MARKETING AND OUTREACH RESTORATION TO EMPOWER HEALTH EDUCATION ACT OF 2019; Congressional Record Vol. 165, No. 82
(House of Representatives - May 16, 2019)

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[Pages H3853-H3876]
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 MARKETING AND OUTREACH RESTORATION TO EMPOWER HEALTH EDUCATION ACT OF 
                                  2019


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and add extraneous material on H.R. 987, the Strengthening Health Care 
and Lowering Prescription Drug Costs Act.
  The SPEAKER pro tempore (Mr. Trone). Is there objection to the 
request of the gentleman from New Jersey?
  There was no objection.
  The SPEAKER pro tempore. Pursuant to House Resolution 377 and rule 
XVIII, the Chair declares the House in the Committee of the Whole House 
on the state of the Union for the consideration of the bill, H.R. 987.
  The Chair appoints the gentleman from Rhode Island (Mr. Langevin) to 
preside over the Committee of the Whole.

                              {time}  1229


                     In the Committee of the Whole

  Accordingly, the House resolved itself into the Committee of the 
Whole House on the state of the Union for the consideration of the bill 
(H.R. 987) to amend the Patient Protection and Affordable Care Act to 
provide for Federal Exchange outreach and educational activities, with 
Mr. Langevin in the chair.
  The Clerk read the title of the bill.

[[Page H3854]]

  The CHAIR. Pursuant to the rule, the bill is considered read the 
first time.
  General debate shall not exceed 90 minutes, with 60 minutes equally 
divided and controlled by the chair and ranking minority member of the 
Committee on Energy and Commerce, and 30 minutes equally divided and 
controlled by the chair and ranking minority member of the Committee on 
Education and Labor.
  The gentleman from New Jersey (Mr. Pallone) and the gentleman from 
Oregon (Mr. Walden) each will control 30 minutes, and the gentleman 
from Virginia (Mr. Scott) and the gentlewoman from North Carolina (Ms. 
Foxx) each will control 15 minutes.
  The Chair recognizes the gentleman from New Jersey.
  Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, I rise to speak in favor of H.R. 987, the Strengthening 
Health Care and Lowering Prescription Drug Costs Act. This legislation, 
Mr. Chairman, is a big step in our commitment to delivering on our 
promise to make healthcare and prescription drugs more affordable.
  It brings together seven bills that passed out of the Energy and 
Commerce Committee last month. Taken together, these bills will 
strengthen our Nation's healthcare system, reverse the Trump 
administration's sabotage of the Affordable Care Act, and help lower 
the costs of healthcare and prescription drugs.
  The first title of this bill contains three bipartisan measures 
intended to address high prescription drug costs by promoting greater 
competition in our pharmaceutical marketplace. One of the most 
effective ways to bring down the cost of prescription drugs is to 
ensure that generics can come to market as soon as possible.
  The first proposal would address so-called exclusively parking, a 
practice where a first-time generic is blocking the approval of other 
generics from entering the market.
  The second proposal prohibits the use of pay-for-delay agreements 
between brand and generic drug manufacturers that delay generic entry 
into the market.
  And finally, the third drug pricing measure would address situations 
where some brand drug companies are delaying or impeding generic entry 
by denying generic drug manufacturers access to samples or to single, 
shared system REMS.
  By eliminating these three barriers, we will prevent some 
manufacturers from manipulating the system to extend their monopolies 
at the expense of consumers, and this will make prescription drugs more 
affordable for all Americans.
  Now, the second title of this bill, Mr. Chairman, will help lower 
Americans' healthcare costs, protect people living with preexisting 
conditions, and reverse some of the most harmful actions the Trump 
administration has carried out to sabotage the Affordable Care Act.
  Two of the proposals will restore funding for the navigator program 
and outreach and enrollment efforts that help provide consumers with 
the support and information that they need to make the right healthcare 
decisions for their families. Restoring this funding is critical, 
considering that the Trump administration gutted funding for consumer 
outreach and marketing by 90 percent. It cut navigator funding by 80 
percent, leaving huge swaths of the country without access to fair and 
unbiased enrollment help.
  H.R. 987 will also provide States with funding to establish their own 
State-based marketplaces, which will help make healthcare more 
affordable. In 2018, premiums in these State marketplaces were 17 
percent lower than in the federally facilitated marketplace, and 
enrollment was higher for the State plans.
  And, finally, Mr. Chairman, H.R. 987 will reverse the Trump 
administration's regulation to expand junk insurance plans, known as 
short-term limited duration health insurance. The Trump administration 
expanded these junk plans from the current 3-month term and made these 
plans available for up to 3 years.
  These junk plans are exactly that, Mr. Chairman: They are junk. They 
discriminate against people with preexisting conditions. They set 
higher premiums for people based on age, gender, and health status. 
They deny access to basic benefits like prescription drugs, maternity 
care, and mental health and substance abuse treatment, and they set 
arbitrary dollar limits for healthcare services leading to huge 
surprise bills for consumers. This legislation would prevent the 
administration's expansion of these plans from taking place.
  In closing, Mr. Chairman, I believe this is an important bill that 
will lower healthcare and prescription drug costs, protect people with 
preexisting conditions, and end some of the administration's ongoing 
sabotage of our Nation's healthcare system.
  Mr. Chairman, I urge my colleagues to support this bill, and I 
reserve the balance of my time.
  Mr. WALDEN. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, The Washington Post said it best. Allow me to quote 
this headline from yesterday: ``Democrats Are Putting a Political 
Pothole in the Way of Bipartisan Drug Pricing Bills.''
  It didn't have to be this way. Americans want us to come together, 
work together, solve problems. This is a big one. I hear about it every 
time I am home, and I have done more townhalls than anybody in this 
House--20 of them so far this year.
  Drug pricing is a big issue. We actually agreed. We worked it out. We 
passed these bills out of committee, unanimously. And then somewhere 
along the path to the House floor, they jammed our bipartisan efforts 
to lower drug costs with clearly partisan bills. The chairman didn't 
mention those bills came out of committee on a partisan vote.
  To bail out ObamaCare, Democrats are once again putting politics and 
partisanship over what could have been bipartisan public policy.
  Republicans and Democrats have been working together on bipartisan 
legislation to bring generic drugs to market faster by incentivizing 
more competition and ensuring patients get the earliest possible access 
to more affordable prescription drugs.
  We agree on that, just as we did in the last Congress when I was 
chairman. We led the effort to revamp every part of the FDA and how 
they can get drugs to market sooner.
  As a result of our work there and in our bipartisan work before that 
on 21st Century Cures, we really ramped up the ability of the FDA to 
get competition and new drugs into the market. They set a record last 
year in getting generics to market as a result of our bipartisan work. 
We could have had that, today, on this floor.
  The first measure that we do agree upon would ensure branded drug 
makers do not withhold samples that are needed to get generic drugs 
approved; the second would ban pay-for-delay agreements; and the third 
would limit first-approved generic makers' ability to stall another 
rival's launch. So we put a stop to what I would say are bad behaviors 
in that process.

  Together, these bills would help patients actually get access to more 
affordable prescription drugs, and those bills are bipartisan. Just how 
bipartisan? Two of the bills passed the Energy and Commerce Committee 
by voice vote, and the third passed unanimously on a 51-0 vote.
  Now, Mr. Chair, this is how the American people expect us to get our 
work done, but, sadly, House Democrats once again could not pass up a 
chance to play gotcha politics. So what did they do? They packaged 
these agreed-to bipartisan drug pricing proposals with a bailout of 
ObamaCare that passed out of committee on a purely partisan vote.
  Now here is what that bill contains:
  First, $200 million a year in taxpayer funding for States to 
establish ObamaCare marketplaces. This funding expired 5 years ago, 
albeit not before hundreds of millions of Federal taxpayer resources 
were wasted, including in my own State that finally had to give up on 
that and go with a national plan.
  New Jersey has recently expressed an interest in creating a new State 
exchange, and they say they can do it without new Federal taxpayer 
money; they can do it without us. If a State decides to create an 
exchange, then they shall be allowed to do so, but we don't need to 
create new Federal grants for things that States say they have the 
capacity to do themselves.

[[Page H3855]]

  Second, $100 million a year--$100 million a year--to fund the 
navigator program. Now, for plan year 2017, navigators received a total 
of $62.5 million in grants, and they enrolled 81,426 individuals. That 
means it cost $767 per person that they enrolled, and that accounted 
for less than 1 percent of the total enrollees.
  Now, it is important to understand, by contrast, agents and brokers 
assisted 42 percent of those in the enrollment year of 2018. Do you 
know what it cost for them to do it? $2.40. Yet, under this law, you 
can't use the funds for the navigators to actually pay for those folks, 
the brokers and agents, to do this work that they do very efficiently. 
$767 per enrollee versus $2.40.
  Third, the bill reverses the administration's efforts to allow more 
State-regulated insurance plan options for consumers who, frankly, are 
getting priced out of the market and are looking for choices that fit 
them and their lives.
  I want to set the record straight on these plans.
  The plans you heard described earlier were actually legal under 
ObamaCare and the Obama administration, and they are legal under the 
Trump administration. They provide choices to people in between jobs or 
people who can't afford these exploding premiums.
  You know, the promise that your premium is going to go down 2,500 
bucks kind of evaporated as soon as the bill became law, so people are 
stuck with ever-increasing premiums, enormous deductibles, and saying: 
Could we please allow our States to put together options for us that 
still have to go through a State insurance regulator? And they 
certainly care about their systems.
  CBO projected premiums for these plans could be as much as 60 percent 
lower than the cheapest Federal mandated plan, 60 percent, and, even 
more, States can regulate these plans. In fact, in the chairman's home 
State of New Jersey, they are simply banned. That is New Jersey's 
choice. They should have that choice.
  In my home State of Oregon, they are limited to 90 days. That is what 
we have chosen. This is kind of federalism at its best.
  But in their Washington-knows-best mentality, the bills brought 
before us today strip away this option for longer term plans, and that 
is wrong and it is unfair.
  Fourth, the bill spends $100,000,000 a year to market the Federal 
plans. They couldn't stop there. Instead of educating patients on all 
the plans' options available to them, their legislation actually places 
a gag order on the promotion of more affordable choices, specifically 
association health plans, known as AHPs, and the short-term limited 
duration insurance plans. You can't even tell consumers about that. Oh, 
no. We are going to have a gag order from Washington.
  So there is simply no reason to combine these bills with our 
bipartisan, I would say unanimously approved, bills to deal with drugs.
  Energy and Commerce Republicans put forth an alternative bill that 
includes all of H.R. 987's bipartisan drug provisions I referenced 
earlier but removes the partisan, the strictly gotcha provisions.
  Our pragmatic plan replaces these partisan provisions with language 
extending funding for community health centers, the National Health 
Service Corps, and other public health extenders for a year. Now, these 
public health extenders should be a top bipartisan priority for the 
Congress, as they must be done before the end of the fiscal year, the 
end of September, and they deserve the attention of Congress.
  Let me go back to the navigators for a minute. The Wall Street 
Journal reported: ``One grantee took in $200,000 to enroll a grand 
total of one person.'' They went on to write: ``The top 10 most 
expensive navigators collected $2.77 million to sign up 314 people.''
  If you take that $2.77 million that they want to give to these 
navigators--they are the most expensive operators on the planet--to 
sign people up for insurance and gave that to our community health 
centers, do you know how many people they could cover with $2.77 
million? One estimate is 20,000 patients--20,000 patients.
  So Republicans are saying let's take that money and actually get it 
out to help patients through our community health centers rather than 
spend it on navigators that can take $200,000 and enroll one person, or 
$767, on average, versus $2.40 when agents and brokers do this 
enrollment.
  We think we have a better way. Our bill, H.R. 2700, is called the 
Lowering Prescription Drug Costs and Extending Community Health Centers 
and Other Public Health Priorities Act. It is pretty straightforward. 
It is an honest title.

  We should take this bill up now, Mr. Chairman, because the majority, 
unfortunately, has decided to put politics before us today with our 
bipartisan efforts to lower drug costs.
  The bill before us right now is going nowhere in the Senate. They 
have said that. The White House has weighed in, so they don't like it 
either.
  We should take up the alternative to move our bipartisan work forward 
and take care of our responsibilities to ensure our community health 
centers and other public health priorities are funded. That has always 
been a bipartisan effort.
  Finally, just to further the point on the blatant and unnecessary 
partisanship on display here today, House Democrats made 26 amendments 
in order on this bill--26. One of those amendments, just one, was 
authored by a Republican.
  Now, they control everything around here, and they said in the 
opening days they are going to open up this process. Ninety-two percent 
of the amendments allowed to be brought to the floor so far this year 
have been from Democrats. When we were in charge, 45 percent--45 
percent--were the minority's amendments that came to the floor.
  So, so much for openness. Just one was authored by a Republican. So 
it is unfortunate we find ourselves here today. It didn't have to be 
this way.

                              {time}  1245

  These are measures, especially on the drug side, we are already all 
in agreement on. If they were separated out, you would have passage. It 
would go right to the President from the Senate. I think they would 
take them up and pass them to become law. So, when the majority is 
ready to make law, let us know.
  In the meantime, we have a better way to take care of our community 
health centers, our patients, and those seeking more choices and more 
affordable rates for an insurance product than what the Federal 
Government is mandating.
  Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from South Carolina (Mr. Clyburn), our distinguished whip.
  Mr. CLYBURN. Mr. Chairman, I thank the gentleman for yielding me the 
time.
  Mr. Chairman, today, I stand for the American people and the voters 
of South Carolina's Sixth Congressional District who spoke loud and 
clear last November, demanding that Congress defend and uphold the 
right to have access to affordable care.
  This is an effort to dismantle the Affordable Care Act, and we stand 
ready to defend every aspect of this legislation.
  We will not stop our efforts to hold this administration and my 
Republican colleagues accountable as they continue misrepresenting and 
undermining the Affordable Care Act.
  The work of this body, a coequal branch of our government, to conduct 
legitimate and lawful oversight in order to protect Americans' access 
to healthcare will not be deterred.
  Today, this House will vote on a package of seven bills that will 
halt the administration's sabotage of the Affordable Care Act, improve 
the act's implementation, and lower the cost of prescription drugs.
  This legislative package, titled the Strengthening Health Care and 
Lowering Prescription Drug Costs Act, prevents the substitution of junk 
policies that take advantage of unsuspecting citizens, and it protects 
against discrimination for preexisting conditions.
  The CHAIR. The time of the gentleman has expired.
  Mr. PALLONE. Mr. Chairman, I yield an additional 30 seconds to the 
gentleman from South Carolina.
  Mr. CLYBURN. Mr. Chairman, this legislation takes meaningful steps to 
control prescription drug costs by expanding access to generic drugs so 
patients don't have to choose between

[[Page H3856]]

lifesaving medications and other necessities, like rent or food.
  Mr. Chairman, Democrats are addressing crucial healthcare needs. We 
stand to protect the healthcare of American citizens.
  Mr. WALDEN. Mr. Chairman, I yield 2 minutes to the gentleman from 
Kentucky (Mr. Guthrie), a very accomplished member of our committee.
  Mr. GUTHRIE. Mr. Chairman, I rise today in opposition to H.R. 987, 
the supposed Strengthening Health Care and Lowering Prescription Drug 
Costs Act.
  I wish I wasn't giving this speech. As many of my colleagues know, I 
have a bipartisan track record here in the House. I have been proud to 
work with many of my Democrat colleagues on a number of issues that 
impact Kentuckians and people across the country, such as Alzheimer's, 
the opioid crisis, and workforce development.
  Last Congress, I had 10 bipartisan bills signed into law, and I had 
two additional bipartisan bills pass the House. I hope my colleagues on 
both sides of the aisle know that I take bipartisanship and our 
responsibility to get things done for our constituents very seriously. 
That is why I am extremely disappointed that I will have to vote 
against H.R. 987 today.
  Wherever I go in my district, I hear from Kentuckians about how drug 
prices are simply too high. This an issue that affects everyone, and it 
is one of the few big issues these days that Republicans and Democrats 
can all agree on. And President Trump has made this a priority.
  As ranking member of the Oversight and Investigations Subcommittee, I 
have launched, with Chair Diana DeGette from Colorado, an investigation 
on rising insulin prices.
  I was proud to support bipartisan legislation in the Health 
Subcommittee and the full Energy and Commerce Committee. Sadly, Mr. 
Chairman, Democrats have loaded up what was previously a bipartisan 
drug pricing legislative bill with political land mines that they know 
we, as Republicans, will never support.
  They made a bipartisan drug pricing bill into an ObamaCare bailout 
bill. They know that this bill is dead on arrival in the Senate and 
that President Trump will never sign it.
  My colleagues are playing games to score cheap political points in 
the short term at the expense of Americans across the country who are 
paying too much at the pharmacy counter.
  I urge my colleagues on the Democratic side not to make lowering drug 
prices another partisan fight. I am willing to work with any of my 
colleagues to fix this problem, and I urge all my colleagues to do the 
same.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Illinois (Mr. Rush), the sponsor of the pay-for-delay legislation.
  Mr. RUSH. Mr. Chairman, I thank the full committee chairman for 
giving me this time.
  Mr. Chairman, I am proud, on behalf of the people of the First 
District of Illinois, to rise today in support of H.R. 987, which 
includes my legislation, the Protecting Consumer Access to Generic 
Drugs Act.
  My legislation included in today's package prohibits the practice of 
pay-for-delay where brand-name companies compensate generics to prevent 
the entry of cheaper drugs into the market.
  I have long stood against these anticompetitive deals that limit 
competition and force consumers to pay more for their medications.
  This disgraceful and deceptive practice ends now. I stand with my 
colleagues to stop drug companies from continuing to rig the system in 
an attempt to take advantage of hardworking Americans.
  My legislation will take a meaningful step toward bringing this 
behavior to a screeching halt and holding drug companies accountable 
once and for all.
  With today's package of prescription drug bills, we are making 
progress toward addressing the skyrocketing cost of prescription drugs 
and are making good on our promise that no American should be forced to 
make the choice between paying their bills and buying their pills.
  Mr. WALDEN. Mr. Chairman, I yield 4 minutes to the gentleman from 
Texas (Mr. Burgess), our top Republican on the Health Subcommittee, a 
former chairman of the subcommittee, and a distinguished member of the 
Rules Committee.
  Mr. BURGESS. Mr. Chairman, I thank the gentleman for yielding, and I 
do rise today to speak in opposition to H.R. 987.
  Mr. Chairman, I am concerned that the Democrats are using bipartisan 
drug pricing bills to pay for partisan politics.
  Look, these bills are proof that we can work together across the 
aisle and do what is best for constituents. Unfortunately, as The 
Washington Post so eloquently said yesterday in ``The Health 202,'' 
``Democrats are putting a political pothole in the way of bipartisan 
drug pricing bills.''
  The Democrats have decided to use $5 billion in savings to fund 
State-based ACA marketplaces, the federally facilitated marketplace 
navigator program.
  This morning, a publication called STAT published an article titled, 
``In Washington, a partisan approach to lowering drug costs leaves 
Democrats doubting their own party leadership.''
  As this article reported, even House Democrats do not understand why 
the Speaker of the House and party leadership have decided to 
politicize bipartisan bills that enjoy widespread support.
  The chairwoman of the Energy and Commerce Health Subcommittee is on 
record as saying she was ``not a fan of what happened.''
  Republicans stand ready to work on solutions. Congressman Mark 
Meadows, the chairman of the Freedom Caucus, told STAT that the 
Democrats' political stunt is a wasted political opportunity.
  He continued, ``You have got the chairman of the Freedom Caucus 
willing to work with Democrats on making real, structural reforms on 
prescription drug prices. And what do they do? They put a poison pill 
in, trying to augment a failing healthcare-delivery system.''
  I ask my friends on the other side of the dais, why are you intent on 
tanking good legislation that can deliver real results for real people? 
You say you want to lower drug prices, but your actions speak loudly 
otherwise.
  Fortunately, I am not just here to complain. I also have a solution 
to the scenario we are facing on the floor today.
  On Tuesday night at the Rules Committee, I offered an amendment that 
would take these three drug policies and the $5 billion in savings from 
those policies, and I introduced H.R. 2700, the Lowering Prescription 
Drug Costs and Extending Community Health Centers and Other Public 
Health Priorities Act.
  H.R. 2700 couples the bipartisan drug pricing policies with 
reauthorization programs, such as Community Health Centers and Special 
Diabetes Programs.
  Look, reauthorizations are tough. I know. I was chairman of the 
Health Subcommittee in the last Congress. September seems like a long 
way away. Many of these programs expire at the end of the fiscal year, 
but the time to get these things done is now.
  We have taken no specific action toward reauthorization of these 
programs. Again, September seems far away, but we have to account for 
the time it takes to move through regular order.
  On the other issues that we are facing today, the short-term, limited 
duration rule repeal, according to the Congressional Budget Office and 
the Joint Committee on Taxation, the policy to repeal the Trump 
administration's short-term, limited duration insurance rule would 
result in 500,000 individuals becoming uninsured.
  Is this what you want? Isn't it better that people have some form of 
insurance than none at all?
  I take meetings in my office back home in my district with families 
that cannot afford the high premium, high deductible plans that they 
have been forced to buy off the ACA exchange. These individuals need 
lower cost options, and that is exactly what these limited duration 
plans provide.
  States already regulate these plans and have the authority to 
disallow them at the State level, if they so choose. This is a case for 
federalism.
  I want to quote from the Congressional Budget Office report: ``CBO 
and JCT estimate that enacting the legislation would result in roughly 
1.5 million fewer people'' participating in insurance plans.
  The CHAIR. The time of the gentleman has expired.

