May 9, 2019 - Issue: Vol. 165, No. 77 — Daily Edition116th Congress (2019 - 2020) - 1st Session

[Pages H3519-H3550]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




      PROTECTING AMERICANS WITH PREEXISTING CONDITIONS ACT OF 2019


                             General Leave

  Mr. PALLONE. Madam Speaker, I ask unanimous consent that all Members 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on H.R. 986, the Protecting Americans with 
Preexisting Conditions Act of 2019.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to House Resolution 357 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the state of the Union for the consideration of the bill, H.R. 986.
  The Chair appoints the gentleman from Illinois (Mr. Garcia) to 
preside over the Committee of the Whole.

                              {time}  1407


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the state of the Union for the consideration of the bill 
(H.R. 986) to provide that certain guidance related to waivers for 
State innovation under the Patient Protection and Affordable Care Act 
shall have no force or effect, with Mr. Garcia of Illinois in the 
chair.
  The Clerk read the title of the bill.
  The CHAIR. Pursuant to the rule, the bill is considered read the 
first time.
  General debate shall be confined to the bill and shall not exceed 1 
hour equally divided and controlled by the chair and ranking minority 
member of the Committee on Energy and Commerce.
  The gentleman from New Jersey (Mr. Pallone) and the gentleman from 
Oregon (Mr. Walden) each will control 30 minutes.
  The Chair recognizes the gentleman from New Jersey.
  Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, I rise to speak in favor of H.R. 986, the Protecting 
Americans With Preexisting Conditions Act, introduced by Representative 
Kuster from our committee.
  This legislation should not be necessary but, unfortunately, the 
Trump

[[Page H3520]]

administration continues to take actions that undermine the healthcare 
of millions of Americans, including the more than 133 million people 
with preexisting conditions.
  Today, we are here because of the Trump administration's proposed 
guidance last October that would allow States to expand and prop up 
short-term junk insurance plans, even providing taxpayer subsidies for 
those plans. In order to take this action, the administration blatantly 
ignored the plain text of the Affordable Care Act and gutted standards 
that States must meet in order to test insurance reforms.
  I believe the administration's action is illegal, but, sadly, this 
administration has never let the law get in the way of its goals. These 
efforts will, without a doubt, seriously undermine the health coverage 
of Americans with preexisting conditions.
  A coalition of 24 national groups representing millions of Americans 
with preexisting conditions, including the American Cancer Society 
Cancer Action Network, the American Heart Association, and the American 
Diabetes Association, wrote a letter in strong support of H.R. 986, 
stating: ``The 1332 guidance substantially erodes the guardrails 
governing coverage that people with preexisting conditions such as 
cystic fibrosis, lung disease, cancer, cardiovascular disease, 
diabetes, rare disorders, pregnant women, and many others rely on in 
the individual marketplace.''
  The patient organizations go on to say that ``these changes 
fundamentally alter the nature of the section 1332 waiver program and 
jeopardize adequate, affordable coverage for people with preexisting 
conditions in the individual market. Halting the implementation of this 
guidance will protect people with preexisting conditions.''
  Mr. Chairman, by encouraging States to promote and expand short-term 
insurance plans, the administration is giving insurers the green light 
to directly discriminate against people with preexisting conditions; it 
is giving the green light to these plans to charge people with 
preexisting conditions more money; and it is giving these plans the 
green light to refuse to cover any treatment that is related to 
someone's preexisting condition.
  The expansion of these junk plans will also undermine the insurance 
market, leading to higher premiums for people with preexisting 
conditions who need comprehensive coverage. This is not the way you 
protect people with preexisting conditions.
  The Trump administration's guidance also undermines the ACA's promise 
of coverage of essential health benefits. The American people should 
not have to worry about whether their insurance plan covers 
prescription drugs, maternity and newborn care, mental health 
and substance use disorder services.

  This guidance is also bad news for older Americans who could be 
charged a lot more for their insurance than what is allowed by the ACA.
  In a nutshell, Mr. Chairman, this guidance is bad news for any 
American who wants access to quality and affordable health coverage 
that is there for them when they need it. Junk plans are just that--
they are junk.
  People shouldn't have to read the fine print to see what is and is 
not covered, and that is the hallmark of the Affordable Care Act. So 
that is why we must rescind the guidance.
  I want to commend my colleague, Ms. Kuster, for her great work on 
this important bill.
  I do want to emphasize that H.R. 986 would not do anything to 
interfere with existing 1332 reinsurance waivers, which have bipartisan 
support and began under the Obama administration. My Republican 
colleagues continue to intentionally conflate these reinsurance waivers 
with the Trump administration's new 1332 waiver guidance from October 
of last year. H.R. 986 does not affect these reinsurance waivers.
  I am disappointed that my Republican colleagues continue to make 
these arguments, but the bad faith is not surprising, given their 
terrible record on protecting people with preexisting conditions.
  Mr. Chairman, this bill is necessary because of the ongoing assault 
by the Trump administration on our healthcare system. I urge my 
colleagues to join me in standing up for people with preexisting 
conditions and standing up for people who want access to affordable and 
quality healthcare.
  Mr. Chairman, I reserve the balance of my time.

                                         House of Representatives,


                                  Committee on Ways and Means,

                                      Washington, DC, May 8, 2019.
     Hon. Frank Pallone,
     Chairman, Committee on Energy and Commerce,
     Washington, DC.
       Dear Chairman Pallone: I am writing with respect to H.R. 
     986, Protecting Americans with Preexisting Conditions Act of 
     2019. As a result of you having consulted with us on 
     provisions that fall within our rule X jurisdiction, and in 
     recognition of the desire to expedite consideration of the 
     measure, the Committee on Ways and Means agrees to waive 
     formal consideration of H.R. 986.
       The Committee on Ways and Means takes this action with the 
     mutual understanding that we do not waive any jurisdiction 
     over the subject matter contained in this or similar 
     legislation, and the Committee will be appropriately 
     consulted and involved as the bill or similar legislation 
     moves forward so that we may address any remaining issues 
     within our jurisdiction. The Committee also reserves the 
     right to seek appointment of an appropriate number of 
     conferees to any House-Senate conference involving this or 
     similar legislation.
       Finally, I would appreciate your response to this letter 
     confirming this understanding, and would ask that a copy of 
     our exchange of letter on this matter be included in the 
     Congressional Record during floor consideration of H.R. 986.
           Sincerely,
                                                  Richard E. Neal,
     Chairman.
                                  ____

                                         House of Representatives,


                             Committee on Energy and Commerce,

                                      Washington, DC, May 9, 2019.
     Hon. Richard E. Neal,
     Chairman, Committee on Ways and Means,
     House of Representatives, Washington, DC.
       Dear Chairman Neal: Thank you for consulting with the 
     Committee on Energy and Commerce and agreeing to discharge 
     H.R. 986, Protecting Americans with Preexisting Conditions 
     Act of 2019 from further consideration, so that the bill may 
     proceed expeditiously to the House floor.
       I agree that your forgoing further action on this measure 
     does not in any way diminish or alter the jurisdiction of 
     your committee or prejudice its jurisdictional prerogatives 
     on this measure or similar legislation in the future. I would 
     support your effort to seek appointment of an appropriate 
     number of conferees from your committee to any House-Senate 
     conference on this legislation.
       I will ensure our letters on H.R. 986 are entered into the 
     Congressional Record during floor consideration of the bill. 
     I appreciate your cooperation regarding this legislation and 
     look forward to continuing to work together as this measure 
     moves through the legislative process.
           Sincerely,
                                               Frank Pallone, Jr.,
                                                         Chairman.

  Mr. WALDEN. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, I rise today to call out the mischaracterization of 
H.R. 986. The misleading title of this bill confirms the Democratic 
majority's position to score political points instead of governing. 
They claim their agenda is ``for the people.'' Well, this bill is ``for 
the politics.''
  So let me be clear. This bill has nothing to do with protecting 
Americans with preexisting conditions. This bill has everything to do 
with eliminating healthcare options that would be affordable for 
Americans who can't afford health insurance today and choices for 
States.
  Section 1332 waivers were first enacted under ObamaCare to provide 
States the opportunity to innovate and to provide their residents with 
affordable health insurance options. The Trump administration has 
simply updated the guidance for these 1332 ObamaCare waivers to make it 
easier for a State's plan to be approved.
  This guidance does not--I repeat, does not--permit the Secretary to 
waive preexisting condition protections.
  But, don't take my word for it alone. CMS Administrator Seema Verma 
confirmed it yesterday, in writing. ``To be very clear, the 2018 
guidance does nothing to erode PPACA's preexisting condition 
provisions, which cannot be waived under section 1332,'' wrote 
Administrator Verma.

                              {time}  1415

  She went on to explain: ``Section 1332 does not permit States to 
waive Public Health Service Act requirements such as guaranteed 
availability and renewability of health insurance, the prohibition on 
using health status to vary premiums, and the prohibition on 
preexisting conditions exclusions. Furthermore, a section 1332 waiver 
cannot

[[Page H3521]]

be approved that might otherwise undermine these requirements. This 
administration stands committed to protecting people with preexisting 
conditions.'' Seema Verma, she is the Administrator.
  It is not just Administrator Verma. I want to quote from the Trump 
administration statement of policy. ``If H.R. 986 were presented to the 
President, his advisers would recommend that he veto it,'' wrote the 
Trump administration in its ``Statement of Administration Policy.''
  It goes on to say: ``The President has repeatedly made clear that 
this administration will protect people with preexisting conditions. 
The 2018 guidance in no way alters the guardrails in place for those 
with preexisting conditions, and it would not allow the administration 
to waive the requirements in place around preexisting conditions. The 
title of this legislation gives the misleading impression that it will 
enhance healthcare protections for Americans with preexisting 
conditions.''
  Put simply, Mr. Chair, this cynically titled messaging bill is all 
about scoring political points and not legislating, which is what we 
should be doing.
  You see, if Democratic Members actually cared about protecting 
individuals living with preexisting conditions, they would govern and 
lock in these important safeguards. Since Democratic leaders chose to 
put politics first, I offered an amendment to protect patients with 
preexisting conditions, to lock that into law.
  Mr. Chair, this amendment wasn't presented to the House for a vote. 
In fact, it was never allowed out of the Rules Committee. That is a 
shame because we could be voting on it today. I have tried to bring 
that vote to the floor on numerous occasions, and I have been denied by 
the Democratic majority.
  My bill is simple. It provides guaranteed issue and renewability, a 
ban on health status underwriting, and a ban on benefits exclusions, 
real preexisting condition protections Democratic Members say they 
support.
  Guess what? It is titled the ``Pre-existing Conditions Protection 
Act.'' How ironic, except my bill does what the title says.
  Let's vote on that bill, Mr. Chair.
  Here is what it comes down to. The status quo is not working for many 
Americans. Healthcare costs are out of control. Patients and families 
are struggling to pay ever-increasing premiums, deductibles, and out-
of-pocket costs.
  There is work that we are doing. I just came from a meeting with the 
President of the United States in the Roosevelt Room talking about 
surprise billing. We are going to work together, Mr. Pallone and I and 
others, to draft legislation to prevent that, to protect consumers.
  We could do more here today than what this bill alleges to do. 
Republicans want to work toward healthcare solutions that will decrease 
costs, increase access, protect individuals with preexisting 
conditions, make the healthcare system work better for families and for 
patients, and actually be affordable.
  We want to let our States innovate. These section 1332 waivers--
originally, again, put forward under President Obama--known as State 
innovation waivers, they are working, Mr. Chair. Premiums have gone 
down in seven States by an average of 20 percent, down 20 percent.
  In my home State of Oregon, we have been a real innovator for decades 
in the space of healthcare coverage and access and trying to get prices 
down. Our premiums, under this 1332 waiver that Oregon has, have gone 
down 6 percent in 2018, down 6 percent thanks to a State innovation 
waiver.
  These waivers could work. States want to innovate. They care about 
their people and want to bring down costs. Instead of allowing more and 
more States to innovate and lower their healthcare costs, 
unfortunately, Democrats are of the mindset that Washington knows best, 
not our States. States can't be trusted, apparently. They want to limit 
the ability of States to innovate on behalf of their citizens.
  This type of top-down, command-and-control, government-knows-best 
approach is what leads to policies like the Democrats' ultimate goal of 
a one-size-fits-all government takeover of healthcare.
  A vote in support of their bill is a vote against innovation, 
lowering costs, my colleagues' constituents, State legislatures, 
Governors, State insurance commissioners, on and on and on. That is 
what my colleagues are doing if they vote for this.
  A vote against the bill is actually a vote for the people.
  Mr. Chair, I encourage my colleagues to oppose this partisan gimmick, 
and I reserve the balance of my time.
  Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman 
from New Hampshire (Ms. Kuster), the sponsor of the bill.
  Ms. KUSTER of New Hampshire. Mr. Chair, I thank Chairman Pallone for 
yielding, and I thank him for his guidance and leadership on the Energy 
and Commerce Committee as we advanced critical legislation this week to 
stabilize the Affordable Care Act and drive down prescription drug 
costs for all Americans.
  Mr. Chair, I rise today in support of my legislation, H.R. 986, the 
Protecting Americans With Preexisting Conditions Act.
  As a patient with a preexisting condition myself, I rise today to 
stand with over 52 million Americans and over 200,000 Granite Staters 
who live with preexisting conditions every single day. They could have 
been denied access to healthcare prior to passage of the Affordable 
Care Act, and many were.
  While we recognize that we need to strengthen and stabilize the ACA, 
we should equally accept the principle that nobody should be denied 
coverage because of a preexisting condition.

  When you think about it, asthma, allergies, Alzheimer's, cancer, 
diabetes, just go right through the alphabet, having a child, even, any 
of these are preexisting conditions. In my home State of New Hampshire 
and across this country, opioid and alcohol addiction are preexisting 
conditions.
  Every week, and again here today, we have heard Republicans on the 
House Energy and Commerce Committee say, ``Oh, of course we want to 
protect Americans with preexisting conditions.'' Yet, at every step, 
this administration is trying to sabotage the consumer protection 
guardrails that are in the ACA, including fighting in court for the 
total elimination of the Affordable Care Act with absolutely no 
replacement.
  The CHAIR. The time of the gentlewoman has expired.
  Mr. PALLONE. Mr. Chair, I yield the gentlewoman an additional 30 
seconds.
  Ms. KUSTER of New Hampshire. Mr. Chair, an important piece of the 
Affordable Care Act, section 1332, created the State innovation 
waivers, which provide States with flexibility in implementing the ACA 
as long as plans remain comprehensive, affordable, and accessible. 
However, the Trump administration recently issued guidance encouraging 
States to promote junk health plans through these waivers in order to 
circumvent essential health benefits and protections for preexisting 
conditions.
  Mr. Chair, I urge my colleagues to vote ``yes'' on this bill.
  Mr. WALDEN. Mr. Chair, I yield 2 minutes to the gentleman from 
Michigan (Mr. Walberg), a very important member of our Energy and 
Commerce Committee.
  Mr. WALBERG. Mr. Chair, I thank the lead Republican for yielding.
  Mr. Chair, I rise today in opposition to H.R. 986. I would give its 
titled name, but it is yet another misleading effort that has nothing 
to do with the title of the bill.
  House Republicans fully support protections--and I will make it 
clear--for patients with preexisting conditions.
  I know that my Democratic colleagues and friends want to continue 
using the mantra that works so well politically without fact, truth, or 
reality during the election. We have gone beyond that now.
  Republicans support protections for patients with preexisting 
conditions. These patients deserve peace of mind and safeguards from 
being treated unfairly. That has always been a priority of ours, and it 
will continue to be, but that is not what the bill before us today 
would do.
  H.R. 986 can be summed up in 3 words: Washington knows best. The bill 
eliminates flexibility at the State level, taking away options for 
States

[[Page H3522]]

to innovate and bring down healthcare premiums.
  The high and rising cost of healthcare is a significant concern for 
patients and families in my district. We need to focus on solutions, 
not politics. We need to focus on solutions to provide relief from 
increasing costs, encourage choice and competition, expand access to 
quality care, and maintain--and I will make it very clear here again--
important protections for patients with preexisting conditions.
  We have the ideas to do that. We have the amendments that would put 
that forward and make this bill something important to people with 
preexisting conditions, but that is not being allowed today.
  Let's stop playing political games with a bill title and a title like 
this and, instead, focus on patient-centered solutions.
  Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman 
from Colorado (Ms. DeGette), who chairs our Oversight and 
Investigations Subcommittee.
  Ms. DeGETTE. Mr. Chair, I thank Chairman Pallone for yielding.
  Mr. Chair, I rise in strong support of the Protecting Americans with 
Preexisting Conditions Act.
  Frankly, if my colleagues on the other side of the aisle were so firm 
in their commitment to protecting Americans with preexisting 
conditions, they would support this bill, because all it says is that 
section 1332 will not stop the protections that we have under current 
law.
  The Trump administration guidance that allows States to undermine the 
preexisting condition provisions of the ACA is, frankly, in clear 
violation of congressional intent.
  Let's be clear about something. When we say we are going to protect 
people with preexisting conditions, we actually mean it. That is 
exactly what this legislation does.
  I would welcome support from my friends on the other side of the 
aisle.
  According to the Kaiser Family Foundation, over 750,000 people just 
in my little State of Colorado would be at risk of losing their 
healthcare coverage if it wasn't for the protections of the ACA.
  The administration's repeated attempts to take these protections away 
from people and deny them their right to obtain healthcare coverage is 
the difference for many of them between life and death.
  We are not going to let this happen. This Congress is going to make 
sure that the goals of the ACA to give full healthcare coverage to 
every American, including people with preexisting conditions, is going 
to be preserved. We have come too far to turn back the clock now.
  Mr. Chair, I am glad that we have this bill on the floor now. I thank 
my colleague, Ms. Kuster, for sponsoring it, and I urge every Member of 
this body to support it.
  Mr. WALDEN. Mr. Chairman, I yield 2 minutes to the gentleman from 
Georgia (Mr. Carter), our pharmacist on the Energy and Commerce 
Committee.
  Mr. CARTER of Georgia. Mr. Chair, I thank the gentleman for yielding.
  Mr. Chair, I rise today in opposition to the so-called Protecting 
Americans with Preexisting Conditions Act.
  Mr. Chair, this is a misnomer. A misnomer is defined as a wrong or 
inaccurate name or designation. That is what the title of this bill is. 
It is wrong.
  I join my colleagues on the Republican side in supporting protections 
for people with preexisting conditions. In fact, it was one of the 
first votes in Congress that we took this year, and it was defeated by 
my colleagues across the aisle.
  This bill, which is ironically, as I say, misnamed because it doesn't 
protect preexisting conditions, would take steps to roll back State 
efforts to innovate and lower premiums for Americans across the 
country.
  One issue I often hear about from my constituents is the cost of 
healthcare coverage and the lack of options available under ObamaCare. 
These waivers would allow for new strategies to address the high 
premiums that so many people are facing.
  In fact, of the States that created their own reinsurance programs, 
they saw, on average, a nearly 20 percent drop in premiums, one State 
seeing a drop as high as 43.4 percent.
  As States continue to grapple with high insurance costs, they have 
looked to these innovative waivers for opportunities to bring about new 
ideas that help people, not remove options and opportunities.
  We all know that there is an issue with affordability of insurance in 
many areas. It should be known that this isn't as though it is just 
more conservative States moving forward with these reinsurance 
programs. States like New Jersey, where the chairman is from, and 
Minnesota and Maryland have seen the benefits of this.
  Mr. Chair, that is why I urge my colleagues to give States the 
flexibility they need to reduce premiums and to vote ``no'' on this 
legislation.
  Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman 
from Illinois (Ms. Schakowsky), who chairs our Consumer Protection and 
Commerce Subcommittee.

                              {time}  1430

  Ms. SCHAKOWSKY. Mr. Chairman, I believe that my colleagues on the 
other side of the aisle are standing up and saying what they would like 
to see, and that is to protect people with preexisting conditions. The 
problem with what they are telling the American people is that what 
they are proposing does not protect people with preexisting conditions.
  I know when I first came to Congress as a woman, being a woman was a 
preexisting condition. There were a lot of things that weren't covered 
because we are women, until we passed the Affordable Care Act.
  While the Republicans are talking about protecting such people, they 
are supporting a lawsuit, right now, that, once again, would undo all 
of the Affordable Care Act, sweeping out with them protections for 
preexisting conditions.
  But the other key word to listen to is flexibility. They are talking 
about allowing up to 4 years of policies that States could enact that 
do not cover the whole panoply of things that the Affordable Care Act 
covers and could exclude even protection for preexisting conditions. 
That is not flexibility. That is taking away benefits from people.
  You can sign up for one of these, what we call, junk policies and you 
are perfectly well, and then all of a sudden you have some kind of an 
illness that, guess what, is not covered, and won't be covered, because 
then you will have a preexisting condition.
  The legislation Democrats have for you today would protect 
preexisting conditions, no questions, period, end of story.
  Mr. WALDEN. Mr. Chairman, I yield 2 minutes to the gentleman from 
Texas (Mr. Arrington) to speak on this matter.
  Mr. ARRINGTON. Mr. Chairman, I rise to shed light on a very deceptive 
practice and the reason the American people refer to politics in 
Washington as ``the swamp.'' That is giving bills names that, not only 
have nothing to do with the legislation, but actually mislead the 
American people to believe it is something that it is not.
  This Democrat bill being considered today, entitled the Protecting 
Americans with Preexisting Conditions Act, has absolutely nothing to do 
with preexisting conditions and protecting people with preexisting 
conditions.
  This bill actually prevents a policy that allows States to have the 
freedom and flexibility to provide for their citizens' healthcare 
needs. Where they have exercised that flexibility, we have seen an 
average of 20 percent in the reduction of healthcare costs.
  There are laws on the books, Mr. Chairman, passed by Democrats and 
Republicans alike, that prevent and punish people and companies who 
participate in such false advertising. In fact, there is a good reason 
the FTC has strong truth in advertising laws and strictly enforces them 
against misleading and deceptive practices, because it hurts people, it 
hurts consumers, and it actually, in this case, compromises the 
American people's trust.
  Mr. Chairman, the American people are sick and tired of political 
games, they are tired of politicians and their duplicity, and they are 
tired of their elected representatives deceiving them. That is what 
this is.
  Mr. Chairman, I encourage my colleagues to not vote for this bill 
that takes the American people as fools and

[[Page H3523]]

preys on their fears, and I encourage both sides to stand in opposition 
of this bill.
  Mr. PALLONE. Mr. Chairman, I yield 1 minute to the gentleman from 
Maryland (Mr. Hoyer), our majority leader.
  Mr. HOYER. Mr. Chairman, I thank the chairman, Mr. Pallone, for the 
extraordinary leadership he has shown on this issue and so many others, 
and for his being an original drafter and sponsor of the Affordable 
Care Act.
  Sitting here, I was listening to speaker after speaker after speaker 
tell me that this doesn't protect preexisting conditions. Of course, it 
does. But those are people who not only didn't want to protect 
preexisting conditions, they wanted to repeal the whole bill. They 
wanted to kick 20 million people off health insurance. Give me a break. 
Their crocodile tears are not, hopefully, deluding anybody. They are 
against the Affordable Care Act. We get that. This administration has 
done everything they can think of to undermine the Affordable Care Act, 
which has an adverse effect on the ability of Americans to get health 
insurance at a price they can afford.
  Mr. Chairman, over the past few years, congressional Republicans and 
the Trump administration have engaged in a dangerous campaign to 
repeal, undermine, and dismantle the Affordable Care Act. Now, 
depending upon how long they have been here, they may well have voted 
over 60 times to repeal the Affordable Care Act. All of it. Preexisting 
conditions and everything else.
  Through executive actions and lawsuits, they have sabotaged the law 
and fueled uncertainty in health insurance markets in the process. They 
have a suit right now which wants to, effectively, repeal the entire 
Affordable Care Act that the Attorney General of the United States and 
the President of the United States are supporting.
  Spare me these crocodile tears about how this bill doesn't protect 
preexisting conditions. It does. But they don't care whether it does or 
not.
  They, the people, want to know that protections for those with 
preexisting conditions won't disappear. That tens of millions of 
Americans won't be made, effectively, uninsurable and lose their 
coverage.
  There are very few of us in this Chamber or in the gallery who don't 
have some sort of preexisting condition. We, Democrats, are committed 
to making sure that that will not preclude people from getting health 
insurance.
  In the first days of the Congress, we took action to do what the 
Trump administration's Justice Department has refused to do: defend the 
law in court. We are taking that action.
  Instead, the Trump administration is seeking to overturn the entire 
law, including the ban on denying coverage for those with preexisting 
conditions.
  Now, the Republicans did pass a bill, when they were in charge. They 
sent it over to the Senate. They had a big--and I know other people 
have talked about that--a big celebration at the White House, and the 
President embraced the bill. Some 10 days later, he said: No, it is a 
mean bill. The President of the United States embraced it, and, 10 days 
later, it is a mean bill.

  Overturning the law means the end of popular provisions, like a ban 
on forcing women to pay more for the same coverage as men or allowing 
those under age 26 to be covered under their parents' policy.
  The administration's lawsuit would also bring back out-of-pocket 
costs for preventive care and screenings. We want to encourage 
preventive care. Why? It saves money and saves lives. Most egregiously, 
it would kick 20 million Americans off health insurance coverage who 
were able to get covered because of the Affordable Care Act.
  Last month, the House passed a resolution written by Colin Allred, 
our new Member from Texas, condemning that lawsuit which would repeal 
the Affordable Care Act, and reiterating the importance of protecting 
Americans' access to quality, affordable care.
  Yesterday, the House took another step by passing bipartisan bills, 
which Mr. Pallone brought to the floor, to help speed up the process of 
bringing the cost of generic drugs down and not prescription costs up.
  Today, we have a bill to overturn the Trump administration's guidance 
that sabotages the Affordable Care Act by allowing substandard plans. 
Are they cheaper? They are. But, in the end, they are much more 
expensive because the coverage is minimal.
  The effect of such a rule is to drive up prices for those with 
preexisting conditions. That wasn't the intent of the Affordable Care 
Act, which aimed to make coverage affordable for all Americans.
  Next week, we will continue focusing on healthcare by considering 
additional legislation to help Americans access quality, affordable 
coverage.
  I urge my colleagues on both sides. Some of them have said they want 
to protect preexisting conditions. Some of them have said that. If they 
believed it, then they need to vote for this bill. They need to do 
something to protect those with preexisting conditions. Today's vote is 
their opportunity to do so.
  I thank Representative Kuster, who is on the floor with us today, for 
introducing this legislation, and, again, Chairman Pallone for bringing 
it to the floor.
  House Democrats will continue, as we pledged to do in this last 
campaign and as the people who voted for us are expecting us to do, to 
protect the Affordable Care Act, protect their ability to get 
insurance, notwithstanding a preexisting condition, protect their 
families, protect them, and make America better.
  Mr. WALDEN. Mr. Chairman, I yield myself such time as I may consume. 
I want to make a couple of comments to my friend from Maryland, and he 
is my friend. He is always quite poignant and eloquent in his remarks.
  What we are debating here today is a bill that is misnamed that 
doesn't do what it says it is going to do. What we do know is that 1332 
waivers work. My State took advantage of that 1332 waiver and reduced 
insurance premiums by 6 percent. The great State of Maryland--I was 
just looking at some data, Mr. Chairman--has about 181,500 in the 
enrollment year. They used a 1332 waiver. This year in the individual 
market their costs for premiums in the individual market percent 
decreased 43.4 percent.
  Mr. HOYER. Will the gentleman yield? I would like to tell the 
gentleman why that happened in Maryland.
  Mr. WALDEN. Mr. Chair, I bet he would. But we know, overall, 19.9 
percent across the country, because we are able to take some of this 
money, put it together, and have a reinsurance program. Maine has done 
it, Maryland has done it, and Oregon has done it. These are things that 
work.
  The complaint I get, Mr. Chairman, is people at home say, I may have 
access to coverage now, but I can't afford the premium, or, if I can 
afford the premium, I can't afford to get sick because the out-of-
pocket costs are so high. They are now falling off. Later in the 
debate, I will share some data that has been published this week 
showing people who literally walk away from healthcare because they 
can't afford it. That should be our common mission and goal.
  When it comes to protecting people with preexisting conditions, I 
introduced legislation--and tried to get a vote on it every chance I 
have had--that would lock into law preexisting condition protections, 
regardless of what this Federal lawsuit's outcome is in Texas. We 
should do that. That would be an easy vote. We could all vote for it. 
But Democrats won't let us bring it to the floor.
  Mr. Chairman, I yield 2 minutes to the gentleman from Oklahoma (Mr. 
Kevin Hern).
  Mr. KEVIN HERN of Oklahoma. Mr. Chairman, let's be honest, we are not 
here to solve a problem today. We are not here to change anything 
today. This bill will do nothing to help people with preexisting 
conditions.

