RESTORING ACCESS TO MEDICATION ACT OF 2018
(House of Representatives - July 25, 2018)

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[Congressional Record Volume 164, Number 125 (Wednesday, July 25, 2018)]
[Pages H7651-H7658]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




               RESTORING ACCESS TO MEDICATION ACT OF 2018

  Ms. JENKINS of Kansas. Mr. Speaker, pursuant to House Resolution 
1012, I call up the bill (H.R. 6199) to amend the Internal Revenue Code 
of 1986 to include certain over-the-counter medical products as 
qualified medical expenses, and ask for its immediate consideration.
  The Clerk read the title of the bill.
  The SPEAKER pro tempore. Pursuant to House Resolution 1012, in lieu 
of the amendment in the nature of a substitute recommended by the 
Committee on Ways and Means printed in the bill, an amendment in the 
nature of a substitute consisting of the text of Rules Committee Print 
115-82 is adopted, and the bill, as amended, is considered read.
  The text of the bill, as amended, is as follows:

                               H.R. 6199

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Restoring 
     Access to Medication and Modernizing Health Savings Accounts 
     Act of 2018''.
       (b) Table of Contents.--The table of contents for this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. First dollar coverage flexibility for high deductible health 
              plans.
Sec. 3. Treatment of direct primary care service arrangements.
Sec. 4. Certain employment related services not treated as 
              disqualifying coverage for purposes of health savings 
              accounts.
Sec. 5. Contributions permitted if spouse has a health flexible 
              spending account.
Sec. 6. FSA and HRA terminations or conversions to fund HSAs.
Sec. 7. Inclusion of certain over-the-counter medical products as 
              qualified medical expenses.
Sec. 8. Certain amounts paid for physical activity, fitness, and 
              exercise treated as amounts paid for medical care.

     SEC. 2. FIRST DOLLAR COVERAGE FLEXIBILITY FOR HIGH DEDUCTIBLE 
                   HEALTH PLANS.

       (a) In General.--Section 223(c)(2) of the Internal Revenue 
     Code of 1986 is amended by adding at the end the following 
     new subparagraph:
       ``(E) First dollar coverage flexibility.--
       ``(i) In general.--A plan shall not fail to be treated as a 
     high deductible health plan by reason of failing to have a 
     deductible for not more than $250 of specified services for 
     self-only coverage (twice such amount in the case of family 
     coverage) during a plan year.
       ``(ii) Specified services.--For purposes of this 
     subparagraph, the term `specified services' means, with 
     respect to a plan, services other than preventive care 
     (within the meaning of subparagraph (C)) identified under the 
     terms of the plan as being services to which clause (i) 
     applies.''.
       (b) Inflation Adjustment.--Section 223(g)(1) of such Code 
     is amended--
       (1) by striking ``and (c)(2)(A)'' each place it appears and 
     inserting ``, (c)(2)(A), and (c)(2)(E)'', and
       (2) in subparagraph (B)--
       (A) by striking ``such taxable year'' in the matter 
     preceding clause (i) and inserting ``the taxable year (plan 
     year in the case of the dollar amount in subsection 
     (c)(2)(E))'', and
       (B) by striking ``clause (ii)'' and inserting ``clauses 
     (ii) and (iii)'' in clause (i), by striking ``and'' at the 
     end of clause (i), by striking the period at the end of 
     clause (ii) and inserting ``, and'', and by inserting after 
     clause (ii) the following new clause:
       ``(iii) in the case of the dollar amount in subsection 
     (c)(2)(E) for plan years beginning in calendar years after 
     2019, `calendar year 2018'.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply with respect to plan years beginning after 
     December 31, 2018.

     SEC. 3. TREATMENT OF DIRECT PRIMARY CARE SERVICE 
                   ARRANGEMENTS.

       (a) In General.--Section 223(c)(1) of the Internal Revenue 
     Code of 1986 is amended by adding at the end the following 
     new subparagraph:
       ``(D) Treatment of direct primary care service 
     arrangements.--
       ``(i) In general.--A direct primary care service 
     arrangement shall not be treated as a health plan for 
     purposes of subparagraph (A)(ii).
       ``(ii) Direct primary care service arrangement.--For 
     purposes of this paragraph--

       ``(I) In general.--The term `direct primary care service 
     arrangement' means, with respect to any individual, an 
     arrangement under which such individual is provided medical 
     care (as defined in section 213(d)) consisting solely of 
     primary care services provided by primary care practitioners 
     (as defined in section 1833(x)(2)(A) of the Social Security 
     Act, determined without regard to clause (ii) thereof), if 
     the sole compensation for such care is a fixed periodic fee.
       ``(II) Limitation.--With respect to any individual for any 
     month, such term shall not include any arrangement if the 
     aggregate fees for all direct primary care service 
     arrangements (determined without regard to this subclause) 
     with respect to such individual for such month exceed $150 
     (twice such dollar amount in the case of an individual with 
     any direct primary care service arrangement (as so 
     determined) that covers more than one individual).

       ``(iii) Certain services specifically excluded from 
     treatment as primary care services.--For purposes of this 
     paragraph, the term `primary care services' shall not 
     include--

       ``(I) procedures that require the use of general 
     anesthesia,
       ``(II) prescription drugs (other than vaccines), and
       ``(III) laboratory services not typically administered in 
     an ambulatory primary care setting.