[[Page H3857]]

  

  Mr. WALDEN. Mr. Chairman, I yield the gentleman from Texas an 
additional 30 seconds.
  Mr. BURGESS. Mr. Chairman, I thank the gentleman.
  Of those, more than 500,000 would instead participate in nongroup 
coverage through the marketplaces established by the Affordable Care 
Act, and 500,000 would become uninsured.
  The drug policies contained in both H.R. 987 and my bill, H.R. 2700, 
are commonsense bipartisan measures to lower drug prices for our 
constituents. I am disappointed they have been rolled into a partisan 
package that will be dead on arrival in the Senate.
  We were able to work together in the committee and subcommittee to 
ensure these policies would improve access to generics for American 
patients. I hope the Democratic leadership would consider the 
bipartisan nature of the policies when moving the packages to the floor 
in the future.
  The CHAIR. Members are reminded to address their remarks to the 
Chair.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ to the gentlewoman from 
Illinois (Ms. Schakowsky), who chairs our Consumer Protection and 
Commerce Subcommittee.
  Ms. SCHAKOWSKY. Mr. Chairman, the real political grandstanding that 
we are hearing today is from the Republican side of the aisle, which 
for nearly 10 years has been fighting against the Affordable Care Act.
  Over 60 times, they voted against the Affordable Care Act. Maybe it 
is because some people call it ObamaCare. We know that millions and 
millions of people have gotten healthcare because of it.
  It is time to stop and to say let's work together to make the 
Affordable Care Act even better and extend access. The fact is that the 
Affordable Care Act and affordable prescription drugs are two pillars 
of healthcare access. They really cannot be separated.
  I am proud that we have an opportunity today to do what was 
impossible while the Republicans were in charge of the Congress. Today, 
we are voting on making impactful, lasting change in lowering the cost 
of healthcare, including prescription drugs, for Americans nationwide.
  Democrats are at the table and ready to pass this legislation.

                              {time}  1300

  We are ready to improve all aspects of healthcare from healthcare 
affordability, to prescription drug affordability. Instead of offering 
amendments in bad faith, we need to pass this bill.
  Mr. Chair, I urge all of my colleagues to reject the amendment by Mr. 
Bucshon and support the passage of H.R. 987 in its entirety.
  Mr. WALDEN. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chair, before I recognize our pharmacist, Mr. Carter from 
Georgia, I just want to say I have been on the floor a lot in the last 
few weeks on this issue, and we keep getting the same refrain about 
Republicans voting 60 times to repeal ObamaCare.
  What is never said is that 30 of those bills, my friends on the other 
side of the aisle voted for, and President Obama signed them into law--
I'm sorry. Twenty-one of those bills were signed into law by President 
Obama. So it is 21 of the 30 were signed into law by President Obama.
  So my point being is, ObamaCare had problems. We came together and 
tried to address those problems with this legislation, repealing the 
unsustainable CLASS Act, the co-ops, the Cadillac and medical device 
taxes we voted to delay, the Independent Payment Advisory Board, and on 
and on. My friends on the other side of the aisle voted with us and we 
with them to fix those sorts of things. So don't come down here and 
tell me it is only Republicans who voted to do things on ObamaCare.
  We also support these drug bills. There is no question about that, 
because we want to get lower-cost drugs and stop bad behaviors that 
prevent generics from coming to market sooner.
  Mr. Chair, I yield 3 minutes to the gentleman from Georgia (Mr. 
Carter), a pharmacist.
  Mr. CARTER of Georgia. Mr. Chair, I thank the gentleman for yielding.
  Mr. Chair, I come before you today a very disappointed person; a 
disappointed Member of Congress; a disappointed pharmacist. I am 
disappointed that my Democratic colleagues have decided to prioritize 
politics over patients by packaging together bipartisan bills to lower 
drug costs with partisan bills to bail out ObamaCare. They are two 
completely different subjects.
  Republicans and Democrats have worked hard to create strong, 
bipartisan bills that will increase the amount of generic drugs 
entering the marketplace, bringing more affordable choices to patients. 
Now, House Democrats have chosen to use these bipartisan bills to pay 
for partisan ObamaCare bills.
  This bill includes major drug pricing proposals like the CREATES Act, 
and the pay for delay, which both seek to increase the ability of 
lower-cost generic drugs getting to the market quickly, providing 
patients with more affordable choices.
  We had long, hard-fought negotiations with our Democratic 
counterparts in multiple markups that ran until midnight over these two 
proposals, but we were eventually able to come to an agreement.
  The other drug-pricing bill in this package is a bill that I have 
worked on with my friend, Representative Schrader from Oregon, the 
BLOCKING Act. This bill mirrors the proposal from President Trump's 
budget proposal to keep bad actors from clogging up our generic drug 
pipeline.
  Hear me, Mr. Chair, and hear me clearly. This bill is the picture-
perfect definition of good bipartisan legislation. Democrats are 
throwing that work away by prioritizing politics over patients. All 
three of these bipartisan drug-pricing bills save money, so the 
Democrats are choosing to use their hard-fought savings and wish lists 
for partisan politics.
  The bill before us today will throw hundreds of millions of dollars 
at the failed ObamaCare marketplace and further restrict patient 
choice. The bottom line is, there is no need for this course. Drug 
pricing should not be a partisan issue.
  In all of my years of being a pharmacist, I have seen patients 
struggle with the high cost of prescription drugs. Now that I am in 
Congress, I hear about it all the time from my constituents back home. 
We all do.
  Voters across the country sent us up here to work together on issues, 
like drug pricing. The three drug-pricing bills in this package show 
that we can, in fact, do that. We can work together on important 
issues.
  When we work together, we can achieve real results that help 
patients. But once again, we are letting politics become the priority 
instead of helping people. Republicans want to work together on drug 
pricing. The people want us to work together on drug pricing.
  I call on my colleagues to do the right thing. Let's put patients 
before politics.
  Mr. Chair, this is important. Strike these partisan poison pills in 
this bill and send our excellent drug-pricing work over to the Senate 
and on to the President's desk and have him sign them into law.
  Mr. PALLONE. Mr. Chair, I yield 1 minute to the gentleman from 
Maryland (Mr. Hoyer), our distinguished majority leader.
  Mr. HOYER. Mr. Chair, if you put patients before politics, you will 
vote for this bill because patients care about prescription drugs, but 
they also care about access to affordable, quality healthcare.
  Now, you sent a bill to the President--or you didn't really send it 
to him because it didn't pass the Senate--and you went down to the 
White House and you exalted about the bill you had passed, and the 
President said: This is a good bill. Then he had the opportunity to, 
perhaps, have his advisers tell him what was in the bill, and 10 days 
later he said: This is a mean bill because it shortchanged patients for 
politics.
  Mr. Chair, last week the House passed H.R. 986, a bill to protect 
coverage for those with preexisting conditions, and the Republicans 
said: No, it doesn't do that. They wanted to change the name of the 
bill. Not only did they want to vote against it, they wanted to change 
the name of the bill. Why? Because they want to tell the public we

[[Page H3858]]

are for protecting you against preexisting conditions. We just don't 
vote that way.
  This week House Democrats are continuing to strengthen access to 
affordable healthcare by passing H.R. 987, an additional package of 
bills aimed at strengthening our healthcare system and lowering 
prescription drug costs because patients don't just worry about 
prescription drugs, they worry about their health coverage. As a matter 
of fact, it is hard to separate the two.
  This effort is critical because the Trump administration, in its 
campaign and from its very first day, and congressional Republicans, 
have been working tirelessly to sabotage healthcare access and 
undermine the reforms of the Affordable Care Act. They voted against it 
and, yes, they voted over, and over, and over again to repeal it.
  With all due respect to my friend, we didn't vote for those bills.
  Now, we may have voted for some bills to improve the Affordable Care 
Act, but we certainly didn't vote for any of your bills which had the 
effect of repealing ObamaCare, because we believe it is in the best 
interest of the American public, and so does the majority of the 
American public.
  Last year, 1.1 million Americans lost health coverage after years of 
gains in coverage. This shows us, dangerously, that the Trump 
administration's administrative sabotage is having its intended adverse 
effect, from limiting access to open enrollment, to allowing junk 
plans.
  Let me say something about junk plans because the gentleman says: 
Well, some people can't afford it. Yes, they get a plan and they think 
they have health coverage, and by the way, it doesn't cover something 
when they get really ill, or they have lifetime limits, or annual 
limits. They don't have this covered. They don't have the other 
covered.
  Not only that, but guess what happens to the insurance pool? It 
becomes riskier. And guess what happens then? The price goes up. You 
don't have to be a genius or know much about the insurance business to 
know that that is the case.
  From repealing votes in Congress, to anti-ACA lawsuits in the courts, 
Republicans have been trying to undermine the Affordable Care Act.
  From shortening enrollment periods, to cutting funding for outreach 
to let people know what is available to them and what is the best 
policy for them. Advice and counsel, they don't have to take any of it, 
but they ought to have that available to them.
  This sabotage is hurting access to affordable, quality healthcare 
coverage for the people. That is what we are here for. For the people. 
And that is what this legislation is for. For the people.
  The legislation before the House today would push back on these 
efforts that sabotage in several ways: first, we are banning junk plans 
that don't provide adequate coverage and raise premiums for 
comprehensive health plans.
  Next, we are taking action to bring generic drugs to market more 
quickly, helping to lower the cost of prescription drugs. I appreciate 
the fact that my Republican colleagues support those bills. I 
appreciate the gentleman who knows full well as a pharmacist the crisis 
that confronts people when they can't afford lifesaving and health-
enhancing prescription drugs.
  But they also are facing real problems on the availability of health 
insurance should they have to have health providers, whether they are 
doctors, or hospitals.
  Finally, H.R. 987 increases funding for outreach, enrollment, and 
navigators to help Americans find the right healthcare plan. That is 
for the people, to help the people understand, and to have access, and 
to be secure in knowing they have adequate healthcare for them and 
their families.
  It also provides States with additional funding to establish State-
based marketplaces. Innovation. Our legislation will provide insurers, 
providers, and patients alike with greater certainty that the 
Affordable Care Act will continue to make healthcare available and 
affordable to Americans with preexisting conditions.
  I am pleased that my Republican colleagues are supporting the 
prescription drug titles of this bill. Perhaps we will send it over to 
the Senate, and maybe that is all they will send back.
  But the fact of the matter is, we have a broader responsibility than 
just prescription drugs. Democrats are committed to bringing healthcare 
costs down and making sure more Americans can access quality, 
affordable coverage.
  Mr. Chair, I want to thank Representatives Cicilline, Rush, Schrader, 
Castor, Kim, and Blunt Rochester for their leadership in the component 
parts of this bill, which will make the security for healthcare better 
for the people. They have introduced the constituent parts of this 
bill.
  Of course, I want to thank my good friend, Frank Pallone. Nobody has 
worked harder for a longer period of time to enhance the healthcare of 
Americans. Nobody has worked harder in committee, both initially on the 
Affordable Care Act, of which he was a very significant part of the 
authorship, and since then in protecting it and trying to enhance it. 
This bill is important for us to pass to do just that.

  That is why I urge my colleagues on both sides of the aisle to join 
us in standing up for the Affordable Care Act and its benefits; not 
undermining the law and its reforms. Having agreement on prescription 
reforms, bringing prices down, and making generics more available is an 
important step. But it is not the only step that we need to take. This 
is not the final step. This is a step. It is an important step.
  I hope that Republicans and Democrats would support this bill 
overwhelmingly because, as I said, it is for the people.
  The CHAIR. Members are reminded to address their remarks to the 
Chair.
  Mr. WALDEN. Mr. Chair, I yield myself such time as I may consume.
  I want to make a couple of points before I introduce the author of 
the CREATES Act. The gentleman that just spoke, Mr. Hoyer, voted 21 
times, on 21 of the bills that were signed into law to repeal parts of 
ObamaCare. The gentleman voted for it because those parts were 
unworkable. So when you hear about 60 times, remember the leader, the 
distinguished leader, my friend, actually voted for 21 of those, as did 
I.
  When we talk about the people, let me read you a little statement 
from Tom from Medford who wrote me in October of last year. He said, 
``Greg, I just received a letter from the insurance company stating 
their monthly premium next year will go up nearly 40 percent, from $632 
to $883 per month, and that is with the plan more or less staying the 
same, but without any out-of-network healthcare.''

                              {time}  1315

  That is not affordable. That is why we think States should have 
options.
  When it comes to the navigators that they want to dump all this money 
into, remember agents and brokers in the private sector cost about 
$2.40 for them to sign somebody up. The navigators would cost, based on 
2017 numbers, $767 per enrollee. And for the $2.7 million that was 
spent to sign up 314 people, if you put that money--as Republicans want 
to do--into community health centers, one estimate is you could cover 
20,000 people with that $2.77 million.
  Mr. Chairman, I yield 2 minutes to the gentleman from Wisconsin (Mr. 
Sensenbrenner). My friend is the former chairman of the Judiciary 
Committee and the former chairman of the Science, Space, and Technology 
Committee, and a leader on this CREATES effort legislation on bringing 
drug prices down.
  Mr. SENSENBRENNER. Mr. Chairman, I rise in opposition to H.R. 987, 
the ObamaCare bailout act.
  One of the things that has frustrated me in the almost 5 months that 
the Democrats have controlled this Chamber is that anything that is 
good, bipartisan, and for the people they turn into a partisan 
screaming contest. That is exactly what they have done with the CREATES 
Act, which will bring down prescription drug prices and has strong 
bipartisan support in both Houses and, as a standalone bill, would have 
a very good chance of being signed into law.
  So we can talk today about all of these things about ObamaCare that 
the other side of the aisle wants to put more money into, but that is 
going nowhere. I think what we should do is look at what we can 
accomplish, and we can accomplish changing the way that drugs are 
priced through the CREATES Act.

[[Page H3859]]

  At a time when everything is a dramatic political battle, lowering 
prescription drug prices is one of the few opportunities where it 
seemed like Republicans and Democrats could get something meaningful 
done for the American people.
  Just a few weeks ago, the Judiciary and Energy and Commerce 
Committees worked across the aisle unanimously reporting out several 
bills to that end. My friend, the gentleman from Rhode Island (Mr. 
Cicilline), and I are sponsors of one of those bills, the CREATES Act. 
Our commonsense legislation would allow consumers to access cheaper 
generic drugs sooner, driving down costs and saving taxpayers money.
  According to CBO estimates, our bill would save the American taxpayer 
$3.9 billion over 10 years. This bill has the kind of bipartisan 
support to become law. However, instead of letting this body vote on 
our commonsense bill in standalone form, the Democratic leadership has 
tacked it on to this ObamaCare bill.
  The CHAIR. The time of the gentleman has expired.
  Mr. WALDEN. Mr. Chairman, I yield an additional 30 seconds to the 
gentleman from Wisconsin.
  Mr. SENSENBRENNER. The ObamaCare bailout package has no chance of 
passing in the Senate. The majority leader just admitted that. This is 
a missed opportunity, and it is highly disappointing.
  The American people want us to work in a bipartisan manner. The 
American people want us to accomplish things, and this is a poison pill 
that will make sure that this bill never sees the light of day in the 
Senate and will never become law.
  When they take up this bill, I hope they strip out all the ObamaCare 
bailout--free of poison pills--and pass the bipartisan drug pricing 
bills so the House will be able to reconsider them in a more bipartisan 
fashion.
  Mr. WALDEN. Mr. Chairman, I yield myself such time as I may consume 
to reinforce what the gentleman from Wisconsin said.
  This is from The Washington Post: ``The Health 202: Democrats Are 
Putting a Political Pothole in the Way of Bipartisan Drug Pricing 
Bills.''
  That is all you need to know. It didn't have to be this way. These 
bills came out of the committee individually. The Democratic leadership 
put them together knowing full well they could put a poison pill into a 
drug reform bill and delay consumers' ability to get more affordable 
drugs sooner, because this legislation could move through the Senate 
and down to the President much more quickly if it didn't have these 
provisions.
  Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1 minute to the gentlewoman from 
California (Ms. Matsui).
  Ms. MATSUI. Mr. Chairman, I rise today as a proud cosponsor of H.R. 
987, legislation that advances Democrats' commitment to rein in the 
soaring costs of healthcare for consumers.
  I am pleased that we are taking important steps forward to address an 
issue I hear from constituents almost daily: the rising cost of 
prescription medicines. Just recently, I heard from Mary, who is living 
with a lifelong chronic condition. The cost of her medication has 
skyrocketed in recent years to the point that it has forced her to 
cancel prescriptions and forgo treatment. This is really unacceptable.
  The bills before us today represent an opportunity to make progress 
by allowing lower cost generic drugs to come to market sooner. 
Furthermore, these efforts aim to make healthcare more affordable for 
patients with preexisting conditions by reversing the Trump 
administration's relentless and ongoing sabotage of the ACA.
  This is critical for people like Charis, a constituent in my district 
who fears that, without the ACA, she would have to hide her rare 
disease in order to get adequate medical care. No patient should have 
to live with such a worry.
  I am pleased to be able to support these patient protections on the 
floor today, and I remain committed to keeping the pressure on tackling 
prescription drug and insurance costs and working to defend Americans' 
rights to quality and affordable healthcare.
  Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Vermont (Mr. Welch).

  Mr. WELCH. Mr. Chairman, this legislation is going to help make 
healthcare more affordable and more accessible.
  There are two things:
  One, we finally are attacking the explosion in the cost of 
prescription drugs, and I thank my Republican colleagues for 
participating in that effort.
  In Vermont, we just had a 16 percent rate increase for requests from 
Blue Cross Blue Shield, and 9 percent of that is attributable to the 
increase in pharma costs. This is happening because pharma has been 
ripping us off for far too long.
  This bill does two things: One, it ends their abusive, outrageous 
practice of paying generic companies to delay bringing their lower cost 
drug to the market. There is no excuse for that. This bill ends it. The 
second thing it does is deny pharma the opportunity to withhold samples 
so that generic companies can come up with a competitive product. That 
is tremendous, it is overdue, and it is just the beginning.
  Second, this makes healthcare more accessible by funding navigators. 
My colleagues disregard that, but, in fact, navigators help people make 
the complicated decision about what is the best healthcare plan for 
them.
  It also provides money for outreach. We want folks to know what is 
available for them, make the best choice, and have the security of 
healthcare.
  Finally, there will be protection for the auto enrollment program. 
Everybody is busy. If the default position is you are back in the plan 
you had, that is good. There is security in that. People can make 
options to get out or to change their plan. We want them to shop. This 
makes healthcare affordable and more accessible.
  Mr. WALDEN. Mr. Chairman, I yield myself such time as I may consume 
to thank the gentleman from Vermont for not only his comments here on 
the floor, but his comments publicly about what we agree with, which is 
these issues should have remained separate and not lumped together.
  Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from Florida (Ms. Castor).
  Ms. CASTOR of Florida. Mr. Chairman, Democrats are doing everything 
that we can to lower the cost of healthcare and prescription drugs, so 
I strongly support the act that is on the floor today. It contains two 
bills that I authored.
  First is H.R. 1010, which prohibits the expansion of these junk 
insurance plans. Junk insurance plans are the ones that do not cover 
preexisting conditions. You can often be tricked into buying one of 
these plans and find out it doesn't even cover the trip to the 
hospital.
  In fact, I asked Secretary Azar, in committee, about this. I asked 
him: You are aware that these junk plans do not cover preexisting 
conditions?
  He said: That is correct.
  The bill also contains another section that I authored, the ENROLL 
Act, to restore funds to our independent navigators who are helping 
American families choose the right health insurance options for them. 
Agents and brokers are important, but they are no substitute for 
independent navigators who are trusted in the community.
  We have got to pass these bills today to lower healthcare costs for 
families all across the country and lower prescription drug costs. I am 
very proud to have authored two portions of this.
  Let's not let them expand these junk plans and leave you on the hook. 
Let's make sure that families have the independent advice that they 
need to choose what makes the most sense for them.
  Mr. WALDEN. Mr. Chairman, I will say that the State of Florida 
actually allows State-regulated plans to go up to 364 days to give 
Floridians an opportunity to have choice. When it comes to association 
health plans that allow small businesses like I used to own to get 
together and offer more affordable health insurance, they put a gag 
order on so that you can't tell America's patients they might have that 
option.
  So, Mr. Chairman, I don't know that I would fully trust all these 
navigators. According to The Wall Street Journal, one grantee took in 
$200,000 of your tax dollars and enrolled one person. The

[[Page H3860]]

top 10 most expensive navigators collected $2.77 million to sign up 314 
people. If you put that $2.77 million into our community health 
centers, as the Republicans would prefer, to spend that money, then you 
would cover 20,000 patients, according to one estimate.
  Mr. Chairman, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Oregon (Mr. Schrader), who is the sponsor of the BLOCKING Act, one 
of the generic competition bills.
  Mr. SCHRADER. Mr. Chairman, I rise today in favor of the package of 
bills before us that includes efforts to stabilize the marketplace and 
address drug prices, a win-win for America. I am particularly proud to 
rise in support of one bill in the package, my bill, cosponsored with 
my good friend from Georgia, Buddy Carter, H.R. 938, the BLOCKING Act.
  As we are all too well aware, the rising cost of drug prices is 
deeply impacting every American. At the same time, addressing this 
issue does not have one big silver bullet solution. The BLOCKING Act is 
one of many that will address this larger problem. It takes action to 
ensure that generic drugs reach the market as quickly as possible.
  Generic drugs save patients tens of billions of dollars every year. 
The more competition we have in the generic space, the more savings we 
see. It is with that knowledge that we provide generic manufacturers 
that incentive of 180 days of exclusivity.
  Unfortunately, in the current system, some generic manufacturers 
delay bringing their drugs to market by parking their applications, 
once being awarded the exclusivity, and not actually bringing their 
drug to market. Doing so does not allow others to come to the market 
and extends their hold, to the disadvantage of the American consumer.
  That being said, a solution is quite simple. We need to prevent 
loopholes that decrease competition and inadvertently keep drug prices 
high.
  I remain committed to working to lower drug prices and urge others to 
support passage of this package of bills that will assist in addressing 
this critical issue for America.
  Mr. WALDEN. Mr. Chairman, my friend from Oregon is right on the drug 
pieces, and like other Democrats I know, there are a lot of people who 
think that we should keep these bills separately and they would zoom on 
through here, but not package them up the way they are.
  Mr. Chairman, I yield 2 minutes to the gentlewoman from Washington 
State (Mrs. Rodgers).
  Mrs. RODGERS of Washington. Mr. Chairman, I thank our Republican lead 
on the Energy and Commerce Committee for yielding. I appreciate the 
gentleman's leadership on this important issue.
  Mr. Chairman, I rise today to voice my support for true bipartisan 
efforts to reduce prescription drug costs. Seniors, patients, and 
families in my district and all across America are counting on us so 
that they can afford their medication and have the certainty that they 
need.
  On the Energy and Commerce Committee, we have led. Republicans and 
Democrats on our committee have been working together on provisions to 
bring generic drugs to the market faster by incentivizing more 
competition among generic manufacturers.
  We recently passed three drug-pricing bills with overwhelming, 
bipartisan support. These are three solutions that President Trump 
stands ready to sign, and we should send them to his desk.
  This is an opportunity to build on the bipartisan work from the last 
Congress to lower drug costs and keep our promises to the American 
people. Remember, just last fall, President Trump signed our bipartisan 
bill to ban the gag clauses so patients can save on prescriptions and 
trust they are getting the best price.
  Again, we should build on that work. That is what the people elected 
us to do; that is what they expect; and that is what they deserve.

