Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I am pleased to be here with Ms. Jenkins, moving forward on this legislation. It represents an opportunity for us to deal with a series of, as she mentioned, bipartisan…
Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I am pleased to be here with Ms. Jenkins, moving forward on this legislation. It represents an opportunity for us to deal with a series of, as she mentioned, bipartisan ideas, relatively simple, to enhance service delivery.
I state from the outset that I am troubled that we were not able to provide opportunities to pay for these. They carry a cost. In committee, even though I thought they were a good idea, I voted against some of them because they were rather expensive.
In the aggregate, these are things, moving forward, that will improve healthcare, and I am hopeful that, as we move along the process, we can find some ways to offset the costs involved.
Some of us have philosophical questions about the role of HSAs and how it fits overall, but this legislation will make key consumer- friendly improvements to our existing system. Direct primary care medical homes are an important example of successful delivery reforms that will become easier to access under this legislation.
DPC arrangements offer individuals access to comprehensive primary care and prevention services in a medical home setting for a flat monthly fee, as opposed to concierge services that some people have in mind. Most of these practices typically charge a low monthly fee, perhaps $50 to $100, in most cases, and they serve low- and
moderate-income patients. These fees support the delivery of high- quality, coordinated care by providing better healthcare upfront in primary care settings.
DPC practices reduce unnecessary hospital and specialty care, as well as administrative expenses. This empowers the doctor-patient relationship, enabling providers to resist financial incentives that distort the decisionmaking process in primary care.
It also reduces the conveyor belt process, where people are typically shuttled into the office in 8-minute increments. This is not the case in direct primary care. It is not uncommon for appointments to last half an hour or even an hour. So they build a better relationship with patients, and they are able to better understand and address healthcare needs.
By offering a high level of access to primary care, evidence shows that direct primary care medical homes improve health outcomes and reduce costs. Today, DPC medical homes serve individuals of all ages and income in at least 47 States.
This legislation simplifies existing IRS regulations and clarifies that direct primary care medical homes are qualified health expenses-- medical services--and not health plans.
I personally question the IRS ruling. We have debated with them, but we have lost that. We fix it with this legislation.
As more individuals and employers seek to utilize the direct primary care delivery model, it is important that this outdated tax barrier not get in the way of patients accessing this successful model.
The legislation will allow HSA plans to cover onsite employee clinics. Think for a moment about the nursing stations that we have here in the House of Representatives to provide that service. They can offer physical exams, immunization, over-the-counter drugs, drug testing, hearing and vision screening, and other minor primary care preventive services to help employers assemble a benefits package for their employees that is both practical and can give them a competitive edge.
Allowing employees to access this basic healthcare service at work means it doesn't disrupt the worksite. It is more convenient for them; it is better for the employer.
Another key consumer change made by this bill is to recognize that employees change jobs. This bill allows individuals to streamline the conversion of a medical savings account, flexible savings account, or HSA so they won't lose savings when they change jobs. These reasonable changes will help consumers make the most of their employer-sponsored coverage.
Now--make no mistake--while this legislation will certainly help some consumers, it doesn't atone for the systematic sabotage that we have seen of the Affordable Care Act by the administration and some of my Republican colleagues. By zeroing out the mandate penalty, estimates are that insurance premiums will rise 15 percent. None of these bills before us today undo that premium hike that is visited upon our constituents unnecessarily.
These premium increases are coming after Republicans gave insurance companies billions in tax cuts in their tax bills. Republican attempts to expand HSAs is no replacement for the Affordable Care Act's financial assistance. Attempts to expand HSAs are a continuation of a platform of shifting families into health plans which provide fewer health benefits and higher out-of-pocket costs, while providing greater tax benefits for those who need them least.
HSAs and high-deductible healthcare plans shift costs to consumers without bending the cost curve or addressing underlying costs of medical care in the United States. I think we can and should do better.
For instance, the President has promised action on lowering prescription drug costs. These bills today do nothing to lower the cost of drugs consumers buy, and seek to move more people into plans that provide only catastrophic coverage, exposing more people to pay the full freight of drug price hikes.
Now, we have legislation before our committees that could move forward to do something about this, and I am saddened, despite Trump's talking about it, that we have really not taken action to do so. And we could, on a bipartisan basis, if we were enabled to do so.
The collection of bills on the floor this week will reduce Federal revenues by about $90 billion and will do nothing to reduce the number of uninsured people that will increase as a result of policy changes my Republican friends have done in this Congress. Their sabotage efforts under the Trump administration have caused millions of people to lose coverage, and millions more will do so in the future.
Now we are seeing, in the budget proposal, my Republican friends proposing to cut Medicare and Medicaid by nearly $1 trillion to try and pay for the deficits that have been exaggerated by tax cuts they have enacted. The bills that we will be considering, especially the next one, will only add fuel to that fire.
