have a preexisting condition, like I talked about Pat's husband in my district who suffers from melanoma, it doesn't matter whether he is a Republican or a Democrat or Independent or whether he is not even registered at all.

What matters is that he is a father to two children, a husband to his wife, and he wants the ability to work with dignity, support himself, and have medical insurance to receive his lifesaving monthly injections that allow him to maintain his quality of life and continue to work and pay taxes and support his kids and family. That is what healthcare coverage is all about.

So let's stop this silly partisanship. This Republican American Health Care Act actually kicks more people off of the healthcare rolls than simply repealing ObamaCare. By creating this brand new entitlement program, they are actually costing an additional 1 millions Americans their healthcare insurance.

But the answer is not to cost 23 million people their healthcare insurance. It is not to take it away from 24 million people. You know what the answer is, Mr. Speaker, is to provide a way that more people can work hard and pay into the system, and that we decrease the number of Americans who lack access to healthcare insurance which, in turn, reduces the costs for the rest of us because of the cost shifting that occurs within health care.

Mr. Speaker, I know so many of my friends on the Republican and Democratic side of the aisle, dedicated public servants with thoughtful ideas that they have based on their life experiences, that they want to present before this body to reduce the cost of health care. Let's let them do it. Let's have an open process.

So, 150 amendments from Democrats were shot down in committees, not even allowed to be debated, not even allowed to be included in this healthcare bill. Three of mine were shot down. In this very rule today, amendments by Mr. Espaillat and Ms. Bonamici were not even allowed to be debated.

The American people want health care to be affordable, and they want Republicans and Democrats to work together to accomplish that end.

Let's vote ``no'' on this rule. Let's reset the process. Let's fix health care. Let's expand coverage. Let's reduce costs. I look forward to working with my colleagues on both sides of the aisle to accomplish those important goals that my constituents have sent me here to work on.

I urge my colleagues to vote ``no'' on the previous question so we can know the cost of any manager's amendment before we vote on it; to vote ``no'' on the rule, and to vote ``no'' on the underlying bill.

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

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

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

Mr. Speaker, today we are considering a bill that purports to make it easier for small businesses to obtain coverage, and tomorrow we will vote on a bill that will take away health insurance coverage for 24 million Americans and force everyone else to pay more for less. So not only are we considering a bill today that will make things worse, we are considering it a day before we vote on ruining health security for working families in order to provide tax cuts for the wealthy.

As we debate the possible replacement of the Affordable Care Act, I think it is instructive that we look back at what the situation was before the ACA passed.

Listening to some, you would think that the costs weren't going up at all. In fact, costs were going through the roof before the ACA, and small businesses, particularly, were having spectacular cost increases--and that is until somebody got sick. At that point, you were unlikely to be able to afford any insurance at all.

Every year before the ACA, small businesses were dropping insurance right and left, particularly after somebody got sick. Also, before the Affordable Care Act, people with preexisting conditions couldn't get insurance. Women were paying more than men. Millions of people were losing their insurance every year.

Since then, the costs have continued to go up, but at the lowest rate in the last 50 years. People with preexisting conditions can get insurance at the standard rate. Small businesses can cover their employees through the Affordable Care Act at the average cost, whether or not anybody in their small business has cancer or diabetes. Women are not paying more than men. Instead of millions of people losing their insurance every year, 20 million more people have insurance.

In addition to that, families now enjoy strong consumer protections. The full name of the Affordable Care Act is the Patient Protection and Affordable Care Act. Now there are no caps on what an insurance company pays, and they can't cancel your policy for anything other than nonpayment. Preventive services such as cancer screenings are available with no copay or deductible. Those up to 26 can stay on their parents' policy, and the doughnut hole is being closed.

The ACA did not cure every problem, but it went a long way to making Americans healthier and giving them some economic security. It could have gone further if, in the past 7 years, Republicans would have been willing to work with Democrats to build on the progress instead of forcing over 60 votes to repeal all parts of the Affordable Care Act.

If we do anything now, we ought to improve the situation, not make it worse. The Republican plan makes things worse. The CBO analysis concluded that 24 million fewer people will have insurance, and most of those that get insurance in the future will be paying more for policies that don't deliver as much.

For seniors, particularly, the costs will skyrocket. And, in fact, the prediction that the rates will go down in

the future are a result of the conclusion that so few seniors will be able to buy insurance that they will no longer be in the insurance pool.

The insurance pool would be younger, and, therefore, the costs would go down. But that is only because seniors won't be able to afford the insurance. Therefore, the insurance pool will be younger and cheaper for those who can actually afford it, but that is not a good thing for seniors who need the insurance and can't afford it.

So today we are considering another failed policy. The association plan ideas have been studied for years, and it has been concluded that it is a bad idea. Under the Affordable Care Act, essentially everybody pays average. If you change that arithmetic so some can pay a little less, then arithmetic matters. Everybody else is going to pay a little more.

In the association plans, quite frankly, I will admit, they will always work for the few that can get into them. That is because, if you can draw out your own group, if they are healthier than average and can pay less, they will pay less and the association will work. But if you pull out a group and it turns out they are a little sicker than average and the bids come in above average, then the association will dissolve and everybody will go back into the insurance pool.

