MIDDLE CLASS HEALTH BENEFITS TAX REPEAL ACT OF 2019; Congressional Record Vol. 165, No. 120
(House of Representatives - July 17, 2019)

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[Pages H5958-H5973]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          MIDDLE CLASS HEALTH BENEFITS TAX REPEAL ACT OF 2019

  Mr. NEAL. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 748) to amend the Internal Revenue Code of 1986 to repeal 
the excise tax on high cost employer-sponsored health coverage, as 
amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                                H.R. 748

       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 ``Middle Class Health Benefits 
     Tax Repeal Act of 2019''.

     SEC. 2. REPEAL OF EXCISE TAX ON HIGH COST EMPLOYER-SPONSORED 
                   HEALTH COVERAGE.

       (a) In General.--Chapter 43 of the Internal Revenue Code of 
     1986 is amended by striking section 4980I.

[[Page H5959]]

       (b) Conforming Amendments.--
       (1) Section 6051 of such Code is amended--
       (A) by striking ``section 4980I(d)(1)'' in subsection 
     (a)(14) and inserting ``subsection (g)'', and
       (B) by adding at the end the following new subsection:
       ``(g) Applicable Employer-Sponsored Coverage.--For purposes 
     of subsection (a)(14)--
       ``(1) In general.--The term `applicable employer-sponsored 
     coverage' means, with respect to any employee, coverage under 
     any group health plan made available to the employee by an 
     employer which is excludable from the employee's gross income 
     under section 106, or would be so excludable if it were 
     employer-provided coverage (within the meaning of such 
     section 106).
       ``(2) Exceptions.--The term `applicable employer-sponsored 
     coverage' shall not include--
       ``(A) any coverage (whether through insurance or otherwise) 
     described in section 9832(c)(1) (other than subparagraph (G) 
     thereof) or for long-term care,
       ``(B) any coverage under a separate policy, certificate, or 
     contract of insurance which provides benefits substantially 
     all of which are for treatment of the mouth (including any 
     organ or structure within the mouth) or for treatment of the 
     eye, or
       ``(C) any coverage described in section 9832(c)(3) the 
     payment for which is not excludable from gross income and for 
     which a deduction under section 162(l) is not allowable.
       ``(3) Coverage includes employee paid portion.--Coverage 
     shall be treated as applicable employer-sponsored coverage 
     without regard to whether the employer or employee pays for 
     the coverage.
       ``(4) Governmental plans included.--Applicable employer-
     sponsored coverage shall include coverage under any group 
     health plan established and maintained primarily for its 
     civilian employees by the Government of the United States, by 
     the government of any State or political subdivision thereof, 
     or by any agency or instrumentality of any such 
     government.''.
       (2) Section 9831(d)(1) of such Code is amended by striking 
     ``except as provided in section 4980I(f)(4)''.
       (3) The table of sections for chapter 43 of such Code is 
     amended by striking the item relating to section 4980I.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
     2019.

     SEC. 3. BUDGETARY EFFECTS.

       (a) Statutory PAYGO Scorecards.--The budgetary effects of 
     this Act shall not be entered on either PAYGO scorecard 
     maintained pursuant to section 4(d) of the Statutory Pay-As-
     You-Go Act of 2010.
       (b) Senate PAYGO Scorecards.--The budgetary effects of this 
     Act shall not be entered on any PAYGO scorecard maintained 
     for purposes of section 4106 of H. Con. Res. 71 (115th 
     Congress).

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Massachusetts (Mr. Neal) and the gentleman from Pennsylvania (Mr. 
Kelly) each will control 20 minutes.
  The Chair recognizes the gentleman from Massachusetts.


                             General Leave

  Mr. NEAL. Madam Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on this bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Massachusetts?
  There was no objection.
  Mr. NEAL. Madam Speaker, I yield myself such time as I may consume.
  Madam Speaker, I rise today in support of H.R. 748, the Middle Class 
Health Benefits Tax Repeal Act of 2019.
  After a decade of fiercely debating the merits of the Affordable Care 
Act, I hope we have turned a corner today and can now focus on 
strengthening the parts of the law that work in the manner we had 
intended and changing the parts of the law, which is not unusual, that 
we believe could be improved.
  This legislation, tirelessly championed by Representative   Joe 
Courtney of Connecticut, with 367 bipartisan cosponsors, addresses the 
so-called ``Cadillac tax,'' a part of the law that had the unintended 
consequences of reducing healthcare benefits that were provided to 
certain American workers.
  More than 181 million Americans currently depend upon employer-
sponsored health insurance. That is the majority of the American 
people, including retirees, low-and moderate-income families, public-
sector employees, small business owners, and nonprofit workers.
  While the name ``Cadillac tax'' implies this excise tax only applies 
to luxury health coverage, the truth is it will eventually apply to 
almost every American with employer-sponsored health insurance.
  At a time when American families are already worried about the 
healthcare costs that apply to them, the Cadillac tax has had the 
effect of increasing deductibles and out-of-pocket costs as employers 
make changes in their plans designed to avoid the tax.
  We have also found that the Cadillac tax affects health plans that 
have higher numbers of workers with chronic diseases or serious 
illnesses, that cover more than a million women or families, or that 
offer coverage to part-time workers because premiums for those plans 
are often higher.
  This was not the goal of this tax when it was originally included in 
the ACA. I know because I helped to negotiate and to write the 
Affordable Care Act.
  Congress wanted to encourage employers and insurance companies to 
find ways to offer better coverage at lower costs. And, while many 
actions in the ACA did bend the cost curve, leading to better care and 
slower cost growth, this excise tax, indeed, did not.
  We want employers to cover their workers with robust, meaningful 
benefits. A good American job with a strong health benefit is part of 
security.
  Employers want this for their employees, labor wants this for their 
members, and American workers and their families want to know they can 
get the care they need when they need it.
  This legislation, as I noted earlier, has strong bipartisan support 
with a diverse group of stakeholder organizations endorsing the 
legislation, from labor to chamber of commerce to patient 
organizations.
  If we fail to repeal the Cadillac tax, we will leave working families 
with less healthcare coverage, higher out-of-pocket healthcare costs, 
and little to no resultant wage increases.
  Madam Speaker, I urge my colleagues to support this legislation, and 
I reserve the balance of my time.
  Mr. KELLY of Pennsylvania. Madam Speaker, I yield myself such time as 
I may consume.
  Madam Speaker, this is a great day for us. We worked with Chairman 
Neal on this and   Joe Courtney. I don't normally go out on a limb, but 
it is nice to see a bunch of Irish guys get together--I am not sure you 
can say that anymore in the people's House--to make sure that we are 
protecting so many people who have earned healthcare through their 
employer.
  I think the last couple days, if you were to look at what happened 
here in the House and you were to go back home and talk to people back 
home, they would ask, ``Can't you guys get along on anything? Can't you 
put away these things you fight over and actually start to talk about 
the things that help us? Can't you do things like that?''
  We have watched it, Madam Speaker, and I am sure people are back home 
saying, ``They can't do anything.''
  Well, I am here to tell you today that is just not true. You are 
going to see a bipartisan effort today on a bipartisan bill to make 
sure that hardworking Americans get to keep their employer-sponsored 
healthcare.
  Those are people in labor unions. Those are people in everyday 
businesses: small businesses, big businesses, all across the board.
  What we are doing today is a move in the right direction. What we are 
doing today is truly bipartisan, and we hope it becomes bicameral.
  Today you are going to see both Republicans and Democrats come 
together to do the right thing for the right reasons, and good things 
are going to come of that.
  It just doesn't get any better than this, especially at a time when 
you go back home and people just look at us and say, ``Holy smokes. On 
the floor of the people's House, you guys can't get along on 
anything?''
  Well, we are. We are going to get along on something. And we are 
going to do something that is really big, and we are going to pass H.R. 
748, the Middle Class Health Benefits Tax Repeal Act. It is also known 
as the Cadillac tax.
  I happen to be a Cadillac dealer. Cadillac has forever been described 
as the standard of the world.
  The healthcare piece we are talking about is a standard of the world. 
And so many times in the past it was described as, this is just too 
darn generous for generations of people who

[[Page H5960]]

went to the bargaining table and negotiated, as part of their labor 
agreements, healthcare.

                              {time}  1630

  Too generous? Too good?
  For all those who thought that was a good statement or a good idea, 
that is just too bad because it was terrible. It made no sense.
  Today, we are going to change that. We are going to take the time we 
have today on the floor to talk about it, to talk to our colleagues and 
say we all need to be on board with this.
  By the way, the gentleman knows this because we have been working on 
it for a long time. It is the gentleman's bill this session, but it has 
gone back and forth, depending on who the majority is.
  This is the end of today's talking when it comes to partisan gridlock 
because it is not going to happen. Much like Mark Twain when he was 
overseas one time, in London, and somebody printed in the paper that 
Mark Twain was not only ill but that he had died. Mark Twain replied, 
``The reports of my death are greatly exaggerated.''
  Let's use that today when we talk about the fact that we can't get 
along here in the people's House.
  The gentleman and I have worked hard on this. Last Congress, we had 
304 cosponsors. This Congress, our legislation has more than 370 
cosponsors. That is the majority of both parties, Democratic and 
Republican.
  Our bill is going to repeal this onerous tax, originally passed as 
part of the Affordable Care Act, that would have been assessed on any 
health plan that would provide more than $10,200 for individual 
coverage, $27,500 for family coverage.
  I deplore the fact that it was called too generous for hardworking 
Americans who get up every day and go off to work to make sure they can 
put a roof over the head of their family, food on the table, clothes on 
the backs of their kids, and somehow plan for the future. If that is a 
bad benefit, I want to see what a good one looks like.
  According to researchers, it is projected--I think Chairman Neal just 
went over some of these numbers--that 75 percent of employer-sponsored 
health plans would be affected if we allow this tax to stand.
  That was put in the Affordable Care Act, but it was never enforced. 
Today, we have a chance to do away with it fully, just repeal it. That 
is what we are trying to get to.
  The groups that support this legislation go across the board. There 
are millions of workers waiting for us to do something today to act in 
their best interests. More than 665 organizations have weighed in, in 
support of repealing this tax.
  It is absolutely an incredible effort that is going to take place 
today. I can't say this enough: It is a bipartisan effort by the 
majority of both parties to get this done for hardworking Americans, to 
protect not only themselves but their families.
  It is a benefit of generational negotiations. It is an incredible 
piece of legislation that we are going to get through today.
  I could keep talking about this forever. I can't wait to get back 
home again to tell people we got it done. Keep in mind, I am going to 
say that ``we got it done,'' not that ``I got it done.''
  I have never seen another place where people take credit for 
legislation that they had nothing to do with, that they kind of 
inherited from previous sessions and say, ``Well, this is my bill.''
  This is not my bill. This is a bill that we have been trying to pull 
off for many, many years, not just me, not just   Joe Courtney, but 
together, all of us, Republicans and Democrats, acting in the best 
interests of the people we represent here on the floor of the people's 
House.
  Madam Speaker, I reserve the balance of my time.
  The SPEAKER pro tempore. Without objection, the gentlewoman from 
Washington (Ms. DelBene) is designated to control the balance of the 
time and is recognized.
  There was no objection.
  Ms. DelBENE. Madam Speaker, I yield 3 minutes to the gentleman from 
Connecticut (Mr. Courtney), the lead sponsor of this legislation.
  Mr. COURTNEY. Madam Speaker, I thank Congresswoman DelBene for her 
leadership managing this bill and the Ways and Means Committee for 
embracing it. Their advocacy sends a powerful message to the House to 
pass the Middle Class Health Benefits Tax Repeal Act of 2019.
  I also thank my friend, Representative   Mike Kelly, for his 
bipartisan support of the bill, defying the polarized politics that too 
often dominates the healthcare debate.
  Madam Speaker, this bill today comes with the support of more than 
660 healthcare groups that represent millions of Americans who have 
joined together to repeal the 40 percent excise tax on health plans 
scheduled to go into effect in 2022.
  Madam Speaker, this tax was a late add-on to the Affordable Care Act 
deliberations and has been rattling around inoperable in the Federal 
Tax Code since 2010, never actually having collected a penny of revenue 
but, nonetheless, casting a statutory shadow over 180 million 
Americans' health plans, which we know, from HR administrators and 
employee reps in real life, has added pressure to shift coverage into 
higher deductible plans, which falls on the backs of working Americans.

  As the Commonwealth Fund recently reported, the number of Americans 
who are underinsured as a result of high deductibles has grown by over 
50 percent since 2005. The Kaiser Family Foundation just reported that 
31 percent of employer health plans will get hit by the excise tax in 
2022, and that number will skyrocket soon after.
  Passage of this bill will lift the shadow that hangs over employer-
sponsored plans and stop the high deductible trend from worsening.
  As the bill's lead sponsor, I want to foot stomp that the repeal of 
the tax does not touch the architecture of the ACA's patient 
protections. Repeal is completely severable from the other 440 sections 
of the law and leaves intact essential health benefits and the 
elimination of preexisting condition exclusions and lifetime limits.
  Given that those patient protections have been in full operation for 
the last 10 years, during which this zombie tax has been in a coma, it 
is abundantly clear that the tax is disconnected from the rest of the 
law.
  Lastly, I want to underscore the CBO determination that passage will 
not result in any increase in the number of uninsured.
  Madam Speaker, with 370 House cosponsors, I am hopeful that an 
overwhelming tally tonight will send a laser-like message to the Senate 
to adopt this bill as soon as possible, as is.
  Madam Speaker, I include in the Record letters from Families USA, a 
strong advocate for the ACA, as well as the Council of Insurance Agents 
& Brokers, in support of the bill, and a 2009 letter signed by 188 
supporters of the ACA in support of this repeal of the excise tax.


                                                  FamiliesUSA,

                                                    July 15, 2019.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives, Washington, DC.
       Dear Speaker Pelosi and Leader McCarthy: On behalf of 
     Families USA, a leading national voice for health care 
     consumers, I write to offer our support for legislation that 
     will be considered by the full House of Representatives this 
     week, H.R. 748, the Middle Class Health Benefits Tax Repeal 
     Act of 2019. This bipartisan legislation would repeal the 
     excise tax on high value employer-sponsored health care 
     coverage, also known as the ``Cadillac Tax''. At a time when 
     almost half of our nation's families report that they are 
     forgoing needed medical care because they cannot afford the 
     care, policymakers should make sure that employers doing the 
     right thing and providing high value health insurance to 
     their employees are supported, not penalized with an 
     egregious tax.
       More than 181 million people--a majority of the country--
     receive employer-sponsored insurance. The Affordable Care Act 
     (ACA) included a provision to impose a 40 percent excise tax 
     on high-cost and high-value employer-sponsored insurance 
     (ESI) coverage. This provision was recently delayed for a 
     second time, until 2022. While the tax would be levied on 
     employers, experts expect its costs largely would be shifted 
     to employees and their families.
       The Cadillac Tax is built on the supposition that by 
     exposing our nation's families to even more financial 
     vulnerability in their health care, families will manage to 
     bring their own health care costs down. Creating greater 
     financial insecurity for families is

[[Page H5961]]

     not the answer. It is the primary responsibility of policy 
     makers, the health care sector, and the government to solve 
     the health care cost crisis. And your constituents agree. 
     More than 80 percent of people in this nation--both Democrats 
     and Republicans--believe it's the responsibility of the 
     government to get control of out-of-control health care 
     costs.
       H.R. 748 is an important opportunity for Congress to 
     support high quality health care and the employers that 
     provide it. In recent years, deductibles in ESI plans have 
     risen considerably while costs have continued to grow. The 
     so-called ``Cadillac Tax'' creates the wrong incentive to 
     employers around the nation. What we need now is higher value 
     insurance, not lower value coverage.
       H.R. 748 has widespread, bipartisan support, and boasts 361 
     cosponsors, including 199 Democrats and 162 Republicans. We 
     urge the House of Representatives to support working families 
     and the employers providing these families high quality 
     health insurance and pass H.R. 748 when it comes to the 
     floor.
           Sincerely,
                                                  Frederick Isasi,
     Executive Director.
                                  ____



                                                  The Council,

                                                    July 15, 2019.
     Re H.R. 748, The Middle Class Health Benefits Tax Repeal Act 
         of 2019.