  Something not many people know about me is my family's history with 
spina bifida.
  I had an older sister, about 13 months older than me, who died 2 
hours after birth because of spina bifida.
  My older sister, who will turn 50 later this month, has lived her 
entire life as a spina bifida survivor, spending the first 6 months of 
her life enduring many surgeries. My mother knew that my sister was 
going to be born with that very birth defect that took the life of her 
first child. My sister had her first daughter, Kristen, who was born 
with a devastating spina bifida condition. During the pregnancies, my

[[Page H3524]]

mother knew about my sister's birth defect and my sister knew of 
Kristen's condition. In spite of that knowledge, their lives were not 
aborted.
  Kristen has a son who just turned 10. In spite of being in a 
wheelchair for her entire life of 30 years, Kristen has been an awesome 
mom to Daniel. Daniel will have an incredible story to tell about his 
life because his great-grandmother and his grandmother did not seek 
abortions to terminate the lives of their ``less than perfect'' 
children. He is alive today, and I am confident he will have an 
incredible impact on those around him.
  These aren't nameless, faceless people we are talking about. This is 
my sister, my niece, and my family.
  These preexisting conditions have had a massive impact on my life and 
the lives of my family. These messaging bills are pointless. People 
need help, not our talking points. Our goal should be success. We 
should aim to write legislation that has a shot to become law and will 
change people's lives for the better.
  The aim of H.R. 986 is not to protect Americans with preexisting 
conditions, but to interfere with the President's ability to govern. 
These are real people and real problems that we are ignoring.
  I believe that life is precious. Every life is worth protecting. We 
have a lot of work to do and it is time to stop talking and act. That 
is what we were elected to do here.
  Mr. Chairman, the American people are tired of these political games.

                              {time}  1445

  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from California (Ms. Matsui).
  Ms. MATSUI. Mr. Chairman, I rise today as a proud cosponsor of H.R. 
986, the Protecting Americans with Preexisting Conditions Act, which 
prohibits the Trump administration from promoting the sale of junk 
insurance plans that do not fully protect Americans with preexisting 
conditions. Today, we are taking a critical step to reverse a damaging 
Trump administration policy.
  With the Affordable Care Act, we sought to ensure that all people 
covered in the same area are charged the same premium as everyone else, 
regardless of their health status. Women cannot be denied coverage or 
charged more simply because they are women, and more Americans now have 
the freedom to start their own business or pursue work in the gig 
economy without fear of losing coverage for preexisting conditions. 
Coverage before the ACA was often tied to employer plans.
  In California, we have taken a stance against the Trump 
administration's sabotage of the ACA by protecting consumers from the 
sale of junk plans, but not every State has followed our lead.
  This legislation protects basic fairness and access to healthcare for 
all Americans, not just those living in States that have sought 
aggressive reforms, changes, and improvements to the law. We now have a 
real opportunity to protect and build on the ACA's success, and I am 
immensely pleased to be able to support such efforts on the floor 
today.
  Mr. WALDEN. Mr. Chairman, I yield 2 minutes to the gentleman from 
Kansas (Mr. Marshall).
  Mr. MARSHALL. Mr. Chairman, the lengths that my colleagues across the 
aisle are willing to go to mislead the public and increase the 
political divide over healthcare is shameful and embarrassing. H.R. 
986, which I refuse to call by its name, makes a mockery of Americans 
with preexisting conditions.
  Mr. Chairman, I practiced obstetrics for over 25 years, and do you 
know what the most common preexisting condition is? It is pregnancy.
  I came to Congress to protect people with preexisting conditions and 
to help patients. H.R. 986 just does the opposite. H.R. 986 prevents 
innovation. It drives the cost of healthcare up and will cause fewer 
people to have healthcare.
  Let me be crystal clear about this, Mr. Chairman. This bill has 
absolutely nothing to do with people with preexisting conditions. That 
is why I am proud to join Congressman Walden and shed light on this 
deceptive bill that the Democrats are pushing.
  Under current law, States do not have the authority to waive 
preexisting conditions using the section 1332 innovation waiver. It is 
that simple.
  Section 1332 waivers are working, and contrary to the Democrats' 
claims, patients are raving about the 1332 waivers for reinsurance.
  These waivers give States flexibility to provide Americans with 
affordable healthcare options. And in the seven States using these 
waivers, premiums have gone down by an average of 20 percent. They went 
down 20 percent, with Maryland achieving a 43 percent premium 
reduction.
  So I stand here today to discuss the facts and not the fiction.
  The 2018 guide from the President is making the process easier, 
helping States pursue innovation strategies that will help more people 
get coverage while delivering quality coverage people can actually 
afford and use.
  Most of us, including the President, are working towards a better 
healthcare future for all Americans, where patients and families, not 
bureaucrats in Washington, are in control of their own healthcare 
decisions. I ask that my colleagues across the aisle stop the partisan 
politics and come together to develop real healthcare policy solutions.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Vermont (Mr. Welch), a member of the committee.
  Mr. WELCH. Mr. Chairman, I thank the gentleman for yielding.
  Mr. Chairman, if we want to level with the American people, let's 
acknowledge something: We have a difference of opinion on healthcare.
  When we passed the Affordable Care Act, it provided, for the first 
time, protections for people who have a preexisting condition.
  Every single one of my colleagues on the Republican side voted 
against that and then spent the next several years--69 times--voting to 
get rid of the protection for preexisting conditions.
  Then when they were in the majority, the first opportunity they had, 
they passed a bill out of the House to take away the protection for 
preexisting conditions.
  And thank you to Senator John McCain for protecting the American 
people.
  Every single opportunity to stand up and protect people who are sick, 
who lost their job but were sick and wanted to get insurance, you voted 
``no''; we voted ``yes.''
  You are talking now about waivers. I like waivers--we have benefited 
in Vermont--but not this waiver. If you pass this waiver, you are going 
to wave good-bye to the protection that we fought long and hard for for 
preexisting conditions.
  We fought for your families. We fought for our families. We fought 
for all American families.
  What kind of world is it if you are sick and you can't get 
healthcare? That is what is at stake now. That should never be in 
debate.
  We will not back down on protecting people from preexisting 
conditions. We will not back down on assaults on Medicare. We will not 
back down on assaults on Medicaid.
  Mr. Chairman, let us pass this bill and continue to protect 
Americans' healthcare.
  The CHAIR. Members are reminded to address their remarks to the 
Chair.
  Mr. WALDEN. Mr. Chairman, I would just say to my friend, the biggest 
assault on Medicare is the Democrats' proposal to do Medicare for All.
  We know it will cost $32 trillion, double personal and corporate 
income taxes. I met with our hospitals yesterday: 40 percent reduction 
in their payments. They are not sure how they would survive. They told 
me most hospitals in America will go bankrupt under the Democrats' 
proposal.
  Mr. Chairman, I yield 2 minutes to the gentleman from New York (Mr. 
Reed), a member of the powerful Ways and Means Committee.
  Mr. REED. Mr. Chairman, I rise today in opposition to the bill before 
us but, as the father of a type 1 diabetic, agree with the basis of the 
law of the Affordable Care Act that says preexisting conditions must be 
protected in every health insurance plan going forward. We should be 
celebrating together that that reform is now the law of the land, and I 
would hope my colleagues would take ``yes'' for an answer.
  But what is being proposed today potentially jeopardizes that 
protection,

[[Page H3525]]

because what you are proposing today is to take away the ability of the 
States to comply with the law of the land to protect those preexisting 
conditions in a way that allows the States to innovate, to drive health 
insurance premiums down as the law protects those with preexisting 
conditions.
  This is not a political game. You are talking about real Americans. 
You are talking about kids, like my son, who is a type 1 diabetic. And 
if this law, as proposed, becomes the law of the land, you potentially 
increase insurance premiums on millions of Americans because you take 
away that innovation ability of the States to deliver the protections 
of preexisting condition reform but lower premiums at the same time.
  So I stand in strong objection to this political effort from my 
colleagues on the other side of the aisle, and rather than engage in 
politics, I join with the silent majority of Americans who say: You 
know what? Enough is enough of politics. Get to the real work of the 
people and lower healthcare costs for everyone.
  Mr. WALDEN. Mr. Chairman, may I inquire as to how much time each side 
has remaining.
  The CHAIR. The gentleman from Oregon has 9 minutes remaining. The 
gentleman from New Jersey has 16\1/2\ minutes remaining.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from New York (Ms. Clarke), the vice chair of the Energy and Commerce 
Committee.
  Ms. CLARKE of New York. Mr. Chairman, I thank our chairman for 
yielding the time. I thank Congresswoman Kuster for her leadership.
  As vice chair of the Committee on Energy and Commerce and cosponsor 
of H.R. 986, I am proud to stand with my colleagues in support of the 
Protecting Americans with Preexisting Conditions Act of 2019.
  Healthcare is a right. In the 21st century, everyone must have the 
right to the best quality and affordable healthcare insurance when they 
need it most.
  This human right must not be only limited to healthy individuals, 
but, rather, the human right to healthcare must be available to every 
American who has ever been ill at any time or is born with a 
preexisting condition. No American should be penalized for a medical 
condition that started before the individual's healthcare coverage 
benefits went into effect.
  Passage of the Protecting Americans with Preexisting Conditions Act 
would rescind the 1332 guidance issued by the Trump administration, 
which weakens coverage and undermines the Affordable Care Act's 
protections for people with preexisting conditions.
  Our friends on the other side of the aisle made more than 70 failed 
attempts to replace and repeal the Affordable Care Act between 2011 and 
2017.
  Mr. Chair, we must do the right thing and enact legislation that 
strengthens the standards of quality healthcare, affordability, 
comprehensiveness, and coverage. Mr. Chairman, I urge my colleagues to 
vote ``yes'' on H.R. 986.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from Michigan (Mrs. Dingell).
  Mrs. DINGELL. Mr. Chairman, I rise today to speak in support of 
protecting people with preexisting conditions.
  Not that long ago, hardworking people who did everything right would 
be denied insurance coverage just because they had diabetes or asthma 
or they wanted to start a family.
  We passed the ACA and ended discrimination against people with 
preexisting conditions. Millions of Americans were able to sign up for 
coverage for the first time in their lives, and millions who already 
had coverage knew it wouldn't be taken away from them.
  Remember the stories of people's insurance being canceled as they 
were being rolled into operating rooms; that was the truth.

  The ACA has done a lot of good. Could we work to improve it? Yes. And 
I will work with any Republican or Democrat on those efforts. But when 
this Congress and this administration attempt to roll back protections 
for people with preexisting conditions, I will always stand against 
those policies.
  Mr. Chair, 2 years ago last week, House Republicans passed a bill to 
rescind the whole ACA and take healthcare away from 20 million 
Americans. Because Americans spoke up, that bill failed.
  I am proud to cosponsor Representative Kuster's bill. Healthcare 
should be affordable to every American.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Virginia (Mr. Beyer).
  Mr. BEYER. Mr. Chairman, I rise today to speak in support of H.R. 
986, the Protecting Americans with Preexisting Conditions Act.
  Frankly, Mr. Chairman, I am confused. I serve on the Ways and Means 
Committee, and a few weeks ago, we had a long, lively hearing on the 
need to preserve the preexisting conditions created by the ACA. I was 
impressed that every member of the Ways and Means Committee, Democrat 
and Republican, spoke passionately about this protection--every one.
  We emerged from that hearing with a clear, bipartisan consensus that 
we would never again condemn Americans who suffer from diabetes or 
cancer or heart disease or epilepsy to unaffordable insurance and 
perhaps an early death.
  But today my Republican friends are ready to vote against the only 
bill this year to keep the Trump administration from gutting the 
preexisting exclusion. They argue that, no, this is not what CMS is 
trying to do, yet this is exactly what would happen with short-term 
insurance plans if the various States are given the opportunity to do 
so. That is why virtually every organization that protects human health 
supports this bill and is against the CMS action.

                              {time}  1500

  States want waivers. States want to innovate. This bill won't keep 
them from innovating or keep them from getting waivers. Remember what 
States did before the Affordable Care Act when there was no prohibition 
against higher costs for preexisting conditions or no insurance.
  If what they say is, indeed, true, there is no harm voting ``yes'' 
for this bill. States will still be able to innovate, as long as they 
don't violate the preexisting conditions exclusion.
  Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
  Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman 
from Texas (Ms. Jackson Lee).
  Ms. JACKSON LEE. Mr. Chair, I thank the chairman very much for 
yielding.
  Just a second on memory lane, for those of us who were here for the 
Affordable Care Act, dozens of our committees, including the Judiciary 
Committee, heard the pain of people whose family members had died 
because they had no access to healthcare and/or they had junk policies.
  Mr. Chair, I rise today with the strongest of support for H.R. 986. I 
thank my good friend, Ann Kuster, for her great leadership and indicate 
that since the Affordable Care Act--and I know that we are now looking 
at Medicare for All and many others. My view of it is yes, so that we 
all can have access to healthcare.
  It is, in fact, sure that this bill that we now have, which is being 
attacked by the Trump administration in the Fifth Circuit right now 
because of my attorney general attacking the Affordable Care Act, Texas 
saw a national decrease of the uninsured from 14.8 to 8.8.
  Now this legislation, which is to turn back the Trump guidance on the 
issue of waivers, is vital because we have lower costs for health 
insurance because of the ability for people to access and be taken care 
of with the Affordable Care Act when they have preexisting conditions.
  Sickle cell, triple negative breast cancer, and diabetes all plague 
my constituency. Insulin costs are going through the roof. With this 
guidance that Trump has put in place, it will be worse. It will be 
compounded.
  Rates will go up, and people suffering from preexisting conditions, 
including pregnancy, will not get policies at a low cost. They will not 
have comprehensive coverage that will include mental health. Certainly, 
they will see a reverse of them being able to have coverage for 
preexisting conditions.

[[Page H3526]]

  That is the civil rights of healthcare. Preexisting conditions must 
be protected.
  I rise to enthusiastically support H.R. 986, and I demand that the 
Trump administration stop taking away constitutional rights in 
everything and denying people their right to good healthcare. Enough is 
enough. Let us support this legislation.
  Mr. Chair, I rise in strong support of H.R. 986, the ``Protecting 
Americans With Pre-Existing Conditions Act of 2019,'' which blocks the 
Trump Administration's efforts to give states the ability to weaken the 
Affordable Care Act's critical protections for Americans with pre-
existing conditions.
  On October 22, 2018, the Centers for Medicare & Medicaid Services 
(CMS), HHS, and Treasury issued a guidance on Section 1332 of the ACA, 
which authorizes states to waive certain requirements of the law and 
experiment with health insurance reforms that could improve the well-
being and health of their residents.
  The ACA has a clear statutory directive that states must maintain the 
level of benefits, affordability, and coverage provided to state 
residents by the ACA.
  Section 1332 requires states to meet four statutory ``guardrails'' 
simultaneously and demonstrate that the proposed waiver will provide 
comprehensive, affordable coverage to a comparable number of residents 
as under the ACA, without increasing the federal deficit.
  But in the 2018 guidance, HHS and Treasury revised the agencies' 
interpretation of the statutory requirements, and significantly 
loosened the standards that states must meet in order to receive waiver 
approval, setting forth weaker requirements that must be met for the 
affordability and comprehensiveness guardrails and adopted a new 
definition of what classifies as coverage.
  The 2018 guidance provided by the Trump Administration would allow 
states to simply demonstrate that a comparable number of residents will 
have access to comprehensive and affordable coverage, regardless of 
whether they actually enroll in that coverage, thereby allowing the 
Secretaries of HHS and Treasury to approve waivers that do not provide 
coverage that is as affordable or as comprehensive as under the ACA.
  The 2018 guidance also allows states to receive waiver approval for 
proposals that direct the ACA's tax credit subsidies towards STLDI 
plans and other types of health insurance plans that do not provide 
protections for pre-existing conditions.
  H.R. 986 revokes and rescinds the October 2018 Section 1332 guidance 
and prohibits the Secretaries of HHS and Treasury from promulgating any 
substantially similar guidance or rule.
  These improper waivers leave consumers with less comprehensive plans 
that do not cover needed services, such as prescription drugs, 
maternity care and substance use disorder treatment.
  Another way the ``Protecting Pre-Existing Conditions and Making 
Health Care More Affordable Act of 2019,'' protects consumers is by 
prohibiting insurance companies from selling junk health insurance 
plans that do not provide coverage for essential medical treatments and 
drugs or cover people with pre-existing medical conditions.
  As a member of Congress who voted against each of the dozens of 
Republican efforts to repeal the Affordable Care Act, I know first-hand 
how important and critical access to affordable, high quality, 
accessible health care available to everyone, including those with pre-
existing conditions, to the well-being of American families.
  Because of the passage of the Affordable Care Act, the national 
uninsured rate has been slashed from 14.8 in 2012 to 8.8 percent in 
2018. Texas has long led the nation in rate of uninsured so the 
comparable rates are 24.6 and 15 percent, respectively.
  Mr. Chair, I distinctly recall a candidate for the highest public 
office in the land saying ``Obamacare is a disaster'' and appealing for 
voters to support him with this question: ``What have you got to 
lose?''
  The question deserves a response so I hope that person, who occupies 
the Oval Office, is listening to my answer.
  The Affordable Care Act, or ``Obamacare,'' has been an unmitigated 
success to the more than 20 million Americans who for the first time 
now have the security and peace of mind that comes with affordable, 
accessible, high quality health care.
  Mr. Chair, Tip O'Neill used to say that ``all politics is local'' so 
let me share with you how Obamacare has dramatically changed lives for 
the better for the people in my home state of Texas.
  1.874 million Texans who have gained coverage since the ACA was 
implemented could lose their coverage if the ACA is entirely or 
partially repealed or invalidated.
  1.1 million Texans who purchased high quality Marketplace coverage 
now stand to lose their coverage if Texas v. United States, No. 4:18-
cv-00167-0 (N.D. Tex.), the lawsuit brought by Republican Governors, 
and now whole-heartedly supported and aided by the Trump Administration 
were to succeed.
  508,000 kids in Texas who have gained coverage since the ACA was 
implemented are also at risk of having their coverage rolled back.
  205,000 young adult Texans who were able to stay on a parent's health 
insurance plan thanks to the ACA now stand to lose coverage if the 
Republican Congress eliminates the requirement that insurers allow 
children to stay on their parents' plans until age 26.
  646,415 Texans who received cost-sharing reductions to lower out-of-
pocket costs such as deductibles, co-pays, and coinsurance are now at 
risk of having healthcare become unaffordable if the Republican 
Congress eliminates costsharing reductions.
  10.28 million Texans who now have private health insurance that 
covers preventive services without any co-pays, coinsurance, or 
deductibles stand to lose this access if the Republican Congress 
eliminates ACA provisions requiring health insurers to cover important 
preventive services without cost-sharing.
  913,177 individuals Texans who received financial assistance to 
purchase Marketplace coverage in 2016, averaging $271 per individual, 
are at risk of having coverage become unaffordable if the Republican 
Congress eliminates the premium tax credits.
  1.1 million Texans could have insurance if all states adopted the 
ACA's Medicaid expansion; these individuals will not be able to gain 
coverage if the Republican Congress eliminates the Medicaid expansion.
  Women in Texas who can now purchase insurance for the same price as 
men are at risk of being charged more for insurance if the ACA's ban on 
gender rating in the individual and small group markets is invalidated.
  Before the ACA, women paid up to 56 percent more than men for their 
health insurance.
  Roughly 4.5 million Texans who have pre-existing health conditions 
are at risk of having their coverage rescinded, being denied coverage, 
or being charged significantly more for coverage if the ACA's ban on 
pre-existing conditions is struck down.
  346,750 Texas seniors who have saved an average of $1,057 each as a 
result of closing the Medicare prescription drug ``donut hole'' gap in 
coverage stand to lose this critical help going forward.
  1.75 million Texas seniors who have received free preventive care 
services thanks to ACA provisions requiring coverage of annual wellness 
visits and eliminating cost-sharing for many recommended preventive 
services covered by Medicare Part B, such as cancer screenings, are at 
risk of losing access to these services if congressional Republicans go 
forward with their plan to repeal the ACA.
  The Affordable Care Act works and has made a life-affirming 
difference in the lives of millions of Americans, in Texas and across 
the country.
  This is what happens when a visionary president cares enough to work 
with a committed and empathetic Congress to address the real issues 
facing the American people.
  You want to know why the American people have Obamacare?
  It is because Obama cared.
  The same cannot be said about this Republican president and 
congressional Republicans who have made careers of attacking and 
undermining the Affordable Care Act's protections and benefits for the 
American people.
  I urge all Members to vote for H.R. 986 and send a powerful message 
to the President and the American people that this House will not stand 
idly by as this Administration tries to take away health care from more 
than 130 million persons.
  Instead, this House will resist by all constitutional and appropriate 
means, including opposing this Administration in the courts and by 
passing H.R. 986, the ``Protecting Pre-Existing Conditions and Making 
Health Care More Affordable Act of 2019.''
  Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
  Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from 
Connecticut (Mr. Courtney).
  Mr. COURTNEY. Mr. Chair, I thank the chairman for yielding.
  Mr. Chair, after 2 years of the Trump administration trying and 
failing in Congress to repeal the Affordable Care Act, they have gone 
to plan B. Plan B is to use the administrative agencies, the Department 
of Health and Human Services, and the court system as a way of trying 
to accomplish what they could not accomplish through the House and the 
Senate in the 115th Congress.
  Today, we are dealing with one of those efforts, which was an order 
that was issued in October of last year, issuing new guidelines for 
State waivers from the Affordable Care Act, repealing the ObamaCare 
guardrails that

[[Page H3527]]

made sure that patient protections would not be affected by such 
waivers--for example, protecting people with preexisting conditions; 
the elimination of lifetime caps on health insurance; and the 
protections that were built in for essential health benefits that 
defined real healthcare, not the cheap healthcare that was being sold 
before the ACA was enacted.
  An intervening event occurred since last October. We had an election. 
It was the largest midterm turnout since 1914. We had a new majority 
that was elected with a plurality of 10 million votes, larger than any 
flip election in the past, any wave election in the past. The number 
one issue from the voters was healthcare and protecting their patient 
rights to affordable and comprehensive benefits.
  Mr. Chair, we are here today debating an issue that the patient 
groups that represent people with chronic illnesses, with expensive 
illnesses like cancer, have stepped up across the board, saying vote 
for this legislation to overturn the Trump order that they are trying 
to get through but that they cannot get through the U.S. Congress. Vote 
for this bill.
  Mr. PALLONE. Mr. Chair, may I inquire how much time remains?
  The CHAIR. The gentleman from New Jersey has 9 minutes remaining. The 
gentleman from Oregon has 9 minutes remaining.
  Mr. PALLONE. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chair, I wanted to mention this issue of reinsurance. Some of the 
Republicans have brought up the fact that in the last few years under 
the Obama administration, actually before President Trump, certain 
States--I believe there are eight now, including my own--applied for 
1332 waivers because they wanted to put in place reinsurance programs.
  I want to assure everyone that those types of waivers that are 
granted for reinsurance would continue and that this legislation in no 
way impacts that. Keep in mind, we are not opposed to 1332 waivers.
  But pursuant to the Affordable Care Act, which I helped draft, those 
waivers, when granted, have to maintain affordability and 
comprehensiveness of coverage and keep the same number of people 
insured as under the ACA.
  When my State and others have applied for waivers for reinsurance 
programs, it is because the ACA reinsurance funding was discontinued at 
some point under the original bill. Those States want to, among other 
things, make sure that there is competitiveness in the marketplace by 
providing some kind of reinsurance or risk protection so that more 
insurers come into the marketplace in those States and create more 
competition and lower prices.
  When you ask the Federal Government for a reinsurance waiver, you are 
still maintaining affordability, probably making things even more 
affordable because of competition. You are still maintaining the 
comprehensiveness of the coverage because you have to provide policies 
that have all the essential benefits. You are keeping the same number 
of people insured. In fact, what you are probably doing is having more 
people insured.
  The difference between that and the section 1332 guidance that the 
Trump administration is now putting forth is that none of those things 
are guaranteed under the waivers that the Trump administration is 
proposing with their guidance.
  For one thing, they are saying you can sell a junk plan that doesn't 
have hospitalization, that doesn't have essential benefits, so you 
violate the section 1332 provision.
  You also end up having fewer people insured because the Trump 
administration says you don't have to have the same number of people 
covered. All you have to do is have access.
  Lastly, affordability, sure, they will argue that somehow it is more 
affordable because a junk plan doesn't cost as much, but that is sort 
of a misnomer because the comprehensiveness of the coverage disappears.
  I want everyone to understand, a State that applies to have 
reinsurance as part of their program and gets a waiver, that is in no 
way impacted by what we are proposing here today with Ms. Kuster's 
bill. In fact, reinsurance reinforces the very things that the 1332 
waivers are seeking to guarantee.
  So that is a very false bit of information that my colleagues on the 
other side are trying to put out here today. I wanted to explain that.
  Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
  Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman 
from Michigan (Ms. Slotkin).
  Ms. SLOTKIN. Mr. Chair, I rise today in support of the Protecting 
Americans with Preexisting Conditions Act.
  For me, this issue is particularly personal. It is a major reason why 
I ended up coming here to Congress.
  I believe that the sabotage, the attempts at legislating out 
protections for people with preexisting conditions, is something that 
is just out of touch with the American people, certainly in Michigan's 
Eighth Congressional District.
  It is particularly personal to me because of my mom. My mom passed 
away in 2011 from ovarian cancer. When she was diagnosed, she did not 
have healthcare.
  She had trouble with healthcare her entire life. She had breast 
cancer as a young 31-year-old mom, so for the rest of her life, she had 
a preexisting condition.
  My parents divorced, and she lost her job. Because of that 
preexisting condition, she could not afford health insurance. She went 
5\1/2\ years without a checkup and no gynecological exam.
  We finally got her health insurance, my brother and I. It was $1,000 
a month, with a $10,000 deductible, her highest bill in Detroit.
  In 2009, without us knowing, she let it lapse. Two months later, she 
walked into an ER and was diagnosed with stage IV ovarian cancer.
  I am sure my colleagues around the room know what it is like to have 
a loved one get a terminal diagnosis. Your life as you know it 
explodes.
  That same week and that same month that our lives were exploding was 
the same week and the same month we spent filling out the paperwork for 
her to declare bankruptcy.
  I think no matter whether you are a Republican, a Democrat, or an 
independent, it is essential that we support people with preexisting 
conditions, and I urge my colleagues to do so.
  Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
  Mr. PALLONE. Mr. Chair, I yield myself such time as I may consume. I 
am still waiting for one of our other speakers.
  Mr. Chair, I want to respond to my colleague, the ranking member, 
whom I respect a great deal. He has several times today, as well as in 
committee and as a representative at the Rules Committee, talked about 
this amendment that he has on preexisting conditions.
  First of all, the reality is that the ACA guarantees people coverage 
with preexisting conditions. The problem here is not that we need to 
restate that, but that the section 1332 guidance that the Trump 
administration has proposed would undermine it.
  On its surface, Mr. Walden's amendment appears to maintain 
protections for preexisting conditions, but, again, that is not the 
issue because he is not getting rid of the guidance that the Trump 
administration has put forward under 1332.
  What does that mean? It means that even with his amendment, the Trump 
administration, under their guidance, would allow insuring companies to 
not offer basic services such as hospitalization, maternity coverage, 
mental health, and substance abuse disorders. Insurance companies would 
no longer have to offer these benefits to people with preexisting 
conditions who need those benefits.
  Mr. Walden's amendment also does not include prohibitions on annual 
and lifetime limits, which are critical protections for individuals 
with preexisting conditions. These limits, which were commonplace prior 
to the ACA, are a threat to the life and health of individuals with 
serious medical conditions.
  The Walden amendment would also allow insurance companies to charge 
women more than men and put a significant financial burden on older 
Americans.
  We are not interested in these half measures that would leave 
Americans worse off.

