CREATES Act of 2019

Mr. Chairman, I rise in opposition to the amendment.

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

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

So let's talk about the navigator program. They enroll less than 1 percent today, less than 1 percent.

Wall Street Journal reported an investigation that one grantee took in $200,000 to enroll a grand total of 1 person; and they found the top 10 most expensive navigators collected 2.77 million taxpayer dollars, 2.77, Mr. Chairman.

Do you know how many people they signed up? 314.

They want to add $25 million more on top of the $62,500,000 in grants. We are talking about less than 1 percent.

Meanwhile, while they are talking about oh, we have got to educate people about all their options, then they put a gag rule in here that says, can't talk to you about short-term duration plans. Oh, no, we can't educate about that choice. No, you can't know about that. No, we are going to stop that. Oh, and you can't know about association health plan options either. It might be better for you and your family and actually be more affordable. No, no, no, because that is not our Federal decision here. They decide, and they don't want you to even know. So navigators can't talk about those things. That is gagged in this law.

The amazing thing we never hear about is the good work of the Trump administration and the economy as it has taken off. And I say that in the context that we have seen the lowest unemployment rates for virtually every American and group of Americans; whether it is African Americans, Hispanic Americans, you name it, we are seeing, the lowest rates, in some cases, since they began keeping track of unemployment.

So the economy is doing really well. Over 3 percent GDP growth the first quarter.

So what has that meant for insurance?

We have heard the constant, unrelenting attacks; you might as well use impeachment here at some point probably today.

Look, the number of Americans in employer health coverage has increased by more than 2.5 million since President Trump took office. Two-and-one-half million more Americans aren't having to get their healthcare through the government and taxpayers. They are getting it through a job and their employer.

In fact, today, there is a greater percentage of Americans in employer health coverage since Trump took office than any time since 2000, any time since 2000.

See, there is another way to provide healthcare and that is through a job.

Now, I know those who support a full Federal takeover of everybody's health insurance don't like to hear that because, see, they don't think that employers should offer health insurance. They think only the government knows best. And so their Medicare for All plan, which would cause great delays in access to care, drive up costs, you would pay more; but it would take away your health insurance. If you get it from your employer, or if you get it from your union, or if you are a senior on Medicare and you have a Medicare advantage policy, that goes away too. Veterans with TRICARE? Democrats' Medicare for All program, that is gone, too.

It is kind of ironic to talk about how wonderful the Affordable Care Act is working for Americans, who, by the way, tell me: ``Look, I am getting stuck with the highest deductibles and premiums I have ever seen. I can't afford it.''

We had an example from Grand Island, Nebraska, last week. A 60-year- old couple makes $70,000 a year. They were paying $38,000 in premiums and $11,000 in deductibles.

That is affordable insurance? I don't think so.

That is why we think States should have the ability to experiment and regulate plans at the State level, as they did under ObamaCare.

All that talk about junk plans and all that, by the way, those were approved under ObamaCare. Those were allowed under ObamaCare. Trump just allowed them to be there longer. But because he changed something, there is this automatic partisan response.

I think we all ought to come together here. I have fought my entire legislative career in Oregon and here to make healthcare more affordable.

The underlying drug bills, there is no light between us, none, between Republicans and Democrats. Those bills came out of committee unanimously.

The only reason we are having this fight on the floor today is because somewhere along the way, the political operatives, Mr. Chairman, decided to bolt these two unrelated sets of bills together. They knew it would be kind of a poison pill and kind of fun to watch Republicans squirm on the floor. That is why we are here.

The ObamaCare bills we are voting on today just dump more money into programs that investigations have shown are filled with fraud and abuse. How can you justify putting another $25 million into a program where the top 10 most expensive navigators collected $2.77 million and signed up a grand total of 314 people? Who in their right mind in private business, Mr. Chairman, would make that kind of investment?

