H.Res. 953

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

Mr. Speaker, when it comes to healthcare, Republicans are focused on lowering costs and expanding choice for all Americans. That is 347 million people, not just 7 percent of the population, which is all you are going to hear from the other side of the aisle, and that is all you have been hearing from the other side of the aisle.

Mr. Speaker, for more than a decade, Democrats have promised that ObamaCare would lower costs. They actually named the bill the ``Affordable Care Act.'' Find one American--find one American who says that their healthcare is now cheaper today than it was when they passed this disastrous bill. You won't. You won't find one.

In fact, the sky is falling because of their enhanced premium tax credits that they made temporary because they decided to make permanent tax benefits for wealthy environmentalists who support them. That is why we are where we are today.

Mr. Speaker, since ObamaCare has passed, we have seen 150-plus hospitals close their doors. Since ObamaCare has passed, we have seen premiums go up more than 80 percent. It doesn't sound like the Affordable Care Act by any means.

Even worse, the Government Accountability Office has confirmed what Republicans have been warning for years: ObamaCare is riddled with

waste, fraud, and abuse. The GAO led a covert investigation by creating fictitious ObamaCare applicants with fake documentation where 100 percent of those applicants were accepted and enrolled.

Guess what? A year later, this year, of that 100 percent, 90 percent were still receiving subsidies. That means that insurance companies were still being subsidized for fake accounts where the people didn't even exist.

Data analysis from GAO also finds that 58,000-plus enrollees matched Social Security numbers with death records, with 7,000 of them dead before enrollment even began. There were dead people on the rolls, but what do they want to do? Their answer is to just continue the same old- same old by extending the current program with no reforms.

Mr. Speaker, one Social Security number alone had more than 125 different policies attached to it--just one. This all came from the GAO. This didn't come from the House Republicans.

We should not continue propping up a system that has completely failed to lower costs for Americans. The Lower Healthcare Premiums for All Americans Act takes a much different approach. It is one that delivers real relief.

First, it provides more freedom and flexibility through CHOICE Arrangements, empowering small businesses to offer tax-free benefits so that their employees can find health coverage that works for them.

This levels the playing field for small businesses, putting them on equal footing with large employers when competing for workers. These arrangements are proven to be successful. In fact, 83 percent of employers using CHOICE Arrangements are offering coverage for the very first time.

The bill also brings transparency to pharmacy benefit managers, requiring them to open up the books to finally give employers the data that they need to increase competition and negotiate better drug prices for workers. The result: Healthcare costs and premiums will be lowered for all--for all Americans, not just the 7 percent that the Democrats are fighting for in the enhanced COVID-era premium tax credits, but also for the 300 million-plus Americans.

Mr. Speaker, ObamaCare has driven costs up and choice down. This bill does the complete opposite.

Mr. Speaker, I urge my colleagues to support the Lower Healthcare Premiums for All Americans Act and stand with families, workers, and small businesses who deserve--they deserve a real affordable, accountable healthcare plan.

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

Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Arrington), the chairman of the Budget Committee.

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

Mr. Speaker, may I inquire as to how much time I have remaining.

Mr. Speaker, I yield 1 minute to the gentleman from Ohio (Mr. Miller).

Mr. Speaker, I include in the Record the bombshell GAO report showing the waste, fraud, and abuse within the ObamaCare exchanges.

GAO, U.S. Government

Accountability Office,

Washington, DC, December 3, 2025.

Hon. Brett Guthrie,

Chairman, Committee on Energy and Commerce,

House of Representatives.

Hon. Jim Jordan,

Chairman, Committee on the Judiciary,

House of Representatives.

Hon. Jason Smith,

Chairman, Committee on Ways and Means,

House of Representatives.

Patient Protection and Affordable Care Act: Preliminary Results from Ongoing Review Suggest Fraud Risks in the Advance Premium Tax Credit

Persist

The Patient Protection and Affordable Care Act (PPACA)

provides premium tax credits to those who purchase private

health insurance plans and meet certain income and other

requirements. Individuals may have the federal government pay

this credit to their health insurance issuers in advance on

their behalf, known as the advance premium tax credit (APTC),

which lowers their monthly premium payments.

