American Dream and Promise Act of 2019

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

Mr. Chairman, I rise today to call out the mischaracterization of H.R. 986. The misleading title of this bill confirms the Democratic majority's position to score political points instead of governing. They claim their agenda is ``for the people.'' Well, this bill is ``for the politics.''

So let me be clear. This bill has nothing to do with protecting Americans with preexisting conditions. This bill has everything to do with eliminating healthcare options that would be affordable for Americans who can't afford health insurance today and choices for States.

Section 1332 waivers were first enacted under ObamaCare to provide States the opportunity to innovate and to provide their residents with affordable health insurance options. The Trump administration has simply updated the guidance for these 1332 ObamaCare waivers to make it easier for a State's plan to be approved.

This guidance does not--I repeat, does not--permit the Secretary to waive preexisting condition protections.

But, don't take my word for it alone. CMS Administrator Seema Verma confirmed it yesterday, in writing. ``To be very clear, the 2018 guidance does nothing to erode PPACA's preexisting condition provisions, which cannot be waived under section 1332,'' wrote Administrator Verma.

She went on to explain: ``Section 1332 does not permit States to waive Public Health Service Act requirements such as guaranteed availability and renewability of health insurance, the prohibition on using health status to vary premiums, and the prohibition on preexisting conditions exclusions. Furthermore, a section 1332 waiver cannot

be approved that might otherwise undermine these requirements. This administration stands committed to protecting people with preexisting conditions.'' Seema Verma, she is the Administrator.

It is not just Administrator Verma. I want to quote from the Trump administration statement of policy. ``If H.R. 986 were presented to the President, his advisers would recommend that he veto it,'' wrote the Trump administration in its ``Statement of Administration Policy.''

It goes on to say: ``The President has repeatedly made clear that this administration will protect people with preexisting conditions. The 2018 guidance in no way alters the guardrails in place for those with preexisting conditions, and it would not allow the administration to waive the requirements in place around preexisting conditions. The title of this legislation gives the misleading impression that it will enhance healthcare protections for Americans with preexisting conditions.''

Put simply, Mr. Chair, this cynically titled messaging bill is all about scoring political points and not legislating, which is what we should be doing.

You see, if Democratic Members actually cared about protecting individuals living with preexisting conditions, they would govern and lock in these important safeguards. Since Democratic leaders chose to put politics first, I offered an amendment to protect patients with preexisting conditions, to lock that into law.

Mr. Chair, this amendment wasn't presented to the House for a vote. In fact, it was never allowed out of the Rules Committee. That is a shame because we could be voting on it today. I have tried to bring that vote to the floor on numerous occasions, and I have been denied by the Democratic majority.

My bill is simple. It provides guaranteed issue and renewability, a ban on health status underwriting, and a ban on benefits exclusions, real preexisting condition protections Democratic Members say they support.

Guess what? It is titled the ``Pre-existing Conditions Protection Act.'' How ironic, except my bill does what the title says.

Let's vote on that bill, Mr. Chair.

Here is what it comes down to. The status quo is not working for many Americans. Healthcare costs are out of control. Patients and families are struggling to pay ever-increasing premiums, deductibles, and out- of-pocket costs.

There is work that we are doing. I just came from a meeting with the President of the United States in the Roosevelt Room talking about surprise billing. We are going to work together, Mr. Pallone and I and others, to draft legislation to prevent that, to protect consumers.

We could do more here today than what this bill alleges to do. Republicans want to work toward healthcare solutions that will decrease costs, increase access, protect individuals with preexisting conditions, make the healthcare system work better for families and for patients, and actually be affordable.

We want to let our States innovate. These section 1332 waivers-- originally, again, put forward under President Obama--known as State innovation waivers, they are working, Mr. Chair. Premiums have gone down in seven States by an average of 20 percent, down 20 percent.

In my home State of Oregon, we have been a real innovator for decades in the space of healthcare coverage and access and trying to get prices down. Our premiums, under this 1332 waiver that Oregon has, have gone down 6 percent in 2018, down 6 percent thanks to a State innovation waiver.

These waivers could work. States want to innovate. They care about their people and want to bring down costs. Instead of allowing more and more States to innovate and lower their healthcare costs, unfortunately, Democrats are of the mindset that Washington knows best, not our States. States can't be trusted, apparently. They want to limit the ability of States to innovate on behalf of their citizens.

This type of top-down, command-and-control, government-knows-best approach is what leads to policies like the Democrats' ultimate goal of a one-size-fits-all government takeover of healthcare.

A vote in support of their bill is a vote against innovation, lowering costs, my colleagues' constituents, State legislatures, Governors, State insurance commissioners, on and on and on. That is what my colleagues are doing if they vote for this.

A vote against the bill is actually a vote for the people.

Mr. Chair, I encourage my colleagues to oppose this partisan gimmick, and I reserve the balance of my time.

Mr. Chair, I yield 2 minutes to the gentleman from Michigan (Mr. Walberg), a very important member of our Energy and Commerce Committee.

Mr. Chairman, I yield 2 minutes to the gentleman from Georgia (Mr. Carter), our pharmacist on the Energy and Commerce Committee.

Mr. Chairman, I yield 2 minutes to the gentleman from Texas (Mr. Arrington) to speak on this matter.

Mr. Chairman, I yield myself such time as I may consume. I want to make a couple of comments to my friend from Maryland, and he is my friend. He is always quite poignant and eloquent in his remarks.

What we are debating here today is a bill that is misnamed that doesn't do what it says it is going to do. What we do know is that 1332 waivers work. My State took advantage of that 1332 waiver and reduced insurance premiums by 6 percent. The great State of Maryland--I was just looking at some data, Mr. Chairman--has about 181,500 in the enrollment year. They used a 1332 waiver. This year in the individual market their costs for premiums in the individual market percent decreased 43.4 percent.

Mr. Chair, I bet he would. But we know, overall, 19.9 percent across the country, because we are able to take some of this money, put it together, and have a reinsurance program. Maine has done it, Maryland has done it, and Oregon has done it. These are things that work.

The complaint I get, Mr. Chairman, is people at home say, I may have access to coverage now, but I can't afford the premium, or, if I can afford the premium, I can't afford to get sick because the out-of- pocket costs are so high. They are now falling off. Later in the debate, I will share some data that has been published this week showing people who literally walk away from healthcare because they can't afford it. That should be our common mission and goal.

When it comes to protecting people with preexisting conditions, I introduced legislation--and tried to get a vote on it every chance I have had--that would lock into law preexisting condition protections, regardless of what this Federal lawsuit's outcome is in Texas. We should do that. That would be an easy vote. We could all vote for it. But Democrats won't let us bring it to the floor.

Mr. Chairman, I yield 2 minutes to the gentleman from Oklahoma (Mr. Kevin Hern).

Mr. Chairman, I yield 2 minutes to the gentleman from Kansas (Mr. Marshall).

Mr. Chairman, I would just say to my friend, the biggest assault on Medicare is the Democrats' proposal to do Medicare for All.

We know it will cost $32 trillion, double personal and corporate income taxes. I met with our hospitals yesterday: 40 percent reduction in their payments. They are not sure how they would survive. They told me most hospitals in America will go bankrupt under the Democrats' proposal.

Mr. Chairman, I yield 2 minutes to the gentleman from New York (Mr. Reed), a member of the powerful Ways and Means Committee.

Mr. Chairman, may I inquire as to how much time each side has remaining.

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

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

Mr. Chairman, how much time remains on each side?

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

Mr. Chairman, let me address a few issues. First of all, my friend my New Jersey--and he is my friend--referenced my amendment.

It is unfortunate that we can't debate my amendment on the floor, because the Democrats who control the Rules Committee wouldn't allow my amendment to be considered, nor would they allow us to bring a bill to the floor that I have authored that has more than 100 cosponsors that would make sure that preexisting conditions are protected in case the court decision in Texas goes against the ACA and wipes out those protections.

This would be an insurance policy in public law for people with a preexisting condition. We can do that today. If it has some shortcomings, then let's have a markup on this bill and work that out.

I care deeply about preexisting condition protection. I fought for it as a legislator. I helped create the high-risk pools in Oregon back in the late eighties and early nineties. I have supported it every step of the way.

Let me again quote from the Department of Health and Human Services. We asked them, and they wrote back to me, about protection for preexisting conditions. Seema Verma, the Administrator, said in her letter to me: ``To be very clear, the 2018 guidance does nothing to erode PPACA's preexisting condition provisions, which cannot be waived under section 1332.''

So they cannot do that. They cannot waive those protections under 1332.

``Section 1332 does not permit States to waive Public Health Service Act requirements, such as guaranteed availability and renewability of health insurance, the prohibition on using health status to vary premiums, and the prohibition on preexisting conditions exclusions. Furthermore, a section 1332 waiver cannot be approved that might otherwise undermine these requirements. This administration stands committed to protecting people with preexisting conditions.''

That is the head of CMS. It is her agency that approves 1332 waivers.

There have been no waivers so far approved under this guidance, and that is what she tells us in writing, period, because of the information that is being sent around.

We do know that seven States have taken advantage of the prior 1332 process, and it has yielded more affordable insurance premiums for American citizens.

Now, I find it curious. My State has been very progressive in these areas. When I was in the State legislature, I helped try to expand access to affordable healthcare. We had to come to Washington to get a waiver for the Oregon health plan and Medicaid, and we looked at all kinds of different ways to get access to affordable healthcare, and I have never let up on that.

I believe strongly in helping people with preexisting conditions. Like my colleagues on the other side of the aisle, my wife and I had a son who did not survive because of a heart condition. We dealt with all of these issues leading up to his birth and eventual death. So I am fully committed to protecting people with preexisting conditions.

What we are arguing about here is: Is health insurance affordable for Americans and are there better ways, using States as laboratories, to innovate and bring down costs of care and costs of insurance, because more of us are paying more out of our pocket than at any time in our history.

There was a very interesting story which I will put in the Record for everyone to read, data from the Kaiser Foundation this week that ran in a publication called Axios. I just want to share some of what they found about what is really going on if you get outside of the beltway here in Washington and talk to real people.

They evaluated people who had coverage under their employer, in this case, and had a chronic condition of some sort. It is not a small group.

About half of Americans who have employer coverage--so that is half of 158 million--report that 6 in 10 in that group report they or a family member skipped or postponed medical care or prescription drugs they needed because of the costs, or, in some cases, they tried a home remedy.

High deductibles make things worse. Among those with chronic conditions whose deductibles were at least $3,000 for an individual or $5,000 for a family, three-quarters, Mr. Chairman, 75 percent, report skipping or postponing some type of care; and about half, 49 percent, say they or a family member had problems paying medical bills or difficulty affording their premiums, deductibles, or copays in the last year.

So what States--including mine, including New Jersey, including Maryland, and including Maine and Alaska--did was say: Hey, Washington, D.C., give us just a little flexibility here. Let us come with up with plans that may be more affordable.

They did that under the prior rules, and rates went down, on average, 19.9 percent--some States more, some less.

Now, what happens when people can't afford to use their own insurance? Because that is happening with these deductibles and with these high levels, let alone the premiums.

The ripple effect on family budgets, according to the story in Axios, is a substantial share of people reported taking measures such as increasing credit card debt, 28 percent; using up most of their savings, 26 percent; getting an extra job, 19 percent; borrowing money from family or friends, 14 percent.

This is what we are trying to argue could be better taken care of. This is the issue that is being ignored by a Washington one size fits all.

So we protect people with preexisting conditions, 1332 waivers--that law

stays in effect--but we want to give States a little more flexibility to go after this to bring down the cost.

Now, my friend from New Jersey and I, Mr. Chairman, are working together on some of these drug reforms so we can get drug costs down.

I was at the White House today with the President on surprise billing, and I think we are going to work together on that issue, Mr. Chairman, so that no American consumer who follows the rules gets stuck with a surprise bill. What are you supposed to do, wake up in the middle of the operation and say: Hey, is everybody in this room still on my plan? If you play by the rules, you shouldn't get stuck unfairly with a surprise bill. We are going to find a solution.

My State came up with a way to do that already and other States have other ideas, but we are going to protect consumers there as well. We are going to drive down the cost of drugs, and we should continue to go after this issue of the high cost of healthcare because that is what Americans in my 20 townhalls--and I don't think anybody in the House has done more.

I have done 20 townhalls this year. In almost every one of them, they are asking: How do you get the costs down?

Mr. Chairman, 1332 waivers gave my State the opportunity to get costs down, and we should not impede that process.

We are going to debate a lot about these policies going forward, and if there are junk plans, then let's expose them for what they are, and let's pass Ms. Eshoo's bill from, I think, last Congress, which required more transparency and accountability so you don't have fraud and deception. Count me all in on that.

There is a lot more we can do to drive down costs.

My legislation--again, Democrats refused to bring up in committee or have on the floor--would make sure, regardless of any lawsuit, people with preexisting conditions can continue to get covered. So irrespective of the court decisions, they would get covered.

If my bill were allowed to be voted on in the House, I guarantee you, we might have some issues we need to work out. I am happy to do that. If it passed, it would become law. This President is firmly committed to protecting people with preexisting conditions, so we should do that.