     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
       Dear Madame Speaker: On behalf of The Council of Insurance 
     Agents and Brokers (``The Council''), I write to express our 
     members' strong support for H.R. 748, The Middle Class Health 
     Benefits Tax Repeal Act of 2019. The legislation repeals the 
     looming ``Cadillac Tax'' that undermines the employer 
     sponsored insurance market. The ``Cadillac tax'' is a 40% tax 
     on the value of employer-sponsored health coverage that 
     exceeds certain benefit thresholds--estimated to be $11,100 
     for self-only coverage and $29,750 for family coverage in 
     2022. We thank Congressman Joe Courtney and Mike Kelly for 
     their leadership on this important issue, and urge members of 
     the House of Representatives to support H.R. 748.
       By way of background, The Council represents the largest 
     and most successful employee benefits and property/casualty 
     agencies and brokerage firms. Council member firms annually 
     place more than $300 billion in commercial insurance business 
     in the United States and abroad. Council members conduct 
     business in some 30,000 locations and employ upwards of 
     350,000 people worldwide. In addition, Council members 
     specialize in a wide range of insurance products and risk 
     management services for business, industry, government, and 
     the public.
       The ``Cadillac Tax,'' has been delayed twice by Congress to 
     protect Americans from its harmful impact. But the latest 
     implementation date of 2022 continues to cause an adverse 
     effect on the affordability and quality of health coverage 
     available to employees and their families. The Kaiser Family 
     Foundation notes that deductibles have risen 89% since 2010, 
     while wage growth has remained comparatively flat.
       The tax was intended to impact Americans with ``gold-
     plated'' plans, but the reality is that very modest plans 
     covering low- and moderate-income working families will 
     trigger the tax. More than 181 million Americans--including 
     retirees, low- and moderate-income families, public-sector 
     employees, small business owners, nonprofit workers and the 
     self-employed--currently depend on employer-provided health 
     coverage. Employer provided coverage covers more Americans 
     than Medicare and Medicaid combined. This tax has real and 
     harmful consequences--Americans cannot afford to pay more for 
     their health care.
       Thank you again for your continued efforts to address these 
     important issues.
           Best,
     Ken A. Crerar,
           President/CEO, The Council.
     Joel Wood,
       SVP, Government Affairs, The Council.
     Joel Kopperud,
       VP, Government Affairs, The Council.
                                  ____



                                Congress of the United States,

                                  Washington, DC, October 7, 2009.
     Speaker Pelosi,
     Office of the Speaker,
     Washington, DC.
       Dear Speaker Pelosi: As Congress continues to consider 
     revenue sources for America's Affordable Health Choices Act 
     and other health insurance reform proposals, we strongly 
     encourage you to reject imposing an excise tax on so called 
     high cost insurance plans. Such a tax would impact regions 
     with high health care costs in the short-term, and, in the 
     long-term, inevitably extend to more and more middle-income 
     Americans across the country.
       As you know, the Senate Finance Committee reform proposal, 
     America's Healthy Future Act, currently includes a 40 percent 
     excise tax on insurers for plans that exceed certain cost 
     thresholds. Real life experience with both health insurers 
     and inelastic markets for services such as health insurance 
     has clearly warned us that this tax will be passed along to 
     insurance payers. Beginning in 2013, the threshold for 
     individual plans will be $8,000 and $21,000 for family 
     coverage. In subsequent years, increases in the cost 
     thresholds will be tied to the Consumer Price Index for urban 
     consumers (CPI-U) plus one percent. The proposal also 
     includes a transition relief rule, which will set cost 
     thresholds 20 percent higher for the 17 highest cost states. 
     The transition relief rule will be phased out by 2016. It is 
     important to note that the proposed thresholds for such a tax 
     already have been surpassed for many middle-income Americans 
     in 2009.
       For middle-income Americans that have forgone wage and 
     salary increases for strong insurance benefits, these 
     thresholds are simply too low. And, for middle-income 
     Americans who live in the nation's highest cost regions for 
     health care, the transition relief rule is also too low and 
     phased out far too soon.
       A Commonwealth Fund report issued on August 20, 2009, 
     ``Paying the Price: How Health Insurance Premiums Are Eating 
     Up Middle-Class Incomes,'' outlined projected increases in 
     insurance premiums if nothing is done to change the current 
     cost trajectory. According to the report, average insurance 
     premiums will increase 94 percent over the next ten years, 
     with average annual increases of 5.7 percent. The report went 
     on to conclude that average premium costs for family coverage 
     in 2015 will range from $15,508 in the lowest cost state to 
     $19,731 in the highest cost state. Considering high and low 
     cost states will be treated the same with regard to the 
     proposed excise tax in 2015, the average premium projections 
     in high cost regions teeter on the projected cost thresholds 
     of the excise tax.
       Further, the lessons learned from the alternative minimum 
     tax (AMT) should also serve as a warning for the creation of 
     an excise tax on high cost insurance plans. Over the past 
     four decades, the AMT has morphed from a tax on the 
     wealthiest Americans to a tax on the middle class. In 1969, 
     when the AMT was first enacted, the tax impacted only the 
     wealthiest of Americans. In 2010, nearly one in five 
     Americans will be subjected to the tax. A similar situation 
     with the proposed excise tax is possible considering our 
     experiences with medical inflation.
       While America's Affordable Health Choices Act will work to 
     rein in insurance premium costs, these savings will be 
     generated from long-term fixes and may not substantially 
     mitigate premium costs in the short-term before the costs of 
     such an excise tax are passed from the insurer to the 
     customer, including middle-income families.
       Beyond these other arguments, there is a fundamental flaw 
     in assuming a tax on so called high cost plans will sway 
     choice of insurance coverage, and in turn, discourage 
     wasteful health care spending. This assumption is based on 
     access to a substantial choice in coverage, which is 
     certainly not the case under our current system. Today, small 
     employers pay more for a given insurance plan than a large 
     employer-- not because of benefit quality or an employees' 
     excessive use of plan benefits, but due to smaller risk 
     pools. While America's Affordable Health Choices Act will 
     help close most of these price discrepancies, this won't be 
     achieved until 2018 when all reforms are enacted. Further, 
     America's Affordable Health Choices Act will allow for 
     continued use of age rating with determining premium costs. 
     While age rating will be restricted, the practice underscores 
     limited choice for cheaper coverage options.
       America's Affordable Health Choices Act includes sensible 
     revenue sources to pay for the legislation. However, 
     inclusion of an excise tax on high cost insurance plans, as 
     proposed by the Senate Finance Committee, could have 
     significant and detrimental implications for millions of 
     middle-class Americans. The short-term impact would be 
     greatest on individuals and families living in high cost 
     regions and for those that have sacrificed pay increases for 
     strong benefits. Over the long term, the number of 
     individuals and families subjected to the tax would likely 
     continue to grow. To this end, we urge you to continue to 
     reject proposals to enact an excise tax on high cost 
     insurance plans that could be potentially passed on the 
     middle class families.
       We look forward continuing to work with you to advance 
     health care reform legislation that expands coverage and 
     lowers care costs.
           Sincerely,
     Joe Courtney.
     Tim Walz.
     Allyson Schwartz.
     Mike Ross.


                          COSIGNATORIES (190)

       Courtney, Joe; Abercrombie, Neil; Ackerman, Gary; Andrews, 
     Robert; Arcuri, Mike; Baca, Joe; Baldwin, Tammy; Berkley, 
     Shelly; Bishop, Sanford; Bishop, Tim; Blumenauer, Earl; 
     Boccieri, John; Boren, Dan; Boswell, Leonard; Boucher, Rick; 
     Brady, Robert; Braley, Bruce; Brown, Corrine; Capps, Lois; 
     Capuano, Michael; Cardoza, Dennis; Carnahan, Russ; Carson, 
     Andre; Chandler, Ben; Christensen, Donna; Chu, Judy; Clarke, 
     Yvette; Clay, Lacy; Cleaver, Emanuel; Cohen, Steve; Conyers, 
     John; Costello, Jerry; Crowley, Joseph; Cummings, Elijah; 
     Dahlkemper, Kathy; Davis, Danny; Davis, Lincoln; DeFazio, 
     Peter; Delahunt, Bill; DeLauro, Rosa; Dicks, Norman; Dingell, 
     John; Doggett, Lloyd; Doyle, Mike; Driehaus, Steve; Edwards, 
     Donna; Ellison, Keith; Ellsworth, Brad; Engel, Eliot; Eshoo, 
     Anna; Farr, Sam; Fattah, Chaka; Filner, Bob.
       Foster, Bill; Frank, Barney; Fudge, Marcia; Gonzalez, 
     Charles; Garamendi, John;

[[Page H5962]]

     Grayson, Alan; Green, Al; Green Gene; Grijalva, Raul; 
     Gutierrez, Luis; Hall, John; Halvorson, Debbie; Hare, Phil; 
     Harman, Jane; Hastings, Alcee; Heinrich, Martin; Higgins, 
     Brian; Himes, Jim; Hinchey, Maurice; Hirono, Mazie; Hodes, 
     Paul; Holden, Tim; Holt, Rush; Honda, Mike; Inslee, Jay; 
     Israel, Steve; Jackson Jr., Jesse; Jackson-Lee, Sheila; 
     Johnson, Eddie Bernice; Johnson, Hank; Kagen, Steve; Kaptur, 
     Marcy; Kennedy, Patrick; Kildee, Dale; Kilpatrick, Carolyn 
     Cheeks; Kilroy, Mary Jo; Kucinich, Dennis; Langevin, James; 
     Larson, John; Lee, Barbara; Levin, Sander; Lewis, John; 
     Lipinski, Dan.
       Loebsack, David; Lofgren, Zoe; Lowey, Nita; Lujan, Ben; 
     Lynch, Stephen; Maffei, Dan; Maloney, Carolyn; Markey, 
     Edward; Massa, Eric; Matsui, Doris; McCarthy, Carolyn; 
     McCollum, Betty; McDermott, Jim; McGovern, Jim; McMahon, 
     Michael; Meek, Kendrick; Meeks, Gregory; Michaud, Michael; 
     Miller, Brad; Miller, George; Mollohan, Alan; Moore, Dennis; 
     Moore, Gwen; Murphy, Chris; Murphy, Scott; Murtha, John; 
     Nadler, Jerrold; Napolitano, Grace; Neal, Richard; Norton, 
     Elanore Holmes; Oberstar, James; Olver, John; Ortiz, Solomon; 
     Owens, Bill; Pascrell, Bill; Pastor, Ed; Payne, Donald; 
     Perlmutter, Ed; Perriello, Thomas; Peters, Gary; Pingree, 
     Chellie; Quigley, Mike; Rahall, Nicek; Reyes, Silvestre; 
     Richardson, Laura; Rodriguez, Ciro; Ross, Mike.
       Rothman, Steve; Royal-Allard, Lucille; Rush, Bobby; Ryan, 
     Tim; Salazar, John; Sanchez, Linda; Sanchez, Loretta; 
     Sarbanes, John; Schakowsky, Janice; Schauer, Mark; Schiff, 
     Adam; Schrader, Kurt; Schwartz, Allison; Scott, Bobby; Scott, 
     David; Serrano, Jose; Sestak, Joe; Shea-Porter, Carol; 
     Sherman, Brad; Shuler, Health; Sires, Albio; Slaughter, 
     Louise; Space, Zach; Speier, Jackie; Stark, Peter; Stupak, 
     Bart; Sutton, Betty; Teague, Harry; Thompson, Bennie; 
     Tierney, John; Titus, Dina; Tonko, Paul; Towns, Edolphus; Van 
     Hollen, Chris; Velazquez, Nydia; Visclosky, Peter; Walz, Tim; 
     Wasserman Shultz, Debbie; Waters, Maxine; Watson, Diane; 
     Weiner, Anthony; Welch, Peter; Wexler, Robert; Wilson, 
     Charlie; Woolsey, Lynn; Wu, David; Yarmuth, John.