So if you can pull out a group, they will always pay less until somebody gets sick, and then everybody jumps back into the insurance pool. The higher cost groups will be left behind. The lower cost groups will segment out, and then the rates will go down for a few and up for everybody else.

This is exactly why the American Academy of Actuaries has said that expanding association plans ``could result in unintended consequences such as market segmentation that could threaten . . . viability and make it more difficult for high-cost individuals and groups to obtain coverage.''

One of the other problems is a lack of regulation. If a group is allowed to circumvent State regulations, that policy may be cheaper because the policy is not as good.

There are a lot of ways that you can save money. You can pull out a group of just young men and save on maternity benefits. That would be cheaper for them but more expensive for everybody else.

And what happens when a new spouse needs coverage and tries to get it as an optional benefit? They won't be able to afford it.

Workers and businessowners are likely to get fewer benefits under the association approach and will be disadvantaged compared to those in the regular pool getting comprehensive benefits.

This is exactly why Consumers Union has stated that the legislation is ``likely . . . to provide minimal and nonuniform benefits.''

Mr. Speaker, this bill will make it easier to set up these kinds of associations and let them avoid State regulations, which could require solvency, nice solvency requirements, and consumer protections. The protections in this bill are not sufficient to protect consumers, and most States would require stronger capital requirements than the bill requires.

Much like the Republican replacement bill, this bill goes in the wrong direction, so I urge my colleagues to vote ``no.''

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

Mr. Speaker, I yield 4 minutes to the gentleman from New York (Mr. Espaillat).

Mr. Speaker, I yield 4 minutes to the gentleman from Connecticut (Mr. Courtney).

Mr. Speaker, I yield an additional 1 minute to the gentleman.

Mr. Speaker, would the Chair advise us how much time is available on both sides?

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

Mr. Speaker, I just wanted to point out a few letters that we have received, one from the Diabetes Association, which includes, in part: ``The Association has serious concerns that AHPs would lead to a two- tiered market, in which AHPs offer inadequate coverage to healthy groups only, while State-regulated plans provide adequate coverage with consumer protections but at an increasingly higher premiums. For these reasons, we urge you to oppose the Small Business Health Fairness Act of 2017, H.R. 1101.''

We have also received a letter, Mr. Speaker, from the National Association of Insurance Commissioners. They said in their letter: ``The legislation as written would eliminate all State consumer protections and solvency standards that ensure consumers receive the coverage for which they pay their monthly premium. These protections are the very core of a State regulatory system that has protected consumers for nearly 150 years . . . history has demonstrated that AHP- type entities have done more harm than good to small businesses.''

Mr. Speaker, we also received a letter from The Main Street Alliance, which said: ``In short, H.R. 1101 would result in higher premiums and poorer coverage for the most vulnerable small-business owners, would destabilize the small group market, and would lead small-business owners and employees to assume unnecessary financial risks.''

We also heard from the Consumers Union: ``Consumer's Union has long raised the inadequacies of AHPs . . . and urges Congress to reject them as likely to fragment the insurance risk pool and provide minimal and nonuniform benefits exempt from State benefit mandates.''

We also heard from a long coalition of consumer groups, providers, and labor unions which said that this bill would just move backward to a two-tiered system that makes it harder to purchase comprehensible, affordable coverage for all but a minority of small businesses.

Mr. Speaker, I include in the Record these letters.

American Diabetes Association,

March 21, 2017.

Hon. Paul Ryan,

Speaker, House of Representatives,

Washington, DC.

Hon. Nancy Pelosi,

Democratic Leader, House of Representatives,

Washington, DC.

Dear Speaker Ryan and Leader Pelosi: On behalf of the

nearly 30 million Americans living with diabetes and the 86

million more with prediabetes, the American Diabetes

Association (Association) is writing to express our strong

opposition to the Small Business Health Fairness Act (H.R.

1101). This legislation is nearly identical to legislation

considered by previous Congresses and that last passed the

House of Representatives in 2003. The Association opposed

that legislation and writes now to express our strong

concerns with this bill and the impact it will have for

people with, and at risk for, diabetes.

The legislation would create federally certified

association health plans (AHPs) with the goal of making

coverage more affordable for small businesses by allowing

them to band together to purchase coverage on behalf of a

larger insurance pool. We share the goal of making coverage

more affordable, but not at the expense of required consumer

protections, signed into law in 47 states, which ensure

people with diabetes have access to the services and

financial protection they need.

H.R. 1101 would broadly exempt AHPs from critical state

benefit standards, solvency rules, and consumer protections,

including requirements to cover health services essential to

those with diabetes. Specifically, H.R. 1101 would confer on

AHPs wide authority to:

Determine benefits to be covered: Other than requiring AHPs

to meet limited federal requirements for ERISA-governed

plans, H.R. 1101 would give AHPs broad discretion to omit

important health benefits.