We should also have a hearing on the Medicare for All bill that some on the other side are promoting. I have asked for that.

I know there was one in the Rules Committee, but Energy and Commerce is the committee of jurisdiction for most of that. We have not seen that hearing yet. I hope, in the future, we will, because we should know the impact of wiping out Medicare Advantage plans and Medigap plans.

I have been told TRICARE would go away, all private insurance would go away, and it would be a one-size-fits-all, government-run system. I am worried about the delay in access to care. I am worried about the access to the great, new innovative drugs and procedures that we would lose in America.

So, Mr. Chairman, I must oppose this underlying legislation. I remain committed to protecting people with preexisting conditions, as do my colleagues on the Republican side. Then we ought to focus together, Mr. Chairman, as a Congress to do the best thing for our constituents, which is to bring the greatest leverage possible to reduce unnecessary costs in the healthcare system in America.

Mr. Chairman, I ask my colleagues to oppose this bill, and I yield back the balance of my time.

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

Mr. Chairman, I would just say that section 1332 does not permit States to waive preexisting condition protections, period. And I would,

again, cite the guidance from the CMS director, Ms. Seema Verma, where she states that. And that will be in the Record.

Again, I think what we are trying to do here is give States more flexibility to bring down the cost of health insurance, while following these guidelines as outlined.

As I mentioned earlier in the debate, high deductibles are pricing people out of coverage, and by that, I mean they are walking away from getting the care that they need because they can't pay for it; or they are driving up their credit card debt, wiping out their savings, they are having to take another job, they are borrowing money from others.

So, what the Trump administration is trying to do is build on what the Obama administration created, 1332 waivers, that have, frankly, been very successful in many, many States.

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

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

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

Mr. Chairman, I am not necessarily opposed to his amendment, but I do think it is important to talk about the issues that really matter when it comes to affordable healthcare.

Again, when we talked about giving States the authority to innovate and to protect their citizens, we are for that. I come from a State that pioneered the Oregon Health Plan.

I was there. I created a select committee when I was the Republican majority leader of the Oregon House, when we finally got the waiver from the Federal Government after a couple of years to actually implement the Oregon Health Plan. It was very creative about how to hold down healthcare costs and expand coverage and do all those things. We have worked on a lot of different issues over the years.

What we did with the President today, I think, is really important and, that is, looked at this issue of surprise billing: If you follow all the rules, you go to a hospital that is in your network, and let's say some provider gets sick in the night and they substitute somebody else who doesn't turn out to be in your network and then, weeks later, you get an astronomical bill through no fault of your own.

There was a parent down there whose daughter had had, I think, some sort of

surgery, and the physician, on the way out, said: Oh, by the way, I want you to do just a little urine test here. We are going to run an analysis.

So she did, left, and, a period of time later, got a bill for $17,000.

Her dad is a doctor and said: How did this happen?

Well, it turned out whoever did the test was not in the network of her insurance. She didn't know.

What are you going to do? You have had whatever surgery she had, and on the way out the doctor says: Hey, by the way, give us a little sample. I just want to run a test because I have got you on this drug, and I want to make sure it is all working right.

Then a $17,000 bill arrives a couple of months later.

They were there with the President today in the Roosevelt Room at this bipartisan event. And her dad negotiated. He couldn't say what level, but it was certainly not what the insurer would have paid.

Do you know what the insurer would have paid for that, in network? A hundred bucks. He said you can probably get the test done now for $25.

A $17,000 bill arrives.

This is what is happening to Americans who have insurance, and that is why we have got to deal with the surprise billing issue. It is why we have to squeeze the juice out of the middle of the healthcare delivery system.

We do all these great innovations. And Republicans led the effort on the 21st Century Cures Act.

We met with Dr. Francis Collins yesterday, the extraordinary leader of NIH; the longest-serving President-appointed--under Obama--NIH director in the history of our country.

Because of what we put forward to dramatically increase investment in NIH--Republicans led that effort, Fred Upton, but joined with Diana DeGette, a Democrat out of Colorado, and a bunch of us--they are now finding cures.

Dr. Collins said yesterday they have identified now 6,500 genetic diseases where they now can figure out, I'll say, the misspelling of the DNA code.

Some of my colleagues may have seen on ``60 Minutes'' Dr. Collins talking about that they think they found a cure for sickle cell anemia. They found a misspelling--one letter misspelled in that big chain of DNA--that they were able to go in with our new technology--some of it is a result of what we have done collaboratively here--and change, alter, that letter.

And they have these people now that there is no evidence of sickle cell in their blood platelets.

There are 6,500 diseases that they now know the misspelling. Now they have got to figure out how to train your body, using immuno technology, to have your own cells turned on in a little different way and go after these diseases.

These are remarkable advances in lifesaving medicines and treatments.

We, I think, as a country, have to figure out how we pay for that, if each one of these is individualized.

Our system is antiquated and doesn't deal with this effectively. We are going to have to figure that out because a lifesaving cure isn't going to cure a life if people can't afford to get the medicine.

We also need to drill down on telehealth and telemedicine.

One of our colleagues today was talking about mental health services. My district is bigger than any State east of the Mississippi, unless you have to count Lake Michigan with Michigan, which, of course, you do. So telehealth really matters, and we are getting great results for our veterans and for our citizens using telehealth. But our providers don't often get paid for the service they provide over telehealth. Why? That is something we have to address.

You go one thing after another after another here, where we should be spending our valuable legislative time solving the problems that real Americans run into every day of the week: How do I pay the bill? You tell me I have insurance, and I do, and I pay a record--I don't know whose premium under ObamaCare went down $2,500 a month, but I will talk about this more.

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

Mr. Chair, I claim the time in opposition, although I am not necessarily opposed to the gentlewoman's amendment.

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

Mr. Chair, I appreciate the gentlewoman's comments and her amendment. I don't intend to oppose her amendment, but I do want to pick up on something she said that is really important.

The gentlewoman mentioned opioids. In the last Congress, when I chaired the Energy and Commerce Committee, I helped lead the bipartisan effort to produce 60 pieces of legislation dealing with the opioid crisis, to help those who were addicted get the assistance they need, to get resources into our communities to help medical advancements to find non-opioid-related medical treatments, and to stop fentanyl from coming into our country.

I didn't get the opportunity, but I hope the President and his team will continue to raise this issue with the Chinese leadership when they come because a lot of this illicit fentanyl is being produced in China and then coming to the United States.

Dr. Burgess, who was our chair of the Subcommittee on Health and is now the top Republican, I think went up to the chairman's district in New Jersey and viewed one of the international mail processing facilities. At least, it was in New Jersey. I don't know its precise location.

Together we said, working with the Trump administration's FDA Commissioner, we have to do more at these mail processing facilities to stop fentanyl from coming in.

By the way, fentanyl is like 100 times more potent than morphine. If you had a salt shaker and put out, I don't know, 10, 15 grains of salt and ingested that, if it was fentanyl, it would kill you.

We said let's put more resources toward stopping illegal fentanyl from coming into the United States, and we are doing that now. We are beefing that up.

It comes in through Mexico as well. It is both China and Mexico. It is creating pockets of death in our communities. Especially in some of our urban areas, we have seen where it gets mixed in with heroin to give even a higher high or whatever. Then you see groups of people who take this, not knowing it has been jacked up with fentanyl, and you have a whole group that dies.

The most insidious discussion or incident I heard about was a parent who I got to know a little bit, whose daughter, he told me, self- medicated occasionally with heroin, and she died in college.

When they did the autopsy, they figured out she had been given 100 percent fentanyl. It wasn't a mix with heroin, Mr. Chair.

The tragedy of that was, he felt that her supplier knew she was an occasional user so had low tolerance and, basically, probably killed her to prove to his other buyers that he had the most potent stuff on the street.

A colleague of ours, Mr. Katko, who was a prosecutor before he came to the Congress, he and I were having a discussion on this matter. He said he prosecuted a case just like that. That is how evil this stuff is.

As we look at the whole panoply of issues about healthcare, mental health services, addiction services, stopping these things from coming in, we can find a lot of common ground.

Republicans supported protections for preexisting conditions before the ACA, during the ACA, after the ACA today. We did. Same with putting kids on your policies at 26. We agreed with those principles.

But the ObamaCare act was rammed through this House and the Senate, and we weren't even allowed to bring any of the 90-some amendments we offered to the floor. We were completely shut out of that process. It was a horrible process, and it shouldn't be repeated.

I hear a lot about how we voted to repeal it a bazillion times. Well, you know what? If you go through and dissect those votes, there were a whole bunch of Democrats that voted with us. The President at the time, President Obama, signed some of that legislation because even he admitted there were problems in the ACA.

Going forward, I hope we can address the big problem in America, which is high-cost insurance, high deductibles, but, moreover, the high cost of healthcare itself because it is pretty hard to go home and explain why things cost what they do today.

We have to get around the high cost issue. The access issue, that is where earlier I talked about telehealth and telemedicine. There is a lot of work we will do together.

Unfortunately, this is a mislabeled bill today. The laws governing 1332 waivers prohibit what the majority is concerned about. But I don't have opposition to this amendment.

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

Mr. Chair, I claim the time in opposition to the gentleman's amendment.

Mr. Chair, I appreciate the gentleman's amendment.

Look, we all care deeply about getting mental health services into our community. In fact, under Republican leadership on the Energy and Commerce Committee a few years ago, we

rewrote America's mental health laws for the first time since John Kennedy signed the last bill into law before he was tragically assassinated in Texas. It was a lot of work, but it was bipartisan work.

Not only did we look at those mental health laws that were on the books, because what happens around here is somebody comes up with a new idea, so you put a new program in place, and you give an authorization. Maybe it gets funded, maybe it doesn't. A year goes by. Somebody has a new idea. Put another one on the books. Nobody ever goes back and looks at what worked and what didn't.

So our colleague, Dr. Murphy, at the time, who is a psychologist and a terrific leader in this area, really drove this review and said, look, we have to help kids with mental illness, and we need to help adults.

We could deal with a lot of the violence in America if you got people care. It is not that everybody with mental illness goes violent, but we do know that mental health services help people in every way and that the programs we had--we had a lot of them--weren't funded, weren't funded properly, or didn't work. Some worked better than others.

We had this comprehensive review in the Energy and Commerce Committee of these different programs the Federal Government has. Then we said, going forward--kind of what you are trying to do with this GAO report in a little different way--let's measure the efficacy of the programs we do have.

Let's find out what is working in our communities, and then let's get aid into our communities directly. Let's cut out the middle bureaucracy and get assistance, financial assistance into our communities.

So we passed that. That is now the law of the land. And I think last year we were able to get money into that, finally, and I hope we can do more going forward, because we know that--I am being a little sarcastic here, but it is an extraordinary finding. Guess what? Your brain and your physical body are connected. Who knew, right? And we have all known that.

So I supported the effort to get the same treatment under insurance for mental health as physical health because they are completely connected. So going forward, we have got to make sure that that bond is strengthened, not weakened, and that people continue to get help for mental health.

I am a big believer in that. I know it works. It is fascinating to see, with the whole genome project, now they can do a genetic test and figure out which mental health drug will work in your body or my body. We didn't know that before, and now they can figure out which one will actually work for you or me or whomever.

I hope we have lifted the stigma on people needing mental health services. We are just a big bag of chemicals, and things get out of balance. So I hope that we have lifted that as we did, I believe, on addiction.

There are a lot of people, and over time people evolve their views and get better understandings, and I think over time we realized that people with drug addictions--especially this came out through our opioids work--weren't necessarily criminals. They weren't to be shunned from society.

What we learned in the course of our work on opioids was, when I talked to parents whose kids had a high school football injury or something and the doctor gave them a painkiller, all of a sudden, this stuff is so addictive, a few treatments and they are hooked, and then they need more and more and more and more.

I always remember my friend Mr. Rush from the Chicago area, when we were talking about treatment for opioids, said: That is great you are doing that. When the people I represented had issues in terms of crack cocaine and all, you just called them druggies and you put them in prison.

That affected what we wrote and how we legislated, and we moved away from calling it treatment for opioids to people with substance abuse because we realized we needed to think broader as a country and as a Congress, and we did that and we changed the law. All that now is law to deal with opioids and mental health services.

So, Mr. Chairman, I don't have an objection to this amendment, but there is a lot we have done and a lot more we need to do, and I will talk about some of the things we need to do going forward.

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

Mr. Chairman, I have an amendment at the desk. I believe it is No. 5, printed in House Report 116-51.

Mr. Chairman, I would just say, in terms of this amendment, it is just trying to make the point that the bill we have before us today is not as described or labeled. In our opinion, it is more about politics and gotcha politics than it is about the underlying issue.

We know from the Department of Health and Human Services, they have made it clear in the letter from the Director who would approve these waivers that she believes that the underlying law protects people with preexisting conditions and all the other things I talked about earlier, that they can't waive that law--they cannot.