The Las Vegas Review-Journal said, after reading that, ``The navigator scheme is a make-work government jobs program rife with corruption and highly susceptible to scam artists.''

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

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

Mr. Chairman, I yield such time as he may consume to the gentleman from Georgia (Mr. Carter), America's only pharmacist in the U.S. House of Representatives and a distinguished gentleman from the Energy and Commerce Committee.

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

Mr. Chairman, I appreciate the comments of my friend from Georgia, a distinguished member of the Energy and Commerce Committee.

We really have come to rely upon Mr. Carter for his guidance, especially on areas related to pharmacies and trying to get the costs of prescription drugs down for consumers. We are all about that.

We worked together in the last Congress to empower the FDA to get more generics to market sooner so we have more competition. That was a bipartisan bill.

That is the way we operated in the last Congress, Mr. Chairman, as Republicans and Democrats. I led the committee, and we revamped everything at the FDA in generics, on medical device approvals, and on pharmaceuticals so we could benefit the patient first.

We brought those bills to the floor unanimously. We didn't mess around with them and package them up with poison pills. We said: Let's go legislate, and let's get this done. And they did. They got done. They got into law, signed by President Trump.

And guess what? Last year, the FDA approved more generics in one year than at any time in its history. So we did do things, led by Republicans in the House, the Republican leader of the Senate, and President Trump, joining with Democrats, just as we have attempted to do on the drug bills before us today.

We are in full agreement. Stop the bad behaviors, get competition into the market, and bring down costs of drugs. But we also believe we should make sure Americans have choices that are

more affordable when it comes to their insurance.

Democrats voted for ObamaCare. They blocked every amendment we had as Republicans at the time that was legislated. Remember, the former Speaker, now Speaker again, said you have to pass it so you can find out what is in it. It is kind of an odd way to legislate, but, anyway, here we are.

By the way, the short-term plans they call junk plans on that side, Mr. Chairman, those short-term plans are the same ones we are debating today, except all President Trump did is say you can have them a little longer, because guess what? For some people, it is the only affordable health insurance they have access to in their States.

They are regulated by the States. They are not unregulated. States can do all kinds of things. We should empower them to do things to make insurance more affordable.

Unlike my friends on the other side, Mr. Chairman, they want to gag the navigators so they can't even tell them about alternatives that may actually benefit them and be more affordable.

The plans that the other side of the aisle is railing against today, Mr. Chairman, are plans that are very much like the ones that were approved under President Obama and ObamaCare. It is just that President Trump said you can have them for longer if they work for you. But the States can come in and say, no, no.

My State says just 3 months. That is it. Boom. Other States say 30 days. Some States say none at all.

Mr. Chairman, I am not going to oppose this amendment, and I yield back the balance of my time.

Mr. Chairman, I seek time in opposition to the gentlewoman's amendment.

Mr. Chairman, I thank the gentlewoman from Pennsylvania for her amendment. We are not going to object to the amendment. The exchanges already do a lot of this reporting, and more information is better than less.

Now, I want to talk about these short-term, State-regulated, limited duration insurance policies because I think I have got a chart here, and we

will put it in the Record that there are 27 of our States, Mr. Chairman--27--that have decided that short-term plans are good for their people to be able to take advantage of. There are States from Alaska to Wyoming, from Kansas to Iowa, to Idaho and Pennsylvania where you can go up to 364 days.

Now, there are 12 other States that have said, you know: We want to limit these to 6 months. That includes places like Colorado and Arizona and Nevada and Oklahoma, North Dakota.

Then there are eight States, Mr. Chairman, that said: No, we want 3 months. We think that is all we need in places like Oregon, Hawaii, or New Mexico.

Then there are four States--California, Massachusetts, New Jersey, and New York--that said: No, we are just not going to allow any of these options in our State.

Guess what. That is federalism. They get that right.