Millions of consumers have purchased health insurance plans

through the marketplaces established under PPACA. The Centers

for Medicare & Medicaid Services (CMS), within the Department

of Health and Human Services (HHS), is responsible for

maintaining the federal Marketplace and overseeing state-

based marketplaces. Under PPACA, states may elect to operate

their own state-based marketplace or to use the federal

Marketplace. These marketplaces determine eligibility for

APTC, based in part on income, and allow individuals to

compare and choose among insurance plans offered by

participating private health care coverage issuers. CMS

estimated it paid nearly $124 billion in APTC for about 19.5

million enrollees for plan year 2024.

Consumers can enroll in health insurance coverage through a

marketplace independently or with assistance, such as from an

insurance agent or broker. As discussed later in this report,

agents and brokers can help a consumer apply for coverage,

including for related financial assistance, and enroll in a

plan. Assistance from an agent or broker is of no cost to a

consumer. Rather, agents and brokers are allowed to receive

compensation directly from health insurance issuers in

accordance with agreements with those issuers and any

applicable state requirements.

Indictments from December 2024 and February 2025 highlight

concerns about agent and broker practices in the federal

Marketplace. Specifically, the indictments allege that bad

actors enrolled consumers in insurance through the federal

Marketplace by falsifying information on their applications.

Additionally, according to CMS, the agency received

approximately 275,000 complaints between January and August

2024 that consumers were enrolled in a plan or had their plan

changed without their consent. Such practices can result in

wasteful federal spending on APTC for enrollees who are not

eligible. Further, such practices can result in harm and

unexpected costs for consumers. These can include loss of

access to medical providers and medications, higher

copayments and deductibles, or repayment of APTC if income or

other eligibility was misrepresented.

We previously reported that APTC is at risk of fraud. For

example, in September 2016, we found that federal and state

marketplaces approved coverage for our fictitious applicants.

Nearly all of these fictitious applicants remained covered

after we sent fictitious documents or no documents to resolve

issues with our applications. Further, in July 2017, we found

that CMS did not design processes to verify eligibility for

APTC, including preventing duplicate coverage.

You asked us to review issues related to fraud risk

management in APTC. This report is based on preliminary

results and analyses from that ongoing work. Specifically.

this report addresses preliminary results from our

1. covert testing of federal Marketplace enrollment

controls'for plan years 2024 and 2025,

2. analyses of federal Marketplace enrollment data for plan

years 2023 and 2024, and

3. evaluation of CMS's fraud risk assessment and antifraud

strategy for APTC.

To perform covert testing of federal Marketplace enrollment

controls, we created 20 fictitious identities and submitted

applications for individual health care coverage in the

federal Marketplace. We submitted applications for four of

these fictitious identities in October 2024 for coverage

through December 2024, which was the remainder of that plan

year. We pursued coverage for plan year 2025 for all 20

fictitious identities, including the four identities for

which we already submitted applications. Our covert testing

for plan year 2025 is ongoing, since the plan year is not yet

complete. As a result, we will describe additional details of

the 2025 applications in a future report.

Our covert testing included applications submitted

independently through HealthCare.gov, which is the federal

Marketplace's website, and applications submitted with

assistance from an insurance agent or broker. For all our

applicant scenarios, we sought to act as an ordinary

consumer would in attempting to make a successful

application. For example, if, during online applications,

we were directed to make phone calls to complete the

process, we acted as instructed.

For applications for plan year 2024, our covert tests

included fictitious applicants who provided invalid (i.e.,

never issued) Social Security numbers (SSN). Additionally, we

stated income at a level eligible to obtain APTC. As

appropriate, we used publicly available information to

construct our applications for coverage and subsidies. We

also used publicly available hardware, software, and

materials to produce counterfeit documents that we submitted,

if appropriate for our testing, when instructed to do so. We

then observed the outcomes of the document submissions, such

as any approvals received or requests to provide additional

supporting documentation. The results of our covert testing,

while illustrative of potential enrollment control

weaknesses, cannot be generalized to the overall enrollment

population.