[[Page H3528]]

  Mr. Chair, I yield such time as he may consume to the gentleman from 
California (Mr. Harder).
  Mr. HARDER of California. Mr. Chair, I rise today in support of my 
amendment. My legislation would simply require the Federal Government 
to issue an expert analysis of the impact of junk plans on mental 
healthcare access. People deserve access to mental healthcare, and we 
don't know how many people will lose that access if these junk plans 
become used more widely.
  That is exactly what my amendment would tell us.
  People who are struggling with depression, anxiety, schizophrenia, or 
substance use disorder deserve coverage. We are talking about real 
people in our communities who need help, and they should get it.
  That is especially true because of the stigma surrounding mental 
health issues. If you tell your friends that you have cancer, they tell 
you to get help. If you tell your friends you have depression, they 
tell you to tough it out or go to the gym.
  Without access to mental healthcare, a lot of people end up self-
medicating. That is why we have to make sure that they are covered with 
real insurance, not junk plans.

                              {time}  1515

  These plans are a scam.
  I heard a horror story from a woman in Stanislaus County about her 
family's experience with a junk plan before the Affordable Care Act. 
Her daughter went off to school and got cheap, university-sponsored 
insurance.
  After a couple of years, she had a mental health issue present, but 
she was completely denied coverage for the treatment that she needed. 
Even though she paid premiums for years, she wasn't covered, and her 
family had to pay thousands of dollars out of pocket. Years later, they 
are still paying it off today, more than 10 years after her mental 
health episode.
  That is a common story because only about half of these plans cover 
mental healthcare, and only about one-third cover substance use 
disorder, and that is a huge problem in the Central Valley, especially 
for young people.
  It is in people's twenties that they start showing signs of a lot of 
mental health problems, and this often coincides with the development 
of substance use disorders. People who turn 26 have to get off their 
parents' insurance. They pick the cheapest thing they can find.
  If we don't pass this amendment, millions of people who have similar 
stories will be denied coverage for mental health issues when they need 
it most.
  That is a scam. That is what my amendment demands.
  Mr. WALDEN. Mr. Chairman, how much time remains on each side?
  The CHAIR. The gentleman from Oregon has 9 minutes remaining. The 
gentleman from New Jersey has 1 minute remaining.
  Mr. WALDEN. Mr. Chairman, I yield myself the balance of my time.
  Mr. Chairman, let me address a few issues. First of all, my friend my 
New Jersey--and he is my friend--referenced my amendment.
  It is unfortunate that we can't debate my amendment on the floor, 
because the Democrats who control the Rules Committee wouldn't allow my 
amendment to be considered, nor would they allow us to bring a bill to 
the floor that I have authored that has more than 100 cosponsors that 
would make sure that preexisting conditions are protected in case the 
court decision in Texas goes against the ACA and wipes out those 
protections.
  This would be an insurance policy in public law for people with a 
preexisting condition. We can do that today. If it has some 
shortcomings, then let's have a markup on this bill and work that out.
  I care deeply about preexisting condition protection. I fought for it 
as a legislator. I helped create the high-risk pools in Oregon back in 
the late eighties and early nineties. I have supported it every step of 
the way.
  Let me again quote from the Department of Health and Human Services. 
We asked them, and they wrote back to me, about protection for 
preexisting conditions. Seema Verma, the Administrator, said in her 
letter to me: ``To be very clear, the 2018 guidance does nothing to 
erode PPACA's preexisting condition provisions, which cannot be waived 
under section 1332.''
  So they cannot do that. They cannot waive those protections under 
1332.
  ``Section 1332 does not permit States to waive Public Health Service 
Act requirements, such as guaranteed availability and renewability of 
health insurance, the prohibition on using health status to vary 
premiums, and the prohibition on preexisting conditions exclusions. 
Furthermore, a section 1332 waiver cannot be approved that might 
otherwise undermine these requirements. This administration stands 
committed to protecting people with preexisting conditions.''
  That is the head of CMS. It is her agency that approves 1332 waivers.
  There have been no waivers so far approved under this guidance, and 
that is what she tells us in writing, period, because of the 
information that is being sent around.
  We do know that seven States have taken advantage of the prior 1332 
process, and it has yielded more affordable insurance premiums for 
American citizens.
  Now, I find it curious. My State has been very progressive in these 
areas. When I was in the State legislature, I helped try to expand 
access to affordable healthcare. We had to come to Washington to get a 
waiver for the Oregon health plan and Medicaid, and we looked at all 
kinds of different ways to get access to affordable healthcare, and I 
have never let up on that.
  I believe strongly in helping people with preexisting conditions. 
Like my colleagues on the other side of the aisle, my wife and I had a 
son who did not survive because of a heart condition. We dealt with all 
of these issues leading up to his birth and eventual death. So I am 
fully committed to protecting people with preexisting conditions.
  What we are arguing about here is: Is health insurance affordable for 
Americans and are there better ways, using States as laboratories, to 
innovate and bring down costs of care and costs of insurance, because 
more of us are paying more out of our pocket than at any time in our 
history.
  There was a very interesting story which I will put in the Record for 
everyone to read, data from the Kaiser Foundation this week that ran in 
a publication called Axios. I just want to share some of what they 
found about what is really going on if you get outside of the beltway 
here in Washington and talk to real people.
  They evaluated people who had coverage under their employer, in this 
case, and had a chronic condition of some sort. It is not a small 
group.
  About half of Americans who have employer coverage--so that is half 
of 158 million--report that 6 in 10 in that group report they or a 
family member skipped or postponed medical care or prescription drugs 
they needed because of the costs, or, in some cases, they tried a home 
remedy.
  High deductibles make things worse. Among those with chronic 
conditions whose deductibles were at least $3,000 for an individual or 
$5,000 for a family, three-quarters, Mr. Chairman, 75 percent, report 
skipping or postponing some type of care; and about half, 49 percent, 
say they or a family member had problems paying medical bills or 
difficulty affording their premiums, deductibles, or copays in the last 
year.

  So what States--including mine, including New Jersey, including 
Maryland, and including Maine and Alaska--did was say: Hey, Washington, 
D.C., give us just a little flexibility here. Let us come with up with 
plans that may be more affordable.
  They did that under the prior rules, and rates went down, on average, 
19.9 percent--some States more, some less.
  Now, what happens when people can't afford to use their own 
insurance? Because that is happening with these deductibles and with 
these high levels, let alone the premiums.
  The ripple effect on family budgets, according to the story in Axios, 
is a substantial share of people reported taking measures such as 
increasing credit card debt, 28 percent; using up most of their 
savings, 26 percent; getting an extra job, 19 percent; borrowing money 
from family or friends, 14 percent.
  This is what we are trying to argue could be better taken care of. 
This is the issue that is being ignored by a Washington one size fits 
all.
  So we protect people with preexisting conditions, 1332 waivers--that 
law

[[Page H3529]]

stays in effect--but we want to give States a little more flexibility 
to go after this to bring down the cost.
  Now, my friend from New Jersey and I, Mr. Chairman, are working 
together on some of these drug reforms so we can get drug costs down.
  I was at the White House today with the President on surprise 
billing, and I think we are going to work together on that issue, Mr. 
Chairman, so that no American consumer who follows the rules gets stuck 
with a surprise bill. What are you supposed to do, wake up in the 
middle of the operation and say: Hey, is everybody in this room still 
on my plan? If you play by the rules, you shouldn't get stuck unfairly 
with a surprise bill. We are going to find a solution.
  My State came up with a way to do that already and other States have 
other ideas, but we are going to protect consumers there as well. We 
are going to drive down the cost of drugs, and we should continue to go 
after this issue of the high cost of healthcare because that is what 
Americans in my 20 townhalls--and I don't think anybody in the House 
has done more.
  I have done 20 townhalls this year. In almost every one of them, they 
are asking: How do you get the costs down?
  Mr. Chairman, 1332 waivers gave my State the opportunity to get costs 
down, and we should not impede that process.
  We are going to debate a lot about these policies going forward, and 
if there are junk plans, then let's expose them for what they are, and 
let's pass Ms. Eshoo's bill from, I think, last Congress, which 
required more transparency and accountability so you don't have fraud 
and deception. Count me all in on that.
  There is a lot more we can do to drive down costs.
  My legislation--again, Democrats refused to bring up in committee or 
have on the floor--would make sure, regardless of any lawsuit, people 
with preexisting conditions can continue to get covered. So 
irrespective of the court decisions, they would get covered.
  If my bill were allowed to be voted on in the House, I guarantee you, 
we might have some issues we need to work out. I am happy to do that. 
If it passed, it would become law. This President is firmly committed 
to protecting people with preexisting conditions, so we should do that.
  We should also have a hearing on the Medicare for All bill that some 
on the other side are promoting. I have asked for that.
  I know there was one in the Rules Committee, but Energy and Commerce 
is the committee of jurisdiction for most of that. We have not seen 
that hearing yet. I hope, in the future, we will, because we should 
know the impact of wiping out Medicare Advantage plans and Medigap 
plans.
  I have been told TRICARE would go away, all private insurance would 
go away, and it would be a one-size-fits-all, government-run system. I 
am worried about the delay in access to care. I am worried about the 
access to the great, new innovative drugs and procedures that we would 
lose in America.
  So, Mr. Chairman, I must oppose this underlying legislation. I remain 
committed to protecting people with preexisting conditions, as do my 
colleagues on the Republican side. Then we ought to focus together, Mr. 
Chairman, as a Congress to do the best thing for our constituents, 
which is to bring the greatest leverage possible to reduce unnecessary 
costs in the healthcare system in America.
  Mr. Chairman, I ask my colleagues to oppose this bill, and I yield 
back the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield myself the balance of my time.
  Mr. Chairman, the problem is that nothing that my colleague on the 
Republican side says about his amendment and nothing that is in Seema 
Verma's letter will help a person with preexisting conditions.
  The bottom line is this 1332 guidance that the Trump administration 
has put forward allows junk plans to be sold so that people with 
preexisting conditions will not get the coverage they need. They can be 
charged more. They are not guaranteed that things like recisions and 
lifetime limits don't go back into place.
  So the problem that we face is we can't allow people with preexisting 
conditions to suffer and not get coverage because they are going to be 
charged more or because they are not going to get the coverage they 
need by buying a junk plan.
  If you really care about that and you want to make sure that people 
with preexisting conditions really are guaranteed good coverage and can 
afford their coverage, then you have to vote for Ms. Kuster's bill. 
That is all we are saying here.
  I am not saying that my colleague on the other side is not well 
meaning, but nothing he has said will protect the people with 
preexisting conditions from the problems with the Trump guidance. So I 
would ask my colleagues to support this bill.
  Mr. Chairman, I include in the Record two letters from various 
nonprofit health organizations supporting the bill.

                                                      May 8, 2019.
     Hon. Greg Walden,
     Ranking Member,
     House Energy & Commerce Committee,
     Washington, DC.
       Dear Ranking Member Walden: Our 35 organizations, 
     representing the interests of the millions of patients and 
     consumers who live with serious, acute, and chronic 
     conditions, have worked together for many months to ensure 
     that patient voices are reflected in the ongoing 
     Congressional debate regarding the accessibility of health 
     coverage for all Americans and families. In March 2017, we 
     identified three overarching principles to guide and measure 
     any work to further reform and improve the nation's health 
     insurance system. Our core principles are that health care 
     must be adequate, affordable, and accessible. Together, our 
     organizations understand what individuals and families need 
     to prevent disease, manage health, and cure illness. As the 
     116th Congress progresses, we welcome the opportunity to work 
     with members on both sides of the aisle on solutions that 
     will preserve coverage for individuals who are currently 
     covered, extend coverage to those who remain uninsured, and 
     lower costs and improve quality for all.
       Prior to the Affordable Care Act (ACA), individuals who 
     were in the most need of health insurance coverage--including 
     older and sicker Americans and people living with pre-
     existing conditions--often found it difficult, if not 
     impossible, to obtain health insurance that provided the 
     coverage they needed. Many individuals were denied coverage 
     due to their pre-existing conditions or were charged 
     outrageous premiums and/or were left with inadequate benefit 
     packages.
       Without access to comprehensive health coverage they could 
     afford, many patients with serious and chronic conditions 
     were often forced to delay or forego necessary health care. 
     Before the patient protections provided under the ACA, more 
     than half of heart patients reported difficulty paying for 
     their care and of those patients more than 40 percent said 
     they had delayed care or had not filled prescriptions. 
     Uninsured patients with diabetes were six times as likely to 
     forgo necessary medical care than those with coverage. 
     Uninsured patients were less likely to be screened for cancer 
     and more likely to be diagnosed with later stage disease 
     which is harder to survive and more costly to treat.
       Individuals and families with pre-existing conditions rely 
     on critical protections in current law to help them access 
     comprehensive, affordable health coverage that meets their 
     medical needs. Unfortunately, the arguments of the plaintiffs 
     and the recent change of opinion by the Department of Justice 
     in the Texas v. U.S. case continue to represent a serious 
     threat to these protections. We are troubled by the argument 
     made by the plaintiffs and DOJ that the court must invalidate 
     the entire ACA due to Congress' repeal of the individual 
     mandate, as many provisions of the ACA directly protect 
     people with pre-existing conditions.
       Our organizations appreciate that members of Congress share 
     our concerns about the potential impact of Texas v. U.S. on 
     people with pre-existing conditions. Several bills have been 
     introduced in response to this case, from H. Res. 14, which 
     authorized the Speaker, on behalf of the House of 
     Representatives, to intervene in the case of Texas v. United 
     States, to S. 1125, the Protect Act, and H.R. 692, the Pre-
     existing Conditions Protection Act of 2019.
       Some of these bills--including S. 1125 and H.R. 692--
     attempt to provide protection to people with pre-existing 
     conditions should the ACA be invalidated. We recognize and 
     appreciate the sponsors' efforts, and know that in many 
     cases, in response to stakeholder feedback, sponsors have 
     revised previous drafts of these bills to offer additional 
     protections for consumers, including those with pre-existing 
     conditions. However, we remain concerned that the policies 
     outlined in these bills fall far short of the comprehensive 
     protections and coverage expansion included in current law.
       As you are aware, current law requires issuers to comply 
     with a set of provisions that work together to promote 
     adequate, affordable, and accessible coverage for people with 
     pre-existing conditions. A holistic approach that includes--
     but is not limited to--community rating, guaranteed issue, 
     essential health benefits, cost-sharing limits, a

[[Page H3530]]

     prohibition of lifetime and annual limits, allowing young 
     people to stay on their parents' insurance to age 26, the ban 
     on pre-existing condition exclusions, and other important 
     provisions protect people with serious health care needs from 
     discriminatory coverage practices and promote access to 
     affordable coverage. Medicaid expansion also brought coverage 
     to millions of Americans who were previously uninsured, many 
     of whom went without vital care. These policies are 
     inextricably linked and repealing any of them threatens 
     access to critical care for people with life-threatening, 
     disabling, chronic, or serious health care needs.
       We hope that you will keep these critical patient 
     protections and the interlocking functions of current law 
     that safeguard coverage for consumers, patients, and 
     individuals with pre-existing conditions at the front of your 
     mind during the 116th Congress. We are grateful that Congress 
     is committed to exploring both immediate and long-term 
     approaches that can be taken to shore up and strengthen the 
     individual insurance market and we remain ready and willing 
     to work with Congress to achieve that goal and provide all 
     Americans with the health care they need and deserve. If you 
     have any questions about this letter, please contact Katie 
     Berge, Federal Government Relations Manager for the American 
     Heart Association.
           Sincerely,
       United Way Worldwide, COPD Foundation, Hemophilia 
     Federation of America, Susan G. Komen, Family Voices, 
     American Heart Association, National Health Council, Epilepsy 
     Foundation, March of Dimes, ALS Association, National 
     Hemophilia Foundation, National Coalition for Cancer 
     Survivorship, Alpha-1 Foundation, American Liver Foundation, 
     National Multiple Sclerosis Society, WomenHeart: The National 
     Coalition for Women with Heart Disease, American Cancer 
     Society Cancer Action Network.
       Muscular Dystrophy Association, National Patient Advocate 
     Foundation, Leukemia & Lymphoma Society, Lutheran Services in 
     America, National Kidney Foundation, American Lung 
     Association, Cystic Fibrosis Foundation, American Diabetes 
     Association, National Psoriasis Foundation, National Alliance 
     on Mental Illness, Adult Congenital Heart Association, 
     Arthritis Foundation, Chronic Disease Coalition, Immune 
     Deficiency Foundation, Cancer Support Community, National 
     Organization for Rare Disorders, Pulmonary Hypertension 
     Association, Juvenile Diabetes Research Foundation.
                                  ____

                                                      May 8, 2019.
     Re Letter of Support from 23 Patient and Consumer Advocacy 
         Organizations for H.R. 986.

     Hon. Ann McLane Kuster,
     House of Representatives,
     Washington, DC.
       Dear Representative Kuster: Our 24 organizations, 
     representing the interests of the millions of patients and 
     consumers who live with serious, acute, and chronic 
     conditions, have worked together for many months to ensure 
     that patient voices are reflected in the ongoing 
     Congressional debate regarding the accessibility of health 
     coverage for all Americans and families. Today, we write in 
     strong support of your legislation to protect people with 
     pre-existing conditions who receive coverage in the 
     individual marketplace. The Protecting Americans with 
     Preexisting Conditions Act of 2019, H.R. 986, would require 
     the Administration to rescind its Section 1332 State Relief 
     and Empowerment Waivers Guidance, released on October 22, 
     2018 (1332 guidance). We are concerned about the impact that 
     this guidance could have on the people we represent and 
     applaud your introduction of this bill.
       In March 2017, we identified three overarching principles 
     to guide and measure any work to further reform and improve 
     the nation's health insurance system. Our core principles are 
     that health insurance coverage must be adequate, affordable, 
     and accessible. Together, our organizations understand what 
     individuals and families need to prevent disease, manage 
     health, and cure illness. Our organizations are deeply 
     concerned about how the new 1332 guidance will affect the 
     individual marketplace's stability in states that choose to 
     pursue some of the policies allowed under this guidance, 
     including those that promote short term plans and other 
     substandard coverage. We are pleased that this legislation 
     represents a significant and meaningful step towards 
     protecting all Americans from coverage that does not cover 
     what they need to promote their health and well-being.
       As you know, the 1332 guidance substantially erodes the 
     guardrails governing coverage that people with pre-existing 
     conditions such as cystic fibrosis, lung disease, cancer, 
     cardiovascular disease, diabetes, rare disorders, pregnant 
     women, and many others rely on in the individual marketplace. 
     Of particular concern, the new guidance would allow states to 
     let individuals use advanced premium tax credits to purchase 
     non-compliant short-term, limited duration insurance plans--
     which could further draw younger, healthier people out of the 
     risk pool for comprehensive insurance and drive up premiums 
     for those who need comprehensive coverage. The guidance also 
     eliminates protections for vulnerable populations, such as 
     individuals with low incomes and those with chronic and 
     serious health issues, by removing the requirement to 
     safeguard those populations under any waiver. We are deeply 
     concerned by this as these changes fundamentally alter the 
     nature of the Section 1332 waiver program and jeopardize 
     adequate, affordable coverage for people with pre-existing 
     conditions in the individual market. Halting the 
     implementation of this guidance will protect people with pre-
     existing conditions from the repercussions of these market 
     destabilizing actions.
       H.R. 986 represents a significant step towards protecting 
     patients and consumers. Yet, we also recognize that there is 
     much more that needs to be done to improve upon our current 
     system of care, including making coverage more accessible and 
     affordable. Up until this year, health insurance enrollment 
     has steadily increased, and, with it, the promise of a more 
     diverse risk pool and greater protection for people with 
     serious health care needs. However, the recent 
     reinterpretation of the guidelines is jeopardizing 
     enrollment. Shortened enrollment periods, fewer resources for 
     outreach and education and less funding for consumer 
     navigators not only creates confusion for consumers but 
     directly impacts the number of individuals who enroll in 
     Marketplace coverage. Without Congressional action, these 
     trends will make it harder for many to access coverage and 
     will further contribute to the destabilization of insurance 
     markets and result in higher premiums for many enrollees.
       Making high-quality coverage and care more affordable is 
     also a high priority for the people that we represent. 
     Passage of legislation that expands access to and the level 
     of advance premium tax credits, fixes the family glitch, 
     creates a nationwide reinsurance program, and reduces 
     systemic health care costs could significantly ease the cost 
     burden for people of all income levels who rely on the 
     individual marketplace for coverage. We urge Congress to 
     support legislation that maintains the quality of coverage 
     while expanding access and affordability.
       Again, thank you for your leadership on this critical issue 
     for people with pre-existing conditions. We support your 
     efforts to halt the implementation of the 2018 guidance, 
     ensuring the guidance from 2015 remains intact and promoting 
     stability in the individual marketplace. We urge members of 
     Congress to vote for H.R. 986.
           Sincerely,
       Hemophilia Federation of America, National Health Council, 
     Cystic Fibrosis Foundation, Epilepsy Foundation, March of 
     Dimes, National Coalition for Cancer Survivorship, American 
     Heart Association, Alpha-1 Foundation, American Liver 
     Foundation, Susan G. Komen, National Hemophilia Foundation, 
     WomenHeart: The National Coalition for Women with Heart 
     Disease.
       National Multiple Sclerosis Society, Muscular Dystrophy 
     Association, Lutheran Services in America, American Lung 
     Association, National Alliance on Mental Illness, National 
     Patient Advocate Foundation, Arthritis Foundation, Leukemia & 
     Lymphoma Society, American Cancer Society Cancer Action 
     Network, National Organization for Rare Disorders, Pulmonary 
     Hypertension Association, Cancer Support Community.

  Mr. PALLONE. Mr. Chair, I yield back the balance of my time.
  Ms. JOHNSON of Texas. Mr. Chair, I want to voice my support for H.R. 
986, the Protecting Americans with Preexisting Conditions Act of 2019.
  This legislation will rescind the administration's October 2018 
Section 1332 waiver guidance, which is an essential step to protect 
pre-existing conditions and prevent the loss of comprehensive coverage 
plans. We will ensure that our constituents will be able to access the 
essential health benefits guaranteed under the Patient Protection and 
Affordable Care Act.
  As representatives of Americans from all corners of our country, we 
have a responsibility to protect the most vulnerable in our 
communities. We must ensure that our constituents, many with pre-
existing conditions, are not placed at risk of losing their health 
insurance coverage or fall victim to plans which fail to offer 
essential health benefits.
  As the first registered nurse elected to the United States Congress, 
I am proud to safeguard the healthcare of my constituents and all 
Americans through my support of the Protecting Americans with 
Preexisting Conditions Act of 2019.
  I urge my colleagues to support this legislation.
  Ms. CASTOR of Florida. Mr. Chair, I rise today to stand up for my 
neighbors--including those with preexisting conditions--by supporting 
H.R. 986, the Protecting Americans with Preexisting Conditions Act. 
Health care in American should be affordable and accessible to all. 
Passage of the Affordable Care Act in 2010 ensured that our neighbors 
with a preexisting condition, like asthma, heart disease or cancer, 
would no longer be denied insurance.
  It is unfortunate that the President and Republicans in Congress have 
made it their mission to sabotage the affordable health care of 
hardworking families, including gutting protections for people with 
preexisting conditions and take away affordable, quality health care 
from millions of Americans. I am cosponsoring the Protecting Americans 
with Preexisting Conditions Act to safeguard Americans from the Trump 
administration's efforts to undo the affordability and 
comprehensiveness of our

[[Page H3531]]

health care. H.R. 986 will overturn the Trump administration's 
expansion of Section 1332 waivers that were originally included in the 
Affordable Care Act to give states flexibility to experiment with 
insurance reforms that could improve the health and well-being of 
citizens. Unfortunately, the administration would instead use those 
waivers to weaken standards put in place to protect the health of 
Americans--especially our neighbors with preexisting conditions.
  H.R. 986 would end the administration's push of Americans into sub-
par and deceptive junk plans that many times exclude coverage for 
preexisting conditions. These plans do not provide basic benefits or 
financial protection standard and would return patients to the days 
when they would discover only when they get sick or God forbid get a 
cancer diagnosis that their plan imposes unreasonable limits on 
coverage and excludes vital benefits. They discriminate based on age, 
health status and gender.
  Democrats will not allow the Trump administration and Congressional 
Republicans to drive premiums higher in the individual market and rip 
coverage away from those that need it the most. I want to thank my 
colleague Rep. Kuster for helping lead this charge and I urge my 
colleagues to support H.R. 986 and support our neighbors with 
preexisting conditions.
  The CHAIR. All time for general debate has expired.
  Pursuant to the rule, the bill shall be considered for amendment 
under the 5-minute rule, and shall be considered as read.
  The text of the bill is as follows:

                                H.R. 986

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Protecting Americans with 
     Preexisting Conditions Act of 2019''.

     SEC. 2. PROVIDING THAT CERTAIN GUIDANCE RELATED TO WAIVERS 
                   FOR STATE INNOVATION UNDER THE PATIENT 
                   PROTECTION AND AFFORDABLE CARE ACT SHALL HAVE 
                   NO FORCE OR EFFECT.

       Beginning April 1, 2019, the Secretary of Health and Human 
     Services and the Secretary of the Treasury may not take any 
     action to implement, enforce, or otherwise give effect to the 
     guidance entitled ``State Relief and Empowerment Waivers'' 
     (83 Fed. Reg. 53575 (October 24, 2018)), and the Secretaries 
     may not promulgate any substantially similar guidance or 
     rule.

  The CHAIR. No amendment to the bill shall be in order except those 
printed in part A of House Report 116-51. Each such amendment may be 
offered only in the order printed in the report, by a Member designated 
in the report, shall be considered read, shall be debatable for the 
time specified in the report, equally divided and controlled by the 
proponent and an opponent, shall not be subject to amendment, and shall 
not be subject to a demand for division of the question.


                Amendment No. 1 Offered by Mr. Langevin

  The CHAIR. It is now in order to consider amendment No. 1 printed in 
part A of House Report 116-51.
  Mr. LANGEVIN. Mr. Chairman, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 3, insert after line 5 the following:

     SEC. 2. FINDINGS.

        Congress finds the following:
       (1) On October 24, 2018, the administration published new 
     guidance to carry out section 1332 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18052) entitled ``State 
     Relief and Empowerment Waivers'' (83 Fed. Reg. 53575).
       (2) The new guidance encourages States to provide health 
     insurance coverage through insurance plans that may 
     discriminate against individuals with preexisting health 
     conditions, including the one in four Americans living with a 
     disability.
       (3) The implementation and enforcement of the new guidance 
     weakens protections for the millions of Americans living with 
     preexisting health conditions and jeopardizes Americans' 
     access to quality, affordable health insurance coverage.
       Page 3, line 6, redesignate section 2 as section 3.

  The CHAIR. Pursuant to House Resolution 357, the gentleman from Rhode 
Island (Mr. Langevin) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Rhode Island.
  Mr. LANGEVIN. Mr. Chairman, I yield myself such time as I may 
consume.
  Mr. Chairman, Americans with disabilities have always faced 
significant barriers to healthcare. A decade ago, an insurer could 
charge a family an exorbitant amount to cover a child, merely because 
the child had asthma. An insurer could tell an amputee that they would 
cover her medical equipment except for treatment related to her 
amputated limb. Or an insurer could flat-out deny coverage to the 
victim of an accidental shooting at the age of 16 simply because he had 
a spinal cord injury.
  Essentially, insurers could legally discriminate against individuals 
with disabilities and face no consequences. That is absolutely 
outrageous, Mr. Chairman.
  Then Congress finally passed the Affordable Care Act and started to 
bring those barriers down. For the first time, people with preexisting 
health conditions, including the one in four Americans living with a 
disability, no longer had to worry about whether they would be denied 
comprehensive health insurance.

