Do No Harm in Medicaid Act

Mr. Speaker, I thank the gentleman from Virginia for yielding the customary 30 minutes, and I yield myself such time as I may consume.

Mr. Speaker, we heard a lot of words from the gentleman from Virginia, but the reality is that some people's premiums are going up 100 percent. Their big, grand plan is to give people an 11 percent coupon. This is laughable. It is pathetic.

Mr. Speaker, here we are, likely one of the very last floor debates of the year, and Republicans have decided to use it to eliminate healthcare for millions of Americans, not by accident, but because they simply don't care, because they are clueless. They are incompetent, and they are unbelievably out of touch.

This Republican majority has done nothing for working people, nothing to lower costs, nothing to make life more affordable, but, boy, have they delivered for billionaires, corporations, and special interests.

They have spent an entire year screwing over the people they represent. They are betraying the voters who sent them here.

They are pretending like Trump's economy is great, even though they know it sucks. They have showered tax breaks on the ultrarich. They have bent the knee to Big Oil, Big Pharma, and Big Tech. They have handed the Pentagon billions it didn't even ask for, and now they have the nerve to tell working families: Sorry, no money for your healthcare; can't do a thing.

I mean, really? Give me a freaking break.

The American people are begging for action on affordability. They are begging for action to lower the cost of healthcare. What more do they need to do to get Republicans to take action?

Premiums are about to double, triple, and in some cases, quadruple. Families could see their premiums increase as much as $1,000 a month.

Open enrollment deadlines have already passed. Parents have sat at their kitchen tables and realized that between rent, groceries, childcare, and Trump's tariffs driving up the cost of damn near everything, health insurance is something they could no longer afford.

Instead of a plan on healthcare, last night in the Rules Committee, I heard one Republican excuse after another about why they can't extend these tax credits that help people get insurance coverage.

You guys have been in charge of this place for 3 years, for God's sake. Donald Trump has been President or running for President for like a decade. Where the hell is the Republican plan on healthcare? Where is it?

Republicans keep blaming the ACA. They have spent years and years trying to repeal it, but they haven't repealed it yet because they have no replacement, no alternative.

Mr. Speaker, one of your own Republican Members called this entire charade political malpractice. He was right.

Meanwhile, Democrats have been trying for months to avert this crisis.

Governors, doctors, and patients have been sounding the alarm. Instead of working with us, they decided to shut down the government. Instead of trying to partner with us, Donald Trump is calling affordability a con job. That is unbelievable and so out of touch with reality.

Now, Republicans have slapped together this pathetic bill to provide cover, a bill that is not worth the paper it is printed on, a bill that actually kicks people off of coverage and fails to extend the tax credits that keep healthcare affordable for over 20 million Americans.

I mean, come on. Get real.

Just to make sure that we all know that they aren't serious, Republicans included a poison pill which brings us closer and closer to a nationwide abortion ban. They are going after abortion even in States where it is legal.

I mean, who the hell asked for this? This is like a plot of ``The Handmaid's Tale.''

Despite Republicans' endless attempts to undermine the ACA, it is popular because it works. After Democrats strengthened people's ability to pay for healthcare by plussing up the premium tax credits, enrollment more than doubled from around 11 million to over 24 million Americans with real health insurance.

Eighty-eight percent of that growth happened in States that Donald Trump won in 2024, by the way. So by choosing to not extend these credits, Republicans are simply hurting their own constituents, hurting the people who trusted them, and hurting the people who voted for them.

More than 20 million Americans will see their healthcare costs explode on January 1. Instead of a fix, we get a stupid, pathetic, last-minute bill designed to let Republicans cover their ass before they flee town for the holidays.

What a lousy, rotten, pathetic thing to do. This is a terrible bill that screws over millions of American families. I urge every Member of this House to vote ``hell, no'' on this Republican rule.

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

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

The gentleman from Virginia keeps saying that if we really supported premium tax credits that we would have made them permanent.

I think we all know that is kind of ridiculous because I want to point out that their number one floor protocol requires that programs end or sunset by a certain date. I mean, it was part of their ridiculous Pledge to America. I mean, maybe they don't believe all of the garbage that they put out there, but that is their protocol.

Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Doggett).

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

Mr. Speaker, I merely point out Republican hypocrisy which we deal with every single day, and we want to have a vote on extending the tax credits, but Republicans denied that in the Rules Committee.

Republicans could be bringing up a bill to make the enhanced premium tax credits permanent, but they are not. Instead, what they did is they brought a bill to the floor to make tax cuts for multimillionaires and billionaires permanent. Every millionaire in this country is going to get an $80,000 tax break. That is where their priorities are. Every millionaire will get an $80 million tax credit, and the 25 million people in this country who are relying on enhanced tax credits so they won't lose their health insurance, they are basically saying to them: To hell with you.

That is where their priorities are.

We don't share the same values when it comes to making sure the people in this country have healthcare that is affordable and that is quality. That is the difference. That is the difference.

We are here today to fight to make sure that we have a vote to extend these tax credits so that people do not lose their health insurance and people do not see their healthcare premiums explode.

Mr. Speaker, I yield 2 minutes to the gentlewoman from Ohio (Mrs. Sykes).

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

Mr. Speaker, Republicans keep talking about how Democrats want to give more money to insurance companies, which is absolutely absurd, and they all know that. Nothing could be more ridiculous.

Let me correct the record. First of all, ACA tax credits go to our constituents to help them pay for healthcare. Second, it was the Affordable Care Act, you know the bill that the gentleman and a lot of Republicans want to repeal, which mandated that greedy insurance companies have to spend 80 percent to 85 percent of premiums on medical care. It is called the medical loss ratio. The gentleman should look it up. It is in the Affordable Care Act.

When he is talking about repealing the ACA, he is the one who wants to overturn that provision and let insurance companies rip people off even more than they already do.

Let me make one last point. We could easily move away from health insurance companies ripping people off. We could do what the vast majority of developed nations do and move toward a public option so that people don't have to choose a private health insurance company. But to say the Democrats are the ones who want to enrich insurance companies is absurd.

Mr. Speaker, Republicans support big banks. They support Big Tech. They support billionaires, and they support tax breaks for huge, greedy corporations. And they accuse Democrats of being in the pocket of the insurance industry?

Give me a break. Nobody believes this BS.

Mr. Speaker, look at your big, ugly bill. Look at all the tax breaks that go to millionaires and billionaires and big corporations. Every millionaire, as I stated before, because of Republicans, are getting an $80,000 tax break, every millionaire in this country.

What we are saying here is we want to make sure that health insurance is affordable for every single person in this country, and Republicans are replying by: We can't be bothered with that. That is not where our priorities are.

Maybe they don't write big enough checks for their campaigns.

The bottom line is that we are here arguing that people in this country shouldn't lose their healthcare because they can't afford it. We could do something right this instant to fix that. Republicans are blocking every attempt, and they are bringing this crappy bill to the floor that didn't even go through regular order and it didn't go through committee. They just patched it together and brought it before the Rules Committee.

By the way, CBO says that their terrible bill that they are bringing to the floor will throw another 100,000 people off of health insurance. By just passing this bill, 100,000 additional people will lose their health insurance. This is ridiculous.

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

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

Mr. Speaker, the gentlewoman, the chairwoman of the Rules Committee, knows I have great affection for her, but I just want to correct something. She says that the Republicans have always had a plan to deal with healthcare and to lower costs for people, but the truth is they have always said they have a plan, but they have never had a plan.