To examine federal Marketplace enrollment for plan years

2023 and 2024, we obtained and analyzed federal Marketplace

enrollment and payment data, including APTC information, from

CMS. We also matched enrollee SSNs in the data to two

additional data sources: (1) Social Security Administration's

(SSA) full death file, a database containing records of death

that have been reported to SSA, as of November 2024 and (2)

April 2025 data from the Internal Revenue Service (IRS) on

APTC reconciliation from tax forms filed for tax year 2023.

We assessed the reliability of all data sets by performing

electronic tests to determine the completeness and accuracy

of key fields. We also reviewed agency documentation and

interviewed knowledgeable agency officials about the

reliability of the data. Overall, we found that the data were

reliable for our purposes.

To examine CMS's fraud risk assessment and antifraud

strategy for APTC, we reviewed documentation of CMS's

policies and fraud risk management activities related to

APTC. This included CMS's 2018 fraud risk

assessment for APTC. Additionally, we interviewed agency

officials about CMS's fraud risk management activities in

this program. We reviewed relevant reports from GAO and HHS's

Office of the Inspector General. We evaluated information

from relevant documentation and interviews of agency

officials against relevant leading practices in GAO's A

Framework for Managing Fraud Risks in Federal Programs (Fraud

Risk Framework).

To support all three objectives, we interviewed CMS

officials and representatives from seven stakeholder

organizations that represent agents and brokers, state

insurance regulators, researchers, and one of the entities

that CMS approved to host a non-marketplace website where

consumers can apply for and enroll in a plan offered through

the federal Marketplace.

The ongoing work upon which this report is based is being

conducted in accordance with generally accepted government

auditing standards. Those standards require that we plan and

perform the audit to obtain sufficient, appropriate evidence

to provide a reasonable basis for our findings and

conclusions based on our audit objectives. We believe that

the evidence obtained provides a reasonable basis for our

preliminary findings and conclusions based on our audit

objectives. Additionally, our related investigative work is

being conducted in accordance with standards prescribed by

the Council of the Inspectors General on Integrity and

Efficiency.

Background

APTC Eligibility and Enrollment Processes

APTC Eligibility

To qualify for a premium tax credit, individuals must be

enrolled in a qualified health plan offered through a

marketplace and meet certain criteria. These tax credits can

be paid in advance through APTC. See figure 1 for the APTC

eligibility requirements.

The amount of the premium tax credit varies based on

household income and the cost of a benchmark plan. The credit

limits what the consumer would pay for that plan to be no

more than a certain percentage of their household income. The

American Rescue Plan Act of 2021 made temporary changes to

premium tax credits by expanding eligibility to higher-income

individuals and increasing premium tax credits for lower-

income individuals for tax years 2021 and 2022. For example,

the law increased the premium tax credit amounts for eligible

individuals and families, resulting in access to plans with

no premium contributions for those earning 100 to 150 percent

of the federal poverty level. It also expanded eligibility

for premium tax credits to include certain individuals and

families with incomes at or above 400 percent of the

federal poverty level. Public Law 117-169--commonly known

as the Inflation Reduction Act of 2022--extended these

provisions through the end of tax year 2025. See table 1.

In 2013, CMS developed the Data Services Hub (Hub) to help

verify applicant eligibility in an automated manner. To do

so, the Hub matches applicant information, such as SSN and

estimated income, against trusted data sources. These sources

include records from SSA and IRS. In the federal Marketplace,

the system generates an inconsistency when data matching

processes are not able to verify applicant information

against the Hub's trusted sources. When an inconsistency is

generated, applicants are instructed to provide documentation

to support information on their applications that cannot be

verified by the Hub's data matching.

Marketplaces and Enrollment Pathways

States, along with the District of Columbia, may elect to

rely on the federal Marketplace or operate their own health

insurance marketplace. Table 2 describes the types of health

insurance marketplaces.

