Insulin Access for All Act of 2019

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.

Mr. Chair, congratulations. What a joy to see the gentleman in the chair. I thank Chairman Pallone for his extraordinary leadership as chair of the Energy and Commerce Committee and Congresswoman Anna Eshoo, chair of the Health Subcommittee. I thank them so much for all their hard work to bring us to this series of bills today, in addition to the bills of last week.

I commend our colleague who just spoke, Ann Kuster, for her important legislation to preserve the benefit of preexisting conditions not being a barrier to access to care and insurance, and also to Lisa Blunt Rochester for her leadership on the legislation before us today to lower the cost of prescription drugs.

Mr. Chairman and colleagues, on Sunday we marked Mother's Day, a special tribute to our mothers and also a somber reminder of the days when being a mother--when being a woman--was a preexisting medical condition. As a mother of five, I can speak from some experience as to what an obstacle that could be to access to insurance.

Last week, we took action to block the administration's cynical efforts to drag our country back to the dark days of discrimination in healthcare coverage by passing the Protecting Americans With Preexisting Conditions Act.

Again, I salute Congresswoman Kuster for her leadership on this, and also our chairman.

This is not a fight about legislation that we are gathered about here today. This is about a fight for our lives, the lives of many people affected.

I want to take the opportunity to salute a hero, a hero who testified last week on healthcare at the Rules Committee, Mr. Ady Barkan.

Ady Barkan is a hero to us. He is a man who suffers from ALS, but, in speaking out for better healthcare, with courage, he testified before the committee 2 weeks ago.

Ady said: I was healthy a year ago. I was running on the beach. I am 33 years old. I have an 18-month-old son, Carl. And, out of nowhere, I was diagnosed with ALS, which, as you know, has a life expectancy of 3 to 4 years. No treatment, no cure.

Like so many others, Rachael--that is his wife--and I have had to fight with our insurers, which has issued outrageous denials instead of covering the benefits we paid for.

We have so little time left together, yet our system forces us to waste it dealing with bills and bureaucracy.

That is why I am here today urging you to build a more rational, fair, efficient, and effective system.

That was Ady testifying 2 weeks ago.

Since then, Ady lost his grandmother, Dina Abramov, and our sympathy goes out to him. Our congratulations to her for having such a magnificent and courageous grandson.

But Ady has been here so many times with our Little Lobbyists who have preexisting conditions, with many of the communities that represent people with diagnoses that need prescription drugs and cannot afford them.

So, in the coming weeks and months, Democrats will continue our action to strengthen health protections for people like Ady, the Little Lobbyists, and others, because this is life or death. It certainly is quality of life.

And now, our Democratic House, today, is proud to pass the Strengthening Healthcare and Lowering Prescription Drug Costs Act, with Congresswoman Blunt Rochester.

With this legislation, we are further reducing the price of prescription drugs by promoting competition with generics and reversing the Republican sabotage that we have seen.

Mr. Chair, when we passed the Affordable Care Act, it was absolutely necessary that we do so. Even if everyone in our country approved and loved their insurer and was happy with their healthcare--which was not the case, but even if they did--it was essential that we pass the Affordable Care Act because we could not sustain the costs of healthcare in our country at the time: the cost to an individual; to a family; to a small business; to corporate America, who was paying a big part of the bill; and to the public sector, was a tremendous burden.

With the Affordable Care Act, we were able to lower the rate of increase of healthcare costs in our country.

But one sector, one segment of the healthcare arena that we did not conquer was the cost of prescription drugs, which continues to contribute to the increase of healthcare costs in our country.

That is the main reason healthcare costs rise: the cost of prescription drugs.

So, I salute the chairman and the committee and Anna Eshoo, chair of the subcommittee, and our distinguished chairman of the full committee for his legislation today which helps to lower the cost of prescription drugs to people, to individuals, to families, to everyone who has a part in funding the good health of the American people.

This is really essential. And it is a fight. And it is a fight, but we are taking it one piece at a time.

The reason it had to be combined with other bills is so that it could be paid for. Our Republicans salute the first part of the bill where we encourage competition among generics and this, that, and the other, but want to walk away from the part of the bill that is essential for paying for the legislation.

So, we want to be very, very responsible in all of this.

One of our colleagues on the floor earlier said that this bill was going to go die in hell or someplace. I don't know where. Actually, the distinguished--well, not so in this case, but the Republican leader of the Senate has said that he is the grim reaper and all these bills will die, designating the Senate a graveyard for legislation that would help the good health of the American people, lower costs for them, improve their lives. But he talked about everything that we passed here.

I have some news for the distinguished leader in the Senate, the Republican leader, Mr. McConnell. The support for this legislation, these bills, is alive and well among the American people, and he will be hearing from them, because this legislation, these bills, are a matter of life and death and, certainly, quality of life for America's working families.

So we will never limit the aspirations and meeting the needs of the American people to what might be legislatively acceptable in the mind of a person in the United States Senate, but we will recognize our responsibility to not only pass the boldest common denominator, but to do so in a way that honors what President Lincoln told us: Public sentiment is everything. With public sentiment, you can pass almost anything; without it, practically nothing.

But, in order for the public sentiment to weigh in, the public has to know. And passing legislation of this kind is a strong message. And our advocates, whether it is the Little Lobbyists; whether it is those who are affected by so many aspects that the Republican leadership is out to sabotage, that the Trump administration is out to sabotage, whether in the Congress or in the courts--well, we will take it to the court, as we are in the Supreme Court.

We will fight them in the Supreme Court, but we will also fight them in the court of public opinion. This is very, very important to, not only the health, but also the financial well-being of America's working families.

So, I salute the chairman for this legislation, and I urge everyone to vote for it. And I know that there is bipartisan support for some parts of the bill. I hope that will apply to all of it so that it really can work.