     The Secretary, after consultation with the Secretary of 
     Health and Human Services, shall issue regulations or other 
     guidance regarding the application of this clause.''.
       (b) Direct Primary Care Service Arrangement Fees Treated as 
     Medical Expenses.--Section 223(d)(2)(C) is amended by 
     striking ``or'' at the end of clause (iii), by striking the 
     period at the end of clause (iv) and inserting ``, or'', and 
     by adding at the end the following new clause:
       ``(v) any direct primary care service arrangement.''.

[[Page H7652]]

       (c) Inflation Adjustment.--Section 223(g)(1) of such Code, 
     as amended by section 2(b), is amended--
       (1) by inserting ``(c)(1)(D)(ii)(II),'' after ``(b)(2),'' 
     each place it appears, and
       (2) in subparagraph (B), by striking ``and (iii)'' and 
     inserting ``, (iii) and (iv)'' in clause (i), by striking 
     ``and'' at the end of clause (ii), by striking the period at 
     the end of clause (iii) and inserting ``, and'', and by 
     inserting after clause (iii) the following new clause:
       ``(iv) in the case of the dollar amount in subsection 
     (c)(1)(D)(ii)(II) for taxable years beginning in calendar 
     years after 2019, `calendar year 2018'.''.
       (d) Reporting of Direct Primary Care Service Arrangement 
     Fees on W-2.--Section 6051(a) of such Code is amended by 
     striking ``and'' at the end of paragraph (16), by striking 
     the period at the end of paragraph (17) and inserting ``, 
     and'', and by inserting after paragraph (17) the following 
     new paragraph:
       ``(18) in the case of a direct primary care service 
     arrangement (as defined in section 223(c)(1)(D)(ii)) which is 
     provided in connection with employment, the aggregate fees 
     for such arrangement for such employee.''.
       (e) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2018, in 
     taxable years ending after such date.

     SEC. 4. CERTAIN EMPLOYMENT RELATED SERVICES NOT TREATED AS 
                   DISQUALIFYING COVERAGE FOR PURPOSES OF HEALTH 
                   SAVINGS ACCOUNTS.

       (a) In General.--Section 223(c)(1) of the Internal Revenue 
     Code of 1986, as amended by section 3(a), is amended by 
     adding at the end the following new subparagraph:
       ``(E) Special rule for qualified items and services.--
       ``(i) In general.--An individual shall not be treated as 
     covered under a health plan for purposes of subparagraph 
     (A)(ii) merely because the individual, in connection with the 
     employment of the individual or the individual's spouse, 
     receives (or is eligible to receive) qualified items and 
     services at--

       ``(I) a healthcare facility located at a facility owned or 
     leased by the employer of the individual (or of the 
     individual's spouse), or operated primarily for the benefit 
     of such employer's employees, or
       ``(II) a healthcare facility located within a supermarket, 
     pharmacy, or similar retail establishment.

       ``(ii) Qualified items and services defined.--For purposes 
     of this subparagraph, the term `qualified items and services' 
     means the following:

       ``(I) Physical examinations.
       ``(II) Immunizations, including injections of antigens 
     provided by employees.
       ``(III) Drugs other than a prescribed drug (as such term is 
     defined in section 213(d)(3)).
       ``(IV) Treatment for injuries occurring in the course of 
     employment.
       ``(V) Drug testing, if required as a condition of 
     employment.
       ``(VI) Hearing or vision screenings.
       ``(VII) Other similar items and services that do not 
     provide significant benefits in the nature of medical care.

       ``(iii) Aggregation.--For purposes of clause (i)(I), all 
     persons treated as a single employer under subsection (b), 
     (c), (m), or (o) of section 414 shall be treated as a single 
     employer.''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to months beginning after December 31, 2018, in 
     taxable years ending after such date.

     SEC. 5. CONTRIBUTIONS PERMITTED IF SPOUSE HAS A HEALTH 
                   FLEXIBLE SPENDING ACCOUNT.

       (a) Contributions Permitted if Spouse Has a Health Flexible 
     Spending Account.--Section 223(c)(1)(B) of the Internal 
     Revenue Code of 1986 is amended by striking ``and'' at the 
     end of clause (ii), by striking the period at the end of 
     clause (iii) and inserting ``, and'', and by inserting after 
     clause (iii) the following new clause:
       ``(iv) coverage under a health flexible spending 
     arrangement of the spouse of the individual for any plan year 
     of such arrangement if the aggregate reimbursements under 
     such arrangement for such year do not exceed the aggregate 
     expenses which would be eligible for reimbursement under such 
     arrangement if such expenses were determined without regard 
     to any expenses paid or incurred with respect to such 
     individual.''.
       (b) Effective Date.--The amendment made by this section 
     shall apply to plan years beginning after December 31, 2018.

     SEC. 6. FSA AND HRA TERMINATIONS OR CONVERSIONS TO FUND HSAS.