The federal Marketplace offers multiple pathways to enroll

in health insurance coverage and receive APTC. Consumers in

states that use the federal Marketplace may enroll in

coverage through the pathway known as HealthCare.gov or an

enhanced direct enrollment (EDE) pathway, among others. Table

3 describes examples of enrollment pathways in the federal

Marketplace.

Role of Agents and Brokers

Consumers seeking to obtain health insurance through the

federal Marketplace may receive assistance from agents and

brokers who help them apply for coverage, including related

financial assistance, and enroll in a health plan. In return,

agents and brokers receive payment (commissions or salaries)

from the issuers of the health plans. Agents and brokers must

be licensed in the state in which they sell plans and

registered with CMS to sell plans through the federal

Marketplace. According to CMS, most enrollments in the

federal Marketplace are assisted by an agent or broker

through the EDE and direct enrollment pathways.

CMS is responsible for oversight of agents and brokers in

the federal Marketplace and ensuring that they comply with

federal rules. Agents and brokers are required to, among

other things, obtain and document consumers' consent before

assisting them with applying for and enrolling in coverage

through the federal Marketplace. For example, consumer

consent is required before the agent or broker can:

collect or use any personally identifiable information,

such as name, date of birth, and SSN;

help a consumer apply for coverage or financial assistance

by completing an eligibility application on their behalf; and

actively enroll a consumer in a plan offered through the

federal Marketplace.

After a consumer has applied or is enrolled, the agent or

broker can also update a consumer's eligibility application

or plan selection on their behalf, if the initial consent

authorized the agent or broker to do so, or if they obtained

subsequent consent for any new actions. Agents and brokers

are required to make documentation of consumer consent

available to CMS upon request in response to monitoring,

audit, and enforcement actions.

Fraud Risk Management

The objective of fraud risk management is to ensure program

integrity by continuously and strategically mitigating both

the likelihood and effects of fraud, while also facilitating

a program's mission. The Fraud Risk Framework provides a

comprehensive set of leading practices that serve as a guide

for agency managers to use when developing efforts to combat

fraud in a strategic, risk-based manner. As depicted in

figure 2, the framework organizes the leading practices

within four components: (1) Commit, (2) Assess, (3) Design

and Implement, and (4) Evaluate and Adapt.

In June 2016, the Fraud Reduction and Data Analytics Act of

2015 (FRDAA) required the Office of Management and Budget

(OMB) to establish guidelines for federal agencies to create

controls to identify and assess fraud risks to design and

implement antifraud control activities. The act further

required OMB to incorporate the leading practices from the

Fraud Risk Framework in the guidelines. The Payment Integrity

Information Act of 2019 repealed FRDAA but maintained the

requirement for OMB to provide guidelines to agencies in

implementing the Fraud Risk Framework.

In its 2016 Circular No. A-123 guidelines, OMB directed

agencies to adhere to, the Fraud Risk Frameworks leading

practices. In October 2022, OMB issued a Controller Alert

reminding agencies that they must establish financial and

administrative controls to identify and assess fraud risks.

In addition, the alert reminded agencies that they should

adhere to the leading practices in the Fraud Risk Framework

as part of their efforts to effectively design, implement,

and operate an internal control system that addresses fraud

risks.

The Federal Marketplace Approved Subsidized Coverage for Nearly All of

Our Fictitious Applicants in Plan Years 2024 and 2025, Suggesting

Weaknesses Persist

Our convert testing of enrollment controls in the federal

Marketplace suggests weaknesses have persisted since our

tests in plan years 2015 through 2016. All four of our

fictitious applications received subsidized coverage through

the federal Marketplace in late 2024. Additionally, although

our work is ongoing, as of September 2025 18 of our 20

fictitious applications for plan year 2025 were receiving

subsidized coverage. We will continue to monitor the status

of these applications during plan year 2025.

All Four of Our Fictitious Applicants Received Subsidized

Coverage in Late 2024

To test enrollment controls, we developed and submitted

four fictitious applications to obtain insurance coverage

with APTC through the federal Marketplace. We applied for

coverage for these four applicants in October 2024. We

submitted the applications outside of the open enrollment

period, using a special enrollment period for low-income

applicants. in two cases, we applied for coverage directly

through HealthCare.gov. In the other two cases, we applied

via telephone with assistance from an insurance broker. The

brokers that assisted us used EDE systems to submit our

applications.