                              {time}  1530

  Coverage of essential health benefits meant a mother with a traumatic 
brain injury could obtain rehabilitative services and learn how to 
walk, a man with Parkinson's could access medication to control his 
tremors, or a child with a vision impairment could visit an eye doctor 
to prevent further vision loss.
  This access to healthcare is vital because, when Americans with 
disabilities are healthy, they can stay active with their families, 
pursue fulfilling careers, and engage in their communities.
  Unfortunately, the Trump administration is, once again, working to 
raise barriers to health coverage instead of working to eliminate them. 
The administration's October 2018 guidance encourages States to allow 
insurers to offer short-term, limited-duration plans that do not have 
to provide coverage of preexisting conditions or essential health 
benefits.
  This means insurers offering these junk plans can discriminate 
against disabled individuals by charging astronomical prices, excluding 
necessary treatments from coverage, or denying an individual health 
insurance altogether.
  This is outrageous. If you are having deja vu, it is because this is 
exactly what was happening to Americans with disabilities before the 
passage of the Affordable Care Act.
  The amendment that I am offering today makes clear exactly what 
people with disabilities have to lose if States act on the 
administration's guidance.
  I have spent my near two decades in Congress championing efforts to 
eliminate barriers to access and integration for people with 
disabilities and helping my fellow Americans understand their great 
potential.
  But, fundamentally, none of that matters if people with disabilities 
are not healthy because insurers deny them coverage to treat their 
conditions.
  The damage from the administration's guidance would be borne 
disproportionately by the disabled community, my community, and my 
amendment makes that clear.
  Whether someone is born with a disability, develops a disability, or 
becomes disabled due to an accident, that disability--I assure you--
happened by chance, not by choice.
  Even the healthiest 30-year-old today could be in a car accident 
tonight and wake up with a lifelong disability tomorrow; and, if that 
30-year-old had one of these junk plans, much of the cost of that care 
would fall on his or her own shoulders, and they would be on their own.
  I had hoped that, 9 years after the passage of the Affordable Care 
Act, I would no longer have to come here and defend the idea that 
quality, affordable healthcare is a right and not a privilege. But, 
once again, here we are.
  Mr. Chairman, I support my friend Congresswoman Kuster's underlying 
legislation, and I ask my colleagues to support my amendment to make 
clear the damage the Trump administration's guidance would cause to 
people with disabilities.
  Mr. Chairman, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I claim the time in opposition to the 
amendment.
  The CHAIR. The gentleman from Oregon is recognized for 5 minutes.
  Mr. WALDEN. Mr. Chairman, I would just say that section 1332 does not 
permit States to waive preexisting condition protections, period. And I 
would,

[[Page H3532]]

again, cite the guidance from the CMS director, Ms. Seema Verma, where 
she states that. And that will be in the Record.
  Again, I think what we are trying to do here is give States more 
flexibility to bring down the cost of health insurance, while following 
these guidelines as outlined.
  As I mentioned earlier in the debate, high deductibles are pricing 
people out of coverage, and by that, I mean they are walking away from 
getting the care that they need because they can't pay for it; or they 
are driving up their credit card debt, wiping out their savings, they 
are having to take another job, they are borrowing money from others.
  So, what the Trump administration is trying to do is build on what 
the Obama administration created, 1332 waivers, that have, frankly, 
been very successful in many, many States.
  Mr. Chairman, I reserve the balance of my time.
  Mr. LANGEVIN. Mr. Chairman, I just want to, in reference to the 
gentleman from Oregon's comments, state that the plans under the Obama 
administration were supposed to be very short in duration, for a 3-
month period, while individuals sought more comprehensive, appropriate 
health coverage according to their needs.
  It wasn't supposed to be a replacement for a good quality, affordable 
healthcare plan that would cover preexisting conditions and essential 
health benefits to identify problems early on, a potential lifelong or 
a very serious illness with long-term health consequences that could 
potentially even lead to losing one's life.
  They took what was supposed to be a stopgap, and now they are trying 
to make that a permanent plan. That is just wrong.
  The CHAIR. The time of the gentleman from Rhode Island has expired.
  Mr. WALDEN. Mr. Chairman, I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from Rhode Island (Mr. Langevin).
  The amendment was agreed to.


            Amendment No. 2 Offered by Mr. Brown of Maryland

  The CHAIR. It is now in order to consider amendment No. 2 printed in 
part A of House Report 116-51.
  Mr. BROWN of Maryland. Mr. Chair, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

        Page 3, line 17, insert after the period the following new 
     sentence: ``Nothing in the previous sentence shall be 
     construed to affect the approval of waivers under section 
     1332 of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18052) that establish reinsurance programs that are 
     consistent with the requirements under subsection (b)(1) of 
     such section (42 U.S.C. 18052(b)(1)), lower health insurance 
     premiums, and protect health insurance coverage for people 
     with preexisting conditions.''.

  The CHAIR. Pursuant to House Resolution 357, the gentleman from 
Maryland (Mr. Brown) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Maryland.
  Mr. BROWN of Maryland. Mr. Chair, I yield myself such time as I may 
consume.
  Mr. Chair, I rise in support of the underlying bill that will 
preserve protections for hundreds of thousands of Marylanders and 
Americans who, like me, have a preexisting condition.
  And I rise in support, of course, of my amendment to protect States 
which are acting to strengthen their insurance marketplaces, lower 
premiums, and expand access to high-quality care by preserving their 
reinsurance programs that they have established.
  For more than 2 years, the President, in concert with Republicans in 
Congress, have tried every trick in the book to undermine the 
Affordable Care Act. They tried repealing it, taking it to the courts, 
and now want to allow States to gut protections for those the 
Affordable Care Act helped most.
  These attacks jeopardize healthcare for Americans with chronic 
conditions like asthma, high blood pressure, and diabetes and threaten 
to bankrupt thousands of families with a loved one who has fallen ill 
due to no fault of their own.
  It is not just bad policy. It is fundamentally cruel.
  That is why, in the face of this onslaught by the Trump 
administration to make the Affordable Care Act less effective, we must 
provide States with every tool in the toolbox to keep premiums down, 
while preventing the Trump administration from giving States the power 
to gut essential protections.
  I firmly believe that States should have the power and flexibility to 
innovate and find healthcare solutions that work best for them. The 
Affordable Care Act always envisioned a critical role for States.
  States design their own exchanges, shape their Medicaid programs, and 
take the lead in enforcing patient protections and reviewing rate 
increases.
  These waivers took on new importance after President Trump and the 
Republican Congress failed to repeal ObamaCare and, instead, sought to 
undermine the Affordable Care Act by eliminating the requirement to 
obtain health insurance, ending cost-sharing payments for low-income 
individuals, passing regulations that encouraged short-term and junk 
insurance, and defunding advertising and outreach during open 
enrollment.
  This sabotage has caused more families to pay higher premiums and 
made fewer people able to get the high-quality care they deserve.
  States acted to counteract these efforts by establishing reinsurance 
programs and applying for State innovation waivers.
  Reinsurance programs protect insurers from very high, unpredictable 
medical expenses incurred by their Members.
  Alaska, Minnesota, Oregon, Maine, Wisconsin, New Jersey, and my own 
State of Maryland have all received Federal approval to establish 
reinsurance programs.
  These are the very programs my amendment seeks to protect. These 
programs work and meet the shared goal of making health insurance 
affordable and accessible to all Americans, including those with 
preexisting conditions.
  Reinsurance programs have been able to cut premiums by 20 percent, on 
average, and save the Federal Government nearly $1 billion.
  Maryland saw the biggest savings, lowering individual premiums by 
more than 43 percent. These lower premiums will help entice younger and 
healthier individuals to get insurance, making healthcare more 
affordable for everyone.
  While we have a President in the White House and Republicans in 
Congress who have made healthcare prohibitively expensive and stripped 
protections for those who need it most, it is imperative that this 
Congress protect our partners at the State level who are working with 
us to protect healthcare for all Americans.
  My amendment will protect these innovative reinsurance programs and 
encourage more States to adopt them.
  Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I claim the time in opposition to the 
gentleman's amendment.
  The CHAIR. The gentleman from Oregon is recognized for 5 minutes.
  Mr. WALDEN. Mr. Chairman, I am not necessarily opposed to his 
amendment, but I do think it is important to talk about the issues that 
really matter when it comes to affordable healthcare.
  Again, when we talked about giving States the authority to innovate 
and to protect their citizens, we are for that. I come from a State 
that pioneered the Oregon Health Plan.
  I was there. I created a select committee when I was the Republican 
majority leader of the Oregon House, when we finally got the waiver 
from the Federal Government after a couple of years to actually 
implement the Oregon Health Plan. It was very creative about how to 
hold down healthcare costs and expand coverage and do all those things. 
We have worked on a lot of different issues over the years.
  What we did with the President today, I think, is really important 
and, that is, looked at this issue of surprise billing: If you follow 
all the rules, you go to a hospital that is in your network, and let's 
say some provider gets sick in the night and they substitute somebody 
else who doesn't turn out to be in your network and then, weeks later, 
you get an astronomical bill through no fault of your own.
  There was a parent down there whose daughter had had, I think, some 
sort of

[[Page H3533]]

surgery, and the physician, on the way out, said: Oh, by the way, I 
want you to do just a little urine test here. We are going to run an 
analysis.
  So she did, left, and, a period of time later, got a bill for 
$17,000.
  Her dad is a doctor and said: How did this happen?
  Well, it turned out whoever did the test was not in the network of 
her insurance. She didn't know.

  What are you going to do? You have had whatever surgery she had, and 
on the way out the doctor says: Hey, by the way, give us a little 
sample. I just want to run a test because I have got you on this drug, 
and I want to make sure it is all working right.
  Then a $17,000 bill arrives a couple of months later.
  They were there with the President today in the Roosevelt Room at 
this bipartisan event. And her dad negotiated. He couldn't say what 
level, but it was certainly not what the insurer would have paid.
  Do you know what the insurer would have paid for that, in network? A 
hundred bucks. He said you can probably get the test done now for $25.
  A $17,000 bill arrives.
  This is what is happening to Americans who have insurance, and that 
is why we have got to deal with the surprise billing issue. It is why 
we have to squeeze the juice out of the middle of the healthcare 
delivery system.
  We do all these great innovations. And Republicans led the effort on 
the 21st Century Cures Act.
  We met with Dr. Francis Collins yesterday, the extraordinary leader 
of NIH; the longest-serving President-appointed--under Obama--NIH 
director in the history of our country.
  Because of what we put forward to dramatically increase investment in 
NIH--Republicans led that effort, Fred Upton, but joined with Diana 
DeGette, a Democrat out of Colorado, and a bunch of us--they are now 
finding cures.
  Dr. Collins said yesterday they have identified now 6,500 genetic 
diseases where they now can figure out, I'll say, the misspelling of 
the DNA code.
  Some of my colleagues may have seen on ``60 Minutes'' Dr. Collins 
talking about that they think they found a cure for sickle cell anemia. 
They found a misspelling--one letter misspelled in that big chain of 
DNA--that they were able to go in with our new technology--some of it 
is a result of what we have done collaboratively here--and change, 
alter, that letter.
  And they have these people now that there is no evidence of sickle 
cell in their blood platelets.
  There are 6,500 diseases that they now know the misspelling. Now they 
have got to figure out how to train your body, using immuno technology, 
to have your own cells turned on in a little different way and go after 
these diseases.
  These are remarkable advances in lifesaving medicines and treatments.

                              {time}  1545

  We, I think, as a country, have to figure out how we pay for that, if 
each one of these is individualized.
  Our system is antiquated and doesn't deal with this effectively. We 
are going to have to figure that out because a lifesaving cure isn't 
going to cure a life if people can't afford to get the medicine.
  We also need to drill down on telehealth and telemedicine.
  One of our colleagues today was talking about mental health services. 
My district is bigger than any State east of the Mississippi, unless 
you have to count Lake Michigan with Michigan, which, of course, you 
do. So telehealth really matters, and we are getting great results for 
our veterans and for our citizens using telehealth. But our providers 
don't often get paid for the service they provide over telehealth. Why? 
That is something we have to address.
  You go one thing after another after another here, where we should be 
spending our valuable legislative time solving the problems that real 
Americans run into every day of the week: How do I pay the bill? You 
tell me I have insurance, and I do, and I pay a record--I don't know 
whose premium under ObamaCare went down $2,500 a month, but I will talk 
about this more.
  Mr. Chair, I yield back the balance of my time.
  Mr. BROWN of Maryland. Mr. Chair, I join my colleague, the gentleman 
from Oregon, in acknowledging the great work that is happening in the 
States of Oregon, New Jersey, and Maryland in establishing these 
reinsurance programs. It is my amendment that seeks to protect these 
very strong programs, so I urge my colleagues to support this 
amendment.
  Mr. Chair, I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from Maryland (Mr. Brown).
  The question was taken; and the Chair announced that the ayes 
appeared to have it.
  Mr. BROWN of Maryland. Mr. Chair, I demand a recorded vote.
  The CHAIR. Pursuant to clause 6 of rule XVIII, further proceedings on 
the amendment offered by the gentleman from Maryland will be postponed.


                Amendment No. 3 Offered by Ms. Pressley

  The CHAIR. It is now in order to consider amendment No. 3 printed in 
part A of House Report 116-51.
  Ms. PRESSLEY. Mr. Chair, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       In section 2, insert ``, including any such action that 
     would result in individuals losing health insurance coverage 
     that includes the essential health benefits package (as 
     defined in subsection (a) of section 1302 of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18022(a)) 
     without regard to any waiver of any provision of such package 
     under a waiver under such section 1332), including the 
     maternity and newborn care essential health benefit described 
     in subsection (b)(1)(D) of such section'' after ``(October 
     24, 2018))''.

  The CHAIR. Pursuant to House Resolution 357, the gentlewoman from 
Massachusetts (Ms. Pressley) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Massachusetts.
  Ms. PRESSLEY. Mr. Chair, I rise today in support of my amendment to 
H.R. 986, the Protecting Patients with Preexisting Conditions Act.
  Quality, affordable healthcare is a fundamental human right, period. 
No one should have to face financial ruin while they are fighting for 
their life.
  When people are using GoFundMe pages to pay their medical bills, when 
parents are burying their children who ration their insulin to pay 
their student loans, we know that we are in the midst of a moral 
crisis. Yet, we must contend with an administration that is determined 
to roll back these rights and protections.
  Each of us has loved ones whose lives are put in conditional jeopardy 
when we erode protections for preexisting conditions. These efforts put 
lives at risk, and we are here today to fight back.
  In my district, the Massachusetts Seventh, half the residents are 
living with preexisting conditions. Families are struggling with some 
of the highest per capita healthcare costs in the Nation, even as they 
live in the shadow of some of the best healthcare institutions in the 
world.
  In my district, travel 3 miles from Back Bay to Roxbury, and life 
expectancy drops 30 years--30.
  Since its implementation, the ACA has provided critical protections 
for the nearly 3 million residents of Massachusetts living with 
preexisting conditions.
  Our families, our neighbors, our communities are depending on us to 
uphold the lifesaving protections for people with preexisting 
conditions. We can do that today by passing H.R. 986.
  Mr. Chair, my amendment to H.R. 986 affirms that women's healthcare 
isn't optional. It is an essential benefit every plan must cover. At a 
time when more than 67 million American women and girls are living with 
a preexisting condition, we cannot--no, we will not go backward.
  At a time when life expectancy is declining because of gun violence, 
opioid use, and a maternal mortality crisis, we cannot afford to 
compromise on these essential services.
  Before the ACA, Mr. Chair, typical insurance plans considered 
maternity care a luxury benefit, and women consistently paid more for 
primary care than men. In fact, women who have given birth, had a C-
section, or were living with HIV or a previous breast cancer diagnosis 
could be considered to

[[Page H3534]]

have preexisting conditions and denied coverage.
  Thanks to the ACA, many women who were previously uninsured gained 
health coverage, including vital access to preventative care.
  This administration's cruel and dangerous guidance would weaken these 
provisions and allow insurers to sell skimpy plans that can exclude 
coverage like maternity care and pediatric services.
  The ACA is our floor, not our ceiling. We must continue to fight for 
universal healthcare. We must continue to push for a healthcare system 
that meets the needs of the people we represent, a healthcare system 
that sees all people, hears all people, and cares for all people in a 
way that promotes safety, dignity, and respect. I urge my colleagues to 
support this amendment.
  Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chair, I claim the time in opposition, although I am 
not necessarily opposed to the gentlewoman's amendment.
  The CHAIR. Without objection, the gentleman from Oregon is recognized 
for 5 minutes.
  There was no objection.
  Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
  Ms. PRESSLEY. Mr. Chair, I yield back the balance of my time.
  Mr. WALDEN. Mr. Chair, I appreciate the gentlewoman's comments and 
her amendment. I don't intend to oppose her amendment, but I do want to 
pick up on something she said that is really important.
  The gentlewoman mentioned opioids. In the last Congress, when I 
chaired the Energy and Commerce Committee, I helped lead the bipartisan 
effort to produce 60 pieces of legislation dealing with the opioid 
crisis, to help those who were addicted get the assistance they need, 
to get resources into our communities to help medical advancements to 
find non-opioid-related medical treatments, and to stop fentanyl from 
coming into our country.
  I didn't get the opportunity, but I hope the President and his team 
will continue to raise this issue with the Chinese leadership when they 
come because a lot of this illicit fentanyl is being produced in China 
and then coming to the United States.
  Dr. Burgess, who was our chair of the Subcommittee on Health and is 
now the top Republican, I think went up to the chairman's district in 
New Jersey and viewed one of the international mail processing 
facilities. At least, it was in New Jersey. I don't know its precise 
location.
  Together we said, working with the Trump administration's FDA 
Commissioner, we have to do more at these mail processing facilities to 
stop fentanyl from coming in.
  By the way, fentanyl is like 100 times more potent than morphine. If 
you had a salt shaker and put out, I don't know, 10, 15 grains of salt 
and ingested that, if it was fentanyl, it would kill you.
  We said let's put more resources toward stopping illegal fentanyl 
from coming into the United States, and we are doing that now. We are 
beefing that up.
  It comes in through Mexico as well. It is both China and Mexico. It 
is creating pockets of death in our communities. Especially in some of 
our urban areas, we have seen where it gets mixed in with heroin to 
give even a higher high or whatever. Then you see groups of people who 
take this, not knowing it has been jacked up with fentanyl, and you 
have a whole group that dies.
  The most insidious discussion or incident I heard about was a parent 
who I got to know a little bit, whose daughter, he told me, self-
medicated occasionally with heroin, and she died in college.
  When they did the autopsy, they figured out she had been given 100 
percent fentanyl. It wasn't a mix with heroin, Mr. Chair.
  The tragedy of that was, he felt that her supplier knew she was an 
occasional user so had low tolerance and, basically, probably killed 
her to prove to his other buyers that he had the most potent stuff on 
the street.
  A colleague of ours, Mr. Katko, who was a prosecutor before he came 
to the Congress, he and I were having a discussion on this matter. He 
said he prosecuted a case just like that. That is how evil this stuff 
is.
  As we look at the whole panoply of issues about healthcare, mental 
health services, addiction services, stopping these things from coming 
in, we can find a lot of common ground.
  Republicans supported protections for preexisting conditions before 
the ACA, during the ACA, after the ACA today. We did. Same with putting 
kids on your policies at 26. We agreed with those principles.
  But the ObamaCare act was rammed through this House and the Senate, 
and we weren't even allowed to bring any of the 90-some amendments we 
offered to the floor. We were completely shut out of that process. It 
was a horrible process, and it shouldn't be repeated.
  I hear a lot about how we voted to repeal it a bazillion times. Well, 
you know what? If you go through and dissect those votes, there were a 
whole bunch of Democrats that voted with us. The President at the time, 
President Obama, signed some of that legislation because even he 
admitted there were problems in the ACA.
  Going forward, I hope we can address the big problem in America, 
which is high-cost insurance, high deductibles, but, moreover, the high 
cost of healthcare itself because it is pretty hard to go home and 
explain why things cost what they do today.
  We have to get around the high cost issue. The access issue, that is 
where earlier I talked about telehealth and telemedicine. There is a 
lot of work we will do together.
  Unfortunately, this is a mislabeled bill today. The laws governing 
1332 waivers prohibit what the majority is concerned about. But I don't 
have opposition to this amendment.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the 
gentlewoman from Massachusetts (Ms. Pressley).
  The amendment was agreed to.


          Amendment No. 4 Offered by Mr. Harder of California

  The CHAIR. It is now in order to consider amendment No. 4 printed in 
part A of House Report 116-51.
  Mr. HARDER of California. Mr. Chairman, I have an amendment at the 
desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add at the end the following:

     SEC. 3. GAO REPORT ON AFFECT OF STATE INNOVATION WAIVERS ON 
                   COVERAGE OF INDIVIDUALS AND ON MENTAL HEALTH 
                   HEALTH CARE TREATMENT.

       Not later than 1 year after the date of the enactment of 
     this Act, the Comptroller General of the United States shall 
     submit to Congress a report on the number of individuals 
     expected to lose access to health insurance coverage (as 
     defined in section 2791 of the Public Health Service Act (42 
     U.S.C. 300gg-91)) if section 2 were not enacted and waivers 
     under section 1332 of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 18052) were approved under the guidance 
     described in such section 2. Such report shall include an 
     analysis of the expected effect such waivers approved under 
     such guidance would have on mental health care treatment.

  The CHAIR. Pursuant to House Resolution 357, the gentleman from 
California (Mr. Harder) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from California.
  Mr. HARDER of California. Mr. Chair, I rise in support of my 
amendment.
  As I stated in my previous remarks, my amendment would simply require 
the Federal Government to issue an expert analysis of the impact of 
junk plans on mental health access.
  People deserve access to mental healthcare, and we need to know how 
many people will lose that access if these junk plans become used more 
widely.
  Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chair, I claim the time in opposition to the 
gentleman's amendment.
  The CHAIR. The gentleman from Oregon is recognized for 5 minutes.
  Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
  Mr. HARDER of California. Mr. Chair, I yield back the balance of my 
time.
  Mr. WALDEN. Mr. Chair, I appreciate the gentleman's amendment.
  Look, we all care deeply about getting mental health services into 
our community. In fact, under Republican leadership on the Energy and 
Commerce Committee a few years ago, we

[[Page H3535]]

rewrote America's mental health laws for the first time since John 
Kennedy signed the last bill into law before he was tragically 
assassinated in Texas. It was a lot of work, but it was bipartisan 
work.
  Not only did we look at those mental health laws that were on the 
books, because what happens around here is somebody comes up with a new 
idea, so you put a new program in place, and you give an authorization. 
Maybe it gets funded, maybe it doesn't. A year goes by. Somebody has a 
new idea. Put another one on the books. Nobody ever goes back and looks 
at what worked and what didn't.
  So our colleague, Dr. Murphy, at the time, who is a psychologist and 
a terrific leader in this area, really drove this review and said, 
look, we have to help kids with mental illness, and we need to help 
adults.
  We could deal with a lot of the violence in America if you got people 
care. It is not that everybody with mental illness goes violent, but we 
do know that mental health services help people in every way and that 
the programs we had--we had a lot of them--weren't funded, weren't 
funded properly, or didn't work. Some worked better than others.
  We had this comprehensive review in the Energy and Commerce Committee 
of these different programs the Federal Government has. Then we said, 
going forward--kind of what you are trying to do with this GAO report 
in a little different way--let's measure the efficacy of the programs 
we do have.

                              {time}  1600

  Let's find out what is working in our communities, and then let's get 
aid into our communities directly. Let's cut out the middle bureaucracy 
and get assistance, financial assistance into our communities.
  So we passed that. That is now the law of the land. And I think last 
year we were able to get money into that, finally, and I hope we can do 
more going forward, because we know that--I am being a little sarcastic 
here, but it is an extraordinary finding. Guess what? Your brain and 
your physical body are connected. Who knew, right? And we have all 
known that.
  So I supported the effort to get the same treatment under insurance 
for mental health as physical health because they are completely 
connected. So going forward, we have got to make sure that that bond is 
strengthened, not weakened, and that people continue to get help for 
mental health.
  I am a big believer in that. I know it works. It is fascinating to 
see, with the whole genome project, now they can do a genetic test and 
figure out which mental health drug will work in your body or my body. 
We didn't know that before, and now they can figure out which one will 
actually work for you or me or whomever.
  I hope we have lifted the stigma on people needing mental health 
services. We are just a big bag of chemicals, and things get out of 
balance. So I hope that we have lifted that as we did, I believe, on 
addiction.
  There are a lot of people, and over time people evolve their views 
and get better understandings, and I think over time we realized that 
people with drug addictions--especially this came out through our 
opioids work--weren't necessarily criminals. They weren't to be shunned 
from society.
  What we learned in the course of our work on opioids was, when I 
talked to parents whose kids had a high school football injury or 
something and the doctor gave them a painkiller, all of a sudden, this 
stuff is so addictive, a few treatments and they are hooked, and then 
they need more and more and more and more.
  I always remember my friend Mr. Rush from the Chicago area, when we 
were talking about treatment for opioids, said: That is great you are 
doing that. When the people I represented had issues in terms of crack 
cocaine and all, you just called them druggies and you put them in 
prison.
  That affected what we wrote and how we legislated, and we moved away 
from calling it treatment for opioids to people with substance abuse 
because we realized we needed to think broader as a country and as a 
Congress, and we did that and we changed the law. All that now is law 
to deal with opioids and mental health services.
  So, Mr. Chairman, I don't have an objection to this amendment, but 
there is a lot we have done and a lot more we need to do, and I will 
talk about some of the things we need to do going forward.
  Mr. Chairman, I yield back the balance of my time.
  The CHAIR. The question is on the amendment offered by the gentleman 
from California (Mr. Harder).
  The amendment was agreed to.


                 Amendment No. 5 Offered by Mr. Walden

  The CHAIR. It is now in order to consider amendment No. 5 printed in 
part A of House Report 116-51.
  Mr. WALDEN. Mr. Chairman, I have an amendment at the desk. I believe 
it is No. 5, printed in House Report 116-51.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Beginning on page 3, line 4, strike ``Protecting Americans 
     with Preexisting Conditions Act of 2019'' and insert ``This 
     Bill Actually Has Nothing to do with Protecting Americans 
     with Preexisting Conditions Act''.

  The CHAIR. Pursuant to House Resolution 357, the gentleman from 
Oregon (Mr. Walden) and a Member opposed each will control 5 minutes.
  The Chair recognizes the gentleman from Oregon.
  Mr. WALDEN. Mr. Chairman, I would just say, in terms of this 
amendment, it is just trying to make the point that the bill we have 
before us today is not as described or labeled. In our opinion, it is 
more about politics and gotcha politics than it is about the underlying 
issue.
  We know from the Department of Health and Human Services, they have 
made it clear in the letter from the Director who would approve these 
waivers that she believes that the underlying law protects people with 
preexisting conditions and all the other things I talked about earlier, 
that they can't waive that law--they cannot.
  So I would enter into the Record again, Mr. Chairman, as part of my 
remarks, her comments about the guidance, the 2018 guidance, and where 
she says it does not erode ObamaCare's preexisting condition 
provisions. She is the one in charge of this. That is what she is 
saying.
  But I want to talk about something else she says in this letter about 
premiums and the costs to people getting their insurance. She says: 
``Under the PPACA''--or ObamaCare or the Affordable Care Act, however 
you want to describe it--``we have seen dramatically higher premiums 
and decreased options for millions of consumers, in large part due to 
the law's overly prescriptive mandates and excessive Federal Government 
takeover of areas traditionally left under State oversight.''
  She points out: ``In 2019, the average monthly premium for a 
benchmark plan for a family of four on HealthCare.gov is now over 
$1,500, which can easily exceed a family's mortgage.''
  Continuing with her letter to me, she said: ``There are many areas of 
the country with far higher monthly premiums. For example, a of 60-
year-old couple living in Grand Island, Nebraska, making $70,000 a 
year, will need to pay over $3,000 per month for the lowest cost silver 
plan available. That is almost $38,000 per year for a plan with an 
$11,100 deductible.''
  Now, think about that, Mr. Chair. This is a couple that is making 
$70,000 a year. They are 60 years old. They live in Nebraska, and 
$3,000 a month in premiums, over $3,000, and an $11,000 deductible. 
That is over $48,000, and they only make $70,000 a year.
  This is happening in America today. Heck, it is happening in Nebraska 
right now. So what we are saying is people are walking away.
  She goes on to say: ``For millions of Americans, coverage this 
expensive is not a realistic option, and many choose to go without 
coverage at all. In fact, after average premiums rose by 21 percent, 
1.3 million unsubsidized people walked away from the market in 2017.''
  Those are the people we need to be helping. There is a lot more we 
need to be doing. I will put the rest of this in the Record. But I 
think everybody knows we are just trying make a point with this 
amendment.
  Mr. Chair, I ask unanimous consent to withdraw my amendment.
  The CHAIR. Is there objection to the request of the gentleman from 
Oregon?
  Mr. PALLONE. Mr. Chair, I object.