                              {time}  1330

  So, what has changed, and where are we today?
  The new majority--at the expense of patients, seniors, and families--
is playing politics with lowering the costs of prescription drugs.
  H.R. 987 includes our bipartisan bills, but my colleagues across the 
aisle have packaged them with very partisan bills to bail out 
ObamaCare.
  These partisan proposals would restrict access to healthcare coverage 
and stop the administration's work to reduce wasteful spending on 
programs that aren't working.
  The Washington Post called these poison bills a political pothole. We 
don't need any more political potholes. We need real reforms that the 
President will sign. This is a ploy, and it is just the latest.
  The Energy and Commerce Committee has historically been the most 
bipartisan committee in the House, putting more bipartisan legislation 
on the President's desk than any other.
  I am disappointed that we have found ourselves here.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from New Hampshire (Ms. Kuster), who is the sponsor of our Protecting 
Americans With Preexisting Conditions Act that we passed last week.
  Ms. KUSTER of New Hampshire. Mr. Chair, I thank Chairman Pallone for 
yielding and for his guidance and leadership on the Energy and Commerce 
Committee as we advance critical legislation this week to stabilize the 
Affordable Care Act and drive down prescription drug costs for all 
Americans.
  Mr. Chair, I rise today in support of H.R. 987, the Strengthening 
Health Care and Lowering Prescription Drug Costs Act. I rise hand in 
hand with Granite Staters and all Americans who have been denied care 
or have been charged more for care because of preexisting conditions.
  Asthma, allergies, Alzheimer's, cancer, diabetes--you can go right 
through the alphabet--having a child, these are preexisting conditions. 
And I believe people should not suffer more when they are at their most 
vulnerable. Patients should not be discriminated against or treated 
unfairly when they need help the most.
  I am committed to reversing the Trump administration's continuous, 
unrelenting sabotage of the Affordable Care Act that allows and 
encourages junk health plans.
  H.R. 987 invests in access to quality care while lowering 
prescription drug prices. It ensures that generics can come to market 
as soon as possible so that seniors are not skipping the medication 
they need because they cannot afford it.
  I support this legislation because it puts patients first. I thank 
Representative Lisa Blunt Rochester for her leadership on this bill, 
and I encourage my colleagues to vote ``yes'' on H.R. 987.
  Mr. WALDEN. Mr. Chairman, at this point I would reserve the balance 
of my time to close.
  Mr. PALLONE. Mr. Chairman, I yield 1 minute to the gentlewoman from 
California (Ms. Pelosi), our dynamic leader, our Speaker.
  Ms. PELOSI. Mr. Chair, congratulations. What a joy to see the 
gentleman in the chair. I thank Chairman Pallone for his extraordinary 
leadership as chair of the Energy and Commerce Committee and 
Congresswoman Anna Eshoo, chair of the Health Subcommittee. I thank 
them so much for all their hard work to bring us to this series of 
bills today, in addition to the bills of last week.
  I commend our colleague who just spoke, Ann Kuster, for her important 
legislation to preserve the benefit of preexisting conditions not being 
a barrier to access to care and insurance, and also to Lisa Blunt 
Rochester for her leadership on the legislation before us today to 
lower the cost of prescription drugs.
  Mr. Chairman and colleagues, on Sunday we marked Mother's Day, a 
special tribute to our mothers and also a somber reminder of the days 
when being a mother--when being a woman--was a preexisting medical 
condition. As a mother of five, I can speak from some experience as to 
what an obstacle that could be to access to insurance.
  Last week, we took action to block the administration's cynical 
efforts to drag our country back to the dark days of discrimination in 
healthcare coverage by passing the Protecting Americans With 
Preexisting Conditions Act.
  Again, I salute Congresswoman Kuster for her leadership on this, and 
also our chairman.

[[Page H3861]]

  This is not a fight about legislation that we are gathered about here 
today. This is about a fight for our lives, the lives of many people 
affected.
  I want to take the opportunity to salute a hero, a hero who testified 
last week on healthcare at the Rules Committee, Mr. Ady Barkan.
  Ady Barkan is a hero to us. He is a man who suffers from ALS, but, in 
speaking out for better healthcare, with courage, he testified before 
the committee 2 weeks ago.
  Ady said: I was healthy a year ago. I was running on the beach. I am 
33 years old. I have an 18-month-old son, Carl. And, out of nowhere, I 
was diagnosed with ALS, which, as you know, has a life expectancy of 3 
to 4 years. No treatment, no cure.
  Like so many others, Rachael--that is his wife--and I have had to 
fight with our insurers, which has issued outrageous denials instead of 
covering the benefits we paid for.
  We have so little time left together, yet our system forces us to 
waste it dealing with bills and bureaucracy.
  That is why I am here today urging you to build a more rational, 
fair, efficient, and effective system.
  That was Ady testifying 2 weeks ago.
  Since then, Ady lost his grandmother, Dina Abramov, and our sympathy 
goes out to him. Our congratulations to her for having such a 
magnificent and courageous grandson.
  But Ady has been here so many times with our Little Lobbyists who 
have preexisting conditions, with many of the communities that 
represent people with diagnoses that need prescription drugs and cannot 
afford them.
  So, in the coming weeks and months, Democrats will continue our 
action to strengthen health protections for people like Ady, the Little 
Lobbyists, and others, because this is life or death. It certainly is 
quality of life.

  And now, our Democratic House, today, is proud to pass the 
Strengthening Healthcare and Lowering Prescription Drug Costs Act, with 
Congresswoman Blunt Rochester.
  With this legislation, we are further reducing the price of 
prescription drugs by promoting competition with generics and reversing 
the Republican sabotage that we have seen.
  Mr. Chair, when we passed the Affordable Care Act, it was absolutely 
necessary that we do so. Even if everyone in our country approved and 
loved their insurer and was happy with their healthcare--which was not 
the case, but even if they did--it was essential that we pass the 
Affordable Care Act because we could not sustain the costs of 
healthcare in our country at the time: the cost to an individual; to a 
family; to a small business; to corporate America, who was paying a big 
part of the bill; and to the public sector, was a tremendous burden.
  With the Affordable Care Act, we were able to lower the rate of 
increase of healthcare costs in our country.
  But one sector, one segment of the healthcare arena that we did not 
conquer was the cost of prescription drugs, which continues to 
contribute to the increase of healthcare costs in our country.
  That is the main reason healthcare costs rise: the cost of 
prescription drugs.
  So, I salute the chairman and the committee and Anna Eshoo, chair of 
the subcommittee, and our distinguished chairman of the full committee 
for his legislation today which helps to lower the cost of prescription 
drugs to people, to individuals, to families, to everyone who has a 
part in funding the good health of the American people.
  This is really essential. And it is a fight. And it is a fight, but 
we are taking it one piece at a time.
  The reason it had to be combined with other bills is so that it could 
be paid for. Our Republicans salute the first part of the bill where we 
encourage competition among generics and this, that, and the other, but 
want to walk away from the part of the bill that is essential for 
paying for the legislation.
  So, we want to be very, very responsible in all of this.
  One of our colleagues on the floor earlier said that this bill was 
going to go die in hell or someplace. I don't know where. Actually, the 
distinguished--well, not so in this case, but the Republican leader of 
the Senate has said that he is the grim reaper and all these bills will 
die, designating the Senate a graveyard for legislation that would help 
the good health of the American people, lower costs for them, improve 
their lives. But he talked about everything that we passed here.
  I have some news for the distinguished leader in the Senate, the 
Republican leader, Mr. McConnell. The support for this legislation, 
these bills, is alive and well among the American people, and he will 
be hearing from them, because this legislation, these bills, are a 
matter of life and death and, certainly, quality of life for America's 
working families.
  So we will never limit the aspirations and meeting the needs of the 
American people to what might be legislatively acceptable in the mind 
of a person in the United States Senate, but we will recognize our 
responsibility to not only pass the boldest common denominator, but to 
do so in a way that honors what President Lincoln told us: Public 
sentiment is everything. With public sentiment, you can pass almost 
anything; without it, practically nothing.
  But, in order for the public sentiment to weigh in, the public has to 
know. And passing legislation of this kind is a strong message. And our 
advocates, whether it is the Little Lobbyists; whether it is those who 
are affected by so many aspects that the Republican leadership is out 
to sabotage, that the Trump administration is out to sabotage, whether 
in the Congress or in the courts--well, we will take it to the court, 
as we are in the Supreme Court.
  We will fight them in the Supreme Court, but we will also fight them 
in the court of public opinion. This is very, very important to, not 
only the health, but also the financial well-being of America's working 
families.
  So, I salute the chairman for this legislation, and I urge everyone 
to vote for it. And I know that there is bipartisan support for some 
parts of the bill. I hope that will apply to all of it so that it 
really can work.
  Mr. WALDEN. Mr. Chairman, may I inquire as to how much time remains 
on each side, please.
  The CHAIR. The gentleman from Oregon has 2 minutes remaining. The 
gentleman from New Jersey has 11\1/2\ minutes remaining.
  Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from California (Ms. Barragan).
  Ms. BARRAGAN. Mr. Chair, I rise today on behalf of the millions of 
Americans who are struggling to afford their lifesaving medications. 
Every day, millions face the tough decision of having to pay for their 
prescriptions or other basic costs of living like groceries and rent, 
Americans like Victoria Stuessel from Los Angeles, a mother of three 
who was just diagnosed with MS.
  Because of the high cost of her medications which she uses to delay 
the progress of her disease, she was forced to skip doses. But this is 
just one of many stories of people like Victoria who ration their care 
or stop taking their medication altogether.
  Not only is this dangerous, but it could result in death.
  The Strengthening Healthcare and Lowering Prescription Drug Costs Act 
is the first step to stop the rigging of the system so there is no 
delay to get generics to consumers faster.
  That will increase competition, and it will keep drug prices down for 
consumers.
  While there is still much more work that needs to be done to drive 
down the price of prescription drugs, this bill is a strong first step 
in ensuring that all Americans can afford the medication they need.
  Let's pass this bill and move forward in helping consumers.
  Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from Delaware (Ms. Blunt Rochester).

                              {time}  1345

  Ms. BLUNT ROCHESTER. Mr. Chairman, I thank Chairman Pallone for 
yielding and for his leadership.
  Mr. Chairman, I rise in strong support of H.R. 987, the Strengthening 
Health Care and Lowering Prescription Drug Costs Act. This legislative 
package is comprised of commonsense proposals that will advance 
important gains made by the Affordable Care Act and further improve our 
healthcare

[[Page H3862]]

system by, one, lowering the cost of prescription drug prices and, two, 
increasing access to care.
  Included in this package is my bill, the MORE Health Education Act, 
which will restore funding to the Affordable Care Act's marketing and 
outreach programs and, according to the CBO, help an additional 5 
million Americans get health coverage.
  Educating Americans about when they can enroll and what their options 
are gets more people covered, creates a better risk pool, brings down 
some of the cost of high premiums, and gets us one step closer to 
stabilizing the individual marketplace.
  ACA outreach not only boosts enrollment, but is also cost effective. 
The private sector spends between $250 and $1,000 per enrollment; 
however, it costs the government just $29 to enroll someone in the 
individual marketplace using TV ads--$29.
  The goal of affordable, accessible, and high-quality healthcare is 
not a D or an R, it is an A for American.
  I urge my colleagues to vote ``yes'' on this bill.
  Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Texas (Mr. Doggett), who chairs the Ways and Means Health 
Subcommittee.
  Mr. DOGGETT. Mr. Chairman, I am here to wade through the pool of 
crocodile tears being shed by Republicans who, for eight long years, 
have done nothing meaningful to address prescription price gouging.
  This bill provides some protection from anticompetitive 
pharmaceutical practices. And while it fails to lower drug prices 
immediately as we need, it offers great hope for the future. Key 
provisions are substantially the same as legislation I have introduced 
twice before.
  Big Pharma depends on monopoly power to spike prices. Taxpayers 
finance much of the drug development; then the government grants a 
monopoly and, too often, that patent monopoly is extended wrongfully by 
buying off the competition in what are called pay-for-delay contracts.
  Big Pharma claims that it has to price-gouge in order to solve and 
provide cures for the future. What it is really innovative about is not 
cures, but maintaining its monopoly position.
  Today's modest action is very important, but it will not fulfill our 
Democratic promise to deliver on lowering drug costs until we use the 
full power of the Federal Government, its purchasing power, to directly 
negotiate drug prices, much the way that the Veterans Administration 
gets lower prices for our veterans.
  Big Pharma will not yield its monopoly prices willingly. It will take 
more than a cry of, ``Kumbaya.'' It will take enough Members here with 
the intestinal fortitude to stand up to one of the most powerful 
lobbies in America and provide genuine relief.
  Let's do that.
  Mr. WALDEN. Mr. Chairman, I continue to reserve the balance of my 
time.
  Mr. PALLONE. Mr. Chairman, I yield 1 minute to the gentleman from New 
Jersey (Mr. Kim), who is the sponsor of the legislation that encourages 
State exchanges.
  Mr. KIM. Mr. Chairman, I rise today in support of taking action to 
lower healthcare and prescription drug costs.
  In each of my townhalls, I heard from my neighbors that they are 
tired of the politics; they can't afford the partisanship; and they 
need Congress to be the adults in the room and to act now. I am proud 
that my bill, the SAVE Act, has been incorporated into the bill that we 
will be voting on today.
  The SAVE Act came from a conversation, a single conversation, as I 
reached across the aisle to Congressman Brian Fitzpatrick, put aside 
our parties, and worked together to help the people we wake up every 
day committed to serve.
  Congress needs more conversations like that. Congress needs bold 
action like the one we will be taking today. I call on our colleagues 
in the House to recognize that our neighbors need healthcare relief, 
and I call on our colleagues in the Senate to recognize that our 
neighbors cannot wait for that relief to come.
  This is our moment to act to lower healthcare costs. This is our 
moment to get something done for the American people.
  Mr. WALDEN. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman 
from Georgia (Mr. Austin Scott).
  Mr. AUSTIN SCOTT of Georgia. Mr. Chairman, as I have listened, again, 
I want to point out the same thing I pointed out the other day, that 
they act as if you go to the doctor and the doctor says you have a 
dreaded disease, that you can go out the next day and get an insurance 
contract. That is simply not true.
  Affordable Care Act contracts are not available until January 1 of 
next year. You can sign up for them starting in November, but you will 
not have coverage until the first of next year.
  And if you think healthcare was expensive and insurance was expensive 
before the Affordable Care Act, you sure ought to look at it now, 
because it is significantly more.
  I just want to point out that there is a lot of good stuff in this 
legislation, there really is. I commend both the Democrats and the 
Republicans on the committee for the work that is done to help the 
American citizens on the prescription drug issue.
  But as a Representative who has 24 counties, in over half the 
counties that I represent, they have only one insurance carrier--only 
one insurance carrier. I can tell you these skinny plans are important. 
If you lose your coverage, where we live, it is, in many cases, the 
only thing that is available to you.
  Is it what people want to have? Is it what we want people to have? I 
would tell you, no, it is not, but it is sure better than nothing.
  So I hope that, as things move forward, we will be able to get some 
things done on the prescription drugs.
  But again, 24 counties that I represent, half of them only have one 
insurance option. Those insurance carriers, exempt from the antitrust 
laws of the country--that is the way they wrote the Affordable Care 
Act. They left them exempt from the antitrust laws of the country.
  Mr. PALLONE. Mr. Chairman, I yield 1 minute to the gentlewoman from 
Minnesota (Mrs. Craig).
  Mrs. CRAIG. Mr. Chairman, I join my colleagues today in strong 
support of the Strengthening Health Care and Lowering Prescription Drug 
Costs Act.
  Healthcare is the number one issue I hear about from the families 
that I represent, and we must do the right thing for the American 
people and finally focus on lowering the cost of healthcare.
  As a child, in my own family, we struggled at times to afford health 
insurance. I know directly that, if healthcare isn't affordable, it 
isn't accessible. That is why I have cosponsored bills in this package 
to lower prescription drug costs and stabilize the Affordable Care Act.
  It is unacceptable that 29 percent of Americans ration lifesaving 
medicine because they cannot keep up with the cost. We need to stop 
brand-name drug companies from keeping affordable generic alternatives 
from the market and support efforts to develop lower cost options for 
families. These efforts have bipartisan support, and I am proud to 
support them.
  Mr. WALDEN. Mr. Chairman, may I inquire again about the amount of 
time on each side.
  The CHAIR. The gentleman from Oregon has 30 seconds remaining. The 
gentleman from New Jersey has 5 minutes remaining.
  Mr. WALDEN. Mr. Chair, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 1 minute to the gentleman from 
Colorado (Mr. Neguse).
  Mr. NEGUSE. Mr. Chairman, across the State of Colorado and across my 
district, the cost of healthcare is an urgent concern to so many of my 
constituents. That is why I am proud to support the legislation 
championed by our chairman today.
  Today's legislation will provide much-needed reforms to lower the 
cost of healthcare, protect people with preexisting conditions, and 
lower the cost of prescription drugs--and these reforms are urgently 
needed.
  We know for a fact that American consumers pay far more for 
prescription drugs than it costs to manufacture them. In Colorado, over 
half a million people each year don't fill a prescription because of 
the cost--half a million people. The burden has led to heartbreaking 
stories across my State and

[[Page H3863]]

across the Nation of individuals forced to choose between feeding their 
loved ones and taking life-sustaining medications.
  Today's legislation will provide much-needed reforms, will lower 
prescription drug costs by ending the tactics used by so many drug 
manufacturers to keep less expensive drugs off the market, and will 
bring generics to market faster.
  I urge passage of the provisions on the floor today to ensure that no 
American has to skip doses of lifesaving medication because of the cost 
and no American goes bankrupt paying for their healthcare.
  I thank the chairman again for his leadership in championing this 
legislation.
  Mr. WALDEN. Mr. Chair, I continue to reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I yield 2 minutes to the gentleman from 
New York (Mr. Jeffries), the Democratic Caucus chair.
  Mr. JEFFRIES. Mr. Chairman, I thank the distinguished chair for his 
leadership on this critically important issue.
  The reckless and reprehensible Republican assault on healthcare is 
un-American, unconscionable, and unacceptable.
  This administration wants to take away healthcare protection from 
tens of millions of Americans.
  This administration wants to impose an age tax on people between 50 
and 64, which will dramatically increase premiums, copays, and 
deductibles.
  This administration wants to take away protections for those with 
preexisting conditions, adversely impacting more than 100 million 
Americans.
  Here is the Democratic response: Keep your hands off of the 
healthcare of everyday Americans.
  Our legislation will strengthen the Affordable Care Act, protect 
people with preexisting conditions, lower healthcare costs, and drive 
down the high costs of lifesaving prescription drugs because Democrats 
believe that, in this great country, no American should ever have to 
choose between putting food on the table, paying the rent, or getting 
access to lifesaving medication. We believe that healthcare is a right; 
it is not a privilege. We are not going backward; we are just going to 
move forward.
  This is the wealthiest country in the history of the world. Every 
single American should have access to high-quality and affordable 
healthcare, and we are taking a substantial step in that direction 
today.
  I thank the chair and the tremendous members of the relevant 
committees for their great work.
  Mr. Chairman, I urge a ``yes'' vote.
  Mr. WALDEN. Mr. Chairman, I continue to reserve the balance of my 
time.
  Mr. PALLONE. Mr. Chairman, I think I am prepared to close, but I just 
want to ask about the time on each side once more.
  The CHAIR. The gentleman from New Jersey has 2 minutes remaining. The 
gentleman from Oregon has 30 seconds remaining.
  Mr. WALDEN. Mr. Chairman, I yield myself the balance of my time, as I 
have no other speakers.
  I would just like to point out, make clear for the Record and for all 
our colleagues, Republicans supported and worked closely with our 
Democratic colleagues on the drug reform bills here to get lower cost 
prescriptions and more generics into the market sooner. There is no 
light between our shoulders on those issues.
  If those bills were brought here independently as they came out of 
committee independently, they would be headed to the Senate and likely 
to the President, and we would be moving forward. But, instead, 
Democrats merged in bills they know Republicans oppose.
  When it comes to navigators, the actual number is $767 per individual 
the navigators signed up; agents and brokers cost $240 per enrollee. 
Mr. Chairman, we would rather take that money and put it into community 
health centers. That would take care of 20,000 patients, just at $2.7 
million.
  Mr. Chairman, I urge opposition to the bill, and I yield back the 
balance of my time.

