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…
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.