[[Page H3536]]

  The CHAIR. Objection is heard.
  Mr. PALLONE. Mr. Chair, I claim the time in opposition to the 
amendment.
  The CHAIR. The gentleman from New Jersey will suspend.
  The gentleman from Oregon is recognized.
  Mr. WALDEN. Mr. Chairman, just to clarify, from a parliamentary 
standpoint, I was just going to withdraw the amendment, but if the 
gentleman wants to speak on it, I can ask unanimous consent to withdraw 
it after he speaks.
  Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I claim the time in opposition to the 
gentleman from Oregon's amendment.
  The CHAIR. The gentleman from New Jersey is recognized for 5 minutes.
  Mr. PALLONE. Mr. Chairman, it disturbs me, I guess, that my colleague 
on the other side, whom I greatly respect, keeps mentioning this letter 
from Seema Verma, the CMS Administrator.
  Nothing that she says in her letter is in any way going to change the 
guidance that she and the Trump administration have put forward that 
would undermine people with preexisting conditions' ability to get good 
insurance if this guidance is allowed to continue and States get 
waivers pursuant to the guidance, because of, again, the issue of 
affordability.
  You see, the problem is that the 1332 waivers, the way they are set 
out in the ACA, have certain guardrails, if you will, to prevent 
waivers that would allow for junk insurance and other policies that 
would undermine people with preexisting conditions from getting good 
insurance.
  Those guardrails say that any kind of waiver has to guarantee 
affordability, has to guarantee comprehensive coverage, the essential 
benefits package, robust coverage, and also not reduce the number of 
people who are insured.
  This guidance that Seema Verma and the Trump administration have put 
forward does exactly the opposite, because it allows insurance to be 
sold, if a State seeks to do so, that would eliminate, for example, 
hospitalization or eliminate mental health coverage or eliminate 
coverage for maternity care.
  Now, if you are someone with preexisting conditions and they 
eliminate coverage for your preexisting condition, that relates to your 
preexisting condition, you might as well not even have insurance, and 
that is why we say it is junk. It lets a waiver be granted that would 
allow the insurance companies of that State to charge more based on 
age, based on sex. I mean, the list goes on.
  So Seema Verma can send out all the letters she wants, but it doesn't 
mean anything.
  I like to say, you know, one of the things that disturbs me most, 
also, is we on the Democratic side, myself and some of the other 
chairmen of some of the other committees, sent a letter and a request, 
because it has been pointed out repeatedly that Seema Verma has been 
putting out contracts up to $4 million a year to basically promote 
herself, and that is being investigated right now as we speak.

  So, again, I don't like to say bad things about people, but the 
bottom line is she is in no position to be telling us what is in this 
guidance. This guidance is going to hurt people with preexisting 
conditions, and there is no way that she is going to get around it.
  Mr. Chair, I reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I would just suggest that it was Seema 
Verma who is the head of CMS who issued the guidance, so I think she is 
in a position to have a say about what she believes the guidance allows 
or doesn't.
  To be clear, to quote her letter again: ``The 2018 guidance does 
nothing to erode the PPACA's preexisting condition provisions.'' That 
is what she is saying.
  So I think that letter is important. She put it in writing. She has 
said that repeatedly, and so I take her at her word. I do. I include 
her letter in the Record.
                                            Centers for Medicare &


                                            Medicaid Services,

                                      Washington, DC, May 7, 2019.
     Hon. Greg Walden,
     Ranking Member, House Committee on Energy and Commerce, House 
         of Representatives, Washington, DC.
       Dear Representative Walden: Thank you for your continued 
     interest in new state flexibility available under guidance 
     recently issued interpreting section 1332 of the Patient 
     Protection and Affordable Care Act (PPACA) (the 2018 
     guidance). Working within the limitations of the PPACA, this 
     2018 guidance is an important element of the Administration's 
     actions to expand options and lower costs for patients around 
     the country. I wanted to take this opportunity to set the 
     record straight and reaffirm this Administration's commitment 
     to lowering healthcare costs, increasing consumer choices, 
     and protecting our most vulnerable citizens, including those 
     who have pre-existing conditions.
       To be very clear, the 2018 guidance does nothing to erode 
     the PPACA's pre-existing condition provisions, which cannot 
     be waived under section 1332. Section 1332 does not permit 
     states to waive Public Health Service Act requirements such 
     as guaranteed availability and renewability of health 
     insurance, the prohibition on using health status to vary 
     premiums, and the prohibition on pre-existing conditions 
     exclusions. Furthermore, a section 1332 waiver cannot be 
     approved that might otherwise undermine these requirements. 
     This Administration stands committed to protecting people 
     with pre-existing conditions.
       Under the PPACA, we have seen dramatically higher premiums 
     and decreased options for millions of consumers, in large 
     part due to the law's overly prescriptive mandates and 
     excessive Federal government takeover of areas traditionally 
     under state oversight. In 2019, the average monthly premium 
     for a benchmark plan for a family of four on HealthCare.gov 
     is now over $1,500, which can easily exceed a family's 
     mortgage. There are many areas of the country with far higher 
     monthly premiums. For example, a 60-year-old couple living in 
     Grand Island, Nebraska, making $70,000 a year, will need to 
     pay over $3,000 per month for the lowest cost silver plan 
     available. That's almost $38,000 per year for a plan with an 
     $11,100 deductible. That's over half their income.
       For millions of Americans, coverage this expensive is not a 
     realistic option, and many choose to go without coverage at 
     all. In fact, after average premiums rose by 21 percent, 1.3 
     million unsubsidized people walked away from the market in 
     2017, the last year the prior administration oversaw open 
     enrollment. While these higher premiums force some people to 
     go uninsured, coverage is generally not optional for people 
     with a pre-existing condition and so, without a subsidy, 
     someone with a pre-existing condition must face the full 
     burden of the PPACA's skyhigh premiums. This Administration 
     has not forgotten the people facing this hardship.
       Section 1332 of the PPACA provides the discretion to 
     approve a section 1332 state waiver plan if the following 
     four statutory guardrails are met: affordability, 
     comprehensiveness, coverage, and federal deficit neutrality. 
     Section 1332 allows states to develop new healthcare programs 
     and solutions that would be not permissible without a section 
     1332 waiver.
       Unfortunately, guidance issued under the prior 
     Administration in December 2015 (the 2015 guidance) regarding 
     section 1332 waivers had the effect of significantly 
     restricting the innovation states could pursue. The prior 
     Administration imposed a one-size-fits-all approach to these 
     waivers, making it difficult for states to address the 
     specific needs of their residents.
       In October, the Administration issued guidance under 
     section 1332 of the PPACA to provide states with significant 
     opportunities to chart a different course for their markets 
     through expanded flexibility. Section 1332 and the 2018 
     guidance ensure that consumers who wish to retain coverage 
     similar to that provided under the PPACA can do so, but they 
     empower states to take steps to stabilize their markets and 
     allow more affordable coverage options that may be more 
     attractive to individuals and families priced out of the 
     current market, including people with pre-existing 
     conditions.
       Over the past two years, this Administration has approved 
     seven section 1332 waivers authorizing reinsurance programs 
     to help fund claims for people with high healthcare costs. 
     These reinsurance programs provide much needed premium relief 
     for people in the market and, in particular, for people with 
     pre-existing conditions without other coverage options. These 
     section 1332 waivers were all approved under the prior, more 
     restrictive 2015 guidance. I believe, given the expanded 
     flexibility discussed in the 2018 guidance, states will be 
     able to develop additional healthcare programs and solutions 
     that work for their residents.
       As you know, some have criticized the state flexibility 
     offered under the 2018 guidance, claiming that states will 
     pursue section 1332 waivers that undermine their own 
     individual market risk pools and make coverage more expensive 
     for their own residents with pre-existing conditions. Again, 
     I want to make clear that a section 1332 waiver cannot 
     undermine coverage for people with pre-existing conditions. 
     Moreover, any section 1332 waiver will need to carefully 
     account for any impact on the individual market risk pool and 
     guarantee that access to coverage is at least as 
     comprehensive and affordable as would exist without the 
     waiver.
       So, if a state seeks to pursue the use of more affordable 
     options, such as catastrophic plans or short-term limited 
     duration plans, under a section 1332 state waiver plan, the 
     state must ensure access to coverage that is overall as 
     affordable and comprehensive for people who remain in the 
     individual market risk pool.

[[Page H3537]]

       Thank you again for your shared interest in bringing down 
     healthcare costs and protecting our fellow Americans with 
     pre-existing conditions. We remain focused on improving our 
     nation's health care system by empowering states to innovate 
     and develop new solutions to expand access to affordable and 
     high value coverage options, and we look forward to working 
     with you to achieve these goals. Should you have questions, 
     please contact the CMS Office of Legislation.
           Sincerely,
                                                      Seema Verma.

  Mr. WALDEN. Now, Mr. Chair, I was willing to withdraw the amendment. 
That takes unanimous consent, and I just would attempt to do that 
again. I don't know if my colleague cares about that or not.
  Mr. PALLONE. Mr. Chair, I have no objection.
  Mr. WALDEN. Mr. Chairman, so we can move on to the other amendments, 
I ask unanimous consent to withdraw the amendment.
  The CHAIR. Is there objection to the request of the gentleman from 
Oregon?
  There was no objection.
  The CHAIR. The amendment is withdrawn.
  The Chair understands that amendment No. 6 will not be offered.


                 Amendment No. 7 Offered by Mr. Holding

  The CHAIR. It is now in order to consider amendment No. 7 printed in 
part A of House Report 116-51.
  Mr. HOLDING. Mr. Chairman, I have an amendment at the desk.
  The CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 3, beginning on line 4, strike ``Protecting Americans 
     with Preexisting Conditions Act of 2019'' and insert ``Insert 
     Politically Punchy Title That Doesn't Reflect the Bill 
     Substance Act''.
  The CHAIR. Pursuant to House Resolution 357, the gentleman from North 
Carolina (Mr. Holding) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from North Carolina.
  Mr. HOLDING. Mr. Chairman, I believe my amendment speaks for itself.
  My friends on the other side of the aisle are playing political games 
with their bill trying to convince the American people that it would 
accomplish something that it would not. I have offered a title that 
accurately reflects the political grandstanding that my Democrat 
friends are effecting today.
  Mr. Chair, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I claim the time in opposition to the 
amendment.
  The CHAIR. The gentleman from New Jersey is recognized for 5 minutes.
  Mr. PALLONE. Mr. Chairman, just to back up what I said previously 
about the implications for this Trump administration and Seema Verma's 
guidance that they put forward with regard to 1332, I want to read a 
section from a letter that was sent by 23 patient and consumer advocacy 
organizations in support of H.R. 986, the bill that is before us. These 
organizations include the Heart Association, the Lung Association, the 
Epilepsy Foundation, et cetera. This goes back to the guardrails.
  As I said, under 1332, in the ACA, there are guardrails that say that 
any waivers have to guarantee affordability, have to guarantee 
comprehensiveness of coverage, and have to, at the same time, not 
reduce the number of people with insurance.
  Nothing that Seema Verma or anything on the other side that is being 
said is suggesting in any way that, under this guidance, those 
principles wouldn't be violated. In fact, they would be violated.
  So this is what these 23 patient and consumer advocacy organizations 
say about the Trump guidance waiver: ``This gross misinterpretation of 
the guardrails will have real consequences for patients, steering 
people into substandard coverage, such as short-term, limited-duration 
plans and association health plans, which often do not cover the full 
range of benefits and services that patients rely on to manage their 
conditions.
  ``Further, policies that could be implemented under this new 
interpretation could fundamentally alter the risk pool for a State's 
individual marketplace, making comprehensive coverage unaffordable for 
patients who rely on it and jeopardizing the stability of the State's 
marketplace. The resulting lack of access to care could have 
devastating short- and long-term consequences for the millions of 
patients we represent.''

                              {time}  1615

  The bottom line is this is going to dramatically hurt people with 
preexisting conditions if they try to buy insurance that will cover the 
maladies that they want to cover, and they need to have covered.
  Again, I don't understand, Mr. Holding and, previously, Mr. Walden 
have these amendments that really have nothing substantive to say. All 
they do is talk about changing the title because they are trying to 
ridicule what Democrats are trying to do here, which is to guarantee 
that people with preexisting conditions are protected.
  I don't want to get upset, but I think that it is kind of 
inappropriate, when here we are trying to guarantee people with 
preexisting conditions are protected--even Republicans on the other 
side are saying that is important to them--and, instead of having a 
serious debate about this, they put forward amendments that change the 
title to ridicule what we are trying to do. It is just unfortunate that 
we are at that point now, but that is where we are.
  Madam Chairman, I reserve the balance of my time.
  Mr. HOLDING. Madam Chair, I yield to the gentleman from Oregon (Mr. 
Walden).
  Mr. WALDEN. Madam Chair, I thank the gentleman for yielding.
  Madam Chair, I just want to say that I, too, wish we were debating my 
legislation that I tried to offer the first of the Congress and was 
refused the opportunity to bring it to the floor. That would lock into 
statute preexisting protections for people who have preexisting 
conditions.
  This court case is pending. We could get a ruling tomorrow. Somewhere 
in the last couple of months, Congress could have acted to put in 
statute a separate law that would be there, irrespective of the 
decision of the judge, or judges as it goes through its process, that 
could wipe out all of the ACA and could wipe out preexisting condition 
protections. We could do that, except their Committee on Rules put 
these amendments in order to debate on the floor, but not the amendment 
that actually protects people with preexisting conditions. So it is not 
my fault--we don't control of the Rules Committee--that my serious 
amendment about protecting people with preexisting conditions was not 
made in order. I don't control the Rules Committee. The Speaker does, 
and others.
  When we talk about affordability, remember the example that Seema 
Verma points out, in Grand Island, Nebraska, a couple making $60,000 a 
year, 60 years old, $38,000 for the plan, and $11,000 deductible. How 
is that affordable? It is not.
  I want our States to innovate. Do you know what, if a State doesn't 
want to innovate, it doesn't have to. And if they violate the rules, 
they are not going to get their waiver.
  But what we do know is that when States have innovated, like mine, 
like the gentlemen from Wisconsin and Alaska, they have seen reductions 
in premiums and full-throated coverage. I want innovation. I don't want 
to price people out of the market.
  Mr. HOLDING. Madam Chair, this bill before us today makes no 
structural changes to improve access to or delivery of care. It would 
limit healthcare choices and stifle State level innovation that has 
proven to lower premiums. This bill does not help those with 
preexisting conditions, but it does attempt to confuse them and 
encourage more political dysfunction to the detriment of the American 
people.
  Madam Chair, I yield back the balance of my time.
  Mr. PALLONE. Madam Chair, my colleagues on the other side started out 
this debate on these amendments by basically saying they wanted to 
substitute the title rather than talking about the substance. Now, my 
colleague, the ranking member, starts talking about the lawsuit that 
would--I think he is talking about the lawsuit that would repeal the 
Affordable Care Act.
  Again, my colleagues on the other side are not looking to protect 
people with preexisting conditions, they are not looking to protect 
anybody, because now they are saying that it is a

[[Page H3538]]

good idea to repeal the Affordable Care Act. So we are back to the 
basic debate about whether or not we should have the Affordable Care 
Act, which until President Trump came along and started sabotaging the 
bill, 97 percent of Americans had health insurance, an all-time high in 
the history of this country.
  So, okay, that is fine. Now we are going to say that they want to 
repeal the Affordable Care Act once again. This is what this is all 
about on their side of the aisle: repeal the act, move to court to try 
to get the courts to declare the act unconstitutional, no effort to 
worry about the millions and millions of Americans who have gotten 
coverage because of the Affordable Care Act.
  I really don't know what else I can say at this point, but at least 
they revealed their true motive, which is simply to repeal the whole 
bill.
  Once again, I guess there is not much to say here, other than to say 
that I would urge my colleagues to reject this amendment. Let's get 
back to talking about the substance of the bill that is before us, 
which would guarantee that there are protections for people with 
preexisting conditions.
  Madam Chair, I yield back the balance of my time.
  The Acting CHAIR (Ms. Underwood). The question is on the amendment 
offered by the gentleman from North Carolina (Mr. Holding).
  The question was taken; and the Acting Chair announced that the noes 
appeared to have it.
  Mr. PALLONE. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from North 
Carolina will be postponed.


                 Amendment No. 8 Offered by Ms. Porter

  The Acting CHAIR. It is now in order to consider amendment No. 8 
printed in part A of House Report 116-51.
  Ms. PORTER. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       In section 2, insert ``, including any such action that 
     would result in a decrease in the number of such individuals 
     enrolled in coverage that is at least as comprehensive as the 
     coverage defined in section 1302(a) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18022(a)) compared to the 
     number of such individuals who would have been so enrolled in 
     such coverage had such action not been taken'' after 
     ``(October 24, 2018))''.

  The Acting CHAIR. Pursuant to House Resolution 357, the gentlewoman 
from California (Ms. Porter) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from California.
  Ms. PORTER. Madam Chair, I rise today to offer an amendment to the 
Protecting Americans with Preexisting Conditions Act.
  This bill would prevent the Trump administration from allowing States 
to use waivers to provide junk health plans that reduce coverage and 
decrease cost sharing provisions.
  In the Affordable Care Act, section 1332 waivers were created to 
provide States flexibility to implement innovative plans that would 
expand coverage, reduce costs, and provide more comprehensive benefits.
  Our States can be incubators for opportunity and these waivers allow 
them the opportunity to improve access to affordable, quality services 
in groundbreaking ways. But, last year, the Trump administration 
released guidance that would allow States to use these waivers to take 
care away from the individuals who need it most, and that is 
unacceptable.
  Because of the Affordable Care Act, 3,826,000 Californians have 
gained health coverage. In my home district, the 45th District of 
California, more than 338,000 people have a preexisting condition, many 
of whom gained coverage or received more affordable coverage because of 
new protections established under the Affordable Care Act.
  This Sunday is Mother's Day. Having given birth, being a mother, is a 
preexisting condition, a factor that used to contribute to higher 
insurance costs for most of the women we will celebrate this weekend. 
We can't go back to the days when being a woman was enough to let an 
insurance company charge you more for basic healthcare.
  My amendment will prohibit the administration from issuing any 
waivers that would let States craft healthcare plans that would reduce 
the number of individuals enrolled in comprehensive plans that are 
compliant with our country's current healthcare laws.
  This bill preserves waivers that provide States with flexibility. 
This bill encourages States to provide innovative plans. But what this 
bill does is make sure that those waivers can be used for their 
original intent: expanding care and decreasing costs.
  Madam Chair, I urge my colleagues to support my amendment, and I 
reserve the balance of my time.
  Mr. WALDEN. Madam Chair, I seek time in opposition to the 
gentlewoman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Madam Chair, I would like to point out a couple of 
things.
  One, I have introduced legislation to protect people with preexisting 
conditions. I did that because I knew this lawsuit is pending. We can 
argue about the ACA and the lawsuit and all that, but the long and 
short of it is that if the court rules the ACA gets thrown out as 
unconstitutional, which may happen, people with preexisting conditions 
would be exposed, and I don't want that to happen. That is why I 
introduced legislation.
  I would be honored if we could take that up in the Energy and 
Commerce Committee that I used to chair and put it on the House floor. 
I tried to bring it here as an amendment and it was denied by the 
Democrat majority, so we can't even have a debate here about it. If it 
is not everything it should be, then I am happy to work with people to 
try and make it as durable and robust as it needs to be. So that is 
one.
  When we talk about insurance--and there is kind of silence on the 
other side--2.5 million Americans since President Trump have gotten 
healthcare insurance through their employer. We have one of the most 
robust economies most Americans have ever seen: 3.2 percent, I think, 
GDP growth the first quarter. Some have said, you need fairy dust to do 
that. Well, that is not true. You need good economic policy. We have 
that in America: the lowest unemployment for African Americans, 
Hispanic Americans, all Americans. Incredible numbers, incredible 
growth. As a result, people are getting off government subsidized 
healthcare, or fully funded healthcare, onto private health insurance, 
which Democrats want to wipe out. One hundred and fifty-eight million 
Americans get their health insurance through their employer or through 
their union.
  And when it comes to the Affordable Care Act, that is what put in 
place the big cuts that are coming to our hospitals, the DSH cuts, that 
I held off as chairman of the Energy and Commerce Committee. We passed 
legislation to prevent the DSH cuts from hitting our disproportionate 
share of hospitals, those that deal with more lower income folks. We 
are going to have to do that again. Because ObamaCare says you got to 
hit your hospital with a big cost increase, if you will, or take away a 
subsidy.
  The Cadillac tax. I met with building trade folks in my State. These 
people bargained away, potentially, wages for better benefits. And then 
along comes ObamaCare, the Affordable Care Act, that says: Oh, by the 
way, if you have got too generous a plan, according to the government, 
you are going to have to pay a 40 percent tax on that plan. And, by the 
way, it was never indexed for inflation. And guess what, healthcare 
costs continue to go up and premiums go up.
  More and more Americans' health insurance is going to fall into this 
so-called Cadillac tax. There will be a 40 percent tax on those plans. 
The working men and women, who are part of a union or in the private 
sector and who have good, generous healthcare benefits, the Federal 
Government, the Democrat-driven plan that is totally partisan passed, 
it says, we are going to whack you with a 40 percent tax. How fair is 
that, Madam Chair? I don't think it is. We have kept that tax from 
taking effect as Republicans. We will see what this Congress does.
  But, moreover, we fully funded our community health centers. We, 
under Republicans, funded the children's health insurance program, a 
Republican creation, for a decade. I led that

[[Page H3539]]

effort. Most Democrats consistently voted against funding children's 
health insurance time and time again. It had never been funded for more 
than 5 years ever in its history. One hundred and twenty-two thousand, 
seven hundred Oregonian kids and pregnant moms get their health 
insurance through CHIP. It is a marvelous program. Republicans led the 
effort, because I did it. We first tried to get 5, then 6, and then 
eventually we got 10 years funded. That is locked into law.

  We need to go back and fund our community health centers. I told 
people that if I were chairman, my palms would be getting a little 
sweaty now at the list of things we need to get done--I am looking at 
my friends.
  In Oregon, in my district, I think we had 63 delivery sites and 12 
community health centers. We fully funded those centers at a record 
level in the last Congress, because I believe fully in that network of 
the delivery of healthcare. It is extraordinarily important. We should 
be doing that today, but we are not.
  We have got the National Health Service Corps, special diabetes 
programs for Indians, special diabetes programs for type I diabetes, 
teaching health centers, personal responsibility education programs, 
sexual risk avoidance education grants, and family-to-family health 
information centers. We have demo programs, increased access to dental 
healthcare services, and delay in authority to terminate contracts for 
Medicare Advantage plans. We have protection for recipients of HCBS 
against spousal impoverishment. We have demonstration of approved 
community behavioral health clinics, Medicaid funding for territories, 
delay in effective date for Medicaid amendments related to beneficiary 
liability settlements, DSH allotment, and money follows the person. All 
those expire at the end of this fiscal year. We have real work we need 
to get done, Madam Chair.
  Madam Chair, I yield back the balance of my time.

                              {time}  1630

  Ms. PORTER. Madam Chair, I yield 1 minute to the distinguished 
gentlewoman from California (Ms. Pelosi).
  Ms. PELOSI. Madam Chair, I thank the gentlewoman for yielding, and I 
thank her for the constructive amendment and for her exceptional 
leadership as a leading Member of an outstanding freshman class.
  I also thank Congressman Pallone, chairman of the full committee, for 
giving us the opportunity to bring to the floor historic legislation 
that will make a tremendous difference in the lives of the American 
people.
  Today, with the Protecting Americans with Preexisting Conditions Act, 
Democrats are honoring their promises to the American people.
  Madam Chair, our Democratic majority ran on the promise to protect 
American families' quality, affordable healthcare.
  We have now voted three times to oppose the GOP healthcare lawsuit, 
but every time, with every vote, House Republicans reveal their 
inconsistency and complicity with the administration's assault on 
people with preexisting conditions and every American's healthcare.
  It was interesting to listen to the distinguished ranking member of 
the committee express his views when the fact is that, 2 years ago, 
House Republicans voted to gut protections for people with preexisting 
conditions and take away millions of families' healthcare, and they 
then threw a party to celebrate.
  They went down to the White House and celebrated: We have taken away 
the preexisting conditions benefit.
  The American people resoundingly rejected the Republicans' attack on 
their healthcare and their financial security, yet the GOP is plowing 
full steam ahead with their monstrous campaign to sabotage the 
Affordable Care Act and take away healthcare.
  Just last week, the administration doubled down on its demands that 
the courts throw out every protection and benefit provided by the 
Affordable Care Act.
  Again, over and over, we have had bills on the floor to invite the 
Republicans to join us in rejecting that Republican attack. 
Overwhelmingly, they have rejected that.
  Today, again, we can celebrate that we are protecting Americans with 
preexisting conditions and honoring that promise we made to the 
American people, as I said.
  The bill reverses a dangerous part of the Trump administration's 
reckless sabotage campaign, blocking cynical guidance to States. Here 
is what they do: dismantle protections for people with preexisting 
conditions and push families into junk plans that discriminate against 
people with preexisting conditions and do not cover essential benefits.
  In fact, you are paying for nothing.
  The Trump guidance puts lives on the line, not only sabotaging the 
healthcare law but the health of millions of Americans who rely on it.
  Nearly 30 national groups representing people with preexisting 
conditions have spoken out, including the American Cancer Society, 
Cancer Action Network, American Heart Association, American Diabetes 
Association, American Lung Association, National Alliance on Mental 
Illness, Susan G. Komen, and many more.
  They write, ``This dangerous action could take us back to the days 
when people with preexisting conditions were openly discriminated 
against and blatantly denied access to lifesaving care.''
  These organizations, I want Ranking Member Walden to hear because he 
seemed to have been distracted, all these organizations for cancer, 
diabetes, heart, lung, mental health, all of that, they write, ``This 
dangerous action could take us back to the days when people with 
preexisting conditions were openly discriminated against and blatantly 
denied access to lifesaving care.''
  We thank all the groups and families--including the sick little 
children, the Little Lobbyists--for their courage to speak out and show 
that this is a fight not just about legislation but about lives. 
Nothing is more eloquent than the stories that they tell, and many have 
told their stories here.
  They had 10,000 events around the country to stop the Republicans' 
sabotage on healthcare, much of it from people with preexisting 
conditions, especially children born with preexisting conditions.
  This bill that we have today is just the beginning. In the coming 
weeks, House Democrats will bring forth more bold legislation to reduce 
the price of prescription drugs, to empower States to build better 
exchanges, and to block junk plans and reverse the GOP's enrollment 
sabotage.
  Senator McConnell said that he is the grim reaper. He wears that as a 
badge of honor.
  He is the grim reaper. He is going to kill any House legislation for 
the people, saying that he will bury our bills in the Senate graveyard, 
effectively. That is really not a very hopeful political agenda, the 
grim reaper.
  I have news for him. Legislation to protect the preexisting condition 
benefit and many of the other pieces of this agenda are alive and well 
among the American people, and they will make their voices heard.
  The American people want action, and the special interest GOP Senate 
needs to stop standing in their way, Leader McConnell.
  I urge a strong vote for this legislation for the people.
  I commend the gentlewoman for her very important amendment. She said 
being a mom was a preexisting condition. As the mother of five, it is 6 
years to the day when I talked to the insurance company about my bad 
back.
  They said: Why would we even insure you? You are a poor risk, having 
had children.
  I said: That is funny you say that. I thought it was a show of 
strength on my part to have five children. Are you calling that 
something that would be a barrier to my getting insurance?
  I want to emphasize, as we approach Mother's Day, how important this 
particular amendment is to help moms and their families.
  Madam Chair, I urge a ``yes'' vote on Congresswoman Porter's 
important Mother's Day amendment.
  Ms. PORTER. Madam Chair, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from California (Ms. Porter).
  The amendment was agreed to.


                 Amendment No. 9 Offered by Mr. Pappas

  The Acting CHAIR. It is now in order to consider amendment No. 9 
printed in part A of House Report 116-51.

[[Page H3540]]

  

  Mr. PAPPAS. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       In section 2, insert ``, including any such action that 
     would, with respect to individuals with substance use 
     disorders, including opioid use disorders, reduce the 
     availability or affordability of coverage that is at least as 
     comprehensive as the coverage defined in section 1302(a) of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     18022(a)) compared to the availability or affordability, 
     respectively, of such coverage had such action not been 
     taken'' after ``(October 24, 2018))''.