                              {time}  1400

  Mr. PALLONE. Mr. Chair, I yield myself such time as I may consume.
  Mr. Chair, I want to acknowledge the many Members who wanted to lend 
their strong support to this legislation but were unable to add 
themselves as cosponsors due to this package being combined for floor 
consideration as part of the Rules Committee proceedings. Those Members 
include the sponsors of the individual bills incorporated into this 
package, as well as Members like Representative Sheila Jackson Lee who 
strongly support our efforts to make healthcare more accessible and 
affordable.
  Let me say, Mr. Chairman, in closing, as Democrats, we promised, and 
we will fulfill the promise, that we are going to make healthcare more 
affordable, that we are going to bring down the costs of prescription 
drugs, that we are going to make sure people who have preexisting 
conditions are protected, and that we are offering robust, 
comprehensive plans with all the essential benefits as part of the 
package.
  That is what this bill is about. That is what the bill last week was 
about as well, guaranteeing that if you have a preexisting condition, 
you will get affordable health coverage, and saying that in the case of 
prescription drugs, 90 percent of prescription drugs now have or could 
have a generic alternative to bring down costs.
  They bring them down considerably, but the brand-name drug companies 
have conspired, in many cases, to make it more difficult for generics 
to come to market and delayed them coming to market. That drives up the 
costs of prescription drugs.
  We have watched this Trump administration sabotage the Affordable 
Care Act and put out junk plans so people don't have comprehensive 
coverage and people with preexisting conditions have trouble finding 
affordable coverage. They have made it more difficult for people to 
even know what to buy in the marketplace by cutting back on navigators 
and the outreach that makes people aware. They have also made it so 
that many people, unfortunately, don't even have options.
  We are going to do whatever we can. Republicans may like some bills, 
and they may not like others, but we are going to move forward with a 
package today and also in the future on whatever we can to make 
premiums more affordable and to bring down drug prices.
  Mr. Chair, I urge support for these bills for those reasons, and I 
yield back the balance of my time.
  The CHAIR. The gentleman from Virginia (Mr. Scott) and the 
gentlewoman from North Carolina (Ms. Foxx) each will control 15 
minutes.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield myself such time as I 
may consume.
  Mr. Chairman, I rise today in support of this bill to improve access 
to quality health coverage, protect the Affordable Care Act, and cut 
prescription drug costs for consumers.
  Unfortunately, Mr. Chairman, the administration has consistently 
undermined quality, affordable coverage that Americans have come to 
expect. House Republicans actually passed a bill last year that CBO 
concluded would provide coverage for over 20 million fewer people, 
would increase premiums 20 percent the first year, would cover less, 
and would jeopardize protections for those with preexisting conditions.
  We can do better.
  Mr. Chairman, I want to speak on one important provision of H.R. 987 
that reverses the administration's attempt to proliferate junk 
insurance plans.
  Mr. Chairman, for healthier, younger Americans, short-term junk plans 
may sound like a good idea. Unfortunately, those policies will fail to 
cover essential benefits and will lack consumer protections. They may 
not provide decent coverage for when they get sick.
  The major problem with the proliferation of junk plans is the fact 
that they allow insurance companies to sell plans to healthy people 
only, meaning that everybody else would be in an insurance pool that is 
sicker than they are today. While a privileged few may pay less, 
everybody else will pay more.
  In fact, one study showed that the combination of all these junk 
plans and lack of mandates and other sabotage of the Affordable Care 
Act could result in thousands of dollars more for everybody else to 
pay.
  These plans will raise costs for most Americans, and that is a step 
in the wrong direction.

[[Page H3864]]

  Mr. Chairman, we should be reducing the cost of insurance for most 
Americans, not increasing the cost.
  Mr. Chair, this bill will prevent the administration from going in 
the wrong direction, so I urge my colleagues to support H.R. 987.
  Mr. Chair, I reserve the balance of my time.
  Ms. FOXX of North Carolina. Mr. Chairman, I yield myself such time as 
I may consume.
  Mr. Chairman, I rise as leader of the Republicans on the committee of 
jurisdiction over employer-sponsored healthcare, the House Committee on 
Education and Labor.
  We have a vital stake in this debate because that is how most 
Americans get their healthcare, through their employer. Our focus 
should be on improving those options. Instead, we are here so our 
Democratic colleagues can grind an ax against the few remaining 
healthcare options they don't get to control.
  Among its many choice-eliminating, freedom-limiting provisions, this 
legislation would eliminate short-term, limited-duration insurance 
plans. These plans are an obvious potential solution for millions of 
Americans, working or not, who may find themselves between jobs or 
unable to afford rising premiums in the already expensive individual 
market.
  If any of my colleagues on the other side of the aisle claim to be 
champions for hardworking Americans or the unemployed, their support 
for this provision is proof that those claims are empty.
  It is worth noting for the Record that short-term, limited-duration 
plans were legal under the Obama administration and that States still 
have the authority to regulate these plans both under the Obama 
administration and under the current rules. If States choose to limit 
or prohibit the sale of these plans, they are free to do so.

  By considering this bill, House Democrats are once again defaulting 
to their standard uncreative, blind support for one-size-fits-all 
Federal mandates instead of respecting the judgment of State lawmakers 
and authorities, as well as individuals, to act in their States' and 
their own best interests.
  Republicans on the Education and Labor Committee have been and remain 
fully dedicated to protecting Americans with preexisting conditions and 
unleashing new customizable, affordable, workable healthcare options 
that take into account the changing needs of all Americans at all 
stages of life.
  The bill before the House today will not lower drug prices, will not 
protect anyone from surprise billings, will not lower premiums, will 
not cut any out-of-pocket costs, and will not provide one cent of tax 
relief.
  Its failure to achieve any of those objectives makes it simply 
unacceptable for us as Republicans.
  Mr. Chair, I reserve the balance of my time.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield 2 minutes to the 
gentlewoman from Pennsylvania (Ms. Wild).
  Ms. WILD. Mr. Chairman, I thank Mr. Scott for yielding.
  Mr. Chair, I rise in support of H.R. 987. I am proud that we are 
about to follow through on key campaign promises: lowering drug costs 
by removing barriers to generic drugs coming to market, reversing the 
sabotage of the ACA, and rescinding the administration's rule to expand 
junk plans.
  As we all know, Congress sometimes engages in hyperbole, but this is 
not hyperbole: These plans are truly junk. They are not required to 
include essential benefit coverage requirements of the ACA. They can 
deny consumers coverage or charge more based on age, gender, or health 
status. They come with no guarantees for basic benefits like maternity 
care, mental healthcare, prescription drug coverage, and other 
preventive services. They are not subject to the out-of-pocket 
limitations of the ACA that are designed specifically to protect 
consumers.
  I know a bit about these junk plans because I spent time over 
Mother's Day weekend desperately helping my 26-year-old son find 
insurance coverage. In March, he turned 26 and found himself uninsured. 
He is in a sandwich situation between his 26th birthday and when he 
will again become eligible for employer-provided healthcare.
  Only because I have read countless insurance policies over the years 
of my legal career did my son avoid the trap of paying $6,000 for a 
policy that would afford him almost no coverage with a $10,000 
deductible. That deductible would have applied even to his prescription 
drugs, of which he needs one.
  Just as important, my son is exactly the kind of person we need in 
the marketplace.
  Let's encourage robust participation in marketplace plans, which was 
the intent of the Affordable Care Act. These junk plans lure young, 
healthy people away from the ACA pool of plans, resulting in more 
expensive premiums for the rest of Americans.
  Let's pass this bill.
  Ms. FOXX of North Carolina. Mr. Chairman, I yield 3 minutes to the 
gentleman from Virginia (Mr. Cline).
  Mr. CLINE. Mr. Chairman, well, here we go again, another bait and 
switch by the Democrats.
  We have a great bill, the CREATES Act, that allows consumers to 
access cheaper generic drugs, driving down costs, saving Americans $3.9 
billion over 10 years.
  What have they done with it? They have stuck in poison pills designed 
to take choice away from Americans when it comes to their health 
insurance plans.
  As lawmakers, we owe it to Americans to protect their rights to make 
their own decisions, particularly as it relates to healthcare. The fact 
that we are here debating even further reducing these options available 
to Americans proves that we are not keeping up our end of the bargain.
  ObamaCare created a healthcare paradigm that aimed to take away 
options from Americans and give that authority to the government. As a 
result, premiums are skyrocketing, with the highest in the country 
being in my home State of Virginia.
  President Trump, thankfully, has stepped in to allow flexible, short-
term, limited-duration plans to help those in my district, where my 
constituents are pleading for more choices in health insurance. This 
administration is simply trying to give more options to Americans in 
this desert of choice.
  We should be creating an environment that encourages more choices for 
individuals and families. This includes a more individualized market, 
particularly with regard to employer-sponsored health insurance.

  It also means increasing pricing transparency at the point of sale to 
avoid surprise medical billing, which the President championed last 
week.
  Finally, we should address consolidation in the healthcare system 
through increased enforcement from the FTC and the DOJ under the 
Sherman Antitrust Act.
  This legislation is the height of arrogance. Government knows best, 
yet again. The American people know nothing about their own choices 
when it comes to health insurance.
  To double down on ObamaCare and take away the few options that are 
left for constituents, and giving those choices to those who caused 
this failure in the first place, the Federal Government, is beyond 
offensive to American citizens.
  Mr. Chair, I urge my colleagues to join me in rejecting this 
legislation. Reject this idea that government knows best, and stand up 
for affordable and accessible health insurance for all Americans.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield 1\1/2\ minutes to the 
gentlewoman from North Carolina (Ms. Adams).
  Ms. ADAMS. Mr. Chairman, I thank the gentleman from Virginia for 
yielding and for his support on this issue.
  Mr. Chair, I rise today in strong support of H.R. 987. We must 
reverse the administration's attempt to sabotage the Affordable Care 
Act.
  Healthcare should not be a partisan issue. It doesn't matter if you 
are a Democrat, Republican, or unaffiliated. If you get sick, you need 
to see a doctor. Your body certainly doesn't make the distinction about 
what your politics are.
  The ACA has given millions of Americans, including 500,000 in my home 
State of North Carolina, access to quality and affordable care. That is 
huge because people need healthcare.
  No one should worry about losing access to quality, affordable health 
insurance because of a preexisting condition. We all have them.

[[Page H3865]]

  Black women shouldn't have to worry about dying in childbirth because 
they don't have equal access to healthcare.
  I am proud to support H.R. 987 to invest in quality healthcare for 
the American people, a healthcare system that works for everyone.

                              {time}  1415

  Ms. FOXX of North Carolina. Mr. Chairman, I yield 3 minutes to the 
gentleman from Tennessee (Mr. David P. Roe), the distinguished ranking 
member of the Veterans Affairs' Committee.
  Mr. DAVID P. ROE of Tennessee. Mr. Chairman, I rise today in 
opposition to H.R. 987, the Democrats' ObamaCare bailout act. This 
legislation includes three bipartisan bills that could help lower the 
cost of prescription drugs. Unfortunately, the majority has decided to 
package these positive bills with four bills that double down on trying 
to force ObamaCare on people who don't want it and can't afford it.
  We are back on the floor again using valuable time to consider 
legislation that will not pass the Senate. Make no mistake: If House 
Democrats wanted to accomplish something, they could have put their 
three drug pricing bills on the floor by themselves today and they 
would have passed. Everyone needs to understand that.
  Instead of working together to find ways to bring down the costs of 
healthcare, House Democrats are acting to eliminate affordable options 
that many folks across the country rely upon for covering their 
family's healthcare needs.
  One provision in this bill would be to limit the availability of 
short-term limited duration plans to no more than 3 months. This change 
by President Obama went into effect January of 2017 and overturned 20 
years of regulations that had been in place since Bill Clinton was in 
office, including the entirety of President Obama's administration.
  These plans are for essential health benefits chosen by the 
individual consumer, not the Federal Government. We have different 
needs at different points in our life. Unfortunately, the ACA does not 
allow for plans to be sold as ``compliant'' unless they contain 
government approved what you need, not what you and your family decide 
what is in your best interest and can afford.
  If my colleagues want to get rid of junk plans, they can start by 
working with us to get rid of ObamaCare.
  In my district, while the individual mandate was in effect, there 
were 20,000 people who purchased their coverage through the exchange 
and about 15,000 who paid the penalty. Many of those people who paid 
the penalty were able to find a plan that was affordable through the 
Tennessee Farm Bureau or the Christian sharing ministries.
  I have said it before and I will say it again: ObamaCare is a good 
deal for you if you get a subsidy, of which about 90 percent do. But 
these subsidies hide the true cost of the care, and for people who 
don't receive a subsidy, it is unaffordable.
  When the Education and Labor Committee marked up the short-term bill 
last month, I heard the argument that these short-term plans were too 
difficult to understand, that consumers don't know what they are 
getting.
  This is offensive to me. This is saying, just because patients don't 
choose plans that Washington bureaucrats think are good for them, they 
don't have enough sense to figure it out on their own.
  They do. I trust the American people.
  Why on earth when we do something using common sense and creating 
association health plans that allow small groups to get together--
Washington State does that, hardly a conservative State. They have had 
AHPs for over 20 years, and they are working well.
  If my friends across the aisle want to engage in a good faith effort 
to find solutions to high healthcare costs, I am all in, Mr. Chairman. 
I want to help. But the point is that people are finding ways outside 
of ObamaCare to best access coverage for their families.
  The CBO initially said there would be 27 million people in the 
exchanges in 2019. That number is 8 million. Competition works.
  I hope my colleagues oppose this legislation, and I am ready to work 
in a bipartisan way to solve these problems.
  Ms. FOXX of North Carolina. Mr. Chairman, may I inquire as to the 
amount of time left.
  The Acting CHAIR (Mr. Sablan). The gentlewoman from North Carolina 
has 6\1/2\ minutes remaining. The gentleman from Virginia has 10 
minutes remaining.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield 2 minutes to the 
gentleman from Rhode Island (Mr. Cicilline).
  Mr. CICILLINE. Mr. Chairman, every day in kitchens and living rooms 
all across America, working men and women sit down and try to figure 
out how to pay for their prescription drugs. That is because 25 percent 
of the people in this country can't afford the medicine they have been 
prescribed.
  Seniors are choosing between COPD and their the groceries. People 
with cancer are being forced to delay their treatment, cut pills in 
half, or even forgo treatment altogether. This is happening in the 
richest, most powerful nation in the history of the world. It is a 
disgrace.
  If government is going to work for the people, then the people who 
serve in government need to end this crisis, and Democrats are 
committed to doing just that. We are taking on the big pharmaceutical 
companies and their lobbyists, and we are going to get the job done.
  That is why I am proud that my legislation, the CREATES Act, is 
included in this legislative package. The CREATES Act will save 
taxpayers $3.9 billion, according to the CBO, and bring down the cost 
of some prescription drugs by as much as 85 percent.
  The CREATES Act does this by directly addressing the abusive delay 
tactics that big drug companies use to block or delay generic 
competitors from entering the market.
  Over the past decade, some of the biggest drug companies have abused 
regulatory protocols so they can prevent the sale of affordable drugs. 
This lets them maintain their control of the marketplace, pull in 
monopoly profits, and keep their prices at inflated levels.
  If it is signed into law, the CREATES Act will create a tailored path 
for generic drug competitors to obtain the samples that are necessary 
for regulatory approval of their lower cost formulations.

  I am proud that this bill is not only backed by many of our 
colleagues, but it also has the support of a diverse coalition of 
healthcare providers, patient groups, and public interest 
organizations, including AARP and Public Citizen. And I am proud it is 
included in this package today.
  The majority leader in the Senate likes to describe himself as the 
grim reaper for Democratic legislative proposals. I hope that won't be 
the case here. He needs to put the interests of the American people 
ahead of his obsession with fighting Democrats every step of the way.
  The CREATES Act and these other proposals that are contained in this 
package deserve an up-or-down vote in the United States Senate. The 
American people deserve relief from these outrageous prescription drug 
prices, and this legislation will achieve that.
  Ms. FOXX of North Carolina. Mr. Chairman, I yield 3 minutes to the 
gentleman from Michigan (Mr. Walberg), the distinguished Republican 
leader on the Subcommittee on Health, Employment, Labor and Pensions.
  Mr. WALBERG. Mr. Chairman, I rise today in opposition to H.R. 987, 
and I truly lament the fact that the other side is once again, under 
their leadership's direction, trying to score political points instead 
of truly solving problems.
  Republicans and Democrats agree on the need to tackle out-of-control 
prescription drug costs. It is an issue that touches all of our 
districts. People are struggling and in need of relief.
  All of the names mentioned today, the illustrations, from the Speaker 
of the House on to my colleagues, names that were mentioned of people 
who are hurting and need relief from drug costs, are being let down by 
the Democrat leadership today.
  Up until today, we have been working together on solutions. On the 
Energy and Commerce Committee on which I sit, as well, we passed three 
drug pricing bills with overwhelming bipartisan support: The CREATES 
Act, the Protecting Consumer Access to Generic Drugs Act, and the 
Bringing Low-cost Options and Competition while

[[Page H3866]]