Let me just go through a list of things here.

In February 2016, then-Presidential candidate Donald Trump said: ``We are going to replace ObamaCare with something so much better.'' Nothing followed.

On February 27, 2017, the President said: ``We have a really terrific, I believe, healthcare plan coming out.'' Never did.

May 10, 2018, Donald Trump said: ``But wait until you see the plans that we have coming out literally over the next 4 weeks. We have great healthcare plans coming out.'' Nothing happened.

At a press gaggle near Air Force One in May 2019, he said: ``We are coming up with a great healthcare plan. We are going to have fantastic healthcare, and the plan is coming out over the next 4 weeks.'' Nothing ever materialized.

June 16, 2019, the President said: ``We are going to produce phenomenal healthcare, and we already have the concept of a plan, and it will be so much better healthcare. Yeah, well, we will be announcing it in about 2 months, maybe less.'' Nothing happened.

In a FOX News interview, the President said: ``We are signing a healthcare plan within 2 weeks, a full and complete healthcare plan.'' Nothing happened.

July 2020, the President said: ``Well, we are going to be doing a healthcare plan. We are going to be doing a very inclusive healthcare plan. I will be signing it sometime very soon. It might be--it might be Sunday, but it is going to be very soon.'' Nothing happened.

August 3, 2020, the President said: ``We are going to be introducing a tremendous healthcare plan sometime prior--hopefully, prior to the end of the month. It is just about completed now.'' Nothing.

September 15, 2020, the President says: ``You are going to have new healthcare. We have other alternatives to ObamaCare that are 50 percent less expensive, and they are actually better.'' Nothing. It never happened.

September 10, 2024, ABC News Presidential debate, he says: ``I have concepts of a plan. . . . You will be hearing about it in the not-too- distant future.'' Nothing happened.

December 8, 2024, he said: ``Yes, we have concepts of a plan that would be better. You will see it very soon.'' It produced nothing.

In May 2025, at a White House event, he said: ``So we are going to maybe come up with something. I think this gives the Republicans a chance to actually do a healthcare that is much better than ObamaCare.'' Nothing.

People are sick and tired of the empty rhetoric. They are sick and tired of Republicans saying they have a plan, and they never produce one. All they want to do is undermine healthcare for hardworking, average Americans.

Mr. Speaker, I yield 2 minutes to the gentlewoman from California (Ms. Rivas).

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

Mr. Speaker, if we defeat the previous question, I will offer an amendment to the rule to provide for consideration of H.R. 6074, which would extend the Affordable Care Act enhanced premium tax credits for 3 years, through 2028.

Mr. Speaker, this is it. This is the one last chance this year, this session, for this Republican majority to do the right thing and vote to extend the ACA enhanced premium tax credits.

If Republicans allow them to expire, millions of Americans, millions of their constituents, will be faced with rising health insurance costs and, in some cases, by more than $1,000 per month.

Mr. Speaker, I have an important announcement to make, and if there is anybody in the press gallery listening, I want them to hear this. I have called on Republicans to put country over politics, put country over their party, to do the right thing for their constituents. We have a discharge petition that 214 Democrats have signed on to, to force a bill on a 3-year clean extension. While we have been debating, four Republicans have actually done that.

We are now at 218. What that means is that it sets in place a process that will allow us to vote on a clean extension. We have 218 people who will vote for it, which means we will pass it.

Unfortunately, the procedures on a discharge petition mean that we can't get to it until we come back from our holiday break in January, but we don't need to wait for the discharge petition to ripen. We can actually act today if we want to preserve the tax credits for 20 million working-class Americans that rely on them.

Democrats in this House and in the Senate have acted like adults during our entire monthslong effort to get Republicans to do the right thing. I thank those Republicans who signed the discharge petition because that is actually going to make sure that we have a vote and that we can extend these tax benefits.

Again, we can kind of short-circuit the process. If we defeat the previous question, we could vote on it today. We are offering this to be able to bring it up immediately.

Mr. Speaker, I ask unanimous consent to insert the text of my amendment into the Record, along with any extraneous material, immediately prior to the vote on the previous question.

Mr. Speaker, I yield to the gentleman from Texas (Mr. Doggett) for the purpose of a colloquy.

That is correct. We do thank these Republicans for getting us to 218, but we hope they would join us.

This would be the key vote.

Mr. Speaker, I yield 3 minutes to the gentlewoman from Connecticut (Mrs. Hayes) to discuss our proposal.

Mr. Speaker, may I inquire as to the time remaining.

Mr. Speaker, I yield myself 1 minute.

Mr. Speaker, Republicans love to find ways to justify kicking millions of working people off of healthcare. The chairwoman of the Rules Committee talked about fraud. If fraud is your primary concern, how about you start with President Trump, who has pardoned or commuted not one, not two, but 12 people. He pardoned 12 people convicted of healthcare fraud. My Republican friends have been silent, not a word.

One guy was convicted of $1.3 billion in a Medicare fraud scheme, the largest healthcare fraud scheme charged by the Department of Justice. We had another woman convicted of orchestrating $205 million in a Medicare fraud scheme involving assisted living facilities. We had another guy convicted of 67 counts of healthcare fraud and related charges relating to Medicare and other healthcare programs.

I could go on and on, Mr. Speaker. I am not sure what they did to earn those pardons, but maybe they promised to say nice things about Trump.

When Republicans come to the floor and talk about fraud, just remember that they are the ones who pardoned over and over and over again healthcare fraudsters while at the same time screwing over the American people by taking away their healthcare.

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

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

Mr. Speaker, let's be honest about what is happening here because this really is not that complicated, and the American people aren't stupid.

This Republican bill does not fix the healthcare crisis facing this country. It doesn't even try. Instead, Republicans are going to raise costs, weaken coverage, and deliberately allow the Affordable Care Act tax credits to expire, knowing full well that millions of families will lose affordable coverage as a result.

That outcome is not a side effect. It is the point. For more than a decade,

Republicans have promised a better healthcare system, a replacement for the ACA, something, anything that would justify taking coverage away from people who need it.

Ten years later, there is still no plan, no replacement, no solution. Why? Because they are totally fine with a system of the haves and have- nots. They want a system where those at the top have affordable care, and everyone else is left in the dust.

Mr. Speaker, Republicans have controlled the House of Representatives for 3 long years. During that time, the priorities of this majority have been crystal clear.

When billionaires, CEOs, and corporate special interests need something, Republicans move with lightning speed. Loopholes appear out of nowhere. Regulations vanish into thin air while Big Oil, Big Tech, and big banks get what they want.

Republicans have no problem handing out massive tax giveaways to donors who write big campaign checks. They have no problem padding the profits of greedy corporations. They have no problem voting to give the Pentagon $8 billion more than it even asked for without so much as a shrug.

When it comes to working people, when they need affordable healthcare, suddenly the story changes. Suddenly, there is hand- wringing. Suddenly, there is paralysis. Suddenly, the money is gone. Suddenly, America can't pay for it.

If my friends on the other side of the aisle are okay with that, we do not share the same values. If they think it is fine to give handouts to billionaires, while stealing healthcare from regular people, we do not have the same moral compass.

The bottom line is this country has a Republican Congress that works just fine for the rich and powerful, while telling everybody else to tighten their belts.

