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115th Congress    }                                      {      Report
                        HOUSE OF REPRESENTATIVES
 2d Session       }                                      {     115-906

======================================================================



 
                      EMPLOYER RELIEF ACT OF 2018

                                _______
                                

August 28, 2018.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

Mr. Brady of Texas, from the Committee on Ways and Means, submitted the 
                               following

                              R E P O R T

                             together with

                            DISSENTING VIEWS

                        [To accompany H.R. 4616]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Ways and Means, to whom was referred the 
bill (H.R. 4616) to amend the Patient Protection and Affordable 
Care Act to provide for a temporary moratorium on the employer 
mandate and to provide for a delay in the implementation of the 
excise tax on high cost employer-sponsored health coverage, 
having considered the same, report favorably thereon with an 
amendment and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
  I. SUMMARY AND BACKGROUND...........................................2
 II. EXPLANATION OF THE BILL..........................................4
          A. Moratorium on Employer Mandate......................     4
          B. Delay in Implementation of Excise Tax on High Cost 
              Employer-Sponsored Health Coverage.................     5
III. VOTES OF THE COMMITTEE...........................................8
 IV. BUDGET EFFECTS OF THE BILL.......................................9
          A. Committee Estimate of Budgetary Effects.............     9
          B. Statement Regarding New Budget Authority and Tax 
              Expenditures Budget Authority......................    11
          C. Cost Estimate Prepared by the Congressional Budget 
              Office.............................................    11
  V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE......16
          A. Committee Oversight Findings and Recommendations....    16
          B. Statement of General Performance Goals and 
              Objectives.........................................    16
          C. Information Relating to Unfunded Mandates...........    16
          D. Applicability of House Rule XXI 5(b)................    16
          E. Tax Complexity Analysis.............................    16
          F. Congressional Earmarks, Limited Tax Benefits, and 
              Limited Tariff Benefits............................    17
          G. Duplication of Federal Programs.....................    17
          H. Disclosure of Directed Rule Makings.................    17
 VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED...........17
          A. Text of Existing Law Amended or Repealed by the 
              Bill, as Reported..................................    17
VII. DISSENTING VIEWS................................................23

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Employer Relief Act of 2018''.

SEC. 2. MORATORIUM ON EMPLOYER MANDATE.

  Section 4980H of the Internal Revenue Code of 1986 is amended by 
adding at the end the following new subsection:
  ``(e) Suspension.--This section shall not apply to any month 
beginning after December 31, 2014, and before January 1, 2019.''.

SEC. 3. DELAY IN IMPLEMENTATION OF EXCISE TAX ON HIGH COST EMPLOYER-
                    SPONSORED HEALTH COVERAGE.

  Section 9001(c) of the Patient Protection and Affordable Care Act is 
amended by striking ``December 31, 2021'' and inserting ``December 31, 
2022''.

                       I. SUMMARY AND BACKGROUND


                         A. Purpose and Summary

    The bill H.R. 4616, as reported by the Committee on Ways 
and Means, provides retroactive relief from Obamacare's 
employer mandate and one additional year of delay in the 
implementation of the law's ``Cadillac tax'' on high-cost 
employer health plans.

                 B. Background and Need for Legislation

    The Affordable Care Act (ACA), also known as ``Obamacare,'' 
imposes a mandate on employers with more than 50 full-time 
equivalent workers (FTEs) to offer health coverage to their 
workers or pay one of two penalties. Full-time workers for the 
purposes of the employer mandate are defined as those who work 
at least 30 hours per week. After a one-year delay by the Obama 
Administration, the employer mandate was partially implemented 
in 2015 and then fully implemented in 2016. In November 2017, 
the Internal Revenue Service (IRS) began issuing notices to 
employers of employer mandate penalty collection for 2015.
    The ACA also imposes a 40 percent excise tax on high-cost 
employer health plans, commonly referred to as the ``Cadillac 
tax.'' The tax was originally supposed to be implemented in 
2018 but has since been delayed by Congress until 2022.
    The ACA's government intrusion into the employer/employee 
relationship through the employer mandate and flawed Cadillac 
tax increases costs on employers and harms job growth. The 
Obama Administration appears to have failed to take required 
action to protect employees, employers, and the taxpayers with 
respect to timely notification of potential liability under the 
law's employer mandate. Now, employers are being asked to prove 
they were in compliance with the employer mandate for coverage 
in 2015, three years after the fact. This retroactive 
enforcement for compliance with a then partially implemented 
mandate that lacked clear guidance places a needless burden on 
employers.

