Lowering Prescription Drug Costs and Extending Community Health Centers and Other Public Health Priorities Act

Madam Speaker, by direction of the Committee on Rules, I call up House Resolution 377 and ask for its immediate consideration.

Madam Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Oklahoma (Mr. Cole), 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

Madam Speaker, I ask unanimous consent that all Members be given 5 legislative days to revise and extend their remarks.

Madam Speaker, on Tuesday, the Rules Committee met and reported a rule, House Resolution 377, providing for consideration of H.R. 5 under a closed rule, with 90 minutes of debate equally divided and controlled by the Chair and ranking minority member of the Committee on the Judiciary.

The resolution also provides for consideration of H.R. 312 under a closed rule, with 1 hour of general debate equally divided and controlled by the Chair and ranking minority member of the Committee on Natural Resources.

Lastly, this resolution provides for consideration of H.R. 987 under a structured rule, with 90 minutes of general debate, 60 minutes equally divided and controlled by the Chair and ranking minority member of the Committee on Energy and Commerce and 30 minutes equally divided and controlled by the Chair and ranking minority member of the Committee on Education and Labor. Twenty-seven amendments are made in order.

Madam Speaker, we are here today to debate the rule for three important pieces of legislation: H.R. 987, H.R. 312, and H.R. 5.

H.R. 987 is the Strengthening Health Care and Lowering Prescription Drug Costs Act, a package of several bills, many of them bipartisan, that went through the House Energy and Commerce Committee under regular order. This bill combines three key bills to lower drug costs by promoting generic competition and four key bills to strengthen healthcare, reverse the sabotage of the ACA by this administration with respect to marketing and outreach, and rescind the Trump administration's efforts to promote junk plans that lack the protections of the Affordable Care Act.

The American people are justifiably demanding action by Congress to make prescription drugs more affordable. Prices are so high that recent data show 24 percent of Americans didn't fill a prescription in the past year due to high costs.

My constituents have been vocal in demanding action on drug pricing, patients like Bill, a senior with diabetes who attends my church, parents like Sarah with children who have special health needs. Folks like these need help now.

This package would lower costs by banning anticompetitive practices that large drug companies employ to keep generics off the market.

This bill will also tackle many of the reasons we have seen enrollment

through the Affordable Care Act decline in recent years.

Since coming into office, President Trump has cut paid advertising and outreach efforts for healthcare exchanges by 90 percent. This wanton political decision to cut these efforts is but one part of the administration's attempts to dismantle the Affordable Care Act.

Furthermore, lack of transparency on the part of Health and Human Services around funding levels for outreach plan enrollment rates and other vital statistics has created an information vacuum on the performance of the ACA.

Greater transparency is required in order for Congress to hold the administration accountable for its efforts to defund education and outreach for the Affordable Care Act.

Second, we have H.R. 312, the Mashpee Wampanoag Tribe Reservation Reaffirmation Act. This important bill recognizes and respects the Tribal sovereignty of the Mashpee Wampanoag, a Tribe that has inhabited New England for over 12,000 years and, in fact, welcomed the Pilgrims to the new world.

This legislation has strong bipartisan support in Massachusetts among other Tribal nations and with Tribal allies in Congress. Had President Trump not tweeted about this bill last week, it would have likely passed on suspension and been sent to the Senate for consideration. The members of this Tribe cannot wait any longer for recognition, and we need to pass this critical legislation without further delay.

Finally, Madam Speaker, this is a week that will be remembered in our history books because, at long last, this body is taking up consideration of the Equality Act. Forty-five years ago this week, the legendary Congresswoman Bella Abzug introduced the first version of the Equality Act, a bill that will give full legal protections to LGBTQ people all across our country.

This version of the Equality Act that we consider today is the result of years of careful legislative drafting and amends existing civil rights laws to provide protections from discrimination based on sexual orientation and gender identity in key areas of public life: employment, housing, credit, education, public spaces and services, federally funded programs, and jury service.

Additionally, the Equality Act updates the public spaces and services covered in current law to include retail stores, services such as banks, legal services, and transportation services. These important updates will strengthen existing protections for everyone.

The journey to this final version of the Equality Act was led by a man who is a history maker in his own right, co-chair of the LGBTQ Equality Caucus and my colleague on the Judiciary Committee, Congressman David Cicilline from Rhode Island.

Congressman Cicilline worked with lawyers and advocates from the left and the right, religious groups, and myriad civil rights groups to make sure that the language of the Equality Act achieved full legal equality while doing nothing to undermine existing civil rights protections for other marginalized groups.

The resulting bill is supported by 130 of the largest employers in the country, our largest labor unions, and hundreds of organizations, including, to name just a few, the Leadership Conference for Civil and Human Rights, the NAACP, the National Women's Law Center, the Episcopal Church, the Union for Reform Judaism, and the United Church of Christ.

Most importantly, it is supported by a clear and overwhelming majority of the American people. Seventy-one percent of Americans support legislation like the Equality Act to protect LGBTQ people against discrimination in employment, housing, and public accommodations.

Rarely does Congress have the chance to take up legislation so clearly supported by our constituents. That is probably why, since the day that Congressman Cicilline first introduced this version of the Equality Act in 2015, it has always earned bipartisan support and currently has Republican cosponsors in both the House and the Senate.

The clear majority of both this Chamber and the American people recognize that, for far too long, LGBTQ people have faced discrimination with no Federal legal recourse. It is beyond dispute that LGBTQ people, especially transgender people and especially transgender women of color, face discrimination across this country.

This is a personal issue for me. It has been personal since my baby sister came out to me about 40 years ago.

For many people in this country, that is when the fight hits home. It gets personal when someone you love says, ``This is who I am,'' and you know and value that person, and you will do whatever you can to make sure that your loved one can live life to the fullest, free from hate and discrimination.

I am sad to say that my home in the Commonwealth of Pennsylvania is one of the 30 States that defies the will of its people by not having legal protections for LGBTQ people. The idea that my sister, someone who put her life on the line for our country when she served in the armed forces, could drive across State lines and lose protections is heartbreaking.

The Equality Act ends the patchwork of State laws and creates uniform nationwide protections. LGBTQ people won't have to worry that being transferred to another State by their employer or needing to move home to take care of ailing parents will cause them to lose civil rights protections. From sea to shining sea, LGBTQ people will have the security and stability that comes from knowing that if they face discrimination, they have legal recourse.

It is also important to note what the Equality Act does not do. The Equality Act does not impinge on religious liberty. Religious liberty is a cornerstone value of our Constitution and our country. Religious organizations are able to prefer their own members and their version of morality in hiring for religious positions such as ministers, rabbis, or schoolteachers. The Equality Act does nothing to change that.

The Equality Act clarifies what has long been held, though, that religious freedom laws do not create an exemption to civil rights laws. Just like a person can't use a claim of religious freedom to refuse to sell a house to an interracial couple, under the Equality Act, LGBTQ families will be protected from discrimination, regardless of its motivation.

Consider the stakes facing LGBTQ people too often across this country. A same-sex couple walks into a restaurant. They hired a babysitter to look after their young children and are hoping to have a relaxing night out. They are seated and looking at the menu when the manager comes over and tells them they have to leave. They are not welcome there.