Determine eligibility for coverage: While H.R. 1101 would

require AHPs to comply with ERISA non-discrimination

provisions, the AHP board would retain sole discretion to

approve applications for participation in the plan and to set

premiums based on an employer's health care claims

experience.

Maintain inadequate reserves: H.R. 1101 applies federally

determined solvency standards that are weaker than state

standards, exposing plan members to the risk of insolvency

and unpaid medical bills.

Because AHPs would compete with state-regulated plans on an

uneven playing field, they would likely cherry-pick healthy

small employer groups, making the risk pool in the state-

regulated market less healthy and more costly. In addition,

those who obtain coverage through an AHP would likely have

benefits that lack coverage for essential services and would

expose them to higher out-of-pocket costs and potential plan

insolvencies. In fact, numerous AHPs offered in the past have

gone insolvent and left consumers uninsured and with unpaid

medical bills.

The Association has serious concerns that AHPs would lead

to a two-tiered market, in which AHPs offer inadequate

coverage to healthy groups only, while state-regulated plans

provide adequate coverage with consumer protections but at

increasingly higher premiums. For these reasons, we urge you

to oppose the Small Business Health Fairness Act of 2017,

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

Mr. Speaker, the bad idea in this plan has been exposed in one of the letters that I mentioned. I said there are a lot of consumer groups, and I just want to name the groups that signed the letter. The American Nurses Association; the Alliance for Retired Americans; the American Cancer Society Cancer Action Network; the American Diabetes Association; the American Federation

of State, County and Municipal Employees; the Association of Reproductive Health Professionals; Bazelon Center for Mental Health Law; Community Catalyst; Consumers Union; Families USA; International Union, United Automobile, Aerospace and Agricultural Implement Workers of America--the UAW; NARAL Pro-Choice America; the National Council of La Raza; the National Education Association; the National Institute for Reproductive Health; National Partnership for Women and Families; National Women's Health Network; Raising Women's Voices for the Health Care We Need; and the Service Employees International Union all oppose this legislation.

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

Mr. Speaker, I just want to quote from another letter that we received from Blue Cross Blue Shield Association. They say: ``We have very serious concerns that H.R. 1101 would create preferential rules that would allow an AHP to be entirely exempt from State regulation by being self-insured or follow the rules of a single State nationwide. Research clearly shows that creating special rules for AHPs and exempting them from State regulation would lead to major problems, including . . . increased insolvency risk . . . increased costs for older, sicker workers.'' Therefore, they are also in opposition to this legislation.

I include in the Record the entire letter.

BlueCross BlueShield Association,

Washington, DC, March 7, 2017.

Hon. Virginia Foxx,

Chair, Committee on Education and the Workforce, House of

Representatives, Washington, DC.

Hon. Robert C. Scott,

Ranking Member, Committee on Education and the Workforce,

House of Representatives, Washington, DC.

Dear Madam Chairwoman and Mr. Ranking Member: The Blue

Cross and Blue Shield Association shares your commitment to

ensuring small employers are able to provide their employees

with high quality, affordable health coverage. However, we

are concerned that H.R. 1101, the ``Small Business Health

Fairness Act'' would not accomplish this critical goal, as it

does not reflect key principles that are essential to

ensuring a viable private health insurance market: (1) all

competitors should abide by the same set of rules; and (2)

states should have clear authority to regulate.

Today, small businesses are able to join together to

purchase coverage through association health plans (AHPs).

AHPs are currently regulated by the states, just like other

insurance in the small group market, and can be a good option

for small employers who want to provide their employees with

affordable coverage.

We have very serious concerns that H.R. 1101 would create

preferential rules that would allow an AHP to be entirely

exempt from state regulation by being self-insured or follow

the rules of a single state nationwide. Research clearly

shows that creating special rules for AHPs and exempting them

from state regulation would lead to major problems,

including:

Increased insolvency risk: The legislation as drafted would

allow for some AHPs to be entirely exempt from state

regulation, and instead operate under very limited federal

rules and oversight. Past experiences with these kinds of

arrangements left millions without health coverage and unpaid

claims due to insolvencies.

Increased costs for older, sicker workers: Ultimately, H.R.

1101 would make it much harder for small employers with

older, sicker workers to obtain coverage. This is because

lower-cost groups would move to a more loosely regulated AHP

with fewer benefit and rating rules, while older and/or high-

cost groups would remain in traditional insurance plans.

Attached is a compendium of research findings, which

provides overwhelming evidence that AHP legislation would

make health insurance less accessible, less affordable and

less secure for small employers and individual consumers.

We look forward to working with you on solutions that can

be taken to improve access and affordability for small

employers.

Sincerely,

Alissa Fox,

Senior Vice President.

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

Mr. Speaker, association plans will help the fortunate few who can get in so long as the members of that association remain healthier than average. But everybody else will pay more. Furthermore, these plans, when they are formed under the bill, will evade important State regulations that could improve solvency and provide important consumer protections.

This is not unlike the philosophy, I guess, on the other replace bill where 24 million fewer people will have insurance; the rest will pay more and get less; while millionaires benefit with huge tax cuts. In this, the fortunate few benefit to the expense of everybody else.