The federal Marketplace approved fully subsidized insurance

coverage for all four of our fictitious applicants for

November through December 2024. The combined total amount of

APTC paid to insurance companies for all four fictitious

enrollees was about $2,350 per month. While our fictitious

enrollees are not generalizable to the universe of enrollees,

they suggest weaknesses in enrollment controls--such as

identity proofing and income verification--in the federal

Marketplace through both HealthCare.gov and EDE systems.

Table 4 summarizes the results of our covert testing of

enrollment controls for plan year 2024.

The results of our covert testing for plan year 2024 are

generally consistent with results of similar testing we

conducted for plan years 2014 through 2016.

Mr. Speaker, I have no additional speakers. I am prepared to close, and I reserve the balance of my time.

Mr. Speaker, we have heard a lot of comments from the Democrats on this side of the floor.

Back where I come from, the comments that I have heard, we call it hogwash, because it has not been true and it has not been factual. This bill before you will lower healthcare costs for all Americans, not just the 7 percent that they are fighting for. It lowers costs for all 347 million.

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, pursuant to House Resolution 953, I call up the bill (H.R. 6703) to ensure access to affordable health insurance, and ask for its immediate consideration in the House.

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and insert extraneous material on the legislation, H.R. 6703.

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

Mr. Speaker, I rise today in strong support of H.R. 6703, the Lower Health Care Premiums for All Americans Act.

When the Democrats passed ObamaCare over a decade ago, they sold the bill on the promise that it would lower healthcare costs and preserve plan options. If you like your plan, you can keep it and if you like your doctor, you can keep them, we remember being quoted. These famous last words still haunt us.

Today, we know that ObamaCare has not lived up to the Democrats' lofty promises. Instead, the consequences of that bill continue to burden American patients as they have since its enactment. Healthcare spending has nearly doubled since ObamaCare passed.

Healthcare plan options have been decimated by Democratic overreach, and millions of Americans are saddled with medical debt across the country.

ObamaCare premiums are up 80 percent since the program's inception, with patients paying on average $5,000 out of their own pocket to hit their deductible. The average out-of-pocket spending maximum for 1 year is over $20,000. Without a doubt, ObamaCare has proven to be unaffordable and unsustainable.

In an attempt to respond to the affordability crisis created by ObamaCare, Democrats leveraged a public health emergency to shovel hundreds of billions of dollars to big health insurance plans to mask the risk of rising unaffordability of coverage. First, in the American Rescue Plan of 2021 and then again in the Inflation Reduction Act of 2023, Democrats sent temporary taxpayer-funded enhanced premium tax credits directly to the coffers of big insurance plans.

They did this without a single Republican vote of support. On both occasions, Democrats chose to make these COVID credits temporary. They could have made them permanent, but they chose instead to focus on advancing priorities for wealthy Americans, which some of these they did make permanent by subsidizing electric vehicles for politically connected cronies to siphon off Federal dollars of the greenhouse gas slush fund.

Now, Democrats are uniting behind that policy to send billions more of taxpayer dollars to big health insurance plans. With the Democrats' temporary COVID credits set to expire at the end of the year, they are attempting to turn their policy failures into political gains using the American people as collateral.

It is worth reiterating. Democrats funded temporary Band-Aids to cover up unaffordable care. They set the expiration dates. They chose to fund liberal priorities instead of making them permanent.

While Democrats continue to fearmonger, I want to shed light on what Republicans are doing to fix the Democrats' affordability crisis, with policies that deliver real, lasting relief to the American people. These include eliminating health plan gimmicks like silver loading, which will lower ACA premiums by 11 percent; increasing transparency for pharmacy benefit managers, the middlemen that will lower costs of drugs for all Americans; and increasing affordable plan choices and putting patients back in the driver's seat for their own healthcare plan choices by instituting association health plans, CHOICE arrangements, and stop-loss insurance.