There is always money for giveaways to CEOs and corporate stock buybacks. There is always money for billionaire tax shelters. When a working family needs help staying insured, Republicans say it is too expensive. This is a question of our priorities as a Nation.

What makes this even more infuriating is that Democrats have already put forward a responsible and reasonable solution that would help stop this crisis in its tracks. We have 218 people who have signed this discharge petition. Mr. Speaker, four Republicans signed this discharge petition. I hope they will vote to bring this same bill up today.

To the moderates who didn't get the opportunity to sign it, I say this. This is their chance to go on record and show their constituents that they are serious about getting this done. Imagine what that would mean. It would mean lower costs, stable coverage, and a Congress that proves it still answers to working families instead of to the billionaire class. Instead, we get this GOP inaction and incompetence.

Mr. Speaker, at the end of the day, healthcare coverage should not depend on how much money someone makes. We live in the richest country on Earth. Healthcare should be a human right available to every person and every community without exception.

The United States remains the only major developed Nation that does not guarantee healthcare for everyone. That is not because we can't afford it. It is because powerful interests make too much money from the status quo.

To any Republican who knows this bill is wrong, who understands what this will do back home, and who still believes that this institution should work for the people it represents, this is the moment. Extend the tax credits. Protect the coverage of our constituents. Stand with us to say that it is time for Congress to put patients ahead of profits and working families ahead of billionaires.

Mr. Speaker, I urge a ``no'' vote on this rule, and I yield back the balance of my time.

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

Mr. Speaker, I demand a recorded vote.

Mr. Speaker, I ask unanimous consent that all Members

may have 5 legislative days in which to revise and extend their remarks.

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

Mr. Speaker, the Rules Committee met last night and reported out a rule providing for consideration of three measures: H.R. 6703, Lower Healthcare Premiums for All Americans Act; H.R. 498, Do No Harm in Medicaid Act; and H.R. 3492, Protect Children's Innocence Act.

Mr. Speaker, House Resolution 953 provides for consideration of H.R. 6703, the Lower Healthcare Premiums for All Americans Act, under a closed rule. The rule provides 1 hour of general debate, equally divided among and controlled by the respective chairs and ranking minority members of the Committees on Education and the Workforce, Energy and Commerce, and Ways and Means, or their respective designees, and one motion to recommit.

The rule also provides for consideration of H.R. 498, the Do No Harm in Medicaid Act, under a closed rule with 1 hour of general debate, equally divided and controlled by the chair and ranking minority member of the Committee on Energy and Commerce, or their respective designees, and provides one motion to recommit.

The rule further provides for consideration of H.R. 3492, the Protect Children's Innocence Act, under a structured rule with 1 hour of general debate, equally divided and controlled by the chair and ranking minority member of the Committee on the Judiciary, or their respective designees, and provides each one a motion to recommit.

Finally, the rule provides that, during consideration of H.R. 4776, pursuant to House Resolution 951, the further amendment specified in section 5 of this resolution shall be considered as adopted.

Mr. Speaker, this rule deals with several important bills that will lower healthcare costs for Americans and protect children. One of the bills, H.R. 3492, the Protect Children's Innocence Act, is led by the gentlewoman from Georgia (Ms. Greene).

This bill prohibits genital and bodily mutilation and chemical castration for a minor, which generally is anyone under the age of 18 years, while also preserving the exception for this care if there is a legitimate medical need for certain procedures.

Another bill we are considering in this rule is H.R. 498, the Do No Harm in Medicaid Act, led by the gentleman from Texas (Mr. Crenshaw).

This is a simple bill that prohibits Federal medical dollars to pay for gender transition procedures for individuals under the age of 18. The bill also includes protections for individuals if some of those treatments are medically necessary.

These are important bills to ensure that Federal taxpayer dollars are not going toward a minor's gender transition surgery if it is not medically necessary. These bills also put guardrails in place so that minors cannot make permanent life-altering decisions before they are 18 years of age.

Finally, we are considering H.R. 6703, the Lower Healthcare Premiums for All Americans Act, led by the gentlewoman from Iowa (Mrs. Miller- Meeks).

This bill lowers premiums for Americans, creates more insurance options, brings greater transparency, and cuts red tape.

Unlike our Democrat friends' plan, our Republican plan actually lowers premiums by double digits, roughly 11 percent, according to the data.

All the Democrats want to do is throw billions more dollars toward insurance companies. Instead of attempting to lower the premiums of the individuals who are on the insurance plan that the Democrats created, which should be called the unaffordable care act, the Democrats have cried wolf that Republicans are responsible for premiums being unaffordable, but let's get the facts straight.

Every single Democrat voted in support of the so-called Affordable Care Act. They claimed that people's premiums would be lowered; patients would have more choice; and if you like your doctor, you can keep him or her. However, just the opposite has happened. Their so- called Affordable Care Act has caused premiums to skyrocket. Due to this, the Democrats are too afraid to own up to the fact that their health plan has failed to actually lower premiums.

Instead, they have said to themselves: Hey, instead of acknowledging our failure, let's just blame the Republicans for that failure.

Mr. Speaker, I distinctly remember a hearing before the Committee on Energy and Commerce, shortly after I was elected, where most of the witnesses said that the so-called Affordable Care Act was going to make insurance premiums go up for Americans.

Mr. Speaker, that was over a decade ago, but the Democrats on the committee insisted that the witnesses were wrong and that Republicans were merely trying to scare the American people.

Mr. Speaker, unfortunately for the American people, the witnesses were right. The so-called Affordable Care Act has, in fact, negatively impacted the price of health insurance in America. This plan, the so- called Affordable Care Act, is a major reason that your insurance premiums have gone up and have done so repeatedly.

When not blaming Republicans for the failures of this so-called Affordable Care Act, do you know what the Democrats' solution is? Folks watching this debate at home won't be surprised to know it. Democrats want to throw billions of additional dollars to healthcare insurance companies in an attempt to distract the American people from their own policy failures.

I don't know if you all have been following the news closely, but the insurance companies that the Democrats want to give an additional $85 billion to with their 3-year clean extension of the temporary COVID enhanced premium tax credits have not been knocking on the doors, Mr. Speaker, of the United States bankruptcy courts seeking protection or aid. In fact, they have been making record profits--record profits.

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Further, we know these temporary COVID-enhanced premium tax credits have been riddled with waste, fraud, and abuse.

The independent Government Accountability Office recently came out with a preliminary report that showed one Social Security number was used to receive over 125 different insurance policies in 2023 alone. That is fraud.

There is also a huge amount of waste. Mr. Speaker, my estimate, based on data that I have seen, is that roughly 20 percent of enrollees in the temporary COVID-enhanced premium tax credits don't really exist. They are shadow enrollees.

Let me explain. In most healthcare insurance plans, they generally have about 15 percent of the enrollees who make no claims in a given year. In the arena of the temporary COVID-enhanced premium tax credits, that number for those particular policies that have no claims is closer to 35 percent. There is no reasonable explanation, Mr. Speaker, other than those extra 20 percent of people not making claims don't really exist. Now, I call this waste and not fraud, and that is because I actually believe the insurance companies don't know which enrollees are shadow enrollees.

How does this happen? It is a glitch in the way the bill was written originally. People move around. If an individual signed up for a program in north Florida to receive the enhanced premium tax credit and then moved to south Georgia, or even to another city in Florida, and signed up again, thinking, ``Well, I have moved, so I probably need a different plan,'' the consumer has a right to believe that somebody at their new plan or new company will notify the old carrier that they have switched policies.