Mr. Chairman, Democrats are doing everything that we can to lower the cost of healthcare and prescription drugs, so I strongly support the act that is on the floor today. It contains two bills that I authored.

First is H.R. 1010, which prohibits the expansion of these junk insurance plans. Junk insurance plans are the ones that do not cover preexisting conditions. You can often be tricked into buying one of these plans and find out it doesn't even cover the trip to the hospital.

In fact, I asked Secretary Azar, in committee, about this. I asked him: You are aware that these junk plans do not cover preexisting conditions?

He said: That is correct.

The bill also contains another section that I authored, the ENROLL Act, to restore funds to our independent navigators who are helping American families choose the right health insurance options for them. Agents and brokers are important, but they are no substitute for independent navigators who are trusted in the community.

We have got to pass these bills today to lower healthcare costs for families all across the country and lower prescription drug costs. I am very proud to have authored two portions of this.

Let's not let them expand these junk plans and leave you on the hook. Let's make sure that families have the independent advice that they need to choose what makes the most sense for them.

Mr. Chairman, we are trying to turn back the sabotage of the Trump administration on people's healthcare for the folks back home who we represent. The Trump administration has done everything they can to make it more expensive, whether we are talking about prescription drugs or that all-important health insurance policy.

Don't just take it from me and my Democratic colleagues. Take it from folks who are on the side of our families day in and day out: the American Cancer Society Cancer Action Network, the American Diabetes Association, the American Heart Association, and the American Lung Association. I could go on and on.

Mr. Chair, I include in the Record letters from over 20 health groups that represent our families back home who say: Pass this bill.

May 15, 2019.

Hon. Kathy Castor,

House of Representatives,

Washington, DC.

Dear Representative Castor: The 23 undersigned

organizations, representing millions of American patients,

providers, and consumers, write today in strong support of

H.R. 1010, To provide that the rule entitled ``Short-Term,

Limited Duration Insurance ``shall have no force or effect,''

which is now included in H.R. 987. Our organizations strongly

support providing protections for patients from short-term,

limited-duration (STLDI or short-term) plans and support

preventing action on implementing or enforcing the ``Short-

Term, Limited-Duration Insurance'' final rule (83 FR 38212,

published August 3, 2018).

Our organizations remain concerned about this final rule

which expands the maximum

duration of short-term health insurance plans from three

months to 364 days. Previously, short term plans were

available to fill a temporary gap in coverage, such as gaps

in employment. However, since the rule was finalized, the

growth and availability of these products continues to

threaten patients with pre-existing conditions because

insurers offering these policies can either deny coverage or

charge higher premiums to individuals with pre-existing

conditions. Expanding access to these policies could cause

premiums in the marketplace to increase, as younger and

healthier individuals choose to enroll in the short-term

plans. This forces individuals with serious or chronic

conditions into a smaller, sicker risk pool to obtain the

coverage they need to manage their health. Premiums for these

comprehensive plans would likely skyrocket, making insurance

unaffordable.

Short-term plans also lack patient protections guaranteed

by the Affordable Care Act (ACA), severely impacting

individuals with serious or chronic health conditions. Plan

providers are permitted to consider pre-existing conditions

in decisions to deny coverage, charge higher premiums, or not

cover certain care and treatments. After enrolling in a

short-term plan, providers are permitted to rescind or amend

coverage based on new health issues. Short-term plans are not

required to cover all of the Essential Health Benefits (EHBs)

categories outlined in the ACA, potentially forcing

individuals to pay out-of-pocket for expensive treatments.

These plans can also impose lifetime and annual limits on

coverage and do not require limits on out-of-pocket expenses

and deductibles.

H.R. 1010 would both protect patients and consumers from

substandard insurance products and assist in stabilizing the

marketplace. The decreased up-front costs of short-term plans

may be more appealing to younger, healthier individuals,

thus, dividing the individual marketplace risk pool.

Segmenting the market in this way will result in increased

premiums for comprehensive ACA-compliant plans in the

marketplace, decreasing marketplace stability, and reducing

affordable access to insurance.

It is for these reasons we enthusiastically endorse your

legislation and urge Congress to act swiftly to limit the

sale of short-term insurance plans. People with pre-existing

conditions need access to adequate, affordable health

insurance. Again, our organizations thank you for your

leadership on this critical issue for people with pre-

existing conditions, and we support your efforts to expand

access to affordable health insurance.

Sincerely,

American Cancer Society Cancer Action Network, American

Heart Association, American Lung Association, Arthritis

Foundation, Cystic Fibrosis Foundation, Epilepsy Foundation,

Hemophilia Federation of America, Leukemia & Lymphoma

Society, Lutheran Services in America, March of Dimes, Mended

Little Hearts, Muscular Dystrophy Association.

National Alliance on Mental Illness, National Coalition for

Cancer Survivorship, National Health Council, National

Hemophilia Foundation, National Multiple Sclerosis Society,

National Organization for Rare Disorders, National Patient

Advocate Foundation, National Psoriasis Foundation, Susan G.

Kamen, The ALS Association, Women Heart: The National

Coalition for Women with Heart Disease.

Mr. Chair, I wanted to make one more important point. I have heard so much misinformation today from my colleagues on the other side of the aisle who have denigrated our navigators. They say agents and brokers can do the job of helping to sign up our neighbors for health insurance.

Boy, that is not the case. Yes, agents and brokers are important, but we heard expert testimony in our committee that the navigators provide independent, trusted advice. They are our community-based folks at community health centers and groups like the American Cancer Society, who I mentioned, that understand how important it is.

A lot of the agents and brokers send their customers over to navigators to sign up because the agents and brokers are not interested in going over to folks who rely on Medicaid, or the Children's Health Insurance Program.