So I would enter into the Record again, Mr. Chairman, as part of my remarks, her comments about the guidance, the 2018 guidance, and where she says it does not erode ObamaCare's preexisting condition provisions. She is the one in charge of this. That is what she is saying.

But I want to talk about something else she says in this letter about premiums and the costs to people getting their insurance. She says: ``Under the PPACA''--or ObamaCare or the Affordable Care Act, however you want to describe it--``we have seen dramatically higher premiums and decreased options for millions of consumers, in large part due to the law's overly prescriptive mandates and excessive Federal Government takeover of areas traditionally left under State oversight.''

She points out: ``In 2019, the average monthly premium for a benchmark plan for a family of four on HealthCare.gov is now over $1,500, which can easily exceed a family's mortgage.''

Continuing with her letter to me, she said: ``There are many areas of the country with far higher monthly premiums. For example, a of 60- year-old couple living in Grand Island, Nebraska, making $70,000 a year, will need to pay over $3,000 per month for the lowest cost silver plan available. That is almost $38,000 per year for a plan with an $11,100 deductible.''

Now, think about that, Mr. Chair. This is a couple that is making $70,000 a year. They are 60 years old. They live in Nebraska, and $3,000 a month in premiums, over $3,000, and an $11,000 deductible. That is over $48,000, and they only make $70,000 a year.

This is happening in America today. Heck, it is happening in Nebraska right now. So what we are saying is people are walking away.

She goes on to say: ``For millions of Americans, coverage this expensive is not a realistic option, and many choose to go without coverage at all. In fact, after average premiums rose by 21 percent, 1.3 million unsubsidized people walked away from the market in 2017.''

Those are the people we need to be helping. There is a lot more we need to be doing. I will put the rest of this in the Record. But I think everybody knows we are just trying make a point with this amendment.

Mr. Chair, I ask unanimous consent to withdraw my amendment.

Mr. Chairman, just to clarify, from a parliamentary standpoint, I was just going to withdraw the amendment, but if the gentleman wants to speak on it, I can ask unanimous consent to withdraw it after he speaks.

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

Mr. Chairman, I would just suggest that it was Seema Verma who is the head of CMS who issued the guidance, so I think she is in a position to have a say about what she believes the guidance allows or doesn't.

To be clear, to quote her letter again: ``The 2018 guidance does nothing to erode the PPACA's preexisting condition provisions.'' That is what she is saying.

So I think that letter is important. She put it in writing. She has said that repeatedly, and so I take her at her word. I do. I include her letter in the Record.

Centers for Medicare &

Medicaid Services,

Washington, DC, May 7, 2019.

Hon. Greg Walden,

Ranking Member, House Committee on Energy and Commerce, House

of Representatives, Washington, DC.

Dear Representative Walden: Thank you for your continued

interest in new state flexibility available under guidance

recently issued interpreting section 1332 of the Patient

Protection and Affordable Care Act (PPACA) (the 2018

guidance). Working within the limitations of the PPACA, this

2018 guidance is an important element of the Administration's

actions to expand options and lower costs for patients around

the country. I wanted to take this opportunity to set the

record straight and reaffirm this Administration's commitment

to lowering healthcare costs, increasing consumer choices,

and protecting our most vulnerable citizens, including those

who have pre-existing conditions.

To be very clear, the 2018 guidance does nothing to erode

the PPACA's pre-existing condition provisions, which cannot

be waived under section 1332. Section 1332 does not permit

states to waive Public Health Service Act requirements such

as guaranteed availability and renewability of health

insurance, the prohibition on using health status to vary

premiums, and the prohibition on pre-existing conditions

exclusions. Furthermore, a section 1332 waiver cannot be

approved that might otherwise undermine these requirements.

This Administration stands committed to protecting people

with pre-existing conditions.

Under the PPACA, we have seen dramatically higher premiums

and decreased options for millions of consumers, in large

part due to the law's overly prescriptive mandates and

excessive Federal government takeover of areas traditionally

under state oversight. In 2019, the average monthly premium

for a benchmark plan for a family of four on HealthCare.gov

is now over $1,500, which can easily exceed a family's

mortgage. There are many areas of the country with far higher

monthly premiums. For example, a 60-year-old couple living in

Grand Island, Nebraska, making $70,000 a year, will need to

pay over $3,000 per month for the lowest cost silver plan

available. That's almost $38,000 per year for a plan with an

$11,100 deductible. That's over half their income.

For millions of Americans, coverage this expensive is not a

realistic option, and many choose to go without coverage at

all. In fact, after average premiums rose by 21 percent, 1.3

million unsubsidized people walked away from the market in

2017, the last year the prior administration oversaw open

enrollment. While these higher premiums force some people to

go uninsured, coverage is generally not optional for people

with a pre-existing condition and so, without a subsidy,

someone with a pre-existing condition must face the full

burden of the PPACA's skyhigh premiums. This Administration

has not forgotten the people facing this hardship.

Section 1332 of the PPACA provides the discretion to

approve a section 1332 state waiver plan if the following

four statutory guardrails are met: affordability,

comprehensiveness, coverage, and federal deficit neutrality.

Section 1332 allows states to develop new healthcare programs

and solutions that would be not permissible without a section

1332 waiver.

Unfortunately, guidance issued under the prior

Administration in December 2015 (the 2015 guidance) regarding

section 1332 waivers had the effect of significantly

restricting the innovation states could pursue. The prior

Administration imposed a one-size-fits-all approach to these

waivers, making it difficult for states to address the

specific needs of their residents.

In October, the Administration issued guidance under

section 1332 of the PPACA to provide states with significant

opportunities to chart a different course for their markets

through expanded flexibility. Section 1332 and the 2018

guidance ensure that consumers who wish to retain coverage

similar to that provided under the PPACA can do so, but they

empower states to take steps to stabilize their markets and

allow more affordable coverage options that may be more

attractive to individuals and families priced out of the

current market, including people with pre-existing

conditions.

Over the past two years, this Administration has approved

seven section 1332 waivers authorizing reinsurance programs

to help fund claims for people with high healthcare costs.

These reinsurance programs provide much needed premium relief

for people in the market and, in particular, for people with

pre-existing conditions without other coverage options. These

section 1332 waivers were all approved under the prior, more

restrictive 2015 guidance. I believe, given the expanded

flexibility discussed in the 2018 guidance, states will be

able to develop additional healthcare programs and solutions

that work for their residents.

As you know, some have criticized the state flexibility

offered under the 2018 guidance, claiming that states will

pursue section 1332 waivers that undermine their own

individual market risk pools and make coverage more expensive

for their own residents with pre-existing conditions. Again,

I want to make clear that a section 1332 waiver cannot

undermine coverage for people with pre-existing conditions.

Moreover, any section 1332 waiver will need to carefully

account for any impact on the individual market risk pool and

guarantee that access to coverage is at least as

comprehensive and affordable as would exist without the

waiver.

So, if a state seeks to pursue the use of more affordable

options, such as catastrophic plans or short-term limited

duration plans, under a section 1332 state waiver plan, the

state must ensure access to coverage that is overall as

affordable and comprehensive for people who remain in the

individual market risk pool.

Thank you again for your shared interest in bringing down

healthcare costs and protecting our fellow Americans with

pre-existing conditions. We remain focused on improving our

nation's health care system by empowering states to innovate

and develop new solutions to expand access to affordable and

high value coverage options, and we look forward to working

with you to achieve these goals. Should you have questions,

please contact the CMS Office of Legislation.

Sincerely,

Seema Verma.

Now, Mr. Chair, I was willing to withdraw the amendment. That takes unanimous consent, and I just would attempt to do that again. I don't know if my colleague cares about that or not.

Mr. Chairman, so we can move on to the other amendments, I ask unanimous consent to withdraw the amendment.

Madam Chair, I thank the gentleman for yielding.

Madam Chair, I just want to say that I, too, wish we were debating my legislation that I tried to offer the first of the Congress and was refused the opportunity to bring it to the floor. That would lock into statute preexisting protections for people who have preexisting conditions.

This court case is pending. We could get a ruling tomorrow. Somewhere in the last couple of months, Congress could have acted to put in statute a separate law that would be there, irrespective of the decision of the judge, or judges as it goes through its process, that could wipe out all of the ACA and could wipe out preexisting condition protections. We could do that, except their Committee on Rules put these amendments in order to debate on the floor, but not the amendment that actually protects people with preexisting conditions. So it is not my fault--we don't control of the Rules Committee--that my serious amendment about protecting people with preexisting conditions was not made in order. I don't control the Rules Committee. The Speaker does, and others.

When we talk about affordability, remember the example that Seema Verma points out, in Grand Island, Nebraska, a couple making $60,000 a year, 60 years old, $38,000 for the plan, and $11,000 deductible. How is that affordable? It is not.

I want our States to innovate. Do you know what, if a State doesn't want to innovate, it doesn't have to. And if they violate the rules, they are not going to get their waiver.

But what we do know is that when States have innovated, like mine, like the gentlemen from Wisconsin and Alaska, they have seen reductions in premiums and full-throated coverage. I want innovation. I don't want to price people out of the market.

Madam Chair, I seek time in opposition to the gentlewoman's amendment.

Madam Chair, I would like to point out a couple of things.

One, I have introduced legislation to protect people with preexisting conditions. I did that because I knew this lawsuit is pending. We can argue about the ACA and the lawsuit and all that, but the long and short of it is that if the court rules the ACA gets thrown out as unconstitutional, which may happen, people with preexisting conditions would be exposed, and I don't want that to happen. That is why I introduced legislation.

I would be honored if we could take that up in the Energy and Commerce Committee that I used to chair and put it on the House floor. I tried to bring it here as an amendment and it was denied by the Democrat majority, so we can't even have a debate here about it. If it is not everything it should be, then I am happy to work with people to try and make it as durable and robust as it needs to be. So that is one.

When we talk about insurance--and there is kind of silence on the other side--2.5 million Americans since President Trump have gotten healthcare insurance through their employer. We have one of the most robust economies most Americans have ever seen: 3.2 percent, I think, GDP growth the first quarter. Some have said, you need fairy dust to do that. Well, that is not true. You need good economic policy. We have that in America: the lowest unemployment for African Americans, Hispanic Americans, all Americans. Incredible numbers, incredible growth. As a result, people are getting off government subsidized healthcare, or fully funded healthcare, onto private health insurance, which Democrats want to wipe out. One hundred and fifty-eight million Americans get their health insurance through their employer or through their union.

And when it comes to the Affordable Care Act, that is what put in place the big cuts that are coming to our hospitals, the DSH cuts, that I held off as chairman of the Energy and Commerce Committee. We passed legislation to prevent the DSH cuts from hitting our disproportionate share of hospitals, those that deal with more lower income folks. We are going to have to do that again. Because ObamaCare says you got to hit your hospital with a big cost increase, if you will, or take away a subsidy.

The Cadillac tax. I met with building trade folks in my State. These people bargained away, potentially, wages for better benefits. And then along comes ObamaCare, the Affordable Care Act, that says: Oh, by the way, if you have got too generous a plan, according to the government, you are going to have to pay a 40 percent tax on that plan. And, by the way, it was never indexed for inflation. And guess what, healthcare costs continue to go up and premiums go up.

More and more Americans' health insurance is going to fall into this so-called Cadillac tax. There will be a 40 percent tax on those plans. The working men and women, who are part of a union or in the private sector and who have good, generous healthcare benefits, the Federal Government, the Democrat-driven plan that is totally partisan passed, it says, we are going to whack you with a 40 percent tax. How fair is that, Madam Chair? I don't think it is. We have kept that tax from taking effect as Republicans. We will see what this Congress does.

But, moreover, we fully funded our community health centers. We, under Republicans, funded the children's health insurance program, a Republican creation, for a decade. I led that

effort. Most Democrats consistently voted against funding children's health insurance time and time again. It had never been funded for more than 5 years ever in its history. One hundred and twenty-two thousand, seven hundred Oregonian kids and pregnant moms get their health insurance through CHIP. It is a marvelous program. Republicans led the effort, because I did it. We first tried to get 5, then 6, and then eventually we got 10 years funded. That is locked into law.

We need to go back and fund our community health centers. I told people that if I were chairman, my palms would be getting a little sweaty now at the list of things we need to get done--I am looking at my friends.

In Oregon, in my district, I think we had 63 delivery sites and 12 community health centers. We fully funded those centers at a record level in the last Congress, because I believe fully in that network of the delivery of healthcare. It is extraordinarily important. We should be doing that today, but we are not.

We have got the National Health Service Corps, special diabetes programs for Indians, special diabetes programs for type I diabetes, teaching health centers, personal responsibility education programs, sexual risk avoidance education grants, and family-to-family health information centers. We have demo programs, increased access to dental healthcare services, and delay in authority to terminate contracts for Medicare Advantage plans. We have protection for recipients of HCBS against spousal impoverishment. We have demonstration of approved community behavioral health clinics, Medicaid funding for territories, delay in effective date for Medicaid amendments related to beneficiary liability settlements, DSH allotment, and money follows the person. All those expire at the end of this fiscal year. We have real work we need to get done, Madam Chair.

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

Madam Chair, I seek time in opposition to the amendment.