I would hope we would defeat the legislation.

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

Mr. Speaker, I ask unanimous consent to claim the time in opposition, although I am not opposed to the amendment.

Mr. Speaker, I appreciate the intent of the amendment offered by the gentlewoman from Washington, which seems to allow health association plans that are currently in existence to continue to operate under existing State and Federal law. In fact, giving States the ability to regulate association plans is very important. That is why I oppose the underlying bill.

The amendment also points out another interesting fact, and that is associations currently exist under current law, and the underlying bill simply unravels most of the regulations that apply to them, and this amendment would at least maintain State regulations.

We know that this bill creates winners and losers. The winners are those who are young and healthy enough to be invited into an association. The losers are small businesses and employers who are older, sicker, or just have more costly health bills. There is no guarantee that plans under this legislation will have the standard level of benefits or consumer protections, and that is why I am disappointed that the majority failed to rule any Democratic amendments submitted to the Rules Committee in order, although each and every one was germane.

The gentleman from New York (Mr. Espaillat), who is a member of the committee, offered an amendment that

would have protected the ability of the States to regulate any association health plan, including regulation related to benefits, consumer protections, and rating restrictions. Representative Torres from California offered an amendment to ensure that association plans cover 10 essential health benefits under the Patient Protection and Affordable Care Act.

One amendment was offered by Representatives Susan Davis of California and Suzanne Bonamici from Oregon--both committee members-- would have required association plans to provide for women's health benefits, including maternity care.

Representatives Bonamici, Davis, and Wilson also offered an amendment to prevent this legislation from taking effect if it would lead to increased premiums for older workers. These older workers will not be able to get into the associations because they would increase average costs of the association, and the point of the association is to get away from high-cost enrollees like older Americans. So these older people will be left out of the pool with other older and sicker workers where they will necessarily be paying more.

It is simple arithmetic. Their amendment would have been particularly important because we know that the Republican replacement plan contains an age tax that will severely disadvantage older populations.

None of the Democratic amendments, although germane, were allowed under the rule, and there does not seem to be any earnest attempt to look to try to correct the shortcomings of the bill. So while I do not intend to oppose this amendment, I do not think the amendment is enough of an improvement of the bill, nor does it change the underlying fact that the legislation does not adequately protect small businesses, workers, and their families, nor does it help those left behind who are not invited into the association who will necessarily be paying more.

Mr. Speaker, if those on the other side of the aisle want to go on a rescue mission, they ought to improve things, not make things worse. For most Americans, this bill will make things worse, and, tomorrow, 24 million Americans will be left out while many others will be paying more for less while millionaires get huge tax cuts. That is not an improvement.

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

Mr. Speaker, I would point out that when one size fits all, everybody can benefit; but when you start picking and choosing winners and losers, some will benefit and many others will lose. Under this bill, a fortunate few who get into association plans will benefit; everybody else loses.

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

Mr. Speaker, I demand a recorded vote.

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 210 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 may have 5 legislative days to revise and extend their remarks.

Mr. Speaker, House Resolution 210 provides for consideration of H.R. 1101, the Small Business Health Fairness Act of 2017.

President Trump promised to repeal and replace ObamaCare, which is negatively affecting our economy and causing great hardship on the American people. Congress is responding this week with multiple bills to do just that.

After years of endless premium increases, we must take steps to make health insurance more accessible and affordable, including for small businesses that employ the majority of Americans. H.R. 1101, the Small Business Health Fairness Act, will do just

that by helping to level inequalities between large and small employers, ultimately making health insurance more affordable for millions of Americans.

Simply put, the Small Business Health Fairness Act will empower small businesses to band together through association health plans to purchase health insurance. This will allow them to increase their bargaining power, negotiating for lower health insurance rates on behalf of their employees, just like their large competitors do.

Additionally, the bill will allow their plans to fall under the Employee Retiree Income Security Act of 1974, or ERISA, and the Department of Labor, just like the large self-funded employer plans, preempting a myriad of State regulations that often make insurance unaffordable for small businesses.

The usefulness of this legislation is easy to imagine. For example, a small accounting firm might employ just three or four people while the largest firms employ tens of thousands. If that small firm could join together with others just like it to provide health insurance through their national association, it could have the same bargaining power and be subject to the same regulation as the firm with thousands of employees. This parity means more options and lower costs for employers and employees.

Mr. Speaker, our Nation's small businesses were hit especially hard by the passage of ACA. In fact, a 2016 survey by the National Federation of Independent Businesses found that small businesses identified the cost of health care as their number one challenge.

An estimated 300,000 small-business jobs were destroyed, and an estimated 10,000 small businesses closed altogether due to the failed ObamaCare policies.

Since 2008, 36 percent of all small businesses with fewer than 10 employees have stopped offering healthcare coverage. This has resulted in less overall healthcare options for working families.

ObamaCare's compliance costs and mandates have resulted in $19 billion in lost wages for small-business employees.

The bottom line is that small businesses--the backbone of our Nation's economy--and their employees are feeling the pain of ObamaCare's failures and broken promises.