       (a) In General.--Section 106(e)(2) of the Internal Revenue 
     Code of 1986 is amended to read as follows:
       ``(2) Qualified hsa distribution.--For purposes of this 
     subsection--
       ``(A) In general.--The term `qualified HSA distribution' 
     means, with respect to any employee, a distribution from a 
     health flexible spending arrangement or health reimbursement 
     arrangement of such employee directly to a health savings 
     account of such employee if--
       ``(i) such distribution is made in connection with such 
     employee establishing coverage under a high deductible health 
     plan (as defined in section 223(c)(2)) after a significant 
     period of not having such coverage, and
       ``(ii) such arrangement is described in section 
     223(c)(1)(B)(iii) with respect to the portion of the plan 
     year after such distribution is made.
       ``(B) Dollar limitation.--The aggregate amount of 
     distributions from health flexible spending arrangements and 
     health reimbursement arrangements of any employee which may 
     be treated as qualified HSA distributions in connection with 
     an establishment of coverage described in subparagraph (A)(i) 
     shall not exceed the dollar amount in effect under section 
     125(i)(1) (twice such amount in the case of coverage which is 
     described in section 223(b)(2)(B)).''.
       (b) Partial Reduction of Limitation on Deductible HSA 
     Contributions.--Section 223(b)(4) of such Code is amended by 
     striking ``and'' at the end of subparagraph (B), by striking 
     the period at the end of subparagraph (C) and inserting ``, 
     and'', and by inserting after subparagraph (C) the following 
     new subparagraph:
       ``(D) so much of any qualified HSA distribution (as defined 
     in section 106(e)(2)) made to a health savings account of 
     such individual during the taxable year as does not exceed 
     the aggregate increases in the balance of the arrangement 
     from which such distribution is made which occur during the 
     portion of the plan year which precedes such distribution 
     (other than any balance carried over to such plan year and 
     determined without regard to any decrease in such balance 
     during such portion of the plan year).''.
       (c) Conversion to HSA-compatible Arrangement for Remainder 
     of Plan Year.--Section 223(c)(1)(B)(iii) of such Code, as 
     amended by section 5(a), is amended to read as follows:
       ``(iii) coverage under a health flexible spending 
     arrangement or health reimbursement arrangement for the 
     portion of the plan year after a qualified HSA distribution 
     (as defined in section 106(e)(2) determined without regard to 
     subparagraph (A)(ii) thereof) is made, if the terms of such 
     arrangement which apply for such portion of the plan year are 
     such that, if such terms applied for the entire plan year, 
     then such arrangement would not be taken into account under 
     subparagraph (A)(ii) of this paragraph for such plan year, 
     and''.
       (d) Inclusion of Qualified HSA Distributions on W-2.--
       (1) In general.--Section 6051(a) of such Code, as amended 
     by section 3(d), is amended by striking ``and'' at the end of 
     paragraph (17), by striking the period at the end of 
     paragraph (18) and inserting ``, and'', and by inserting 
     after paragraph (18) the following new paragraph:
       ``(19) the amount of any qualified HSA distribution (as 
     defined in section 106(e)(2)) with respect to such 
     employee.''.
       (2) Conforming amendment.--Section 6051(a)(12) of such Code 
     is amended by inserting ``(other than any qualified HSA 
     distribution, as defined in section 106(e)(2))'' before the 
     comma at the end.
       (e) Effective Date.--The amendments made by this section 
     shall apply to distributions made after December 31, 2018, in 
     taxable years ending after such date.

     SEC. 7. INCLUSION OF CERTAIN OVER-THE-COUNTER MEDICAL 
                   PRODUCTS AS QUALIFIED MEDICAL EXPENSES.

       (a) HSAs.--Section 223(d)(2) of the Internal Revenue Code 
     of 1986 is amended--
       (1) by striking the last sentence of subparagraph (A) and 
     inserting the following: ``For purposes of this subparagraph, 
     amounts paid for menstrual care products shall be treated as 
     paid for medical care.'', and
       (2) by adding at the end the following new subparagraph:
       ``(D) Menstrual care product.--For purposes of this 
     paragraph, the term `menstrual care product' means a tampon, 
     pad, liner, cup, sponge, or similar product used by women 
     with respect to menstruation or other genital-tract 
     secretions.''.
       (b) Archer MSAs.--Section 220(d)(2)(A) of such Code is 
     amended by striking the last sentence and inserting the 
     following: ``For purposes of this subparagraph, amounts paid 
     for menstrual care products (as defined in section 
     223(d)(2)(D)) shall be treated as paid for medical care.''.
       (c) Health Flexible Spending Arrangements and Health 
     Reimbursement Arrangements.--Section 106 of such Code is 
     amended by striking subsection (f) and inserting the 
     following new subsection:
       ``(f) Reimbursements for Menstrual Care Products.--For 
     purposes of this section and section 105, expenses incurred 
     for menstrual care products (as defined in section 
     223(d)(2)(D)) shall be treated as incurred for medical 
     care.''.
       (d) Effective Dates.--
       (1) Distributions from health savings accounts.--The 
     amendments made by subsections (a) and (b) shall apply to 
     amounts paid after December 31, 2018.
       (2) Reimbursements.--The amendment made by subsection (c) 
     shall apply to expenses incurred after December 31, 2018.

     SEC. 8. CERTAIN AMOUNTS PAID FOR PHYSICAL ACTIVITY, FITNESS, 
                   AND EXERCISE TREATED AS AMOUNTS PAID FOR 
                   MEDICAL CARE.