Now, I know my friends on the other side of the aisle would like to take away that ability for these short-term duration, State-regulated plans and remove options from consumers, and I don't think that is the way to go. It is an honest disagreement here that we have, Mr. Chairman, between the parties.

I have seen a lot of innovation come out of my home State of Oregon. I was meeting with one of our former Governors, John Kitzhaber, this morning, talking about the effect of the coordinated care organizations, and they have been able to actually bend the cost curve and improve access to delivery of care by having the flexibility, in some cases through waivers, to bring providers together, match them up with patients, and deliver care more efficiently and more effectively and with better outcomes. That should be what we are debating today: How do we get to better outcomes?

We should also be debating how we get healthcare costs down, Mr. Chairman. We are doing a bit of that with the drug bills.

It is unfortunate. It didn't have to be this way that they got made into partisan issues, because there is no partisan divide on those bills. It is the fact that, you know, bailing out some of these programs in ObamaCare that are so expensive.

When it costs $2.40 per enrollee for agents and brokers to assist in enrollment and $767 if you spent $62.5 million in grants and they enrolled 81,000 individuals, it averages out, just a rough average, to over $700, why would we pour more money into the navigators that cost 700 bucks and then say: Oh, by the way, these agents and brokers can't do anything to keep them out of this?

The Trump administration actually expanded the authority for the agents and brokers to be involved, leveraging that private-sector help, and do you know what? They support 3,660,000 health plan enrollments. That is 42 percent of the plan enrollments in 2018 on the Federal platform exchanges--42 percent. Mr. Chairman, navigators do 1 percent. And my friends on the other side of the aisle want to keep dumping more and more money into the navigator program that, as I pointed out earlier, we found all kinds of wasteful spending in.

So there is really an issue about spending. We know the results. We know there is a much better way to do this.

So, Mr. Chairman, I am not going to oppose this particular amendment. It is fine, and more information is better than less.

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

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

Mr. Chairman, it is interesting; the prior amendment that passed added $25 million more to this navigator program. For the plan year 2017, navigators received a total of $62.5 million in grants and yet only enrolled 81,426 individuals. That is less than 1 percent of the total enrollees.

You see, the issue here isn't whether we should or shouldn't enroll more people. The issue is who is most efficient with the taxpayer or private-sector dollar to do that.

We keep pouring more and more money into this navigator program and we know there is all this, well, I guess I am going to call it waste. I don't know if it is fraud.

But holy smokes, as I have said before, one grantee, according to The Wall Street Journal, took in $200,000 and enrolled one person--one person. You want to have a Government Accountability Office report and investigation, let's look at the underlying program and how in the heck that could happen.

And then they also found the top 10 expensive navigators collected $2.77 million and signed up 314.

These aren't my numbers. These are The Wall Street Journal investigative reporters. You know, in the press, these are facts, which caused the Las Vegas Review-Journal to editorialize that: ``The navigator scheme is a make-work government jobs program rife with corruption and highly susceptible to scam artists. It's a slush fund for progressive constituent groups.''

Not my words, that is the press. I have a journalism degree. I have a great respect for the press and what they write. I don't always agree with them.

But, look, when you take these independent reviews and you look at what is happening there, CMS reported that 17 of those navigators enrolled fewer than 100 people at an average cost of $5,000 per enrollee--$5,000. $5,000. And my friends on the other side of the aisle want to shovel more money into that program. I think that is the height of fiscal irresponsibility.

See, for $2.7 million, if we put that into community health centers, Mr. Chairman, do you know how many people we could cover? We could take care of 20,000 patients, according to one estimate--20,000.

Health centers are really, really important to me and my constituents. We have 63 different places in my district, which is bigger than eight States east of the Mississippi, Mr. Chairman, where people get their healthcare in our communities. We have to reauthorize this year, by the end of September, our community health centers.

Now, when I was chairman, we did that at a record level because they deliver record good healthcare. We have had no plan yet to figure out how to pay for that, but you are going dump $25 million more into this navigator program. Why don't we put it into actual healthcare?