I meet with these small-business owners from south Alabama every day. They want to take care of their employees and provide them with high- quality health insurance. Through enacting the Small Business Health Fairness Act, we can help thousands of small businesses achieve that goal.

Mr. Speaker, I also want to point out that this legislation includes strong protections to ensure association health plans are solvent and that the families covered by them are indeed protected. A sponsor of a plan must be a bona fide trade, industry, or professional organization and can't be established for the purpose of providing medical care.

The sponsor must have existed for a period of at least 3 consecutive years before providing group health insurance coverage. The association health plan must be operated by a board of trustees and will be supervised by the Department of Labor. This will include minimum capital requirements and a requirement that plans have a stop-loss and solvency insurance.

Finally and most importantly, the bill prohibits association health plans from discriminating based upon health status and preexisting conditions.

Mr. Speaker, the Small Business Health Fairness Act is about ensuring our Nation's small businesses are afforded the same opportunities given to large corporations and labor unions. When similar legislation has been brought to the floor in the past, it has received strong bipartisan support, as I hope this bill will today.

Ultimately, this bill is just one part of our larger plan to rescue the American people from the failures of ObamaCare. This week, the House intends to vote to repeal ObamaCare, along with its mandates and its taxes.

But we do also understand that the pre-ObamaCare status quo is not acceptable. That is why the House is already moving to consider bills to give Americans the freedom, choices, and control they deserve.

Our solutions are built on free market and patient-centered principles. By getting the government out of the way and increasing competition, we can draw down costs and help Americans obtain health care that actually works for them.

Mr. Speaker, I urge my colleagues to support House Resolution 210 and the underlying bill.

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

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

My colleague from Colorado raised an important question: What are the Republicans trying to accomplish here? It is pretty simple. We are trying to give freedom and choice back to the American people who lost their freedom and choice and control over their healthcare plans, who lost freedom and control over their health care because of an ill- considered law passed by this Congress several years ago.

He talked about the cost to American consumers. If you want to pass something that is going to increase cost to American consumers, this Congress did that several years ago. Look at the dramatic increase in healthcare insurance premiums, the dramatic increase in people's deductibles that have occurred since the Affordable Care Act--the so- called Affordable Care Act--was passed here in Congress several years ago.

We are trying to reverse that. We are trying to get control back. And, in fact, we know from the Congressional Budget Office score that it will lower premiums by 10 percent. We haven't seen premiums go lower in years. So if they want to know what we are trying to accomplish, it is plain on its face.

The gentleman referred to some amendments that he offered in committee. Every one of those amendments was ruled nongermane.

And for those of us that maybe don't understand a lot about what ``germane'' means, it is pretty simple. You can't offer amendments to a bill that aren't related to the subject matter of the bill.

The chairwoman of the committee ruled that he offered amendments that weren't germane to the bill that we have today. So the gentleman didn't lose because people were trying to lock him out of the process. He just offered amendments that had nothing to do with the underlying bill.

He talked about the fact that this underlying bill for the rule we have today will lure away young and healthy workers.

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Let me say it again. I said this in my principal remarks. Under this bill, none of these association health plans can discriminate against anybody. They can't do that. They can't say we are only going to let young or healthy people in the plan. They have to admit everyone. So there is no discrimination here. Everyone will be covered.

And remember how many people in America work for small businesses. All types of Americans work for small businesses. We are not trying to hurt them. We are trying to give them more opportunities to get better health insurance that will cost less money.

And if there was anything in here that would cause discrimination, we would have heard long and hard about that before this point. I would suggest to you, Mr. Speaker, that that is not a relevant argument to this particular bill. Every plan that is going to be

under this bill must comply with the regulations of the Department of Labor, just like big corporation plans have to comply with the regulations of the Department of Labor.

We are simply treating small businesses through these associations the same way we treat big corporations. We have essentially denied to the employees of small businesses the same opportunities to get good health insurance at a lower cost that their colleagues that work for bigger corporations get.

The reason the bigger corporations have this is because the Department of Labor comes up with a nationwide rule so you don't have all these different variations from State to State and allows for those big companies to do the things that they can do so very well because of their size to get better health care for an affordable cost for their employees. We are giving the same thing to these small businesses through their associations.

And remember, this is not just one bill. We actually just passed a rule. We will be considering another bill that will exempt, from the provisions of McCarran-Ferguson, health insurance so we get more competition into the health insurance market.

This bill is on top of that. It is on top of the AHCA that we will be considering later this week and other bills that will be coming, because there are a host of things that we are doing on this side of the aisle to make sure we restore freedom and choice and affordable care to the people of our country.

We are not removing people from health insurance in any of the bills that we are doing. We are giving them the freedom to choose. And that is what America is really all about: the freedom to choose.

Right now we are coercing, by law, people to go out and buy health insurance that they don't want. That shouldn't be done in America. We are going to give them their freedom back. And if they chose not to buy health insurance, that is their right as Americans. That is not taking something away from somebody. That is giving them their freedom back.