Madam Chair, I reserve the balance of my time.

Actually, I believe I get to close, don't I?

That is what I thought.

Madam Chair, I reserve the balance of my time.

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

Section 1332 already requires that the State plan will provide coverage that is at least as comprehensive as the essential health benefits, including mental health and substance use disorder services. That is already required, including behavioral health treatment, and would provide coverage to at least a comparable number of its residents. That is already in the 1332 requirements.

I appreciate the gentleman's passion for dealing with the opioid epidemic. I led the effort that brought together Republicans and Democrats. We passed 60 different pieces of legislation. I think 57 of them, by the time we were done working together, passed unanimously in this House.

We bundled them up into H.R. 6 because we all know the Senate can't handle 57 or 60 different pieces of legislation, but they could handle one. The work we did here and the work they did there ended up in, I would argue, the Nation's most comprehensive legislation to address a drug problem our country has ever had. And that is our law.

The President of the United States, who was just disparaged here on the House floor, helped lead this effort because he passionately cares about the issue of addiction. He lost a brother, I believe, to alcoholism.

He was a leader, and his team were leaders, in this effort we put together on opioids. He invited Republicans and Democrats to the White House for the bill signing. Mrs. Trump helped organize all of that.

This legislation is comprehensive on opioids. It wasn't part of the ACA. You see, we can work together and improve underlying laws. We can address major problems facing the country when majorities want to do that. We did it last Congress under my leadership, and it was Republicans and Democrats. We didn't start out agreeing on some of these matters, but we ended up there, with just a couple of exceptions.

I sent my friend, Madam Chair, the chairman of the Energy and Commerce Committee today, a comprehensive list of kind of what we learned in the final phase of our investigation into how America ended up in the place it was with opioids. There are some additional recommendations that I hope and assume we will get to out of that investigative report that we concluded at the end of the year. Hopefully, we will get there.

I believe we need to do oversight on the legislation we passed. I have always felt that about bills we passed. We need to go take a second look.

What is working? What is not? We are not going to get it right the first time, and we always know there is more to do, and we need to do more on what was H.R. 6 in the last Congress, our opioids legislation.

Madam Chair, I am not opposed to the gentleman's amendment, and you have to say you are in order to get the time, I guess, but I am not.

I am fully committed to making sure that people with substance abuse disorders continue to get the help they need in our communities. That is what our whole legislative thrust was about last Congress and will remain there. As I say, section 1332 already requires that in these plans.

Again, remember what we are talking about here is States coming to the Federal Government saying: We have a

better idea to fill a gap, so people have affordable insurance. That is what a waiver is under 1332. And, I guess, I have more confidence in my State than others must have in theirs, but I think from my own experience, Republicans and Democrats work together in Oregon to get health insurance out, and coverage out, and expand access to care. I have always continued to try to do that.

I have faith that my State would do this. These plans we will hear more about next week, but they are regulated by State insurance commissioners. I am not in the school that says all of those people are bad and we are the only ones with a great idea. I want innovation. I want it from the States, and I want to drive down costs of healthcare while improving access and delivery of services.

So I am not opposed to the gentleman's amendment. I do hope we can address these issues of fully funding our community health centers, our National Health Service Corps, and these diabetes programs which we reauthorized and funded in the last Congress, and which we need to do again. They are called the Special Diabetes Program for Indians and Special Diabetes Program for type 1 diabetes.

We have got to get after that, too, Madam Chair. We have to find the money to do it. It is not easy. I know we have a lot of other things. I just wish we were doing those sorts of the things today because these programs expire in September, and we don't have that many legislative days left.

Hopefully, we can move on to the things I know we can agree on and find solutions for, and that we do it sooner rather than later.

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

Madam Chairwoman, I seek time in opposition to the gentleman's amendment.

Madam Chair, I am not opposed to the gentleman's amendment, but I am happy to speak on it.

Again, section 1332 already requires that the State plan, the one they submit, will provide coverage that is at least as comprehensive as the essential health benefits, including mental health and substance use disorder services, including behavioral health treatment, and will provide coverage to at least a comparable number of its residents.

Madam Chair, I reserve the balance of my time.

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

Madam Chair, I just want to go back to what is going on in America's healthcare costs and look at some of what is going on elsewhere around the world.

First of all, I would draw the Member's attention to the Kaiser Foundation report that Axios reported on about people who have health insurance and still can't afford to use it. They talked about just over half of those with employer coverage have some sort of chronic disease, so they have health insurance. But the deductibles which are at $3,000 to $5,000 are so high that three-quarters of the people reported skipping or postponing some type of care. Half, 49 percent, said that a family member had a problem paying medical bills or difficulty affording their premiums, deductibles, or copays in the last year.

What we are trying to do is help those people in the individual market, and we would love to help those people in the market that employer-provided health insurance is in as well, and put downward pressure on pricing, and go after the cost of healthcare from one end to the other.

Now, the gentleman from California, I believe, has talked about going to a, I guess, government-run, single-payer system. I have got two veterans that work virtually full time helping veterans in Oregon's Second District get access to a similar sort of system. You know of it as the VA. Think about the problems we have with that government-run, single, sort of, payer-operated system.

If you get in, I have veterans saying: It is great. I have got coverage. But it is people who have to wait 6 months to get eyeglasses at one point, or they can't get in to get their surgery done. And we are working with thousands of veterans that have to come to their Member of Congress to be able to get access to the healthcare they were promised when they put on the Nation's uniform.

We have that system in place, and it has incredible problems in wait time, so I had to create the Choice Program and everything else.

Then I was intrigued by a story about a woman in Nova Scotia who is 33 years old. She is under one of those systems my friend wants for us, I guess. After three trips to the emergency room, they just never would believe her and her problem and see her, and she couldn't get access to doctors. When she finally did, her anal cancer had progressed to stage

Madam Chair, I claim the time in opposition to the gentleman's amendment.

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

Madam Chair, I do not oppose this amendment because this amendment does not do anything the law already, I think, requires.

Section 1332 does not permit States to waive preexisting condition protections. Section 1332 already requires that the State plan will provide coverage that is at least as comprehensive as the essential health benefits and will provide coverage and cost-sharing protections against excessive out-of-pocket spending. That is what the underlying law already does.

We have the assurance from the CMS Administrator saying, once again, to be clear: ``The 2018 guidance does nothing to erode the PPACA's preexisting condition provisions, which cannot be waived under section 1332.''

She is the one who makes the decision.

By the way, I would just point out that no State has come to the Trump administration under this new authority that we are aware of and said: ``Please approve our plan.''

Junk plans--and we will hear more about that term of art. By the way, those junk plans were allowed for under the Obama administration and under the ACA. At that time, they were only allowed for 3 months. There seemed to be a lot of interest in a variety of options for citizens to take advantage of that covered their needs.

So the Trump administration said, well, if they are good for 3 months, what if we extend them to 12 months or just at 12 months? That is what they did. They were junk plans under Trump; they were wonderful options under Obama. It is the same set of plans.

You can always go on the exchange, and you can always find other coverage that fits your need. We are trying to not have just one plan that nobody can afford. That is what you are seeing in this situation that Ms. Seema Verma put forward, Madam Chair, the head of the CMS, the Administrator for the Centers for Medicare and Medicaid Services.

She uses, as an example, this situation in Grand Island, Nebraska. It is not Oregon; it is Nebraska. A $70,000-a-year, 60-year-old couple are paying $38,000 a year for their insurance with an $11,100 deductible. Now, how is that affordable? Does anybody in here think that is a great idea?

That is what you are saying: Don't innovate. We have got it covered. The ACA has it covered. There is no need for innovation here, nothing to see. The plan works great.

Then we know, from the Kaiser Foundation study, people are saying: I can't afford it. So I will jack up my credit card, and I will wipe out my savings.

All this is going on. The ACA did not solve every problem. It expanded coverage. You can't help but do that, spend that much money. States like mine took full advantage of it. But we are left with these pockets and problems in America that I think States could assist us in if we gave them expanded authority under 1332 waivers to say: Hey, guess what, Washington? We have a better idea here. Here it is. Take a look at it, and make sure it fits the Federal guidelines and law, but let us innovate.

Oregon did that. Under the prior 1332 approval process, insurance rates went down 6 percent; Wisconsin down 10.6; New Jersey, 15; Maryland, 43; Maine, 9.4; Minnesota, 20; Alaska, 34.7. Using this sort of ``Mother May I'' approval, that is what you have to do.

I remember when Oregon did the Oregon health plan. I was in the State legislature then, and we had to plead and beg with the administration at the time to get approval to try and experiment on Medicaid coverage to expand coverage and improve access to care. We couldn't do it without Mother Washington, Father Washington, or Brother Washington, whoever, back here, saying: Yeah, okay. We will let you try that.

We should be in partnerships with our States.

By the way, States can pass a law and say: We are not going down this path. They have every right to do it. New Jersey has done it, and California has done it: None of these short-term duration plans, we are not going to be a part of that.

Every State has that right. But there are a lot of States that look at their citizens and say: $38,000 a year for your insurance and $11,000 for your deductible; you are making $70,000; you are 60 years old. That is not working real well either. So maybe we can find a product that would work for you and help you out.

So we are talking about a range of options and choices. America has always done well and markets do better when we have more choices. That is what we are talking about here.

The gentleman's amendment I don't object to at all. I think it is the underlying law as described by the head of the Department who would have to approve all these 1332 waivers.

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

Madam Chair, I claim the time in opposition to the gentlewoman's amendment.

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

Madam Chair, let's talk about this amendment.

I have talked earlier about all the things that need to be reauthorized--community health centers, special diabetes programs, all of that which I know the committee is aware of and I hope we begin marking. I wish we were dealing with that today.

I heard from the gentlewoman about Republicans and preexisting conditions and ``Where is your plan?'' It is sitting up in the Rules Committee because your party would not allow my amendment to do that and to be brought to the floor for debate today. I don't control the Rules Committee. It is 2 to 1 by the majority. It is just the way it works around here, and I respect that.

But you allowed my amendments that were more in jest about the false nature of the title of the bill to be debated but not the substantive amendment I offered which does protect people with preexisting conditions in case the lawsuit were to prevail and ObamaCare is thrown out. But, no, we couldn't have that debate.

I have asked for my bill to be considered in the committee of jurisdiction. That hasn't happened either.

I have also asked for the Democrats' one-size-fits-all takeover of healthcare, Medicare for All, however you want to describe it, that we have a hearing in Energy and Commerce. That hasn't happened either. We are the committee of jurisdiction.

You talk about working people. It is ObamaCare that puts a 40 percent tax on union plans and employer plans that exceed a certain level of costs, and they don't index it. Now, I don't know where the gentlewoman is on the Cadillac tax, but I want to repeal it. I never voted for it.

So, if they want to enshrine the Affordable Care Act in its entirety and make no changes, then I guess they are for a 40 percent tax on the kind of insurance plans that my building tradespeople negotiated to get--and other unions--instead of getting wage increases.

We have delayed that.

And when we look at the cuts in the Affordable Care Act coming at our hospitals in rural areas that serve lower-income areas, the DSH payments, we put off those cuts to our hospitals--last cycle--under Republican leadership. And we are going to face that question in this Congress under Democrat leadership.

So, a vote to delay those DSH cuts again--if one does that--is voting to repeal or delay part of ObamaCare.

I hear 60, 70 votes to do these things to ObamaCare--repeal the CLASS Act, which was a long-term health insurance program that was destined for failure, and even President Obama signed its repeal.

I can go through a whole list of things that got repealed. We are the only ones who ever get tagged with voting to repeal.

As far as our commitment to preexisting conditions protection: It is real, it is robust, and it was always in everything we did.

Yeah, I know what the political rhetoric was. I have run campaigns. I have been around that. I know how you can nuance around. But we always protected people with preexisting conditions--always, period, hard stop. Protected people with preexisting conditions, in what came out of my committee and came across this House floor, they were always covered--always.

So I hear the political rhetoric, but I know the facts. See, I am an old journalism major, and I believe in facts.

The facts of the matter are that 1332 waivers have given our States an opportunity to give our citizens an affordable health insurance plan, not one that I guess they will defend--$38,000 a year in premiums, $11,000 a year in deductibles, copays, out-of-pocket costs.

How is that working for anybody?

And shouldn't that 60-year-old couple in Nebraska have a chance to have a better plan option? Nope, guess not. Washington is going to decide it all for you. Write your check: 38 grand. That is for the premiums. And $11,000 in out-of-pocket costs, your deductibles. Then maybe you can get something covered, right?

Well, what is left? We know from this Kaiser study I have cited earlier that was in Axios: People wipe out their savings. They put it on their credit cards. They borrow from their friends. Or they simply don't get coverage.

That is the world they want to freeze-frame and leave in place. That is not what the Republicans are for. We want innovation. We want choice. We believe in our States having the opportunity to innovate and do it even better, not to go back to the old ways. No. That is not what we are for. I know that is what Democrats want to label us as being for, but it is not true.

And we have proven results in opioids; Community Health Centers; the longest funding for Children's Health Insurance Program in the history of the United States of America, under Republican leadership--10 years.