  Mr. KELLY of Pennsylvania. Madam Speaker, I yield 2 minutes to the 
gentleman from California (Mr. Nunes).
  Mr. NUNES. Madam Speaker, I thank Mr. Kelly for giving me time to 
speak in support of H.R. 748, the Middle Class Health Benefits Tax 
Repeal Act of 2019. This bill will provide much-needed relief from one 
of the most burdensome and blunt taxes in ObamaCare.
  By repealing this tax, we will save employers from paying a 40 
percent tax on high-cost employer-sponsored health coverage. The bill 
will provide much-needed relief not only for employers but for 
employees, some of whom are low-income earners with high-cost health 
benefits who are forced to bear the repercussions of this tax.
  That said, I am disappointed that the majority chose not to repeal 
the medical device tax or the health insurance tax, both of which are 
harming hardworking Americans across the country.
  The medical device tax is a 2.3 percent excise tax on the value of 
medical devices sold domestically. Making lifesaving products more 
expensive is not good policy and should be included in this repeal 
bill.
  The health insurance tax, or HIT, is a more than $100 billion sales 
tax on private health insurance that affects every private plan in the 
country. At a time when we are all trying to lower the cost of 
healthcare, why are the Democrats in the majority preventing us from 
removing this unnecessary and burdensome tax?
  This bill could do so much more, but I am happy that the majority is 
finally admitting that the ObamaCare tax increases are bad for the 
country and that good tax policy doesn't need to be replaced with more 
bad tax hikes.
  At a time when much of our healthcare system is failing, when 
healthcare costs are still unaffordable for many, when Medicare will be 
insolvent within a decade, and when Medicaid's uncontrollable costs are 
bankrupting our States, it still leaves millions of low- and middle-
income earners without access to doctors. We should be working harder 
to provide more access and choice to the American people in a fiscally 
responsible way.
  Madam Speaker, I support the repeal of this tax, and I urge adoption 
of the bill.
  Ms. DelBENE. Madam Speaker, I yield 1 minute to the gentleman from 
Connecticut (Mr. Larson).
  Mr. LARSON of Connecticut. Madam Speaker, I commend my colleague on 
the Ways and Means Committee,   Mike Kelly, for his hard work and 
diligence in bringing this bill to the floor, as he acknowledged, in a 
bipartisan way.
  I think the gentleman and everybody in this body understand and 
respect the persistence, hard work, and dedication of   Joe Courtney. 
From its introduction and inception, from its first letter to its more 
than 370 sponsors, ultimately, he has demonstrated that, yes, in this 
body, we can arrive at solutions across the aisle, working together in 
the common interest of every American citizen.
    Joe Courtney was chairman of the Public Health Committee in the 
Connecticut Legislature. He has forgotten more about these programs 
than most people will ever remember. But it is his diligence, 
persistence, and ability to work across the aisle that has brought this 
legislation here today to be passed unanimously.
  Mr. KELLY of Pennsylvania. Madam Speaker, I yield 2 minutes to the 
gentleman from Kansas (Mr. Estes).
  Mr. ESTES. Madam Speaker, I rise today in support of H.R. 748, the 
Middle Class Health Benefits Tax Repeal Act of 2019.
  This important bill repeals the so-called Cadillac tax, a policy 
implemented through ObamaCare that would have placed a 40 percent tax 
on high-cost employer healthcare plans.
  The tax was originally included as a way to help pay for the Patient 
Protection and Affordable Care Act, commonly called ObamaCare, by 
targeting expensive health plans and insurance companies. However, in 
practice, it would have been middle-class workers bearing the real 
burden to pay for it through taxes. It would have hurt union members, 
nonunion members, small businesses, and nonprofits.
  In fact, the Joint Committee on Taxation and the Congressional Budget 
Office predicted that a whopping 70 percent of the revenue collected by 
the Cadillac tax would have come from higher income and payroll taxes 
rather than excise taxes on insurers.
  This massive tax increase would have devastated middle-class workers 
and families, many of whom continue to struggle with the rising costs 
of ObamaCare as it is.
  I thank my colleagues for realizing the bad implications of this 
failed policy and for working in a bipartisan way to repeal the 
Cadillac tax.
  I am hopeful that today's action will allow us to move forward to 
address similar policies, like the health insurance tax and the medical 
device tax.
  Instead of propping up the failed Patient Protection and Affordable 
Care Act through higher taxes and reduced choices, we must get serious 
about improving healthcare and our economy.
  Madam Speaker, I believe H.R. 748 is a great first step, and I urge 
my colleagues to support it.
  Ms. DelBENE. Madam Speaker, I yield 1\1/2\ minutes to the gentleman 
from New Jersey (Mr. Pascrell).
  Mr. PASCRELL. Madam Speaker, I include the letters that I have in my 
hand in the Record.
         International Federation of Professional & Technical 
           Engineers, AFL-CIO & CLC,
                                    Washington, DC, July 15, 2019.
       Dear Representative: On behalf of 90,000 workers 
     represented by the International Federation of Professional 
     and Technical Engineers (IFPTE), we are writing to urge you 
     to vote for the passage of H.R. 748, the Middle Class Health 
     Benefits Tax Repeal Act. This important bipartisan 
     legislation repeals the 40 percent ``Cadillac Tax'' on high-
     cost employer-sponsored health care plans--set to take effect 
     in 2022--that millions of working and retired Americans 
     depend on.
       Since the 40 percent excise tax was enacted as part of the 
     Patient Protection & Affordable Care Act, out of pocket 
     health care costs have continued to increase faster than 
     wages. At the bargaining table, workers in all sectors of the 
     economy are accepting lower or no pay increases, and cuts to 
     other important benefits in exchange for an employer-provided 
     health benefit that is both affordable and meets the health 
     needs of their families. If this tax is not repealed, 
     millions of workers and retirees will see the gains from 
     these tradeoffs fall by the wayside, while the underlying 
     issues driving health care costs will go unaddressed.
       Analysis by the Congressional Research Service and the 
     Congressional Budget Office shows that the costs of this tax 
     will be passed onto workers in the form of lower wages, 
     reduced benefits, and the loss of coverage options. Even 
     though the excise tax has not taken effect yet, it has 
     already affected the benefits and quality of employer-
     sponsored health insurance. Employers themselves admit that 
     they have little appetite for providing a health care 
     benefits that could end up triggering the 40% excise tax. In 
     anticipation of the tax's original effective date in 2018, 
     the American Health Policy Institute reported in 2015 that 
     ``Almost 90 percent of large employers are taking steps to

[[Page H5963]]

     try to prevent their company from having a plan that triggers 
     the excise tax.'' In the federal sector, the OPM's Federal 
     Employees Health Benefits Program carrier guidance tells 
     insurance companies to design plans to avoid triggering the 
     excise tax.
       If the excise tax is allowed to take effect, it will 
     further burden working families instead of addressing the 
     factors that continue to drive up the cost of health care. As 
     it stands, the excise tax will go into effect in 2022 on 
     plans that exceed annual limits of $11,500 for individual 
     coverage and $31,100 for family coverage and will be chained 
     to inflation. By and large, plans that will be subject to the 
     excise tax have high costs not due to generous benefits, but 
     because of demographic factors, geographic disparities, 
     market concentration, and risk pool size.
       H.R. 748 has board support from affected stakeholders, 
     including unions, public and private sector employers, health 
     advocacy organizations, and health insurance providers. 
     Today, a bipartisan majority in the House recognizes that the 
     excise tax will result in reduced health benefits and 
     coverage options, lower wages and pension benefits, hurt 
     employers who are trying to provide competitive benefits to 
     employees, while failing to address the real cost drivers in 
     the health care system.
       Therefore, we urge you to vote for H.R. 748.
           Sincerely,
     Paul Shearon,
       President.
     Matthew Biggs,
       Secretary-Treasurer/Legislative Director.
                                  ____

                           International Association of Machinists


                                        and Aerospace Workers,

                                Upper Marlboro, MD, July 15, 2019.
       Dear Representative: On behalf of the International 
     Association of Machinists and Aerospace Workers (1AM), I 
     strongly urge you to support working families and vote 
     ``Yes'' on the bipartisan Middle Class Health Benefits Tax 
     Repeal of 2019, H.R. 748. This vital legislation introduced 
     by Representatives Joe Courtney (D-CT) and Mike Kelly (R-PA) 
     would rightly repeal the 40% health benefits tax on employer-
     sponsored healthcare before working Americans and their 
     families are further impacted by this onerous tax.
       In a time where so many Americans are feeling the pinch of 
     rising healthcare costs, the so-called ``Cadillac Tax'', as 
     it is commonly known, is a gut punch directed squarely at the 
     middle class and working families. Despite several delays in 
     its implementation, millions of Americans are already feeling 
     the impact of the 40 percent health benefits tax. They feel 
     its impact at the doctor's office and at the bargaining table 
     as employers increase deductibles, reduce benefits, and drop 
     plan options to prepare for the tax's looming threat. In 
     order to halt its harmful repercussions on American workers, 
     the tax must not simply be further delayed, but swiftly 
     repealed.
       Originally, the 40% health benefits tax was intended only 
     to be levied only on ``gold-plated'' health insurance plans 
     with very rich benefits. However, the realities of continued 
     medical cost inflation, an aging workforce, and new medical 
     technologies are pushing the cost of even modest plans above 
     the tax's threshold. We also know that the impact of the tax 
     would disproportionately burden certain demographics that 
     often face higher healthcare premiums. Plans hit by the tax 
     often cover more female employees, more workers with 
     dependent children, more senior workers, employees at smaller 
     businesses, and employees with physically demanding jobs.
       To be clear, it is not employers or insurance companies who 
     will end up shouldering the tax's burden; it is workers and 
     middle-class families who end up floating the bill for this 
     regressive tax. Researchers at CUNY School of Public Health 
     found the 40 percent health benefits tax will 
     ``disproportionately harm families with incomes between 
     $38,550 and $100,000, while sparing the wealthy''. This tax 
     will only serve to increase healthcare costs and reduce 
     benefits for working Americans in a time where they simply 
     cannot afford to pay more for less coverage.
       For all of these reasons, I urge you to support working 
     families and vote ``Yes'' on H.R. 748, the Middle Class 
     Health Benefits Tax Repeal of 2019.
           Thank you,
                                             Robert Martinez, Jr.,
     International President.
                                  ____

                                         International Brotherhood


                                                 of Teamsters,

                                    Washington, DC, July 15, 2019.
     House of Representatives,
     Washington, DC.
       Dear Representative: This week, the House of 
     Representatives will consider H.R. 748, the Middle Class 
     Health Benefits Tax Repeal Act of 2019. On behalf of the more 
     than 1.4 million members of the International Brotherhood of 
     Teamsters, I ask you to vote yes on H.R. 748. This bipartisan 
     legislation would repeal the excise tax on high value 
     employer sponsored health insurance (ESI), often referred to 
     as the ``Cadillac Tax''.
       The Teamsters have long opposed proposals that tax worker 
     health benefits. Attempts to tax employer provided health 
     care benefits through the 40 percent excise tax on high 
     quality health care plans reduce the health benefits that 
     hard working Americans receive and increase their out of 
     pocket costs. Policy makers should not penalize, with an 
     egregious tax, employers that do the right thing and provide 
     high value health insurance to their workers.
       More than 181 million people (a majority of the country) 
     receive employer sponsored insurance. While the tax is 
     ``levied'' on employers, experts expect costs largely to be 
     shifted to workers and their families. And, it is 
     unconscionable that hard working Americans will continue to 
     have this 40 percent penalty on benefits that they have 
     fought hard to achieve/receive looming over them. While this 
     tax does not take effect until 2022, having twice been 
     delayed by Congress, this egregious tax is already hollowing 
     out the benefits of working people who have employment-based 
     coverage. Indeed, employers are already scaling back their 
     health care benefits and offerings, and/or increasing 
     workers' out of pocket costs.
       In recent years, deductibles and out of pocket costs of ESI 
     plans have risen considerably, while costs continue to grow. 
     According to the CUNY School of Public Health research, the 
     health benefits tax predominantly impacts the middle class. 
     Congress should be looking for ways to strengthen the middle 
     class instead of promoting policies that will ultimately take 
     money from their hard earned paychecks and reduce, and make 
     more costly, the health care benefits they receive.
       I call on you to support the full and permanent repeal of 
     the so-called ``Cadillac Tax''. I hope that I can report to 
     our members that you stood with the International Brotherhood 
     of Teamsters family to pass this important legislation. Vote 
     yes on H.R. 748.
           Sincerely,
                                                   James P. Hoffa,
     General President.
                                  ____

                                         International Association


                                             of Fire Fighters,

                                    Washington, DC, July 16, 2019.
       Dear Representative: The International Association of Fire 
     Fighters represents more than 316,000 professional fire 
     fighters and emergency medical personnel, working in every 
     state in the nation. We strongly support the bipartisan 
     Middle-Class Health Benefits Tax Repeal Act of 2019 (HR 748) 
     and request that you vote YES this Wednesday when it is 
     considered under suspension of the rules.
       Voting yes on HR 748 would repeal the 40 percent tax on 
     employer-provided health insurance and protect the healthcare 
     that so many public safety workers have fought to get and 
     protect.
       This ill-conceived tax was originally sold to lower and 
     slow the rate of healthcare costs. What the tax actually does 
     is shift more costs onto consumers through higher 
     deductibles, copays and coinsurance. Taxing health plans with 
     high premiums will do nothing to drive down costs because the 
     real drivers of those costs are age, gender and geography. As 
     a result, this tax will punish fire fighters based on who 
     they work with or where they live, and that is both bad 
     policy and unfair to workers.
       Proponents of the tax argued it would only target the 
     richest Americans, but that too turned out to be untrue. Most 
     plans that would fall victim to this tax cover working class, 
     middle-income Americans. Fire fighters in particular, fall 
     into this category. The dangerous nature and high risks 
     associated with working in the fire service make fire 
     fighters' health plans critically important; workers will 
     often choose to protect their health care over increased pay.
       Taxing health benefits will undermine an integral component 
     of our health care system. One of the primary reasons why 
     most Americans receive health care coverage through their 
     employer is owed to the fact that their benefits are not 
     taxed. At the risk of weakening health benefits, depressing 
     wages and burdening workers with higher taxes, we should not 
     support policies that tax health care for American workers.
       While the tax does not go into effect until 2022, the IAFF 
     seeks its immediate repeal. Many of our members negotiate 
     multi-year contracts that are directly impacted by the 
     eventual implementation of this tax. The time for incremental 
     relief is over. Congress must pass HR 748 and fully repeal 
     the excise tax on employer-provided health insurance.
       When the House votes tomorrow on this measure, I ask that 
     you stand with all public safety workers and vote YES. Thank 
     you for your considered support on this important issue.
           Respectfully,
                                           Harold A. Schaitberger,
     General President.
                                  ____

                                               International Union


                                       of Operating Engineers,

                                                    July 16, 2019.
     Hon. Nancy Pelosi,
     Washington, DC.
     Hon. Kevin McCarthy,
     Washington, DC.
       Dear Speaker Pelosi and Leader McCarthy: On behalf of 
     400,000 members of the International Union of Operating 
     Engineers and their families, I respectfully request that you 
     support H.R. 748, the Middle Class Health Benefits Tax Repeal 
     Act of 2019.
       The International Union of Operating Engineers (IUOE) 
     represents nearly 400,000 working men and women in the United 
     States and Canada, thousands of whom would be affected by 
     this 40% tax on high-cost health insurance premiums.
       As you know, Congress has acted twice to delay this tax--
     its current effective date is

[[Page H5964]]

     January 1, 2022--but multi-year collective bargaining 
     negotiations are now underway and the uncertainty surrounding 
     the possible imposition of the tax is already pushing 
     employers to hollow out the health-care benefits of their 
     workers. The excise tax on high-premium health plans should 
     be permanently repealed.
       Proponents of the tax argued that it would incentivize 
     employers to move away from ``overly generous'' health care 
     coverage. They argued that forcing workers to have more 
     ``skin in the game'' would reduce ``overutilization'' of 
     health care services, forcing people to consider the 
     financial implications of seeking care. Surveys of employers 
     over the years have shown that they have reduced coverage 
     under their health plans in anticipation of the tax. The tax, 
     however, would have no effect on a ``unit cost'' of health 
     care.
       In the decade since the tax was enacted, it is clear that 
     the health care affordability crisis now affects millions of 
     individuals with employment-based coverage. From 2008-2018, 
     the general annual deductible for family coverage has 
     increased 212 percent, while workers' earnings have only 
     increased 26 percent. This tax is clearly having a negative 
     impact on working families, and its repeal is overdue.
       The International Union of Operating Engineers supports 
     H.R. 748 and respectfully requests that you repeal the tax on 
     high-cost health insurance premiums as quickly as possible. 
     We believe that permanent repeal of the 40-percent tax should 
     be a top priority for this 116th Congress, and we look 
     forward to working with you to enact it into law.
       Thank you for your leadership on this vital issue for 
     Operating Engineers and their families.
           Sincerely,
                                                James T. Callahan,
                                                General President.