  The Acting CHAIR. Pursuant to House Resolution 357, the gentleman 
from New Hampshire (Mr. Pappas) and a Member opposed each will control 
5 minutes.
  The Chair recognizes the gentleman from New Hampshire.
  Mr. PAPPAS. Madam Chair, I yield myself such time as I may consume.
  Madam Chair, I thank my colleague from New Hampshire, Representative 
Kuster, for offering this legislation that will safeguard healthcare 
protections for the 130 million Americans with preexisting conditions.
  The amendment I am offering today would ensure that we don't take any 
steps backward in our fight against this Nation's opioid epidemic.
  For people in my home State of New Hampshire, the Affordable Care Act 
is a lifesaving law. It is the best tool we have to combat the opioid 
crisis. As I travel around my district, I hear heartbreaking stories of 
those lost and those still fighting hard.
  I also hear from constituents who, on a regular basis, can't fathom 
where they would be without coverage for their substance use disorder.
  I am here today on behalf of constituents like Phil Spagnuolo from 
Laconia. As Phil fought to recover from substance use disorder, he took 
comfort in knowing that he could rely on coverage that was affordable 
and accessible to him in the midst of the greatest medical challenge of 
his life.
  Thanks to the Affordable Care Act, Phil has gone from jail to 
treatment and recovery to serving as a leader in the recovery 
community, coaching and advocating for those grappling with addiction.
  New Hampshire is incredibly proud of his story and his example, and 
it is all made possible because of the ACA and its basic protections.
  The collective impact of substance use disorder coverage has expanded 
treatment and recovery opportunities in New Hampshire and across the 
country.
  Unfortunately, far too many still do not access this kind of 
lifesaving care. We still lose 130 Americans each and every day in 
their battle with opioid addiction.
  The scope of this crisis is simply immense. No region, no community, 
no family has been spared.
  Despite the alarming statistics, the administration issued guidance 
that would allow insurance companies to discriminate against Americans 
with preexisting conditions, including the 19.7 million Americans like 
Phil with a history of substance use.
  That is why I am offering this amendment today, to strengthen the 
underlying legislation and prohibit any further actions to reduce the 
availability or affordability of coverage for those battling substance 
use disorder.
  We should be working together to open the doors to those most in 
need, not shutting them because of politics.
  I urge the adoption of this amendment, and I reserve the balance of 
my time, Madam Chair.
  Mr. WALDEN. Madam Chair, I seek time in opposition to the amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Madam Chair, I reserve the balance of my time.
  Mr. PAPPAS. Madam Chair, I am willing to close if the gentleman from 
Oregon is, and I reserve the balance of my time.
  Mr. WALDEN. Actually, I believe I get to close, don't I?
  The Acting CHAIR. The gentleman from Oregon has the right to close.
  Mr. WALDEN. That is what I thought.
  Madam Chair, I reserve the balance of my time.
  Mr. PAPPAS. Madam Chair, this is a critical issue. This is an 
important piece of legislation. I, for one, don't trust this 
administration to get it right.
  They have tried every trick in the book they can to repeal the 
Affordable Care Act outright legislatively and to undermine it 
administratively. They have gone to the courts to take away critical 
protections from Americans who need them most. I, for one, am not going 
to stand for it.
  The people of New Hampshire and of this country, we are ensuring that 
we get this right for them. It is very critical for those suffering 
from substance use disorder that we ensure those important protections 
remain on the books so that people can access care.
  There is no more important tool in our toolbox than ensuring that 
people have health insurance to take care of their substance use 
disorder. That is why I brought forward this amendment today.
  Madam Chair, I yield back the balance of my time.
  Mr. WALDEN. Madam Chair, I yield myself such time as I may consume.
  Section 1332 already requires that the State plan will provide 
coverage that is at least as comprehensive as the essential health 
benefits, including mental health and substance use disorder services. 
That is already required, including behavioral health treatment, and 
would provide coverage to at least a comparable number of its 
residents. That is already in the 1332 requirements.
  I appreciate the gentleman's passion for dealing with the opioid 
epidemic. I led the effort that brought together Republicans and 
Democrats. We passed 60 different pieces of legislation. I think 57 of 
them, by the time we were done working together, passed unanimously in 
this House.
  We bundled them up into H.R. 6 because we all know the Senate can't 
handle 57 or 60 different pieces of legislation, but they could handle 
one. The work we did here and the work they did there ended up in, I 
would argue, the Nation's most comprehensive legislation to address a 
drug problem our country has ever had. And that is our law.
  The President of the United States, who was just disparaged here on 
the House floor, helped lead this effort because he passionately cares 
about the issue of addiction. He lost a brother, I believe, to 
alcoholism.
  He was a leader, and his team were leaders, in this effort we put 
together on opioids. He invited Republicans and Democrats to the White 
House for the bill signing. Mrs. Trump helped organize all of that.
  This legislation is comprehensive on opioids. It wasn't part of the 
ACA. You see, we can work together and improve underlying laws. We can 
address major problems facing the country when majorities want to do 
that. We did it last Congress under my leadership, and it was 
Republicans and Democrats. We didn't start out agreeing on some of 
these matters, but we ended up there, with just a couple of exceptions.
  I sent my friend, Madam Chair, the chairman of the Energy and 
Commerce Committee today, a comprehensive list of kind of what we 
learned in the final phase of our investigation into how America ended 
up in the place it was with opioids. There are some additional 
recommendations that I hope and assume we will get to out of that 
investigative report that we concluded at the end of the year. 
Hopefully, we will get there.
  I believe we need to do oversight on the legislation we passed. I 
have always felt that about bills we passed. We need to go take a 
second look.

                              {time}  1645

  What is working? What is not? We are not going to get it right the 
first time, and we always know there is more to do, and we need to do 
more on what was H.R. 6 in the last Congress, our opioids legislation.
  Madam Chair, I am not opposed to the gentleman's amendment, and you 
have to say you are in order to get the time, I guess, but I am not.
  I am fully committed to making sure that people with substance abuse 
disorders continue to get the help they need in our communities. That 
is what our whole legislative thrust was about last Congress and will 
remain there. As I say, section 1332 already requires that in these 
plans.
  Again, remember what we are talking about here is States coming to 
the Federal Government saying: We have a

[[Page H3541]]

better idea to fill a gap, so people have affordable insurance. That is 
what a waiver is under 1332. And, I guess, I have more confidence in my 
State than others must have in theirs, but I think from my own 
experience, Republicans and Democrats work together in Oregon to get 
health insurance out, and coverage out, and expand access to care. I 
have always continued to try to do that.
  I have faith that my State would do this. These plans we will hear 
more about next week, but they are regulated by State insurance 
commissioners. I am not in the school that says all of those people are 
bad and we are the only ones with a great idea. I want innovation. I 
want it from the States, and I want to drive down costs of healthcare 
while improving access and delivery of services.
  So I am not opposed to the gentleman's amendment. I do hope we can 
address these issues of fully funding our community health centers, our 
National Health Service Corps, and these diabetes programs which we 
reauthorized and funded in the last Congress, and which we need to do 
again. They are called the Special Diabetes Program for Indians and 
Special Diabetes Program for type 1 diabetes.
  We have got to get after that, too, Madam Chair. We have to find the 
money to do it. It is not easy. I know we have a lot of other things. I 
just wish we were doing those sorts of the things today because these 
programs expire in September, and we don't have that many legislative 
days left.
  Hopefully, we can move on to the things I know we can agree on and 
find solutions for, and that we do it sooner rather than later.
  Madam Chair, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from New Hampshire (Mr. Pappas).
  The amendment was agreed to.


                 Amendment No. 10 Offered by Mr. Rouda

  The Acting CHAIR. It is now in order to consider amendment No. 10 
printed in part A of House Report 116-51.
  Mr. ROUDA. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       In section 2, insert ``, including any such action that 
     would result, with respect to vulnerable populations 
     (including low-income individuals, elderly individuals, and 
     individuals with serious health issues or who have a greater 
     risk of developing serious health issues), in a decrease in 
     the availability of coverage that is at least as 
     comprehensive as the coverage defined in section 1302(a) of 
     the Patient Protection and Affordable Care Act (42 U.S.C. 
     18022(a)) with coverage and cost sharing protections required 
     under section 1332(b)(1)(B) of such Act (42 U.S.C. 
     18052(b)(1)(B))'' after ``(October 24, 2018))''.

  The Acting CHAIR. Pursuant to House Resolution 357, the gentleman 
from California (Mr. Rouda) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from California.
  Mr. ROUDA. Madam Chairwoman, 9 years ago our Nation took a monumental 
step forward to address the needs of millions of Americans with a 
preexisting condition. Before the passage of the Affordable Care Act, 
individuals across the country were denied coverage or charged higher 
premiums due to their medical history.
  While I came to Washington to protect our healthcare, the Trump 
administration has continued its assault on the Affordable Care Act. In 
this case, the administration is trying to use an ACA provision 
designed to give States the ability to test new insurance reforms that 
could improve the wellbeing of their residents, but, instead, that 
provision is being used to undermine protections for people with 
preexisting conditions and the coverage of essential health benefits, 
all in an effort to prop up junk, short-term insurance plans.
  Today, we will stand up to that assault on America's healthcare by 
passing H.R. 986, to nullify these efforts. We must be clear that any 
future administrative actions by this administration or any other 
administration should not harm the vulnerable populations that the 
Affordable Care Act was designed to protect.
  To that end, my amendment would prohibit any future rule or guidance 
from diminishing the Affordable Care Act that would result in reduction 
in the availability, affordability, and comprehensiveness for people 
with preexisting conditions, the elderly and low-income individuals.
  My amendment would affirm these critical guardrails that protect the 
care of so many Americans across our country and help strengthen and 
uphold the principles of this landmark law.
  I would like to thank Chairman Pallone, Chairman Neal, and their 
respective staff for their assistance with this amendment.
  I ask my colleagues to join me in supporting this amendment to ensure 
that this and future administrations do not undermine the healthcare of 
vulnerable populations.
  Madam Chair, I reserve the balance of my time.
  Mr. WALDEN. Madam Chairwoman, I seek time in opposition to the 
gentleman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Madam Chair, I am not opposed to the gentleman's 
amendment, but I am happy to speak on it.
  Again, section 1332 already requires that the State plan, the one 
they submit, will provide coverage that is at least as comprehensive as 
the essential health benefits, including mental health and substance 
use disorder services, including behavioral health treatment, and will 
provide coverage to at least a comparable number of its residents.
  Madam Chair, I reserve the balance of my time.
  Mr. ROUDA. Madam Chairwoman, we are at a crossroads in our country. 
When we look at the global stage, there are approximately 200 
countries, of which 40 are industrialized, developed countries. Of 
those 40 industrialized, developed countries, 39 of them have universal 
healthcare. Only one does not, the wealthiest, greatest country in the 
history of the world. That is why we have tens of millions of 
individuals in our country without insurance.
  We know that preexisting conditions have to be covered because when 
we look at the fact that this country spends 18.5 percent of its GDP on 
healthcare, almost double what these other industrialized, developed 
countries spend, you would think the United States of America has the 
healthiest people in the world.
  Madam Chairwoman, that is not the case. I am sad to report that most 
critical criteria when looking at Americans' healthcare, we are in the 
bottom quartile, even though we spend 18.5 percent of our GDP. We know 
that the inability to pay healthcare costs is a leading cause of 
involuntary bankruptcy and homelessness.
  Preexisting conditions is the underlying reason for those two things. 
That is why we must make sure that we protect affordable healthcare in 
the United States through the act, and make sure that preexisting 
conditions are covered today and tomorrow for future generations.
  Madam Chair, I yield back the balance of my time.
  Mr. WALDEN. Madam Chairwoman, I yield myself such time as I may 
consume.
  Madam Chair, I just want to go back to what is going on in America's 
healthcare costs and look at some of what is going on elsewhere around 
the world.
  First of all, I would draw the Member's attention to the Kaiser 
Foundation report that Axios reported on about people who have health 
insurance and still can't afford to use it. They talked about just over 
half of those with employer coverage have some sort of chronic disease, 
so they have health insurance. But the deductibles which are at $3,000 
to $5,000 are so high that three-quarters of the people reported 
skipping or postponing some type of care. Half, 49 percent, said that a 
family member had a problem paying medical bills or difficulty 
affording their premiums, deductibles, or copays in the last year.
  What we are trying to do is help those people in the individual 
market, and we would love to help those people in the market that 
employer-provided health insurance is in as well, and put downward 
pressure on pricing, and go after the cost of healthcare from one end 
to the other.

[[Page H3542]]

  Now, the gentleman from California, I believe, has talked about going 
to a, I guess, government-run, single-payer system. I have got two 
veterans that work virtually full time helping veterans in Oregon's 
Second District get access to a similar sort of system. You know of it 
as the VA. Think about the problems we have with that government-run, 
single, sort of, payer-operated system.
  If you get in, I have veterans saying: It is great. I have got 
coverage. But it is people who have to wait 6 months to get eyeglasses 
at one point, or they can't get in to get their surgery done. And we 
are working with thousands of veterans that have to come to 
their Member of Congress to be able to get access to the healthcare 
they were promised when they put on the Nation's uniform.

  We have that system in place, and it has incredible problems in wait 
time, so I had to create the Choice Program and everything else.
  Then I was intrigued by a story about a woman in Nova Scotia who is 
33 years old. She is under one of those systems my friend wants for us, 
I guess. After three trips to the emergency room, they just never would 
believe her and her problem and see her, and she couldn't get access to 
doctors. When she finally did, her anal cancer had progressed to stage 
III.
  Now, at 33, she is in menopause, she writes. She had a Facebook post 
recently wanting to meet with the Premier to explain how broken their 
healthcare system is.
  We all know stories about Canadians who come across the border who 
can afford to get their healthcare done here because they can get it 
done sooner. We all know of stories in other countries where they have 
global budgets, and when they run out, you are done. I have had people 
tell me the little secret is: Get sick before June because they are 
going to run out and you won't get in. That is what is going on around 
the world.
  And I think, in many measures, when people are especially sick, if 
they have the money, they come to the United States for care. They go 
to MD Anderson Cancer Center, and they go to the Mayo Clinic.
  Those are the folks who come to America. What I want is the MD 
Andersons and the Mayo Clinics, and the Oregon and Health & Science 
Universities to be affordable and available to all Americans.
  We had a hearing today--I think it was pretty good--on drug pricing, 
following up on what I did 2 years ago looking at the manufacturers, 
the PBMs, the distributors, and the insurers. Everybody wants a piece 
of this. Everybody is getting a chunk. The result is, we have a 
healthcare system that costs too much. So let's go figure that out.
  That is what innovation is about, and that is what our States can do 
in their wonderful laboratories. Some of them will do really good 
things, and some of them will make mistakes and learn from it. We 
should pick the best from among the States. That is what we are looking 
for here in these 1332 waivers is some flexibility for our States to 
innovate.
  I believe our States and my colleagues--and by the way, Oregon is 
completely Democrat controlled--but they care about citizens of the 
State of Oregon, and so does the insurance commissioner, and they are 
only going to ask for permission for a plan that will be better than 
what the Federal Government is trying to jam down their throat in a 
one-size-fits-all.
  So I don't object to the gentleman's amendment. I think we can do 
better by harnessing great innovation. We do it in medicine, and we do 
it everywhere else. We have competitive insurance products for a lot of 
other things we buy, and I would like to see more options, more choice, 
more transparency in healthcare, and more consumer involvement.
  Madam Chairwoman, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from California (Mr. Rouda).
  The amendment was agreed to.


               Amendment No. 11 Offered by Mr. Malinowski

  The Acting CHAIR. It is now in order to consider amendment No. 11 
printed in part A of House Report 116-51.
  Mr. MALINOWSKI. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       In section 2, insert ``, including any such action that 
     would, with respect to individuals with preexisting 
     conditions, reduce the affordability of coverage that is at 
     least as comprehensive as the coverage defined in section 
     1302(a) of the Patient Protection and Affordable Care Act (42 
     U.S.C. 18022(a)) compared to the affordability of such 
     coverage had such action not been taken'' after ``(October 
     24, 2018))''.

  The Acting CHAIR. Pursuant to House Resolution 357, the gentleman 
from New Jersey (Mr. Malinowski) and a Member opposed each will control 
5 minutes.
  The Chair recognizes the gentleman from New Jersey.
  Mr. MALINOWSKI. Madam Chairwoman, there are many problems in our 
healthcare system. We have heard about a number of them today, but we 
are here for one simple, specific reason, because of the guidance that 
the administration issued last year that allows States to expand the 
availability and duration of junk, short-term insurance plans.
  Now, the administration and its defenders will not say this because 
it has become politically impossible to do so, but these plans are 
cheaper precisely because they deny coverage to people with preexisting 
conditions and for, what any reasonable person would agree are 
essential benefits, like maternity care and prescription drugs.
  That is what they mean when they use the euphemism ``flexibility.'' 
Will these plans take hold? Here is what happens, in plain language, if 
you have a preexisting condition. You have a choice. Either stay in 
your ACA plan and see your premiums rise as healthy people move to 
cheaper, junk insurance, or you sign up for a junk plan yourself and 
risk getting gouged when the services you need aren't covered.
  You end up with a two-tiered healthcare system in America: one for 
healthy people, and one for sick people. Now, the underlying bill 
rescinds that guidance. The amendment I have submitted would prohibit 
the administration from taking any other action that would reduce the 
affordability of comprehensive coverage for Americans with preexisting 
conditions.

                              {time}  1700

  Now, this would not in any way prevent States from using section 1332 
waivers to make healthcare better and more affordable. Many States, as 
we have heard, have done so in ways that have lowered health insurance 
premiums without, in any way, undermining protections for people with 
preexisting conditions.
  Yes, section 1332 has a clear directive that States must maintain the 
benefits, affordability, and coverage provided by the ACA, but it is 
clear that the administration has disregarded these standards and could 
do so again to remove protections for vulnerable groups, to promote 
expansion of health plans that are not compliant with the ACA, and to 
take other steps that would increase costs, especially for women and 
older adults.
  This amendment, along with the overall bill, makes sure that we keep 
our promise to the American people. It makes clear that, when we say we 
are going to protect everyone with a preexisting condition, that is not 
an empty slogan that means whatever we want it to mean. Those words 
mean something, that every American deserves quality health insurance, 
and no American should be forced to pay more for good coverage because 
of a preexisting health problem.
  Madam Chair, that is what H.R. 986 and my amendment guarantee. I urge 
my colleagues to support both, and I reserve the balance of my time.
  Mr. WALDEN. Madam Chair, I claim the time in opposition to the 
gentleman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Madam Chair, I reserve the balance of my time.
  Mr. MALINOWSKI. Madam Chair, I will close by saying there is no 
question whatsoever what the administration intends to do. They have 
been trying from day one, from January 2017, to repeal the Affordable 
Care Act and its essential protections for the American people.
  The only thing that has changed is that it has become politically 
impossible for anyone in America to say that

[[Page H3543]]

you are opposed to protecting people with preexisting conditions, and 
so a war against healthcare protections is being covered up by a war 
against the English language.
  Everyone says, ``We are for preexisting conditions,'' yet every 
single step the administration and its supporters take is designed to 
weaken those protections. This amendment and the underlying bill say 
that you can't do that anymore. They guarantee, going forward, that the 
ACA's protections are respected and that any experimentation by the 
States will have to be consistent with those protections.
  Madam Chair, I urge my colleagues' support for the amendment and the 
bill, and I yield back the balance of my time.
  Mr. WALDEN. Madam Chair, I yield myself such time as I may consume.
  Madam Chair, I do not oppose this amendment because this amendment 
does not do anything the law already, I think, requires.
  Section 1332 does not permit States to waive preexisting condition 
protections. Section 1332 already requires that the State plan will 
provide coverage that is at least as comprehensive as the essential 
health benefits and will provide coverage and cost-sharing protections 
against excessive out-of-pocket spending. That is what the underlying 
law already does.
  We have the assurance from the CMS Administrator saying, once again, 
to be clear: ``The 2018 guidance does nothing to erode the PPACA's 
preexisting condition provisions, which cannot be waived under section 
1332.''
  She is the one who makes the decision.
  By the way, I would just point out that no State has come to the 
Trump administration under this new authority that we are aware of and 
said: ``Please approve our plan.''
  Junk plans--and we will hear more about that term of art. By the way, 
those junk plans were allowed for under the Obama administration and 
under the ACA. At that time, they were only allowed for 3 months. There 
seemed to be a lot of interest in a variety of options for citizens to 
take advantage of that covered their needs.
  So the Trump administration said, well, if they are good for 3 
months, what if we extend them to 12 months or just at 12 months? That 
is what they did. They were junk plans under Trump; they were wonderful 
options under Obama. It is the same set of plans.
  You can always go on the exchange, and you can always find other 
coverage that fits your need. We are trying to not have just one plan 
that nobody can afford. That is what you are seeing in this situation 
that Ms. Seema Verma put forward, Madam Chair, the head of the CMS, the 
Administrator for the Centers for Medicare and Medicaid Services.
  She uses, as an example, this situation in Grand Island, Nebraska. It 
is not Oregon; it is Nebraska. A $70,000-a-year, 60-year-old couple are 
paying $38,000 a year for their insurance with an $11,100 deductible. 
Now, how is that affordable? Does anybody in here think that is a great 
idea?
  That is what you are saying: Don't innovate. We have got it covered. 
The ACA has it covered. There is no need for innovation here, nothing 
to see. The plan works great.
  Then we know, from the Kaiser Foundation study, people are saying: I 
can't afford it. So I will jack up my credit card, and I will wipe out 
my savings.
  All this is going on. The ACA did not solve every problem. It 
expanded coverage. You can't help but do that, spend that much money. 
States like mine took full advantage of it. But we are left with these 
pockets and problems in America that I think States could assist us in 
if we gave them expanded authority under 1332 waivers to say: Hey, 
guess what, Washington? We have a better idea here. Here it is. Take a 
look at it, and make sure it fits the Federal guidelines and law, but 
let us innovate.
  Oregon did that. Under the prior 1332 approval process, insurance 
rates went down 6 percent; Wisconsin down 10.6; New Jersey, 15; 
Maryland, 43; Maine, 9.4; Minnesota, 20; Alaska, 34.7. Using this sort 
of ``Mother May I'' approval, that is what you have to do.

  I remember when Oregon did the Oregon health plan. I was in the State 
legislature then, and we had to plead and beg with the administration 
at the time to get approval to try and experiment on Medicaid coverage 
to expand coverage and improve access to care. We couldn't do it 
without Mother Washington, Father Washington, or Brother Washington, 
whoever, back here, saying: Yeah, okay. We will let you try that.
  We should be in partnerships with our States.
  By the way, States can pass a law and say: We are not going down this 
path. They have every right to do it. New Jersey has done it, and 
California has done it: None of these short-term duration plans, we are 
not going to be a part of that.
  Every State has that right. But there are a lot of States that look 
at their citizens and say: $38,000 a year for your insurance and 
$11,000 for your deductible; you are making $70,000; you are 60 years 
old. That is not working real well either. So maybe we can find a 
product that would work for you and help you out.
  So we are talking about a range of options and choices. America has 
always done well and markets do better when we have more choices. That 
is what we are talking about here.
  The gentleman's amendment I don't object to at all. I think it is the 
underlying law as described by the head of the Department who would 
have to approve all these 1332 waivers.
  Madam Chair, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from New Jersey (Mr. Malinowski).
  The question was taken; and the Acting Chair announced that the ayes 
appeared to have it.
  Mr. MALINOWSKI. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from New Jersey 
will be postponed.


                  Amendment No. 12 Offered by Ms. Wild

  The Acting CHAIR. It is now in order to consider amendment No. 12 
printed in part A of House Report 116-51.
  Ms. WILD. Madam Chair, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 3, line 16, insert after ``2018)),'' the following: 
     ``including any such action that would result in higher 
     health insurance premiums for individuals enrolled in health 
     insurance coverage that is at least as comprehensive as the 
     coverage defined in section 1302(b) of such Act (42 U.S.C. 
     18022(b)),''.

  The Acting CHAIR. Pursuant to House Resolution 357, the gentlewoman 
from Pennsylvania (Ms. Wild) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentlewoman from Pennsylvania.
  Ms. WILD. Madam Chair, I rise today to offer an amendment to H.R. 
986, the Protecting Americans with Preexisting Conditions Act of 2019.
  My amendment would put an end to the rising cost of premiums. It is 
an amendment that should be met with overwhelming bipartisan support 
and without opposition.
  Specifically, my amendment would prohibit the administration from 
taking any further action that would result in higher premiums for 
Americans who need comprehensive coverage.
  This administration has unilaterally made healthcare more expensive 
and less accessible for the American people by taking actions that run 
contrary to the spirit and purpose of the ACA. That has resulted in 
higher premiums and reduced enrollment.
  In 2017, the administration stopped cost-sharing payments that helped 
reduce out-of-pocket costs for low-income Americans. This action alone 
increased premiums by 20 percent and raised costs for families not 
receiving subsidies.
  In 2018, the administration issued new section 1332 guidance that 
allows States to raise healthcare costs for people with preexisting 
conditions. This 2018 guidance also gave a green light to insurance 
companies to expand junk plans that don't cover essential health 
benefits. We know that pulling people out of the pool only makes 
insurance premiums more expensive for those with preexisting 
conditions.
  Also, in 2018, the administration slashed funding for consumer 
enrollment assistance and outreach. Their

[[Page H3544]]

goal: reduced healthcare enrollment; the result: higher premiums.
  Just last month, the administration finalized a rule that would 
increase limits on total out-of-pocket costs for millions. The 
administration moved forward with this even though the rule itself 
noted that all commenters on this topic expressed opposition to or 
concerns about the proposed change.
  This past Monday, the administration released a notice seeking 
comment on a proposal that would reduce eligibility for Medicaid and 
cut premium tax credits for millions.
  It is time to say ``no'' to future attempts to sabotage working 
Americans' healthcare.
  Madam Chair, I reserve the balance of my time.
  Mr. WALDEN. Madam Chair, I claim the time in opposition to the 
gentlewoman's amendment.
  The Acting CHAIR. The gentleman from Oregon is recognized for 5 
minutes.
  Mr. WALDEN. Madam Chair, I reserve the balance of my time.
  Ms. WILD. Madam Chairman, my amendment is about fairness. Patients 
should not face increased premiums at the whim of appointed government 
officials, especially for essential health benefits like emergency 
services, maternity, newborn, pediatric care, mental health and 
substance abuse treatment, prescription drugs, laboratory services, and 
preventive and wellness services for chronic disease management.
  From malicious lawsuits aimed at striking down the ACA in its 
entirety and, along with it, the protections for preexisting conditions 
to ending the practice of public advertisement of enrollment period and 
educating the people about the complexities of health insurance, it has 
become clear that Congress must reclaim its legislative authority and 
ensure that this administration faithfully executes the spirit of this 
law.
  The ACA is the law. The Constitution gives Congress the power to make 
laws and requires the executive branch to faithfully execute the laws 
that Congress passes.
  We all heard Republicans on the campaign trail last year say that 
they would protect coverage for preexisting conditions and help drive 
down our premiums. This is their chance to fulfill those campaign 
promises with concrete action.
  Action, not words, is what the American people demand, and it is what 
they deserve. Let's make that commitment a reality by adopting this 
amendment, passing this bill, and pushing the Senate to take it up so 
that we can get it signed into law.
  In closing, Madam Chair, this is about standing up for the dignity of 
working families in the most basic and fundamental sense. It is about 
saying that every child, woman, man, and family in this country 
deserves the same certainty of being able to afford high-quality 
healthcare.
  Our people deserve better. We need to stop the political 
gamesmanship, and we need to focus on people across our country who 
need good, affordable healthcare right now.