We are the ones, Republicans, who led the effort to invest in medical research at unprecedented rates under

what Fred Upton put forward and what Newt Gingrich put forward.

Madam Speaker, I have a motion to recommit at the desk.

Oh, yes, I am, Madam Speaker, in its current form.

Madam Speaker, this bill is blatantly political in its title. The misleading title of the bill confirms the Democratic majority's passion to score political points instead of governing. Madam Speaker, they claim the agenda is ``for the people.'' This bill is ``for the politics'' and the TV ads.

This motion to recommit is simple, Madam Speaker. First, it strikes the Democrats' misleading title, and it includes findings to make clear that, under current law, Health and Human Services cannot waive protections for individuals with preexisting conditions, period. They are protected.

Second, Madam Speaker, the motion to recommit would prohibit the Secretaries of HHS and Treasury from reissuing substantially similar guidance, including guidance that allows the State to waive guaranteed availability and renewability of health insurance, the prohibition on using health status to vary premiums, and the prohibition on preexisting conditions exclusions.

Madam Speaker, the Trump administration guidance does not amend section 1332. It does not permit the Secretary of Health and Human Services to waive protections for individuals with preexisting conditions, like guaranteed availability and renewability of health insurance, like the prohibition on using health status to vary premiums, and the prohibition on preexisting conditions exclusions.

Moreover, the President's guidance stipulates that any section 1332 waiver will need to carefully account for any impact on the individual market risk pool and guarantee--guarantee--that access to coverage is at least as comprehensive and as affordable as would exist without the waiver.

Now, this is fully explained, Madam Speaker, in the letter I have here from the head of CMS, Seema Verma, and I want to quote directly from it because I think it is important for our Members to understand the facts of the matter here, because facts matter.

``To be very clear, the 2018 guidance does nothing to erode,'' I am going to say ObamaCare or the Affordable Care Act's ``preexisting condition provisions''--nothing--``which cannot be waived under section 1332. Section 1332 does not permit States to waive Public Health Service Act requirements such as guaranteed availability and renewability of health insurance, the prohibition on using health status to vary premiums, and the prohibition on preexisting conditions exclusions.''

Now why are we here? Why are we having this discussion? Because people at home can't afford the health insurance they are being peddled, and we want States to be able to innovate and cut costs for consumers. That is why we are here. That is what we are for.

Democrats don't want that. Democrats are opposed to letting States innovate, apparently. And let's look at what happens.

Madam Speaker, according to Health and Human Services Administrator Seema Verma, Grand Island, Nebraska, a 60-year-old couple making $70,000 a year is paying about $38,000 for their insurance premiums, and that plan, under ObamaCare, gets them an $11,100 deductible.

$38,000 in premiums, $11,000 in deductibles, and they call that coverage. I call that unaffordable.

Now, meanwhile, we have seven States that have used the authority under the last administration. See, ObamaCare allows this 1332; Trump expands it. They have been able to drive down premiums by 19.9 percent. My State, it is 6 percent; other States have been more. Alaska, New Jersey, other States have taken advantage of this.

Republicans and Democrats agree we will always protect people with preexisting conditions. We will always do that. They can run their ads; they can deceive people; they can mislead people, Madam Speaker; but we will always fight to protect people with preexisting conditions-- always. Our plan last year did it. Our plan this year does it.

I will tell you what, Madam Speaker. We would have a vote today on the House floor to do that, to actually enshrine in statute, irrespective of the lawsuit, protections for Americans with preexisting conditions, except the Democrats and the Rules Committee refuse to allow that amendment to be considered on the House floor. They would not do that, because it was my amendment; it is my bill.

I have been pleading to have this bill considered so we can lock into statute protections for Americans' preexisting conditions. They want the argument. They want the politics. They don't want the policy.

We are for innovation; we are for lower premiums; we are for more consumer choice; and we are for driving down the cost of healthcare in America so people have coverage they can afford, Madam Chair. That is what our motion to recommit will do, and I urge our support.

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

Madam Speaker, I demand a recorded vote.

Madam Speaker, I ask unanimous consent that all Members have 5 legislative days in which to revise and extend their remarks and include extraneous material on H.R. 986, the Protecting Americans with Preexisting Conditions Act of 2019.

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

Mr. Chairman, I rise to speak in favor of H.R. 986, the Protecting Americans With Preexisting Conditions Act, introduced by Representative Kuster from our committee.

This legislation should not be necessary but, unfortunately, the Trump

administration continues to take actions that undermine the healthcare of millions of Americans, including the more than 133 million people with preexisting conditions.

Today, we are here because of the Trump administration's proposed guidance last October that would allow States to expand and prop up short-term junk insurance plans, even providing taxpayer subsidies for those plans. In order to take this action, the administration blatantly ignored the plain text of the Affordable Care Act and gutted standards that States must meet in order to test insurance reforms.

I believe the administration's action is illegal, but, sadly, this administration has never let the law get in the way of its goals. These efforts will, without a doubt, seriously undermine the health coverage of Americans with preexisting conditions.

A coalition of 24 national groups representing millions of Americans with preexisting conditions, including the American Cancer Society Cancer Action Network, the American Heart Association, and the American Diabetes Association, wrote a letter in strong support of H.R. 986, stating: ``The 1332 guidance substantially erodes the guardrails governing coverage that people with preexisting conditions such as cystic fibrosis, lung disease, cancer, cardiovascular disease, diabetes, rare disorders, pregnant women, and many others rely on in the individual marketplace.''

The patient organizations go on to say that ``these changes fundamentally alter the nature of the section 1332 waiver program and jeopardize adequate, affordable coverage for people with preexisting conditions in the individual market. Halting the implementation of this guidance will protect people with preexisting conditions.''

Mr. Chairman, by encouraging States to promote and expand short-term insurance plans, the administration is giving insurers the green light to directly discriminate against people with preexisting conditions; it is giving the green light to these plans to charge people with preexisting conditions more money; and it is giving these plans the green light to refuse to cover any treatment that is related to someone's preexisting condition.

The expansion of these junk plans will also undermine the insurance market, leading to higher premiums for people with preexisting conditions who need comprehensive coverage. This is not the way you protect people with preexisting conditions.

The Trump administration's guidance also undermines the ACA's promise of coverage of essential health benefits. The American people should not have to worry about whether their insurance plan covers prescription drugs, maternity and newborn care, mental health and substance use disorder services.

This guidance is also bad news for older Americans who could be charged a lot more for their insurance than what is allowed by the ACA.

In a nutshell, Mr. Chairman, this guidance is bad news for any American who wants access to quality and affordable health coverage that is there for them when they need it. Junk plans are just that-- they are junk.

People shouldn't have to read the fine print to see what is and is not covered, and that is the hallmark of the Affordable Care Act. So that is why we must rescind the guidance.

I want to commend my colleague, Ms. Kuster, for her great work on this important bill.

I do want to emphasize that H.R. 986 would not do anything to interfere with existing 1332 reinsurance waivers, which have bipartisan support and began under the Obama administration. My Republican colleagues continue to intentionally conflate these reinsurance waivers with the Trump administration's new 1332 waiver guidance from October of last year. H.R. 986 does not affect these reinsurance waivers.

I am disappointed that my Republican colleagues continue to make these arguments, but the bad faith is not surprising, given their terrible record on protecting people with preexisting conditions.

Mr. Chairman, this bill is necessary because of the ongoing assault by the Trump administration on our healthcare system. I urge my colleagues to join me in standing up for people with preexisting conditions and standing up for people who want access to affordable and quality healthcare.

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

House of Representatives,

Committee on Ways and Means,

Washington, DC, May 8, 2019.

Hon. Frank Pallone,

Chairman, Committee on Energy and Commerce,

Washington, DC.

Dear Chairman Pallone: I am writing with respect to H.R.

986, Protecting Americans with Preexisting Conditions Act of

2019. As a result of you having consulted with us on

provisions that fall within our rule X jurisdiction, and in

recognition of the desire to expedite consideration of the

measure, the Committee on Ways and Means agrees to waive

formal consideration of H.R. 986.

The Committee on Ways and Means takes this action with the

mutual understanding that we do not waive any jurisdiction

over the subject matter contained in this or similar

legislation, and the Committee will be appropriately

consulted and involved as the bill or similar legislation

moves forward so that we may address any remaining issues

within our jurisdiction. The Committee also reserves the

right to seek appointment of an appropriate number of

conferees to any House-Senate conference involving this or

similar legislation.

Finally, I would appreciate your response to this letter

confirming this understanding, and would ask that a copy of

our exchange of letter on this matter be included in the

Congressional Record during floor consideration of H.R. 986.

Sincerely,

Richard E. Neal,

Chairman.

Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman from New Hampshire (Ms. Kuster), the sponsor of the bill.

Mr. Chair, I yield the gentlewoman an additional 30 seconds.

Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman from Colorado (Ms. DeGette), who chairs our Oversight and Investigations Subcommittee.

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

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

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

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

Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman from New York (Ms. Clarke), the vice chair of the Energy and Commerce Committee.

Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman from Michigan (Mrs. Dingell).

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

Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman from Texas (Ms. Jackson Lee).

Mr. Chair, I yield 1\1/2\ minutes to the gentleman from Connecticut (Mr. Courtney).

Mr. Chair, may I inquire how much time remains?

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

Mr. Chair, I wanted to mention this issue of reinsurance. Some of the Republicans have brought up the fact that in the last few years under the Obama administration, actually before President Trump, certain States--I believe there are eight now, including my own--applied for 1332 waivers because they wanted to put in place reinsurance programs.

I want to assure everyone that those types of waivers that are granted for reinsurance would continue and that this legislation in no way impacts that. Keep in mind, we are not opposed to 1332 waivers.

But pursuant to the Affordable Care Act, which I helped draft, those waivers, when granted, have to maintain affordability and comprehensiveness of coverage and keep the same number of people insured as under the ACA.

When my State and others have applied for waivers for reinsurance programs, it is because the ACA reinsurance funding was discontinued at some point under the original bill. Those States want to, among other things, make sure that there is competitiveness in the marketplace by providing some kind of reinsurance or risk protection so that more insurers come into the marketplace in those States and create more competition and lower prices.

When you ask the Federal Government for a reinsurance waiver, you are still maintaining affordability, probably making things even more affordable because of competition. You are still maintaining the comprehensiveness of the coverage because you have to provide policies that have all the essential benefits. You are keeping the same number of people insured. In fact, what you are probably doing is having more people insured.

The difference between that and the section 1332 guidance that the Trump administration is now putting forth is that none of those things are guaranteed under the waivers that the Trump administration is proposing with their guidance.

For one thing, they are saying you can sell a junk plan that doesn't have hospitalization, that doesn't have essential benefits, so you violate the section 1332 provision.

You also end up having fewer people insured because the Trump administration says you don't have to have the same number of people covered. All you have to do is have access.

Lastly, affordability, sure, they will argue that somehow it is more affordable because a junk plan doesn't cost as much, but that is sort of a misnomer because the comprehensiveness of the coverage disappears.

I want everyone to understand, a State that applies to have reinsurance as part of their program and gets a waiver, that is in no way impacted by what we are proposing here today with Ms. Kuster's bill. In fact, reinsurance reinforces the very things that the 1332 waivers are seeking to guarantee.

So that is a very false bit of information that my colleagues on the other side are trying to put out here today. I wanted to explain that.

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

Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman from Michigan (Ms. Slotkin).

Mr. Chair, I yield myself such time as I may consume. I am still waiting for one of our other speakers.

Mr. Chair, I want to respond to my colleague, the ranking member, whom I respect a great deal. He has several times today, as well as in committee and as a representative at the Rules Committee, talked about this amendment that he has on preexisting conditions.

First of all, the reality is that the ACA guarantees people coverage with preexisting conditions. The problem here is not that we need to restate that, but that the section 1332 guidance that the Trump administration has proposed would undermine it.

On its surface, Mr. Walden's amendment appears to maintain protections for preexisting conditions, but, again, that is not the issue because he is not getting rid of the guidance that the Trump administration has put forward under 1332.

What does that mean? It means that even with his amendment, the Trump administration, under their guidance, would allow insuring companies to not offer basic services such as hospitalization, maternity coverage, mental health, and substance abuse disorders. Insurance companies would no longer have to offer these benefits to people with preexisting conditions who need those benefits.

Mr. Walden's amendment also does not include prohibitions on annual and lifetime limits, which are critical protections for individuals with preexisting conditions. These limits, which were commonplace prior to the ACA, are a threat to the life and health of individuals with serious medical conditions.

The Walden amendment would also allow insurance companies to charge women more than men and put a significant financial burden on older Americans.

We are not interested in these half measures that would leave Americans worse off.

Mr. Chair, I yield such time as he may consume to the gentleman from California (Mr. Harder).

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

Mr. Chairman, the problem is that nothing that my colleague on the Republican side says about his amendment and nothing that is in Seema Verma's letter will help a person with preexisting conditions.