We reauthorized the Children's Health Insurance Program under Republicans and fully funded it for a decade. The longest that had ever been done was 5 years, and, unfortunately, most of my friends on the other side of the aisle voted repeatedly against doing that for a whole host of reasons, but they voted ``no.'' In Oregon, we have 122,700 children and expectant moms that rely on CHIP, SCHIP, partnership with the State for their health insurance.

So there are a lot of things we can invest in with the proceeds from the savings from the drug bills, but investing in the navigator program? $5,000 per enrollee?

There are 100 navigators, that is all they did? One for 200,000, enrolled one person? I mean, come on. There has got to be a better way to not spend the taxpayers' money than that.

And so I think you look at the incredible growth in men and women working in America, getting better paying jobs, bigger paychecks and healthcare, 2.5 million since President Trump took office, and Republicans put progrowth policies into the Tax Code, progrowth regulatory policies into the bureaucracy.

Jobs are coming up. The biggest issue I run into with employers now is not overregulation; it is: Where do I find more people to work?

So we need to look at job training. We need to work at available workforce. But this, this amendment, I think, is, frankly, from my perspective--with all due respect, GAO doesn't need to waste their time on this nor the taxpayer's money, and especially after $25 million more was just signed up in addition to--what?--$63 million, roughly, an enormous amount of money into a program that I think has a lot of problems. And the editorial writers at the Review-Journal said, ``highly susceptible to scam artists,'' ``slush fund for progressive constituent groups.'' So I oppose the amendment.

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

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

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

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

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

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

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

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

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

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

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

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

Now here is what that bill contains:

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

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

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

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

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

I want to set the record straight on these plans.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Chair, I yield myself 2 minutes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mr. Chairman, I claim the time in opposition.

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

Mr. Chairman, I believe I have the right to close.

Mr. Chairman, it is great being on the floor with a lot of my friends on the Energy and Commerce Committee and my colleagues across the aisle. Obviously, we have a fundamental disagreement.

I know, in southern Illinois, one of the biggest questions I always got and concerns was that ObamaCare plans are too expensive, and the deductibles

are too high, so we can't use them. Hence, no one wanted to use them.

Part of the change in the political landscape because of that was Republicans controlled the House. That is what happened politically. Here we are, and my colleagues and I have belabored this point all day, Mr. Chairman, about what we are trying to do. We are trying to lower the cost of prescription drugs, but we have to go back to this ObamaCare debate.

Republicans control the Senate. They are not going to bring it up. The President is not going to sign the bill. It is instructional to have this debate. We understand it. We will eventually come back, and we will address these prescription drug bills. We will get there, but we have to go through this exercise. I understand that.

The three bills that we could vote on and pass right now, probably on a suspension calendar and a voice vote, would be the three prescription drug bills that are part of this package. Those are the CREATES Act, the Protecting Consumers' Access to Generic Drugs Act, and the Bringing Low-cost Options and Competition while Keeping Incentives for New Generics Act, called the BLOCKING Act.

That is what we could be doing today, that and some other things. We hope that what we will be addressing will make major changes in affordability, transparency, and the like.

My colleagues also point out the numerous votes to repeal or replace parts of ObamaCare. I am proud to say I voted for all of them. The facts state that a lot of Democrats supported these, to fundamentally change provisions of ObamaCare.

In fact, 30 of the bills my friends are citing were signed into law. Twenty-one of those bills were signed into law by President Obama. Of the 30 that were signed into law, Speaker Pelosi voted ``yes'' on 19 of them. These are part of the 60 bills that would repeal and replace, and we have 21, and 19 were voted for by Speaker Pelosi. Leader Hoyer voted ``yes'' on 21 of them. My friend Chairman Pallone voted on 20 of them.