This kind of insecurity and humiliation occurs on a daily basis across this country. In 30 States, the couple would have no legal recourse. Often, humiliation is just the tip of the iceberg.

Same-sex couples are far more likely to be denied housing. Qualified and high-performing transgender people are more likely to be fired from their jobs. LGBTQ young people face rejection, homelessness, and discrimination in school, denying them an education. These injuries compound and lead to poverty, homelessness, and violence.

The impact is felt hardest by transgender women of color, who confront racial discrimination, sex discrimination, and gender-identity discrimination. The intersection of these forms of discrimination can even be deadly, as it was for Shantee Tucker, a transgender woman of color from Philadelphia who was murdered last fall.

The protections provided by the Equality Act give LGBTQ people an equal chance at the American Dream. While discrimination and rejection have ended the lives of too many transgender people, many are succeeding, despite discrimination.

In Pennsylvania, Dr. Rachel Levine, a transgender woman, serves in the Governor's cabinet as secretary for health. Mara Keisling, a Pennsylvania native, is the founder and executive director of the National Center for Transgender Equality and a pioneer for civil rights protections. Danica Roem, the first transgender State legislator, serves in the Virginia House of Delegates. LaLa Zannell is fighting violence in New York City. Raffi Freedman-Gurspan was the first openly transgender White House staffer. Miss Major Griffin-Gracy, who was at Stonewall, has spent her life fighting to end

the over-incarceration of transgender people. The list goes on and on.

I am proud that the House will finally act to provide Federal protections to LGBTQ people with passage of the Equality Act. The fight for equal rights is far from over, but I am proud to be part of a majority that prioritizes equal treatment for all of its citizens, regardless of whom they love.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I would just note that, with respect to H.R. 5, we had regular order. H.R. 5, the Equality Act, went through the Committee on the Judiciary. It had a hearing, and then we also had a markup. This is a new process, apparently, since the last Congress. And then, of course, we had the Rules hearing last night.

Madam Speaker, I yield 1 minute to the gentlewoman from California (Ms. Speier).

Madam Speaker, I yield 3 minutes to the gentleman from Massachusetts (Mr. McGovern), the distinguished chairman of the Committee on Rules.

Madam Speaker, I yield the gentleman from Massachusetts an additional 1 minute.

Madam Speaker, I yield 2 minutes to the gentlewoman from Massachusetts (Mrs. Trahan).

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

Madam Speaker, I include in the Record four letters, first, a letter from the National Partnership for Women & Families urging support; second, a letter from the Human Rights Campaign, also urging support for H.R. 5; third, a letter from the American Federation of Government Employees; and finally, a letter from several civil rights groups, all urging support for H.R. 5.

National Partnership

for Women & Families,

Washington, DC, May 14, 2019.

Dear Representative: The National Partnership for Women &

Families is a nonprofit, nonpartisan organization that has

fought for decades to advance the rights and well-being of

America's women and families. We work to foster a society in

which workplaces are fair, equitable and family friendly;

where everyone has access to quality, affordable health care,

including reproductive health care; and where every person

has the opportunity to achieve economic security and live

with dignity.

We write to voice our strong support for the Equality Act

(H.R. 5) and to urge you to vote YES on this groundbreaking

legislation. We also urge you to vote NO on any motion to

recommit that may be offered to undermine or alter the

Equality Act or otherwise harm civil liberties.

Despite significant progress, lesbian, gay, bisexual,

transgender and queer (LGBTQ) people still face considerable

discrimination and lack necessary protections across the

country. While some states have enacted laws that protect

against discrimination, the patchwork nature of these

protections means that millions of people continue to face

harassment, exclusion and uncertainty that negatively impact

their safety, their day-to-day lives, their families and

their ability to participate fully in society.

Part of achieving our nation's promise of equality, dignity

and fairness is ensuring that all people, regardless of

sexual orientation or gender identity, have equal opportunity

to succeed. No one should have access to services or doors to

opportunity closed because of outdated gender stereotypes

about how people should act, look or behave. This requires

stronger national nondiscrimination protections based on sex,

sexual orientation and gender identity.

The Equality Act is historic civil rights legislation that

would amend and supplement the Civil Rights Act of 1964 and

other key federal nondiscrimination laws that provide

protection from discrimination on the basis of race, color,

national origin or religion. This legislation would

strengthen protections from discrimination on the basis of

sex, and add critical new protections from discrimination on

the basis of sexual orientation and gender identity.

Specifically, it would provide clear, explicit protection

against discrimination based on sexual orientation and gender

identity in education, employment, housing, credit, federally

funded programs and federal jury services. These protections

are essential in ensuring that LGBTQ people have the right to

live with dignity and equality.

While the primary focus of the Equality Act is on LGBTQ

people, the Act would also close longstanding gaps in federal

law and provide important new legal protections for all women

by, for the first time, prohibiting discrimination on the

basis of sex in public spaces and services and in all

federally-funded activities. This means that, for example,

when women experience harassment as customers in restaurants,

stores, hotels, taxis or airports, there will now be a

remedy. The law will also ensure that breastfeeding parents

aren't excluded from or treated less favorably in public

places just for feeding their children, and it will make

clear that pharmacies can't refuse to fill a woman's birth

control prescription.

The bill's provisions that would ensure that sex does not

stand as a barrier to full participation in federally funded

programs or activities will mean, for example, that a

developer with a federal grant couldn't discriminate against

women-owned businesses in its contracting. Women would also

have new tools to challenge a police department's

systematically inadequate response to sexual violence and

intimate partner violence, if the police department received

federal funds; and would be able to challenge denials of

reproductive health care where a federally-funded entity

otherwise provides comparable or comprehensive health care.

These protections against sex discrimination are a critical

step forward in advancing women's equality in this country.

As a leading national women's rights organization we also

feel compelled to state emphatically that the Equality Act's

protections for transgender and gender nonconforming people

in no way undermine the rights or protections afforded to

women and do not jeopardize women's safety or their ability

to participate fully or equally in sport or in any other

aspect of our society. Transgender women are women, and any

attempt to mischaracterize their gender identity or suggest

that they are trying to ``take advantage'' of protected class

status fundamentally misunderstands the reality of

transgender people's lives and experiences. Furthermore, it

causes real harm to the more than one million Americans who

identify as transgender, a population already subject to high

rates of violence and abuse, negative mental and physical

health outcomes, and experiences with discrimination and

stigmatization.

The Equality Act is a long-overdue step forward in

extending civil rights protections to millions of women and

LGBTQ people. Establishing clear protections is critical at a

time when vulnerable communities are

under attack. The Equality Act would provide a consistent,

national standard and ensure that everyone has the

opportunity to live safely and with dignity, to advance at

work, to provide for one's family and to thrive economically.

Sincerely,

National Partnership for Women & Families.

Madam Speaker, I yield 2 minutes to the gentleman from Pennsylvania (Mr. Cartwright).

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

Madam Speaker, I include in the Record a list of 364 organizations endorsing the Equality Act, as well as a list of companies supporting H.R. 5 who employ over 9.8 million workers in the United States.