The way the program was designed by our friends on the other side of the aisle, that never happens, and because an individual is automatically reenrolled each year, this can go on for years. Thus, over time, it builds up to that 20 percent of shadow enrollees.

We cannot, in good conscience, in defense of the American taxpayers' money, just cleanly extend these temporary COVID-enhanced premium tax credits without addressing the realities behind the waste, the fraud, and the abuse that is occurring in this program.

I also find it interesting that the Democrats voted twice to extend these temporary enhanced premium tax credits but specifically did not make these

premium tax credits permanent. They didn't do it. They had many opportunities to make these permanent if they wanted to do that as much as they say today, but they didn't. They had many opportunities to make these permanent if the enhanced premium tax credits were as imperative to make the system work as they will claim here on the floor today, and have been for several weeks, but they didn't do it.

Whose fault is that? Logic would tell us it is the Democrats' fault, but when it comes to healthcare, the Democrats are never willing to admit their policies failed. What do they do? Blame Republicans.

In the Inflation Reduction Act, Mr. Speaker, the Democrats prioritized giving out around $1 trillion to Green New Deal initiatives instead of making their temporary premium tax credit program permanent.

The fact is, even they couldn't find the votes when they had control of both Houses and the White House to make the enhanced premium tax credits permanent. Now, they are demanding Republicans do what they could not do and clean up their mess, which was an add-on to the so- called Affordable Care Act.

I can't make that make sense, and, Mr. Speaker, I bet you can't either.

What are they asking for now? You guessed it: another temporary extension that fails to address the underlying causes of the skyrocketing costs; doesn't deal with the waste, fraud, and abuse; and worsens healthcare access caused by their so-called Affordable Care Act. Instead, they just want to blame Republicans, use it as a political issue, and give more money to insurance companies making enormous profits.

What the Republicans have drafted is a plan to address health issues across the board for our people and for our Nation. This bill brings more transparency on the pharmacy benefit manager middlemen, better known as PBMs, for employers. For too long, PBMs have gotten away with operating in a black box and causing drug prices to rise. We are bringing transparency into the commercial market for PBMs under this bill.

The bill also expands access to association health plans, which allow small businesses and self-employed workers to band together and purchase health insurance. One of the biggest complaints we hear from businesses, especially small businesses, is the rising costs of premiums that they have.

In fact, Mr. Speaker, Virginia tried to create these plans, and CMS told them they couldn't do it, that they would penalize them. The Virginia Association of Realtors--let's see if I got the name right--in an article from 2023, the leader said that they would create a plan for 7,000 association members who were uninsured because they don't make enough money to afford the Federal marketplace coverage--that would be the so-called Affordable Care Act--or to qualify for subsidies in the small group and individual plans.

These small businesses don't have the bargaining power that larger businesses do to help lower their premiums. Allowing these small businesses to join together and have more bargaining power will help lower their health insurance costs.

Another part of the plan codifies a 2019 Trump administration rule that allows employers to give tax-advantaged dollars to their employees, who can then use those dollars to purchase health insurance and for other medical costs. When businesses are planning their financial future, unpredictable health insurance costs and rising premiums make it almost financially unviable in some cases. Allowing businesses to have this option brings them more certainty and will give power to their employees to choose a plan that is best for them.

Another flexibility we grant under this bill is by exempting stop- loss insurance from the definition of health insurance coverage. Stop- loss coverage is a type of coverage an employer can purchase to protect themselves from unexpected catastrophic health claims if that employer has chosen to self-insure their employees' healthcare. This allows an employer to limit the financial risk imposed on them if an employee, or a few of them, have unusually high medical claims that exceed the budgeted amount. Some States have attempted to restrict or prohibit these plans, which makes a self-insured option less attractive.

This bill clarifies that this type of coverage is exempted from the definition of health insurance coverage, which means that these States would be limited in how they can regulate stop-loss coverage while still having to follow the regulations of ERISA.

On top of all of this, I would reiterate that the bill lowers premiums of individuals who are enrolled in the so-called Affordable Care Act plans by roughly 11 percent. It does this by appropriating dollars for cost-sharing reductions. This will stop the practice of silver loading by putting dollars toward lowering beneficiaries' out- of-pocket costs, which in turn lowers premiums for Americans who are on the so-called Affordable Care Act, again, by roughly 11 percent.

Today, Mr. Speaker, you will hear my friends and colleagues on the other side, the Democrats, tell you this plan is not meaningful and that the only way to help individuals is to throw more money at big insurance. Throwing more money at the insurance companies, Mr. Speaker, is not the answer.

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

Mr. Speaker, I yield 1\1/2\ minutes to the gentlewoman from Georgia (Ms. Greene).

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

It gets curiouser and curiouser.

The gentleman from Massachusetts referenced that our protocol is to have sunsets, but when my colleagues on the other side of the aisle had the opportunity to make permanent the premium enhanced tax credits, we didn't control the floor. They controlled the floor.

They don't have that protocol, as I understand it. They don't have that protocol that they put sunsets on things. They could have and did make other programs in the Green New Deal permanent. They could have made it permanent; they chose not to. They had the Senate, the House, and the Presidency.

It is not House Republican protocol that stopped them. It was a lack of votes or will. If the program is so imperative today, why wasn't it imperative for them 3 years ago?

I submit this is a paper tiger and that there is no substance in their arguments or, if some substance, just a small amount.

Mr. Speaker, they had the chance. They had the power, and they didn't use it to do what they want us to do today to fix their problems with their so-called Affordable Care Act.

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

Mr. Speaker, I yield 6 minutes to the gentlewoman from North Carolina (Ms. Foxx) who is the chairwoman of the Rules Committee.

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

Mr. Speaker, my colleagues on the other side continually say that we haven't done anything. We just received a message from the Senate on a Republican bill that does something. Now, they may not like it, but I find it fascinating. These debates are always so interesting, Mr. Speaker.

They say we haven't put forward anything at some points, and at other points in their debate, they claim that this bill is terrible, that it does nothing.

Let me remind you, Mr. Speaker, that a part of this bill revives a Democratic plan that was supposed to be short term called cost-sharing reductions. It is fascinating because during the first Trump administration, in May 2017, my Democratic colleagues--and I know some of them weren't here yet--but 196 of them, including the gentleman from Massachusetts, signed a letter asking--because it was not codified-- President Trump to use his executive power to continue the cost-sharing reduction plan.

Mr. Speaker, I would love to hear from my colleagues why cost-sharing reduction by them was considered to be so important to be continued to help 7 million hardworking Americans and their families, more than half--I am reading from their letter--of all marketplace enrollees for 2017 afford their out-of-pocket healthcare costs. That is what cost- sharing reduction does.

Today, they claim, as a part of our bill, it is nothing. It is worthless. It is

not worth the paper it is written on, but in 2017, 196 of them, including the gentleman from Massachusetts, asked the President of the United States to continue the program.

Today, we are answering that call, saying we will answer that and put it in our bill, but because it is now proposed as part of a Republican bill, my colleagues, for some reason, don't remember their position in 2017 and call it trash.

Could it be mere political posturing for November elections? I submit it is.

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

Mr. Speaker, I am prepared to close, and I reserve the balance of my time.