  Mr. PASCRELL. Madam Speaker, I support this legislation, H.R. 748.
  During our discussions on health reform in 2009, many of us strongly 
opposed the excise tax on so-called Cadillac employer-provided health 
plans. We were successful in keeping it out of the House version of the 
bill, but we all know it ended up in the final bill. It has been 
delayed since then, but now it is enactment time. This is imminent. We 
need to do something now.
  The Cadillac tax would impact employers and families whose health 
insurance plans cost more than $11,100 for an individual and $29,750 
for family coverage. This is not a small universe, and the effects will 
be highly negative.
  If we do nothing, this tax would fall squarely on employees, 
encouraging employers to shift away from tax-free health benefits to 
taxable wages.
  As deductibles have risen more than 200 percent in the employer-
sponsored insurance plans, the cost of care has continued to grow while 
wages remain flat. We must ensure that employers can continue to 
provide high-quality healthcare.
  I urge my colleagues to support the bipartisan repeal of the Cadillac 
tax.
  Mr. KELLY of Pennsylvania. Madam Speaker, I yield 2 minutes to the 
gentleman from Indiana (Mr. Banks).
  Mr. BANKS. Madam Speaker, this is a historic day. We have finally 
found a tax that Members and my friends on both sides of the aisle 
agree needs to be cut.
  I am proud to be a cosponsor of today's legislation, and I am excited 
that many of my colleagues on the other side of the aisle as well are 
prepared to get rid of this destructive tax that was put in place by 
ObamaCare.

                              {time}  1645

  But while we are at it, while we are repealing ObamaCare taxes, we 
should include an equally destructive tax in today's repeal: the 
medical device tax.
  I am very proud to serve the residents of Warsaw in northeast 
Indiana, the region that is often referred to as the orthopedic capital 
of the world. Unfortunately, companies in my district and all across 
this country have been needlessly hampered by the inability of this 
Congress to fully and permanently repeal the onerous medical device 
tax. When it was enforced, this tax destroyed 29,000 jobs and caused a 
$34 million reduction in investments in lifesaving research and 
development.
  So today, while we are here voting on this bipartisan legislation to 
repeal the Cadillac tax, I ask that all Members of this body be equally 
mindful in moving swiftly to also repeal the medical device tax.
  Ms. DelBENE. Madam Speaker, I yield 1\1/2\ minutes to the gentleman 
from Illinois (Mr. Danny K. Davis).
  Mr. DANNY K. DAVIS of Illinois. Madam Speaker, I strongly support 
this bill to eliminate the 40 percent tax on high-quality healthcare 
benefits.
  Americans are facing a healthcare affordability crisis. Employers and 
insurers are already using this tax to justify raising the cost of 
healthcare for hardworking Americans by increasing copays, deductibles, 
and out-of-pocket expenses.
  In the last decade, annual deductibles for families have exploded by 
212 percent, and spending on coinsurance has increased nearly 50 
percent. A Kaiser Family survey reveals that these changes create 
alarming barriers to healthcare for working families, with almost 50 
percent of respondents indicating that someone in their family 
postponed care due to costs.
  I stand with the 43 national labor unions and the dozens of patient 
organizations, healthcare advocates, and business leaders who support 
this important bill to protect healthcare benefits for American 
workers. Healthcare is a right. I am pleased to support this bill.
  Mr. KELLY of Pennsylvania. Madam Chair, may I inquire how much time 
is left.
  The SPEAKER pro tempore. The gentleman from Pennsylvania has 9\1/2\ 
minutes remaining. The gentlewoman from Washington has 10\1/2\ minutes.
  Mr. KELLY of Pennsylvania. I reserve the balance of my time.
  Ms. DelBENE. Madam Speaker, I include in the Record letters of 
support for H.R. 748.

                                 The ERISA Industry Committee,

                                    Washington, DC, July 15, 2019.
       Dear Member of Congress: This week, the House is expected 
     to vote on H.R. 748, the ``Middle Class Health Benefits Tax 
     Repeal Act of 2019.'' The ERISA Industry Committee (ERIC) is 
     the only national trade association that advocates 
     exclusively for large employer plan sponsors on health, 
     retirement, and compensation public policies on the federal, 
     state, and local levels. ERIC member companies employ workers 
     in every state and community and provide health coverage that 
     is valued and relied upon by families across the country. 
     ERIC urges members of Congress to vote YES and support this 
     legislation.
       H.R. 748, supported by more than 360 cosponsors in the 
     House, would eliminate the impending 40% ``Cadillac'' excise 
     tax on high-cost employer-sponsored health insurance. The tax 
     does not target overly-generous benefits; instead, it attacks 
     plans based upon their costs. As such, plans that insure more 
     individuals with chronic conditions, more seniors, more 
     women, and populations more likely to incur health care costs 
     will be unfairly taxed at an unsustainable rate--as will 
     those based parts of the country where health care is more 
     expensive.
       If Congress fails to repeal the Cadillac tax, employers may 
     have to:
       Directly shift costs to employees. This could include 
     increasing the portion of the plan premium employees pay, 
     increasing deductibles, copays and coinsurance.
       Eliminate employer contributions to consumer-directed 
     accounts. This includes Health Savings Accounts (HSAs), 
     Health Reimbursement Arrangements (HRAs), or Flexible 
     Spending Accounts (FSAs).
       Reduce access to care. This includes tightening networks 
     and excluding high-cost providers, implementing barriers to 
     high cost treatments and providers (step therapy, prior 
     authorization), moving expensive medicines deeper into Rx 
     formularies, and eliminating coverage for some medications.
       Eliminate coverage for spouses and dependents, and separate 
     out or eliminate excepted benefits. These include dental, 
     vision, hospital indemnity, cancer-only, or other ``add-on'' 
     benefits.
       Drastically redesign plans. For instance, ending preferred 
     provider organization (PPO) or similar plans, and 
     implementing a high-deductible health plan (HDHP) or a health 
     maintenance organization (HMO).
       Eliminate investments in health. Investments that plan 
     sponsors make to improve health may save money later, but the 
     costs of those investments could be considered to add value 
     to the plan. As such, plans may consider eliminating on-site 
     clinics, wellness programs, telehealth benefits, health 
     information technology investments, and other health 
     improvement efforts that have up-front costs.
       As we have previous reported to Congress, the Cadillac tax 
     is an existential threat to employer-sponsored health 
     benefits. Repealing the Cadillac tax is ERIC's top priority 
     on behalf of our member companies. While employers support 
     efforts to reduce health care costs, a tax on benefits will 
     do the opposite, making health insurance less affordable for 
     workers, their families, and retirees.
       As such, when H.R. 748 comes to a vote, ERIC urges members 
     to vote YES. We look forward to working with Congress to 
     finally repeal this damaging tax, to ensure affordability of 
     health benefits for patients.
           Sincerely,

                                             James P. Gelfand.

[[Page H5965]]

     
                                  ____
                                        American Benefits Council,
                                    Washington, DC, July 14, 2019.
     Hon. Nancy Pelosi,
     Speaker of the House, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Leader McCarthy: We are very 
     gratified that the Middle Class Health Benefits Tax Repeal 
     Act (H.R. 748) will be voted upon shortly in the House of 
     Representatives. This widely bipartisan measure sponsored by 
     Representatives Joe Courtney and Mike Kelly would fully and 
     immediately repeal the 40 percent ``Cadillac Tax'' that 
     threatens the high-value, high-quality health coverage that 
     181 million Americans receive through employers. We ask that 
     you strongly urge the members of your respective caucuses to 
     support this measure. Passage of H.R. 748 with a large 
     bipartisan majority will send a powerful signal to the Senate 
     of the need to quickly approve this legislation.
       The American Benefits Council's members either directly 
     sponsor or support sponsors of health and retirement benefits 
     for virtually all Americans covered by employer-provided 
     plans. Consequently, we are keenly aware of the drastic 
     impact the ``Cadillac Tax'' would have on health care 
     benefits. We have already witnessed some of the negative 
     consequences, even though the tax does not technically go 
     into effect until 2022.
       Starting that year, a 40 percent excise tax will be imposed 
     on employer-sponsored coverage that exceeds certain dollar 
     thresholds. For millions of Americans who rely upon health 
     insurance coverage through an employer, the looming 
     implementation of the tax has already resulted in reduced 
     coverage and increased out-of-pocket costs. The reason for 
     this is, to ensure the impact of the tax on participants is 
     not imposed suddenly and severely in 2022, many employers 
     have already reluctantly been compelled to make plan changes: 
     reducing important benefits or asking workers to assume a 
     larger share of deductibles and copayments. This trend will 
     accelerate without swift action by Congress.
                                  ____


    AGC Key Vote: Vote ``Yes'' on H.R. 748, the Middle Class Health 
                    Benefits Tax Repeal Act of 2019

                                                    July 16, 2019.
       Dear Representative: On behalf of the Associated General 
     Contractors of America (AGC), I write to urge you to support 
     the Middle Class Health Benefits Tax Repeal Act (H.R. 748). 
     This bipartisan legislation would repeal the 40 percent 
     excise tax on employer-sponsored health coverage and employee 
     benefits under the Affordable Care Act (ACA). Because 
     ensuring the ability to provide affordable health care is a 
     critical issue for the construction industry, AGC reserves 
     the right to record your vote on this bill as a ``key vote'' 
     for the education of its membership.
       The 40 percent excise tax, also known as the ``Cadillac 
     tax,'' would force contractors to cut or limit employee 
     benefits for millions of employees. Though dubbed the 
     Cadillac tax because the provision was targeting ``high 
     cost'' employer-sponsored health coverage, it is causing an 
     adverse effect on the affordability and quality of health 
     coverage available to construction employees and their 
     families even before it has taken effect.
       While we appreciate prior delays of this tax, uncertainty 
     remains in the employer health market as the U.S. Treasury 
     Department begins to develop proposed rules for 
     implementation. As construction employers make health plan 
     decisions well in advance of a coverage year beginning, 
     looming proposed rules have a direct impact on their planning 
     process for the next several coverage years.
       AGC supports the affordability and viability of providing 
     employersponsored coverage now and in the future. As such, 
     the 40 percent excise tax should be permanently repealed. 
     Again, AGC reserves the right to record your vote as a ``key 
     vote'' for the education of its membership.
           Sincerely,
                                               Jimmy Christianson,
     Vice President, Government Relations.
                                  ____



                            National Business Group on Health,

                                                    July 16, 2019.
     Hon. Joe Courtney (D-CT)
     Washington, DC.
     Hon. Mike Kelly (R-PA)
     Washington, DC.
       Dear Representatives Courtney and Kelly: The National 
     Business Group on Health (Business Group) again writes in 
     strong support of your bipartisan bill (H.R. 748) that would 
     eliminate the 40 percent tax on the value of health benefits 
     above a government-determined amount imposed by the Patient 
     Protection and Affordable Care Act (ACA), commonly referred 
     to as the ``Cadillac Tax''. Any tax that raises the cost of 
     health benefits will harm the more than 181 million Americans 
     who rely on and value employer-sponsored health coverage. 
     Even though the Cadillac Tax is delayed to 2022, the Business 
     Group urges the 116th Congress to pass this important 
     bipartisan legislation early in 2019 to provide permanent 
     relief and clarity to employees that this fundamentally 
     flawed tax will not impact their health benefits.
       According to our survey data, absent plan changes, 73% of 
     companies who responded will have at least one plan that 
     triggers the tax in 2022 and 94% will in 2026. In a few short 
     years, if the tax is not repealed, it will affect nearly 100% 
     of employer plans since the tax is indexed to general 
     inflation, not medical inflation, which is consistently much 
     higher.
       Furthermore, the National Business Group on Health, which 
     represents 440, primarily large, employers (including 75 of 
     the Fortune 100) who voluntarily provide health benefits and 
     other health programs to over 55 million American employees, 
     retirees, and their families, believes that not only is this 
     tax flawed, it is also not the most effective way to tackle 
     rising health care costs. Rather than focus on demand-side 
     taxes that will raise costs for working Americans and their 
     employers, Congress should focus on supply-side drivers of 
     medical inflation and unnecessary.
           Sincerely,
                                                Brian J. Marcotte,
     President and CEO.
                                  ____



                               National Coalition on Benefits,

                                                    July 17, 2019.
       To the Members of the U.S. House of Representatives: The 
     National Coalition on Benefits (NCB), a coalition of 
     businesses and associations committed to protecting the 
     ability of employers to provide uniform employee health 
     benefits across the country, strongly supports the passage of 
     H.R. 748, the ``Middle Class Health Benefits Tax Repeal Act 
     of 2019.'' This legislation would repeal the looming 
     ``Cadillac Tax,'' a 40 percent excise tax imposed on employee 
     health benefits above a certain threshold.
       Employers strongly support the full repeal of the Cadillac 
     Tax because this tax inevitably forces the reduction of 
     employee benefits and, because of the flawed indexing 
     provisions of the underlying Affordable Care Act, this tax 
     will affect most plans in a few years, even those with 
     reduced benefits. Employers devise benefit plans two years in 
     advance of the actual plan year. As a result, employers are 
     being forced now to reduce employee benefits in order to 
     avoid the impending reach of the Cadillac Tax.
       Working Americans don't want their health benefits taxed at 
     a time when they're already confronting higher premiums and 
     out-of-pocket costs. Indeed, a 2018 election night poll, 
     conducted by pollster Frank Luntz, highlights that 81 percent 
     of voters oppose taxes on employer-provided health coverage.
       The Cadillac Tax presents a direct threat to the more than 
     181 million Americans who rely on employer-sponsored coverage 
     to meet their health care needs. The NCB thanks Reps. Joe 
     Courtney and Mike Kelly for their dogged and unwavering 
     commitment to repealing this onerous tax on employee benefits 
     and urges the House to approve H.R. 748.
           Sincerely,
     National Coalition on Benefits.
                                  ____

       Dear Representative: On behalf of NFIB, the nation's 
     leading small business advocacy organization, I write in 
     support of H.R. 748, the Middle Class Health Benefits Tax 
     Repeal Act of 2019. This legislation repeals the 40 percent 
     excise tax on employer-sponsored health insurance, also known 
     as the ``Cadillac tax.'' This bill will be considered an NFIB 
     Key Vote for the 116th Congress.
       The cost of health insurance continues to be the number one 
     problem for small business owners, according to NFIB's 
     Problems and Priorities survey. As health insurance costs 
     increase, fewer small business owners are able to offer 
     coverage to employees. In 2010, 39 percent of small 
     businesses offered health insurance. In 2018, fewer than 30 
     percent of small businesses offered coverage, a net decrease 
     of 24 percent. The Cadillac tax will exacerbate this trend. 
     Health insurance cost increases will accelerate as more small 
     businesses are subject to the Cadillac tax.
       The Cadillac tax will also be an administrative nightmare 
     for small business owners. Early guidance from the Internal 
     Revenue Service (IRS) proposed requiring small business 
     owners to calculate their tax liability, notify the IRS and 
     health insurers of their tax liability, and remit the tax 
     liability to the health insurers. Small business owners do 
     not have time or resources for significant new compliance and 
     reporting burdens.
       NFIB supports passage of H.R. 748 and will consider a vote 
     in favor of the legislation as an NFIB Key Vote for the 116th 
     Congress. H.R. 748 will help mitigate health insurance cost 
     increases and relieve administrative burdens for small 
     business owners and employees. We look forward to working 
     with you to protect small business as the 116th Congress 
     moves forward.
  Ms. DelBENE. Madam Speaker, I yield 1\1/2\ minutes to the gentlewoman 
from California (Ms. Sanchez).
  Ms. SANCHEZ. Madam Speaker, I rise in support of the Middle Class 
Health Benefits Tax Repeal Act, and I want to thank Chairman Neal and 
Mr. Courtney for their tireless efforts to get this legislation passed.
  I have been proud to support the repeal of the Cadillac tax for many 
years. Last Congress, I offered an amendment to repeal the tax during 
the healthcare repeal and replace debate.
  It is important to remember that the Cadillac tax does not just 
affect high-value plans. If Congress does not act, the tax will hit 
hardworking Americans and their families who receive employer-sponsored 
insurance. Employers

[[Page H5966]]

have already started shifting costs to their workers in anticipation by 
increasing deductibles, copays, and coinsurance.
  Congress has voted twice to delay the tax, but now is the time to 
officially repeal it. I am pleased that we are finally taking this vote 
today. I look forward to passage today and will keep working to 
strengthen and protect America's healthcare.
  I include in the Record letters from CWA, UAW, AFSCME, AFT, and AFGE 
and the AFL-CIO in support of this bill.