So I would suggest to the gentleman that, if he wants to look for something that is going to help the workers of America, this bill and the other bills that our side of the aisle are proposing will do just that.

Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr. Dunn).

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

Mr. Speaker, the manager's amendment that has been referred to was put on a public website last night. Everyone in the House of Representatives will have 3 days to read the manager's amendment. There is nothing secret about it.

Bills are not written in front of cameras. They are written so that they can be put on public websites for all of us to see it. This manager's amendment was handled like many, many other manager's amendments are handled, including the way manager's amendments have been handled by the other side when they were in the majority.

Let's remember, in 2010 when the reconciliation bill was passed that established the ACA, no amendments were allowed on the floor--none, zero. So if there is a precedent that has been set in this House, it was set by my friends on the other side of the aisle when they passed the Affordable Care Act and wouldn't allow any amendments by any Member of the House. That is the precedent.

There is nothing new about the way this manager's amendment was handled. It was handled the way manager's amendments are handled virtually all the time. Everybody in this House now has a copy of it, has plenty of time to read it and ask questions about it. Nothing secret going on here.

The truth of the matter is that we are moving forward with our plan, as we said we were, to repeal and replace ObamaCare, to give freedom and choice back to the people of America so that patients control their health care, not a bureaucrat in Washington.

I reserve the balance of my time.

Will the gentleman yield?

As far as I know, speaking back to the gentleman from Colorado, the manager's amendments that were posted last night are going to be the manager's amendments that we will consider tomorrow in the Rules Committee.

Mr. Speaker, I am ready to answer the question.

We believe that we will be receiving the CBO table prior to the vote on the floor of the House of Representatives.

Mr. Speaker, from what I saw in the CBO score of the bill, the AHCA bill actually reduces government spending, reduces taxes, and reduces health insurance premiums over the window of the CBO score.

So it does the exact opposite of what the gentleman suggested. It does exactly what the American people sent us here to do.

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

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

I certainly agree with my colleague from Colorado that we should avoid silly partisanship, and I hope that that means we won't see silly partisan procedural motions and points of order between now and the end of the week. We have seen plenty of those up until this point in time by our friends on the other side of the aisle, and I hope that his statement means we won't see any more since he believes that silly partisanship is bad for this body and the consideration of these important healthcare bills.

We are not here today to talk about the AHCA. We are here today to talk about the Small Business Health Fairness Act. That is what this rule covers.

Let me go over again what has happened to small businesses, but, more importantly, what has happened to the people who work for small businesses. An estimated 300,000 small-business jobs were destroyed by ObamaCare; 10,000 small businesses closed because of ObamaCare.

Since 2008, 36 percent of small businesses that have fewer than 10 employees have stopped offering healthcare coverage altogether. ObamaCare's compliance costs and mandates have resulted in $19 billion in lost wages for small-business employees.

The majority of people in this country work for small businesses. We are trying to give them a fair shake. We are trying to give them their freedom and their choice back. We are trying to give them affordable care because their freedom and their choice and the affordability of their care has evaporated over the last several years.

Ask anybody in America. They come up to me all the time in my district and tell me this.

We, through this bill and the other bills we are considering, are repairing the damage done to the people of America by ObamaCare.

Now, my colleagues can throw up dilatory points of order and other procedural items later on if they want to engage in silly partisanship, or we can get down to the business of taking care of the workers in America.

This bill, or a concept like this bill, has been on this floor before and enjoyed bipartisan support. If we are going to drop silly partisanship, let's drop it right now on this rule and on this bill, and adopt it for the good of the workers in these small businesses throughout America.

Mr. Speaker, I again urge my colleagues to support House Resolution 210 and the underlying bill.

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

Mr. Speaker, pursuant to House Resolution 210, I call up the bill (H.R. 1101) to amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees, and ask for its immediate consideration.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material on H.R. 1101.

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

I rise today in support of H.R. 1101, the Small Business Health Fairness Act of 2017.

Mr. Speaker, this week marks 7 years since ObamaCare was signed into law. We all remember the promises former President Obama and Washington Democrats made at the time.

Families were promised that their healthcare costs would go down. They were promised more choices and more competition. Small businesses and their employees were promised greater access to affordable health care.

But for 7 years, we have watched as all of those promises were broken. For 7 years, we have heard from families and small businesses across the country that have seen their healthcare costs skyrocket and their choices diminish.

Members of the House Education and the Workforce Committee recently heard from Scott Bollenbacher, an Indiana small-business owner with 11 full-time employees. The company has been forced to switch healthcare plans twice now under ObamaCare, and their only viable option this year was a plan with a 78 percent premium increase.

Mr. Bollenbacher is one of countless small-business owners struggling to make ends meet under a failed government takeover of health care. Because of ObamaCare, 300,000 small-business jobs have been destroyed, including nearly 8,000 in my home State of North Carolina.

Additionally, an estimated 10,000 small businesses nationwide have closed their doors, and small business employees have lost $19 billion each year in wages.

It should come as no surprise that, since 2008, the share of small businesses with fewer than 10 employees offering health coverage has dropped 36 percent. It is not that they don't want to; it is that onerous mandates and regulations have made it simply unaffordable to do so.