Madam Speaker, today we will move forward on three pieces of legislation whose timely consideration is long overdue. We will move to protect Americans' access to health insurance; provide much-needed relief on prescription drug prices; provide Federal recognition to a Native American community; and at long last, pass the Equality Act, to remove the burden of discrimination and move us closer to a country where members of the LGBTQ community have an equal opportunity to achieve the American Dream.

The Equality Act will not be the end of our long journey towards full LGBTQ equality, but it will finally get

our laws in line with the values our country was founded upon. As was recognized in our founding documents, we must continually take steps to make our country more perfect.

Acknowledging in law the challenges facing LGBTQ people, and taking concrete action to correct them, brings us one step closer to that perfect union.

Madam Speaker, I urge a ``yes'' vote on the rule and the previous question.

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

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

Madam Speaker, I want to begin by thanking the gentlewoman from Pennsylvania (Ms. Scanlon), my good friend, for yielding me the customary 30 minutes.

We, Madam Speaker, are here today on three very different pieces of legislation, which, unfortunately, makes this a complicated rule. One of our bills concerns civil rights, one concerns healthcare, and one concerns Native Americans. I will move through each of these bills relatively quickly, and then I want to address the process we followed to get here today.

The first bill, Madam Speaker, H.R. 5, is a complicated and complex piece of legislation that would make sweeping changes to our Nation's civil rights laws, if enacted. In general, the bill adds the terms ``sexual orientation'' and ``gender identity'' to the list of protected classes under the Civil Rights Act, joining classes like race, gender, religion, and national origin.

As I noted in our hearing yesterday, most Republicans in the House will oppose this bill not because we do not believe that all people should receive equal treatment under the law but because we have real concerns about how this bill will work in practice. A term like ``gender identity'' has such a vague definition that even proponents of the bill do not agree on exactly what the term means.

That should cause legislators to be especially thoughtful and provide clarity about what the term means and how the law will be applied. But we have not done so here.

Republicans have raised numerous questions about how this bill will work in practice. Will female athletes in junior high, high school, and college be forced to compete in women's athletics against competitors who were born biologically male? Will female sexual assault victims be forced to share vulnerable same-sex spaces like locker rooms and dressing rooms with other individuals who were born biologically male? And since the legislation appears to allow people to define their own gender identity, will it allow people to shift back and forth between gender as it suits them?

These are not rhetorical questions. They are real concerns that we have raised, with good reason, throughout the process.

H.R. 5 is known as the Equality Act, and I know every Member of the House, Republican and Democrat, agrees with the principle that all people should be treated equally under the law. But even as we strive toward that goal, when we are dealing with legislation of this magnitude, we must consider how the bill will work in practice.

Unfortunately, I don't think my friends in the majority have clear answers to very legitimate questions. Last night, during debate at the Rules Committee, our concerns were dismissed as we were told that the courts and administrative bureaucrats would sort out these unanswered issues. That is simply unacceptable.

Why would we want any ambiguity when it comes to a person's civil rights? We should be very clear about congressional intent, and the only way to do that is to write a law the way you intend for it to be carried out. Sadly, this bill falls well short of that certainty.

The second bill, H.R. 987, is actually seven bills: three genuinely bipartisan bills addressing prescription drug costs and four partisan and controversial bills addressing ObamaCare.

As I pointed out last night in our hearing, I don't particularly understand what the majority is trying to accomplish here. There are three bills that are all bipartisan that could easily progress to becoming law. I am even a cosponsor of one of those bills. Yet, I have to vote against the entire package because I do not support the partisan and controversial bills attached by Democrats.

Madam Speaker, at some point, the majority needs to decide if they are here to score political points or if they are here to govern. If they want to continue scoring rhetorical victories, then by all means, they should keep doing what they are doing, keep putting up partisan bills that won't go anywhere in the Senate and won't be signed into law, keep putting up messaging bills for the purpose of signaling to their primary voters, and keep spending their days engaged in show votes that won't ever improve the lives of those they were elected to represent.

If they want to govern for the American people, then the majority must move forward with real legislation that can get real support here, in the Senate, and at the White House.

We had the chance to do that with this package. The majority chose not to do so. I think that is a real missed opportunity for us, both as an institution and as a country.

Finally, the third bill, H.R. 312, the Mashpee Wampanoag Tribe Reservation Reaffirmation Act, is a matter I want to discuss at some length because I think there has been, frankly, a lot of misinformation put out about this particular piece of legislation.

The Mashpee Wampanoag is a federally recognized Tribe based in Mashpee, Massachusetts. H.R. 312 would simply reaffirm the taking of land into trust for the benefit of this Tribe.

When the Federal Government takes land into trust for a Tribe, it is reserving that land for the benefit of the Tribe and Tribal members both now and into the future. It ensures that the Tribes have a home, that they have a stable place to build communities and to marshal their resources and conduct business. It ensures that the land that was promised to Tribes, and that was held by those Tribes, in many cases for many centuries, remains in Tribal hands.

Holding land in trust is a commitment made to Tribes by the Federal Government. It affirms Tribes will continue to be able to exercise sovereignty over their own land. That is really all this issue is about today, whether or not the Mashpee Wampanoag will be able to exercise their own sovereignty over their own land.

Unfortunately, some who oppose this bill are doing so because they are viewing this issue through a purely political lens rather than what our own Constitution says about Tribal sovereignty. This isn't a bill about a particular use for the land, and it isn't a bill about particular Members of this institution or the Senate. Instead, this is a bill about keeping Federal promises to Tribes.

Our country hasn't always kept those promises, and we have an opportunity today to step up and make clear that regardless of what happened in the past, today, the Federal Government keeps its promises to Tribes, no ifs, ands, or buts.

Before I close, I would like to make a couple of points about the process this week, particularly on the Equality Act and the healthcare issue.

On the Equality Act, 35 amendments were proposed. I thought that many, if not most, of these should have been considered on the floor. Yet, in the final rule, not one amendment was made in order, and we are considering this bill under a closed rule.

The majority is choosing not to make in order many amendments that deserve our consideration on the floor, like Ms. Holmes Norton's amendment to clarify that Washington, D.C., residents cannot be excluded or disqualified from jury service based on sexual orientation or gender identity, or the bipartisan amendment that would restore the application of the Religious Freedom Restoration Act to this bill, or Representative Johnson's commonsense amendment clarifying that nothing in the act should be construed as to deny parents the right to be involved in their minor child's medical care. These are all deserving amendments that should have been heard on the floor, and yet the majority chose to make precisely none in order.

On H.R. 987, the majority went in a different direction. In total, 51 amendments were submitted to the Rules Committee, and 15 of those were sponsored by Republicans. Yet with today's rule, 27 amendments were made in order, but just one amendment was made in order that was sponsored by a Republican, along with one bipartisan

manager's amendment--one out of 15. All the remaining amendments, 92 percent of those made in order, were sponsored solely by Democrats.

Madam Speaker, I think we can do better than that.

Last week, I reminded the House that when my party was in charge of the last Congress, we went out of our way to make minority and bipartisan amendments in order. Forty-five percent of all amendments made in order in the last Congress were sponsored solely by Democrats, while a further 17 percent were bipartisan.