                            Communications Workers of America,

                                                    July 15, 2019.
       Dear Representative Neal: On behalf of the officers and 
     700,000 members of the Communications Workers of America 
     (CWA), I am writing to urge you to vote in favor of H.R. 748, 
     the Middle Class Health Benefits Tax Repeal Act of 2019, when 
     it comes before the House this week.
       This bill will permanently repeal the 40% tax on employer 
     health benefits which is currently scheduled to take effect 
     in 2022. It will provide relief to our members, and working 
     people everywhere, whose health benefits are under continual 
     attack by employers looking to shift the cost of care to 
     workers.
       A recent study by the Commonwealth Fund found that the 
     number of Americans who are underinsured as a result of high 
     out-of-pocket costs and deductibles has grown by over 50% 
     since 2010. The fastest growth in under-insurance has come 
     from Americans with employer-provided coverage.
       This is consistent with our members' experience at the 
     bargaining table, where fights to preserve affordable 
     coverage and prevent plan cuts dominate our negotiations at 
     every employer. The 40% benefit tax will exacerbate this 
     trend and force cuts across our health plans, making health 
     care less affordable.
       Our members are currently negotiating agreements with 
     employers that extend to 2022. Current data indicates many of 
     our largest member health plans will be subject to this tax 
     immediately when it goes into effect that year. That is why 
     action now to resolve this issue now is critical.
       H.R. 748, the Middle Class Health Benefits Tax Repeal Act, 
     will improve health care for working people across the 
     country, providing relief to workers who are paying high 
     prices for their negotiated healthcare. CWA will consider 
     votes on this bill on our Congressional Scorecard.
       Thank you in advance for your consideration.
           Sincerely,
                                                     Shane Larson,
     Director of Legislative, Political and International Affairs.
                                  ____

         International Union, United Automobile, Aerospace & 
           Agricultural Implement Workers Of America--UAW
                                       Detroit, MI, July 16, 2019.
       Dear Representative: On behalf of the more than one million 
     active and retired members of the International Union, United 
     Automobile, Aerospace & Agricultural Implement Workers of 
     America (UAW), we urge you to vote yes on the Middle Class 
     Health Benefits Tax Repeal Act (H.R. 748). This bill would 
     permanently repeal the excise tax on high cost employer-
     sponsored health coverage. The tax is scheduled to be levied 
     on the aggregate amount of employer-sponsored coverage 
     exceeding thresholds established in the law ($11,200 for 
     individual coverage and $30,100 for family coverage). The 
     excise tax is currently set to take effect in 2022.
       The UAW believes affordable comprehensive health care 
     should be a right for every American. That is why we strongly 
     support the Affordable Care Act (ACA) and vehemently oppose 
     all efforts to repeal the law. The ACA has made important 
     strides towards the goal of universal, comprehensive, 
     affordable coverage. In fact, since its passage in March 
     2010, more than 20 million people have gained health care 
     coverage. In addition, tens of millions more with preexisting 
     conditions have been able to get affordable and comprehensive 
     insurance because discriminating against people with pre-
     existing conditions is prohibited under the ACA. Workers with 
     employer sponsored coverage have benefited from this and 
     other protections, like the prohibition on lifetime caps, 
     found in the law. Without these protections, unionized 
     workers would have to collectively bargain for these 
     essential, common sense protections.
       Like any comprehensive law, the ACA needs to be refined and 
     repealing the scheduled tax on employer sponsored coverage 
     would improve our health care system.
       As the Congressional Budget Office (CBO) and prominent 
     economists have predicted, employers have responded to the 
     impending tax by increasing worker's deductibles, copays, 
     and/or coinsurance in order to avoid being hit by the tax. 
     Employers have increased cost sharing under their plans, 
     switched to lower cost benefits, eliminated plan options, or 
     narrowed provider networks in anticipation of the tax, 
     according to a 2016 national survey of employers conducted by 
     the Kaiser Family Foundation.
       The percentage of employers with a plan reaching the 
     threshold is projected to grow fairly rapidly over time, to 
     28% in 2025 and 37% in 2030.
       If Congress fails to act, working families will be 
     negatively impacted as employers turn to a range of options 
     to avoid the tax by reducing the value of health care 
     coverage, which could include increasing deductibles, copays, 
     coinsurance and out-of-pocket limits. This tax places a 
     disproportionate burden on working families and makes health 
     care less affordable.
       We urge you to vote in support of the Middle-Class Health 
     Benefits Tax Repeal Act (H.R. 748).
           Sincerely,
                                                      Josh Nassar,
     UAW Legislative Director.
                                  ____



                                                       AFSCME,

                                    Washington, DC, July 16, 2019.
     House of Representatives,
     Washington DC.
       Dear Representative: On behalf of the members of American 
     Federation of State, County and Municipal Employees (AFSCME), 
     I urge you to support passage of the bipartisan ``Middle 
     Class Health Benefits Tax Repeal Act of 2019'' (H.R. 748), 
     which would repeal the 40 percent (``Cadillac'') tax on 
     employer-sponsored high cost worker and retiree health 
     benefits. AFSCME strongly supports H.R. 748 to prevent 
     further increases in workers' health costs and erosion of 
     their health benefits.
       Repealing the 40 percent tax is needed because it 
     encourages employers and insurers to reduce working families' 
     health benefits thereby raising medical copays, coinsurance, 
     deductibles, and related out-of-pocket health expenses. 
     AFSCME seeks immediate repeal because, while the tax does not 
     take effect until 2022, it already is reducing benefits--as 
     AFSCME (and other stakeholders) are already negotiating 
     multi-year contracts extending beyond early 2022. This tax is 
     troubling because it is regressive, disproportionately 
     burdens working families, and discriminates against female 
     dominated occupations like nurses and teachers. Groups of 
     workers who are relatively older, less healthy, or working 
     jobs with relatively high health risks will also suffer 
     additional health costs.
       More broadly, America's health care system faces an 
     escalating affordability crisis and this 40 percent tax 
     worsens it. For example, the Congressional Budget Office 
     (CBO) analysis of this tax states, ``empirical evidence 
     suggest that it will be passed on to employers who purchase 
     or provide insurance that is subject to the tax--and then 
     ultimately passed on to workers.'' To help workers and 
     improve affordability, this 40 percent tax should be repealed 
     now. This tax also is a poorly targeted and ineffective tool. 
     It will soon affect tens of millions of working families and 
     recently released data reports 21 percent to 31 percent of 
     employers offering health benefits in 2022 will owe this tax. 
     Others estimate more large employers will owe this tax, 
     dispelling the myth that this tax only affects plans with 
     strong benefits.
       H.R. 748 has diverse and broad support, including 
     endorsements from 43 national labor unions, many patient and 
     consumer organizations, such as Families USA, groups that 
     treat and cure diseases such as American Cancer Society 
     Cancer Action Network, and prominent business interests like 
     the U.S. Chamber of Commerce and Business Roundtable. 
     Furthermore, the public has opposed this tax for years and a 
     2018 Election Day poll reported 81 percent of voters oppose 
     taxing employer-provided health coverage. Repealing the 40 
     percent tax is a vital step to help make health care more 
     affordable. We urge you to support the bipartisan ``Middle 
     Class Health Benefits Tax Repeal Act,'' H.R. 748, and vote 
     yes on this important legislation.
           Sincerely,
                                                       Scott Frey,
     Director of Federal Government Affairs.
                                  ____



                                                          AFT,

                                    Washington, DC, July 15, 2019.
     House of Representatives,
     Washington, DC.
       Dear Representative: On behalf of the 1.7 million members 
     of the American Federation of Teachers, I urge you to vote 
     YES on H.R. 748, the Middle Class Health Benefits Tax Repeal 
     Act.
       The AFT has always opposed the 40 percent excise tax on 
     high-quality healthcare plans, included in the Affordable 
     Care Act, which will negatively impact families that have 
     worked for, and earned, strong healthcare coverage. We have 
     been gratified that Congress has pushed back the 
     implementation date of this tax in the past. It is clear, 
     however, that full repeal of this excise tax is needed to 
     prevent employers from using the threat of the tax as a 
     cudgel to demand reduced benefits or coverage from educators, 
     nurses, bus drivers, social workers and other AFT members.
       The AFT strongly supports the ACA's expansion of health 
     insurance, as well as the act's consumer protections and 
     emphasis on preventive care. We know firsthand that having 
     affordable, high-quality health insurance is a key component 
     to upward mobility and a sustainable middle class. Under 
     current law, the number of insured Americans is higher than 
     ever before; that includes the large number of contingent 
     workers we represent, who make up an increasing share of 
     today's workforce.
       The ACA was intended to help ensure that we all have access 
     to high-quality healthcare without depleting our paychecks 
     and compromising our ability to save for the future. The 
     excise tax, rather than expanding high-quality healthcare, 
     would do the opposite. If

[[Page H5967]]

     the 40 percent excise tax on the cost of employer-sponsored 
     health insurance plans is implemented, working families will 
     be hurt.
       Some analysts argue that this tax will lead employers and 
     employees to seek out ``more efficient'' plans and perhaps to 
     an increase in wages. However, we have not seen an increase 
     in wages and remain concerned that workers will be moved to 
     high deductible/co-pay health plans as a result of this tax. 
     The cost curve will not bend; costs will simply be shifted 
     over to those lower- and middle-income workers already 
     struggling because of stagnant wages. This will lead to more 
     workers forgoing necessary care or going into debt to pay for 
     the high out-of-pocket costs.
       In addition to having the potential to shift costs to 
     working families, the excise tax will disproportionately 
     affect older workers and women. This is of particular concern 
     to the AFT, as a substantial number of our members are 
     female, and many live in high-cost regions. Congress did 
     recognize the obvious impact on women and older workers by 
     trying to mitigate it with the ``age and gender adjustment'' 
     provisions in the law. However, these provisions are 
     insufficient, and implementation of the tax would almost 
     certainly lead to higher healthcare costs for these groups.
       There is near-universal agreement between employers and 
     employees that the excise tax is bad policy for American 
     workers, and must be repealed. That is why more than 360 
     members of the House have co-sponsored this much-needed, 
     bipartisan legislation. I urge you to join them and vote YES 
     on H.R. 748.
       Finally, I want to thank Rep. Joe Courtney, who introduced 
     H.R. 748, for his relentless efforts and commitment to 
     repealing this counterproductive tax. His determination and 
     leadership on this issue have been remarkable, and our 
     members appreciate his dedication.
       Thank you for considering our views on this important 
     matter.
           Sincerely,
                                                 Randi Weingarten,
     President.
                                  ____

                                            American Federation of


                                Government Employees, AFL-CIO.

       Dear Representative: On behalf of the more than 700,000 
     federal and District of Columbia employees represented by the 
     American Federation of Government Employees, AFL-CIO (AFGE), 
     I write to urge your support for the bipartisan ``Middle 
     Class Health Benefits Tax Repeal Act of 2019'' (H.R. 748) 
     which would eliminate the unfair and unwarranted 40 percent 
     tax on relatively high cost employer-sponsored health 
     insurance. We ask that you vote ``YES'' when the bill comes 
     to the floor later this week.
       Most federal employees and federal retirees participate in 
     the Federal Employee Health Benefits Program (FEHBP). The 
     premiums for almost every plan that participates in FEHBP 
     would be hit by this tax, making a very expensive program 
     even more expensive for both taxpayers and participants. 
     FEHBP plans are expensive, and thus are subject to this tax, 
     not because the benefits they provide are so comprehensive, 
     but because the structure of FEHBP leads to high premiums. 
     FEHBP plans yield enormous political power to charge high 
     prices, escape audit by virtue of their exemption from 
     application of the government's cost accounting standards, 
     and are characterized by risk segmentation that raises their 
     premiums above the actuarial value of their benefits. Indeed, 
     the generosity of benefits is a relatively insignificant 
     factor in the overall size of FEHBP's premiums. Age, gender, 
     health status and program structure are the most important 
     factors in determining premiums, and premiums determine 
     whether a plan is subject to the tax.
       The 40 percent excise tax is not scheduled to take effect 
     until 2022, so now is the time for repeal, before it has any 
     further deleterious effect on the working and middle class 
     families that are its targets. Support for repeal of this 
     regressive tax is widespread. There is no doubt that its 
     effect will be to make health insurance less affordable. That 
     is certainly true for federal employees and retirees whose 
     compensation has declined in real terms over the past decade 
     due to pay freezes and retirement benefit reductions. AFGE 
     strongly urges you to support H.R. 748, the ``Middle Class 
     Health Benefits Tax Repeal Act of 2019.''
           Sincerely yours,
                                                 J. David Cox, Sr.
  Ms. DelBENE. Madam Speaker, I yield 1 minute to the gentlewoman from 
California (Ms. Judy Chu).
  Ms. JUDY CHU of California. Madam Speaker, I rise in support of H.R. 
748, repealing the so-called Cadillac tax.
  I believe that we in Congress should be incentivizing employer-
sponsored insurance to be more generous, not less; and at a time when 
the President is working to dismantle the Affordable Care Act and 
pushing through regulations that allow junk plans to flourish, we need 
to stand with American workers and fight for more generous health 
plans.
  The plans that are hit by this tax cover more female employees, more 
workers with dependent children, more older workers, and employees at 
small businesses. These are the people who are being hit by high 
deductibles, rising premiums, and more cost sharing in the health 
system than ever before.
  A recent study showed that in 2018, 58 percent of Americans do not 
have $1,000 of savings in case of an emergency, and yet the average 
deductible in 2018 was $1,350.
  We must pass this bill.
  I include letters of support for H.R. 748 into the Congressional 
Record from organizations such as the Alliance for Retired Americans, 
the Alliance to Fight the 40, and the College and University 
Professional Association for Human Resources.