The bottom line is this 1332 guidance that the Trump administration has put forward allows junk plans to be sold so that people with preexisting conditions will not get the coverage they need. They can be charged more. They are not guaranteed that things like recisions and lifetime limits don't go back into place.

So the problem that we face is we can't allow people with preexisting conditions to suffer and not get coverage because they are going to be charged more or because they are not going to get the coverage they need by buying a junk plan.

If you really care about that and you want to make sure that people with preexisting conditions really are guaranteed good coverage and can afford their coverage, then you have to vote for Ms. Kuster's bill. That is all we are saying here.

I am not saying that my colleague on the other side is not well meaning, but nothing he has said will protect the people with preexisting conditions from the problems with the Trump guidance. So I would ask my colleagues to support this bill.

Mr. Chairman, I include in the Record two letters from various nonprofit health organizations supporting the bill.

May 8, 2019.

Hon. Greg Walden,

Ranking Member,

House Energy & Commerce Committee,

Washington, DC.

Dear Ranking Member Walden: Our 35 organizations,

representing the interests of the millions of patients and

consumers who live with serious, acute, and chronic

conditions, have worked together for many months to ensure

that patient voices are reflected in the ongoing

Congressional debate regarding the accessibility of health

coverage for all Americans and families. In March 2017, we

identified three overarching principles to guide and measure

any work to further reform and improve the nation's health

insurance system. Our core principles are that health care

must be adequate, affordable, and accessible. Together, our

organizations understand what individuals and families need

to prevent disease, manage health, and cure illness. As the

116th Congress progresses, we welcome the opportunity to work

with members on both sides of the aisle on solutions that

will preserve coverage for individuals who are currently

covered, extend coverage to those who remain uninsured, and

lower costs and improve quality for all.

Prior to the Affordable Care Act (ACA), individuals who

were in the most need of health insurance coverage--including

older and sicker Americans and people living with pre-

existing conditions--often found it difficult, if not

impossible, to obtain health insurance that provided the

coverage they needed. Many individuals were denied coverage

due to their pre-existing conditions or were charged

outrageous premiums and/or were left with inadequate benefit

packages.

Without access to comprehensive health coverage they could

afford, many patients with serious and chronic conditions

were often forced to delay or forego necessary health care.

Before the patient protections provided under the ACA, more

than half of heart patients reported difficulty paying for

their care and of those patients more than 40 percent said

they had delayed care or had not filled prescriptions.

Uninsured patients with diabetes were six times as likely to

forgo necessary medical care than those with coverage.

Uninsured patients were less likely to be screened for cancer

and more likely to be diagnosed with later stage disease

which is harder to survive and more costly to treat.

Individuals and families with pre-existing conditions rely

on critical protections in current law to help them access

comprehensive, affordable health coverage that meets their

medical needs. Unfortunately, the arguments of the plaintiffs

and the recent change of opinion by the Department of Justice

in the Texas v. U.S. case continue to represent a serious

threat to these protections. We are troubled by the argument

made by the plaintiffs and DOJ that the court must invalidate

the entire ACA due to Congress' repeal of the individual

mandate, as many provisions of the ACA directly protect

people with pre-existing conditions.

Our organizations appreciate that members of Congress share

our concerns about the potential impact of Texas v. U.S. on

people with pre-existing conditions. Several bills have been

introduced in response to this case, from H. Res. 14, which

authorized the Speaker, on behalf of the House of

Representatives, to intervene in the case of Texas v. United

States, to S. 1125, the Protect Act, and H.R. 692, the Pre-

existing Conditions Protection Act of 2019.

Some of these bills--including S. 1125 and H.R. 692--

attempt to provide protection to people with pre-existing

conditions should the ACA be invalidated. We recognize and

appreciate the sponsors' efforts, and know that in many

cases, in response to stakeholder feedback, sponsors have

revised previous drafts of these bills to offer additional

protections for consumers, including those with pre-existing

conditions. However, we remain concerned that the policies

outlined in these bills fall far short of the comprehensive

protections and coverage expansion included in current law.

As you are aware, current law requires issuers to comply

with a set of provisions that work together to promote

adequate, affordable, and accessible coverage for people with

pre-existing conditions. A holistic approach that includes--

but is not limited to--community rating, guaranteed issue,

essential health benefits, cost-sharing limits, a

prohibition of lifetime and annual limits, allowing young

people to stay on their parents' insurance to age 26, the ban

on pre-existing condition exclusions, and other important

provisions protect people with serious health care needs from

discriminatory coverage practices and promote access to

affordable coverage. Medicaid expansion also brought coverage

to millions of Americans who were previously uninsured, many

of whom went without vital care. These policies are

inextricably linked and repealing any of them threatens

access to critical care for people with life-threatening,

disabling, chronic, or serious health care needs.

We hope that you will keep these critical patient

protections and the interlocking functions of current law

that safeguard coverage for consumers, patients, and

individuals with pre-existing conditions at the front of your

mind during the 116th Congress. We are grateful that Congress

is committed to exploring both immediate and long-term

approaches that can be taken to shore up and strengthen the

individual insurance market and we remain ready and willing

to work with Congress to achieve that goal and provide all

Americans with the health care they need and deserve. If you

have any questions about this letter, please contact Katie

Berge, Federal Government Relations Manager for the American

Heart Association.

Sincerely,

United Way Worldwide, COPD Foundation, Hemophilia

Federation of America, Susan G. Komen, Family Voices,

American Heart Association, National Health Council, Epilepsy

Foundation, March of Dimes, ALS Association, National

Hemophilia Foundation, National Coalition for Cancer

Survivorship, Alpha-1 Foundation, American Liver Foundation,

National Multiple Sclerosis Society, WomenHeart: The National

Coalition for Women with Heart Disease, American Cancer

Society Cancer Action Network.

Muscular Dystrophy Association, National Patient Advocate

Foundation, Leukemia & Lymphoma Society, Lutheran Services in

America, National Kidney Foundation, American Lung

Association, Cystic Fibrosis Foundation, American Diabetes

Association, National Psoriasis Foundation, National Alliance

on Mental Illness, Adult Congenital Heart Association,

Arthritis Foundation, Chronic Disease Coalition, Immune

Deficiency Foundation, Cancer Support Community, National

Organization for Rare Disorders, Pulmonary Hypertension

Association, Juvenile Diabetes Research Foundation.

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

Mr. Chair, I object.

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

Mr. Chairman, I claim the time in opposition to the gentleman from Oregon's amendment.

Mr. Chairman, it disturbs me, I guess, that my colleague on the other side, whom I greatly respect, keeps mentioning this letter from Seema Verma, the CMS Administrator.

Nothing that she says in her letter is in any way going to change the guidance that she and the Trump administration have put forward that would undermine people with preexisting conditions' ability to get good insurance if this guidance is allowed to continue and States get waivers pursuant to the guidance, because of, again, the issue of affordability.

You see, the problem is that the 1332 waivers, the way they are set out in the ACA, have certain guardrails, if you will, to prevent waivers that would allow for junk insurance and other policies that would undermine people with preexisting conditions from getting good insurance.

Those guardrails say that any kind of waiver has to guarantee affordability, has to guarantee comprehensive coverage, the essential benefits package, robust coverage, and also not reduce the number of people who are insured.

This guidance that Seema Verma and the Trump administration have put forward does exactly the opposite, because it allows insurance to be sold, if a State seeks to do so, that would eliminate, for example, hospitalization or eliminate mental health coverage or eliminate coverage for maternity care.

Now, if you are someone with preexisting conditions and they eliminate coverage for your preexisting condition, that relates to your preexisting condition, you might as well not even have insurance, and that is why we say it is junk. It lets a waiver be granted that would allow the insurance companies of that State to charge more based on age, based on sex. I mean, the list goes on.

So Seema Verma can send out all the letters she wants, but it doesn't mean anything.

I like to say, you know, one of the things that disturbs me most, also, is we on the Democratic side, myself and some of the other chairmen of some of the other committees, sent a letter and a request, because it has been pointed out repeatedly that Seema Verma has been putting out contracts up to $4 million a year to basically promote herself, and that is being investigated right now as we speak.

So, again, I don't like to say bad things about people, but the bottom line is she is in no position to be telling us what is in this guidance. This guidance is going to hurt people with preexisting conditions, and there is no way that she is going to get around it.

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

Mr. Chair, I have no objection.

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

Mr. Chairman, just to back up what I said previously about the implications for this Trump administration and Seema Verma's guidance that they put forward with regard to 1332, I want to read a section from a letter that was sent by 23 patient and consumer advocacy organizations in support of H.R. 986, the bill that is before us. These organizations include the Heart Association, the Lung Association, the Epilepsy Foundation, et cetera. This goes back to the guardrails.

As I said, under 1332, in the ACA, there are guardrails that say that any waivers have to guarantee affordability, have to guarantee comprehensiveness of coverage, and have to, at the same time, not reduce the number of people with insurance.

Nothing that Seema Verma or anything on the other side that is being said is suggesting in any way that, under this guidance, those principles wouldn't be violated. In fact, they would be violated.

So this is what these 23 patient and consumer advocacy organizations say about the Trump guidance waiver: ``This gross misinterpretation of the guardrails will have real consequences for patients, steering people into substandard coverage, such as short-term, limited-duration plans and association health plans, which often do not cover the full range of benefits and services that patients rely on to manage their conditions.

``Further, policies that could be implemented under this new interpretation could fundamentally alter the risk pool for a State's individual marketplace, making comprehensive coverage unaffordable for patients who rely on it and jeopardizing the stability of the State's marketplace. The resulting lack of access to care could have devastating short- and long-term consequences for the millions of patients we represent.''

The bottom line is this is going to dramatically hurt people with preexisting conditions if they try to buy insurance that will cover the maladies that they want to cover, and they need to have covered.

Again, I don't understand, Mr. Holding and, previously, Mr. Walden have these amendments that really have nothing substantive to say. All they do is talk about changing the title because they are trying to ridicule what Democrats are trying to do here, which is to guarantee that people with preexisting conditions are protected.

I don't want to get upset, but I think that it is kind of inappropriate, when here we are trying to guarantee people with preexisting conditions are protected--even Republicans on the other side are saying that is important to them--and, instead of having a serious debate about this, they put forward amendments that change the title to ridicule what we are trying to do. It is just unfortunate that we are at that point now, but that is where we are.

Madam Chairman, I reserve the balance of my time.

Madam Chair, my colleagues on the other side started out this debate on these amendments by basically saying they wanted to substitute the title rather than talking about the substance. Now, my colleague, the ranking member, starts talking about the lawsuit that would--I think he is talking about the lawsuit that would repeal the Affordable Care Act.

Again, my colleagues on the other side are not looking to protect people with preexisting conditions, they are not looking to protect anybody, because now they are saying that it is a

good idea to repeal the Affordable Care Act. So we are back to the basic debate about whether or not we should have the Affordable Care Act, which until President Trump came along and started sabotaging the bill, 97 percent of Americans had health insurance, an all-time high in the history of this country.

So, okay, that is fine. Now we are going to say that they want to repeal the Affordable Care Act once again. This is what this is all about on their side of the aisle: repeal the act, move to court to try to get the courts to declare the act unconstitutional, no effort to worry about the millions and millions of Americans who have gotten coverage because of the Affordable Care Act.

I really don't know what else I can say at this point, but at least they revealed their true motive, which is simply to repeal the whole bill.

Once again, I guess there is not much to say here, other than to say that I would urge my colleagues to reject this amendment. Let's get back to talking about the substance of the bill that is before us, which would guarantee that there are protections for people with preexisting conditions.

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

Madam Chair, I demand a recorded vote.

Madam Speaker, I demand a recorded vote.

Madam Speaker, I rise to support the underlying bill and the rule that is presently before us.

As I do so, let me thank my colleague on the Judiciary Committee. We have served for any number of years, and Congresswoman Lofgren has been on the front lines of reason and trying to address the question of comprehensive immigration reform.

Together, respectively, and parallel to each other, we have introduced, over and over again, comprehensive immigration reform. We have watched it be refuted and rebutted by those who really could have helped us solve even the problem of the surge that we are seeing crossing the border today.

Let me, as well, thank Madam Speaker, who has been engaged in a very important way, and my friend and colleague Lucille Roybal-Allard, who has clearly been leading on this issue and many others. Let me thank the Judiciary Committee as well, where we came together as a team.

Let me reinforce what has been said over and over again, and that is that Dreamers are Americans. Those who

are beneficiaries of TPS, they have been here 20 to 30 years because of the difficulty of their home countries. They have, likewise, shown themselves to love this country.

There was a period of time when Dreamers had joined in and went to the Iraq war. They were not citizens, but they went there because they loved this country so much. They came as a child, and they realized the wonderment of this country.

It is important to convince those who believe that we are opening the doors and that we are reckless. Let me be very clear. Besides the Immigration and Nationality Act that is already in existence, there are very clear parameters on dealing with people who are felons or a threat to national security, individuals who have committed DUIs, those who have misdemeanors. There are clear parameters of ensuring that the Nation is protected. But, as well, there is dignity and human rights.