Here are the examples that we want to lay out: repealing the unworkable and unsustainable CLASS Act, rescinding billions of dollars for the failed ObamaCare co-op program, delaying the Cadillac tax and medical device tax, cutting funding to the Independent Payment Advisory Board, providing regulatory and financial relief from ObamaCare's requirements for small business and independent contractors, requiring accurate income verification before disbursing subsidies to ObamaCare exchanges, and modifying eligibility for ObamaCare exchange subsidies.

We can have this tit for tat, Mr. Chairman, and they will still want to defend ObamaCare. We will always say that the private market is better to provide lower cost and rapid response. It is an ideological fight.

We will get through this debate. We will eventually come back and address these prescription drug issues that, as I mentioned, Mr. Chairman, we probably would pass on a voice vote once we return to this.

I thank my colleagues. I have great respect for my colleague from Vermont. He is a very sincere and good friend. We look forward to debating this more in the future.

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

Mr. Chairman, it is hard to sell a lemon, no matter how much you give in advertising. That is kind of the basis of our opposition to this amendment.

Mr. Chair, as you heard me say in the last debate, in my congressional district, people didn't want to be forced to buy something that was too high, that was unaffordable, that the deductibles were too high, and that we in Washington mandated that they have to buy.

Now we see a period where, in essence, people have a few more choices because of the waiver system, the 1332s. We see people flocking away from

ObamaCare plans to 1332 waivers within the States, which we think is a good deal.

Part of the debate on this is: Let's pump more money in and maybe these people will stay in these failed ObamaCare plans. We reject that. We reject it based upon what we have done with Medicare Advantage and Medicare part D.

The executive branch has said: Let's spend the same amount of money that we do for Medicare part D and Medicare Advantage, which have much higher enrollment than the ObamaCare exchanges.

So we think that is appropriate. We do think that, with $100 million or more to try to get people to buy a product and you see enrollment go down, that is not a good use of money.

Mr. Chair, with that, we would ask for a ``no'' vote on the amendment, and I yield back the balance of my time.

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

Mr. Chairman, I don't know my colleague very well, but I think it is instructive to our citizens as a whole that Members come from across this great land and have a lot of different issues. I think it is instructive that even Members of Congress can be fighting illnesses and need lifesaving medicine to do that.

I don't think we are fundamentally opposed to the amendment. We don't think it does exactly what the author is claiming it will do.

In this package, in this bill, it is not, obviously, going to go anywhere because the President is not going to sign this bill. It is not going to go through the Senate.

Mr. Chair, I would encourage my colleague to come back and visit with us so that we start moving something that can get bipartisan agreement that I think would be very instructive in looking at this as an addition.

Now, I am speaking for myself, not for the ranking member of the full committee, because the gentleman is right that we need to have information. And when government is helpful in creating the initial science that then goes over to the private sector, that then goes to creating blockbuster drugs, then we should know, kind of, the skin in the game, Mr. Chairman, and how much that is due to good Federal policy by not just legislators, but also our agencies that help push that research by NIH or the CDC or the National Cancer Institute.

Had this bill been brought and the three prescription drug transparency lower cost options been brought to the floor, as I said before--and I am not going to restate this every amendment debate--but we probably would have had a voice vote and we could have gone out for dinner. But it is attached to the ObamaCare rescue mission, which we think the public has already rejected.

So we will get through this process, but I would encourage my colleague to join with the chairman of the committee and Republicans in looking at what we can do on this provision in the future.

Mr. Chair, I would ask my colleagues to vote ``no,'' and I yield back the balance of my time.

Mr. Chair, I would reserve the balance of my time unless my colleague yielded back.

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

Again, I appreciate my colleague coming down to the floor, especially when, in his opening statement, he says he wants drug costs to go down now.

It is not going to happen now because it is in a package that is not going to be accepted by the Senate and the President is not going to sign.

So, if we really want drug prices to go down now, we would have done what we did out of the full committee. We would have packaged this up with H.R. 965, the CREATES Act, which is a bipartisan agreement that is part of this bill, which would penalize branded drugmakers that withhold samples from generic manufacturers.