                               Alliance for Retired Americans,

                                    Washington, DC, July 15, 2019.
       Dear Representative: On behalf of the 4.4 million members 
     of the Alliance for Retired Americans, I am writing to urge 
     you to vote in favor of H.R. 748, the Middle Class Health 
     Benefits Tax Repeal Act, when it comes up for a vote on the 
     House floor this week.
       As you know, approximately 181 million Americans rely on 
     employer-provided health insurance to pay for the medical 
     care that they need. The 40% excise tax, originally passed as 
     a part of the Affordable Care Act, is assessed on any health 
     plan that provides more than $10,200 for individual coverage 
     and $27,500 for family coverage.
       While intended to target high-premium plans for the wealthy 
     to expand benefits and coverage for uninsured individuals, 
     the tax squarely affects middle class workers and their 
     families. Johns Hopkins University researchers projected that 
     75% of employer-sponsored plans will be affected by the tax.
       Retirees are especially vulnerable to higher health care 
     costs and will be hurt if the tax goes into effect. Older 
     Americans' retiree insurance plans typically have higher 
     premiums. If not repealed, employers may reduce the benefits 
     provided to their retirees who are younger than 65 and 
     eliminate supplemental coverage altogether for Medicare 
     eligible retirees age 65 and over. In addition, the tax 
     disproportionately hurts women, low- to middle-class 
     individuals and families, people with disabilities, workers 
     with high-risk occupations, and those with chronic medical 
     conditions.
       Many workers are already experiencing the effects of the 
     tax. Some employers are reducing health coverage for their 
     employees to avoid the tax. Others are increasing premiums 
     and deductibles to shift costs to workers. The Middle Class 
     Health Benefits Tax Repeal Act will eliminate this looming 
     danger facing millions of American workers.
       I urge you to vote in favor of H.R. 748 to protect quality 
     health coverage for older Americans and millions of workers 
     and their families. The importance of this vote cannot be 
     overstated.
           Sincerely,
                                                Richard J. Fiesta,
     Executive Director.
                                  ____



                                     Alliance to Fight the 40,

                                                    July 15, 2019.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate,
     Washington, DC.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Charles Schumer,
     Minority Leader, U.S. Senate,
     Washington, DC.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Leader McConnell, Minority Leader Schumer, Speaker 
     Pelosi, and Minority Leader McCarthy: We are writing on 
     behalf of the 181 million Americans who receive health care 
     coverage through an employer. This coverage is threatened by 
     the looming 40% tax on employer-provided coverage. We applaud 
     the House for the bipartisan support and for bringing H.R. 
     748, a bill that fully repeals the ``Cadillac Tax,'' to the 
     floor for a vote this week. We urge the Senate to approve 
     quickly, and send this bill to the president before the end 
     of the year.
       The tax is having a real impact, today, on the lives and 
     pocketbooks of American workers. A poll conducted July 12, 
     2019, found that 86% of voters oppose taxing employer-
     provided health insurance.
       The ``Cadillac Tax'' increases the health care cost burden 
     for working Americans, threatens patient access to care, and 
     targets vulnerable populations such as the families and sick 
     individuals most needing care. A significant majority of 
     voters--across party lines--oppose this tax because it 
     increases out-of-pocket costs for older, sicker and 
     underserved communities. Taxing workers trying to manage 
     chronic conditions fails to address our most urgent health 
     care challenges.
       At 40%, the tax is twice the top corporate rate and will 
     have significant consequences. Waiting to address the tax 
     forces employers to adjust benefits now in anticipation of 
     the tax. Several studies have shown that the ``Cadillac Tax'' 
     would have a direct and negative impact on the continued 
     affordability of employer-provided health insurance because 
     employers will be compelled to reduce benefits and increase 
     deductibles and other out-of-pocket costs to avoid the tax.
       We need to protect the millions of American families with 
     employer-provided health care coverage from further benefit 
     losses and cost hikes. A healthy workforce drives a healthy 
     economy, but the so-called ``Cadillac Tax'' will drive 
     America's health care--and workforce--in the wrong direction.
       There is strong support for repealing the 40% tax from both 
     sides of the aisle and both

[[Page H5968]]

     sides of the Capitol--and all across the country. Currently, 
     there are more than 360 cosponsors in the House and 42 
     cosponsors in the Senate who support legislation to repeal 
     the tax. In addition, 665 organizations including, 
     businesses, nonprofits, cities, chambers of commerce, 
     insurers, brokers, unions, and patient advocacy groups 
     recently signed a letter supporting full repeal of the 
     ``Cadillac Tax.''
       We urge you to keep health care affordable for working 
     families by including full repeal of the ``Cadillac Tax'' in 
     any package under consideration before the end of this year.
       Thank you for your consideration of this request.
     Alliance to Fight the 40.
                                  ____

   College and University Professional Association for Human Resources,
                                     Knoxville, TN, July 17, 2019.
     Hon. Mitch McConnell,
     Majority Leader, U.S. Senate,
     Washington, DC.
     Hon. Charles Schumer,
     Minority Leader, U.S. Senate,
     Washington, DC.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Leader McConnell, Minority Leader Schumer, Speaker 
     Pelosi, and Minority Leader McCarthy: On behalf of the 
     College and University Professional Association for Human 
     Resources (CUPA-HR), I write in support of H.R. 748, a bill 
     that fully repeals the ``Cadillac Tax,'' and urge members of 
     the House to vote ``YES'' when the bill comes to the floor 
     for a vote this week. I also urge the Senate to approve this 
     bill quickly and send the bill to the President's desk before 
     the end of the year.
       CUPA-HR serves as the voice of human resources (HR) in 
     higher education, representing more than 31,000 human 
     resources professionals and other higher education leaders at 
     over 2,000 colleges and universities across the country. Its 
     membership includes 93 percent of all U.S. doctoral 
     institutions, 79 percent of all master's institutions, 58 
     percent of all bachelor's institutions and over 500 two-year 
     and specialized institutions. Higher education employs over 
     3.9 million workers nationwide, with colleges and 
     universities in all 50 states.
       CUPA-HR members collectively provide comprehensive health 
     benefits to millions of employees, retirees, students and 
     their families. As such, CUPA-HR supports and encourages 
     employer efforts to provide benefits that enhance employees' 
     health and wellness--including efforts to keep healthcare 
     affordable.
       For these reasons we urge the full House to vote ``yes'' on 
     this legislation. Please do not hesitate to reach out to me 
     to discuss this issue further.
           Sincerely,
     Joshua A. Ulman,
       Chief Government Relations Officer, College and University 
     Professional Association for Human Resources.
                                  ____

         SHRM,
                                    Alexandria, VA, July 15, 2019.
     Speaker Nancy Pelosi,
     House of Representatives.
     Leader Kevin McCarthy,
     House of Representatives.
     Leader Charles Schumer,
     U.S. Senate.
     Leader Mitch McConnell,
     U.S. Senate.
       Dear Speaker Pelosi, Leader McCarthy, Leader Schumer, and 
     Leader McConnell, For over seventy years the Society for 
     Human Resource Management (SHRM) has represented the 
     interests of our nation's Human Resources (HR) professionals. 
     Today, with more than 300,000 members who impact the lives of 
     115 million employees each day we use our voice to elevate 
     issues squarely at the intersection of work, workers and the 
     workplace. Workplace healthcare is one of those issues.
       SHRM believes public policy must strengthen the employer-
     based health care system, which provides coverage to more 
     than 181 million Americans. As the bedrock of the U.S. health 
     care system, employer-sponsored plans are the largest 
     providers of health insurance (66 percent of the workforce) 
     to individuals in the United States. Therefore, I write to 
     share SHRM's strong support of H.R. 748 and S. 684, the 
     Middle Class Health Benefits Tax Repeal Act.
       Although not effective until 2022, employers are already 
     restructuring their health care benefit offerings to avoid 
     the tax. According to a new analysis by the Kaiser Family 
     Foundation, the anticipated tax would affect one in five 
     (21%) employers offering health benefits when it takes effect 
     in 2022 unless employers change their health plans.
       As 2022 approaches, more employers will have to closely 
     scrutinize their health benefit offerings and make the 
     necessary changes to avoid the tax, which may include 
     reducing benefits and/or altering wellness and chronic care 
     prevention programs. While the excise tax is only intended to 
     target high-value plans, modest plans will also be impacted, 
     meaning millions of Americans and their families could face 
     higher copays and deductibles, causing some to decline 
     employer-provided health care.
       The Cadillac Tax must be dealt with well in advance of its 
     proposed implementation date, otherwise employees could see 
     further changes in their benefit options. For these reasons, 
     I urge you to support H.R. 748 when it is considered on the 
     House floor this week and encourage swift action in the 
     Senate.
           Sincerely,
                                  Johnny C. Taylor, Jr., SHRM-SCP,
     President & CEO.
                                  ____

                                                   Partnership for


                                  Employer-Sponsored Coverage,

                                                    July 15, 2019.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Leader McCarthy: As members of the 
     Partnership for Employer-Sponsored Coverage, we write with 
     our strong support for passage of the Middle Class Health 
     Benefits Tax Repeal Act (H.R. 748), to repeal the 40 percent 
     excise tax on employer-sponsored health coverage and employee 
     benefits under the Affordable Care Act (ACA). This important 
     reform effort impacts the over 181 million Americans covered 
     through employment-based benefits plans.
       The Partnership for Employer-Sponsored Coverage is 
     committed to ensuring that employer-sponsored coverage is 
     strengthened and remains a viable, affordable option for 
     decades to come. Employer-sponsored coverage has been the 
     backbone of our nation's health system for nearly eight 
     decades. Employers have a vested interest in health care 
     quality, value, and system viability.
       The 40 percent excise tax, also known as the Cadillac tax, 
     would force employers to cut or limit employee benefits. The 
     tax is a blunt instrument that proponents envision will 
     address the demand side of rising health costs. While dubbed 
     the Cadillac tax because the provision was targeting ``high 
     cost'' employer-sponsored health coverage, it would impact 
     the vast majority of employee benefits plans.
       While we appreciate prior delays of this tax, uncertainty 
     remains in the employer health market as the U.S. Treasury 
     Department begins to develop proposed rules for 
     implementation. Employers make plan decisions well in advance 
     of a coverage year beginning and looming proposed rules have 
     a direct impact on plan decisions that are being made now for 
     the 'next several coverage years.
       Full repeal of the Cadillac tax is extremely timely. H.R. 
     748 will bring certainty to millions insured under an 
     employer plan.
           Sincerely,
       American Hotel & Lodging Association.
       American Rental Association.
       American Staffing Association.
       Associated General Contractors of America.
       Auto Care Association.
       The Council of Insurance Agents & Brokers.
       Food Marketing Institute.
       HR Policy Association.
       International Franchise Association.
       National Association of Health Underwriters.
       National Association of Wholesaler-Distributors.
       National Restaurant Association.
       National Retail Federation.
       Retail Industry Leaders Association.
       Society for Human Resource Management.

  Ms. DelBENE. Madam Speaker, I yield 1\1/2\ minutes to the gentleman 
from Pennsylvania (Mr. Brendan F. Boyle).
  Mr. BRENDAN F. BOYLE of Pennsylvania. Madam Speaker, I thank my 
friend from Washington State for yielding.
  More than anything, today is about fairness for America's workers. I 
come to this issue with the experience of remembering on several 
occasions when I was growing up, my parents, who were both hardworking 
members of organized labor, going through a contract negotiation and 
wondering, if they were going to go out on strike, what was going to 
happen.
  On more than one occasion, it would end like this. They would say: 
Well, I think we got a fair deal. We are forgoing a pay increase, but 
thank God we are able to save our healthcare and our benefits.
  Time and time again, thousands--indeed, millions--of American workers 
made that decision that they would forgo pay raises, forgo pay 
increases, so they could save their healthcare. So then, decades later, 
to face a 40 percent tax on that healthcare just is not right and not 
fair to America's workers.
  So I am proud to stand here today with my fellow Pennsylvanian on the 
other side of the aisle, with colleagues

[[Page H5969]]

of mine on both sides of the aisle, in order to repeal this Cadillac 
tax which never should have been passed in the first place.
  Madam Speaker, I will enter into the Record a number of letters from 
organizations all supporting this piece of legislation to repeal the 
Cadillac tax.

                                                          NRF,

                                                    July 16, 2019.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Minority Leader McCarthy: I write 
     to share the strong support of the National Retail Federation 
     (NRF) for H.R. 748, the Middle Class Health Benefits Tax 
     Repeal Act of 2019. Please note that NRF may consider votes 
     on the strongly bipartisan H.R. 748 and related procedural 
     motions as Opportunity Index Votes for our annual voting 
     scorecard.
       The National Retail Federation, the world's largest retail 
     trade association, passionately advocates for the people, 
     brands, policies and ideas that help retail thrive. From its 
     headquarters in Washington, D.C., NRF empowers the industry 
     that powers the economy. Retail is the nation's largest 
     private-sector employer, contributing $2.6 trillion to annual 
     GDP and supporting one in four U.S. jobs--42 million working 
     Americans. For over a century, NRF has been a voice for every 
     retailer and every retail job, educating, inspiring and 
     communicating the powerful impact retail has on local 
     communities and global economies.
       H.R. 748, introduced by Representatives Joe Courtney (D-CT) 
     and Mike Kelly (R-PA), will repeal the Affordable Care Act's 
     40% excise tax on the excess value of employer-sponsored 
     health plans. Though portrayed as being targeted at rich 
     ``gold-plated'' benefit plans, the ``Cadillac Tax'' is 
     projected to hit much more mainstream plans covering low- and 
     middle-class families in the coming years because of how it 
     is indexed.
       This legislation helps protect health insurance coverage 
     enjoyed by 181 million Americans. According to 2018 mid-term 
     election polling, 81 percent of voters oppose taxing 
     employer-provided health coverage.
       NRF appreciates Congress' past two successful efforts to 
     delay the ``Cadillac Tax.'' We urge its full repeal, however, 
     because this tax forces the reduction of benefits well in 
     advance of its effective date. Employers generally craft 
     benefit plans two or more years in advance of the actual plan 
     year. Benefits are being reduced now (increasing employee 
     cost-sharing) to avoid the unfair tax on ``excess'' benefits.
       We strongly urge your support for H.R. 748, bipartisan 
     legislation to repeal the ``Cadillac Tax.''
           Sincerely,
                                                     David French,
     Senior Vice President, Government Relations.
                                  ____

                                                             NECA,


                                     House of Representatives,

                                                   Washington, DC.
       Dear Representative: On behalf of the National Electrical 
     Contractors Association (NECA), I am writing in strong 
     support of H.R. 748--Middle Class Health Benefits Tax Repeal 
     Act of 2019, introduced by Rep. Joe Courtney (D-CT) and Rep. 
     Mike Kelly (R-PA)
       This critically needed legislation seeks to repeal the 
     ``Cadillac tax,'' which if implemented would levy a 40 
     percent tax on ``high-end'' employer-sponsored health 
     insurance plans with benefits valued at $10,200 per year per 
     individual or $27,500 per family. This tax ignores 
     significant demographic and geographic factors and applies to 
     benefits that help keep employees healthy, such as health 
     savings accounts. Most importantly, it penalizes employers, 
     including NECA contractors, for providing their employees 
     with quality health coverage.
       NECA contractors work to provide quality, affordable health 
     coverage through self-insured, employer-sponsored group plans 
     to well over 500,000 employees across our nation. Employer-
     sponsored health insurance provides affordable quality 
     coverage in the best interest of American businesses and 
     their workers. Although the tax does not go into effect until 
     2022, employers are already being compelled to reduce 
     benefits or implement increased cost-sharing to avoid being 
     on a trajectory to trigger the tax thresholds. If Congress 
     does not act now, the tax will hurt millions of Americans 
     with employer-sponsored health care.
       Thank you for your consideration of these views. As the 
     nationally recognized voice of the $171 billion electrical 
     construction industry, NECA, and our 118 local chapters 
     nationwide urge you to vote yes on H.R 748. Please note that 
     we will include this vote in our NECA Legislative Report Card 
     for the 116th Congress.
       Thank you for your consideration of our views.
           Sincerely,