       (a) In General.--Section 213(d)(1) of the Internal Revenue 
     Code of 1986 is amended by striking ``or'' at the end of 
     subparagraph (C), by striking the period at the end of 
     subparagraph (D) and inserting ``, or'', and by adding at the 
     end the following new subparagraph:
       ``(E) for qualified sports and fitness expenses.''.
       (b) Qualified Sports and Fitness Expenses.--Section 213(d) 
     of such Code is amended by adding at the end the following 
     paragraph:
       ``(12) Qualified sports and fitness expenses.--
       ``(A) In general.--The term `qualified sports and fitness 
     expenses' means amounts paid for--
       ``(i) membership at a fitness facility,
       ``(ii) participation or instruction in a program of 
     qualified physical activity, or
       ``(iii) safety equipment for use in a program (including a 
     self-directed program) of qualified physical activity.
       ``(B) Limitations.--
       ``(i) Overall dollar limitation.--The aggregate amount 
     treated as qualified sports and

[[Page H7653]]

     fitness expenses with respect to any taxpayer for any taxable 
     year shall not exceed $500 (twice such amount in the case of 
     a joint return or a head of household (as defined in section 
     2(b))).
       ``(ii) Dollar limitation on safety equipment.--The amount 
     treated as qualified sports and fitness expenses with respect 
     to any item of safety equipment described in subparagraph 
     (A)(iii) shall not exceed $250.
       ``(iii) Exclusion of exercise videos, etc.--Qualified 
     sports and fitness expenses shall not include videos, books, 
     or similar materials.
       ``(C) Qualified physical activity.--For purposes of this 
     paragraph--
       ``(i) In general.--Except as provided in clause (ii), the 
     term `qualified physical activity' means any physical 
     exercise or physical activity.
       ``(ii) Exclusions.--The Secretary, after consultation with 
     the Secretary of Health and Human Services, shall issue 
     guidance to determine for purposes of this paragraph what 
     does not constitute a qualified physical activity, including 
     golf, hunting, sailing, horseback riding, and other similar 
     activities.
       ``(D) Fitness facility defined.--For purposes of 
     subparagraph (A)(i), the term `fitness facility' means a 
     facility--
       ``(i) providing instruction in a program of qualified 
     physical activity or facilities for qualified physical 
     activity,
       ``(ii) which is not a private club owned and operated by 
     its members,
       ``(iii) whose health or fitness facility is not incidental 
     to its overall function and purpose, and
       ``(iv) which is fully compliant with applicable State and 
     Federal anti-discrimination laws.
       ``(E) Programs which include components other qualified 
     physical activity.--Rules similar to the rules of paragraph 
     (6) shall apply in the case of any program or facility that 
     includes qualified physical activity (or facilities 
     therefore) and also other components. For purposes of the 
     preceding sentence, travel and accommodations shall be 
     treated as an other component.
       ``(F) Inflation adjustment.--In the case of any taxable 
     year beginning in a calendar year after 2019, the $500 amount 
     in subparagraph (B)(i) and the $250 amount in subparagraph 
     (B)(ii) shall each be increased by an amount equal to--
       ``(i) such dollar amount, multiplied by
       ``(ii) the cost-of-living adjustment determined under 
     section 1(f)(3) for the calendar year in which such taxable 
     year begins, determined by substituting `calendar year 2018' 
     for `calendar year 2016' in subparagraph (A)(ii) thereof.

     If any increase determined under the preceding sentence is 
     not a multiple of $10, such increase shall be rounded to the 
     next lowest multiple of $10.''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2018.

  The SPEAKER pro tempore. The bill, as amended, shall be debatable for 
1 hour equally divided and controlled by the chair and ranking minority 
member of the Committee on Ways and Means.
  The gentlewoman from Kansas (Ms. Jenkins) and the gentleman from 
Oregon (Mr. Blumenauer) each will control 30 minutes.
  The Chair recognizes the gentlewoman from Kansas.