We would have brought to the floor, either separately or in a package, H.R. 1499, the Protecting Consumer Access to Generic Drugs Act, bipartisan out of the committee. This would ban pay-for-delay agreements, which are a problem.

And we would have brought up H.R. 938, the Bringing Low-cost Options and Competition while Keeping Incentives for New Generics, which is called the BLOCKING Act, which would limit the first-approved generic maker's ability to stall another rival's launch.

I think we all want to get there. I think we will get there. We still are going to go through this process. But, make no mistake, this is not going to be signed into law that we can go down to the White House for a ceremony.

Again, I would encourage my colleagues to work with the chairman of the Energy and Commerce Committee, my good friend Frank Pallone, and we can address this amendment and other processes and hopefully bring the bipartisan bill to the floor that would address a lot of other colleagues' concerns and really work on a bipartisan agreement that, then, by that bipartisan approach, the Senate would have to really look at seriously, and, hopefully, we would convince the President to sign the bill.

I am just a simple man from southern Illinois, taught high school civics: two Chambers, President has got to sign the bill. Sometimes when we use all this time, it is for other purposes than really trying to have a bill become law.

So, with that, I would ask my colleagues to vote ``no'' on the amendment, and I yield back the balance of my time.

Mr. Chairman, obviously, I rise in opposition to this, and I understand my colleague from Florida's great expertise in this area and served in the previous administration.

But when you have to subsidize a plan--there are a couple of problems. First of all, before ObamaCare came into being, or the Affordable Care Act--I am not trying to be disrespectful--insurance was regulated by States. The new law yanked that away from States to the point where they created a system of mandatory coverage that was unaffordable.

So then part of the plan was, well, we need to subsidize these plans because, actuarially, they are not going to work without government intervention.

Now, the Court case on this, we thought--and actually, I guess the Court case is still pending. Can the Federal Government force someone to buy something they don't want to buy? And we probably will hear another ruling on that. Initially, they said, yeah.

The real debate shifted to: Does the Federal Government have the power to tax, versus do you have the power to force someone to buy something they don't want to buy?

So the Supreme Court, in that ruling, said, since the Federal Government has the power to tax, this is really a tax; then, yeah, we can do this.

So then we had the rollout. And the rollout, I think, in the public's eye, as a whole--first, due to the delay because of the computer system, the network couldn't manage it. And then, just the cost.

As I said before, premiums way too high; deductibles too high; people forced to buy an insurance product that they could not use.

People would go in and say, oh, I got coverage. Okay. But your coverage is you still got to pay the first $10,000 in deductible. And people say, what? That is not very good insurance.

Well, that is what we created in this national healthcare delivery system.

The public rendered judgment, as they do, through the political process. Republicans came back into control.

Now, what we are trying to do is return to federalism. We have returned to States' regulation of insurance; provide more options to consumers. That is what is occurring now, so the higher cost or the costs are going down. In fact, I think there was a projection that 30 percent--there was 30 percent increases until this last cycle, when there was a 3 percent increase. Why?

Well, because, under the law, there are 1332 waivers which allow States to present another package; and you see our citizens, our constituents, voting with their feet to go to these State-based plans. That is a good thing.

So we are trying--we don't want to turn the clock back again. So that is why I would ask my colleagues to vote ``no'' on the gentlewoman's amendment. Although brought well-intentioned and lovingly, I know.

Mr. Chairman, I reject that. I ask for a ``no'' vote, and I yield back the balance of my time.

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

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

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

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

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

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

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

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

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

This is an omnibus bill that includes the:

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

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

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

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

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

Health care should be a fundamental right for all Americans.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

These prices dwarf manufacturing costs.

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

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

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

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

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

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

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

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

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

The consequences of these staggering costs are not benign.

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

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

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

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

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

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

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