                                  Marco A. Giamberardino, MPA,

                                        Vice President, Government
     and Public Affairs.
                                  ____

                                           National Association of


                                          Health Underwriters,

                                    Washington, DC, July 15, 2019.
     Hon. Nancy Pelosi,
     Speaker, House of Representatives,
     Washington, DC.
     Hon. Kevin McCarthy,
     Minority Leader, House of Representatives,
     Washington, DC.
       Dear Speaker Pelosi and Leader McCarthy: The National 
     Association of Health Underwriters (NAHU) endorses the 
     passage of H.R. 748, a repeal of the 40% excise tax on 
     certain employer-sponsored health insurance plans, known as 
     the ``Cadillac Tax.'' NAHU represents 100,000 licensed agents 
     and brokers who are engaged in the sale and service of health 
     insurance and other ancillary products. NAHU members serve 
     employers and consumers around the country. Our members work 
     to help millions of employers of all sizes finance, 
     administer and utilize their group health benefit plans on a 
     daily basis, and they know firsthand how the 40% excise tax 
     on health benefits will hurt middle-class consumers.
       H.R. 748 has received bipartisan support with 361 co-
     sponsors with a majority of each party caucus supporting 
     repeal of the Cadillac Tax. The Cadillac Tax, set to go into 
     effect in 2022, will impose a 40% excise tax on health plans 
     that exceed certain cost thresholds beginning in 2022. 
     Specifically, the law calls for a 40% excise tax on the 
     amount of the aggregate monthly premium of each primary 
     insured individual that exceeds the year's applicable dollar 
     limit, which will be adjusted annually to the Consumer Price 
     Index plus one percent. The current threshold for when the 
     tax applies is set to $11,100 for individual coverage and 
     $29,750 for ``other than self-only'' coverage. Because of the 
     wide-ranging benefits that can be counted towards the tax, 
     including HSAs, HRAs, FSAs and other cost-containment 
     measures, many employers will find their plans exceeding 
     these thresholds when the tax takes effect. While designed as 
     a disincentive for employers offering the most benefit-rich 
     plans, in reality the tax will impact a majority of plans, 
     including those that aren't benefit-rich and were not the 
     intended targets of this provision.
       All employers could be subjected to this tax, with various 
     factors determining the likelihood of a plan's costs 
     exceeding the threshold. These include family size, state 
     benefit mandates, high-cost geography, age, health status, 
     the size of the employer and other factors. In addition to 
     paying the tax, employers will be forced to handle onerous 
     compliance requirements on a monthly basis to record and pay 
     the tax to insurers. In turn, insurers will be required to 
     treat the tax as revenue and will be taxed on that amount, 
     which will increase the size of the tax for everyone. 
     Individuals and families who are already struggling to afford 
     existing plan premiums and higher deductibles will also be 
     hit by the tax, further increasing their costs.
       We appreciate your consideration on this issue that is 
     important for businesses and their employees so that all 
     families can afford quality healthcare. We look forward to 
     working with you and your colleagues in enacting this 
     bipartisan legislation this year.
       Best regards,
                                                  Janet Trautwein,
     Executive Vice President and CEO.
                                  ____

                                           National Association of


                                                Manufacturers,

                                                    July 16, 2019.
     House of Representatives,
     Washington, DC.
       Dear Representative: On behalf of the National Association 
     of Manufacturers (NAM), the largest manufacturing association 
     in the United States representing 14,000 manufacturers in 
     every industrial sector and in all 50 states, I am writing to 
     urge you to support the Middle Class Health Benefits Tax 
     Repeal Act of 2019 (H.R. 748) introduced by Representatives 
     Joe Courtney (D-CT) and Mike Kelly (R-PA).
       Manufacturers consistently rank the rising cost of health 
     care as a primary business challenge in the NAM's Quarterly 
     Outlook Survey. Despite the challenge, approximately 98 
     percent of NAM members continue to provide health insurance 
     to employees. The manufacturing industry is committed to 
     providing quality health benefits to employees to maintain a 
     healthy workforce, attract and retain talent and because it 
     is the right thing to do. Many are leading new health benefit 
     initiatives to provide quality care that reduces growing 
     health benefits costs. Additionally, manufacturers oppose 
     applying heavy federal tax burdens on employers' and workers' 
     health bills.
       H.R. 748 would permanently repeal the 40 percent tax-hike 
     on ``high-cost'' health benefits, commonly referred to as the 
     Cadillac Tax. While this tax was initially intended to impact 
     high-cost employer-sponsored health care plans, it is 
     expected to burden a broad crosssection of small and large 
     employers across the country and to discourage employer 
     innovations that are improving benefits for manufacturing 
     workers. Manufacturers have been forced to begin plan 
     preparations even though the tax is scheduled to go into 
     effect in 2022. Fully repealing the Cadillac tax, health 
     insurance tax and medical device tax remain top health care 
     priorities for manufacturers.
       The NAM urges strong support for H.R. 748 and appreciates 
     ongoing efforts to eliminate the looming threat of health 
     care taxes on manufacturers. Thank you for your 
     consideration.
           Sincerely,
     Robyn M. Boerstling,

[[Page H5970]]

       Vice President, Infrastructure, Innovation and Human 
     Resources Policy.
                                  ____


                        National Taxpayers Union


                    50th Anniversary, July 16, 2019

       NTU urges all Representatives to vote ``YES'' on H.R. 748, 
     the Middle Class Health Benefits Tax Repeal Act of 2019. This 
     legislation would permanently repeal the flawed ``Cadillac 
     tax'' scheduled to go into effect in 2022, which could impact 
     up to one in five employers immediately. Congress should also 
     work to permanently repeal the medical device tax and the 
     Health Insurance Tax (HIT), both of which are scheduled to go 
     into effect in 2020.
       NTU has noted before that the Affordable Care Act's excise 
     tax on high-cost employer-sponsored insurance (ESI), 
     popularly known as the ``Cadillac tax,'' is a poor solution 
     to a real policy dilemma--addressing the employer-sponsored 
     health insurance tax exclusion that has distorted markets. 
     Even though the intent of the tax was to reduce health care 
     costs and boost the economy, the Joint Committee on Taxation 
     (JCT) and the Congressional Budget Office (CBO) have 
     estimated that the Cadillac tax will depress wages.
       The Cadillac tax would also have a far-reaching impact on 
     ESI plans. The Kaiser Family Foundation (KFF) recently 
     reported that the Cadillac tax could impact more than one in 
     five employers (21 percent) in 2022, when the tax is 
     scheduled to go into effect. Since the cost of ESI plans is 
     expected to rise faster than inflation, a growing proportion 
     of plans will likely become subject to the tax over time. 
     KFF-estimates that nearly two in five ESI plans (37 percent) 
     will be subject to the tax by 2030.
       When it comes to taxes imposed by the Affordable Care Act, 
     though, Congress should not stop with Cadillac tax repeal. 
     Both the medical device tax and the Health Insurance Tax 
     (HIT) have been suspended by Congress, but are scheduled to 
     resume in 2020. The costs of these taxes will ultimately be 
     borne by consumers, in the form of higher health spending and 
     higher premiums. Additionally, Congress should examine the 
     tax treatment of health care in a holistic fashion and work 
     toward a minimally distortionary environment that empowers 
     consumers to make decisions about their own health care 
     needs.
       NTU strongly urges Representatives to support H.R. 748, and 
     additionally to permanently repeal both the medical device 
     tax and HIT.
       Roll call votes on H.R. 748 will be included in our annual 
     Rating of Congress and a ``YES'' vote will be considered the 
     pro-taxpayer position.

  Ms. DelBENE. Madam Speaker, I yield 1\1/2\ minutes to the gentleman 
from Nevada (Mr. Horsford).
  Mr. HORSFORD. Madam Speaker, thank you to my colleague from 
Washington for managing this important bill.
  I rise today to speak in support of the Middle Class Health Benefits 
Tax Repeal Act. We cannot afford to let this 40 percent excise tax on 
employer-sponsored health plans to take effect. This tax would increase 
costs for America's working and middle-class families.
  For many working families, necessary medical treatment remains 
tragically unaffordable due to exorbitant out-of-pocket costs and 
deductibles. If this so-called Cadillac tax isn't repealed, this crisis 
of affordability for medical care will only worsen.
  To avoid the excise tax, employers will, in all likelihood, reduce 
the value of their plans and reduce benefits and even increase their 
workers' share of the cost. This would result in increases in out-of-
pocket costs for more than 180 million workers, including 1.3 million 
people in my home State of Nevada, and it would decrease access to 
quality insurance plans across the country.
  This vote helps labor throughout the country, including the Culinary 
Workers Union in my home State. Members' benefits, wages, and overall 
compensation allow them to stay afloat financially, and to quote the 
international union president for UNITE HERE, D. Taylor: ``They drive 
used cars, not Cadillacs, and their healthcare does not include spa 
treatments.''
  At a time when this is the reality for our constituents, Congress 
should make sure that employers doing the right thing and providing 
high-value health insurance to their employees are supported.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Ms. DelBENE. Madam Speaker, I yield an additional 30 seconds to the 
gentleman from Nevada.
  Mr. HORSFORD. Madam Speaker, Congress should make sure that employers 
doing the right thing and providing high-value health insurance to 
their employees are supported, not penalized with an egregious tax.
  Madam Speaker, I include in the Record a letter from UNITE HERE and 
several other national organizations.

                                                   UNITEHERE!,

                                     Las Vegas, NV, July 15, 2019.
     House of Representatives,
     Washington, DC.
       Dear Representative: On behalf of UNITE HERE and the 
     300,000 men and women and their families from the fastest 
     growing private sector labor union in America, I am asking 
     for your vote to approve H.R. 748, the ``Middle Class Health 
     Benefits Tax Repeal Act of 2019.''
       It is time to finally put a marker down and bring real tax 
     relief to hard pressed working Americans, not just to health 
     insurance and medical device companies who have a legion of 
     lobbyists at their disposal. At a time when consumer anxiety 
     is high and where only one job should be enough to make a 
     living but isn't, the 181 million middle-class Americans who 
     receive their health benefits from a private employer need an 
     economic boost and some good news. I want to make the 
     position of our union and membership clear: We support tax 
     relief for middle-class Americans, starting with the repeal 
     of the 40% excise tax on employer-sponsored health insurance.
       The so-called ``Cadillac Tax'' impacts far more health 
     plans than many members of Congress, including some 
     Democrats, who characterize these hard-earned health benefits 
     ``overly generous.'' In fact, the 40% excise tax unfairly 
     taxes our own members who make--all in, salary and benefits--
     under $50,000 a year. UNITE HERE members' benefits, wages, 
     and overall compensation allow them to stay afloat 
     financially. They drive used cars, not Cadillacs, and their 
     health care does not include spa treatments.
       Delayed but not yet repealed, this tax has already 
     incentivized employers to dramatically reduce their health 
     benefits and overall compensation to avoid the tax 
     thresholds. As you should be aware, health care costs are 
     soaring. In fact, 73% of employers have changed, or plan to 
     change, their health insurance offerings to avoid the tax, 
     according to a recent survey by the International Foundation. 
     Many of our low-income members reject pay raises just to 
     maintain their health benefits.
       Our union is already doing its part to keep health costs 
     down among our members. Ken Blair, President of UNITE HERE 
     Local 217 says: We're fighting hard to keep our costs down 
     inside our union by making sure our members stay healthy or 
     making sure they use the most cost effective way to keep our 
     insurance low. Now we're going to be taxed!
       Our membership is majority minority, a majority of women, 
     and represent workers from over (111) countries. On behalf of 
     our members, I again urge you to vote for H.R. 748 and stand 
     up for millions of middle-class Americans who receive modest 
     health insurance coverage through their jobs.

                                                    D. Taylor,

                                          International President,
     UNITE HERE.
                                  ____

                                                 Service Employees


                                          International Union,

                                    Washington, DC, July 17, 2019.
       Dear Representative: On behalf of the two million members 
     of the Service Employees International Union (SEIU), I urge 
     you to vote for H.R. 748, Middle Class Health Benefits Tax 
     Repeal Act, which will eliminate the 40 percent ``Cadillac'' 
     tax on health benefits. Employers are using the tax as 
     justification to shift more costs to employees, raising costs 
     for workers and their families. Congress must take action to 
     ensure that everyone has access to affordable coverage 
     whether that coverage comes through an employer-sponsored 
     plan, private non-group coverage, or public programs.
       Too many working families are struggling to afford high out 
     of pocket costs--including deductibles, co-insurance, and co-
     payments required under their employer sponsored insurance 
     (ESI) plans. Unfortunately, the impending 40 percent health 
     benefits tax has exacerbated the trend of shifting health 
     costs to working people by creating new pressure for 
     employers to reduce the generosity of coverage in order to 
     avoid triggering the tax. Though some claim providing 
     consumers more ``skin in the game'' through increased cost-
     sharing will encourage them to use care more efficiently and 
     reduce costs, research demonstrates that high cost-sharing 
     requirements prevent people from accessing even necessary 
     care, including care for chronic illnesses that could prevent 
     more expensive interventions in the future. For example, a 
     2019 survey of adults with employer health benefits conducted 
     by the Kaiser Family Foundation/LA Times found that half of 
     respondents said that they or someone in their family went 
     without or postponed needed care or medication as a result of 
     cost. Given the economic stress working people face, policies 
     should encourage high-value comprehensive coverage. The 40 
     percent health benefits tax acts to discourage it.
       Furthermore, since their inception, unions have advocated 
     and bargained on behalf of their members for comprehensive 
     affordable healthcare. As a union, we value the robust health 
     insurance coverage we fought for at the bargaining table for 
     so many years, often at the expense of higher wages. Many of 
     our members live in geographic areas with higher living 
     expenses that include significant

[[Page H5971]]

     health costs. The majority of our membership is comprised of 
     women; as they are likely to need health services that will 
     cost more than their younger male counterparts, their 
     coverage plans will be more expensive. We should not punish 
     workers who, through their union, are able to have a voice in 
     their pay and benefits and in fact should honor the choices 
     and decisions workers make through negotiations with their 
     employers.
       For decades, SEIU members have fought for healthcare as a 
     basic human right, not a privilege. We believe that everyone 
     in America has a right to quality, affordable healthcare. 
     SEIU members support all legislation that improves and 
     strengthens our healthcare system--including expanding 
     coverage and lowering excessive out-of-pocket costs--that are 
     a huge financial burden on working American families today 
     and a major cause of economic stress. We view repeal of the 
     excise tax as a necessary improvement that is consistent with 
     our goal to support policies that make healthcare more 
     affordable. While some in the Administration and Congress 
     actively work to sabotage our healthcare system, whether 
     through regulation or legal attacks, it is heartening to see 
     that others are taking seriously their obligation to try and 
     improve America's healthcare seriously.
       For all these reasons, we ask you to support the Middle 
     Class Health Benefits Tax Repeal Act (H.R. 74).
           Sincerely,
                                                   Mary Kay Henry,
     International President.
                                  ____