Keeping Incentives for New Generics Act. These bills would foster 
greater competition and help bring generic drugs to market as soon as 
possible and at more affordable prices.
  Once again, they all had bipartisan support. They were bills that 
were good bills.
  Unfortunately, the Democrats turned this bipartisan issue into a 
political football by adding several partisan provisions to this bill 
package, and they let down everyone that they have talked about today 
who needs affordable prescription drugs. They are costly provisions 
that bail out failed ObamaCare programs and strip away affordable 
healthcare options for families.
  The Democrats also rejected a number of commonsense amendments, 
including one I offered to protect expanded access to association 
health plans. These association health plans give more affordable 
options to workers and small businesses to purchase healthcare that 
fits their needs. We should be encouraging these options, not removing 
them.
  But most of all, today should be a moment of bipartisanship, a moment 
of meaningful results. We had an opportunity to get something done 
today on behalf of our constituents who are struggling with 
skyrocketing costs of prescription drugs. Instead, politics got in the 
way and we missed that opportunity.
  The American people deserve better than that, and I think most of us 
are better than that. We stand ready to work on lowering prescription 
drug costs.
  I hope our colleagues on the other side of the aisle will talk to 
their leadership and put politics aside and join us in that effort. I 
believe we and they are better than that and that, by standing up to 
leadership that wants to make it political, if they do that, we can get 
this done. I stand ready to work.
  I hate to do this, Mr. Chairman. I want to keep talking about this 
and get a solution, but my time is up.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield 1\1/2\ minutes to the 
gentlewoman from Texas (Ms. Jackson Lee).
  Ms. JACKSON LEE. Mr. Chairman, I am pleased to rise and support, 
enthusiastically, H.R. 987, the Strengthening Health Care and Lowering 
Prescription Drug Costs Act.
  This omnibus bill combines three key bills to lower drug costs by 
promoting generic competition--long overdue--and four key bills to 
strengthen healthcare, reverse the GOP sabotage, and rescind the Trump 
administration's devastating junk plan rule.
  I know full well what happens when individuals are impacted by junk 
plans, and they don't have the courage they need. I encourage my good 
friends on the other side of the aisle to drop politics and join with 
us to pass this legislation.
  This omnibus bill invests most of the savings of $13.8 billion 
created by its cracking down on junk plans into strengthening 
healthcare, which will fund about 500,000 additional enrollees into 
non-group coverage and Medicaid.
  Let me say to you, in 2017, due to the direct interference by the 
Trump administration, the number of uninsured people increased by 
700,000, the first increase since implementation of the Affordable Care 
Act.
  I know full well that Texas, which is the number one State in the 
number of uninsured, is experiencing the devastation of not having the 
expanded Medicaid and the Affordable Care Act at its fullest.
  We had a roundtable discussion with people who experience diabetes. 
Insulin is going through the roof. These people are suffering. The 
average uninsured resident in my congressional district pays 23 times 
more for a form of insulin than people living in Australia, 15 times 
more than they would in the United Kingdom, and 13 times more than they 
would in Canada.
  Let's protect those with preexisting conditions, and let's pass this 
bill to bring down these drugs and save the lives of our constituents.
  Mr. Chair, I rise in strong support of H.R. 987, the Strengthening 
Health Care and Lowering Prescription Drug Cost Act.
  This is an omnibus bill that includes the:
  H.R. 938, The BLOCKING (Bringing Low-Cost Options and Competition 
While Keeping Incentives for New Generics) Act;
  H.R. 1499, Protecting Consumer Access to Generic Drugs of 2019;
  H.R. 965, The CREATES (Creating and Restoring Equal Access to 
Equivalent Samples) Act; and
  H.R. 1010, Rescinding Trump Administration's Final Rule Promoting 
Junk Insurance Plans.
  This omnibus bill invests most of the savings of $13.8 billion 
created by its cracking down on junk plans into strengthening health 
care, which will fund about 500,000 additional enrollees in nongroup 
coverage and Medicaid.
  Health care should be a fundamental right for all Americans.
  This is why I introduced the Breath of Fresh Air Act, which 
establishes a Department of Education grant program to be used by local 
education agencies for the purchase of nebulizers for use in elementary 
and secondary schools and secured passage of Amendments to the Commerce 
Justice State spending bills that preserve and expand upon green spaces 
needed to reduce the worse symptoms of respiratory illnesses.
  Each Congress I have secured adoption of amendments to Department of 
Defense Appropriations and Authorization Bills that increase funding 
for triple negative breast cancer research and treatment.
  I am an original sponsor of H.R. 366, the Insulin Access for All Act 
of 2019, which addresses the extreme financial hardship most vulnerable 
Americans face and too many may face untimely deaths due to insulin 
rationing.
  Last month, I held a forum in my Congressional district in Houston 
Texas that engaged physicians, patients, public health officials in a 
discussion about the high cost of insulin.
  The Affordable Care Act (ACA) led to historic gains in health 
insurance coverage by extending Medicaid coverage to many low-income 
individuals and providing Marketplace subsidies for individuals below 
400 percent, of poverty.
  The number of uninsured nonelderly Americans decreased from over 44 
million in 2013, the year before major provisions of the ACA went into 
effect, to just below 27 million in 2016.
  Unfortunately, the Trump Administration has been doing all that it 
can to undermine the ACA and deny deserving Americans access to 
affordable health insurance.
  In 2017, due to direct interference by the Trump Administration the 
number of uninsured people increased by nearly 700,000 people, the 
first increase since implementation of the ACA.
  One of the most difficult challenges are the hurdles to healthcare 
created by lack of health insurance and the expense of prescription 
medication.
  In 2017, private health insurance coverage continued to be more 
prevalent than government coverage, at 67.2 percent and 37.7 percent, 
respectively.
  Of the subtypes of health insurance coverage, employer-based 
insurance was the most common, covering 56 percent of the population 
for some or all of the calendar year, followed by Medicaid (19.3 
percent), Medicare (17.2 percent), direct-purchase coverage (16.0 
percent), and military coverage (4.8 percent).
  Unfortunately, the state of Texas remains the state with the most 
uninsured persons at 17 percent because it refuses to accept federal 
Medicaid funding to cover the poorest residents of the state.
  According to the Kaiser Family Foundation, one in four people taking 
prescription drugs report difficulty affording their medication.
  In 2017, diabetes contributed to the death of 277,000 Americans--and 
was the primary cause of death for 85,000 of those individuals.
  That same year diagnosed diabetes cost the United States an estimated 
$327 billion--including $237 billion in direct medical costs and $90 
billion in productivity losses.
  Diabetes drugs, including insulin and oral medications that regulate 
blood sugar levels, play a critical role in helping people with 
diabetes manage their condition and reduce the risk of diabetes-related 
health complications.
  After the Democrats took control of the House in January we got to 
work on a report on the high cost of insulin and we determined that the 
Americans with diabetes are in crisis.
  Insulin--used by approximately 7.5 million Americans to treat their 
diabetes--was discovered nearly a century ago by Canadian researchers 
Frederick Banting, Charles Best, J.B. Collip, and J.J.R. Macleod, who 
assigned their patent to the University of Toronto with the goal of 
making the medication widely available.
  The researchers charged $3.00 to transfer ownership of insulin to the 
University of Toronto.
  Even though analog insulin has been on the market for nearly 30 
years, it has no meaningful generic competition.
  Over the past two decades, manufacturers have systematically and 
dramatically raised the prices of their insulin products by more than 
tenfold--often in lockstep.
  These prices dwarf manufacturing costs.
  One study found manufacturers could charge as little as $7 to $11 per 
month for insulin and still make a profit.

[[Page H3867]]

  In recent years, the high prices of diabetes drugs have placed a 
tremendous strain on diabetes patients as well as the federal 
government, which provides diabetes medications to more than 43 million 
Medicare beneficiaries.
  Reva Verma, is a type 1 diabetic who faces firsthand the struggles of 
managing diabetes in an era of skyrocketing insulin prices.
  Diabetes is a life-threatening disease that disproportionately 
affects communities of color.
  Diabetes is associated with serious health problems, including heart 
disease and stroke, kidney failure, and blindness.
  There are 15,000 Medicare beneficiaries in the Eighteenth 
Congressional District who have been diagnosed with diabetes.
  These individuals are my constituents and I know that on average, 
each of them pay 4.8 times the cost of similar medication in Australia, 
3.6 times the cost in the United Kingdom, and 2.6 times the cost in 
Canada.
  Additionally, in the Eighteenth Congressional District, there are 
191,000 uninsured residents in this district and, because they lack 
insurance, they often pay significantly more than their insured 
counterpart, or any patient overseas.
  The average uninsured resident in my congressional district pays 23 
more times for a form of insulin than people living in Australia, 15 
more times than they would in the United Kingdom, and 13 more times 
than they would in Canada.
  The consequences of these staggering costs are not benign.
  Many patients often speak of having to make heart-wrenching decisions 
about what to buy with the commonly fixed incomes attendant to seniors.
  Many medical professionals indicate that the high prices for 
prescription drugs are a function of a lack of competition, and 
authorizing Medicare to create a program to negotiate drug prices may 
be an estimable way to lower the cost of prescription drugs.
  All told this reflects a disturbing trend: in our country, the cost 
of branded drugs tends to go up, whereas in other countries, the costs 
tend to go down.
  These high prices lead many people to ration or stop taking their 
medications, which can result in serious health complications and even 
death, as the Energy and Commerce Committee heard in direct testimony 
earlier this year.
  The prices of diabetes medications--and insulin in particular--are 
far higher in the United States than they are overseas, in part because 
certain federal programs lack the authority to negotiate directly with 
drug manufacturers.
  The Democratic majority came into office with a promise to the 
American people, to make sure that they had affordable and dependable 
healthcare.
  Today, we are delivering on that promise, not just for persons with 
diabetes but for all Americans who have pre-existing conditions that 
require medication management.
  Ms. FOXX of North Carolina. Mr. Chairman, I yield 3 minutes to the 
gentleman from Idaho (Mr. Fulcher).
  Mr. FULCHER. Mr. Chair, I rise in opposition to H.R. 987, as well, 
for a number of reasons; but one in particular that has been raised 
already is the provision that it terminates the short-term limited 
duration insurance provision.
  Now, these are a good thing, and they have been good for Idaho. Idaho 
has been one of the States that has been leading on this front.
  Mr. Chairman, before the Affordable Care Act, the average premium in 
our State was $1,915. After the Affordable Care Act, that premium 
average went to $5,267. And that is, from what I understand, not unlike 
what has happened in other States, because the young and the healthy 
left the plans. That left the older, less healthy who were remaining in 
those plans, and it has driven those costs up.
  The younger and the more healthy have gone out of the plan altogether 
or they have joined a Medi-Share. But the point is that it has driven 
those numbers up significantly.
  In my State, the legislature passed a 3-year provision for short-term 
plans, and it is good for everyone. If you are in between those jobs or 
if you are in between coverage for some reason or you need to maintain 
continuity among the plans, it allows for that.
  Mr. Chairman, I have heard a couple of times these referred to as 
junk. If they were junk, there wouldn't be such demand for it. I would 
reframe that argument to say that junk would be better described to the 
system that has driven those prices up from $1,915 to $5,267. We want 
to draw that younger constituency into those plans. Everyone wins. We 
all win when that is the case.
  Mr. Chairman, again, H.R. 987 strikes that provision, and for that 
reason, I will oppose it, and I ask my colleagues to do the same.

                              {time}  1430

  Mr. SCOTT of Virginia. Mr. Chairman, I yield 1\1/2\ minutes to the 
gentlewoman from New York (Ms. Clarke).
  Ms. CLARKE of New York. Mr. Chairman, I would like to, first of all, 
thank the gentlewoman from Delaware (Ms. Blunt Rochester) for 
introducing this very important legislation, and thank Chairman Scott 
for yielding me time and for his leadership and support in continuing 
to provide access to quality healthcare for working families.
  As vice chair of the House Committee on Energy and Commerce, I am 
happy to stand with my colleagues on the Education and Labor Committee 
to urge my colleagues to support the Strengthening Healthcare and 
Lowering Prescription Drug Costs Act.
  While H.R. 987 is not a panacea to the many challenges that we face 
in our Nation's healthcare delivery system, it is sound legislation 
that will reduce drug pricing and increase market competition to bring 
generic drugs to the market sooner.
  It improves the lives of Americans by lowering the cost of premiums 
and out-of-pocket expenses and that presents real financial hardships 
to Americans who have to struggle with limited resources and ask 
themselves, Do I pay for medication, or do I purchase food, or school 
fees, or transportation to and from work?
  While my home State of New York has banned the sale of short-term 
health insurance plans, they are legal in other states and often do not 
provide a comprehensive level of healthcare insurance and coverage in 
the event of an emergency.
  Mr. Chairman, let's do the right thing and enact legislation that 
will lower the skyrocketing cost of prescription drugs and give 
protections to the consumers of health insurance coverage, lifting the 
burden of access and affordability from the American people.
  Ms. FOXX of North Carolina. Mr. Chairman, I reserve the balance of my 
time.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield 1\1/2\ minutes to the 
gentlewoman from Delaware (Ms. Blunt Rochester).
  Ms. BLUNT ROCHESTER. Mr. Chairman, I thank the gentleman from 
Virginia (Mr. Scott), the chairman of the committee.
  According to the Merriam-Webster Dictionary, ``sabotage'' is, an act 
or process intended to hurt or hamper.
  I am a person who is really particular about words, and I have heard 
this word used a lot. And when I look at what has happened to the 
Affordable Care Act over the past few years, the administration has 
slashed the enrollment period, we scrubbed the ACA from government 
websites, we have cut in-person assistance, and eliminated almost all 
of the educational outreach for the open enrollment period.
  All of the administration's actions were intended to deliberately 
damage the ACA and hamper American's access to affordable, quality 
healthcare.
  I don't question people's motivations. I think we all want the same 
thing. We all want healthcare for Americans.
  But this bill, H.R. 987, is intended to do two things. Number one, 
lower the cost of prescription drugs, and number two, strengthen this 
historic legislation, the ACA.
  Today, we have an opportunity to reverse the administration's 
relentless sabotage of the healthcare system and lower prescription 
drug prices. And as I think about individuals in my State, I think 
about a woman who came to me crying because of the cost of her 
prescription drugs.
  Every one of us in here wants to see something happen. Today, we have 
the opportunity to make that happen.
  Mr. Chairman, I urge my colleagues to support H.R. 987.
  Ms. FOXX of North Carolina. Mr. Chairman, I reserve the balance of my 
time.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield 2\1/2\ minutes to the 
gentlewoman from Florida (Ms. Shalala).
  Ms. SHALALA. Mr. Chairman, this amendment expresses the sense of 
Congress that the secretary should not do anything that prohibits State 
insurance commissioners from allowing for so-called silver loading.

[[Page H3868]]

  Let me walk you through how we got to this point. Because while 
silver loading has worked to keep costs on the exchange lower for folks 
who get subsidies, it has only been used because the President was 
actively trying to kill the Affordable Care Act.
  In 2017, the President decided to stop reimbursing health insurance 
companies for what are called cost-sharing reductions, or CSRs.
  CSRs are payments that health insurance companies are required to 
make to help low- and moderate-income people afford healthcare.
  Under the Affordable Care Act, the health insurance companies must 
help people that have more affordable, and, possibly, no co-pays or 
deductibles.
  The Federal Government was supposed to reimburse insurance providers 
for making these payments; however, in October of 2017, the 
administration stopped making these payments.
  This was a deliberate attempt to make health insurance on the 
exchange unaffordable, and undermine, weaken, and attack the Affordable 
Care Act.
  In response to this, States let health insurance plans do what is now 
called silver loading. State insurance regulators, in a desperate and 
creative attempt to stabilize the insurance marketplaces, allowed 
insurance companies to bill the unpaid CSR costs into their silver 
plans on the exchange. This was a very creative attempt to stabilize 
the insurance market.
  This wasn't the solution that anyone wanted, but it is a solution 
that has worked and has created some stability and predictability in 
the insurance market in the face of an administration that seeks chaos.
  Because the tax credits are benchmarked to the silver plan, silver 
loading has meant that most who receive subsidies did not see an 
increase in their health insurance premiums.
  In fact, new data shows that 2.6 million healthcare.gov consumers are 
now paying lower premiums as a result of silver loading.
  States that allowed for silver loading as a way to cope with the 
manufactured chaos that the administration tried to inflict on the 
market, actually saw an increase in enrollment in the exchanges.
  The Acting CHAIR. The time of the gentlewoman has expired.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield an additional 30 seconds 
to the gentlewoman from Florida.
  Ms. SHALALA. Mr. Chairman, the administration must stop trying to 
sabotage the Affordable Care Act.
  My amendment expresses that it is the sense of Congress that the 
secretary of Health and Human Services shall not do anything to 
prohibit the use of silver loading, a program designed by the States to 
stabilize the health insurance marketplace.
  Ms. FOXX of North Carolina. Mr. Chairman, I continue to reserve the 
balance of my time.
  Mr. SCOTT of Virginia. Mr. Chairman, may I inquire as to how much 
time each side has remaining.
  The Acting CHAIR. The gentleman from Virginia has 45 seconds 
remaining. The gentlewoman from North Carolina has 1 minute remaining.
  Mr. SCOTT of Virginia. Mr. Chairman, do I have the right to close?
  The Acting CHAIR. The gentleman enjoys the right to close.
  Mr. SCOTT of Virginia. Mr. Chairman, I am ready to close, and I 
reserve the balance of my time.
  Ms. FOXX of North Carolina. Mr. Chairman, I yield myself the balance 
of my time.
  Mr. Chairman, Republicans predicted all the bad things that have 
resulted from the so-called Affordable Care Act. It has not been 
affordable and has actually increased the cost of health insurance and 
care.
  Unfortunately, our colleagues are so invested in supporting this 
legislation that they blame Republicans for its failure.
  The legislation has failed because it is hopelessly flawed and cannot 
be fixed.
  Mr. Chairman, the piece of legislation before us, as I said earlier, 
is a choice-limited, freedom-limiting bill, and should not pass.
  I would also like to make one more observation.
  My colleagues have made repeated references to junk plans. Every time 
they do that, they are insulting the person who has chosen that plan 
for one reason or another due to individual circumstances or 
preferences.
  Just because a product isn't something I would buy, or you would buy, 
does that make it junk? No.
  Dismissing less expensive and more flexible health plans as junk 
isn't taking up for anyone, it is actually putting them down.
  That is not the way we should be in this country.
  Mr. Chairman, I yield back the balance of my time.
  Mr. SCOTT of Virginia. Mr. Chairman, I yield myself the balance of my 
time.
  Mr. Chairman, I just want to say a final word about these junk plans.
  The problem with them is that you allow them to screen for 
preexisting conditions and have lower benefits. That might be a good 
idea for the person buying the plan, but what happens is under the 
Affordable Care Act everybody pays an average. If you let healthy 
people buy these junk plans, everybody else's premium will go up.
  This sabotage has been estimated with this and the other sabotage, 
thousands of dollars more for everybody else left behind.
  So I rise today in support of the bill, which will improve access to 
quality health coverage, protect the Affordable Care Act and cut 
prescription drugs cost.
  Mr. Chairman, I yield back the balance of my time.
  Mr. CARSON of Indiana. Mr. Chair, last November, the American people 
elected us to this body because of the urgent need to shore up our 
health care system and bring down the cost of prescription drugs.
  Today, we are making good on that promise to the country by passing 
another critically-important piece of legislation.
  H.R. 987, the Strengthening Health Care and Prescription Drugs Act 
helps protect the Affordable Care Act from the sabotage of the Trump 
Administration.
  In particular, this bill bans the use of ``junk'' health care plans 
that harm people with pre-existing conditions; it also helps provide 
states with more resources to increase health care coverage.
  Second, this legislation helps increase generic prescription drug 
competition which will help bring down prices for patients.
  In particular, this legislation includes a bill that I cosponsored 
that makes it illegal for prescription drug manufacturers to use a 
practice called ``pay-for-delay.'' This anti-competitive practice 
delays generic manufacturers from bringing cheaper drugs to market. 
This bill will prohibit this practice and help increase drug 
competition.
  This bill will not solve every problem ailing our health care system, 
nor will it immediately fix our prescription drug prices problems.
  But the American people deserve these needed reforms without delay. 
This bill's passage today will help us build additional policies to 
shore up our health care system and further bring down the cost of 
prescription drugs. I encourage all of my colleagues to support it.
  Ms. BLUNT ROCHESTER. Mr. Chair, I would like to revise my remarks 
made during general debate of the underlying measure, H.R. 987. In my 
remarks, I stated that the marketing and outreach provision under Title 
II of H.R. 987 would increase enrollment into health plans by five 
million over the ten year period as estimated by the Congressional 
Budget Office. Due to the methodology adopted by the Congressional 
Budget Office to estimate the enrollment effect of the underlying 
measure, the figure is more appropriately represented as increasing 
enrollment by about 500,000 each year over the ten year period.
  The Acting CHAIR. All time for general debate has expired.
  In lieu of the amendment in the nature of a substitute recommended by 
the Committee on Energy and Commerce, printed in the bill, an amendment 
in the nature of a substitute consisting of the text of the Rules 
Committee Print 116-14, shall be considered as adopted and shall be 
considered as an original bill for purpose of further amendment under 
the 5-minute rule. The bill, as amended, shall be considered as read.
  The text of the bill, as amended, is as follows:

                                H.R. 987

       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 ``Strengthening Health Care 
     and Lowering Prescription Drug Costs Act''.

     SEC. 2. TABLE OF CONTENTS.

       The table of contents of this Act is as follows:

Sec. 1. Short title.
Sec. 2. Table of contents.

[[Page H3869]]

               TITLE I--LOWERING PRESCRIPTION DRUG COSTS

  Subtitle A--Bringing Low-cost Options and Competition While Keeping 
                      Incentives for New Generics

Sec. 101. Change conditions of first generic exclusivity to spur access 
              and competition.

        Subtitle B--Protecting Consumer Access to Generic Drugs

Sec. 111. Unlawful agreements.
Sec. 112. Notice and certification of agreements.
Sec. 113. Forfeiture of 180-day exclusivity period.
Sec. 114. Commission litigation authority.
Sec. 115. Statute of limitations.

 Subtitle C--Creating and Restoring Equal Access to Equivalent Samples

Sec. 121. Actions for delays of generic drugs and biosimilar biological 
              products.
Sec. 122. REMS approval process for subsequent filers.
Sec. 123. Rule of construction.

            TITLE II--HEALTH INSURANCE MARKET STABILIZATION

Sec. 201. Preserving State option to implement health care 
              marketplaces.
Sec. 202. Providing for additional requirements with respect to the 
              navigator program.
Sec. 203. Federal Exchange outreach and educational activities.
Sec. 204. Short-term limited duration insurance rule prohibition.

                      TITLE III--BUDGETARY EFFECTS

Sec. 301. Determination of budgetary effects.

               TITLE I--LOWERING PRESCRIPTION DRUG COSTS

  Subtitle A--Bringing Low-cost Options and Competition While Keeping 
                      Incentives for New Generics

     SEC. 101. CHANGE CONDITIONS OF FIRST GENERIC EXCLUSIVITY TO 
                   SPUR ACCESS AND COMPETITION.

       Section 505(j)(5)(B)(iv) of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355(j)(5)(B)(iv)) is amended--
       (1) in subclause (I), by striking ``180 days after'' and 
     all that follows through the period at the end and inserting 
     the following: ``180 days after the earlier of--

       ``(aa) the date of the first commercial marketing of the 
     drug (including the commercial marketing of the listed drug) 
     by any first applicant; or
       ``(bb) the applicable date specified in subclause (III).''; 
     and

       (2) by adding at the end the following new subclause:
       ``(III) Applicable date.--The applicable date specified in 
     this subclause, with respect to an application for a drug 
     described in subclause (I), is the date on which each of the 
     following conditions is first met:

       ``(aa) The approval of such an application could be made 
     effective, but for the eligibility of a first applicant for 
     180-day exclusivity under this clause.
       ``(bb) At least 30 months have passed since the date of 
     submission of an application for the drug by at least one 
     first applicant.
       ``(cc) Approval of an application for the drug submitted by 
     at least one first applicant is not precluded under clause 
     (iii).
       ``(dd) No application for the drug submitted by any first 
     applicant is approved at the time the conditions under items 
     (aa), (bb), and (cc) are all met, regardless of whether such 
     an application is subsequently approved.''.

        Subtitle B--Protecting Consumer Access to Generic Drugs

     SEC. 111. UNLAWFUL AGREEMENTS.