Fortunately, relief is on the way. This week we are not only moving to repeal ObamaCare, we are also advancing positive reforms that promote affordable coverage for working families, including the Small Business Health Fairness Act.

As its title implies, this important legislation is about fairness for small businesses and their employees. Today, small businesses are on an unfair playing field with larger companies and unions when it comes to health care. Large businesses have the ability to negotiate for more affordable healthcare costs for their employees, but small businesses do not have the same advantage. Because of their size, small businesses have limited bargaining power, which means their employees can end up paying more for health insurance.

With millions of Americans employed by a small business, it is long past time to level the playing field. That is exactly what this commonsense legislation is about. This bill would empower small businesses to band together through association health plans, or AHPs, to purchase high-quality health care at a lower cost for workers.

This bill represents a first step toward a more competitive health insurance market that crosses State lines. Under H.R. 1101, small businesses in different States could join together through a group health plan. These plans would have strong protections and solvency requirements to ensure workers can count on healthcare coverage when they and their families need it.

What does all of this mean: more choices, more freedom, and more affordable health care for working families and small-business owners like Scott Bollenbacher. This is a better way, one that stands in stark contrast to ObamaCare's failed approach. Instead of more mandates, this bill empowers individuals to access the high-quality, affordable healthcare plan that meets their needs.

I want to thank my colleague Representative Sam Johnson for championing, for years, the positive reforms in this bill.

I urge Members to vote ``yes'' on H.R. 1101 so we can level the playing field for small businesses and expand affordable health coverage for working families.

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

Mr. Speaker, I yield 6 minutes to the gentleman from Texas (Mr. Sam Johnson), the author of the bill.

Mr. Speaker, I yield 2 minutes to the gentleman from Michigan (Mr. Walberg), the chairman of the Subcommittee on Health, Employment, Labor, and Pensions.

Mr. Speaker, I yield an additional 15 seconds to the gentleman.

Mr. Speaker, I yield 2 minutes to the gentleman from Tennessee (Mr. Roe), a distinguished colleague, a member of the committee, and the chair of the Veterans' Affairs Committee.

Mr. Speaker, I now yield 1\1/2\ minutes to the gentleman from Ohio (Mr. Chabot), the distinguished chairman of the Small Business Committee.

Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Georgia (Mr. Allen), a member of our committee.

Mr. Speaker, I now yield 2 minutes to the distinguished gentleman from Michigan (Mr. Mitchell), a member of the committee.

Mr. Speaker, I yield 2 minutes to the distinguished gentleman from Minnesota (Mr. Lewis), a member of our committee.

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

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

Mr. Speaker, some of our colleagues on the other side of the aisle have spent a lot of their time extolling ObamaCare and indicating that we should just stay with what we have, but we all know that ObamaCare is failing.

Republicans are on a rescue mission. We truly do have a better way. As some of my colleagues have stated, we will be passing the American Health Care Act tomorrow. What we are doing here with this bill is something we could not include in that legislation that will round out what it is we want to do with keeping our promise in what we promised last year in our program called A Better Way.

Let me just talk a little bit about the failures of ObamaCare. As my colleagues have said, all the promises were broken: if you wanted to keep your doctor, you could keep your doctor; if you wanted to keep your healthcare plan, you could keep your healthcare plan. Those promises were the most obvious ones that went away. The cost of health care would be going down, and none of that happened.

Mr. Speaker, in addition to that, there is a 25 percent average increase in premiums this year for millions of Americans trapped in ObamaCare, healthcare.gov exchanges. Nearly one-third of U.S. counties have only one insurer offering exchange plans; 4.7 million Americans were kicked off their healthcare plans by ObamaCare. There was $1 trillion in new taxes, mostly falling on families and job creators; 18 failed ObamaCare co-ops out of 23, which my colleague from Tennessee so eloquently pointed out.

These were established as an alternative to the public option. Those healthcare co-ops collapsed, costing

taxpayers nearly 1.9 billion and forcing patients to find new insurance; $53 billion in new regulations requiring more than 176,800,000 hours of paperwork. ObamaCare regulations are driving up healthcare premiums and costing small-business employees at least $19 billion annually.

As I said in the hearing that we had on this bill, the Democrats want a coercive system. Republicans want a system based on freedom.

Today we have an opportunity to make a real difference in the lives of hardworking men and women who are employed by small business. We have an opportunity to deliver much-needed relief to small-business owners who are trying to do the right thing and provide high-quality healthcare coverage for their employees. This legislation represents a truly positive reform that will help lower healthcare costs for working families and put small businesses on a fair and level playing field.

Small businesses are the backbone of our Nation's economy, and there is no reason why they should be at a disadvantage when it comes to finding an affordable healthcare plan. They should be treated in the same fashion as larger businesses and have the ability to craft healthcare plans that meet the needs of their employees. If we want to encourage small businesses to offer health care at a lower cost to workers, this is one commonsense step we can make.

Again, I thank our colleague, Congressman Sam Johnson, a true patriot and servant of this country, for his longtime support of this legislation.