This proposal results in more than double the premium reduction that Democrats' extension of the enhanced tax credit subsidies would. The Congressional Budget Office estimates this plan will lower premiums by 11 percent compared to just 5 percent from the Democratic subsidies. These policies will also lower healthcare costs for all Americans, not just the roughly 7 percent enrolled in the ObamaCare marketplace. Many of these policies are bipartisan: Ending silver loading, addressing nefarious PBM practices, and strengthening the employer insurance marketplace all have garnered broad bipartisan support.

I hope we can overlook politics that are clouding the issue and come together to pass this bill and continue to work together in 2026 to deliver more affordable healthcare to all Americans.

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

Mr. Speaker, I yield 2 minutes to the gentlewoman from Iowa (Mrs. Miller-Meeks), the sponsor of this legislation.

Mr. Speaker, I will remind my friends that the premium tax credits from the ACA are extended. They are permanent. These are the enhanced premium tax credits. It is good, and sad, that my colleagues are recognizing that the Affordable Care Act is failing.

Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Pfluger), my good friend and leader on the Energy and Commerce Committee.

Mr. Speaker, I yield myself 1 minute.

Mr. Speaker, we have heard sad stories. Last night, in the Rules Committee, the Rules chairman read through different stuff. The Rules' ranking member was in townhalls and heard stories about people who had to buy care on the Affordable Care Act marketplace that is failing.

There is one thing nobody has ever answered. They say they have to face their constituents. Do my colleagues explain to their constituents that in the bill that they voted for that gave billions of dollars of the Green New Deal; in the same bill they set these tax cuts to expire?

I know it was during reconciliation they could have done them within 10 years instead of 5. They also could have done them permanently. There is a way in reconciliation to do them permanently, as well.

No one on the other side has ever explained why they chose to make these tax credits expire. I am still waiting to hear the answer for that.

In the meantime, we have our bill that will lower premiums, calculated by CBO, in the individual market by 11 percent, as opposed to the 5 percent that would happen if we just passed the enhanced tax credits. Not just the 7 percent in the ObamaCare marketplace will benefit but all Americans will benefit from this bill.

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

Mr. Speaker, I yield myself 30 seconds.

Mr. Speaker, I again ask the question: Why were these set to expire? We hear the stories that people are reading about people in their districts, and they say how it is unconscionable. It is unconscionable that money was spent on the Green New Deal at the expense of the enhanced tax credits they talk about.

We want to solve it. Mr. Speaker, $39,000 is what is brought up for

healthcare. That is the problem in America. Mr. Speaker, $39,000 for health insurance is what we have to fix.

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

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

Mr. Speaker, we are here to solve the problem for all Americans. Mr. Speaker, 20 million people are trapped in the Affordable Care Act marketplace. Our proposal lowers those premiums by 11 percent.

There are over 160 million Americans who get it through their employers. There are Americans on other types of health insurance. We need to fix this problem.

My good friend from Florida, Mr. Speaker, said $39,000 is what they pay for health insurance. That is the problem. That is what we need to fix.

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

Madam Speaker, Pursuant to House Resolution 953, I call up the bill (H.R. 3492) to amend section 116 of title 18, United States Code, with respect to genital and bodily mutilation and chemical castration of minors, and ask for its immediate consideration in the House.

Madam Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous material on H.R. 3492.

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

Madam Speaker, we as a Nation are facing one of the greatest crises of our time: Child abuse disguised as medical intervention. Children are being coerced by adults in positions of authority into life- altering and medically questionable gender transition procedures without a full understanding of the meaning or that impact.

Democrats have embraced an extreme position on this so-called gender- affirming care. They are more interested in promoting the radical left policies than protecting our children from harm. Despite the American public's widespread rejection of the practice in 2024, the radical left continues to distort the debate surrounding so-called gender affirming care.

Instead of accurately describing the procedures as harmful and life- altering, the left deceptively frames the

procedures as being necessary to improve the health and the well-being of our children.