       (a) Agreements Prohibited.--Subject to subsections (b) and 
     (c), it shall be unlawful for an NDA or BLA holder and a 
     subsequent filer (or for two subsequent filers) to enter 
     into, or carry out, an agreement resolving or settling a 
     covered patent infringement claim on a final or interim basis 
     if under such agreement--
       (1) a subsequent filer directly or indirectly receives from 
     such holder (or in the case of such an agreement between two 
     subsequent filers, the other subsequent filer) anything of 
     value, including a license; and
       (2) the subsequent filer agrees to limit or forego research 
     on, or development, manufacturing, marketing, or sales, for 
     any period of time, of the covered product that is the 
     subject of the application described in subparagraph (A) or 
     (B) of subsection (g)(8).
       (b) Exclusion.--It shall not be unlawful under subsection 
     (a) if a party to an agreement described in such subsection 
     demonstrates by clear and convincing evidence that the value 
     described in subsection (a)(1) is compensation solely for 
     other goods or services that the subsequent filer has 
     promised to provide.
       (c) Limitation.--Nothing in this section shall prohibit an 
     agreement resolving or settling a covered patent infringement 
     claim in which the consideration granted by the NDA or BLA 
     holder to the subsequent filer (or from one subsequent filer 
     to another) as part of the resolution or settlement includes 
     only one or more of the following:
       (1) The right to market the covered product that is the 
     subject of the application described in subparagraph (A) or 
     (B) of subsection (g)(8) in the United States before the 
     expiration of--
       (A) any patent that is the basis of the covered patent 
     infringement claim; or
       (B) any patent right or other statutory exclusivity that 
     would prevent the marketing of such covered product.
       (2) A payment for reasonable litigation expenses not to 
     exceed $7,500,000 in the aggregate.
       (3) A covenant not to sue on any claim that such covered 
     product infringes a patent.
       (d) Enforcement by Federal Trade Commission.--
       (1) General application.--The requirements of this section 
     apply, according to their terms, to an NDA or BLA holder or 
     subsequent filer that is--
       (A) a person, partnership, or corporation over which the 
     Commission has authority pursuant to section 5(a)(2) of the 
     Federal Trade Commission Act (15 U.S.C. 45(a)(2)); or
       (B) a person, partnership, or corporation over which the 
     Commission would have authority pursuant to such section but 
     for the fact that such person, partnership, or corporation is 
     not organized to carry on business for its own profit or that 
     of its members.
       (2) Unfair or deceptive acts or practices enforcement 
     authority.--
       (A) In general.--A violation of this section shall be 
     treated as an unfair or deceptive act or practice in 
     violation of section 5(a)(1) of the Federal Trade Commission 
     Act (15 U.S.C. 45(a)(1)).
       (B) Powers of commission.--Except as provided in 
     subparagraph (C) and paragraphs (1)(B) and (3)--
       (i) the Commission shall enforce this section in the same 
     manner, by the same means, and with the same jurisdiction, 
     powers, and duties as though all applicable terms and 
     provisions of the Federal Trade Commission Act (15 U.S.C. 41 
     et seq.) were incorporated into and made a part of this 
     section; and
       (ii) any NDA or BLA holder or subsequent filer that 
     violates this section shall be subject to the penalties and 
     entitled to the privileges and immunities provided in the 
     Federal Trade Commission Act.
       (C) Judicial review.--In the case of a cease and desist 
     order issued by the Commission under section 5 of the Federal 
     Trade Commission Act (15 U.S.C. 45) for violation of this 
     section, a party to such order may obtain judicial review of 
     such order as provided in such section 5, except that--
       (i) such review may only be obtained in--

       (I) the United States Court of Appeals for the District of 
     Columbia Circuit;
       (II) the United States Court of Appeals for the circuit in 
     which the ultimate parent entity, as defined in section 
     801.1(a)(3) of title 16, Code of Federal Regulations, or any 
     successor thereto, of the NDA or BLA holder (if any such 
     holder is a party to such order) is incorporated as of the 
     date that the application described in subparagraph (A) or 
     (B) of subsection (g)(8) or an approved application that is 
     deemed to be a license for a biological product under section 
     351(k) of the Public Health Service Act (42 U.S.C. 262(k)) 
     pursuant to section 7002(e)(4) of the Biologics Price 
     Competition and Innovation Act of 2009 (Public Law 111-148; 
     124 Stat. 817) is submitted to the Commissioner of Food and 
     Drugs; or
       (III) the United States Court of Appeals for the circuit in 
     which the ultimate parent entity, as so defined, of any 
     subsequent filer that is a party to such order is 
     incorporated as of the date that the application described in 
     subparagraph (A) or (B) of subsection (g)(8) is submitted to 
     the Commissioner of Food and Drugs; and

       (ii) the petition for review shall be filed in the court 
     not later than 30 days after such order is served on the 
     party seeking review.
       (3) Additional enforcement authority.--
       (A) Civil penalty.--The Commission may commence a civil 
     action to recover a civil penalty in a district court of the 
     United States against any NDA or BLA holder or subsequent 
     filer that violates this section.
       (B) Special rule for recovery of penalty if cease and 
     desist order issued.--
       (i) In general.--If the Commission has issued a cease and 
     desist order in a proceeding under section 5 of the Federal 
     Trade Commission Act (15 U.S.C. 45) for violation of this 
     section--

       (I) the Commission may commence a civil action under 
     subparagraph (A) to recover a civil penalty against any party 
     to such order at any time before the expiration of the 1-year 
     period beginning on the date on which such order becomes 
     final under section 5(g) of such Act (15 U.S.C. 45(g)); and
       (II) in such civil action, the findings of the Commission 
     as to the material facts in such proceeding shall be 
     conclusive, unless--

       (aa) the terms of such order expressly provide that the 
     Commission's findings shall not be conclusive; or
       (bb) such order became final by reason of section 5(g)(1) 
     of such Act (15 U.S.C. 45(g)(1)), in which case such findings 
     shall be conclusive if supported by evidence.
       (ii) Relationship to penalty for violation of an order.--
     The penalty provided in clause (i) for violation of this 
     section is separate from and in addition to any penalty that 
     may be incurred for violation of an order of the Commission 
     under section 5(l) of the Federal Trade Commission Act (15 
     U.S.C. 45(l)).
       (C) Amount of penalty.--
       (i) In general.--The amount of a civil penalty imposed in a 
     civil action under subparagraph (A) on a party to an 
     agreement described in subsection (a) shall be sufficient to 
     deter violations of this section, but in no event greater 
     than--

       (I) if such party is the NDA or BLA holder (or, in the case 
     of an agreement between two subsequent filers, the subsequent 
     filer who gave the value described in subsection (a)(1)), the 
     greater of--

       (aa) 3 times the value received by such NDA or BLA holder 
     (or by such subsequent filer) that is reasonably attributable 
     to the violation of this section; or
       (bb) 3 times the value given to the subsequent filer (or to 
     the other subsequent filer) reasonably attributable to the 
     violation of this section; and

       (II) if such party is the subsequent filer (or, in the case 
     of an agreement between two subsequent filers, the subsequent 
     filer who received the value described in subsection (a)(1)), 
     3 times

[[Page H3870]]

     the value received by such subsequent filer that is 
     reasonably attributable to the violation of this section.

       (ii) Factors for consideration.--In determining such 
     amount, the court shall take into account--

       (I) the nature, circumstances, extent, and gravity of the 
     violation;
       (II) with respect to the violator, the degree of 
     culpability, any history of violations, the ability to pay, 
     any effect on the ability to continue doing business, profits 
     earned by the NDA or BLA holder (or, in the case of an 
     agreement between two subsequent filers, the subsequent filer 
     who gave the value described in subsection (a)(1)), 
     compensation received by the subsequent filer (or, in the 
     case of an agreement between two subsequent filers, the 
     subsequent filer who received the value described in 
     subsection (a)(1)), and the amount of commerce affected; and
       (III) other matters that justice requires.

       (D) Injunctions and other equitable relief.--In a civil 
     action under subparagraph (A), the United States district 
     courts are empowered to grant mandatory injunctions and such 
     other and further equitable relief as they deem appropriate.
       (4) Remedies in addition.--Remedies provided in this 
     subsection are in addition to, and not in lieu of, any other 
     remedy provided by Federal law.
       (5) Preservation of authority of commission.--Nothing in 
     this section shall be construed to affect any authority of 
     the Commission under any other provision of law.
       (e) Federal Trade Commission Rulemaking.--The Commission 
     may, in its discretion, by rule promulgated under section 553 
     of title 5, United States Code, exempt from this section 
     certain agreements described in subsection (a) if the 
     Commission finds such agreements to be in furtherance of 
     market competition and for the benefit of consumers.
       (f) Antitrust Laws.--Nothing in this section shall modify, 
     impair, limit, or supersede the applicability of the 
     antitrust laws as defined in subsection (a) of the first 
     section of the Clayton Act (15 U.S.C. 12(a)), and of section 
     5 of the Federal Trade Commission Act (15 U.S.C. 45) to the 
     extent that such section 5 applies to unfair methods of 
     competition. Nothing in this section shall modify, impair, 
     limit, or supersede the right of a subsequent filer to assert 
     claims or counterclaims against any person, under the 
     antitrust laws or other laws relating to unfair competition.
       (g) Definitions.--In this section:
       (1) Agreement resolving or settling a covered patent 
     infringement claim.--The term ``agreement resolving or 
     settling a covered patent infringement claim'' means any 
     agreement that--
       (A) resolves or settles a covered patent infringement 
     claim; or
       (B) is contingent upon, provides for a contingent condition 
     for, or is otherwise related to the resolution or settlement 
     of a covered patent infringement claim.
       (2) Commission.--The term ``Commission'' means the Federal 
     Trade Commission.
       (3) Covered patent infringement claim.--The term ``covered 
     patent infringement claim'' means an allegation made by the 
     NDA or BLA holder to a subsequent filer (or, in the case of 
     an agreement between two subsequent filers, by one subsequent 
     filer to another), whether or not included in a complaint 
     filed with a court of law, that--
       (A) the submission of the application described in 
     subparagraph (A) or (B) of paragraph (9), or the manufacture, 
     use, offering for sale, sale, or importation into the United 
     States of a covered product that is the subject of such an 
     application--
       (i) in the case of an agreement between an NDA or BLA 
     holder and a subsequent filer, infringes any patent owned by, 
     or exclusively licensed to, the NDA or BLA holder of the 
     covered product; or
       (ii) in the case of an agreement between two subsequent 
     filers, infringes any patent owned by the subsequent filer; 
     or
       (B) in the case of an agreement between an NDA or BLA 
     holder and a subsequent filer, the covered product to be 
     manufactured under such application uses a covered product as 
     claimed in a published patent application.
       (4) Covered product.--The term ``covered product'' means a 
     drug (as defined in section 201(g) of the Federal Food, Drug, 
     and Cosmetic Act (21 U.S.C. 321(g))), including a biological 
     product (as defined in section 351(i) of the Public Health 
     Service Act (42 U.S.C. 262(i)).
       (5) NDA or bla holder.--The term ``NDA or BLA holder'' 
     means--
       (A) the holder of--
       (i) an approved new drug application filed under section 
     505(b)(1) of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355(b)(1)) for a covered product; or
       (ii) a biologics license application filed under section 
     351(a) of the Public Health Service Act (42 U.S.C. 262(a)) 
     with respect to a biological product;
       (B) a person owning or controlling enforcement of the 
     patent on--
       (i) the list published under section 505(j)(7) of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355(j)(7)) in 
     connection with the application described in subparagraph 
     (A)(i); or
       (ii) any list published under section 351 of the Public 
     Health Service Act (42 U.S.C. 262) comprised of patents 
     associated with biologics license applications filed under 
     section 351(a) of such Act (42 U.S.C. 262(a)); or
       (C) the predecessors, subsidiaries, divisions, groups, and 
     affiliates controlled by, controlling, or under common 
     control with any entity described in subparagraph (A) or (B) 
     (such control to be presumed by direct or indirect share 
     ownership of 50 percent or greater), as well as the 
     licensees, licensors, successors, and assigns of each of the 
     entities.
       (6) Patent.--The term ``patent'' means a patent issued by 
     the United States Patent and Trademark Office.
       (7) Statutory exclusivity.--The term ``statutory 
     exclusivity'' means those prohibitions on the submission or 
     approval of drug applications under clauses (ii) through (iv) 
     of section 505(c)(3)(E) (5- and 3-year exclusivity), clauses 
     (ii) through (iv) of section 505(j)(5)(F) (5-year and 3-year 
     exclusivity), section 505(j)(5)(B)(iv) (180-day exclusivity), 
     section 527 (orphan drug exclusivity), section 505A 
     (pediatric exclusivity), or section 505E (qualified 
     infectious disease product exclusivity) of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355(c)(3)(E), 
     355(j)(5)(B)(iv), 355(j)(5)(F), 360cc, 355a, 355f), or 
     prohibitions on the submission or licensing of biologics 
     license applications under section 351(k)(6) (interchangeable 
     biological product exclusivity) or section 351(k)(7) 
     (biological product reference product exclusivity) of the 
     Public Health Service Act (42 U.S.C. 262(k)(6), (7)).
       (8) Subsequent filer.--The term ``subsequent filer'' 
     means--
       (A) in the case of a drug, a party that owns or controls an 
     abbreviated new drug application submitted pursuant to 
     section 505(j) of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 355(j)) or a new drug application submitted 
     pursuant to section 505(b)(2) of the Federal Food, Drug, and 
     Cosmetic Act (21U.S.C. 355(b)(2)) and filed under section 
     505(b)(1) of such Act (21 U.S.C. 355(b)(1)) or has the 
     exclusive rights to distribute the covered product that is 
     the subject of such application; or
       (B) in the case of a biological product, a party that owns 
     or controls an application filed with the Food and Drug 
     Administration under section 351(k) of the Public Health 
     Service Act (42 U.S.C. 262(k)) or has the exclusive rights to 
     distribute the biological product that is the subject of such 
     application.
       (h) Effective Date.--This section applies with respect to 
     agreements described in subsection (a) entered into on or 
     after the date of the enactment of this Act.

     SEC. 112. NOTICE AND CERTIFICATION OF AGREEMENTS.

       (a) Notice of All Agreements.--Section 1111(7) of the 
     Medicare Prescription Drug, Improvement, and Modernization 
     Act of 2003 (21 U.S.C. 355 note) is amended by inserting ``or 
     the owner of a patent for which a claim of infringement could 
     reasonably be asserted against any person for making, using, 
     offering to sell, selling, or importing into the United 
     States a biological product that is the subject of a 
     biosimilar biological product application'' before the period 
     at the end.
       (b) Certification of Agreements.--Section 1112 of such Act 
     (21 U.S.C. 355 note) is amended by adding at the end the 
     following:
       ``(d) Certification.--The Chief Executive Officer or the 
     company official responsible for negotiating any agreement 
     under subsection (a) or (b) that is required to be filed 
     under subsection (c) shall, within 30 days of such filing, 
     execute and file with the Assistant Attorney General and the 
     Commission a certification as follows: `I declare that the 
     following is true, correct, and complete to the best of my 
     knowledge: The materials filed with the Federal Trade 
     Commission and the Department of Justice under section 1112 
     of the Medicare Prescription Drug, Improvement, and 
     Modernization Act of 2003, with respect to the agreement 
     referenced in this certification--
       `` `(1) represent the complete, final, and exclusive 
     agreement between the parties;
       `` `(2) include any ancillary agreements that are 
     contingent upon, provide a contingent condition for, were 
     entered into within 30 days of, or are otherwise related to, 
     the referenced agreement; and
       `` `(3) include written descriptions of any oral 
     agreements, representations, commitments, or promises between 
     the parties that are responsive to subsection (a) or (b) of 
     such section 1112 and have not been reduced to writing.'.''.

     SEC. 113. FORFEITURE OF 180-DAY EXCLUSIVITY PERIOD.

       Section 505(j)(5)(D)(i)(V) of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355(j)(5)(D)(i)(V)) is amended by 
     inserting ``section 111 of the Strengthening Health Care and 
     Lowering Prescription Drug Costs Act or'' after ``that the 
     agreement has violated''.

     SEC. 114. COMMISSION LITIGATION AUTHORITY.

       Section 16(a)(2) of the Federal Trade Commission Act (15 
     U.S.C. 56(a)(2)) is amended--
       (1) in subparagraph (D), by striking ``or'' after the 
     semicolon;
       (2) in subparagraph (E), by inserting ``or'' after the 
     semicolon; and
       (3) by inserting after subparagraph (E) the following:
       ``(F) under section 111(d)(3)(A) of the Strengthening 
     Health Care and Lowering Prescription Drug Costs Act;''.

     SEC. 115. STATUTE OF LIMITATIONS.

       (a) In General.--Except as provided in subsection (b), the 
     Commission shall commence any administrative proceeding or 
     civil action to enforce section 111 of this Act not later 
     than 6 years after the date on which the parties to the 
     agreement file the Notice of Agreement as provided by section 
     1112(c)(2) and (d) of the Medicare Prescription Drug, 
     Improvement, and Modernization Act of 2003 (21 U.S.C. 355 
     note).
       (b) Civil Action After Issuance of Cease and Desist 
     Order.--If the Commission has issued a cease and desist order 
     under section 5 of the Federal Trade Commission Act (15 
     U.S.C. 45) for violation of section 111 of this Act and the 
     proceeding for the issuance of such order was commenced 
     within the period required by subsection (a) of this section, 
     such subsection does not prohibit the commencement, after 
     such period, of a civil action under section

[[Page H3871]]

     111(d)(3)(A) against a party to such order or a civil action 
     under subsection (l) of such section 5 for violation of such 
     order.

 Subtitle C--Creating and Restoring Equal Access to Equivalent Samples

     SEC. 121. ACTIONS FOR DELAYS OF GENERIC DRUGS AND BIOSIMILAR 
                   BIOLOGICAL PRODUCTS.

       (a) Definitions.--In this section--
       (1) the term ``commercially reasonable, market-based 
     terms'' means--
       (A) a nondiscriminatory price for the sale of the covered 
     product at or below, but not greater than, the most recent 
     wholesale acquisition cost for the drug, as defined in 
     section 1847A(c)(6)(B) of the Social Security Act (42 U.S.C. 
     1395w-3a(c)(6)(B));
       (B) a schedule for delivery that results in the transfer of 
     the covered product to the eligible product developer 
     consistent with the timing under subsection (b)(2)(A)(iv); 
     and
       (C) no additional conditions are imposed on the sale of the 
     covered product;
       (2) the term ``covered product''--
       (A) means--
       (i) any drug approved under subsection (c) or (j) of 
     section 505 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355) or biological product licensed under subsection 
     (a) or (k) of section 351 of the Public Health Service Act 
     (42 U.S.C. 262);
       (ii) any combination of a drug or biological product 
     described in clause (i); or
       (iii) when reasonably necessary to support approval of an 
     application under section 505 of the Federal Food, Drug, and 
     Cosmetic Act (21 U.S.C. 355), or section 351 of the Public 
     Health Service Act (42 U.S.C. 262), as applicable, or 
     otherwise meet the requirements for approval under either 
     such section, any product, including any device, that is 
     marketed or intended for use with such a drug or biological 
     product; and
       (B) does not include any drug or biological product that 
     appears on the drug shortage list in effect under section 
     506E of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
     356e), unless--
       (i) the drug or biological product has been on the drug 
     shortage list in effect under such section 506E continuously 
     for more than 6 months; or
       (ii) the Secretary determines that inclusion of the drug or 
     biological product as a covered product is likely to 
     contribute to alleviating or preventing a shortage.
       (3) the term ``device'' has the meaning given the term in 
     section 201 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 321);
       (4) the term ``eligible product developer'' means a person 
     that seeks to develop a product for approval pursuant to an 
     application for approval under subsection (b)(2) or (j) of 
     section 505 of the Federal Food, Drug, and Cosmetic Act (21 
     U.S.C. 355) or for licensing pursuant to an application under 
     section 351(k) of the Public Health Service Act (42 U.S.C. 
     262(k));
       (5) the term ``license holder'' means the holder of an 
     application approved under subsection (c) or (j) of section 
     505 of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
     355) or the holder of a license under subsection (a) or (k) 
     of section 351 of the Public Health Service Act (42 U.S.C. 
     262) for a covered product;
       (6) the term ``REMS'' means a risk evaluation and 
     mitigation strategy under section 505-1 of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355-1);
       (7) the term ``REMS with ETASU'' means a REMS that contains 
     elements to assure safe use under section 505-1(f) of the 
     Federal Food, Drug, and Cosmetic Act (21 U.S.C. 355-1(f));
       (8) the term ``Secretary'' means the Secretary of Health 
     and Human Services;
       (9) the term ``single, shared system of elements to assure 
     safe use'' means a single, shared system of elements to 
     assure safe use under section 505-1(f) of the Federal Food, 
     Drug, and Cosmetic Act (21 U.S.C. 355-1(f)); and
       (10) the term ``sufficient quantities'' means an amount of 
     a covered product that the eligible product developer 
     determines allows it to--
       (A) conduct testing to support an application under--
       (i) subsection (b)(2) or (j) of section 505 of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 355); or
       (ii) section 351(k) of the Public Health Service Act (42 
     U.S.C. 262(k)); and
       (B) fulfill any regulatory requirements relating to 
     approval of such an application.
       (b) Civil Action for Failure To Provide Sufficient 
     Quantities of a Covered Product.--
       (1) In general.--An eligible product developer may bring a 
     civil action against the license holder for a covered product 
     seeking relief under this subsection in an appropriate 
     district court of the United States alleging that the license 
     holder has declined to provide sufficient quantities of the 
     covered product to the eligible product developer on 
     commercially reasonable, market-based terms.
       (2) Elements.--
       (A) In general.--To prevail in a civil action brought under 
     paragraph (1), an eligible product developer shall prove, by 
     a preponderance of the evidence--
       (i) that--