  This is also our chance to remind this administration and future 
administrations that Congress makes the laws, and the executive branch 
doesn't get to fool around with the implementation just to see it fail 
for political reasons.
  Madam Chair, I yield back the balance of my time.
  Mr. WALDEN. Madam Chair, I yield myself such time as I may consume.
  Madam Chair, let's talk about this amendment.
  I have talked earlier about all the things that need to be 
reauthorized--community health centers, special diabetes programs, all 
of that which I know the committee is aware of and I hope we begin 
marking. I wish we were dealing with that today.
  I heard from the gentlewoman about Republicans and preexisting 
conditions and ``Where is your plan?'' It is sitting up in the Rules 
Committee because your party would not allow my amendment to do that 
and to be brought to the floor for debate today. I don't control the 
Rules Committee. It is 2 to 1 by the majority. It is just the way it 
works around here, and I respect that.
  But you allowed my amendments that were more in jest about the false 
nature of the title of the bill to be debated but not the substantive 
amendment I offered which does protect people with preexisting 
conditions in case the lawsuit were to prevail and ObamaCare is thrown 
out. But, no, we couldn't have that debate.
  I have asked for my bill to be considered in the committee of 
jurisdiction. That hasn't happened either.
  I have also asked for the Democrats' one-size-fits-all takeover of 
healthcare, Medicare for All, however you want to describe it, that we 
have a hearing in Energy and Commerce. That hasn't happened either. We 
are the committee of jurisdiction.
  You talk about working people. It is ObamaCare that puts a 40 percent 
tax on union plans and employer plans that exceed a certain level of 
costs, and they don't index it. Now, I don't know where the gentlewoman 
is on the Cadillac tax, but I want to repeal it. I never voted for it.

                              {time}  1715

  So, if they want to enshrine the Affordable Care Act in its entirety 
and make no changes, then I guess they are for a 40 percent tax on the 
kind of insurance plans that my building tradespeople negotiated to 
get--and other unions--instead of getting wage increases.
  We have delayed that.
  And when we look at the cuts in the Affordable Care Act coming at our 
hospitals in rural areas that serve lower-income areas, the DSH 
payments, we put off those cuts to our hospitals--last cycle--under 
Republican leadership. And we are going to face that question in this 
Congress under Democrat leadership.
  So, a vote to delay those DSH cuts again--if one does that--is voting 
to repeal or delay part of ObamaCare.
  I hear 60, 70 votes to do these things to ObamaCare--repeal the CLASS 
Act, which was a long-term health insurance program that was destined 
for failure, and even President Obama signed its repeal.
  I can go through a whole list of things that got repealed. We are the 
only ones who ever get tagged with voting to repeal.
  As far as our commitment to preexisting conditions protection: It is 
real, it is robust, and it was always in everything we did.
  Yeah, I know what the political rhetoric was. I have run campaigns. I 
have been around that. I know how you can nuance around. But we always 
protected people with preexisting conditions--always, period, hard 
stop. Protected people with preexisting conditions, in what came out of 
my committee and came across this House floor, they were always 
covered--always.
  So I hear the political rhetoric, but I know the facts. See, I am an 
old journalism major, and I believe in facts.
  The facts of the matter are that 1332 waivers have given our States 
an opportunity to give our citizens an affordable health insurance 
plan, not one that I guess they will defend--$38,000 a year in 
premiums, $11,000 a year in deductibles, copays, out-of-pocket costs.
  How is that working for anybody?
  And shouldn't that 60-year-old couple in Nebraska have a chance to 
have a better plan option? Nope, guess not. Washington is going to 
decide it all for you. Write your check: 38 grand. That is for the 
premiums. And $11,000 in out-of-pocket costs, your deductibles. Then 
maybe you can get something covered, right?
  Well, what is left? We know from this Kaiser study I have cited 
earlier that was in Axios: People wipe out their savings. They put it 
on their credit cards. They borrow from their friends. Or they simply 
don't get coverage.
  That is the world they want to freeze-frame and leave in place. That 
is not what the Republicans are for. We want innovation. We want 
choice. We believe in our States having the opportunity to innovate and 
do it even better, not to go back to the old ways. No. That is not what 
we are for. I know that is what Democrats want to label us as being 
for, but it is not true.
  And we have proven results in opioids; Community Health Centers; the 
longest funding for Children's Health Insurance Program in the history 
of the United States of America, under Republican leadership--10 years.
  We are the ones, Republicans, who led the effort to invest in medical 
research at unprecedented rates under

[[Page H3545]]

what Fred Upton put forward and what Newt Gingrich put forward.
  Mr. WALDEN. Madam Chair, I yield back the balance of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentlewoman from Pennsylvania (Ms. Wild).
  The question was taken; and the Acting Chair announced that the ayes 
appeared to have it.
  Ms. WILD. Madam Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentlewoman from 
Pennsylvania will be postponed.


                    Announcement by the Acting Chair

  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, proceedings 
will now resume on those amendments printed in part A of House Report 
116-51 on which further proceedings were postponed, in the following 
order:
  Amendment No. 2 by Mr. Brown of Maryland.
  Amendment No. 7 by Mr. Holding of North Carolina.
  Amendment No. 11 by Mr. Malinowski of New Jersey.
  Amendment No. 12 by Ms. Wild of Pennsylvania.
  The Chair will reduce to 2 minutes the minimum time for any 
electronic vote after the first vote in this series.


            Amendment No. 2 Offered by Mr. Brown of Maryland

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentleman from Maryland 
(Mr. Brown) on which further proceedings were postponed and on which 
the ayes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The vote was taken by electronic device, and there were--ayes 351, 
noes 70, not voting 16, as follows:

                             [Roll No. 191]

                               AYES--351

     Adams
     Aguilar
     Allred
     Amodei
     Armstrong
     Arrington
     Axne
     Bacon
     Baird
     Balderson
     Barr
     Barragan
     Beatty
     Bera
     Bergman
     Beyer
     Bilirakis
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Bost
     Boyle, Brendan F.
     Brady
     Brindisi
     Brooks (IN)
     Brown (MD)
     Brownley (CA)
     Buchanan
     Bucshon
     Burgess
     Bustos
     Butterfield
     Calvert
     Carbajal
     Carson (IN)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chabot
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Cole
     Collins (NY)
     Conaway
     Connolly
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crawford
     Crenshaw
     Crist
     Crow
     Cuellar
     Cunningham
     Curtis
     Davids (KS)
     Davis (CA)
     Davis, Danny K.
     Davis, Rodney
     Dean
     DeFazio
     DeGette
     DeLauro
     DelBene
     Delgado
     Demings
     DeSaulnier
     Deutch
     Diaz-Balart
     Dingell
     Doggett
     Doyle, Michael F.
     Dunn
     Engel
     Escobar
     Eshoo
     Espaillat
     Evans
     Finkenauer
     Fitzpatrick
     Fleischmann
     Fletcher
     Flores
     Fortenberry
     Foster
     Foxx (NC)
     Frankel
     Fudge
     Gabbard
     Gallagher
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     Gianforte
     Gibbs
     Golden
     Gomez
     Gonzalez (OH)
     Gonzalez (TX)
     Gonzalez-Colon (PR)
     Gottheimer
     Graves (LA)
     Graves (MO)
     Green (TX)
     Griffith
     Grijalva
     Grothman
     Guest
     Guthrie
     Haaland
     Hagedorn
     Harder (CA)
     Hartzler
     Hastings
     Hayes
     Heck
     Herrera Beutler
     Higgins (NY)
     Hill (AR)
     Hill (CA)
     Himes
     Holding
     Hollingsworth
     Horn, Kendra S.
     Horsford
     Houlahan
     Hoyer
     Hudson
     Huffman
     Hunter
     Hurd (TX)
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson (OH)
     Johnson (SD)
     Johnson (TX)
     Joyce (OH)
     Joyce (PA)
     Kaptur
     Katko
     Keating
     Kelly (IL)
     Kelly (PA)
     Kennedy
     Khanna
     Kildee
     Kilmer
     Kim
     Kind
     King (IA)
     King (NY)
     Kinzinger
     Kirkpatrick
     Krishnamoorthi
     Kuster (NH)
     Kustoff (TN)
     LaHood
     LaMalfa
     Lamb
     Langevin
     Larsen (WA)
     Larson (CT)
     Latta
     Lawrence
     Lawson (FL)
     Lee (CA)
     Lee (NV)
     Lesko
     Levin (CA)
     Levin (MI)
     Lewis
     Lieu, Ted
     Lipinski
     Loebsack
     Lofgren
     Long
     Lowenthal
     Lowey
     Lucas
     Luetkemeyer
     Lujan
     Luria
     Lynch
     Malinowski
     Maloney, Carolyn B.
     Maloney, Sean
     Marchant
     Marshall
     Matsui
     McAdams
     McBath
     McCarthy
     McCaul
     McCollum
     McEachin
     McGovern
     McHenry
     McKinley
     McNerney
     Meeks
     Meng
     Meuser
     Miller
     Moolenaar
     Moore
     Morelle
     Moulton
     Mucarsel-Powell
     Mullin
     Murphy
     Nadler
     Napolitano
     Neal
     Neguse
     Newhouse
     Norcross
     Norton
     Nunes
     O'Halleran
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Perlmutter
     Peters
     Peterson
     Phillips
     Plaskett
     Pocan
     Porter
     Pressley
     Price (NC)
     Quigley
     Radewagen
     Raskin
     Reed
     Reschenthaler
     Rice (NY)
     Rice (SC)
     Rodgers (WA)
     Roe, David P.
     Rogers (KY)
     Rose (NY)
     Rose, John W.
     Rouda
     Rouzer
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Rutherford
     Sablan
     Sanchez
     Sarbanes
     Scanlon
     Schakowsky
     Schiff
     Schneider
     Schrader
     Schrier
     Schweikert
     Scott (VA)
     Scott, Austin
     Scott, David
     Sensenbrenner
     Serrano
     Sewell (AL)
     Shalala
     Sherman
     Sherrill
     Shimkus
     Simpson
     Sires
     Slotkin
     Smith (MO)
     Smith (NJ)
     Smith (WA)
     Smucker
     Soto
     Spanberger
     Spano
     Speier
     Stanton
     Stauber
     Stefanik
     Steil
     Stevens
     Stivers
     Suozzi
     Takano
     Taylor
     Thompson (CA)
     Thompson (MS)
     Thompson (PA)
     Thornberry
     Timmons
     Tipton
     Titus
     Tlaib
     Tonko
     Torres (CA)
     Torres Small (NM)
     Trahan
     Trone
     Turner
     Underwood
     Upton
     Van Drew
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Wagner
     Walberg
     Walden
     Wasserman Schultz
     Waters
     Watkins
     Watson Coleman
     Webster (FL)
     Welch
     Westerman
     Wexton
     Wild
     Wilson (FL)
     Wilson (SC)
     Wittman
     Womack
     Yarmuth
     Young
     Zeldin

                                NOES--70

     Aderholt
     Allen
     Amash
     Babin
     Banks
     Biggs
     Brooks (AL)
     Buck
     Budd
     Burchett
     Byrne
     Carter (GA)
     Carter (TX)
     Cheney
     Cline
     Cloud
     Collins (GA)
     Comer
     Cook
     Davidson (OH)
     DesJarlais
     Duffy
     Duncan
     Estes
     Ferguson
     Fulcher
     Gaetz
     Gohmert
     Gooden
     Gosar
     Granger
     Graves (GA)
     Green (TN)
     Harris
     Hern, Kevin
     Hice (GA)
     Higgins (LA)
     Huizenga
     Johnson (LA)
     Jordan
     Kelly (MS)
     Lamborn
     Loudermilk
     Massie
     Mast
     McClintock
     Meadows
     Mitchell
     Mooney (WV)
     Norman
     Palazzo
     Palmer
     Pence
     Perry
     Posey
     Ratcliffe
     Riggleman
     Roby
     Rogers (AL)
     Roy
     Scalise
     Smith (NE)
     Steube
     Stewart
     Walorski
     Weber (TX)
     Williams
     Woodall
     Wright
     Yoho

                             NOT VOTING--16

     Abraham
     Bass
     Bishop (UT)
     Cardenas
     Cummings
     Emmer
     Olson
     Pingree
     Richmond
     Rooney (FL)
     Ryan
     San Nicolas
     Swalwell (CA)
     Walker
     Waltz
     Wenstrup

                              {time}  1744

  Messrs. KELLY of Mississippi, SMITH of Nebraska, MAST, and CARTER of 
Georgia changed their vote from ``aye'' to ``no.''
  Messrs. BUCSHON, BAIRD, WEBSTER of Florida, BACON, FLEISCHMANN, LONG, 
and KELLY of Pennsylvania changed their vote from ``no'' to ``aye.''
  So the amendment was agreed to.
  The result of the vote was announced as above recorded.


                 Amendment No. 7 Offered by Mr. Holding

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentleman from North 
Carolina (Mr. Holding) on which further proceedings were postponed and 
on which the noes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The Acting CHAIR. This will be a 2-minute vote.
  The vote was taken by electronic device, and there were--ayes 184, 
noes 237, not voting 16, as follows:

                             [Roll No. 192]

                               AYES--184

     Aderholt
     Allen
     Amodei
     Armstrong
     Arrington
     Babin
     Bacon
     Baird
     Balderson
     Banks
     Barr
     Bergman
     Biggs
     Bilirakis
     Bost
     Brady
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burchett
     Burgess
     Byrne
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Cloud
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Conaway
     Cook
     Crawford
     Crenshaw
     Curtis
     Davidson (OH)
     Davis, Rodney
     DesJarlais
     Diaz-Balart
     Duffy
     Duncan
     Dunn
     Estes
     Ferguson
     Fleischmann
     Flores

[[Page H3546]]


     Fortenberry
     Foxx (NC)
     Fulcher
     Gaetz
     Gallagher
     Gianforte
     Gibbs
     Gohmert
     Gonzalez (OH)
     Gonzalez-Colon (PR)
     Gooden
     Gosar
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Green (TN)
     Griffith
     Grothman
     Guthrie
     Hagedorn
     Harris
     Hartzler
     Hern, Kevin
     Herrera Beutler
     Hice (GA)
     Hill (AR)
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hunter
     Hurd (TX)
     Johnson (LA)
     Johnson (OH)
     Johnson (SD)
     Jordan
     Joyce (OH)
     Joyce (PA)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Kustoff (TN)
     LaHood
     LaMalfa
     Lamborn
     Latta
     Lesko
     Long
     Loudermilk
     Lucas
     Luetkemeyer
     Marchant
     Marshall
     Massie
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     Meadows
     Meuser
     Miller
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Newhouse
     Norman
     Nunes
     Palazzo
     Palmer
     Pence
     Perry
     Posey
     Radewagen
     Ratcliffe
     Reed
     Reschenthaler
     Rice (SC)
     Riggleman
     Roby
     Rodgers (WA)
     Roe, David P.
     Rogers (AL)
     Rogers (KY)
     Rose, John W.
     Rouzer
     Rutherford
     Scalise
     Schweikert
     Scott, Austin
     Sensenbrenner
     Shimkus
     Simpson
     Smith (MO)
     Smith (NE)
     Smucker
     Spano
     Stauber
     Stefanik
     Steil
     Steube
     Stewart
     Stivers
     Thompson (PA)
     Thornberry
     Timmons
     Tipton
     Turner
     Upton
     Wagner
     Walberg
     Walden
     Walorski
     Waltz
     Watkins
     Weber (TX)
     Webster (FL)
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Wright
     Yoho
     Young
     Zeldin

                               NOES--237

     Adams
     Aguilar
     Allred
     Amash
     Axne
     Barragan
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brindisi
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Carbajal
     Carson (IN)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Cline
     Clyburn
     Cohen
     Connolly
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crist
     Crow
     Cuellar
     Cunningham
     Davids (KS)
     Davis (CA)
     Davis, Danny K.
     Dean
     DeFazio
     DeGette
     DeLauro
     DelBene
     Delgado
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Engel
     Escobar
     Eshoo
     Espaillat
     Evans
     Finkenauer
     Fitzpatrick
     Fletcher
     Foster
     Frankel
     Fudge
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     Golden
     Gomez
     Gonzalez (TX)
     Gottheimer
     Green (TX)
     Grijalva
     Guest
     Haaland
     Harder (CA)
     Hastings
     Hayes
     Heck
     Higgins (LA)
     Higgins (NY)
     Hill (CA)
     Himes
     Horn, Kendra S.
     Horsford
     Houlahan
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson (TX)
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kildee
     Kilmer
     Kim
     Kind
     Kirkpatrick
     Krishnamoorthi
     Kuster (NH)
     Lamb
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee (CA)
     Lee (NV)
     Levin (CA)
     Levin (MI)
     Lewis
     Lieu, Ted
     Lipinski
     Loebsack
     Lofgren
     Lowenthal
     Lowey
     Lujan
     Luria
     Lynch
     Malinowski
     Maloney, Carolyn B.
     Maloney, Sean
     Matsui
     McAdams
     McBath
     McCollum
     McEachin
     McGovern
     McNerney
     Meeks
     Meng
     Moore
     Morelle
     Moulton
     Mucarsel-Powell
     Murphy
     Nadler
     Napolitano
     Neal
     Neguse
     Norcross
     Norton
     O'Halleran
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Perlmutter
     Peters
     Peterson
     Phillips
     Pingree
     Plaskett
     Pocan
     Porter
     Pressley
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Rose (NY)
     Rouda
     Roy
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Sablan
     Sanchez
     Sarbanes
     Scanlon
     Schakowsky
     Schiff
     Schneider
     Schrader
     Schrier
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shalala
     Sherman
     Sherrill
     Sires
     Slotkin
     Smith (WA)
     Soto
     Spanberger
     Speier
     Stanton
     Stevens
     Suozzi
     Takano
     Taylor
     Thompson (CA)
     Thompson (MS)
     Titus
     Tlaib
     Tonko
     Torres (CA)
     Torres Small (NM)
     Trahan
     Trone
     Underwood
     Van Drew
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Wasserman Schultz
     Waters
     Watson Coleman
     Welch
     Wexton
     Wild
     Wilson (FL)
     Yarmuth

                             NOT VOTING--16

     Abraham
     Bass
     Bishop (UT)
     Cardenas
     Cummings
     Emmer
     Gabbard
     Olson
     Richmond
     Rooney (FL)
     Ryan
     San Nicolas
     Smith (NJ)
     Swalwell (CA)
     Walker
     Wenstrup


                    Announcement by the Acting Chair

  The Acting CHAIR (during the vote). There is 1 minute remaining.

                              {time}  1749

  Messrs. RUSH, ROUDA, PHILLIPS, and Ms. MUCARSEL-POWELL changed their 
vote from ``aye'' to ``no.''
  So the amendment was rejected.
  The result of the vote was announced as above recorded.


               Amendment No. 11 Offered by Mr. Malinowski

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentleman from New Jersey 
(Mr. Malinowski) on which further proceedings were postponed and on 
which the ayes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The Acting CHAIR. This will be a 2-minute vote.
  The vote was taken by electronic device, and there were--ayes 302, 
noes 117, not voting 18, as follows:

                             [Roll No. 193]

                               AYES--302

     Adams
     Aguilar
     Allred
     Armstrong
     Arrington
     Axne
     Bacon
     Balderson
     Barragan
     Beatty
     Bera
     Beyer
     Bilirakis
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Bost
     Boyle, Brendan F.
     Brindisi
     Brooks (IN)
     Brown (MD)
     Brownley (CA)
     Buchanan
     Bucshon
     Burgess
     Bustos
     Butterfield
     Calvert
     Carbajal
     Carson (IN)
     Carter (TX)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chabot
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Cole
     Collins (NY)
     Comer
     Connolly
     Cook
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crenshaw
     Crist
     Crow
     Cuellar
     Cunningham
     Davids (KS)
     Davis (CA)
     Davis, Danny K.
     Davis, Rodney
     Dean
     DeFazio
     DeGette
     DeLauro
     DelBene
     Delgado
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Engel
     Escobar
     Eshoo
     Espaillat
     Evans
     Finkenauer
     Fitzpatrick
     Fletcher
     Flores
     Fortenberry
     Foster
     Frankel
     Fudge
     Gallagher
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     Gianforte
     Gibbs
     Golden
     Gomez
     Gonzalez (OH)
     Gonzalez (TX)
     Gonzalez-Colon (PR)
     Gottheimer
     Graves (LA)
     Graves (MO)
     Green (TX)
     Griffith
     Grothman
     Guest
     Guthrie
     Haaland
     Hagedorn
     Harder (CA)
     Hartzler
     Hastings
     Hayes
     Heck
     Herrera Beutler
     Higgins (NY)
     Hill (CA)
     Himes
     Horn, Kendra S.
     Horsford
     Houlahan
     Hoyer
     Huffman
     Hurd (TX)
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson (OH)
     Johnson (TX)
     Joyce (OH)
     Joyce (PA)
     Kaptur
     Katko
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kildee
     Kilmer
     Kim
     Kind
     King (NY)
     Kinzinger
     Kirkpatrick
     Krishnamoorthi
     Kuster (NH)
     Lamb
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee (CA)
     Lee (NV)
     Levin (CA)
     Levin (MI)
     Lewis
     Lieu, Ted
     Lipinski
     Loebsack
     Lofgren
     Long
     Lowenthal
     Lowey
     Luetkemeyer
     Lujan
     Luria
     Lynch
     Malinowski
     Maloney, Carolyn B.
     Maloney, Sean
     Marshall
     Matsui
     McAdams
     McBath
     McCaul
     McCollum
     McEachin
     McGovern
     McHenry
     McKinley
     McNerney
     Meeks
     Meng
     Moolenaar
     Moore
     Morelle
     Moulton
     Mucarsel-Powell
     Murphy
     Nadler
     Napolitano
     Neal
     Neguse
     Newhouse
     Norcross
     Norton
     O'Halleran
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Perlmutter
     Peters
     Peterson
     Phillips
     Pingree
     Plaskett
     Pocan
     Porter
     Pressley
     Price (NC)
     Quigley
     Radewagen
     Raskin
     Reed
     Rice (NY)
     Rice (SC)
     Rodgers (WA)
     Rose (NY)
     Rouda
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Sablan
     Sanchez
     Sarbanes
     Scanlon
     Schiff
     Schneider
     Schrader
     Schrier
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shalala
     Sherman
     Sherrill
     Shimkus
     Sires
     Slotkin
     Smith (NJ)
     Smith (WA)
     Smucker
     Soto
     Spanberger
     Spano
     Speier
     Stanton
     Stauber
     Stefanik
     Steil
     Stevens
     Stivers
     Suozzi
     Takano
     Taylor
     Thompson (CA)
     Thompson (MS)
     Thompson (PA)
     Tipton
     Titus
     Tlaib
     Tonko
     Torres (CA)
     Torres Small (NM)
     Trahan
     Trone
     Turner
     Underwood
     Upton
     Van Drew
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Wagner
     Walden
     Waltz
     Wasserman Schultz
     Waters
     Watkins
     Watson Coleman
     Welch
     Wexton
     Wild
     Wilson (FL)
     Yarmuth
     Young
     Zeldin

                               NOES--117

     Aderholt
     Allen
     Amash
     Amodei
     Babin
     Baird
     Banks
     Barr
     Bergman
     Biggs
     Brady
     Brooks (AL)
     Buck
     Budd
     Burchett
     Byrne
     Carter (GA)
     Cheney
     Cline
     Cloud
     Collins (GA)
     Conaway
     Crawford
     Curtis
     Davidson (OH)
     DesJarlais
     Diaz-Balart
     Duffy
     Duncan
     Dunn

[[Page H3547]]


     Estes
     Ferguson
     Fleischmann
     Foxx (NC)
     Fulcher
     Gaetz
     Gohmert
     Gooden
     Gosar
     Granger
     Graves (GA)
     Green (TN)
     Harris
     Hern, Kevin
     Hice (GA)
     Higgins (LA)
     Hill (AR)
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hunter
     Johnson (LA)
     Johnson (SD)
     Jordan
     Kelly (MS)
     Kelly (PA)
     King (IA)
     Kustoff (TN)
     LaHood
     LaMalfa
     Lamborn
     Latta
     Lesko
     Loudermilk
     Lucas
     Marchant
     Massie
     Mast
     McCarthy
     McClintock
     Meadows
     Meuser
     Miller
     Mitchell
     Mooney (WV)
     Mullin
     Norman
     Nunes
     Palazzo
     Palmer
     Pence
     Perry
     Posey
     Ratcliffe
     Reschenthaler
     Riggleman
     Roby
     Roe, David P.
     Rogers (AL)
     Rogers (KY)
     Rouzer
     Roy
     Rutherford
     Scalise
     Schweikert
     Scott, Austin
     Sensenbrenner
     Simpson
     Smith (MO)
     Smith (NE)
     Steube
     Stewart
     Thornberry
     Timmons
     Walberg
     Walorski
     Weber (TX)
     Webster (FL)
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Wright
     Yoho

                             NOT VOTING--18

     Abraham
     Bass
     Bishop (UT)
     Cardenas
     Cummings
     Emmer
     Gabbard
     Grijalva
     Olson
     Richmond
     Rooney (FL)
     Rose, John W.
     Ryan
     San Nicolas
     Schakowsky
     Swalwell (CA)
     Walker
     Wenstrup


                    Announcement by the Acting Chair

  The Acting CHAIR (during the vote). There is 1 minute remaining.

                              {time}  1754

  Messrs. STEWART and CURTIS changed their vote from ``aye'' to ``no.''
  Mr. BUCHANAN changed his vote from ``no'' to ``aye.''
  So the amendment was agreed to.
  The result of the vote was announced as above recorded.


                  Amendment No. 12 Offered by Ms. Wild

  The Acting CHAIR. The unfinished business is the demand for a 
recorded vote on the amendment offered by the gentlewoman from 
Pennsylvania (Ms. Wild) on which further proceedings were postponed and 
on which the ayes prevailed by voice vote.
  The Clerk will redesignate the amendment.
  The Clerk redesignated the amendment.