                             General Leave

  Ms. JENKINS of Kansas. Mr. Speaker, I ask unanimous consent that all 
Members may have 5 legislative days within which to revise and extend 
their remarks and include extraneous materials on the bill under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from Kansas?
  There was no objection.
  Ms. JENKINS of Kansas. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I am pleased to come to the floor today to speak in 
support of the Restoring Access to Medication and Modernizing Health 
Savings Account Act of 2018.
  This legislation makes a variety of simple but much-need changes to 
health savings accounts, or HSAs, rules to ensure that folks have more 
access and choice when using their HSAs.
  This bill contains five separate bipartisan pieces of legislation 
that passed the Ways and Means Committee earlier this month. It 
includes a bipartisan policy by Mr. Roskam and Mr. Thompson that would 
allow HSA-eligible plans to offer a certain amount of first-dollar 
coverage in their plan design without losing their HSA-eligibility. 
This allows HSA plans to offer coverage for valuable services like 
telehealth or primary care appointments without a deductible.
  The bill permits patients with HSAs to access the innovative and 
patient-centered direct primary care arrangements with HSA plans, 
provisions championed by the bipartisan team of Mr. Paulsen and Mr. 
Blumenauer.
  The bill also allows coverage for certain medical services from a 
retail or onsite clinic and permits contributions to an HSA if their 
spouse has a health FSA, which is prohibited today.
  Another commonsense provision in the bill allows rollovers from other 
tax-advantaged health accounts to be able to fund HSAs. These proposals 
were included in Mr. Kelly and Mr. Blumenauer's bipartisan legislation.
  Additionally, this bill contains the PHIT Act, introduced in a 
bipartisan manner by Mr. Jason Smith and Mr. Kind, that would allow 
certain qualified fitness expenses to be eligible items that can be 
paid for with tax-advantaged dollars, offsetting a portion of their 
costs and promoting healthy activity.
  Lastly, this legislation repeals the Affordable Care Act's 
unnecessary barriers when it comes to using tax-advantaged health 
accounts to purchase over-the-counter medicines, something that I have 
been pleased to work on with my good friend Congressman Kind for the 
last several years, and I am encouraged that the bipartisan duo of 
Representatives Meng and Paulsen have also joined us in introducing the 
underlying legislation.
  In addition to expanding access for over-the-counter medication, the 
bill also allows for feminine hygiene products to be considered a 
qualified medical expense.
  Since the passage of the Affordable Care Act, Americans have had to 
seek prescriptions in order to use their health savings and flexible 
spending accounts on safe and effective over-the-counter medicines. 
This legislation would end the need for those prescriptions.
  It doesn't make any sense to require the millions of American 
families that use HSAs and FSAs to manage their healthcare needs to go 
to the doctor in order to access over-the-counter medicines for things 
like basic pain management and cold and allergy symptoms.
  Nobody benefits from this nonsensical policy that requires consumers 
to jump through unnecessary hoops and increases the burdens on the 
healthcare system, all while providing no medical benefit. Over-the-
counter medicines are often the frontline treatment for many common 
illnesses and for maintenance of chronic diseases, and they should be 
treated as medically reimbursable healthcare therapies, just as 
prescription medications.
  Mr. Speaker, I am pleased the House is considering H.R. 6199, which 
gives individuals and families more control over their healthcare 
spending and increases their options when it comes to health savings 
accounts.
  Today marks a nice opportunity to pass bipartisan legislation to 
simply make it easier for consumers to meet their basic medical needs. 
These are commonsense, simple, bipartisan solutions, and I urge my 
colleagues to support this legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. BLUMENAUER. 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

[[Page H7654]]

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.

                              {time}  1600

  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.
  Ms. JENKINS of Kansas. Mr. Speaker, I yield 3 minutes to the 
gentleman from South Carolina (Mr. Rice), a distinguished member of the 
House Ways and Means Committee.
  Mr. RICE of South Carolina. Mr. Speaker, I am proud to stand before 
you today to discuss two bills that expand choice and offer lower cost. 
And lower cost and choice are what are needed in healthcare.
  Back home in South Carolina, the average premium before ObamaCare, in 
2013, in the individual market, was $233. In 2017--which the premiums 
were set before the President took office--before the ``assault'' on 
ObamaCare that my colleague was speaking of, the premium reached $512. 
That is a $279-per-month increase in 4 years, a 120 percent increase 
from 2013 to 2017.
  Before ObamaCare, 85 percent of the people in the country were 
covered by health insurance. At the peak, under the Affordable Care 
Act, 91 percent were covered. So we covered 6 percent more people, and 
that is a good thing. But what was the cost of that? To cover 6 percent 
more of our population, the other 85 percent, who were already covered, 
either by Medicare, Medicaid, or private insurance, had to pay another 
120 percent on their premiums in South Carolina, 105 percent 
nationwide. And the premiums are going to go up double digits again 
this year.
  We need lower cost, and we need choice. In South Carolina, all of the 
insurance companies have pulled out of the exchanges except for one. In 
fact, 40 percent of the counties in the country have only one choice 
for health insurance. That is no choice at all. It is either health 
insurance or nothing. You select from that one company, or you get 
nothing. We need lower cost, and we need choice.
  These bills today, by allowing more liberal contributions to health 
savings accounts, by allowing easier access to health savings accounts, 
by allowing health savings accounts to be used for more purposes--like 
private family care or for nonprescription drugs, over-the-counter 
drugs--they are serving the exact causes, the exact purposes, that I 
hear the most complaints about back home.
  My folks back home are saying: How can I afford these insurance 
policies? With the high deductibles that are being forced on us by 
these insurance companies, even if I have the insurance policy, I 
cannot afford to use it.
  Mr. Speaker, I am proud to stand before you today to recommend these 
bills.
  Mr. BLUMENAUER. 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. KIND. Mr. Speaker, I thank my friend and colleague from Oregon 
for yielding me this time. I agree with my colleague.

[[Page H7655]]