As of today's rule, the stats are looking much worse for the current majority. Seventy-three percent of all amendments made in order were solely sponsored by Democrats through May 14. Thirteen percent are bipartisan. Just 14 percent were sponsored by Republicans.

We had an opportunity today, particularly on H.R. 5 and H.R. 987, to take steps toward remedying this issue.

I must continue to encourage my good friend, and he is my good friend, the chairman of the Rules Committee, to work with us to make more bipartisan and minority amendments in order and to ensure that all Members, regardless of party, have an opportunity to be heard on the floor, as he has often promised.

Madam Speaker, I urge opposition to the rule, and I reserve the balance of my time.

Madam Speaker, I yield myself a few seconds to respond to my friend from Pennsylvania.

We don't consider the markup in committee a very good markup. Only four amendments were considered, none were accepted, and, frankly, a number of Members seeking recognition for amendments were not recognized. So to think that this was anything other a train moving through a station, I think, is to mischaracterize how that particular markup worked.

With that, Madam Speaker, I yield 3 minutes to the gentleman from Texas (Mr. Burgess), my very good friend, fellow member of the Rules Committee, and also a leading member of the Committee on Energy and Commerce.

Madam Speaker, I yield myself such time as I may consume for just a few minutes to respond to my good friend, the chairman. I want to tell you, there is nobody I hold in higher regard in the House of Representatives than Chairman McGovern, nobody I consider a better personal friend, nobody I consider a more responsible Member.

On this, we disagree. The gentleman is right, neither side is perfect. In this case, we are going to bring attention to this amendment issue until we see results. That is precisely what my friend did when he was in the minority, and there are some times we should have listened to him and we did not.

In this case, I think the imbalance is so egregious that we are going to continue to make that case until we see a change. Maybe we won't. Hopefully we will, because I know my friend approaches this with good intentions.

Secondly, I would say this bill was so important, the Equality Act, it ought to have amendments. That is the point. That is how you build consensus. I think they are missing the opportunity to get a lot of people who would support the basic concept that they are trying to advance.

And, finally, on the drug bill, I have just got to be honest with you. When they had a chance to pass something that would work and chose to bundle it with something that they knew couldn't pass, that makes me wonder how serious they are about dealing with that problem.

But, hopefully, we will get an opportunity to deal with that again. And that is an area we know we can work together on. We have proved it in committee.

So, with that, I look forward to continuing to work with my good friend, the chairman. I know that we will occasionally have differences. That is what this is all about. We will work those differences out.

Madam Speaker, I yield 3 minutes to the distinguished gentlewoman from Missouri (Mrs. Hartzler), my very good friend, who also is a distinguished member of the House Armed Services Committee.

Madam Speaker, I yield an additional 30 seconds to the gentlewoman from Missouri.

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

Madam Speaker, I want to take this opportunity to inform the House that if we defeat the previous question, I will offer an amendment to the rule to immediately bring up H.R. 336, the Strengthening America's Security in the Middle East Act of 2019.

This bill includes four titles, three of which passed the House last Congress, and one of which has already passed the House this Congress on suspension.

My amendment will also include three additional provisions agreed to by the Senate when they considered their version of this bill, so that what we will debate will be identical to what the Senate passed with an overwhelming majority vote in February.

The most critical title of H.R. 336, in my opinion, is the Combating BDS Act of 2019, which will allow a State or local government to adopt measures to divest assets from entities using boycotts, disbursements, or sanctions to influence Israel's policy.

Madam Speaker, yesterday was the 71st anniversary of the founding of the State of Israel. I can think of no better way to celebrate Israel's independence, reaffirm our support for Israel, and indicate our ongoing commitment to a peaceful and more secure Middle East than to consider and pass H.R. 336 immediately.

Madam 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.

Madam Speaker, I urge a ``no'' vote on the previous question, and I reserve the balance of my time.

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

Madam Speaker, in closing, I want to urge opposition to the rule. The majority has proposed three different measures today, and while I am a supporter of the bill concerning Tribal rights, I am opposed to H.R. 5 and H.R. 987, and I regret that.

Quite frankly, had the process on these bills been different, I think the vote that we would see in this Chamber would be very different today. I think, literally, a more fulsome and more open process and amendments on H.R. 5 might have unlocked dozens of additional votes for that legislation.

I think with H.R. 987 we don't have to speculate. We know three of those bills passed out of the Energy and Commerce Committee with unanimous, bipartisan support, all of them dealing with drug prices. That would have been an easy vote. We could have moved that through.

My friends could have still brought the other four matters that they cared about under a rule, brought it to the floor. They have got the votes to move it. It would have precisely the same prospects of success it is going to have in the United States Senate.

The President has already made it clear, since he issued a statement, that he is very likely to veto it if it were to make it to his desk. So why in the world we threw away an opportunity to do some good for the American people in an area where we agree, in order to advance something that we know cannot become law, is mystifying to me, to say the least.

Again, H.R. 5 is well-intentioned and designed to expand civil rights, but it also adds a term with no clear definition to our civil rights laws without regard for how it will work in practice.

H.R. 987 has four bills that are unacceptable, three bills that are eminently acceptable. I do want to close though on a positive note.

Madam Speaker, I do applaud my friends for bringing the Native American issue to fruition today. I am going to be opposing them on the rule but supporting them on that legislation. I think it was a very wise decision to put it under a rule, quite frankly, and I applaud my good friend Chairman Grijalva for working with my good friend Chairman McGovern and making sure that that happened. This important piece of legislation, which, quite frankly, is important not just to the Tribe in question, but establishes the principle that we won't let land going into trust be taken out of trust, is very important.

Madam Speaker, I urge my colleagues to vote ``no'' on the previous question, ``no'' on the rule, and I yield back the balance of my time.

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

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

Mr. Chairman, The Washington Post said it best. Allow me to quote this headline from yesterday: ``Democrats Are Putting a Political Pothole in the Way of Bipartisan Drug Pricing Bills.''

It didn't have to be this way. Americans want us to come together, work together, solve problems. This is a big one. I hear about it every time I am home, and I have done more townhalls than anybody in this House--20 of them so far this year.

Drug pricing is a big issue. We actually agreed. We worked it out. We passed these bills out of committee, unanimously. And then somewhere along the path to the House floor, they jammed our bipartisan efforts to lower drug costs with clearly partisan bills. The chairman didn't mention those bills came out of committee on a partisan vote.

To bail out ObamaCare, Democrats are once again putting politics and partisanship over what could have been bipartisan public policy.

Republicans and Democrats have been working together on bipartisan legislation to bring generic drugs to market faster by incentivizing more competition and ensuring patients get the earliest possible access to more affordable prescription drugs.

We agree on that, just as we did in the last Congress when I was chairman. We led the effort to revamp every part of the FDA and how they can get drugs to market sooner.

As a result of our work there and in our bipartisan work before that on 21st Century Cures, we really ramped up the ability of the FDA to get competition and new drugs into the market. They set a record last year in getting generics to market as a result of our bipartisan work. We could have had that, today, on this floor.

The first measure that we do agree upon would ensure branded drug makers do not withhold samples that are needed to get generic drugs approved; the second would ban pay-for-delay agreements; and the third would limit first-approved generic makers' ability to stall another rival's launch. So we put a stop to what I would say are bad behaviors in that process.