There is also the question of what investment in dollars you will lose, what you will throw away, $460 billion from the national GDP over the decade from 685,000 workers--in my own State, $8 billion annually in the State GDP.

Immigrants are in the fabric of our society. We are immigrant and nonimmigrant. All of us have come from that history. Mine is different, having been brought here by, meaning those who are of African American heritage, as slaves.

386,300 immigrants are eligible under the American Dream and Promise Act, and 120,000 live in Harris County.

But this is the story that I want to tell and dwell on. A Dreamer died trying to rescue Hurricane Harvey victims. That is Alonso Guillen, who came to help those in the darkest moments of our region, during Hurricane Harvey, the greatest and most significant disaster.

Madam Speaker, I thank the gentlewoman for her courtesy.

He came from Lufkin, Texas. He loved Texas football and country music. He had fundraisers for any manner of needs in his area.

When he saw the devastation and the people in water in Harris County, and we were in 51 trillion gallons of water, he came, with a little boat and a friend. He didn't ask whether they were immigrant or nonimmigrant, Dreamer or non-Dreamer, what their background was. As they were in the water, as they were on their rooftops, as they were desperate without food, he came.

Tragically, his family had come to, ultimately, find him floating in the water, when his boat had toppled and, we believe, had been impacted by the wires in the water.

This is the face of Dreamers. This is the face of those who would benefit from temporary protective status coming from Nepal, from El Salvador, and from countries that are under major devastation.

Many times, there is crime in America, and I understand that. But people don't imagine what it is to flee from the natural disasters that these individuals have fled from, to have no relief from the government, and to compound that with the violence that is going on, knowing so much violence.

I stand here today to ask for rational thought. With a multitude of organizations, I want to raise up one, the U.S. Chamber of Commerce. It doesn't come lightly to this question. I would argue that, had we passed comprehensive immigration reform 10 years ago, 15 years ago, the question of surging across the border would not be an issue.

Let me also be clear that we have built barriers across the border for more than a decade. I remember giving huge sums of money to ensure it, in certain spaces.

What we are saying now is that that is not a sole solution. The solution is regularizing individuals with the safeguards of this legislation.

I would hope my colleagues, Republicans and Democrats, as Americans, understand that this Nation was built with the sweat and tears and love of immigrants. Every American, except Native Americans, can point to coming from somewhere else, no matter what condition they were in when they came.

I ask our colleagues to support this legislation, H.R. 6, because it is the American thing to do.

Madam Speaker, as a senior member of the Committees on the Judiciary and on Homeland Security, and a representative of a state on the southern border, I rise in strong support of the rule governing debate of H.R. 6, the ``American Dream and Promise Act of 2019,'' and the underlying legislation.

The American Dream and Promise Act of 2019 establishes a roadmap to U.S. citizenship for (1) immigrant youth and (2) current or potential holders of (a) temporary protected status (TPS) or (b) deferred enforced departure (DED).

Ensuring a path to earned citizenship is a non-negotiable principle for me and the sine qua non of meaningful immigration reform legislation.

Indeed, providing a path to earned access to citizenship has been a central feature of every comprehensive immigration reform bill I have co-sponsored or sponsored in the Congress since 2007 when I became Ranking Member of the House Judiciary Subcommittee on Immigration and introduced the ``Save America Comprehensive Immigration Reform Act, (H.R. 1525),'' which I have reintroduced in each succeeding Congress.

Like H.R. 6, Section 501 of my legislation provides a path to earned legalization status to those undocumented immigrants who have resided in the United States for 5 years and meet other eligibility requirements.

Madam Speaker, as we stand today on the precipice of passing the American Dream and Promise Act of 2019, I am thinking of the hundreds of thousands of young immigrants whose lives will be changed for the better by keeping our promise to them, so they can realize their dreams and making America better, stronger, and more prosperous.

And at this moment, I am thinking of Alonso Guillen, an heroic DREAMER who lived in my congressional district, and who came to the United States from Mexico as a child and died when his boat capsized while he was rescuing survivors of the flooding caused by Hurricane Harvey in the Houston area.

That is the type of courage, honor, and commitment to service we are talking when we speak of DREAMERS.

Madam Speaker, Title I of H.R. 6, the Dream Act of 2019, contains provisions regarding relief for immigrant youth.

Title II of the bill, American Promise Act of 2019, contains provisions related to persons eligible Temporary Protected Status (TPS) or Deferred Enforcement Departure; the third and final title contains general provisions that apply to both Titles I & II).

Madam Speaker, I support H.R. 6 because it keeps America's word to the more than 800,000 young people we asked to come out of the shadows and walk proudly and unashamedly as legitimate members of the American community.

The legislation does this by providing conditional permanent resident (CPR) status and a roadmap to lawful permanent resident (LPR) status and, eventually, earned U.S. citizenship for immigrant youth who entered the U.S. before age 18, have four or more years of residency, and graduated from high school (or the equivalent).

H.R. 6 also provides an opportunity to apply for LPR status for people who currently have or who may be eligible for TPS or DED and who have three or more years of residency.

Madam Speaker, individuals who are eligible for protection under the bill have lived in the United States for much of their lives; the average Dreamer came to the United States at the age of 8, while the average TPS- or DED-eligible person arrived in 1997.

Without permanent protections such as those in H.R. 6, these immigrants' and their families' futures in the United States--as well as the fiscal and economic contributions they make--are at risk.

Passing this legislation is the right thing to do and now is the time to do it; in fact, it is long overdue.

I am mindful also Madam Speaker that in addition to helping restore America's reputation as the most welcoming nation on earth, the legislation the House will pass also positions America to better compete and win in the global economy of the 21st century.

According to expert studies, including one by the Center for American Progress, ending deferred action for childhood arrivals would result in a loss of $460.3 billion from the national GDP over the ensuing decade and would remove an estimated 685,000 workers from the nation's economy and workforce at a time when more, not fewer, workers are desperately needed.

And 10 states, including my home state of Texas, would stand to lose more than $8 billion annually in state GDP.

Madam Speaker, immigrants eligible for protection under H.R. 6 are part of Texas's social fabric.

Texas is home to 386,300 immigrants who are eligible for protection under the Dream

and Promise Act, 112,000 of whom reside in Harris County.

These individuals live with 845,300 family members and among those family members, 178,700 are U.S.-born citizen children.

Dreamers in Texas who are eligible for protection under the bill arrived in the United States at the average age of 8.

TPS- and DED-eligible immigrants in Texas who would be eligible for protection under H.R. 6 have on average lived in the United States since 1996.

Immigrants eligible for the Dream and Promise Act own 43,500 homes in Texas and pay $340,500,000 in annual mortgage payments.

Eligible immigrants in Texas and their households contribute $2,234,800,000 in federal taxes and $1,265,200,000 in state and local taxes each year.

Annually, these households generate $10,519,000,000 in spending power in Texas and help power the national economy.

Madam Speaker, during general debate on H.R. 6, I will have more to discuss about the salient features of this long overdue legislation that fulfills the American promise that all of its residents who share our values and respect for the Constitution and laws have an opportunity to realize their dreams.

But in the limited time I have now, let me highlight some of the more important provisions of the American Dream and Promise Act.

H.R. 6 helps young persons in the following ways:

1. Extends the length of conditional permanent resident (CPR) status from eight to ten years to give applicants more time to fulfill requirements;

2. Stays the removal of minors who are not yet eligible for relief but may become eligible in the future and who temporarily unenroll from school;

3. Permits people with CPR to obtain legal permanent resident (LPR) status without satisfying the employment, military, or educational tracks if their deportation would cause ``hardship'' to themselves or immediate family members (instead of ``extreme hardship'');

4. Includes apprenticeship programs as a qualifying education to obtain CPR status;

5. Eliminates the costly medical examination for applicants;

6. Establishes a fee ceiling of $495 for immigrant youth applying for CPR status;

7. Clarifies that people with CPR can access professional, commercial, and business licenses;

8. Permits people with CPR who obtain a certificate or credential from an area career and technical education school to obtain LPR status; and

9. Updates the criminal background bars and inadmissibility requirements.

Additionally, H.R. 6 provides LPR status to CPR holders who (1) serve in the uniformed services for two years; (2) complete two years at or obtain a degree from an institution of higher education; or (3) work 75 percent of the time in CPR.

Another important feature of this legislation is that makes it easier for states to provide in-state tuition to immigrant students and establishes that CPR-holders are eligible for federal loans, work study, services, and grants.

For persons with TPS or DED status, the American Dream and Promise Act provides much needed relief.

First, H.R. 6 provides LPR status for people with TPS or DED (and those who were eligible but did not apply) who apply within three years from the date of enactment if they (1) had at least three years of continuous residence (as well as residence since the date required the last time that the person's nation of origin was designated) and (2) were eligible for or had (a) TPS on September 25, 2016, or (b) DED on September 28, 2016.

This protection covers national of 13 countries: El Salvador, Guinea, Haiti, Honduras, Liberia, Nepal, Nicaragua, Sierra Leone, Somalia, South Sudan, Sudan, Syria, and Yemen.

I believe similar protections should be extended to Guatemalan nationals in our country, which is why I will soon reintroduce the ``Continue American Safety Act,'' which extends TPS status to Guatemala and I look forward to working with my colleagues to achieve this outcome.

Second, H.R. 6 classifies people with TPS or DED as inspected and admitted for the purposes of Immigration & Nationality Act (INA) section 245(a), making it easier to obtain LPR status through existing channels (e.g., a family-based petition).

Third, H.R. 6 stays the removal or deportation of an a individual while an application is pending.

Fourth, the American Dream and Promise Act establishes a fee ceiling of $1,140 for people with TPS or DED applying for LPR status.

Fifth, the legislation provides greater transparency by requiring the Secretary of the Homeland Security (DHS) to provide an explanation for and report within three days of publishing notice to terminate TPS designation for certain nationals.

Madam Speaker, H.R. 6 is exceptional legislation and a welcome development but is not a substitute for undertaking the comprehensive reform and modernization of the nation's immigration laws supported by the American people.

Only Congress can do that and passage of H.R. 6 shows that this House has the will and is up to the challenge.

Comprehensive immigration reform is desperately needed to ensure that Lady Liberty's lamp remains the symbol of a land that welcomes immigrants to a community of immigrants and does so in a manner that secures our borders and protects our homeland.

Madam Speaker, let us build on the historic legislation that is the American Dream and Promise Act and seize the opportunity to pass legislation that secures our borders, preserves America's character as the most open and welcoming country in the history of the world, and will yield hundreds of billions of dollars in economic growth.

I urge all Members to support the rule governing debate of H.R. 6 and the underlying bill.

Mr. Chair, I thank the chairman very much for yielding.

Just a second on memory lane, for those of us who were here for the Affordable Care Act, dozens of our committees, including the Judiciary Committee, heard the pain of people whose family members had died because they had no access to healthcare and/or they had junk policies.

Mr. Chair, I rise today with the strongest of support for H.R. 986. I thank my good friend, Ann Kuster, for her great leadership and indicate that since the Affordable Care Act--and I know that we are now looking at Medicare for All and many others. My view of it is yes, so that we all can have access to healthcare.

It is, in fact, sure that this bill that we now have, which is being attacked by the Trump administration in the Fifth Circuit right now because of my attorney general attacking the Affordable Care Act, Texas saw a national decrease of the uninsured from 14.8 to 8.8.

Now this legislation, which is to turn back the Trump guidance on the issue of waivers, is vital because we have lower costs for health insurance because of the ability for people to access and be taken care of with the Affordable Care Act when they have preexisting conditions.

Sickle cell, triple negative breast cancer, and diabetes all plague my constituency. Insulin costs are going through the roof. With this guidance that Trump has put in place, it will be worse. It will be compounded.

Rates will go up, and people suffering from preexisting conditions, including pregnancy, will not get policies at a low cost. They will not have comprehensive coverage that will include mental health. Certainly, they will see a reverse of them being able to have coverage for preexisting conditions.

That is the civil rights of healthcare. Preexisting conditions must be protected.

I rise to enthusiastically support H.R. 986, and I demand that the Trump administration stop taking away constitutional rights in everything and denying people their right to good healthcare. Enough is enough. Let us support this legislation.

Mr. Chair, I rise in strong support of H.R. 986, the ``Protecting Americans With Pre-Existing Conditions Act of 2019,'' which blocks the Trump Administration's efforts to give states the ability to weaken the Affordable Care Act's critical protections for Americans with pre- existing conditions.

On October 22, 2018, the Centers for Medicare & Medicaid Services (CMS), HHS, and Treasury issued a guidance on Section 1332 of the ACA, which authorizes states to waive certain requirements of the law and experiment with health insurance reforms that could improve the well- being and health of their residents.

The ACA has a clear statutory directive that states must maintain the level of benefits, affordability, and coverage provided to state residents by the ACA.

Section 1332 requires states to meet four statutory ``guardrails'' simultaneously and demonstrate that the proposed waiver will provide comprehensive, affordable coverage to a comparable number of residents as under the ACA, without increasing the federal deficit.