  Mr. Speaker, I rise in opposition to this legislation, not because of 
the policy initiatives underlying these bills, but because of how 
fiscally irresponsible it is being done.
  This week, out of the Ways and Means Committee, we have 10 bills to 
be debated and voted on on the House floor, at a total cost of roughly 
$90 billion. There was no effort made to try to find an offset or a 
pay-for in order to maintain some fiscal discipline in this place. That 
is problematic, because we keep digging the hole deeper.
  But my name is on a few of these bills. Yesterday we had the repeal 
of the medical device tax, legislation that I had authored with my 
friend from Minnesota, Erik Paulsen. But that came at a cost of $20 
billion. No offset. No pay-for. Just borrow more money from China and 
let future generations wrestle with it.
  But it made sense policy-wise to try to repeal that in a fiscally 
responsible manner, because we were taxing these manufacturers whether 
they were making a profit or not. In fact, the pre-revenue companies 
were getting hit by the same tax. Policy-wise, it didn't make a lot of 
sense.
  Today, I was happy to introduce legislation from our friend and 
colleague, Ms. Jenkins, on the Restoring Access to Medication Act. This 
will make it easier for patients to purchase over-the-counter medicine 
with their HSA and FSA account money without having to first run to 
their doctor to get a prescription. Just for the sake of efficiency and 
the cost savings, policy-wise, that makes sense; but the legislation 
comes with a cost, and there was no effort to pay for that.
  Also part of this package is legislation I have introduced with our 
colleague, Mr. Smith, called the Personal Health Investment Today Act, 
or the PHIT Act. This would allow HSA and FSA dollars to be used for 
physical exercise, for gym memberships, so that we are investing in the 
front end of wellness and keeping people healthy in their lives rather 
than the hundreds of billions of dollars we spend at the back end 
dealing with chronic disease management.
  Policy-wise that makes sense, but the legislation, again, comes with 
a cost. No attempt to pay for it. I think that is fiscally 
irresponsible.
  At the time when we worked on and passed the Affordable Care Act, 
President Obama had one major request, that all of it had to be paid 
for, all of it had to be offset. We worked hard to accomplish it, and, 
in fact, we did, and then some. We did not add one nickel to our budget 
deficit or to future budget debt forecasts because of how we dealt with 
that in a fiscally responsible manner.
  All we are asking is that our colleagues on the other side who are in 
charge now and running this place try to practice some semblance of 
that fiscal discipline that we showed with the passage of the 
Affordable Care Act.
  We ought to be working together, finding out what is working with the 
healthcare system and fixing what isn't.
  What is not working is the elimination of cost-sharing reduction 
payments that help health insurance providers spread the risk in the 
health insurance exchanges. That is one of the reasons why premiums are 
being driven up right now.

  What is not working is refusing to provide funding to the navigators, 
who help people make the choices with the health plans that they have 
available, or undercutting funding for any education outreach with 
patients, or the elimination of the individual responsibility component 
so that young and healthy people don't get to sit around and wait until 
they get sick or injured and then go out and acquire health insurance. 
That is not how insurance markets work.
  What also doesn't work is an administration that is trying to 
undermine the protections that are in place under the Affordable Care 
Act for people with preexisting conditions. There is a lawsuit pending 
right now. This administration should be defending that preexisting 
condition exclusion, and they are refusing to do so. That will 
implicate millions of lives throughout our country.
  There is a lot that we can and should be working on together to 
improve the healthcare system, to reduce healthcare costs for all 
Americans. This approach, this piecemeal approach, while policy-wise 
there is a lot of justification and explanation for what is happening, 
is being done in a very fiscally irresponsible manner, just piling on 
the debt.
  The SPEAKER pro tempore (Mr. Bost). The time of the gentleman has 
expired.
  Mr. BLUMENAUER. Mr. Speaker, I yield the gentleman from Wisconsin 1 
additional minute.
  Mr. KIND. Mr. Speaker, this comes, by the way, on the heels, in this 
session of Congress, of the passage of a major tax cut last year that 
will add over $2 trillion to our national debt over the next 10 years 
because, again, there was no attempt to pay for it. It comes on the 
heels of the passage of a 2-year budget that will increase spending by 
over half a trillion dollars, none of it paid for, none of it offset.
  Just yesterday, President Trump just announced a $12 billion subsidy 
bailout program for our family farmers because of the adverse effects 
that they are feeling due to his tariffs. And that is going to be 
borrowed money from China, again, to pay our farmers because they can't 
now sell their product--guess where--into the Chinese market.
  How crazy is this? I hope we are not in an era now where budget 
deficits and debt only matters when there is a Democrat in the White 
House. Over the last year and a half, that certainly seems to be the 
case in this Congress.
  Ms. JENKINS of Kansas. Mr. Speaker, I appreciate my friend's point of 
view on the other side of the aisle. Mr. Kind and I have worked really 
hard on this legislation for many years. I want to, for the Record, 
just remind folks that this bill is simply allowing people to keep more 
of their hard-earned money.
  Letting people keep their own money is not government spending that 
needs to be offset. Each of these bills contained in this package were 
authored with our Democratic colleagues without an offset. Each of 
these bills went through committee, with bipartisan support, without an 
offset. It is ironic that Democrats want to, all of a sudden, claim to 
be fiscally conservative.
  This is the same Democratic Party that passed the stimulus in 2009. 
Remember, that bill added nearly $800 billion to the deficit.
  Mr. Speaker, I yield 3 minutes to the gentleman from Pennsylvania 
(Mr. Kelly), a real leader on these issues on the House Committee on 
Ways and Means.
  Mr. KELLY of Pennsylvania. Mr. Speaker, I thank the gentlewoman for 
including my bill, H.R. 6305, the Bipartisan HSA Improvement Act of 
2018, in H.R. 6199, the Restoring Access to Medication and Modernizing 
Health Savings Accounts Act.