Together, these bills would help patients actually get access to more affordable prescription drugs, and those bills are bipartisan. Just how bipartisan? Two of the bills passed the Energy and Commerce Committee by voice vote, and the third passed unanimously on a 51-0 vote.

Now, Mr. Chair, this is how the American people expect us to get our work done, but, sadly, House Democrats once again could not pass up a chance to play gotcha politics. So what did they do? They packaged these agreed-to bipartisan drug pricing proposals with a bailout of ObamaCare that passed out of committee on a purely partisan vote.

Now here is what that bill contains:

First, $200 million a year in taxpayer funding for States to establish ObamaCare marketplaces. This funding expired 5 years ago, albeit not before hundreds of millions of Federal taxpayer resources were wasted, including in my own State that finally had to give up on that and go with a national plan.

New Jersey has recently expressed an interest in creating a new State exchange, and they say they can do it without new Federal taxpayer money; they can do it without us. If a State decides to create an exchange, then they shall be allowed to do so, but we don't need to create new Federal grants for things that States say they have the capacity to do themselves.

Second, $100 million a year--$100 million a year--to fund the navigator program. Now, for plan year 2017, navigators received a total of $62.5 million in grants, and they enrolled 81,426 individuals. That means it cost $767 per person that they enrolled, and that accounted for less than 1 percent of the total enrollees.

Now, it is important to understand, by contrast, agents and brokers assisted 42 percent of those in the enrollment year of 2018. Do you know what it cost for them to do it? $2.40. Yet, under this law, you can't use the funds for the navigators to actually pay for those folks, the brokers and agents, to do this work that they do very efficiently. $767 per enrollee versus $2.40.

Third, the bill reverses the administration's efforts to allow more State-regulated insurance plan options for consumers who, frankly, are getting priced out of the market and are looking for choices that fit them and their lives.

I want to set the record straight on these plans.

The plans you heard described earlier were actually legal under ObamaCare and the Obama administration, and they are legal under the Trump administration. They provide choices to people in between jobs or people who can't afford these exploding premiums.

You know, the promise that your premium is going to go down 2,500 bucks kind of evaporated as soon as the bill became law, so people are stuck with ever-increasing premiums, enormous deductibles, and saying: Could we please allow our States to put together options for us that still have to go through a State insurance regulator? And they certainly care about their systems.

CBO projected premiums for these plans could be as much as 60 percent lower than the cheapest Federal mandated plan, 60 percent, and, even more, States can regulate these plans. In fact, in the chairman's home State of New Jersey, they are simply banned. That is New Jersey's choice. They should have that choice.

In my home State of Oregon, they are limited to 90 days. That is what we have chosen. This is kind of federalism at its best.

But in their Washington-knows-best mentality, the bills brought before us today strip away this option for longer term plans, and that is wrong and it is unfair.

Fourth, the bill spends $100,000,000 a year to market the Federal plans. They couldn't stop there. Instead of educating patients on all the plans' options available to them, their legislation actually places a gag order on the promotion of more affordable choices, specifically association health plans, known as AHPs, and the short-term limited duration insurance plans. You can't even tell consumers about that. Oh, no. We are going to have a gag order from Washington.

So there is simply no reason to combine these bills with our bipartisan, I would say unanimously approved, bills to deal with drugs.

Energy and Commerce Republicans put forth an alternative bill that includes all of H.R. 987's bipartisan drug provisions I referenced earlier but removes the partisan, the strictly gotcha provisions.

Our pragmatic plan replaces these partisan provisions with language extending funding for community health centers, the National Health Service Corps, and other public health extenders for a year. Now, these public health extenders should be a top bipartisan priority for the Congress, as they must be done before the end of the fiscal year, the end of September, and they deserve the attention of Congress.

Let me go back to the navigators for a minute. The Wall Street Journal reported: ``One grantee took in $200,000 to enroll a grand total of one person.'' They went on to write: ``The top 10 most expensive navigators collected $2.77 million to sign up 314 people.''

If you take that $2.77 million that they want to give to these navigators--they are the most expensive operators on the planet--to sign people up for insurance and gave that to our community health centers, do you know how many people they could cover with $2.77 million? One estimate is 20,000 patients--20,000 patients.

So Republicans are saying let's take that money and actually get it out to help patients through our community health centers rather than spend it on navigators that can take $200,000 and enroll one person, or $767, on average, versus $2.40 when agents and brokers do this enrollment.

We think we have a better way. Our bill, H.R. 2700, is called the Lowering Prescription Drug Costs and Extending Community Health Centers and Other Public Health Priorities Act. It is pretty straightforward. It is an honest title.

We should take this bill up now, Mr. Chairman, because the majority, unfortunately, has decided to put politics before us today with our bipartisan efforts to lower drug costs.

The bill before us right now is going nowhere in the Senate. They have said that. The White House has weighed in, so they don't like it either.

We should take up the alternative to move our bipartisan work forward and take care of our responsibilities to ensure our community health centers and other public health priorities are funded. That has always been a bipartisan effort.

Finally, just to further the point on the blatant and unnecessary partisanship on display here today, House Democrats made 26 amendments in order on this bill--26. One of those amendments, just one, was authored by a Republican.

Now, they control everything around here, and they said in the opening days they are going to open up this process. Ninety-two percent of the amendments allowed to be brought to the floor so far this year have been from Democrats. When we were in charge, 45 percent--45 percent--were the minority's amendments that came to the floor.

So, so much for openness. Just one was authored by a Republican. So it is unfortunate we find ourselves here today. It didn't have to be this way.

These are measures, especially on the drug side, we are already all in agreement on. If they were separated out, you would have passage. It would go right to the President from the Senate. I think they would take them up and pass them to become law. So, when the majority is ready to make law, let us know.

In the meantime, we have a better way to take care of our community health centers, our patients, and those seeking more choices and more affordable rates for an insurance product than what the Federal Government is mandating.

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

Mr. Chairman, I yield 2 minutes to the gentleman from Kentucky (Mr. Guthrie), a very accomplished member of our committee.

Mr. Chairman, I yield 4 minutes to the gentleman from Texas (Mr. Burgess), our top Republican on the Health Subcommittee, a former chairman of the subcommittee, and a distinguished member of the Rules Committee.

Mr. Chairman, I yield the gentleman from Texas an additional 30 seconds.

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

Mr. Chair, before I recognize our pharmacist, Mr. Carter from Georgia, I just want to say I have been on the floor a lot in the last few weeks on this issue, and we keep getting the same refrain about Republicans voting 60 times to repeal ObamaCare.

What is never said is that 30 of those bills, my friends on the other side of the aisle voted for, and President Obama signed them into law-- I'm sorry. Twenty-one of those bills were signed into law by President Obama. So it is 21 of the 30 were signed into law by President Obama.

So my point being is, ObamaCare had problems. We came together and tried to address those problems with this legislation, repealing the unsustainable CLASS Act, the co-ops, the Cadillac and medical device taxes we voted to delay, the Independent Payment Advisory Board, and on and on. My friends on the other side of the aisle voted with us and we with them to fix those sorts of things. So don't come down here and tell me it is only Republicans who voted to do things on ObamaCare.