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

Mr. Speaker, the gentleman is absolutely correct on this one point. If what they want is socialized medicine, yes, I am against it and so are most of the Republicans in this House. We are not for socialized medicine.

When I was a student, I remember being in Edinburgh in 1979. Mr. Finch across the hall with socialized medicine had to wait 10 months to get surgery for a blockage in his heart.

When I came home, I discovered that in the United States it would have been 3 days before he would have had that surgery. He died a couple of years later because socialized medicine warehouses people until they have time to get to them. That is not what our system does nor should it.

Further, I would say that the Democrats come here today, and it is their healthcare system. They created it. When they created the Affordable Care Act, there were no Republican votes. When they extended it or changed it a little bit and eventually renewed it again in the Inflation Reduction Act, there were no Republican votes for that.

Today, they want to blame Republicans for their policy failures. The American people will eventually see through that. I know they have done a great job of convincing the American people that is the case, but it isn't true.

They talk about the fact that, as costs are going up and they want this new plan to throw $85 billion at the insurance companies, 85 percent has to be spent on healthcare. That is true.

Mr. Speaker, 15 percent of $500 that the insurance companies get to put in their pockets is a whole lot less than 15 percent of $2,000. If we throw more money at the insurance companies, the big insurance executives get more money to put in their pockets. They are smiling like Cheshire cats as the costs go up and they pocket larger profits.

Perhaps my Democratic colleagues don't want to admit it or don't realize that they are the front men for big insurance, but that is what they are. They are the front men for big insurance. Instead of facing reality, their answer is to blame the Republicans and throw more taxpayer money at the big insurance companies.

Mr. Speaker, giving the insurance companies more money will not solve our healthcare problems.

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

Mr. Speaker, I am very proud to have sponsored this legislation and have fought this battle for many years.

I think we could actually get it done this time. I am not sure that my colleagues even believe what they are saying. I think they know that their constituents don't believe it.

Let's not forget that, in the 1930s, the medical community believed that lobotomies could cure psychosis. They also believed that electroshock therapy could do the same. They even gave the lobotomy inventor a Nobel Prize in 1949. Then the science caught up with the ideology, and medicine was changed for the better.

Today's great sin in medicine is perhaps one of the worst that we have seen in human history. It is a sick and twisted ideology paired with a social media-fueled social contagion that has actually normalized the ultimate lie, which is that biological gender does not matter and can even be changed. Here is the greatest sin: that this lie also applies to children.

There are some very simple, fundamental truths in life: Men are men, women are women, and children are innocent. They can't be told that they are in the wrong body.

Mutilating children is wrong. Irreversible treatments on children who need therapy is wrong. These truths are very obvious to the vast majority of Americans, and it takes an incredible amount of propaganda and institutional coercion to get an entire society to even question these truths. Yet that is exactly what has happened.

Mr. Speaker, polls indicate that more than 70 percent of Americans support a full ban on puberty blockers for minors. That is from places like The Washington Post.

Imagine if the question had been asked differently. That is just about puberty blockers. What if they had been asked about double mastectomies on 12-year-old girls. I think the number would be probably approximately 90 percent, maybe higher.

Mr. Speaker, I am not arguing with my colleagues. I am pleading with Members to understand this. Their constituents don't want children to undergo gender transformations. They don't.

Their constituents know that kids are too young to understand the consequences of permanent physiological changes. I think my colleagues know it, too.

Even if my colleagues are uncertain about that, I think they can be rest assured that they definitely don't want their tax dollars to pay for it, which is all this bill does.

This debate is so often buried under euphemisms. There is gender- affirming care. There is a medical consensus. There is a standard of care.

Strip away the language. Here is the reality: Healthy children are being placed on drugs that halt normal development, sterilize them, permanently alter their bodies before they are even old enough to vote or drink or get a tattoo.

These are kids suffering from teenage angst, and I don't deny the existence of gender dysphoria. However, psychotherapy is the answer to that, not permanent hormonal changes or surgical mutilations. That is not compassion. That is not medicine. That is an abomination.

We are told that questioning this practice puts children at risk and that if we don't medicalize a child's distress, they will take their own life. That claim has been debunked. It is not supported by science. Studies from all over the world have proven it false, and those who continue to promulgate it should be ashamed.

The highest quality medical reviews have consistently found no clear evidence that puberty blockers, cross-sex hormones, or surgeries reduce suicide risk in minors--none. Yet we are told to suspend our moral judgment, suspend scientific skepticism, and accept irreversible harm as the default response to childhood stress. That is not how responsible medicine works.

Puberty blockers are not approved by the FDA for treating gender dysphoria. They were never designed to interrupt normal puberty in otherwise healthy children. Cross-sex hormones can permanently compromise fertility. Surgeries irreversibly alter healthy organs. These are not neutral acts.

These are life-altering decisions imposed on minors whose brains, identities, and bodies are still developing.

We are told that treatments are reversible. That claim is very false. International health authorities have concluded that suppressing puberty often locks children into a pathway toward permanent medical transition. Nearly every child placed on puberty blockers proceeds with the cross-sex hormones. The so-called pause button that almost always leads to irreversible outcomes is not a pause. It is a trap.

While activists insist this is settled science, the rest of the world is pulling the emergency brake. The United Kingdom now limits puberty blockers. Sweden and Finland have sharply restricted their use. France's medical authorities warn of serious risks to bone development and fertility. Those lying, depraved activists reviewed the same evidence and said, No, we are good with it.

Children suffering from gender dysphoria deserve care,

dignity, and clinical compassion, but that compassion does not mean pushing them on a medical pathway that leads to irreversible physical harm.

The answer is in evidence-based psychotherapy care, therapy, family support, and clinical monitoring over time.

What does this bill even do? The Do No Harm in Medicaid Act draws a very clear moral line that the government will not participate in, endorse, or normalize irreversible gender surgeries and chemical interventions on minors.

It is codifying President Trump's agenda to protect our children and keep them healthy. It says he won't be complicit.

Medicaid won't fund this abomination, but contrary to what many of the claims are, it preserves narrow exceptions for genuine medical conditions, like early onset puberty, disorders of sex development, and treatment of complications.

This was a very carefully crafted bill that addresses all the concerns that have been raised. It is not about hate. It is not about politics. It is about protecting kids when adults fail them. It is an easy vote.

Mr. Speaker, I urge my colleagues to support the Do No Harm in Medicaid Act, please.

Mr. Speaker, I don't need much time.

The question was asked if we had ever bothered speaking to trans kids. The answer is absolutely yes. Maybe that is why I am so passionate about this. It turns out there are hundreds and hundreds, thousands perhaps, of trans kids who were coerced by radicalized doctors. Their parents were lied to.

Their parents were given studies that said there is a 1 percent remorse rate. These studies are based on nonsense. They are not even based on a pool of participants that are minors. They were told that these things are just a pause button, that it is reversible, that this is just a standard of care. Standard of care based on what? Based on junk science. We cannot base standards of care on junk science.

Now, the science has caught up: the Cass Review study, the systematic review, which is the gold standard of any kind of study because it looks at all the different studies methodically, and then the 300-page review that HHS just did.

I have had them on my podcast twice to talk about their experiences. Chloe Cole spoke at the Department of Health and Human Services just now, about an hour ago. Chloe Cole, at 12 years old, was going through what a lot of 12-year-olds are going through. She is a tomboy. She has older brothers. She likes sports. She is confused. Doctors tell her that she is a boy. They convinced her parents of the same. She is put on puberty blockers and soon on high levels of testosterone. By age 15, she has a double mastectomy. She is not sure if she can ever have kids, and she definitely can't feed her children normally.