       (I) the covered product is not subject to a REMS with 
     ETASU; or
       (II) if the covered product is subject to a REMS with 
     ETASU--

       (aa) the eligible product developer has obtained a covered 
     product authorization from the Secretary in accordance with 
     subparagraph (B); and
       (bb) the eligible product developer has provided a copy of 
     the covered product authorization to the license holder;
       (ii) that, as of the date on which the civil action is 
     filed, the product developer has not obtained sufficient 
     quantities of the covered product on commercially reasonable, 
     market-based terms;
       (iii) that the eligible product developer has requested to 
     purchase sufficient quantities of the covered product from 
     the license holder; and
       (iv) that the license holder has not delivered to the 
     eligible product developer sufficient quantities of the 
     covered product on commercially reasonable, market-based 
     terms--

       (I) for a covered product that is not subject to a REMS 
     with ETASU, by the date that is 31 days after the date on 
     which the license holder received the request for the covered 
     product; and
       (II) for a covered product that is subject to a REMS with 
     ETASU, by 31 days after the later of--

       (aa) the date on which the license holder received the 
     request for the covered product; or
       (bb) the date on which the license holder received a copy 
     of the covered product authorization issued by the Secretary 
     in accordance with subparagraph (B).
       (B) Authorization for covered product subject to a rems 
     with etasu.--
       (i) Request.--An eligible product developer may submit to 
     the Secretary a written request for the eligible product 
     developer to be authorized to obtain sufficient quantities of 
     an individual covered product subject to a REMS with ETASU.
       (ii) Authorization.--Not later than 120 days after the date 
     on which a request under clause (i) is received, the 
     Secretary shall, by written notice, authorize the eligible 
     product developer to obtain sufficient quantities of an 
     individual covered product subject to a REMS with ETASU for 
     purposes of--

       (I) development and testing that does not involve human 
     clinical trials, if the eligible product developer has agreed 
     to comply with any conditions the Secretary determines 
     necessary; or
       (II) development and testing that involves human clinical 
     trials, if the eligible product developer has--

       (aa)(AA) submitted protocols, informed consent documents, 
     and informational materials for testing that include 
     protections that provide safety protections comparable to 
     those provided by the REMS for the covered product; or
       (BB) otherwise satisfied the Secretary that such 
     protections will be provided; and
       (bb) met any other requirements the Secretary may 
     establish.
       (iii) Notice.--A covered product authorization issued under 
     this subparagraph shall state that the provision of the 
     covered product by the license holder under the terms of the 
     authorization will not be a violation of the REMS for the 
     covered product.
       (3) Affirmative defense.--In a civil action brought under 
     paragraph (1), it shall be an affirmative defense, on which 
     the defendant has the burden of persuasion by a preponderance 
     of the evidence--
       (A) that, on the date on which the eligible product 
     developer requested to purchase sufficient quantities of the 
     covered product from the license holder--
       (i) neither the license holder nor any of its agents, 
     wholesalers, or distributors was engaged in the manufacturing 
     or commercial marketing of the covered product; and
       (ii) neither the license holder nor any of its agents, 
     wholesalers, or distributors otherwise had access to 
     inventory of the covered product to supply to the eligible 
     product developer on commercially reasonable, market-based 
     terms;
       (B) that--
       (i) the license holder sells the covered product through 
     agents, distributors, or wholesalers;
       (ii) the license holder has placed no restrictions, 
     explicit or implicit, on its agents, distributors, or 
     wholesalers to sell covered products to eligible product 
     developers; and
       (iii) the covered product can be purchased by the eligible 
     product developer in sufficient quantities on commercially 
     reasonable, market-based terms from the agents, distributors, 
     or wholesalers of the license holder; or
       (C) that the license holder made an offer to sell 
     sufficient quantities of the covered product to the eligible 
     product developer at commercially reasonable market-based 
     terms--
       (i) for a covered product that is not subject to a REMS 
     with ETASU, by the date that is 14 days after the date on 
     which the license holder received the request for the covered 
     product, and the eligible product developer did not accept 
     such offer by the date that is 7 days after the date on which 
     the eligible product developer received such offer from the 
     license holder; or
       (ii) for a covered product that is subject to a REMS with 
     ETASU, by the date that is 20 days after the date on which 
     the license holder received the request for the covered 
     product, and the eligible product developer did not accept 
     such offer by the date that is 10 days after the date on 
     which the eligible product developer received such offer from 
     the license holder.
       (4) Methods for transmission of requests for covered 
     products.--A written request for a covered product, offer to 
     sell a covered product, or acceptance of such an offer 
     between the eligible product developer and the license holder 
     shall be made by--
       (A) certified or registered mail with return receipt 
     requested;
       (B) personal delivery; or
       (C) electronic means.
       (5) Remedies.--
       (A) In general.--If an eligible product developer prevails 
     in a civil action brought under paragraph (1), the court 
     shall--
       (i) order the license holder to provide to the eligible 
     product developer without delay sufficient quantities of the 
     covered product on commercially reasonable, market-based 
     terms;
       (ii) award to the eligible product developer reasonable 
     attorney's fees and costs of the civil action; and
       (iii) award to the eligible product developer a monetary 
     amount sufficient to deter the license

[[Page H3872]]

     holder from failing to provide eligible product developers 
     with sufficient quantities of a covered product on 
     commercially reasonable, market-based terms, if the court 
     finds, by a preponderance of the evidence--

       (I) that the license holder delayed providing sufficient 
     quantities of the covered product to the eligible product 
     developer without a legitimate business justification; or
       (II) that the license holder failed to comply with an order 
     issued under clause (i).

       (B) Maximum monetary amount.--A monetary amount awarded 
     under subparagraph (A)(iii) shall not be greater than the 
     revenue that the license holder earned on the covered product 
     during the period--
       (i) beginning on--

       (I) for a covered product that is not subject to a REMS 
     with ETASU, the date that is 31 days after the date on which 
     the license holder received the request; or
       (II) for a covered product that is subject to a REMS with 
     ETASU, the date that is 31 days after the later of--

       (aa) the date on which the license holder received the 
     request; or
       (bb) the date on which the license holder received a copy 
     of the covered product authorization issued by the Secretary 
     in accordance with paragraph (2)(B); and
       (ii) ending on the date on which the eligible product 
     developer received sufficient quantities of the covered 
     product.
       (C) Avoidance of delay.--The court may issue an order under 
     subparagraph (A)(i) before conducting further proceedings 
     that may be necessary to determine whether the eligible 
     product developer is entitled to an award under clause (ii) 
     or (iii) of subparagraph (A), or the amount of any such 
     award.
       (c) Limitation of Liability.--A license holder for a 
     covered product shall not be liable for any claim under 
     Federal, State, or local law arising out of the failure of an 
     eligible product developer to follow adequate safeguards to 
     assure safe use of the covered product during development or 
     testing activities described in this section, including 
     transportation, handling, use, or disposal of the covered 
     product by the eligible product developer.
       (d) No Violation of REMS.--Section 505-1 of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 355-1) is amended by 
     adding at the end the following new subsection:
       ``(l) Provision of Samples Not a Violation of Strategy.--
     The provision of samples of a covered product to an eligible 
     product developer (as those terms are defined in section 
     121(a) of the Strengthening Health Care and Lowering 
     Prescription Drug Costs Act) shall not be considered a 
     violation of the requirements of any risk evaluation and 
     mitigation strategy that may be in place under this section 
     for such drug.''.
       (e) Rule of Construction.--
       (1) Definition.--In this subsection, the term ``antitrust 
     laws''--
       (A) has the meaning given the term in subsection (a) of the 
     first section of the Clayton Act (15 U.S.C. 12); and
       (B) includes section 5 of the Federal Trade Commission Act 
     (15 U.S.C. 45) to the extent that such section applies to 
     unfair methods of competition.
       (2) Antitrust laws.--Nothing in this section shall be 
     construed to limit the operation of any provision of the 
     antitrust laws.

     SEC. 122. REMS APPROVAL PROCESS FOR SUBSEQUENT FILERS.

       Section 505-1 of the Federal Food, Drug, and Cosmetic Act 
     (21 U.S.C. 355-1), as amended by section 121, is further 
     amended--
       (1) in subsection (g)(4)(B)--
       (A) in clause (i) by striking ``or'' after the semicolon;
       (B) in clause (ii) by striking the period at the end and 
     inserting ``; or''; and
       (C) by adding at the end the following:
       ``(iii) accommodate different, comparable aspects of the 
     elements to assure safe use for a drug that is the subject of 
     an application under section 505(j), and the applicable 
     listed drug.'';
       (2) in subsection (i)(1), by striking subparagraph (C) and 
     inserting the following:
       ``(C)(i) Elements to assure safe use, if required under 
     subsection (f) for the listed drug, which, subject to clause 
     (ii), for a drug that is the subject of an application under 
     section 505(j) may use--
       ``(I) a single, shared system with the listed drug under 
     subsection (f); or
       ``(II) a different, comparable aspect of the elements to 
     assure safe use under subsection (f).
       ``(ii) The Secretary may require a drug that is the subject 
     of an application under section 505(j) and the listed drug to 
     use a single, shared system under subsection (f), if the 
     Secretary determines that no different, comparable aspect of 
     the elements to assure safe use could satisfy the 
     requirements of subsection (f).'';
       (3) in subsection (i), by adding at the end the following:
       ``(3) Shared rems.--If the Secretary approves, in 
     accordance with paragraph (1)(C)(i)(II), a different, 
     comparable aspect of the elements to assure safe use under 
     subsection (f) for a drug that is the subject of an 
     abbreviated new drug application under section 505(j), the 
     Secretary may require that such different comparable aspect 
     of the elements to assure safe use can be used with respect 
     to any other drug that is the subject of an application under 
     section 505(j) or 505(b) that references the same listed 
     drug.''; and
       (4) by adding at the end the following:
       ``(m) Separate REMS.--When used in this section, the terms 
     `different, comparable aspect of the elements to assure safe 
     use' or `different, comparable approved risk evaluation and 
     mitigation strategies' means a risk evaluation and mitigation 
     strategy for a drug that is the subject of an application 
     under section 505(j) that uses different methods or 
     operational means than the strategy required under subsection 
     (a) for the applicable listed drug, or other application 
     under section 505(j) with the same such listed drug, but 
     achieves the same level of safety as such strategy.''.

     SEC. 123. RULE OF CONSTRUCTION.

       (a) In General.--Nothing in this subtitle, the amendments 
     made by this subtitle, or in section 505-1 of the Federal 
     Food, Drug, and Cosmetic Act (21 U.S.C. 355-1), shall be 
     construed as--
       (1) prohibiting a license holder from providing an eligible 
     product developer access to a covered product in the absence 
     of an authorization under this subtitle; or
       (2) in any way negating the applicability of a REMS with 
     ETASU, as otherwise required under such section 505-1, with 
     respect to such covered product.
       (b) Definitions.--In this section, the terms ``covered 
     product'', ``eligible product developer'', ``license 
     holder'', and ``REMS with ETASU'' have the meanings given 
     such terms in section 121(a).

            TITLE II--HEALTH INSURANCE MARKET STABILIZATION

     SEC. 201. PRESERVING STATE OPTION TO IMPLEMENT HEALTH CARE 
                   MARKETPLACES.

       (a) In General.--Section 1311 of the Patient Protection and 
     Affordable Care Act (42 U.S.C. 18031) is amended--
       (1) in subsection (a)--
       (A) in paragraph (4)(B), by striking ``under this 
     subsection'' and inserting ``under this paragraph or 
     paragraph (1)''; and
       (B) by adding at the end the following new paragraph:
       ``(6) Additional planning and establishment grants.--
       ``(A) In general.--There shall be appropriated to the 
     Secretary, out of any moneys in the Treasury not otherwise 
     appropriated, $200,000,000 to award grants to eligible States 
     for the uses described in paragraph (3).
       ``(B) Duration and renewability.--A grant awarded under 
     subparagraph (A) shall be for a period of two years and may 
     not be renewed.
       ``(C) Limitation.--A grant may not be awarded under 
     subparagraph (A) after December 31, 2022.
       ``(D) Eligible state defined.--For purposes of this 
     paragraph, the term `eligible State' means a State that, as 
     of the date of the enactment of this paragraph, is not 
     operating an Exchange (other than an Exchange described in 
     section 155.200(f) of title 45, Code of Federal 
     Regulations).''; and
       (2) in subsection (d)(5)(A)--
       (A) by striking ``operations.--In establishing an Exchange 
     under this section'' and inserting ``operations.--
       ``(i) In general.--In establishing an Exchange under this 
     section (other than in establishing an Exchange pursuant to a 
     grant awarded under subsection (a)(6))''; and
       (B) by adding at the end the following:
       ``(ii) Additional planning and establishment grants.--In 
     establishing an Exchange pursuant to a grant awarded under 
     subsection (a)(6), the State shall ensure that such Exchange 
     is self-sustaining beginning on January 1, 2024, including 
     allowing the Exchange to charge assessments or user fees to 
     participating health insurance issuers, or to otherwise 
     generate funding, to support its operations.''.
       (b) Clarification Regarding Failure to Establish Exchange 
     or Implement Requirements.--Section 1321(c) of the Patient 
     Protection and Affordable Care Act (42 U.S.C. 18041(c)) is 
     amended--
       (1) in paragraph (1), by striking ``If'' and inserting 
     ``Subject to paragraph (3), if''; and
       (2) by adding at the end the following new paragraph:
       ``(3) Clarification.--This subsection shall not apply in 
     the case of a State that elects to apply the requirements 
     described in subsection (a) and satisfies the requirement 
     described in subsection (b) on or after January 1, 2014.''.

     SEC. 202. PROVIDING FOR ADDITIONAL REQUIREMENTS WITH RESPECT 
                   TO THE NAVIGATOR PROGRAM.

       (a) In General.--Section 1311(i) of the Patient Protection 
     and Affordable Care Act (42 U.S.C. 18031(i)) is amended--
       (1) in paragraph (2), by adding at the end the following 
     new subparagraph:
       ``(C) Selection of recipients.--In the case of an Exchange 
     established and operated by the Secretary within a State 
     pursuant to section 1321(c), in awarding grants under 
     paragraph (1), the Exchange shall--
       ``(i) select entities to receive such grants based on an 
     entity's demonstrated capacity to carry out each of the 
     duties specified in paragraph (3);
       ``(ii) not take into account whether or not the entity has 
     demonstrated how the entity will provide information to 
     individuals relating to group health plans offered by a group 
     or association of employers described in section 2510.3-5(b) 
     of title 29, Code of Federal Regulations (or any successor 
     regulation), or short-term limited duration insurance (as 
     defined by the Secretary for purposes of section 2791(b)(5) 
     of the Public Health Service Act); and
       ``(iii) ensure that, each year, the Exchange awards such a 
     grant to--

       ``(I) at least one entity described in this paragraph that 
     is a community and consumer-focused nonprofit group; and
       ``(II) at least one entity described in subparagraph (B), 
     which may include another community and consumer-focused 
     nonprofit group in addition to any such group awarded a grant 
     pursuant to subclause (I).

     In awarding such grants, an Exchange may consider an entity's 
     record with respect to waste, fraud, and abuse for purposes 
     of maintaining the integrity of such Exchange.''.

[[Page H3873]]

       (2) in paragraph (3)--
       (A) in subparagraph (C), by inserting after ``qualified 
     health plans'' the following: ``, State medicaid plans under 
     title XIX of the Social Security Act, and State child health 
     plans under title XXI of such Act''; and
       (B) by adding at the end the following flush left sentence:

     ``The duties specified in the preceding sentence may be 
     carried out by such a navigator at any time during a year.'';
       (3) in paragraph (4)(A)--
       (A) in the matter preceding clause (i), by striking 
     ``not'';
       (B) in clause (i)--
       (i) by inserting ``not'' before ``be''; and
       (ii) by striking ``; or'' and inserting ``;'';
       (C) in clause (ii)--
       (i) by inserting ``not'' before ``receive''; and
       (ii) by striking the period and inserting ``; and''; and
       (D) by adding at the end the following new clause:
       ``(iii) maintain physical presence in the State of the 
     Exchange so as to allow in-person assistance to consumers.''; 
     and
       (4) in paragraph (6)--
       (A) by striking ``Funding.--Grants under'' and inserting 
     ``Funding.--
       ``(A) State exchanges.--Grants under''; and
       (B) by adding at the end the following new subparagraph:
       ``(B) Federal exchanges.--For purposes of carrying out this 
     subsection, with respect to an Exchange established and 
     operated by the Secretary within a State pursuant to section 
     1321(c), the Secretary shall obligate $100,000,000 out of 
     amounts collected through the user fees on participating 
     health insurance issuers pursuant to section 156.50 of title 
     45, Code of Federal Regulations (or any successor 
     regulations) for fiscal year 2020 and each subsequent fiscal 
     year. Such amount for a fiscal year shall remain available 
     until expended.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply with respect to plan years beginning on or after 
     January 1, 2020.

     SEC. 203. FEDERAL EXCHANGE OUTREACH AND EDUCATIONAL 
                   ACTIVITIES.

       Section 1321(c) of the Patient Protection and Affordable 
     Care Act (42 U.S.C. 18041(c)), as amended by section 
     201(b)(2), is further amended by adding at the end the 
     following new paragraph:
       ``(4) Outreach and educational activities.--
       ``(A) In general.--In the case of an Exchange established 
     or operated by the Secretary within a State pursuant to this 
     subsection, the Secretary shall carry out outreach and 
     educational activities for purposes of informing individuals 
     about qualified health plans offered through the Exchange, 
     including by informing such individuals of the availability 
     of coverage under such plans and financial assistance for 
     coverage under such plans. Such outreach and educational 
     activities shall be provided in a manner that is culturally 
     and linguistically appropriate to the needs of the 
     populations being served by the Exchange (including hard-to-
     reach populations, such as racial and sexual minorities, 
     limited English proficient populations, and young adults).
       ``(B) Limitation on use of funds.--No funds appropriated 
     under this paragraph shall be used for expenditures for 
     promoting non-ACA compliant health insurance coverage.
       ``(C) Non-ACA compliant health insurance coverage.--For 
     purposes of subparagraph (B):
       ``(i) The term `non-ACA compliant health insurance 
     coverage' means health insurance coverage, or a group health 
     plan, that is not a qualified health plan.
       ``(ii) Such term includes the following:

       ``(I) An association health plan.
       ``(II) Short-term limited duration insurance.

       ``(D) Funding.--Out of any funds in the Treasury not 
     otherwise appropriated, there are hereby appropriated for 
     fiscal year 2020 and each subsequent fiscal year, 
     $100,000,000 to carry out this paragraph. Funds appropriated 
     under this subparagraph shall remain available until 
     expended.''.

     SEC. 204. SHORT-TERM LIMITED DURATION INSURANCE RULE 
                   PROHIBITION.

       The Secretary of Health and Human Services, the Secretary 
     of the Treasury, and the Secretary of Labor may not take any 
     action to implement, enforce, or otherwise give effect to the 
     rule entitled ``Short-Term, Limited Duration Insurance'' (83 
     Fed. Reg. 38212 (August 3, 2018)), and the Secretaries may 
     not promulgate any substantially similar rule.

                      TITLE III--BUDGETARY EFFECTS

     SEC. 301. DETERMINATION OF BUDGETARY EFFECTS.

       The budgetary effects of this Act, for the purpose of 
     complying with the Statutory Pay-As-You-Go Act of 2010, shall 
     be determined by reference to the latest statement titled 
     ``Budgetary Effects of PAYGO Legislation'' for this Act, 
     submitted for printing in the Congressional Record by the 
     Chairman of the House Budget Committee, provided that such 
     statement has been submitted prior to the vote on passage.

  The Acting CHAIR. No further amendment to the bill, as amended, shall 
be in order except those printed in House Report 116-61. Each such 
further amendment may be offered only in the order printed in the 
report, by a Member designated in the report, shall be considered read, 
shall be debatable for the time specified in the report, equally 
divided and controlled by the proponent and an opponent, shall not be 
subject to amendment, and shall not be subject to a demand for division 
of the question.


                 Amendment No. 1 Offered by Mr. Pallone

  The Acting CHAIR. It is now in order to consider amendment No. 1 
printed in House Report 116-61.
  Mr. PALLONE. Mr. Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Page 28, strike lines 8 through 11 and insert the 
     following:
       (iii) that the eligible product developer has submitted a 
     written request to purchase sufficient quantities of the 
     covered product to the license holder and such request--

       (I) was sent to a named corporate officer of the license 
     holder;
       (II) was made by certified or registered mail with return 
     receipt requested;
       (III) specified an individual as the point of contact for 
     the license holder to direct communications related to the 
     sale of the covered product to the eligible product developer 
     and a means for electronic and written communications with 
     that individual; and
       (IV) specified an address to which the covered product was 
     to be shipped upon reaching an agreement to transfer the 
     covered product; and

       Page 32, strike lines 15 through 18 and insert the 
     following:
       (C) that the license holder made an offer to the individual 
     specified pursuant to paragraph (2)(A)(iii)(III), by a means 
     of communication (electronic, written, or both) specified 
     pursuant to such paragraph, to sell sufficient quantities of 
     the covered product to the eligible product developer at 
     commercially reasonable market-based terms--
       Page 33, strike lines 13 through 22.
       Page 33, line 23, strike ``(5)'' and insert ``(4)''.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from New Jersey (Mr. Pallone) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from New Jersey.
  Mr. PALLONE. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, I have an amendment sponsored by myself and the ranking 
member of the full committee, Mr. Walden.
  We have been considering the CREATES Act and legislation like it for 
years, and it has long been one of my top priorities. So I was pleased 
to announce a bipartisan amendment that gained the support of our 
Republican colleagues during the Energy and Commerce Committee's 
consideration of the CREATES bill.
  There was only one outstanding concern still to be resolved after 
that amendment was adopted. And I am pleased now to offer a bipartisan 
solution to address that concern today.
  The concern raised during our full committee markup was that there 
was a lack of specificity in the provisions that describe the 
communication requirements related to the request and the delivery of 
the requested samples between the eligible product developer and the 
license holder.
  This bipartisan amendment filed by myself and my colleague, the 
ranking member of the Energy and Commerce Committee, Mr. Walden, will 
provide the additional needed clarity to ensure that communication 
requirements in these negotiations are understood so that there is 
certainty for both parties.
  So I think we have found agreement with our colleagues across the 
aisle around a shared goal of discouraging anti-competitive conduct and 
providing certainty to both brand and generic manufacturers about the 
sample requests and delivery process.
  I appreciate the ranking member and his staff for working with me in 
good faith on this legislation and urge all my colleagues to vote in 
support of this amendment.
  Mr. Chairman, I reserve the balance of my time.