                             Recorded Vote

  The Acting CHAIR. A recorded vote has been demanded.
  A recorded vote was ordered.
  The Acting CHAIR. This will be a 2-minute vote.
  The vote was taken by electronic device, and there were--ayes 308, 
noes 112, not voting 17, as follows:

                             [Roll No. 194]

                               AYES--308

     Adams
     Aguilar
     Allred
     Armstrong
     Arrington
     Axne
     Bacon
     Barragan
     Beatty
     Bera
     Beyer
     Bilirakis
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Bost
     Boyle, Brendan F.
     Brindisi
     Brooks (IN)
     Brown (MD)
     Brownley (CA)
     Buchanan
     Burgess
     Bustos
     Butterfield
     Calvert
     Carbajal
     Carson (IN)
     Carter (TX)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chabot
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Cole
     Collins (NY)
     Comer
     Connolly
     Cook
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crenshaw
     Crist
     Crow
     Cuellar
     Cunningham
     Davids (KS)
     Davis (CA)
     Davis, Danny K.
     Davis, Rodney
     Dean
     DeFazio
     DeGette
     DeLauro
     DelBene
     Delgado
     Demings
     DeSaulnier
     Deutch
     Diaz-Balart
     Dingell
     Doggett
     Doyle, Michael F.
     Engel
     Escobar
     Eshoo
     Espaillat
     Evans
     Finkenauer
     Fitzpatrick
     Fletcher
     Flores
     Fortenberry
     Foster
     Frankel
     Fudge
     Gallagher
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     Gianforte
     Golden
     Gomez
     Gonzalez (OH)
     Gonzalez (TX)
     Gonzalez-Colon (PR)
     Gottheimer
     Graves (LA)
     Graves (MO)
     Green (TX)
     Griffith
     Grijalva
     Grothman
     Guthrie
     Haaland
     Hagedorn
     Harder (CA)
     Hartzler
     Hastings
     Hayes
     Heck
     Herrera Beutler
     Higgins (NY)
     Hill (CA)
     Himes
     Holding
     Horn, Kendra S.
     Horsford
     Houlahan
     Hoyer
     Hudson
     Huffman
     Hunter
     Hurd (TX)
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson (OH)
     Johnson (TX)
     Joyce (OH)
     Joyce (PA)
     Kaptur
     Katko
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kildee
     Kilmer
     Kim
     Kind
     King (NY)
     Kinzinger
     Kirkpatrick
     Krishnamoorthi
     Kuster (NH)
     Lamb
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee (CA)
     Lee (NV)
     Levin (CA)
     Levin (MI)
     Lewis
     Lieu, Ted
     Lipinski
     Loebsack
     Lofgren
     Long
     Lowenthal
     Lowey
     Luetkemeyer
     Lujan
     Luria
     Lynch
     Malinowski
     Maloney, Carolyn B.
     Maloney, Sean
     Marshall
     Matsui
     McAdams
     McBath
     McCaul
     McCollum
     McEachin
     McGovern
     McHenry
     McKinley
     McNerney
     Meeks
     Meng
     Mitchell
     Moolenaar
     Moore
     Morelle
     Moulton
     Mucarsel-Powell
     Murphy
     Nadler
     Napolitano
     Neal
     Neguse
     Newhouse
     Norcross
     Norton
     O'Halleran
     Ocasio-Cortez
     Omar
     Pallone
     Palmer
     Panetta
     Pappas
     Pascrell
     Payne
     Perlmutter
     Peters
     Peterson
     Phillips
     Pingree
     Plaskett
     Pocan
     Porter
     Pressley
     Price (NC)
     Quigley
     Radewagen
     Raskin
     Reed
     Rice (NY)
     Rice (SC)
     Rodgers (WA)
     Rose (NY)
     Rouda
     Rouzer
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Sablan
     Sanchez
     Sarbanes
     Scanlon
     Schakowsky
     Schiff
     Schneider
     Schrader
     Schrier
     Scott (VA)
     Scott, Austin
     Scott, David
     Sensenbrenner
     Serrano
     Sewell (AL)
     Shalala
     Sherman
     Sherrill
     Shimkus
     Sires
     Slotkin
     Smith (NJ)
     Smith (WA)
     Smucker
     Soto
     Spanberger
     Spano
     Speier
     Stanton
     Stefanik
     Steil
     Stevens
     Stivers
     Suozzi
     Takano
     Taylor
     Thompson (CA)
     Thompson (MS)
     Thompson (PA)
     Titus
     Tlaib
     Tonko
     Torres (CA)
     Torres Small (NM)
     Trahan
     Trone
     Turner
     Underwood
     Upton
     Van Drew
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Wagner
     Walden
     Waltz
     Wasserman Schultz
     Waters
     Watkins
     Watson Coleman
     Welch
     Wexton
     Wild
     Wilson (FL)
     Wilson (SC)
     Yarmuth
     Young
     Zeldin

                               NOES--112

     Aderholt
     Allen
     Amash
     Amodei
     Babin
     Baird
     Balderson
     Banks
     Barr
     Bergman
     Biggs
     Brady
     Brooks (AL)
     Buck
     Bucshon
     Budd
     Burchett
     Byrne
     Carter (GA)
     Cheney
     Cline
     Cloud
     Collins (GA)
     Conaway
     Crawford
     Curtis
     Davidson (OH)
     DesJarlais
     Duffy
     Duncan
     Dunn
     Estes
     Ferguson
     Fleischmann
     Foxx (NC)
     Fulcher
     Gaetz
     Gibbs
     Gohmert
     Gooden
     Gosar
     Granger
     Graves (GA)
     Green (TN)
     Guest
     Harris
     Hern, Kevin
     Hice (GA)
     Higgins (LA)
     Hill (AR)
     Hollingsworth
     Huizenga
     Johnson (LA)
     Johnson (SD)
     Jordan
     Kelly (MS)
     Kelly (PA)
     King (IA)
     Kustoff (TN)
     LaHood
     LaMalfa
     Lamborn
     Latta
     Lesko
     Loudermilk
     Lucas
     Marchant
     Massie
     Mast
     McCarthy
     McClintock
     Meadows
     Meuser
     Miller
     Mooney (WV)
     Mullin
     Norman
     Palazzo
     Pence
     Perry
     Posey
     Reschenthaler
     Riggleman
     Roby
     Roe, David P.
     Rogers (AL)
     Rogers (KY)
     Rose, John W.
     Roy
     Rutherford
     Scalise
     Schweikert
     Simpson
     Smith (MO)
     Smith (NE)
     Stauber
     Steube
     Stewart
     Thornberry
     Timmons
     Tipton
     Walberg
     Walorski
     Weber (TX)
     Webster (FL)
     Westerman
     Williams
     Wittman
     Womack
     Woodall
     Wright
     Yoho

                             NOT VOTING--17

     Abraham
     Bass
     Bishop (UT)
     Cardenas
     Cummings
     Emmer
     Gabbard
     Nunes
     Olson
     Ratcliffe
     Richmond
     Rooney (FL)
     Ryan
     San Nicolas
     Swalwell (CA)
     Walker
     Wenstrup


                    Announcement by the Acting Chair

  The Acting CHAIR (Ms. Kendra S. Horn of Oklahoma) (during the vote). 
There is 1 minute remaining.

                              {time}  1801

  So the amendment was agreed to.
  The result of the vote was announced as above recorded.
  The Acting CHAIR. There being no further amendments, under the rule, 
the Committee rises.
  Accordingly, the Committee rose; and the Speaker pro tempore (Ms. 
Underwood) having assumed the chair, Ms. Kendra S. Horn of Oklahoma, 
Acting Chair of the Committee of the Whole House on the state of the 
Union, reported that that Committee, having had under consideration the 
bill (H.R. 986) to provide that certain guidance related to waivers for 
State innovation under the Patient Protection and Affordable Care Act 
shall have no force or effect, and, pursuant to House Resolution 357, 
she reported the bill back to the House with sundry amendments adopted 
in the Committee of the Whole.
  The SPEAKER pro tempore. Under the rule, the previous question is 
ordered.
  Is a separate vote demanded on any amendment reported from the 
Committee of the Whole? If not, the Chair will put them en gros.
  The amendments were agreed to.
  The SPEAKER pro tempore. 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.


                           Motion to Recommit

  Mr. WALDEN. Madam Speaker, I have a motion to recommit at the desk.

[[Page H3548]]

  The SPEAKER pro tempore. Is the gentleman opposed to the bill?
  Mr. WALDEN. Oh, yes, I am, Madam Speaker, in its current form.
  The SPEAKER pro tempore. The Clerk will report the motion to 
recommit.
  The Clerk read as follows:

       Mr. Walden moves to recommit the bill H.R. 986 to the 
     Committee on Energy and Commerce with instructions to report 
     the same back to the House forthwith with the following 
     amendments:
       Page 3, strike lines 3 through 5, and insert the following:

     SECTION 1. FINDINGS.

       Congress finds the following:
       (1) On October 24, 2018, the Administration published new 
     guidance to carry out section 1332 of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18052) entitled ``State 
     Relief and Empowerment Waivers'' (83 Fed. Reg. 53575).
       (2) The new guidance does not amend such section 1332 and 
     does not permit the Secretary of Health and Human Services to 
     waive protections for individuals with preexisting 
     conditions, including guaranteed availability and 
     renewability of health insurance, the prohibition on using 
     health status to vary premiums, and the prohibition on 
     preexisting conditions exclusions.
       (3) Moreover, this guidance stipulates that any section 
     1332 waiver will need to carefully account for any impact on 
     the individual market risk pool and guarantee that access to 
     coverage is at least as comprehensive and affordable as would 
     exist without the waiver.
       Page 3, line 17, insert before the period the following: 
     ``, including if such substantially similar guidance or rule 
     would allow a State to waive such requirements as guaranteed 
     availability and renewability of health insurance, the 
     prohibition on using health status to vary premiums, or the 
     prohibition on preexisting conditions exclusions''.

  The SPEAKER pro tempore. The gentleman from Oregon is recognized for 
5 minutes.
  Mr. WALDEN. Madam Speaker, this bill is blatantly political in its 
title. The misleading title of the bill confirms the Democratic 
majority's passion to score political points instead of governing. 
Madam Speaker, they claim the agenda is ``for the people.'' This bill 
is ``for the politics'' and the TV ads.
  This motion to recommit is simple, Madam Speaker. First, it strikes 
the Democrats' misleading title, and it includes findings to make clear 
that, under current law, Health and Human Services cannot waive 
protections for individuals with preexisting conditions, period. They 
are protected.
  Second, Madam Speaker, the motion to recommit would prohibit the 
Secretaries of HHS and Treasury from reissuing substantially similar 
guidance, including guidance that allows the State to waive guaranteed 
availability and renewability of health insurance, the prohibition on 
using health status to vary premiums, and the prohibition on 
preexisting conditions exclusions.
  Madam Speaker, the Trump administration guidance does not amend 
section 1332. It does not permit the Secretary of Health and Human 
Services to waive protections for individuals with preexisting 
conditions, like guaranteed availability and renewability of health 
insurance, like the prohibition on using health status to vary 
premiums, and the prohibition on preexisting conditions exclusions.
  Moreover, the President's guidance stipulates that any section 1332 
waiver will need to carefully account for any impact on the individual 
market risk pool and guarantee--guarantee--that access to coverage is 
at least as comprehensive and as affordable as would exist without the 
waiver.
  Now, this is fully explained, Madam Speaker, in the letter I have 
here from the head of CMS, Seema Verma, and I want to quote directly 
from it because I think it is important for our Members to understand 
the facts of the matter here, because facts matter.
  ``To be very clear, the 2018 guidance does nothing to erode,'' I am 
going to say ObamaCare or the Affordable Care Act's ``preexisting 
condition provisions''--nothing--``which cannot be waived under section 
1332. Section 1332 does not permit States to waive Public Health 
Service Act requirements such as guaranteed availability and 
renewability of health insurance, the prohibition on using health 
status to vary premiums, and the prohibition on preexisting conditions 
exclusions.''
  Now why are we here? Why are we having this discussion? Because 
people at home can't afford the health insurance they are being 
peddled, and we want States to be able to innovate and cut costs for 
consumers. That is why we are here. That is what we are for.
  Democrats don't want that. Democrats are opposed to letting States 
innovate, apparently. And let's look at what happens.
  Madam Speaker, according to Health and Human Services Administrator 
Seema Verma, Grand Island, Nebraska, a 60-year-old couple making 
$70,000 a year is paying about $38,000 for their insurance premiums, 
and that plan, under ObamaCare, gets them an $11,100 deductible.
  $38,000 in premiums, $11,000 in deductibles, and they call that 
coverage. I call that unaffordable.
  Now, meanwhile, we have seven States that have used the authority 
under the last administration. See, ObamaCare allows this 1332; Trump 
expands it. They have been able to drive down premiums by 19.9 percent. 
My State, it is 6 percent; other States have been more. Alaska, New 
Jersey, other States have taken advantage of this.
  Republicans and Democrats agree we will always protect people with 
preexisting conditions. We will always do that. They can run their ads; 
they can deceive people; they can mislead people, Madam Speaker; but we 
will always fight to protect people with preexisting conditions--
always. Our plan last year did it. Our plan this year does it.
  I will tell you what, Madam Speaker. We would have a vote today on 
the House floor to do that, to actually enshrine in statute, 
irrespective of the lawsuit, protections for Americans with preexisting 
conditions, except the Democrats and the Rules Committee refuse to 
allow that amendment to be considered on the House floor. They would 
not do that, because it was my amendment; it is my bill.
  I have been pleading to have this bill considered so we can lock into 
statute protections for Americans' preexisting conditions. They want 
the argument. They want the politics. They don't want the policy.
  We are for innovation; we are for lower premiums; we are for more 
consumer choice; and we are for driving down the cost of healthcare in 
America so people have coverage they can afford, Madam Chair. That is 
what our motion to recommit will do, and I urge our support.
  Madam Speaker, I yield back the balance of my time.
  Ms. SLOTKIN. Madam Speaker, I claim the time in opposition.
  The SPEAKER pro tempore. The gentlewoman from Michigan is recognized 
for 5 minutes.
  Ms. SLOTKIN. Madam Speaker, I rise because this motion to recommit is 
simply another attempt to take away protections for people with 
preexisting conditions.
  Madam Speaker, at face value, the amendment appears to maintain 
protections for people with preexisting conditions, but make no 
mistake, no matter the language included in this MTR, the goal of the 
1332 guidance expands and promotes junk plans that discriminate against 
people with preexisting conditions. These plans also make comprehensive 
coverage for people with preexisting conditions more expensive.
  It is not enough to say, my colleagues, that you protect preexisting 
conditions. It is what happens on the ground that matters.

                              {time}  1815

  If my colleagues are serious about protecting Americans with 
preexisting conditions, I urge them to oppose this amendment, support 
the underlying bill, and join us in doing what the American public has 
made very clear they want.
  While Members of the other party may claim they are ready to work to 
protect individuals, their actions tell a different story.
  Madam Speaker, 2 years ago, exactly this week, most House Republicans 
voted overwhelmingly for a bill that would have gutted the ACA and 
weakened protections for people with preexisting conditions.
  My colleagues--including you, sir--stood on the White House lawn and 
celebrated that bill and would have made it more difficult for people 
with preexisting conditions.
  A few courageous Republicans, who I applaud--including the late 
Senator John McCain--joined Democratic Members and Senators in 
preventing this bill from becoming law.

[[Page H3549]]

  You can boo John McCain if you want.
  Since then, the administration has tried every play in the book to 
undercut, sabotage, skirt protections in the ACA, including protections 
for people with preexisting conditions.
  We currently have an open suit from your side that is meant to 
invalidate the entirety of the ACA, including protections for people 
with preexisting conditions.
  I stand in opposition to this motion because the issue of protecting 
people with preexisting conditions is deeply personal to me, as it is 
to so many people in this room and in our districts.
  My mom passed away in 2011 from ovarian cancer, and when she was 
diagnosed, she did not have healthcare. She had struggled to afford 
healthcare her entire life.
  She had breast cancer as a 31-year old mom, leaving her with a 
preexisting condition for the rest of her life. When she lost her job 
in 2002, she lost her insurance, and it was impossible to find coverage 
that she could afford. She went 5\1/2\ years with no insurance, no 
checkup, no gynecological exam, no one saying ``you should get 
tested.''
  In 2008, we finally helped her get insurance. Because of her 
preexisting condition, it was $1,000 a month and a $10,000 deductible. 
She let it lapse and walked into an ER a few months later and was 
diagnosed with stage IV ovarian cancer.
  Now, I am sure my colleagues on the other side of the aisle know 
exactly what it is like to have a loved one get a terminal diagnosis. 
Your life as you know it explodes.
  And that same week and that same month that my life was exploding, 
was the same week and the same month that I spent filing the paperwork 
for my mom to declare bankruptcy. So, no one should be gouged because 
they happen to be born with a preexisting condition.
  We have evolved as a country, as a Nation, to see that, and I urge my 
colleagues to evolve as well.
  Madam Speaker, in my district protecting people with preexisting 
conditions is not a Democratic or Republican issue. It is what people 
of all political backgrounds are demanding of us as their 
representatives.
  That is our mission. That is our mandate. And to ignore the interest 
of our constituents at this point, is dereliction of duty, plain and 
simple.
  I urge my colleagues to join me in opposing this amendment that would 
hurt people like my mom. To my colleagues across the aisle, do the 
right thing. Put people before politics. Vote against this amendment.
  Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. Members are reminded to address their 
remarks to the Chair.
  Without objection, the previous question is ordered on the motion to 
recommit.
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion to recommit.
  The question was taken; and the Speaker pro tempore announced that 
the noes appeared to have it.


                             Recorded Vote

  Mr. WALDEN. Madam Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. Pursuant to clause 9 of rule XX, the Chair 
will reduce to 5 minutes the minimum time for any electronic vote on 
the question of passage. This is a 5-minute vote.
  The vote was taken by electronic device, and there were--ayes 182, 
noes 231, not voting 18, as follows:

                             [Roll No. 195]

                               AYES--182

     Aderholt
     Allen
     Amodei
     Armstrong
     Arrington
     Babin
     Bacon
     Baird
     Balderson
     Banks
     Barr
     Bergman
     Biggs
     Bilirakis
     Bost
     Brady
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burchett
     Burgess
     Byrne
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Cline
     Cloud
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Conaway
     Cook
     Crawford
     Crenshaw
     Curtis
     Davidson (OH)
     Davis, Rodney
     DesJarlais
     Diaz-Balart
     Duffy
     Duncan
     Dunn
     Estes
     Ferguson
     Fitzpatrick
     Fleischmann
     Flores
     Fortenberry
     Foxx (NC)
     Fulcher
     Gaetz
     Gallagher
     Gianforte
     Gibbs
     Gohmert
     Gonzalez (OH)
     Gooden
     Gosar
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Green (TN)
     Griffith
     Grothman
     Guest
     Guthrie
     Hagedorn
     Harris
     Hartzler
     Hern, Kevin
     Herrera Beutler
     Hice (GA)
     Higgins (LA)
     Hill (AR)
     Holding
     Hudson
     Huizenga
     Hunter
     Hurd (TX)
     Johnson (LA)
     Johnson (OH)
     Johnson (SD)
     Jordan
     Joyce (OH)
     Joyce (PA)
     Katko
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Kustoff (TN)
     LaHood
     LaMalfa
     Lamborn
     Latta
     Lesko
     Long
     Loudermilk
     Lucas
     Luetkemeyer
     Marchant
     Marshall
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     Meadows
     Meuser
     Miller
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Newhouse
     Norman
     Palazzo
     Palmer
     Pence
     Posey
     Reed
     Reschenthaler
     Rice (SC)
     Riggleman
     Roby
     Roe, David P.
     Rogers (AL)
     Rogers (KY)
     Rose, John W.
     Rouzer
     Rutherford
     Scalise
     Schweikert
     Scott, Austin
     Sensenbrenner
     Shimkus
     Simpson
     Smith (MO)
     Smith (NE)
     Smith (NJ)
     Smucker
     Spano
     Stauber
     Stefanik
     Steil
     Steube
     Stewart
     Stivers
     Taylor
     Thompson (PA)
     Thornberry
     Timmons
     Tipton
     Turner
     Upton
     Wagner
     Walberg
     Walden
     Walorski
     Waltz
     Watkins
     Weber (TX)
     Webster (FL)
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Wright
     Yoho
     Young
     Zeldin

                               NOES--231

     Adams
     Aguilar
     Allred
     Amash
     Axne
     Barragan
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brindisi
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Carbajal
     Carson (IN)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crist
     Crow
     Cuellar
     Cunningham
     Davids (KS)
     Davis (CA)
     Davis, Danny K.
     Dean
     DeFazio
     DeGette
     DeLauro
     DelBene
     Delgado
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Engel
     Escobar
     Eshoo
     Espaillat
     Evans
     Finkenauer
     Fletcher
     Foster
     Frankel
     Fudge
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     Golden
     Gomez
     Gonzalez (TX)
     Gottheimer
     Green (TX)
     Grijalva
     Haaland
     Harder (CA)
     Hastings
     Hayes
     Heck
     Higgins (NY)
     Hill (CA)
     Himes
     Hollingsworth
     Horn, Kendra S.
     Horsford
     Houlahan
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson (TX)
     Kaptur
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kildee
     Kilmer
     Kim
     Kind
     Kirkpatrick
     Krishnamoorthi
     Kuster (NH)
     Lamb
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee (CA)
     Lee (NV)
     Levin (CA)
     Levin (MI)
     Lewis
     Lieu, Ted
     Lipinski
     Loebsack
     Lofgren
     Lowenthal
     Lowey
     Lujan
     Luria
     Lynch
     Malinowski
     Maloney, Carolyn B.
     Maloney, Sean
     Massie
     Matsui
     McAdams
     McBath
     McCollum
     McEachin
     McGovern
     McNerney
     Meeks
     Meng
     Moore
     Morelle
     Moulton
     Mucarsel-Powell
     Murphy
     Nadler
     Napolitano
     Neal
     Neguse
     Norcross
     O'Halleran
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Perlmutter
     Peters
     Peterson
     Phillips
     Pingree
     Pocan
     Porter
     Pressley
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Rose (NY)
     Rouda
     Roy
     Roybal-Allard
     Ruiz
     Ruppersberger
     Rush
     Sanchez
     Sarbanes
     Scanlon
     Schakowsky
     Schiff
     Schneider
     Schrader
     Schrier
     Scott (VA)
     Scott, David
     Serrano
     Sewell (AL)
     Shalala
     Sherman
     Sherrill
     Sires
     Slotkin
     Smith (WA)
     Soto
     Spanberger
     Speier
     Stanton
     Stevens
     Suozzi
     Takano
     Thompson (CA)
     Thompson (MS)
     Titus
     Tlaib
     Tonko
     Torres (CA)
     Torres Small (NM)
     Trahan
     Trone
     Underwood
     Van Drew
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Wasserman Schultz
     Waters
     Watson Coleman
     Welch
     Wexton
     Wild
     Wilson (FL)
     Yarmuth

                             NOT VOTING--18

     Abraham
     Bass
     Bishop (UT)
     Cardenas
     Cummings
     Emmer
     Gabbard
     Nunes
     Olson
     Perry
     Ratcliffe
     Richmond
     Rodgers (WA)
     Rooney (FL)
     Ryan
     Swalwell (CA)
     Walker
     Wenstrup

                              {time}  1825

  So the motion to recommit was rejected.
  The result of the vote was announced as above recorded.
  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.


                             Recorded Vote

  Mr. PALLONE. Madam Speaker, I demand a recorded vote.
  A recorded vote was ordered.
  The SPEAKER pro tempore. This is a 5-minute vote.

[[Page H3550]]

  The vote was taken by electronic device, and there were--ayes 230, 
noes 183, answered ``present'' 1, not voting 17, as follows:

                             [Roll No. 196]

                               AYES--230

     Adams
     Aguilar
     Allred
     Axne
     Barragan
     Beatty
     Bera
     Beyer
     Bishop (GA)
     Blumenauer
     Blunt Rochester
     Bonamici
     Boyle, Brendan F.
     Brindisi
     Brown (MD)
     Brownley (CA)
     Bustos
     Butterfield
     Carbajal
     Carson (IN)
     Cartwright
     Case
     Casten (IL)
     Castor (FL)
     Castro (TX)
     Chu, Judy
     Cicilline
     Cisneros
     Clark (MA)
     Clarke (NY)
     Clay
     Cleaver
     Clyburn
     Cohen
     Connolly
     Cooper
     Correa
     Costa
     Courtney
     Cox (CA)
     Craig
     Crist
     Crow
     Cuellar
     Cunningham
     Davids (KS)
     Davis (CA)
     Davis, Danny K.
     Dean
     DeFazio
     DeGette
     DeLauro
     DelBene
     Delgado
     Demings
     DeSaulnier
     Deutch
     Dingell
     Doggett
     Doyle, Michael F.
     Engel
     Escobar
     Eshoo
     Espaillat
     Evans
     Finkenauer
     Fitzpatrick
     Fletcher
     Foster
     Frankel
     Fudge
     Gallego
     Garamendi
     Garcia (IL)
     Garcia (TX)
     Golden
     Gomez
     Gonzalez (TX)
     Gottheimer
     Green (TX)
     Grijalva
     Haaland
     Harder (CA)
     Hastings
     Hayes
     Heck
     Higgins (NY)
     Hill (CA)
     Himes
     Horn, Kendra S.
     Horsford
     Houlahan
     Hoyer
     Huffman
     Jackson Lee
     Jayapal
     Jeffries
     Johnson (GA)
     Johnson (TX)
     Kaptur
     Katko
     Keating
     Kelly (IL)
     Kennedy
     Khanna
     Kildee
     Kilmer
     Kim
     Kind
     Kirkpatrick
     Krishnamoorthi
     Kuster (NH)
     Lamb
     Langevin
     Larsen (WA)
     Larson (CT)
     Lawrence
     Lawson (FL)
     Lee (CA)
     Lee (NV)
     Levin (CA)
     Levin (MI)
     Lewis
     Lieu, Ted
     Lipinski
     Loebsack
     Lofgren
     Lowenthal
     Lowey
     Lujan
     Luria
     Lynch
     Malinowski
     Maloney, Carolyn B.
     Maloney, Sean
     Matsui
     McAdams
     McBath
     McCollum
     McEachin
     McGovern
     McNerney
     Meeks
     Meng
     Moore
     Morelle
     Moulton
     Mucarsel-Powell
     Murphy
     Nadler
     Napolitano
     Neal
     Neguse
     Norcross
     O'Halleran
     Ocasio-Cortez
     Omar
     Pallone
     Panetta
     Pappas
     Pascrell
     Payne
     Perlmutter
     Peters
     Peterson
     Phillips
     Pingree
     Pocan
     Porter
     Pressley
     Price (NC)
     Quigley
     Raskin
     Rice (NY)
     Rose (NY)
     Rouda
     Roybal-Allard
     Ruiz
     Ruppersberger
     Sanchez
     Sarbanes
     Scanlon
     Schakowsky
     Schiff
     Schneider
     Schrader
     Schrier
     Scott (VA)
     Scott, David
     Sensenbrenner
     Serrano
     Sewell (AL)
     Shalala
     Sherman
     Sherrill
     Sires
     Slotkin
     Smith (NJ)
     Smith (WA)
     Soto
     Spanberger
     Speier
     Stanton
     Stevens
     Suozzi
     Takano
     Thompson (CA)
     Thompson (MS)
     Titus
     Tlaib
     Tonko
     Torres (CA)
     Torres Small (NM)
     Trahan
     Trone
     Underwood
     Van Drew
     Vargas
     Veasey
     Vela
     Velazquez
     Visclosky
     Wasserman Schultz
     Waters
     Watson Coleman
     Welch
     Wexton
     Wild
     Wilson (FL)
     Yarmuth

                               NOES--183

     Aderholt
     Allen
     Amash
     Amodei
     Armstrong
     Arrington
     Babin
     Bacon
     Baird
     Balderson
     Banks
     Barr
     Bergman
     Biggs
     Bilirakis
     Bost
     Brady
     Brooks (AL)
     Brooks (IN)
     Buchanan
     Buck
     Bucshon
     Budd
     Burchett
     Burgess
     Byrne
     Calvert
     Carter (GA)
     Carter (TX)
     Chabot
     Cheney
     Cline
     Cloud
     Cole
     Collins (GA)
     Collins (NY)
     Comer
     Conaway
     Cook
     Crawford
     Crenshaw
     Curtis
     Davidson (OH)
     Davis, Rodney
     DesJarlais
     Diaz-Balart
     Duffy
     Duncan
     Dunn
     Estes
     Ferguson
     Fleischmann
     Fortenberry
     Foxx (NC)
     Fulcher
     Gaetz
     Gallagher
     Gianforte
     Gibbs
     Gohmert
     Gonzalez (OH)
     Gooden
     Gosar
     Granger
     Graves (GA)
     Graves (LA)
     Graves (MO)
     Green (TN)
     Griffith
     Grothman
     Guest
     Guthrie
     Hagedorn
     Harris
     Hartzler
     Hern, Kevin
     Herrera Beutler
     Hice (GA)
     Higgins (LA)
     Hill (AR)
     Holding
     Hollingsworth
     Hudson
     Huizenga
     Hunter
     Hurd (TX)
     Johnson (LA)
     Johnson (OH)
     Johnson (SD)
     Jordan
     Joyce (OH)
     Joyce (PA)
     Kelly (MS)
     Kelly (PA)
     King (IA)
     King (NY)
     Kinzinger
     Kustoff (TN)
     LaHood
     LaMalfa
     Lamborn
     Latta
     Lesko
     Long
     Loudermilk
     Lucas
     Luetkemeyer
     Marchant
     Marshall
     Massie
     Mast
     McCarthy
     McCaul
     McClintock
     McHenry
     McKinley
     Meadows
     Meuser
     Miller
     Mitchell
     Moolenaar
     Mooney (WV)
     Mullin
     Newhouse
     Norman
     Palazzo
     Palmer
     Pence
     Perry
     Posey
     Reed
     Reschenthaler
     Rice (SC)
     Riggleman
     Roby
     Rodgers (WA)
     Roe, David P.
     Rogers (AL)
     Rogers (KY)
     Rose, John W.
     Rouzer
     Roy
     Rutherford
     Scalise
     Schweikert
     Scott, Austin
     Shimkus
     Simpson
     Smith (MO)
     Smith (NE)
     Smucker
     Spano
     Stauber
     Stefanik
     Steil
     Steube
     Stewart
     Stivers
     Taylor
     Thompson (PA)
     Thornberry
     Timmons
     Tipton
     Turner
     Upton
     Wagner
     Walberg
     Walden
     Walorski
     Waltz
     Watkins
     Weber (TX)
     Webster (FL)
     Westerman
     Williams
     Wilson (SC)
     Wittman
     Womack
     Woodall
     Wright
     Yoho
     Young
     Zeldin

                        ANSWERED ``PRESENT''--1

       
     Flores
       

                             NOT VOTING--17

     Abraham
     Bass
     Bishop (UT)
     Cardenas
     Cummings
     Emmer
     Gabbard
     Nunes
     Olson
     Ratcliffe
     Richmond
     Rooney (FL)
     Rush
     Ryan
     Swalwell (CA)
     Walker
     Wenstrup

                              {time}  1834

  So the bill was passed.
  The result of the vote was announced as above recorded.
  A motion to reconsider was laid on the table.

                          ____________________