                                                       LiUNA!,

                                    Washington, DC, July 15, 2019.
     House of Representatives,
     Washington, DC.
       Dear Representative: On behalf of the 500,000 members of 
     the Laborers' International Union of North America (LIUNA), I 
     urge you to support and vote for H.R. 748, bipartisan 
     legislation to repeal the so-called Cadillac Tax provision of 
     the Affordable Care Act (ACA).
       Since the ACA became law, this regressive tax has been a 
     looming dark cloud above every union member's health benefits 
     and the remaining 181 million Americans who rely on their 
     employer-sponsored insurance. For the half-million members of 
     LIUNA whose healthcare benefits are collectively bargained 
     for and essentially self-funded in order to provide good 
     healthcare for themselves and their families, this is 
     unacceptable and it needs to end now.
       For nearly ten years, unions, businesses, patient 
     advocates, and consumer groups have supported repeal of the 
     Cadillac Tax, and, with over 350 cosponsors, we finally have 
     the opportunity to repeal it.
       We urge you to support H.R. 748 and vote to end this unfair 
     tax on America's working class.
       With kind regards, I am
           Sincerely yours,
                                                 Terry O'Sullivan,
     General President.
                                  ____

                                                   Air Line Pilots


                                    Association International,

                                    Washington, DC, July 16, 2019.
       Dear Representative: On behalf of the 62,000 professional 
     pilots represented by the Air Line Pilots Association, 
     International (ALPA), I write in support of the bipartisan 
     Middle Class Health Benefits Tax Repeal Act of 2019 (H.R. 
     748). H.R. 748, introduced by Representative Joe Courtney (D-
     CT), repeals the 40% excise tax on health care plans.
       H.R. 748 currently has 361 bipartisan cosponsors, and polls 
     conducted in 2018 revealed that taxing employer provided 
     health care benefits is opposed by over 81% of Americans. The 
     excise tax on employer provided health care benefits is 
     predicated on the flawed economic assumption that the cost of 
     a health insurance plan is the main driver of health care 
     costs. Detailed analysis of our health insurance system has 
     demonstrated that the real drivers of health care costs are 
     location, occupation, gender and age.
       Without a repeal, many employers are necessarily preparing 
     for the introduction of the excise tax by increasing copays, 
     deductibles and out of pocket maximums in their health care 
     plans. The excise tax will further erode the health care 
     protection provided by our plans and drive out of pocket 
     costs up for professional pilots and other workers.
       When H.R. 748 comes up for a vote this week, I urge you to 
     support it. Thank you for your consideration.
           Sincerely,
                                           Capt. Joseph G. DePete,
     President, Air Line Pilots Association Intl.
                                  ____

                                                    July 15, 2019.
     Hon. Richard E. Neal,
     House of Representatives,
     Washington, DC.
       Dear Congressman Neal: On behalf of our 3 million members 
     and the 50 million students they serve, we urge you to VOTE 
     YES on the Middle Class Health Benefits Tax Repeal Act (H.R. 
     748), which would eliminate the 40 percent excise tax on 
     ``high cost'' employer-sponsored health plans scheduled to 
     take effect in 2022. Votes on this issue may be included in 
     NEA's Report Card for the 116th Congress.
       Under the Affordable Care Act, ``high cost'' employer-
     sponsored health benefits whose value exceeds specified 
     thresholds will be subject to a 40 percent excise tax 
     starting in 2022: $11,200 for single coverage and $30,150 for 
     family coverage, the Tax Policy Center projects. We support 
     repeal because:
       The tax would take money out of the pockets of educators 
     who have accepted lower wages in return for decent health 
     care coverage--just when there's growing recognition among 
     lawmakers and the American people that educators deserve 
     better compensation. Moreover, educators would be among those 
     hit hardest by the tax as noted in an analysis published in 
     Health Affairs.
       The tax applies equally to plans for lower- and higher-
     income employees, as well as retirees, regardless of whether 
     they live in areas with unusually high health care costs.
       The tax is far likelier to hit plans due to factors beyond 
     employees' control--their age, gender, and location--than 
     because of the benefits provided.
       Initially, the Kaiser Family Foundation estimates, the tax 
     would affect 21 percent of employers who provide health 
     coverage--31 percent when workers' voluntary contributions to 
     Flexible Spending Accounts are taken into account as the law 
     requires.
       Over time, more and more workers would be subject to the 
     tax since health care costs continue to rise at a faster rate 
     than inflation.
       Educators are already struggling to make ends meet--they 
     cannot afford to pay even more for health care. Please VOTE 
     YES on the Middle Class Health Benefits Tax Repeal Act (H.R. 
     748).
           Sincerely,

                                                    Marc Egan,

                                 Director of Government Relations,
     National Education Association.
                                  ____



                                          United Steelworkers,

                                    Pittsburgh, PA, July 16, 2019.
     Re United Steelworkers support H.R. 748, the Middle Class 
         Health Benefits Repeal Act of 2019.

     House of Representatives,
     Washington, DC.
       Dear Representative: On behalf of the 850,000 members of 
     the United Steelworkers (USW), I urge you to support the 
     Middle Class Health Benefits Repeal Act of 2019 (H.R. 748).
       With more than half of Americans covered under employer-
     sponsored healthcare, the so-called ``Cadillac Tax'' could 
     affect the healthcare costs of more than 181 million 
     Americans across the country. By allowing this excise tax to 
     go into effect, hardworking middle-class families with 
     employer-sponsored healthcare plans could face reduced 
     benefits and increased out-of-pocket costs as employers push 
     to restructure and renegotiate workers' hard-earned 
     healthcare benefits.
       The bipartisan Middle Class Health Benefits Repeal Act of 
     2019 (H.R. 748) would repeal the 40 percent excise tax on the 
     value of employer-sponsored health plans, ensuring that 
     workers and their families retain access to the care they 
     need. Although the tax has been delayed multiple times since 
     its inception, its looming nature impacts the bargaining of 
     multi-year contracts between USW members and employers. The 
     USW is currently negotiating contracts including healthcare 
     plans that will be subject to the tax without congressional 
     action, and workers are facing the potential costs at a time 
     when out-of-pocket healthcare expenses are already rising.
       Despite hefty increases in premiums, deductibles and co-
     pays, workers are not experiencing equivalent increases in 
     their wages. According to the Kaiser Family Foundation's 2018 
     Employer Health Benefits Survey, workers' healthcare costs 
     are increasing faster than both inflation and wages. Since 
     2008, deductibles on workers' plans have increased 212 
     percent and family premiums have risen 55 percent. Further 
     taxing workers' healthcare benefits will only add to the 
     burden of these increased healthcare costs, not reduce them.
       It is time for Congress to permanently repeal the misguided 
     excise tax on employer-sponsored health plans. The USW urges 
     you to support the Middle Class Health Benefits Repeals Act 
     of 2019 (H.R. 748) and pass this important legislation.
           Sincerely,
                                                 Thomas M. Conway,
                                          International President.

  Mr. HORSFORD. Madam Speaker, I urge all of my colleagues today to 
stand with America's working men and women and support the Middle Class 
Health Benefits Tax Repeal Act and vote in favor of abolishing this 
tax.
  Ms. DelBENE. Madam Speaker, I yield 1 minute to the gentleman from 
Ohio (Mr. Ryan).
  Mr. RYAN. Madam Speaker, I want to thank the gentlewoman for 
yielding.
  Madam Speaker, it is always a pleasure to be able to come to this 
floor and join in agreement with the gentleman from Pennsylvania. It 
does not happen very often, but I am glad we can be here.
  This is about the working class. I represent a district in northeast 
Ohio that has high union membership. As the gentleman from Pennsylvania 
stated a few minutes ago, there are a lot of

[[Page H5972]]

contract negotiations. They are always happening. And more often than 
not, over the last 20 or 30 years, the men and women of labor have been 
forced to negotiate contracts where they didn't get an increase, maybe 
a 1 percent, 1\1/2\ percent increase, but they were always able to 
sustain their healthcare. So this is a very important piece of 
legislation, one I know we have been working on.
  I want to thank the gentlewoman from Washington State. I want to 
thank Chairman Neal from the Ways and Means Committee. This has been a 
long time coming. I hope we can fix this, and I hope it is the first 
step to us building out a better healthcare system that is more 
affordable, more accessible, more innovative, and more focused on 
prevention as we move down road in the next several months.
  Mr. KELLY of Pennsylvania. Madam Speaker, I yield myself the balance 
of my time.
  I want to thank my colleagues on the other side.
  There is an old saying in life that sometimes you get a second chance 
to do the right thing. Eight years ago when the Affordable Care Act was 
passed, I am sure it was an oversight or an undersight or just not 
actually understanding what was taking place that day, my colleagues on 
the other side at that point were looking to pass the Affordable Care 
Act, and one of the victims in that was employer-sponsored insurance.
  We referred to it today as the ``Cadillac tax,'' and I am glad we 
used that term, quite frankly. I told you earlier I am a Cadillac 
dealer, so I am really happy to hear it. Any time anybody thinks 
something is outstanding, they call it a Cadillac.
  But what we are going to do today has nothing to do with fancy cars. 
It has nothing to do with extravagant health plans, but it does have 
everything to do with punishing hardworking Americans and their 
families. What we are doing today is a crucial step toward protecting 
employer-sponsored health insurance for all Americans.
  Again, as I said earlier, we are doing the right things for the right 
reasons for the right people, not just Republicans, not just Democrats, 
but every single American out there who gets his or her health 
insurance through their employer.
  It is a remarkable thing to see happen here on the people's floor, 
the people's House, where we come together and agree that we can fix a 
wrong, we can right a wrong, we can make things right that we maybe had 
a different look at 8 years ago but we decided today that it just 
really makes sense to do that.
  I want to give a special thank-you, though, to my good friends   Tom 
Reed and Josh Gottheimer for forming the Problem Solvers Caucus. In the 
rules package this year, they were able to bring up a rule that says if 
you get 290 sponsors or cosponsors on a piece of legislation, that 
needs to come forward.
    Joe Courtney has worked on this for many years, and we have already 
talked about the number of people who were already on board and ready 
to see this come forward, but it just couldn't get through the 
procedures to get to the floor. And I think when I go back home, people 
would say to me, if you have so many people that agree on the same 
thing and are doing the right thing for the right reasons, why can't 
you get it done? And then you have to say: Well, you know what? Not 
only do you not understand it, I don't either.

                              {time}  1700

  If we are acting in the best interests of the people we represent, 
then we should be able to do these things. So sometimes you take a look 
at what is holding you back from doing the right thing and you say 
there is something in the rules that needs to change, and that has 
taken place today.
  But the really great part of it is--the really great part, is that 
Republicans and Democrats are coming together in the peoples' House and 
doing the right thing, ensuring, at least from our part of the 
Congress, that we can repeal this onerous tax on hardworking Americans.
  So I am so glad to be here today and I am so thankful. Working with   
Joe Courtney has been absolutely marvelous. The gentleman has really 
had staying power. He has never given up on this. He has stayed on it 
and stayed on it and stayed on it. There is an old saying: Play through 
the whistle.
  I have got to tell you, Madam Speaker, in this case,   Joe Courtney 
played through the echo of the whistle. He never gave up.
  So to be here with my colleagues today and coming to a conclusion 
that this is the right thing for us to do is really good.
  Madam Speaker, I want to thank my friends that came here and spoke 
today on behalf of our side of the aisle for supporting this.
  We have had an opportunity this afternoon to do something, to do 
something not for ourselves, but for the people who sent us here to 
represent them.
  Madam Speaker, having said that, I would urge all of my colleagues to 
vote in support of this piece of legislation and pass it and send it on 
to the Senate, where we would hope they would understand that at this 
end of the Capitol, there is overwhelming support for hardworking 
Americans and their healthcare.
  Madam Speaker, I yield back the balance of my time.
  Ms. DelBENE. Madam Speaker, I strongly support H.R. 748, the Middle 
Class Health Benefits Tax Repeal Act of 2019.
  This legislation has been a bipartisan goal since I came to Congress 
in 2012, the permanent repeal of the Cadillac tax. The original design 
of the Cadillac tax was meant to be a narrowly targeted tax on the most 
extravagant plans.
  Instead, the tax will hit working families for a variety of factors 
far beyond their control. That includes age, geography, and occupation.
  A recent analysis from the Kaiser Family Foundation found that the 
Cadillac tax will impact over 20 percent of employers when the tax goes 
into effect in 2022. When flexible spending account contributions are 
included, that number jumps to over 30 percent and would affect just 
under half of all workers by 2030.
  While the intended goal of the Cadillac tax was to put downward 
pressure on plan costs, the mechanics of the tax will simply put more 
costs onto working families in the form of higher deductibles and 
greater cost-sharing so employers can avoid the tax.
  Madam Speaker, I remind my colleagues that healthcare costs are a top 
concern of the American people, and today we can take a meaningful step 
to address that concern.
  Madam Speaker, I urge all Members to vote ``yes'' on this 
legislation, and I yield back the balance of my time.
  Mr. LYNCH. Madam Speaker, I rise in strong support of H.R. 748, the 
Middle-Class Health Benefits Tax Repeal Act. This important, bi-
partisan legislation will finally repeal, once and for all, the excise 
tax on employer and labor union sponsored health plans, also known as 
the ``Cadillac Plan Tax.'' This fix is long overdue.
  This egregious tax, if allowed to take effect, would have hit the 
health insurance that 181 million working Americans and many union 
members and their families rely on. It would have likely resulted in 
increased costs, and ultimately lesser access to health care, thereby 
defeating the purpose for passing the A.C.A. in the first place.
  This was one of the reasons why I voted against the final compromise 
version of the A.C.A. in 2010: because while the Cadillac Tax was not 
in the House-passed bill, the Senate added it into the legislation that 
came back to the House. I believed then, and still do now, that 
imposing a 40 percent tax on health insurance for union workers would 
hurt hard-working American families--the very people who sent us here 
to make their lives better.
  Madam Speaker, before coming to Congress and before becoming a labor 
rights lawyer, I was an ironworker for 18 years. I worked side-by-side 
with men and women in the building trades who wanted nothing more than 
to work hard and be able to take care of their families. When I was 
President of my local union, I was acutely aware of the importance of 
the benefits, such as health care, that we would negotiate on behalf of 
our members. It is important to remember that generations of union 
workers have stood on the picket line or taken less pay in their 
paycheck in order to get better health care coverage. The Cadillac Tax 
included in the A.C.A. actually sought to punish those workers for 
standing up for their families. Imposing this tax would have broken the 
good-faith promises made to these hard-working Americans.
  I am not alone in recognizing the serious harms of the proposed 
excise tax, because

[[Page H5973]]

members of Congress from both sides of the aisle came together to delay 
this tax again and again, moving its effective date from 2018 to 2022. 
In addition, today's legislation, H.R. 748, has an astounding 369 
cosponsors. I think that must be some kind of record. That kind of 
bipartisanship has sadly become rarer these days, but this level of 
agreement only goes to show that passing this bill is the right thing 
to do.
  Madam Speaker, this fix for the A.C.A. has been long-needed and I am 
pleased that we are finally taking this important step to protecting 
health care for hundreds of thousands of hard working, middle-class 
Americans. I urge my colleagues to support this common-sense bill.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Massachusetts (Mr. Neal) that the House suspend the 
rules and pass the bill, H.R. 748, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. KELLY of Pennsylvania. Madam Speaker, on that I demand the yeas 
and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

                          ____________________