We also support these drug bills. There is no question about that, because we want to get lower-cost drugs and stop bad behaviors that prevent generics from coming to market sooner.

Mr. Chair, I yield 3 minutes to the gentleman from Georgia (Mr. Carter), a pharmacist.

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

I want to make a couple of points before I introduce the author of the CREATES Act. The gentleman that just spoke, Mr. Hoyer, voted 21 times, on 21 of the bills that were signed into law to repeal parts of ObamaCare. The gentleman voted for it because those parts were unworkable. So when you hear about 60 times, remember the leader, the distinguished leader, my friend, actually voted for 21 of those, as did

Mr. Chairman, I yield an additional 30 seconds to the gentleman from Wisconsin.

Mr. Chairman, I yield myself such time as I may consume to reinforce what the gentleman from Wisconsin said.

This is from The Washington Post: ``The Health 202: Democrats Are Putting a Political Pothole in the Way of Bipartisan Drug Pricing Bills.''

That is all you need to know. It didn't have to be this way. These bills came out of the committee individually. The Democratic leadership put them together knowing full well they could put a poison pill into a drug reform bill and delay consumers' ability to get more affordable drugs sooner, because this legislation could move through the Senate and down to the President much more quickly if it didn't have these provisions.

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

Mr. Chairman, I yield myself such time as I may consume to thank the gentleman from Vermont for not only his comments here on the floor, but his comments publicly about what we agree with, which is these issues should have remained separate and not lumped together.

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

Mr. Chairman, I will say that the State of Florida actually allows State-regulated plans to go up to 364 days to give Floridians an opportunity to have choice. When it comes to association health plans that allow small businesses like I used to own to get together and offer more affordable health insurance, they put a gag order on so that you can't tell America's patients they might have that option.

So, Mr. Chairman, I don't know that I would fully trust all these navigators. According to The Wall Street Journal, one grantee took in $200,000 of your tax dollars and enrolled one person. The

top 10 most expensive navigators collected $2.77 million to sign up 314 people. If you put that $2.77 million into our community health centers, as the Republicans would prefer, to spend that money, then you would cover 20,000 patients, according to one estimate.

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

Mr. Chairman, my friend from Oregon is right on the drug pieces, and like other Democrats I know, there are a lot of people who think that we should keep these bills separately and they would zoom on through here, but not package them up the way they are.

Mr. Chairman, I yield 2 minutes to the gentlewoman from Washington State (Mrs. Rodgers).

Mr. Chairman, at this point I would reserve the balance of my time to close.

Mr. Chairman, may I inquire as to how much time remains on each side, please.

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

Mr. Chair, I continue to reserve the balance of my time.

Mr. Chairman, I continue to reserve the balance of my time.

Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Georgia (Mr. Austin Scott).

Mr. Chairman, may I inquire again about the amount of time on each side.

Mr. Chairman, I yield myself the balance of my time, as I have no other speakers.

I would just like to point out, make clear for the Record and for all our colleagues, Republicans supported and worked closely with our Democratic colleagues on the drug reform bills here to get lower cost prescriptions and more generics into the market sooner. There is no light between our shoulders on those issues.

If those bills were brought here independently as they came out of committee independently, they would be headed to the Senate and likely to the President, and we would be moving forward. But, instead, Democrats merged in bills they know Republicans oppose.

When it comes to navigators, the actual number is $767 per individual the navigators signed up; agents and brokers cost $240 per enrollee. Mr. Chairman, we would rather take that money and put it into community health centers. That would take care of 20,000 patients, just at $2.7 million.

Mr. Chairman, I urge opposition to the bill, and I yield back the balance of my time.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and add extraneous material on H.R. 987, the Strengthening Health Care and Lowering Prescription Drug Costs Act.

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

Mr. Chairman, I rise to speak in favor of H.R. 987, the Strengthening Health Care and Lowering Prescription Drug Costs Act. This legislation, Mr. Chairman, is a big step in our commitment to delivering on our promise to make healthcare and prescription drugs more affordable.

It brings together seven bills that passed out of the Energy and Commerce Committee last month. Taken together, these bills will strengthen our Nation's healthcare system, reverse the Trump administration's sabotage of the Affordable Care Act, and help lower the costs of healthcare and prescription drugs.

The first title of this bill contains three bipartisan measures intended to address high prescription drug costs by promoting greater competition in our pharmaceutical marketplace. One of the most effective ways to bring down the cost of prescription drugs is to ensure that generics can come to market as soon as possible.

The first proposal would address so-called exclusively parking, a practice where a first-time generic is blocking the approval of other generics from entering the market.

The second proposal prohibits the use of pay-for-delay agreements between brand and generic drug manufacturers that delay generic entry into the market.

And finally, the third drug pricing measure would address situations where some brand drug companies are delaying or impeding generic entry by denying generic drug manufacturers access to samples or to single, shared system REMS.

By eliminating these three barriers, we will prevent some manufacturers from manipulating the system to extend their monopolies at the expense of consumers, and this will make prescription drugs more affordable for all Americans.

Now, the second title of this bill, Mr. Chairman, will help lower Americans' healthcare costs, protect people living with preexisting conditions, and reverse some of the most harmful actions the Trump administration has carried out to sabotage the Affordable Care Act.

Two of the proposals will restore funding for the navigator program and outreach and enrollment efforts that help provide consumers with the support and information that they need to make the right healthcare decisions for their families. Restoring this funding is critical, considering that the Trump administration gutted funding for consumer outreach and marketing by 90 percent. It cut navigator funding by 80 percent, leaving huge swaths of the country without access to fair and unbiased enrollment help.

H.R. 987 will also provide States with funding to establish their own State-based marketplaces, which will help make healthcare more affordable. In 2018, premiums in these State marketplaces were 17 percent lower than in the federally facilitated marketplace, and enrollment was higher for the State plans.

And, finally, Mr. Chairman, H.R. 987 will reverse the Trump administration's regulation to expand junk insurance plans, known as short-term limited duration health insurance. The Trump administration expanded these junk plans from the current 3-month term and made these plans available for up to 3 years.

These junk plans are exactly that, Mr. Chairman: They are junk. They discriminate against people with preexisting conditions. They set higher premiums for people based on age, gender, and health status. They deny access to basic benefits like prescription drugs, maternity care, and mental health and substance abuse treatment, and they set arbitrary dollar limits for healthcare services leading to huge surprise bills for consumers. This legislation would prevent the administration's expansion of these plans from taking place.

In closing, Mr. Chairman, I believe this is an important bill that will lower healthcare and prescription drug costs, protect people with preexisting conditions, and end some of the administration's ongoing sabotage of our Nation's healthcare system.

Mr. Chairman, I urge my colleagues to support this bill, and I reserve the balance of my time.

Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from South Carolina (Mr. Clyburn), our distinguished whip.

Mr. Chairman, I yield an additional 30 seconds to the gentleman from South Carolina.

Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Illinois (Mr. Rush), the sponsor of the pay-for-delay legislation.

Mr. Chairman, I yield 1\1/2\ to the gentlewoman from Illinois (Ms. Schakowsky), who chairs our Consumer Protection and Commerce Subcommittee.

Mr. Chair, I yield 1 minute to the gentleman from Maryland (Mr. Hoyer), our distinguished majority leader.