Yes, we have talked to them. Maybe my colleagues on the other side should, too.

Mr. Speaker, I will not be long. I will just ask a simple question, because the statement was made that all the science suggests that these procedures are medically necessary.

Can they cite their sources? Show me the studies. I cited mine. Cite their sources.

Mr. Speaker, again, it has been stated that these so- called treatments are safe and effective and save lives. I ask the gentlewoman again: Cite your sources. Cite your sources.

You won't. That is because you know that I know all of the sources that you are going to cite. You know what I am going to say about them: about the problems with their methodology; about the pool of participants they use; about how short those studies were; and about how most of them didn't even apply to minors.

You know what I am going to say, and so you won't cite your sources.

Mr. Speaker, I will cite mine. We have systematic reviews that have been published and accepted throughout the scientific community. That is why the rest of the Western world is reversing their stance on this, and the United States needs to also.

That is because I couldn't tell if that speech about harming kids was about our bill or about the act of conducting irreversible physiological changes on children who are going through gender dysphoria.

Yes, we are trying to protect kids. We are trying to love our kids.

Mr. Speaker, this claim is made over and over, that allowing gender-affirming care, as they call it, is saving lives. The problem with that claim is that there is no evidence to suggest that.

All of the reviews, all of the studies, all of the systematic reviews--a systematic review means a systematic review of all of the studies--show that there can be no clear line drawn between suicide rates and doing this kind of care.

A paper published in the British Medical Journal examined the landscape. Mr. Speaker, 61 systematic studies concluded there is great uncertainty about the effects of puberty blockers, cross-sex hormones, and surgeries in young people.

On suicide risk, there is no clear evidence that these medical interventions prevent suicide. A 2020 study analyzing trans-identifying patients of all ages over 40-plus years found that suicides occur at every stage of medical transition.

A 2021 systematic review concluded that based on available data, no conclusions can be drawn about whether hormones, puberty blockers, or surgeries reduced suicide risk.

Again, in 2024, another independent review found that Britain's post- 2020 restriction of puberty blockers did not cause a rise in suicides despite many of the lies told on social media by activists.

They keep saying that every medical society supports this--and, so, okay, then, we have to listen to them. Well, that is true. It is because of ideological pressure rather than scientific evidence. We know that these studies that they are citing are based on low-quality evidence, small sample sizes, and very high risk of bias.

A Johns Hopkins systematic review found that the evidence supporting claims that hormonal treatments may improve quality of life, depression, and anxiety among transgender patients was ``low.'' The study called for more research, particularly on adolescents.

The same review concluded that it was about impossible--this is Johns Hopkins--it was about impossible to draw conclusions about the effects of hormone therapy on suicide risk.

Even a review published by the American Academy of Pediatrics, which institutionally has supported gender transition, admits that ``evidence regarding the psychosocial and cognitive impact of hormonal treatments for transgender adolescents is generally lacking.''

I could keep going. The point here, Mr. Speaker, is you have got a problem, and it is a gender dysphoric problem. We know that a kid is going through something hard. And you want to take the most extreme possible medical intervention to deal with that while the science says we have no idea whether that is a good idea or not.

That is what the actual scientific consensus says.

Now, if the argument was: Hey, give them more fruit or something, then that is not really harmful. That would be fine. We wouldn't be arguing about it, but the minority is talking about double mastectomies. They are talking about puberty blockers and hormonal therapies that permanently change the physiology of a young person before they are old enough to even understand what they might want in 20 years.

That is the most irresponsible type of policymaking one can imagine. It is the most irresponsible type of medicine that one can imagine.

Mr. Speaker, I love debunking lies in real time. It is one of my favorite things to do.

The chairman just did a great job debunking a lie. We were just told that this is the only bill we are doing this week. No, it is not. It is an important bill, but everything he just listed was also pretty important to lower people's healthcare costs. I don't know why there was no Democratic support for it.

I want to debunk some more lies. Again, on this idea that puberty

blockers for children are safe and effective, let me read some more facts. The Center for Investigative Reporting found that the FDA received over 10,000 adverse event reports from women who took Lupron, which is a common puberty blocker, off-label as children, to help them grow taller. Reported side effects included brittle bones and fractures, tooth enamel loss and cracked teeth, spinal disk degeneration and chronic joint pain, seizures, migraines, suicidal thoughts--so it is actually the opposite, isn't it?--cognitive issues, and fertility problems.

The FDA ordered the manufacturer to add a warning label, noting that children taking Lupron may develop new or worsened psychiatric symptoms. Trans-identifying minors are already three times more likely than the general population to experience anxiety, depression, and neurodevelopmental disorders.

Why make it worse? Stop talking about compassion. They are the ones doing the opposite of compassion by tricking these kids into thinking that this might be their answer. It is not. Therapy is.

There was another claim made that this tramples on States' rights, so I guess we need to have a quick civics lesson. We are talking about Federal funding, Medicaid funding provided by the Federal Government. The Federal Government can put restrictions on what that money is used for. It is not a trampling of States' rights. It is not a trampling of doctors' rights.

Let me ask something. My daughter picks up my fake eyes, and she goes: ``Eye, eye, eye.'' She is 2. She puts it on. Maybe when she is old enough to talk, she might identify as somebody with one eye. Should I take her to the doctor and say: Hey, will you enucleate her eyeball because, you know, she identifies as monocular just as I am, just like her daddy.

Mr. Speaker, you would say that is insane. You would call that absolutely insane, and it would be insane.

Here is the reality. The scary part about that analogy is that it is actually a lot less troubling to lose an eye than it is to completely change your gender. Completely changing your gender is a far more invasive procedure than losing an eye. Trust me, I know.

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

Madam Speaker, the bill would subject doctors, nurses, other medical providers, and even parents to up to 10 years' incarceration in Federal prison and up to $250,000 in criminal fines for providing gender- affirming healthcare like hormone therapy to minors.

They want to criminalize more than a dozen different evidence-based medical treatments and procedures that are presently being recommended and used for gender dysphoria including the prescription of puberty blockers, which are commonly used by families for young people who are not trans but who face all the medical and social problems associated with early-onset puberty.

The gentlewoman's bill would engineer a massive invasion of the privacy rights of families engaged in medical decisionmaking in America. I thought a belief that families should be able to make their own decisions for their own children was something that united Liberals and Conservatives.

These are hard and often agonizing decisions that loving American families in our country face. Our colleagues now want to invite the Federal Government to come barging into the family dining room and in the doctor's exam room like a raging bull in a china shop.

Does anyone believe the Freedom Caucus and President Trump love America's children more than their own parents do or that they can make better decisions for tens of thousands of American children than their own parents? I can't understand the logic of it.

At a time of skyrocketing healthcare costs--which our colleagues will do nothing about except perhaps a handful of them who have crossed over to join us today in a discharge petition--at a time of skyrocketing healthcare costs, grocery prices, and housing, not to mention the recent news of escalating unemployment higher than the last 4 years, does anybody think that what the American people need right now and are looking for is a Federal law authorizing FBI agents and government prosecutors to investigate doctors, nurses, hospitals, and parents for providing AMA-recommended medical care to children?