I urge my colleagues to vote ``yes'' on H.R. 1101, the Small Business Health Fairness Act, which will help more Americans access high- quality, affordable health care.

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

Mr. Speaker, I rise in opposition to the motion to recommit.

Mr. Speaker, this motion is nothing more than a last-ditch attempt to defeat a commonsense bill that will help expand access to affordable healthcare coverage for working families. In fact, this motion represents the same failed approach to health care we have experienced in recent years.

We have seen what happens when the Federal Government dictates the kind of health insurance individuals can and cannot buy. Healthcare costs skyrocket and patients have fewer choices.

While our Democrat colleagues offer a motion that doubles down on a failed approach to health care, my Republican colleagues and I are offering the American people a better way.

The Small Business Health Fairness Act is about empowering individuals, families, and small-business owners so more Americans have access to affordable healthcare coverage. By rejecting this motion and supporting the underlying bill, we can take an important step in keeping our promise to deliver free-market, patient-centered healthcare solutions.

I urge my colleagues to vote ``no'' on the motion to recommit and ``yes'' on the Small Business Health Fairness Act.

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

Mr. Speaker, I have an amendment at the desk.

Mr. Speaker, I thank Chairwoman Foxx and the Committee on Education and the Workforce for their work on this important bill that will benefit small businesses and the families who work for them.

My amendment to the Small Business Health Fairness Act provides a straightforward clarification to ensure that existing association health plans can continue to operate and provide high-quality, affordable care to as many people as possible.

This amendment safeguards association health plans that have been successfully operating under State and Federal law--many of them for decades. We will be making certain that they would not inadvertently be disadvantaged by new Federal legislation or regulation or vulnerable to efforts to restrict access and limit choices.

Why do we need this amendment?

Because I fear what happened in my State will happen in others, where the insurance commissioner attempted to reject 42 out of about 60 association health plans. His office interpreted ObamaCare as giving him a mandate as justification for attempting to eliminate virtually all of these popular plans. By adopting my amendment, it will make crystal clear in the underlying bill that this won't be tolerated, and it will support both existing and future association health plans.

Talk to one of the nearly 400,000 individuals in my home State of Washington who get their care from an association plan, and you will find out why so many Washington businesses renew their plans every year.

Our State has been fortunate to have a robust AHP market that has become essential to providing cost-effective choices to small-business employers, thanks to bipartisan legislation enacted in the mid-1990s. In the case of one association plan operating in my State, roughly 40 percent of participating small-business employers did not previously offer health coverage.

My amendment is supported by the U.S. Chamber of Commerce. In its letter to me, which I include in the Record, the U.S. Chamber indicated that it shares my interest in making sure that State-based association health plans that currently exist are able to continue operating in accordance with existing State and Federal law. My amendment is also supported by the Association of Washington Business.

Chamber of Commerce of the

United States of America,

Washington, DC, March 20, 2017.

Hon. Jaime Herrera Beutler,

House of Representatives,

Washington, DC.

Dear Congresswoman Herrera Beutler: Thank you for your

attention to the concerns raised by the Association of

Washington Businesses regarding H.R. 1101, the ``Small

Business Health Fairness Act.'' The U.S. Chamber of Commerce

has several state chambers of commerce members that provide

state-based quality health care coverage to their member

companies. The Chamber shares your interest in making sure

that the state-based Association Health Plans that currently

exist are able to continue to operate in accordance with

existing state and federal law without being disadvantaged by

this new federal legislation.

The Chamber appreciates your commitment to small businesses

and to ensuring that current affordable coverage options

continue to be available alongside new options in a

nondiscriminatory and fair environment. Thank you for your

dedication and efforts, and we look forward to continuing to

work with you to advance the priorities and interest of

business.

Sincerely,

Randel K. Johnson.

Mr. Speaker, I am confident that the underlying legislation before us today will improve the ability of small businesses to access affordable, high-quality health coverage in every State across the country. However, first, this body should, as clearly as possible, ensure that those States that already have successfully operating association health plans are not disrupted, which is what my amendment would do.

I urge my colleagues to support this amendment, and I thank the chairwoman for her work on this.

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

Mr. Speaker, how much time do I have remaining?

Mr. Speaker, I would just like to say that part of the reason this underlying bill is so critical is because we just don't believe one size fits all. When it comes to health coverage, we need to make sure that there are many different options for families, individuals, and businesses. We are clarifying basically a technical change here that allows continued existing plans to operate.

Who can be opposed to existing plans operating and offering more options and more plans?

This is exactly what Republicans are doing right now. We are fighting to make sure that the families and the people we represent have those options and their choices, that they can keep their doctor, that their health premiums will come down, that they can maybe get a plan through their work, or maybe they will be able to get into the individual market and self-insure--options--because one size does not fit all, which is why this bill is crucial and why my amendment to this bill makes it better. That is why we are going to move forward and make sure that more Americans have access to care--not just on paper--but care that gets them to in to the doctor, that gets them the care that they need, whether it is a specialist or a primary care doctor.

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