Mr. Chairman, I yield 1 minute to the gentlewoman from California (Ms. Matsui).

Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Vermont (Mr. Welch).

Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman from Florida (Ms. Castor).

Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Oregon (Mr. Schrader), who is the sponsor of the BLOCKING Act, one of the generic competition bills.

Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman from New Hampshire (Ms. Kuster), who is the sponsor of our Protecting Americans With Preexisting Conditions Act that we passed last week.

Mr. Chairman, I yield 1 minute to the gentlewoman from California (Ms. Pelosi), our dynamic leader, our Speaker.

Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman from California (Ms. Barragan).

Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman from Delaware (Ms. Blunt Rochester).

Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Texas (Mr. Doggett), who chairs the Ways and Means Health Subcommittee.

Mr. Chairman, I yield 1 minute to the gentleman from New Jersey (Mr. Kim), who is the sponsor of the legislation that encourages State exchanges.

Mr. Chairman, I yield 1 minute to the gentlewoman from Minnesota (Mrs. Craig).

Mr. Chairman, I yield 1 minute to the gentleman from Colorado (Mr. Neguse).

Mr. Chairman, I yield 2 minutes to the gentleman from New York (Mr. Jeffries), the Democratic Caucus chair.

Mr. Chairman, I think I am prepared to close, but I just want to ask about the time on each side once more.

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

Mr. Chair, I want to acknowledge the many Members who wanted to lend their strong support to this legislation but were unable to add themselves as cosponsors due to this package being combined for floor consideration as part of the Rules Committee proceedings. Those Members include the sponsors of the individual bills incorporated into this package, as well as Members like Representative Sheila Jackson Lee who strongly support our efforts to make healthcare more accessible and affordable.

Let me say, Mr. Chairman, in closing, as Democrats, we promised, and we will fulfill the promise, that we are going to make healthcare more affordable, that we are going to bring down the costs of prescription drugs, that we are going to make sure people who have preexisting conditions are protected, and that we are offering robust, comprehensive plans with all the essential benefits as part of the package.

That is what this bill is about. That is what the bill last week was about as well, guaranteeing that if you have a preexisting condition, you will get affordable health coverage, and saying that in the case of prescription drugs, 90 percent of prescription drugs now have or could have a generic alternative to bring down costs.

They bring them down considerably, but the brand-name drug companies have conspired, in many cases, to make it more difficult for generics to come to market and delayed them coming to market. That drives up the costs of prescription drugs.

We have watched this Trump administration sabotage the Affordable Care Act and put out junk plans so people don't have comprehensive coverage and people with preexisting conditions have trouble finding affordable coverage. They have made it more difficult for people to even know what to buy in the marketplace by cutting back on navigators and the outreach that makes people aware. They have also made it so that many people, unfortunately, don't even have options.

We are going to do whatever we can. Republicans may like some bills, and they may not like others, but we are going to move forward with a package today and also in the future on whatever we can to make premiums more affordable and to bring down drug prices.

Mr. Chair, I urge support for these bills for those reasons, and I yield back the balance of my time.

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

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

Mr. Chairman, I have an amendment sponsored by myself and the ranking member of the full committee, Mr. Walden.

We have been considering the CREATES Act and legislation like it for years, and it has long been one of my top priorities. So I was pleased to announce a bipartisan amendment that gained the support of our Republican colleagues during the Energy and Commerce Committee's consideration of the CREATES bill.

There was only one outstanding concern still to be resolved after that amendment was adopted. And I am pleased now to offer a bipartisan solution to address that concern today.

The concern raised during our full committee markup was that there was a lack of specificity in the provisions that describe the communication requirements related to the request and the delivery of the requested samples between the eligible product developer and the license holder.

This bipartisan amendment filed by myself and my colleague, the ranking member of the Energy and Commerce Committee, Mr. Walden, will provide the additional needed clarity to ensure that communication requirements in these negotiations are understood so that there is certainty for both parties.

So I think we have found agreement with our colleagues across the aisle around a shared goal of discouraging anti-competitive conduct and providing certainty to both brand and generic manufacturers about the sample requests and delivery process.

I appreciate the ranking member and his staff for working with me in good faith on this legislation and urge all my colleagues to vote in support of this amendment.

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

Mr. Chairman, I appreciate the comments from the gentleman from Illinois.

Again, this is an effort to try to make sure that when a patent expires that the samples or formula are given to generic, so they can develop a generic alternative. That is what the CREATES Act is all about.

I would urge support for my amendment, and I yield back the balance of my time.

Mr. Chairman, I claim the time in opposition to the amendment.

Mr. Chair, I yield myself 2 minutes.

Mr. Chairman, I am very disappointed that my Republican colleagues want to strike all of the ACA stabilization measures that we passed through our committee.

These are important bills that should have strong bipartisan support, but, unfortunately, my Republican colleagues continue to be unwilling to work together on commonsense proposals that would lower healthcare costs for consumers.

Funding for outreach and marketing, why is this even controversial to my Republican colleagues? Outreach and advertising are critical to ensuring that people know about the option to enroll in comprehensive coverage.

We know that last year just one in four uninsured people who buy their own insurance were aware of the open enrollment season and the deadline to enroll in coverage.

Another commonsense proposal to lower healthcare costs is to provide funds to States to set up State-based marketplaces. Again, why is this controversial? Over the last few years, State-based marketplaces have had lower premiums and better enrollment than the Federal marketplace.

Enrollment on healthcare.gov has declined due to the Trump administration's sabotage. Enrollment in the State-based marketplaces has actually increased. The navigator funding provisions the Republicans are trying to strike from the bill, again, this is a program to help hard-to-reach individuals sign up for comprehensive coverage.

Finally, the Republicans want to remove protection that would block the Trump administration's expansion of junk insurance plans that discriminate against people with preexisting conditions.

I really can't understand why my Republican colleagues who claim to support protections for preexisting conditions want to defend these plans that discriminate against preexisting conditions and put consumers at extreme financial risk, other than the fact this is a Trump administration initiative, so they don't want to oppose it.

In addition to discriminating against people with preexisting conditions, these junk plans exclude coverage for many important benefits, such as maternity care. And even when you think you are covered, if you get sick while you are on one of these, the insurance companies find a way to avoid paying the bill.

So in closing, this amendment demonstrates what we all know clearly: that Republicans don't want to do anything to actually help lower healthcare costs for Americans or safeguard preexisting condition protections.

Mr. Chair, I urge opposition to this amendment, and I reserve the balance of my time.

Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman from Delaware (Ms. Blunt Rochester).

Mr. Chair, I would just ask Members to oppose this amendment because it guts the effort to improve the Affordable Care Act.

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

Mr. Chairman, I am pleased to rise and support, enthusiastically, H.R. 987, the Strengthening Health Care and Lowering Prescription Drug Costs Act.

This omnibus bill combines three key bills to lower drug costs by promoting generic competition--long overdue--and four key bills to strengthen healthcare, reverse the GOP sabotage, and rescind the Trump administration's devastating junk plan rule.

I know full well what happens when individuals are impacted by junk plans, and they don't have the courage they need. I encourage my good friends on the other side of the aisle to drop politics and join with us to pass this legislation.