But in the 2018 guidance, HHS and Treasury revised the agencies' interpretation of the statutory requirements, and significantly loosened the standards that states must meet in order to receive waiver approval, setting forth weaker requirements that must be met for the affordability and comprehensiveness guardrails and adopted a new definition of what classifies as coverage.

The 2018 guidance provided by the Trump Administration would allow states to simply demonstrate that a comparable number of residents will have access to comprehensive and affordable coverage, regardless of whether they actually enroll in that coverage, thereby allowing the Secretaries of HHS and Treasury to approve waivers that do not provide coverage that is as affordable or as comprehensive as under the ACA.

The 2018 guidance also allows states to receive waiver approval for proposals that direct the ACA's tax credit subsidies towards STLDI plans and other types of health insurance plans that do not provide protections for pre-existing conditions.

H.R. 986 revokes and rescinds the October 2018 Section 1332 guidance and prohibits the Secretaries of HHS and Treasury from promulgating any substantially similar guidance or rule.

These improper waivers leave consumers with less comprehensive plans that do not cover needed services, such as prescription drugs, maternity care and substance use disorder treatment.

Another way the ``Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019,'' protects consumers is by prohibiting insurance companies from selling junk health insurance plans that do not provide coverage for essential medical treatments and drugs or cover people with pre-existing medical conditions.

As a member of Congress who voted against each of the dozens of Republican efforts to repeal the Affordable Care Act, I know first-hand how important and critical access to affordable, high quality, accessible health care available to everyone, including those with pre- existing conditions, to the well-being of American families.

Because of the passage of the Affordable Care Act, the national uninsured rate has been slashed from 14.8 in 2012 to 8.8 percent in 2018. Texas has long led the nation in rate of uninsured so the comparable rates are 24.6 and 15 percent, respectively.

Mr. Chair, I distinctly recall a candidate for the highest public office in the land saying ``Obamacare is a disaster'' and appealing for voters to support him with this question: ``What have you got to lose?''

The question deserves a response so I hope that person, who occupies the Oval Office, is listening to my answer.

The Affordable Care Act, or ``Obamacare,'' has been an unmitigated success to the more than 20 million Americans who for the first time now have the security and peace of mind that comes with affordable, accessible, high quality health care.

Mr. Chair, Tip O'Neill used to say that ``all politics is local'' so let me share with you how Obamacare has dramatically changed lives for the better for the people in my home state of Texas.

1.874 million Texans who have gained coverage since the ACA was implemented could lose their coverage if the ACA is entirely or partially repealed or invalidated.

1.1 million Texans who purchased high quality Marketplace coverage now stand to lose their coverage if Texas v. United States, No. 4:18- cv-00167-0 (N.D. Tex.), the lawsuit brought by Republican Governors, and now whole-heartedly supported and aided by the Trump Administration were to succeed.

508,000 kids in Texas who have gained coverage since the ACA was implemented are also at risk of having their coverage rolled back.

205,000 young adult Texans who were able to stay on a parent's health insurance plan thanks to the ACA now stand to lose coverage if the Republican Congress eliminates the requirement that insurers allow children to stay on their parents' plans until age 26.

646,415 Texans who received cost-sharing reductions to lower out-of- pocket costs such as deductibles, co-pays, and coinsurance are now at risk of having healthcare become unaffordable if the Republican Congress eliminates costsharing reductions.

10.28 million Texans who now have private health insurance that covers preventive services without any co-pays, coinsurance, or deductibles stand to lose this access if the Republican Congress eliminates ACA provisions requiring health insurers to cover important preventive services without cost-sharing.

913,177 individuals Texans who received financial assistance to purchase Marketplace coverage in 2016, averaging $271 per individual, are at risk of having coverage become unaffordable if the Republican Congress eliminates the premium tax credits.

1.1 million Texans could have insurance if all states adopted the ACA's Medicaid expansion; these individuals will not be able to gain coverage if the Republican Congress eliminates the Medicaid expansion.

Women in Texas who can now purchase insurance for the same price as men are at risk of being charged more for insurance if the ACA's ban on gender rating in the individual and small group markets is invalidated.

Before the ACA, women paid up to 56 percent more than men for their health insurance.

Roughly 4.5 million Texans who have pre-existing health conditions are at risk of having their coverage rescinded, being denied coverage, or being charged significantly more for coverage if the ACA's ban on pre-existing conditions is struck down.

346,750 Texas seniors who have saved an average of $1,057 each as a result of closing the Medicare prescription drug ``donut hole'' gap in coverage stand to lose this critical help going forward.

1.75 million Texas seniors who have received free preventive care services thanks to ACA provisions requiring coverage of annual wellness visits and eliminating cost-sharing for many recommended preventive services covered by Medicare Part B, such as cancer screenings, are at risk of losing access to these services if congressional Republicans go forward with their plan to repeal the ACA.

The Affordable Care Act works and has made a life-affirming difference in the lives of millions of Americans, in Texas and across the country.

This is what happens when a visionary president cares enough to work with a committed and empathetic Congress to address the real issues facing the American people.

You want to know why the American people have Obamacare?

It is because Obama cared.

The same cannot be said about this Republican president and congressional Republicans who have made careers of attacking and undermining the Affordable Care Act's protections and benefits for the American people.

I urge all Members to vote for H.R. 986 and send a powerful message to the President and the American people that this House will not stand idly by as this Administration tries to take away health care from more than 130 million persons.

Instead, this House will resist by all constitutional and appropriate means, including opposing this Administration in the courts and by passing H.R. 986, the ``Protecting Pre-Existing Conditions and Making Health Care More Affordable Act of 2019.''

Madam Speaker, as the whip of the Congressional Hispanic Caucus, I am pleased to lead our second monthly Special Order hour.

Last month, my colleagues and I spoke about the importance of comprehensive immigration reform. Since then, the Congressional Hispanic Caucus Immigration Task Force, led by Congresswoman Linda Sanchez of California, drafted a set of immigration principles, which our caucus has now adopted. We plan to use these as a guide as we work on developing a comprehensive immigration reform proposal. Chief among these principles is a timely path to citizenship for Dreamers and a permanent solution for those with temporary protected status and deferred and forced departure.

Democrats made an important commitment to these communities. After a failed attempt at a bipartisan solution for Dreamers and TPS recipients last year, and again a few weeks ago, we said that if we regained control of the House, we would move quickly to fix this. Democrats have spent the last few weeks working just on that.

In particular, two of our CHC colleagues, Congresswoman Lucille Roybal-Allard and Congresswoman Nydia Velazquez, along with Congresswoman Yvette Clarke, have been putting together a proposal that will provide overdue needed relief. Their Dream and Promise Act, H.R. 6, will be introduced next week. We are also grateful for the time and effort they have put into this critical legislation.

That is why we wanted to take this month's CHC's Special Order to focus on Dreamers and TPS recipients. These are unique groups within our broader immigration community and their current plight--the uncertainty of their status--is entirely the fault of President Donald Trump and actions he took against them.

For Dreamers, the American people have heard us talk about them for many years, but I think it serves reminding just who those folks are. Dreamers are mostly young adults whose parents brought them to this country when they were minors. They do not have legal immigration status in the United States. They are undocumented, just like I was once. They came here through no fault of their own. For the vast majority of them, the United States of America is the only country they have ever known. A good number of them grew up not even knowing they were in immigration limbo and at risk of being deported.

Some only found out when they applied to college. Just think about that, Madam Speaker. You are a young high school student with your whole life ahead of you. You have dreams and aspirations for future careers and you are excited to take on a new chapter of your life. Then one day you find out that you are one of those undocumented folks you have been hearing about. There is now a barrier to your ability to get a higher education, to get a good job, to establish yourself in our society.

President Obama recognized this injustice and he created a program that would give Dreamers relief from deportation, known as the Deferred Action for Childhood Arrivals, or DACA. This gave them some sense of certainty, and, most importantly, it gave them the legal status they needed to pursue an education and career, to buy a home, and begin raising a family.

Nearly 800,000 individuals across the country receive DACA, and thousands more were still eligible. But President Trump abruptly chose to end the program as part of his anti-immigrant policies. Not only is this cruel and unjust, it is economic malpractice.

According to the Center for American Progress, ending DACA will cost our GDP $460 billion. Let me say that again, Madam Speaker. Ending DACA will cost our GDP $460 billion. That is because it will mean removing 685,000 workers out of the workforce.

If President Trump wants to promote economic growth, as he says, then why would he make such a horrible decision? I leave it up to the American people to sort out that mystery. Perhaps they can do it at the ballot box in a couple of years.

TPS recipients. Now, what is worse, Madam Speaker, is that Dreamers aren't the only group President Trump has decided to throw into legal limbo.

Over the course of his 2 years in office, the President has ended also temporary protected status. I know you know that very well, Madam Speaker, because you represent the State of Florida.

For thousands of individuals, the temporary protected status has been attempted to end. TPS is an incredibly important program. It allows individuals to stay and remain in the United States for an extended period of time if some emergency erupts in their home country that prevents them from being able to return. TPS has been using cases of severe natural disasters, as well as armed conflict.

Only a few countries have been granted TPS. The program is so important because it allows these people, who would otherwise be in limbo for an unknown amount of time, to live their lives here in the United States, giving them the ability to work and establish themselves. Some countries have been designated under TPS for many, many years and are still not safe for individuals to return back home.

That is why it has been routinely extended by Presidents of both parties. This is not a Republican or a Democratic program. Presidents of both parties have extended TPS.

TPS holders are established members of our communities. They are workers, they are homeowners, they are our neighbors and they have children and families that have built their lives here. They deserve to stay, Madam Speaker.

And the truth is our economy really needs them. More than 300,000 individuals are currently beneficiaries of TPS, but they account for more than $10 billion in spending power in our economy according to CAP. They pay local, State, and Federal taxes. Once more, so many TPS holders are the parents or relatives of thousands of U.S. citizen children, children who deserve to have their families stay together.

In conclusion, Madam Speaker, families belong together. Whether they are separated at our border, whether they came here with a young child who only recently learned he or she was undocumented, whether they cannot return to a nation that is not able to receive them, they deserve to stay together, and they deserve to remain here in the United States, the place they now call home.

During the rest of this hour, you will hear from a number of CHC colleagues from across the country about how important Dreamers and TPS recipients are to their respective districts, how these hardworking individuals are part of the very fabric of communities they represent. I look forward to hearing from them and sharing their stories with you, Madam Speaker.

Madam Speaker, I yield to my colleague from the State of Illinois (Mr. Garcia) whose State is home to nearly 3,000 TPS holders and more than 42,000 DACA recipients. The GDP law, if DACA were to be removed, is $413 million, and TPS spending power in that State is $91.7 million.

Madam Speaker, let me just share some numbers with you from respective States across the country.

The number of TPS holders, for example, in the State of California, over 50,000 of them; in your home State of Florida, Madam Speaker, over 44,000 of them; in Illinois, close to 3,000 of them; in Massachusetts, over 5,000 of them; in New Mexico, no data, but fewer than 1,500; in New York, over 25,000 of them; in Texas, over 46,000 of them.

And the children living with these TPS recipients are, in California, over 43,000; in Florida, again, over 37,000; in Massachusetts, over 3,000; in New York, over 23,000; and in Texas, 49,000 children are living with TPS recipients.

DACA recipients are also in large numbers. In the State of California, you have close to 223,000 DACA recipients; in Florida, close to 33,000 recipients; in Illinois, Madam Speaker, you have close to 43,000 DACA recipients; in New York, 41,000.

So these are huge numbers for people who are so important to the fabric of our country, and that is why we are here to support them, because families that stay together are stronger together. When a family is divided, our Nation is weaker; when our family is together, our Nation is stronger.

Mr. Speaker, I yield to my colleague from Florida (Ms. Mucarsel- Powell), whose State is the home State to 45,000 TPS recipients and nearly 33,000 DACA recipients

Mr. Speaker, as has been said here tonight, bringing relief, permanent relief to DACA recipients and TPS beneficiaries must not be delayed. Comprehensive immigration reform cannot continue to be delayed.

That is why I am so happy, as I mentioned earlier, that in a week or two, H.R. 6, the Dream and Promise Act, which promises to bring about comprehensive immigration reform in many ways for DACA recipients and TPS recipients and other immigrants, will hit this floor.

We are hoping that all our colleagues from both sides of the aisle will recognize that this is an important effort to finally bring over 800,000 young people permanently to the United States, young people who are teachers, nurses, police offers, members of our Armed Forces. They are business owners. They purchase their own homes, in many cases. These are important members of our communities across the country, and we must allow them to stay in the United States of America.

TPS recipients, many of them cannot return back to dangerous settings in their homeland. Many of them, their countries are reeling from natural disasters. It would be a travesty if we send them back home. They must be allowed to stay here in the United States of America. This is an important moment in our time.

Families that stay together are stronger; families that are divided are weaker. Our country is made stronger when a family is together. That is why I am asking all in this Chamber from both sides of the aisle, next week, to support H.R. 6, the Dream and Promise Act, which will finally bring relief to many, many young people and undocumented people from this Nation, as well as TPS recipients will finally breathe some fresh air and be able to stay here in this great Nation.

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