The politicians that have brought America to a point of crisis in healthcare coverage for millions of Americans--and can't seem to do anything about it--cannot be trusted to make the most intimate and fundamental decisions for the physical, mental, and emotional well- being of America's children. Let us leave it to people's parents. Let us leave it to the families.

Madam Speaker, I reserve the balance of my time.

Madam Speaker, I yield 2 minutes to the distinguished gentleman from California (Mr. Takano), the chair of the Congressional Equality Caucus.

Madam Speaker, I yield an additional 30 seconds to the gentleman from California.

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

Madam Speaker, at a time when our colleagues are perfectly content to see millions of Americans lose their health insurance, when they do nothing to extend the Affordable Care Act tax credits that millions of Americans are depending on, at a time when they are happy to throw millions of people off of Medicaid coverage, they decide to change the subject in order to vilify and demonize a small minority.

That is a time-honored tactic in the authoritarian playbook, to pick a small minority of citizens--here, we are talking about around 2 million people who are transgender in America--and scapegoat them, dehumanize them, demonize them, satanize them, take away their basic freedoms, and even deny their very existence.

It is happening to gay people right now in Putin's Russia and in Orban's Hungary. It is happening to Uyghurs and Tibetans in China. It is happening to Christians and free-thinkers in Pakistan. It is happening to Muslims in India. Now, it is happening to trans people in America when they are happy to attack them, vilify them, and try to destroy their community. If they purport to be acting in the name of the trans community, why is it that the trans community opposes their legislation so strongly?

Madam Speaker, I yield 1 minute to the gentleman from Illinois (Mr. Krishnamoorthi).

Madam Speaker, I yield 1 minute to the gentlewoman from Oregon (Ms. Bonamici).

Madam Speaker, I yield an additional 20 seconds to the gentlewoman from Oregon.

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

Madam Speaker, we know that the proponents of this legislation are certainly not speaking for the families that have to deal with this problem because all of them are lobbying against this. They are saying that the last thing we want at this point is to send the FBI and Federal prosecutors in to deal with the problem. Let them deal with it. Well, perhaps they are speaking from medical authority? No, not at all.

Look at the letter that was just sent to Members of Congress. ``We, the undersigned medical professional organizations, write in strong opposition to H.R. 3492 and H.R. 498. These bills would criminalize and dismantle healthcare for transgender young people and as such represent a direct threat to patient welfare. We urge you to reject these extreme proposals.''

Look who signed this: American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, American Psychiatric Association, and so on.

The leading medical authorities in the country are saying: Hey, we can work this out at the State level.

The gentleman referred to California. There are States that are regulating in the field as they regulate lots of different kinds of medical treatments and procedures. Suddenly, we are going to turn the United States Congress into a super-medical licensing board for the entire country?

This is why our colleague from the other side of the aisle, Mr. Roy, raised the question of whether this is even constitutional. Where is the Federal jurisdictional nexus for us to be overriding State medical boards in order to bulldoze into people's living rooms and their kitchen tables to usurp the family decisionmaking process of Americans across the country?

Madam Speaker, I yield 1 minute to the gentlewoman from Oregon (Ms. Salinas).

Madam Speaker, I yield 1 minute to the gentlewoman from Oregon (Ms. Dexter), who is both a mom and a doctor.

Madam Speaker, I yield 1 minute to the gentleman from Florida (Mr. Frost).

Madam Speaker, I yield 1 minute to the gentlewoman from Illinois (Mrs. Ramirez).

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

Every major medical and mental health association in the United States of America, representing 1.3 million doctors--the American Medical Association, the American Psychological Association, and the American Psychiatric Association--all reject this legislation that is being advanced here. They all support gender-affirming care according to the most up-to-date science and medicine.

So if they are not speaking for the transgender community, which certainly they are not; if they are not speaking for all of the families and parents who are involved, which certainly they are not; if they are not speaking for the medical community and the scientific community, who indeed are they speaking for?

They describe the position that these medical associations have as satanic. I mean, are they looking for an exorcism to deal with the reality of lives for millions of people in the country?

Madam Speaker, I yield 1 minute to the gentlewoman from Oregon (Ms. Hoyle).

Madam Speaker, we are invited to believe that the United States Congress is not only more competent to make medical decisions for America's children than their own parents, but that the United States Congress is more competent than all 50 State legislatures to run medical practices within their States.

Madam Speaker, I yield 1 minute to the gentlewoman from Washington (Ms. Schrier), who is both a mom and a pediatrician.

Madam Speaker, I yield an additional 10 seconds to the gentlewoman from Washington.

Madam Speaker, it is outrageous for the government to commandeer those decisions.

Madam Speaker, I strongly oppose this bill, and I encourage my colleagues to all vote ``no.''

Mr. Speaker, I yield 2 minutes to the gentlewoman from Vermont (Ms. Balint).

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

Madam Speaker, we obviously disagree vehemently on this bill, but this may be the last time that I get to share the floor with the distinguished gentlewoman from Georgia. I thank her for her hard work and her thoughtful comments in CNN news recently which moved me when she said: ``I would like to say, humbly, I am sorry for taking part in the toxic politics. It is very bad for our country. It has been something I thought about a lot, especially since Charlie Kirk was assassinated.''

Madam Speaker, I thank the gentlewoman and wish her and her family all the best in her future.

Having said that, on the gentlewoman's bill, Madam Speaker, there are lots of people in the country who are not getting their kids vaccinated for different reasons and for different kinds of illnesses. A lot of people in the country reject that and oppose that, and perhaps the vast majority do.

Does that mean we should come forward with a bill to the United States Congress to say that we are going to put in jail any parents who don't vaccinate their children because we think they are making the wrong decision for their children?

In other words, we know better than the parents do, and we know better than the doctors do. We know better than the medical associations do, and we know better than all of the States do.

Madam Speaker, I think that would be an absurd abuse of our power and, as the gentleman from Texas (Mr. Roy) has been saying, a very questionable deployment of Federal power, given the fact that the United States Congress has limited powers that are supposed to deal with actual national and Federal issues, which is why medical care has always been left to the States to deal with.

This is like a bulldozer going into everybody's house if you happen to be dealing with this particular kind of medical crisis. You don't have to agree with any particular decision that any particular family or set of parents have made. All you have to do is respect their right to make decisions with and for their own children. That is all that we are talking about.

Do you know who is on this side and opposed to this legislation? Medical associations, like the American Medical Association, the American Psychiatric Association, the American Academy of Pediatrics, and the American Psychological Association, representing more than a million doctors in the country, are saying: No, don't let the politicians start finger painting all over the protocols for dealing with an actual medical problem that millions of people have had to deal with in our country.

We will stand with the families. We will stand with the doctors. We will stand with the medical associations. We will stand with the States. We have got enough real work on our hands.

Let's just try to get medical care and medical attention to the people of America. Millions of people are losing their access to health insurance and to Medicaid. Why don't we try to deal with that before we barge into the doctors' offices, and the living rooms and kitchen tables of America to try to take over what is a fundamentally private and personal decision that we should be trusting families to make for themselves?

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

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

Mr. Speaker, it is shamelessly bold for Republicans to bring a bill to the floor called the Do No Harm in Medicaid Act. That is today's Republican Party. They simply lack any shame.

They say that they are doing no harm to Medicaid when their big, ugly bill earlier this year cut nearly $1 trillion from the Medicaid program. That is a huge cut that will leave millions of low-income families without any health coverage at all.