                              {time}  1615

  This important legislation expands access to and enhances the utility 
of health savings accounts, also known as HSAs.
  My legislation gives employers more flexibility to offer quality 
healthcare in the setting that is best for them, like onsite or retail 
clinics. Employers around the country are offering innovative ways to 
deliver healthcare to their associates, and this provision makes sure 
that individual health savings accounts can utilize these same 
services.
  It also fixes the spouse penalty by allowing individuals to make 
health savings account contributions if a spouse has a flexible 
spending account, while preventing double-dipping in tax benefits.
  Lastly, it makes it easier for people to save for their healthcare by 
streamlining the conversion of other tax-preferred accounts to health 
savings accounts.
  Ultimately, this bill modernizes healthcare delivery and gives 
employers the freedom to innovate and improve their employees' health.
  I am also very pleased to see that the PHIT Act was included in this 
package. I strongly support adding more of an emphasis on exercise and 
wellness to build a healthy American population.
  We spend an incredible amount of money on healthcare but very little 
on maintenance, like exercise and wellness, before we get sick. The 
PHIT Act will better incentivize healthy lifestyles.
  Mr. Speaker, we are trying to improve healthcare for all Americans.

[[Page H7656]]

This means giving consumers a choice in their healthcare by 
incentivizing wellness and exercise. This is a preemptive effort to 
build a healthier, stronger America and the freedom to design insurance 
products that work best for them.
  If you want to keep healthcare costs down, let's just make sure 
people are healthier. That is the best way to do it.
  And do you know what? I really like this debate because we talk about 
how the deficit has grown. And for my colleagues on the other side, I 
wasn't here at the time, but I watched the deficit grow in the 
beginning of the Obama administration from $9 trillion to $20 trillion, 
and I am glad that, finally, somebody has awakened to the fact that we 
are working with huge deficits.
  Now, this bill was passed by the Ways and Means Committee in a 
bipartisan fashion, and I want to thank my friend Earl Blumenauer for 
working on this issue.
  This issue is extremely important for the 175 million Americans who 
get their health insurance from their employer. I strongly urge my 
colleagues on both sides of the aisle to vote in favor of H.R. 6199.
  Mr. BLUMENAUER. 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. DANNY K. DAVIS of Illinois. Mr. Speaker, I thank my colleague who 
demonstrates with regularity the intensification of real care for the 
people.
  Today, we take up another bill that does nothing to make up for the 
long-term Republican sabotage of the Affordable Care Act. Tens of 
millions of working families also see their healthcare costs skyrocket 
due to the repeated Republican efforts to undermine the healthcare 
system.
  Tens of millions of Americans with preexisting conditions will still 
fear the loss of guaranteed health protections with the horrible choice 
of loss of health insurance or untenable premiums.
  The Republicans' sabotage will cost a typical family of four in my 
congressional district $2,250 more in insurance premiums in 2019. The 
Republicans' sabotage will cost a typical 55-year-old couple in my 
congressional district $3,570 more in 2019.
  The 2019 premium hikes follow an average 37 percent increase in 2018. 
These premium hikes are especially disturbing when contrasted with the 
billions in tax cuts the Republicans gave to insurance companies in 
their tax law.
  H.R. 6199 makes a small change to health savings accounts used 
exclusively by the wealthy. Many of my constituents have trouble paying 
for basic living costs like heat, food, and housing. They ask me 
regularly for a few hundred dollars to help their kids stay in college.
  The vast majority of my constituents can't set aside tens of 
thousands of dollars to pay for their medical care out of pocket in a 
health savings account. This legislation does nothing to increase 
coverage, improve affordability, or change the skyrocketing costs of 
healthcare.
  I urge my colleagues to reject this bill, and I urge my Republican 
colleagues to bring up meaningful legislation to improve coverage and 
lower costs to help the tens of millions of Americans in need.
  Ms. JENKINS of Kansas. Mr. Speaker, I yield 3 minutes to the 
gentleman from Kansas (Mr. Estes), my friend and colleague.
  Mr. ESTES of Kansas. Mr. Speaker, I rise to speak in support of two 
bills being considered today as part of our overall goal to improve 
healthcare for families across the country.
  Currently, ObamaCare is broken. As I mentioned in an opinion piece, 
from 2010 to 2016, health insurance premiums increased by nearly $4,400 
per family.
  This year, health insurance costs rose about 30 percent and are 
expected to go up an additional 10 to 20 percent in 2019.
  These skyrocketing costs are not due to some sabotage, as some folks 
have suggested. Instead, they are a product of a system that was 
designed and destined to fail.
  Today, we all recognize that ObamaCare has failed to provide 
insurance for all Americans. Rather than create more government-run 
healthcare, we need competition and free market solutions like health 
savings accounts to put patients in control of their own healthcare. 
That is why I am proud to support H.R. 6199, the Restoring Access to 
Medication Act of 2018, sponsored by Representative Lynn Jenkins and 
Representative Grace Meng.
  H.R. 6199 repeals provisions of the Affordable Care Act that restrict 
health savings accounts, medical savings accounts, health flexible 
spending arrangements, and health reimbursement arrangements to only be 
used for prescription drugs or insulin. Removing these restrictions 
will allow people to use such accounts for over-the-counter drugs.
  I am also proud to support H.R. 6311, the Increasing Access to Lower 
Premium Plans and Expanding Health Savings Accounts Act of 2018, 
sponsored by Representatives Peter Roskam and  Michael Burgess.
  H.R. 6311 provides relief from ObamaCare's rising premiums and 
limited choices by allowing the premium tax credit to be used for plans 
offered outside of ObamaCare exchanges. The bill also expands access to 
the lowest premium plans for people purchasing coverage in the 
individual market and allows the premium tax credit to be used to 
offset the cost of such plans. These measures increase competition for 
consumers and seek to drive down the cost of health insurance.
  I want to thank the Ways and Means Committee for bringing forward 
thoughtful healthcare solutions that will help American families. I 
urge my colleagues to support both bills.
  Mr. BLUMENAUER. 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.
  Ms. JENKINS of Kansas. Mr. Speaker, I yield 2 minutes to the 
gentleman from Illinois (Mr. Roskam), who has provided great leadership 
in this area.
  Mr. ROSKAM. Mr. Speaker, I am pleased to see the inclusion of the 
Promoting High-Value Health Care Through Flexibility for Deductible 
Health Plans in this bill today. This is legislation that is bipartisan 
that I introduced, along with the Congressman from California (Mr. 
Thompson), that gives consumers the choice and flexibility that they 
need to be engaged in their healthcare.
  In a nutshell, the bill allows plans to offer coverage for high-
value, low-cost services like telehealth, chronic disease management 
such as diabetic testing strips, or primary care visits below the 
deductible. In a nutshell, what we are trying to do is give patients 
more choices, more capacity to be more demonstrative about navigating 
through their own healthcare needs.
  This is a good bipartisan approach. I thank the gentlewoman for 
including it, and I thank her for the time. I urge its passage.