Through gender-affirming care, Democrats are indoctrinating children and causing them to make life-altering decisions about their body involving hormones and surgery and jeopardizing their health. So-called gender-affirming care is the genital mutilation and chemical castration of children. It is not lifesaving care. It is child abuse.

All evidence points to the fact that gender transition procedures, including the puberty blockers, the hormones, and the surgeries, are a form of genital mutilation. More and more de-transitioners, such as our brave Chloe Cole, are coming forward to share their horrific experiences of being used as experiments of the medical establishment. The majority of these brave transitioners are girls and women.

The first rule of medicine is do no harm. Yet, those in the medical community performing these grotesque procedures on children are committing some serious harm. In fact, these procedures are so grotesque that during the markup of this legislation, our colleagues on the other side of the aisle had a hard time hearing these specific procedures described. This begs the question: If they cannot bear to hear this, why are they forcing it on our children?

Doctors across the U.S. and other countries are beginning to take a stand against those in the medical community who insist on these being lifesaving procedures. They should be questioned. Even our neighbors to the North have acted responsibly.

In Canada, all genital surgeries are only available to children who are 18 years of age or older. This policy aligns with the World Professional Association for Transgender Health standards. According to these standards, a person must be the age of majority to undergo reassignment surgery.

Likewise, in Austria, the Czech Republic, Croatia, Denmark, Finland, Italy, Latvia, Lithuania, the Netherlands, Poland, Portugal, Spain, and Sweden, the minimum age requirement to undergo any sex reassignment surgery is 18. We should not fall behind these countries when it comes to protecting our children.

The Protect Children's Innocence Act will hold those accountable who perform or attempt to perform genital mutilation and chemical castration on our children. This bill expands the covered offenses to include body mutilation and chemical castration of minors. Victims are protected by ensuring that they cannot be arrested or prosecuted if one of these, or other prohibited procedures, are performed on them.

This legislation continues President Trump's important priority to protect children. Earlier this year, President Trump issued an executive order titled: ``Protecting Children From Chemical and Surgical Mutilation.'' This order defunds the chemical and surgical mutilation of children and halts the use of Federal funds supporting gender-affirming medical care for youth under the age of 19.

H.R. 3492 works to codify President Trump's executive order and amends section 116 of the United States Code to explicitly include bodily mutilation and chemical castration.

My colleagues on the other side of the aisle have lamented: Leave our children alone. Madam Speaker, that is exactly what this bill does. This issue is simple. Do not force children into making decisions that they will not be able to reverse. Do not make these children lifelong patients and dependent on the medical system. Most importantly, do not abuse our Nation's children.

Madam Speaker, I urge my colleagues to support this legislation, and I reserve the balance of my time.

Madam Speaker, I would like to mention that Gavin Newsom signed a bill into law recently not to notify parents. Administrators and schoolteachers don't notify parents that their kids are considering a transition. We do trust parents in many cases, but in a lot of cases in some of these blue States parents are not notified.

Madam Speaker, I yield 5 minutes to the gentlewoman from Georgia (Ms. Greene).

Madam Speaker, I yield an additional 1 minute to the gentlewoman from Georgia.

Madam Speaker, this is not rare; 5,700 children had these surgeries, mainly between 2019 and 2023, in mainly blue States.

Here on PBMs, it says that puberty blockers have not been approved by the FDA for the indication of gender dysphoria, and they are off-label uses. So these are not safe uses in many cases of these transitions.

Madam Speaker, I yield 2 minutes to the gentlewoman from South Carolina (Ms. Mace).

Madam Speaker, I reserve the balance of my time.

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

Madam Speaker, in February 2024, the American College of Pediatricians released a position statement detailing

how social transition, puberty blockers, and cross-sex hormones have no demonstrable long-term benefits on the psychological well-being of adolescents in gender dysphoria.

I am reminded of a quote that a Vanderbilt University doctor said in 2022. He said: ``These affirming procedures are huge moneymakers.''

We are here to protect the children.

Madam Speaker, I yield 2 minutes to the gentleman from West Virginia (Mr. Moore).