                         C. Legislative History


Background

    H.R. 4616 was introduced on December 12, 2017 and was 
referred to the Committee on Ways and Means.

Committee action

    The Committee on Ways and Means marked up H.R. 4616, the 
``Employer Relief Act of 2018,'' on July 11, 2018, and ordered 
the bill, as amended, favorably reported (with a quorum being 
present).

Committee hearings

    The policy issues associated with the employer mandate and 
the issue of tax pertaining to health care and the ACA were 
discussed at the following Ways and Means hearings during the 
112th through 115th Congresses:
           Full Committee Hearing on the Health Care 
        Law's Impact on Jobs, Employers, and the Economy 
        (January 26, 2011)
           Subcommittee on Health Hearing on the 
        Individual and Employer Mandates in the Democrats' 
        Health Care Law (March 29, 2012)
           Subcommittee on Oversight Hearing on the 
        Tax-Related Provisions in the President's Health Care 
        Law (March 5, 2013)
           Subcommittee on Health Hearing on the Delay 
        of the Employer Mandate (July 10, 2013)
           Subcommittee on Health Hearing on the Delay 
        of the Employer Mandate Penalties and Reporting 
        Requirements (July 17, 2013)
           Subcommittee on Health Hearing on the 
        Treasury Department's Final Employer Mandate and 
        Employer Reporting Requirements Regulations (April 8, 
        2014)
           Subcommittee on Health Hearing on the 
        Individual and Employer Mandates in the President's 
        Healthcare Law (April 14, 2015)
           Full Committee Hearing on the Tax Treatment 
        of Health Care (April 14, 2016)
           Subcommittee on Tax Policy Member Day 
        Hearing on Tax Legislation (May 12, 2016)
           Subcommittee on Health Member Day Hearing on 
        Tax-Related Proposals to Improve Health Care (May 17, 
        2016)
           Subcommittee on Health Hearing on Rising 
        Health Insurance Premiums Under the Affordable Care Act 
        (July 12, 2016)
           Subcommittee on Health Hearing on Lowering 
        Costs and Expanding Access to Health Care through 
        Consumer-Directed Health Plans (June 6, 2018)

                      II. EXPLANATION OF THE BILL


                   A. Moratorium on Employer Mandate


                              PRESENT LAW

In general

    An applicable large employer, as defined below, may be 
subject to a tax, called an ``assessable payment,'' for a month 
if one or more of its full-time employees is certified to the 
employer as receiving for the month a premium assistance credit 
with respect to health insurance purchased through an Exchange 
(commonly referred to as the ``employer mandate'').\1\ As 
discussed below, the amount of the assessable payment depends 
on whether the employer offers its full-time employees and 
their dependents the opportunity to enroll in minimum essential 
coverage under a group health plan sponsored by the employer 
and, if it does, whether the coverage offered is affordable and 
provides minimum value.
---------------------------------------------------------------------------
    \1\Sec. 4980H. As discussed in Part A, premium assistance credits 
under section 36B apply with respect to health insurance purchased 
through an Exchange. An employer may also be subject to an assessable 
payment if an employee received reduced cost-sharing with respect to 
coverage purchased through an Exchange as discussed in Part A.
---------------------------------------------------------------------------