                              {time}  1445

  Mr. SHIMKUS. Mr. Chairman, I claim the time in opposition, although I 
do not oppose this amendment.
  The Acting CHAIR. Without objection, the gentleman from Illinois is 
recognized for 5 minutes.
  There was no objection.
  Mr. SHIMKUS. Mr. Chair, the chairman of the full committee is 
correct. We appreciate his help and support in working through these 
technical corrections. We don't oppose them, and with that, I yield 
back the balance of my time.
  Mr. PALLONE. Mr. Chairman, I appreciate the comments from the 
gentleman from Illinois.

[[Page H3874]]

  Again, this is an effort to try to make sure that when a patent 
expires that the samples or formula are given to generic, so they can 
develop a generic alternative. That is what the CREATES Act is all 
about.
  I would urge support for my amendment, and I yield back the balance 
of my time.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from New Jersey (Mr. Pallone).
  The amendment was agreed to.


                Amendment No. 2 Offered by Mr. McKinley

  The Acting CHAIR. It is now in order to consider amendment No. 2 
printed in House Report 116-61.
  Mr. McKINLEY. Mr. Chairman, I rise as the designee of the gentleman 
from Indiana (Mr. Bucshon), and I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Strike title II (and redesignate the subsequent title and 
     update the table of contents accordingly).

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from West Virginia (Mr. McKinley) and a Member opposed each will 
control 5 minutes.
  The Chair recognizes the gentleman from West Virginia.
  Mr. McKINLEY. Mr. Chairman, the bills to recognize lower drug prices 
passed the Energy and Commerce Committee with unanimous bipartisan 
support.
  They were genuine efforts to address the most expensive component of 
healthcare, but Democrats have packaged these bipartisan drug-pricing 
solutions with controversial, ideologically driven legislation that 
will not be taken up by the Senate. Shame on them.
  So here we go again. According to The Washington Post, in so doing, 
the Democrats have put a pothole in the path of drug pricing. We have 
all seen the charts and seen the quotes here earlier in the day.
  Mr. Chairman, as the 11th-most bipartisan Member of the House, I 
recognize the importance of playing nice in the sandbox and putting 
good legislation before politics. This combination fails that test.
  My amendment is simple. It would strike the most controversial 
portions from the bill, leaving those areas that allow us to lower the 
cost of prescription drugs.
  Therefore, if your goal is to lower the cost of prescription drugs, I 
would encourage my friends and colleagues to vote ``yes'' on this 
amendment. But if you want to play politics with the healthcare of 
Americans and see this bill stopped in the Senate, then vote ``no,'' 
and you will see what happens.
  Mr. Chair, I reserve the balance of my time.
  Mr. PALLONE. Mr. Chairman, I claim the time in opposition to the 
amendment.
  The Acting CHAIR. The gentleman from New Jersey is recognized for 5 
minutes.
  Mr. PALLONE. Mr. Chair, I yield myself 2 minutes.
  Mr. Chairman, I am very disappointed that my Republican colleagues 
want to strike all of the ACA stabilization measures that we passed 
through our committee.
  These are important bills that should have strong bipartisan support, 
but, unfortunately, my Republican colleagues continue to be unwilling 
to work together on commonsense proposals that would lower healthcare 
costs for consumers.
  Funding for outreach and marketing, why is this even controversial to 
my Republican colleagues? Outreach and advertising are critical to 
ensuring that people know about the option to enroll in comprehensive 
coverage.
  We know that last year just one in four uninsured people who buy 
their own insurance were aware of the open enrollment season and the 
deadline to enroll in coverage.
  Another commonsense proposal to lower healthcare costs is to provide 
funds to States to set up State-based marketplaces. Again, why is this 
controversial? Over the last few years, State-based marketplaces have 
had lower premiums and better enrollment than the Federal marketplace.
  Enrollment on healthcare.gov has declined due to the Trump 
administration's sabotage. Enrollment in the State-based marketplaces 
has actually increased. The navigator funding provisions the 
Republicans are trying to strike from the bill, again, this is a 
program to help hard-to-reach individuals sign up for comprehensive 
coverage.
  Finally, the Republicans want to remove protection that would block 
the Trump administration's expansion of junk insurance plans that 
discriminate against people with preexisting conditions.
  I really can't understand why my Republican colleagues who claim to 
support protections for preexisting conditions want to defend these 
plans that discriminate against preexisting conditions and put 
consumers at extreme financial risk, other than the fact this is a 
Trump administration initiative, so they don't want to oppose it.
  In addition to discriminating against people with preexisting 
conditions, these junk plans exclude coverage for many important 
benefits, such as maternity care. And even when you think you are 
covered, if you get sick while you are on one of these, the insurance 
companies find a way to avoid paying the bill.
  So in closing, this amendment demonstrates what we all know clearly: 
that Republicans don't want to do anything to actually help lower 
healthcare costs for Americans or safeguard preexisting condition 
protections.
  Mr. Chair, I urge opposition to this amendment, and I reserve the 
balance of my time.
  Mr. McKINLEY. Mr. Chairman, this is the third time today I have heard 
the word ``sabotage'' so that must be the new operative word coming 
from my colleagues across the aisle.
  I would submit to you, I will turn the table back because if there is 
someone trying to sabotage the effort of lowering healthcare prices, it 
is you.
  Our chairman on the other side, however, I think genuinely wanted to 
lower the healthcare prices when the bills came out in a nonpartisan 
fashion which was universally adopted by us. But someplace from the 
time they left Energy and Commerce to the time they came to the floor, 
they were put into something that the Senate has already indicated they 
have no appetite for.
  So if we truly want to lower healthcare prices in this vote, then it 
is a ``yes'' vote. But if you want to sabotage this legislation, you go 
right ahead and do what you have to do.
  So I know, Mr. Chairman, there were good efforts here, bipartisan 
efforts to try to get something done. It looks like something has crept 
in to cause a problem.
  Mr. Chair, I yield back the balance of my time.
  The Acting CHAIR. Members are advised to address their remarks to the 
Chair.
  Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman 
from Florida (Ms. Castor).
  Ms. CASTOR of Florida. Mr. Chairman, we are trying to turn back the 
sabotage of the Trump administration on people's healthcare for the 
folks back home who we represent. The Trump administration has done 
everything they can to make it more expensive, whether we are talking 
about prescription drugs or that all-important health insurance policy.
  Don't just take it from me and my Democratic colleagues. Take it from 
folks who are on the side of our families day in and day out: the 
American Cancer Society Cancer Action Network, the American Diabetes 
Association, the American Heart Association, and the American Lung 
Association. I could go on and on.
  Mr. Chair, I include in the Record letters from over 20 health groups 
that represent our families back home who say: Pass this bill.
                                                     May 15, 2019.
     Hon. Kathy Castor,
     House of Representatives,
     Washington, DC.
       Dear Representative Castor: The 23 undersigned 
     organizations, representing millions of American patients, 
     providers, and consumers, write today in strong support of 
     H.R. 1010, To provide that the rule entitled ``Short-Term, 
     Limited Duration Insurance ``shall have no force or effect,'' 
     which is now included in H.R. 987. Our organizations strongly 
     support providing protections for patients from short-term, 
     limited-duration (STLDI or short-term) plans and support 
     preventing action on implementing or enforcing the ``Short-
     Term, Limited-Duration Insurance'' final rule (83 FR 38212, 
     published August 3, 2018).
       Our organizations remain concerned about this final rule 
     which expands the maximum

[[Page H3875]]

     duration of short-term health insurance plans from three 
     months to 364 days. Previously, short term plans were 
     available to fill a temporary gap in coverage, such as gaps 
     in employment. However, since the rule was finalized, the 
     growth and availability of these products continues to 
     threaten patients with pre-existing conditions because 
     insurers offering these policies can either deny coverage or 
     charge higher premiums to individuals with pre-existing 
     conditions. Expanding access to these policies could cause 
     premiums in the marketplace to increase, as younger and 
     healthier individuals choose to enroll in the short-term 
     plans. This forces individuals with serious or chronic 
     conditions into a smaller, sicker risk pool to obtain the 
     coverage they need to manage their health. Premiums for these 
     comprehensive plans would likely skyrocket, making insurance 
     unaffordable.
       Short-term plans also lack patient protections guaranteed 
     by the Affordable Care Act (ACA), severely impacting 
     individuals with serious or chronic health conditions. Plan 
     providers are permitted to consider pre-existing conditions 
     in decisions to deny coverage, charge higher premiums, or not 
     cover certain care and treatments. After enrolling in a 
     short-term plan, providers are permitted to rescind or amend 
     coverage based on new health issues. Short-term plans are not 
     required to cover all of the Essential Health Benefits (EHBs) 
     categories outlined in the ACA, potentially forcing 
     individuals to pay out-of-pocket for expensive treatments. 
     These plans can also impose lifetime and annual limits on 
     coverage and do not require limits on out-of-pocket expenses 
     and deductibles.
       H.R. 1010 would both protect patients and consumers from 
     substandard insurance products and assist in stabilizing the 
     marketplace. The decreased up-front costs of short-term plans 
     may be more appealing to younger, healthier individuals, 
     thus, dividing the individual marketplace risk pool. 
     Segmenting the market in this way will result in increased 
     premiums for comprehensive ACA-compliant plans in the 
     marketplace, decreasing marketplace stability, and reducing 
     affordable access to insurance.
       It is for these reasons we enthusiastically endorse your 
     legislation and urge Congress to act swiftly to limit the 
     sale of short-term insurance plans. People with pre-existing 
     conditions need access to adequate, affordable health 
     insurance. Again, our organizations thank you for your 
     leadership on this critical issue for people with pre-
     existing conditions, and we support your efforts to expand 
     access to affordable health insurance.
           Sincerely,
       American Cancer Society Cancer Action Network, American 
     Heart Association, American Lung Association, Arthritis 
     Foundation, Cystic Fibrosis Foundation, Epilepsy Foundation, 
     Hemophilia Federation of America, Leukemia & Lymphoma 
     Society, Lutheran Services in America, March of Dimes, Mended 
     Little Hearts, Muscular Dystrophy Association.
       National Alliance on Mental Illness, National Coalition for 
     Cancer Survivorship, National Health Council, National 
     Hemophilia Foundation, National Multiple Sclerosis Society, 
     National Organization for Rare Disorders, National Patient 
     Advocate Foundation, National Psoriasis Foundation, Susan G. 
     Kamen, The ALS Association, Women Heart: The National 
     Coalition for Women with Heart Disease.
                                  ____

                                                     May 15, 2019.
     Hon. Kathy Castor,
     House of Representatives,
     Washington, DC.
       Dear Representative Castor: The 23 undersigned 
     organizations, representing millions of American patients, 
     providers, and consumers, write today in strong support of 
     H.R. 1386, Expand Navigator's Resources for Outreach, 
     Learning, and Longevity (ENROLL) Act of 2019, which is now 
     included as a provision in H.R. 987. Our organizations 
     recognize the importance of navigator programs to assist 
     potential enrollees with the open enrollment process. Your 
     legislation will guarantee resources for navigators, allowing 
     them to continue the important work of educating Americans 
     about their coverage and enrollment options.
       In March 2017, we identified three overarching principles 
     to guide and measure any work to further reform and improve 
     the nation's health insurance system. Our core principles are 
     that health insurance coverage must be adequate, affordable, 
     and accessible. Together, our organizations understand what 
     individuals and families need to prevent disease, manage 
     health, and cure illness. Our organizations are deeply 
     concerned about cuts to these services and the lack of 
     reliable resources for consumers who have questions about how 
     to enroll in coverage. We are pleased that this legislation 
     represents a significant and meaningful step towards 
     increasing access to services that help consumers enroll in 
     high-quality health care, including Medicare and Medicaid.
       Cuts to navigators and outreach and enrollment activities 
     since 2016 have taken away resources that help consumers 
     understand and select health care coverage. Navigators and 
     consumer assisters are critical to educating the public about 
     their health insurance options and helping individuals enroll 
     in appropriate coverage. Navigators conduct outreach and must 
     provide fair, accurate, unbiased, and culturally appropriate 
     information to individuals and families regarding eligibility 
     and enrollment requirements for the marketplaces and other 
     state health insurance programs. They are valuable allies to 
     consumers seeking affordable coverage that meets their needs. 
     Many navigators also provide in-person help to low-income and 
     rural communities, consumers with limited English 
     proficiency, people with disabilities, and other populations 
     for whom such assistance is not often available.
       We strongly and enthusiastically support your legislation 
     to preserve funding for navigator programs. Informed 
     enrollees can choose plans that provide the coverage they 
     need at prices they can afford. Research has shown that 
     states that devote robust resources to marketing, outreach, 
     and enrollment assistance programs experience higher rates of 
     enrollment compared to those who do not. Providing resources 
     to ease the enrollment process will help stabilize the 
     marketplace and result in lower premiums for many enrollees.
       People with pre-existing conditions need access to 
     adequate, affordable health insurance. In order to be 
     accessible, potential enrollees need to understand open 
     enrollment and coverage options. With the increase of 
     coverage options that are not compliant with the Affordable 
     Care Act (ACA), such as short-term, limited-duration 
     insurance plans, navigator programs are particularly 
     important to allow uninsured individuals to make informed 
     decisions. This legislation will keep this information 
     accessible to all. Again, our organizations thank you for 
     your leadership on this critical issue for people with pre-
     existing conditions, and we support your efforts to expand 
     access to affordable health insurance.
           Sincerely,
       American Cancer Society Cancer Action Network, American 
     Diabetes Association, American Heart Association, American 
     Lung Association, Arthritis Foundation, Cystic Fibrosis 
     Foundation, Epilepsy Foundation, Hemophilia Federation of 
     America, Leukemia & Lymphoma Society, Lutheran Services in 
     America, Mended Little Hearts.
       Muscular Dystrophy Association, National Alliance on Mental 
     Illness, National Coalition for Cancer Survivorship, National 
     Health Council, National Hemophilia Foundation, National 
     Kidney Foundation, National Multiple Sclerosis Society, 
     National Organization for Rare Disorders, National Patient 
     Advocate Foundation, National Psoriasis Foundation, Susan G. 
     Komen, Women Heart: The National Coalition for Women with 
     Heart Disease.

  Ms. CASTOR of Florida. Mr. Chair, I wanted to make one more important 
point. I have heard so much misinformation today from my colleagues on 
the other side of the aisle who have denigrated our navigators. They 
say agents and brokers can do the job of helping to sign up our 
neighbors for health insurance.
  Boy, that is not the case. Yes, agents and brokers are important, but 
we heard expert testimony in our committee that the navigators provide 
independent, trusted advice. They are our community-based folks at 
community health centers and groups like the American Cancer Society, 
who I mentioned, that understand how important it is.
  A lot of the agents and brokers send their customers over to 
navigators to sign up because the agents and brokers are not interested 
in going over to folks who rely on Medicaid, or the Children's Health 
Insurance Program.
  Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman 
from Delaware (Ms. Blunt Rochester).
  Ms. BLUNT ROCHESTER. Mr. Chairman, I oppose this amendment because by 
stripping the ACA's stabilization bills from this package, we are 
reneging on the promise that we made to the American people: access to 
quality, affordable healthcare.
  This complete package of bills helps stabilize the ACA which will 
improve the risk pool, reduce premium cost, and lower the number of 
uninsured.
  The CBO found that my bill, the MORE Health Education Act would help 
5 million Americans obtain high-quality health insurance created by the 
ACA. It is supported by AARP, the American Hospital Association, and a 
number of other organizations, as was mentioned before.
  From day one, there has been a concern that when we shorten the 
amount of time that people can enroll, when we tell them that we are 
not going to let them know what is even available to them, and then we 
take away the resources and the individuals that can help them get 
there, that is why we feel like we have been watching and witnessing 
the move backwards.
  What we want to do with this bill is move forward. So I urge my 
colleagues to reject this amendment and support the full legislative 
package for the people.
  Mr. PALLONE. Mr. Chair, I would just ask Members to oppose this 
amendment because it guts the effort to improve the Affordable Care 
Act.

[[Page H3876]]

  Mr. Chair, I yield back the balance of my time.
  Ms. BLUNT ROCHESTER. Mr. Chair, I would like to revise my remarks 
made during debate of amendment No. 2 of H.R. 987, offered by Mr. 
McKinley. In my remarks, I stated that the marketing and outreach 
provision under Title II of H.R. 987 would increase enrollment into 
health plans by five million over the ten year period as estimated by 
the Congressional Budget Office. Due to the methodology adopted by the 
Congressional Budget Office to estimate the enrollment effect of the 
underlying measure, the figure is more appropriately represented as 
increasing enrollment by about 500,000 each year over the ten year 
period.
  The Acting CHAIR. The question is on the amendment offered by the 
gentleman from West Virginia (Mr. McKinley).
  The question was taken; and the Acting Chair announced that the noes 
appeared to have it.
  Mr. McKINLEY. Mr. Chair, I demand a recorded vote.
  The Acting CHAIR. Pursuant to clause 6 of rule XVIII, further 
proceedings on the amendment offered by the gentleman from West 
Virginia will be postponed.


                  Amendment No. 3 Offered by Mr. Welch

  The Acting CHAIR. It is now in order to consider amendment No. 3 
printed in House Report 116-61.
  Mr. WELCH. Mr. Chairman, I have an amendment at the desk.
  The Acting CHAIR. The Clerk will designate the amendment.
  The text of the amendment is as follows:

       Add at the end of title II the following new section:

     SEC. 205. PROTECTION OF HEALTH INSURANCE COVERAGE IN CERTAIN 
                   EXCHANGES.

       In the case of an Exchange that the Secretary of Health and 
     Human Services operates pursuant to section 1321(c)(1) of the 
     Patient Protection and Affordable Care Act (42 U.S.C. 
     18041(c)(1)), the Secretary may not implement any process 
     that would terminate the health insurance coverage of an 
     enrollee solely because such enrollee did not actively enroll 
     during the most recent open enrollment period.

  The Acting CHAIR. Pursuant to House Resolution 377, the gentleman 
from Vermont (Mr. Welch) and a Member opposed each will control 5 
minutes.
  The Chair recognizes the gentleman from Vermont.
  Mr. WELCH. Mr. Chairman, I yield myself such time as I may consume.
  Mr. Chairman, this amendment, which I will describe in a moment, is 
about improving and preserving the Affordable Care Act. The word 
``sabotage'' has been used here. We don't need that word. We have a 
very straightforward, very transparent difference of view.
  The Democrats supported and passed the Affordable Care Act. We have 
been defending it for years. The Republicans opposed it. President 
Trump made it a campaign pledge to get rid of it, and they came within 
a vote in the Senate, except for John McCain, of repealing the law 
altogether.
  We don't have to use words that are pejorative. We think we should 
have the Affordable Care Act. We think we should make it stronger, and 
my colleagues on the other side of the aisle want to vote against it 
and now want to repeal it.

                              {time}  1500

  One of the ways to make the Affordable Care Act effective is to have 
automatic reenrollment. If a family is in the Affordable Care Act and 
the time for reenrollment comes up, if they take no action, then they 
are automatically reenrolled in the plan that they are already in.
  If you take away the automatic reenrollment, folks fall off, 
oftentimes for no particular reason. They were doing other things; they 
didn't notice it; they didn't have the time; or they didn't get to a 
navigator. There are lots of things that come between automatic 
reenrollment and picking your own plan.
  By the way, studies have shown that automatic reenrollment, like 
automatic withdrawal to go into your retirement account, is very, very 
effective.
  The President has indicated a desire to get rid of the automatic 
reenrollment program. He hasn't done that yet. This amendment would 
prohibit him from doing so.
  There is a reason why the administration would like to get rid of 
automatic reenrollment. The evidence suggests that that would mean 
about 2 million Americans would then lose access to their healthcare 
because they hadn't reenrolled.
  We don't want that to happen. We want those American families who 
depend on the healthcare that they have to continue receiving that 
healthcare next year just like they received it this year.
  This amendment makes it very clear that that automatic reenrollment 
program would continue to be part of the Affordable Care Act.
  Keep in mind, it in no way limits the ability of a family or an 
individual to decide to get into a different plan or to affirmatively 
say they don't want to be in any plan. That can still happen. There is 
total and complete freedom of choice, but it gives security. It is 
going to be very beneficial to about 2 million American families.
  Mr. Chairman, I reserve the balance of my time.
  The Acting CHAIR. The Committee will rise informally.
  The Speaker pro tempore (Mr. DeSaulnier) assumed the chair.

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