We already see the devastating effects of their big, ugly bill. States,

which are already facing budget shortfalls, stare down a reduction of as much as 20 percent of their Federal Medicaid funding. They are being left with an impossible challenge.

We are seeing across-the-board cuts that are crippling hospitals, maternity units, home care providers, and clinics. We are seeing healthcare providers close their doors and cut their services. We are seeing States scale back benefits, leaving those who are able to keep their Medicaid coverage with less of the healthcare that they need.

Now, even with all of that, Republicans have the audacity to bring a bill to the floor that they claim is about doing no harm in Medicaid. That is not what this is about.

H.R. 498 is an extreme attack on medically necessary healthcare for children. The bill bans Medicaid funding for gender-affirming care for minors and strips States of even more Medicaid funding if they choose to cover this medically necessary care with their own State dollars.

Mr. Speaker, Republicans are once again reaching into the doctor's office and taking deeply personal and private medical questions out of the hands of doctors, parents, and patients. They are putting it into their own hands, as if anyone wants politicians making medical decisions for them and their children.

As Members of Congress, we ought to be focused on bringing down healthcare costs and ensuring people have access to the healthcare they need, not getting in the way of doctors and parents who know what is best for their patients and their children.

The reality is this floor debate is nothing more than political theater, aimed at distracting from the devastating healthcare crisis Republicans created and are making worse every day.

They are trying to distract from the fact that their healthcare cuts are going to strip healthcare away from 15 million Americans and close hospitals all across the Nation. They are trying to distract from the fact that they are letting the Affordable Care Act's enhanced premium tax credits expire on January 1.

Republican inaction is driving up healthcare costs for more than 20 million Americans who are facing double, triple, or even quadruple premium increases.

Mr. Speaker, Republicans can't distract from this cruelty. I urge my colleagues to vote ``no'' on this bill.

I also call on Speaker Johnson to immediately bring up the Jeffries discharge petition that now has the support of a majority of House Members and that would extend the ACA premium tax credits for 3 years.

A majority of this House--Democrat and Republican--wants to act to extend these tax credits. It is time for Speaker Johnson to bring that bill to the floor.

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

Mr. Speaker, I yield 2 minutes to the gentleman from California (Mr. Takano), the chair of the Congressional Equality Caucus.

Mr. Speaker, I yield 2 minutes to the gentleman from New York (Mr. Tonko), who is the ranking member of our Environment Subcommittee.

Mr. Speaker, I yield 2 minutes to the gentlewoman from Oregon (Ms. Bonamici).

Mr. Speaker, I yield 2 minutes to the gentlewoman from Washington State (Ms. Randall).

Mr. Speaker, I yield an additional 1 minute to the gentlewoman from Washington.

Mr. Speaker, I yield 2 minutes to the gentlewoman from California (Ms. Chu).

Mr. Speaker, I yield 2 minutes to the gentlewoman from Massachusetts (Ms. Pressley).

Mr. Speaker, I yield 2 minutes to the gentlewoman from Washington (Ms. Jayapal).

Mr. Speaker, may I ask how much time remains on our side.

Mr. Speaker, I yield 3 minutes to the gentleman from Illinois (Mr. Schneider).

Mr. Speaker, I yield 2 minutes to the gentleman from Florida (Mr. Soto), who is a member of our committee.

Mr. Speaker, I yield 3 minutes to the gentlewoman from New Mexico (Ms. Stansbury).

Mr. Speaker, may I inquire as to the time remaining.

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

Mr. Speaker, I just have to correct two comments that were made by my Republican colleagues.

First, the sponsor of the bill said that they are just talking about Federal funds. The fact of the matter is, they are not just talking about Federal funds because this bill prevents States like Washington State--we had two people speak about this--from using State funds for gender-affirming care for minors. It is not just a prohibition on Federal funds.

Also, my chairman from Kentucky kept saying that the healthcare bill that the Republicans put on the floor yesterday would lower costs and somehow address the healthcare crisis. It does not. It does not lower costs, and it certainly doesn't extend the tax credits that are necessary under the Affordable Care Act to lower costs. Those expire January 1.

Mr. Speaker, I know the sponsor from Texas also mentioned medical professional organizations that oppose this bill, and there are many, but I include in the Record a letter from four of those organizations: American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American College of Physicians, and American Psychiatric Association.

December 16, 2025.

Dear Members of Congress: We, the undersigned medical

professional organizations, write in strong opposition to

H.R. 3492 and H.R. 498. These bills would criminalize and

dismantle health care for transgender young people and as

such represent a direct threat to patient welfare. We urge

you to reject these extreme proposals.

Families must be able to make personal medical decisions

regarding the care of their child in consultation with

trained health professionals. H.R. 3492 threatens parents and

physicians with imprisonment for obtaining medically

necessary health care. Such a proposal harms the physical and

mental health and well-being of families and interferes with

parents' ability to make informed decisions in the best

interests of their child. It also creates an irresolvable

ethical conflict that makes it impossible to fulfill their

duty to put the needs of the patient first.

Health care for transgender young people is individualized,

age-appropriate, provided according to longstanding expert

clinical guidelines, and supported by leading American

medical organizations. Under existing guidelines, medical

interventions are provided only after careful screening and

joint decision-making including a patient, family, and their

care team. H.R. 498 would insert the federal government

between patients and physicians. It would also put this care

out of reach for families nationwide by prohibiting the use

of federal Medicaid funding for its provision and requiring

physicians to provide different care to patients based on the

health insurance they hold. Preventing anyone from obtaining

medically necessary care threatens their physical and mental

health and well-being and that of their families.

Our organizations are united in opposition to political

interference in the practice of medicine. The confidential

relationship between a patient, their caregiver, and a

physician is the foundation of clinical care. Physicians and

other health professionals should never be criminalized or

penalized for providing care consistent with evidence-based

guidelines and best clinical judgment, and the government

should not interfere. Physicians, not the federal government,

are best positioned to work with patients and their families

to address their unique medical and mental health care needs.

We urge lawmakers to oppose these harmful intrusions into

the patient-physician relationship and the provision of

medical care.

Sincerely,

American Academy of Pediatrics, American College of

Obstetricians & Gynecologists, American College of

Physicians, American Psychiatric Association.

Mr. Speaker, I am going to read certain sections of it. They say: ``We, the undersigned medical professional organizations, write in strong opposition to H.R. 3492.''

``Healthcare for transgender young people is individualized, age- appropriate, provided according to longstanding expert clinical guidelines, and supported by leading American medical organizations. . . . Our organizations are united in opposition to political interference in the practice of medicine. The confidential relationship between a patient, their caregiver, and a physician is the foundation of clinical care.''

Physicians and other health professionals should never be stopped ``from providing care consistent with evidence-based guidelines and best clinical judgment, and the government should not interfere. Physicians, not the Federal Government, are best positioned to work with patients and their families to address their unique medical and mental health care needs.''

Mr. Speaker, I yield 1 minute to the gentleman from Ohio (Mr. Landsman), a member of our committee.

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

Mr. Speaker, I will say that I totally oppose this bill. I think these decisions should be left with parents and physicians, but more than anything else, I will mention today that Republicans need to do the right thing and bring up the Jeffries discharge petition that would extend the tax credits under the ACA for 3 more years. They should not allow them to expire on January 1. It should be brought up now.

I oppose this bill, and I ask that the Speaker bring up the discharge petition now.

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