Definitions of full-time employee and applicable large employer

    Applicable large employer generally means, with respect to 
a calendar year, an employer who employed an average of at 
least 50 full-time employees on business days during the 
preceding calendar year. For purposes of these rules, full-time 
employee means, with respect to any month, an employee who is 
employed on average at least 30 hours of service per week. 
Solely for purposes of determining whether an employer is an 
applicable large employer (that is, whether the employer has at 
least 50 full-time employees), besides the number of full-time 
employees, the employer must include the number of its full-
time equivalent employees for a month, determined by dividing 
the aggregate number of hours of service of employees who are 
not full-time employees for the month by 120. In addition, in 
determining whether an employer is an applicable large 
employer, members of the same controlled group, group under 
common control, and affiliated service group are treated as a 
single employer.\2\ If the group is an applicable large 
employer under this test, each member of the group is an 
applicable large employer even if any member by itself would 
not be an applicable large employer.
---------------------------------------------------------------------------
    \2\The rules for determining controlled group, group under common 
control, and affiliated service group under section 414(b), (c), (m), 
and (o) apply for this purpose.
---------------------------------------------------------------------------

Assessable payments

    If an applicable large employer does not offer its full-
time employees and their dependents minimum essential coverage 
under an employer-sponsored plan and at least one full-time 
employee is so certified to the employer, the employer may be 
subject to an assessable payment (for 2018) of $2,320 (divided 
by 12 and applied on a monthly basis) multiplied by the number 
of its full-time employees in excess of 30, regardless of the 
number of full-time employees so certified.
    Generally an employee who is offered minimum essential 
coverage under an employer-sponsored plan is not eligible for a 
premium assistance credit or reduced cost-sharing unless the 
coverage is unaffordable or fails to provide minimum value.\3\ 
However, if an employer offers its full-time employees and 
their dependents minimum essential coverage under an employer-
sponsored plan and at least one full-time employee is certified 
as receiving a premium assistance credit or reduced cost-
sharing (because the coverage is unaffordable or fails to 
provide minimum value), the employer may be subject to an 
assessable payment (for 2018) of $3,480 (divided by 12 and 
applied on a monthly basis) multiplied by the number of such 
full-time employees. However, the assessable payment in this 
case is capped at the amount that would apply if the employer 
failed to offer its full-time employees and their dependents 
minimum essential coverage.
---------------------------------------------------------------------------
    \3\Coverage under an employer-sponsored plan is unaffordable if the 
employee's share of the premium for self-only coverage exceeds 9.5 
percent of household income, and the coverage fails to provide minimum 
value if the plan's share of total allowed cost of provided benefits is 
less than 60 percent of such costs.
---------------------------------------------------------------------------

                           REASONS FOR CHANGE

    The Committee believes that the employer mandate imposes an 
undue and unnecessary burden on employers by requiring them to 
offer minimum essential coverage to their full-time employees. 
The Committee believes a retroactive moratorium on the employer 
mandate will help provide relief for employers that struggled 
to comply with the ACA's complicated new requirements during 
the first few years of implementation.

                        EXPLANATION OF PROVISION

    Under the proposal, the employer mandate does not apply to 
any month beginning after December 31, 2014, and before January 
1, 2019.

                             EFFECTIVE DATE

    The proposal is effective for taxable years beginning after 
December 31, 2018.