This omnibus bill invests most of the savings of $13.8 billion created by its cracking down on junk plans into strengthening healthcare, which will fund about 500,000 additional enrollees into non-group coverage and Medicaid.

Let me say to you, in 2017, due to the direct interference by the Trump administration, the number of uninsured people increased by 700,000, the first increase since implementation of the Affordable Care Act.

I know full well that Texas, which is the number one State in the number of uninsured, is experiencing the devastation of not having the expanded Medicaid and the Affordable Care Act at its fullest.

We had a roundtable discussion with people who experience diabetes. Insulin is going through the roof. These people are suffering. The average uninsured resident in my congressional district pays 23 times more for a form of insulin than people living in Australia, 15 times more than they would in the United Kingdom, and 13 times more than they would in Canada.

Let's protect those with preexisting conditions, and let's pass this bill to bring down these drugs and save the lives of our constituents.

Mr. Chair, I rise in strong support of H.R. 987, the Strengthening Health Care and Lowering Prescription Drug Cost Act.

This is an omnibus bill that includes the:

H.R. 938, The BLOCKING (Bringing Low-Cost Options and Competition While Keeping Incentives for New Generics) Act;

H.R. 1499, Protecting Consumer Access to Generic Drugs of 2019;

H.R. 965, The CREATES (Creating and Restoring Equal Access to Equivalent Samples) Act; and

H.R. 1010, Rescinding Trump Administration's Final Rule Promoting Junk Insurance Plans.

This omnibus bill invests most of the savings of $13.8 billion created by its cracking down on junk plans into strengthening health care, which will fund about 500,000 additional enrollees in nongroup coverage and Medicaid.

Health care should be a fundamental right for all Americans.

This is why I introduced the Breath of Fresh Air Act, which establishes a Department of Education grant program to be used by local education agencies for the purchase of nebulizers for use in elementary and secondary schools and secured passage of Amendments to the Commerce Justice State spending bills that preserve and expand upon green spaces needed to reduce the worse symptoms of respiratory illnesses.

Each Congress I have secured adoption of amendments to Department of Defense Appropriations and Authorization Bills that increase funding for triple negative breast cancer research and treatment.

I am an original sponsor of H.R. 366, the Insulin Access for All Act of 2019, which addresses the extreme financial hardship most vulnerable Americans face and too many may face untimely deaths due to insulin rationing.

Last month, I held a forum in my Congressional district in Houston Texas that engaged physicians, patients, public health officials in a discussion about the high cost of insulin.

The Affordable Care Act (ACA) led to historic gains in health insurance coverage by extending Medicaid coverage to many low-income individuals and providing Marketplace subsidies for individuals below 400 percent, of poverty.

The number of uninsured nonelderly Americans decreased from over 44 million in 2013, the year before major provisions of the ACA went into effect, to just below 27 million in 2016.

Unfortunately, the Trump Administration has been doing all that it can to undermine the ACA and deny deserving Americans access to affordable health insurance.

In 2017, due to direct interference by the Trump Administration the number of uninsured people increased by nearly 700,000 people, the first increase since implementation of the ACA.

One of the most difficult challenges are the hurdles to healthcare created by lack of health insurance and the expense of prescription medication.

In 2017, private health insurance coverage continued to be more prevalent than government coverage, at 67.2 percent and 37.7 percent, respectively.

Of the subtypes of health insurance coverage, employer-based insurance was the most common, covering 56 percent of the population for some or all of the calendar year, followed by Medicaid (19.3 percent), Medicare (17.2 percent), direct-purchase coverage (16.0 percent), and military coverage (4.8 percent).

Unfortunately, the state of Texas remains the state with the most uninsured persons at 17 percent because it refuses to accept federal Medicaid funding to cover the poorest residents of the state.

According to the Kaiser Family Foundation, one in four people taking prescription drugs report difficulty affording their medication.

In 2017, diabetes contributed to the death of 277,000 Americans--and was the primary cause of death for 85,000 of those individuals.

That same year diagnosed diabetes cost the United States an estimated $327 billion--including $237 billion in direct medical costs and $90 billion in productivity losses.

Diabetes drugs, including insulin and oral medications that regulate blood sugar levels, play a critical role in helping people with diabetes manage their condition and reduce the risk of diabetes-related health complications.

After the Democrats took control of the House in January we got to work on a report on the high cost of insulin and we determined that the Americans with diabetes are in crisis.

Insulin--used by approximately 7.5 million Americans to treat their diabetes--was discovered nearly a century ago by Canadian researchers Frederick Banting, Charles Best, J.B. Collip, and J.J.R. Macleod, who assigned their patent to the University of Toronto with the goal of making the medication widely available.

The researchers charged $3.00 to transfer ownership of insulin to the University of Toronto.

Even though analog insulin has been on the market for nearly 30 years, it has no meaningful generic competition.

Over the past two decades, manufacturers have systematically and dramatically raised the prices of their insulin products by more than tenfold--often in lockstep.

These prices dwarf manufacturing costs.

One study found manufacturers could charge as little as $7 to $11 per month for insulin and still make a profit.

In recent years, the high prices of diabetes drugs have placed a tremendous strain on diabetes patients as well as the federal government, which provides diabetes medications to more than 43 million Medicare beneficiaries.

Reva Verma, is a type 1 diabetic who faces firsthand the struggles of managing diabetes in an era of skyrocketing insulin prices.

Diabetes is a life-threatening disease that disproportionately affects communities of color.

Diabetes is associated with serious health problems, including heart disease and stroke, kidney failure, and blindness.

There are 15,000 Medicare beneficiaries in the Eighteenth Congressional District who have been diagnosed with diabetes.

These individuals are my constituents and I know that on average, each of them pay 4.8 times the cost of similar medication in Australia, 3.6 times the cost in the United Kingdom, and 2.6 times the cost in Canada.

Additionally, in the Eighteenth Congressional District, there are 191,000 uninsured residents in this district and, because they lack insurance, they often pay significantly more than their insured counterpart, or any patient overseas.

The average uninsured resident in my congressional district pays 23 more times for a form of insulin than people living in Australia, 15 more times than they would in the United Kingdom, and 13 more times than they would in Canada.

The consequences of these staggering costs are not benign.

Many patients often speak of having to make heart-wrenching decisions about what to buy with the commonly fixed incomes attendant to seniors.

Many medical professionals indicate that the high prices for prescription drugs are a function of a lack of competition, and authorizing Medicare to create a program to negotiate drug prices may be an estimable way to lower the cost of prescription drugs.

All told this reflects a disturbing trend: in our country, the cost of branded drugs tends to go up, whereas in other countries, the costs tend to go down.

These high prices lead many people to ration or stop taking their medications, which can result in serious health complications and even death, as the Energy and Commerce Committee heard in direct testimony earlier this year.

The prices of diabetes medications--and insulin in particular--are far higher in the United States than they are overseas, in part because certain federal programs lack the authority to negotiate directly with drug manufacturers.

The Democratic majority came into office with a promise to the American people, to make sure that they had affordable and dependable healthcare.

Today, we are delivering on that promise, not just for persons with diabetes but for all Americans who have pre-existing conditions that require medication management.