So, I am pleased that we have got some bipartisan pieces that we can move forward. I am hopeful that we don't abandon a sense of fiscal responsibility to be able to work together to pay for them, and I hope that we can encourage some of my friends on the other side of the aisle to dial back the assault on the Affordable Care Act, especially by the administration, so that we don't destabilize the system further, drive up costs, and increase the number of uninsured.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I yield 4 minutes to the gentleman from Wisconsin (Mr. Kind), a senior member of the Committee on Ways and Means, author of several of these reform provisions, and a champion of value over volume in healthcare, as well as fiscal restraint.
Mr. Speaker, I yield the gentleman from Wisconsin 1 additional minute.
Mr. Speaker, I yield myself 1 minute just to respond briefly.
Mr. Speaker, I was here in 2009. The very month President Obama took office, there were 700,000 jobs lost. There was great fear that we were going to have a complete collapse of the auto industry. There was a whole range of things that we were in an emergency situation on, and the worst economic crisis since the Great Depression.
As it was, a major portion of that bill was tax cuts to try and stimulate the economy. I do point out that as we move forward, our healthcare bill was entirely paid for, and that is what we need to get back to.
Mr. Speaker, I yield 3 minutes to the gentleman from Illinois (Mr. Danny K. Davis), a champion of healthcare, dealing with disparities in the healthcare system, a champion for balance and vision, and I appreciate him being here.
Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, I take modest exception to the notion that somehow the Affordable Care Act failed. It represents the largest expansion of healthcare that we have seen in decades. It is so popular and important that, when my Republican friends attempted to repeal it, something they have been working on for 7 years, it blew up in their face. Even President Trump said their bill was mean. And it continues, even though they are working to dismantle it bolt by bolt.
I would hope that we will return to sanity to be able to work to be able to move forward on things like some of the elements in this bill here today that we agree upon that could move us forward rather than the continued battle over the notion that the Affordable Care Act is something that needs to be destroyed. The American people deserve better.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I reserve the balance of my time.
Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, I appreciate the opportunity for us to have this discussion. It has been fun working with the gentleman from Minnesota (Mr. Paulsen) on this notion of direct primary care. It is a simple notion that runs athwart IRS regulations. I still don't fully understand why these should be classified as ``health plan'' rather than ``payment for service.''
But, nonetheless, we were able to work together on a bipartisan basis to move this forward. It is not expensive. The score is less than $2 billion out of $90 billion that we are tossing around here, and I personally believe that it will result in substantial savings in order to provide more efficient coverage.
But I must say that I am a little troubled by the continuing assault on what we are doing with the fiscal future of this country.
We just saw the latest reports that because of what my Republican friends have done with the budget and with the tax bill, we have doubled the deficit this year. It is doubled.
Now, there were complaints from my friend from Kansas about deficit spending when President Obama took office. Remember, he was only President for one-third of that month and lost 700,000 jobs. The economy was in free fall. Absolutely we took steps: cutting taxes and moving in areas to try and strengthen parts of the economy that was posing huge problems for people across the board. And this was broadly supported by people in business. Economic experts actually agree that probably we didn't do enough, and that slowed the economic recovery. But the economy has recovered.
We have seen 9 consecutive years of private sector job growth. That is what Trump inherited: over 7 years of job growth. The economy was strong. It wasn't in free fall. Yet, in that strong position, we are doubling the deficit this year. We are looking at trillion dollar deficits as far as the eye can see.
And we just had the President announce that he wants to spend $12 billion more, not because we are in economic free fall, but because his ruinous trade policies have resulted in losses to the farming sector. They are going to provide extra government bailout, not because farmers want it, but because they are being injured by these ruinous trade policies.
There was a time when most of my Republican friends would rise up in opposition. It is certain that if these were offered by Bill Clinton or Barack Obama, they would be screaming at the top of their lungs. Most of them are strangely silent now, but it is another $12 billion to try to fix a problem that Trump has created by starting trade wars with our friends, trying to punish China, and, in fact, we are punishing our allies. And somehow auto imports are national security.
This is embarrassing that we are in this situation. But it is not just embarrassing, it is dangerous. We are weakening ourselves economically, while we pick fights with our allies, like Canada and the European Union.
Mr. Speaker, on top of all of this, we are going to advance legislation today that have some nuggets of positive things. I have worked with my colleagues on some of them. There are important advances, but they are coming at a price of $90 billion added to the deficit, without even an attempt to work with us to offset. I think we could have offset the direct primary care piece that we are talking about here. It is relatively small potatoes compared to $90 billion, and compared to $12 billion for tariff relief for a trade war we didn't need.
Mr. Speaker, I enjoy the conversation about some of these items. I think it is important to spotlight them. But I am hopeful that we are able to return to fiscal stability, not having bailouts for farmers that they don't want and wouldn't need if we had a rational tariff policy. I am hopeful that we are not going to have a parade of other things that undermine the Affordable Care Act and add unnecessary costs to the deficit.
Mr. Speaker, I yield back the balance of my time.
Mr. Speaker, on that I demand the yeas and nays.