[[Page H7657]]

  

  Mr. BLUMENAUER. Mr. Speaker, I reserve the balance of my time.
  Ms. JENKINS of Kansas. Mr. Speaker, I yield 2 minutes to the 
gentleman from Minnesota (Mr. Paulsen), who has worked tirelessly in 
this area.
  Mr. PAULSEN. Mr. Speaker, I thank the chairwoman for yielding.
  Mr. Speaker, as an advocate for giving consumers more choice in 
healthcare and lowering costs, I support this bill, which also gives 
more flexibility for those who have healthcare savings accounts, as 
well as some of the other provisions that were already just previously 
mentioned.
  I want to highlight my support for one of the provisions in this bill 
that will allow people to use their healthcare savings account to pay 
for direct primary care and those arrangements.
  The concept of direct primary care is simple, and it is supported by 
a lot of family doctors, a lot of primary care doctors. People pay a 
monthly fee to see their physician in this area anytime they choose, 
over the phone, through telemedicine, or in person, and then they get a 
whole host of services. It is really important for strengthening the 
doctor-patient relationship, and it means that more people will have 
access to primary care services instead of just going to the emergency 
room in order to get care.
  But, unfortunately, the IRS has stated that direct primary care 
arrangements are essentially health insurance, and they categorize them 
in this way so you cannot use your HSAs and those funds to pay for 
direct primary care. That is why Congressman Blumenauer and I authored 
legislation to fix this and to allow HSAs, health savings accounts, to 
be used for direct primary care, and I am pleased that it is included 
in this bill.
  Another important reform will allow employers to offer direct primary 
care arrangements to employees that have an HSA, also. This will let 
more people have access to direct primary care through their healthcare 
savings accounts, allowing family practice doctors like Dr. Julie 
Anderson in Minnesota to expand their practice without having to worry 
about the headache of filling out mountains of paperwork and excessive 
insurance forms, because direct primary care let's the doctor work 
directly with the patient and you don't have to go through extensive 
billing services and insurance.
  Healthcare savings accounts, Mr. Speaker, have already been proven to 
help lower healthcare costs; and expanding them, giving consumers more 
flexibility and more choices, will mean families are also going to be 
better off.
  So let's allow healthcare savings accounts to be used for direct 
primary care and support the underlying bill.
  Mr. BLUMENAUER. 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.

                              {time}  1630

  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.
  Ms. JENKINS of Kansas. Mr. Speaker, I yield myself the remainder of 
my time.
  Mr. Speaker, we have heard my friends on the other side of the aisle 
suggest here, this afternoon, this bill might, in some way, hurt people 
with preexisting conditions. However, we know that is simply not true. 
This bill doesn't touch preexisting conditions. It doesn't raise costs 
or premiums on families. And it doesn't take away anyone's choice of a 
healthcare plan.
  Millions of Americans use tax-advantage healthcare accounts to save 
and pay for healthcare expenses. In fact, there are twice as many 
Americans with an HSA than those who get coverage on the Affordable 
Care Act's exchanges. Almost 22 million people had an HSA in 2017, and 
there is only about 10 million people enrolled on the exchanges in 
2018. Forty-four percent of all civilian workers had access to a health 
flexible spending arrangement in 2017.
  The provisions in this bill allow more things to be paid for out of 
these accounts, like over-the-counter drugs, feminine products, and 
fitness activities. This means people are paying less because they are 
able to use pre-tax dollars or take a deduction for their contribution.
  As a reminder, the policies in the bill are all bipartisan. We have 
worked together to write and advance them.
  This bill helps middle class families afford their healthcare 
expenses, and I hope my colleagues will continue to support this 
legislation.
  Mr. Speaker, I yield back the balance of my time
  The SPEAKER pro tempore. All time for debate has expired.
  Pursuant to House Resolution 1012, the previous question is ordered 
on the bill, as amended.

[[Page H7658]]

  The question is on the engrossment and third reading of the bill.
  The bill was ordered to be engrossed and read a third time, and was 
read the third time.
  The SPEAKER pro tempore. The question is on the passage of the bill.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Mr. BLUMENAUER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________