    B. Delay in Implementation of Excise Tax on High Cost Employer-
                       Sponsored Health Coverage


                              PRESENT LAW

In general

    Effective for taxable years beginning after December 31, 
2021, an excise tax is imposed on the provider of applicable 
employer-sponsored health coverage (the ``coverage provider'') 
if the aggregate cost of the coverage for an employee 
(including a former employee, surviving spouse, or any other 
primary insured individual) exceeds a threshold amount 
(referred to as ``high cost health coverage'').\4\ The tax is 
40 percent of the amount by which aggregate cost exceeds the 
threshold amount (the ``excess benefit'').
---------------------------------------------------------------------------
    \4\Sec. 4980I, was added to the Code by section 9001 of the Patient 
Protection and Affordable Care Act (PPACA) and amended by section 10901 
of PPACA and section 1401 of the Health Care and Education and 
Reconciliation Act (HCERA). The effective date was subsequently changed 
by section 1401(b)(2) of Pub. L. No. 111-152, section 101(a) of Pub. L. 
No. 114-113, and section 4002 of Pub. L. No. 115-120.
---------------------------------------------------------------------------
    The annual threshold amount for 2018 is $10,200 for self-
only coverage and $27,500 for other coverage (such as family 
coverage), multiplied by a one-time health cost adjustment 
percentage.\5\ This threshold is then adjusted annually by an 
age- and gender-adjusted excess premium amount. The age- and 
gender-adjusted excess premium amount is the excess, if any, of 
(1) the premium cost of standard FEHBP coverage for the type of 
coverage provided to an individual if priced for the age and 
gender characteristics of all employees of the employer, over 
(2) the premium cost of standard FEHBP coverage if priced for 
the age and gender characteristics of the national workforce. 
For this purpose, standard FEHBP coverage means the per 
employee cost of Blue Cross/Blue Shield standard benefit 
coverage under the Federal Employees Health Benefit Program.
---------------------------------------------------------------------------
    \5\The health cost adjustment percentage is 100 percent plus the 
excess, if any, of (1) the percentage by which the cost of standard 
FEHBP coverage for 2018 (determined according to specified criteria) 
exceeds the cost of standard FEHBP coverage for 2010, over (2) 55 
percent.
---------------------------------------------------------------------------
    The excise tax is determined on a monthly basis, by 
reference to the monthly aggregate cost of applicable employer-
sponsored coverage for the month and 1/12 of the annual 
threshold amount.

Applicable employer-sponsored coverage and determination of cost

    Subject to certain exceptions, applicable employer-
sponsored coverage is coverage under any group health plan 
offered to an employee by an employer that is excludible from 
the employee's gross income or that would be excludible if it 
were employer-sponsored coverage.\6\ Thus, applicable employer-
sponsored coverage includes coverage for which an employee pays 
on an after-tax basis. Applicable employer-sponsored coverage 
includes coverage under any group health plan established and 
maintained primarily for its civilian employees by the Federal 
government or any Federal agency or instrumentality, or the 
government of any State or political subdivision thereof or any 
agency or instrumentality of a State or political subdivision.
---------------------------------------------------------------------------
    \6\Section 106 provides an exclusion for employer-provided 
coverage.
---------------------------------------------------------------------------
    Applicable employer-sponsored coverage includes both 
insured and self-insured health coverage, including coverage in 
the form of reimbursements under a health flexible spending 
account (``health FSA'') or a health reimbursement arrangement 
and contributions to a health savings account (``HSA'') or 
Archer medical savings account (``Archer MSA'').\7\ In the case 
of a self-employed individual, coverage is treated as 
applicable employer-sponsored coverage if the self-employed 
individual is allowed a deduction for all or any portion of the 
cost of coverage.\8\
---------------------------------------------------------------------------
    \7\Some types of coverage are not included in applicable employer-
sponsored coverage, such as long-term care coverage, separate insurance 
coverage substantially all the benefits of which are for treatment of 
the mouth (including any organ or structure within the mouth) or of the 
eye, and certain excepted benefits. Excepted benefits for this purpose 
include (whether through insurance or otherwise) coverage only for 
accident, or disability income insurance, or any combination thereof; 
coverage issued as a supplement to liability insurance; liability 
insurance, including general liability insurance and automobile 
liability insurance; workers' compensation or similar insurance; 
automobile medical payment insurance; credit-only insurance; and other 
similar insurance coverage (as specified in regulations), under which 
benefits for medical care are secondary or incidental to other 
insurance benefits. Applicable employer-sponsored coverage does not 
include coverage only for a specified disease or illness or hospital 
indemnity or other fixed indemnity insurance if the cost of the 
coverage is not excludible from an employee's income or deductible by a 
self-employed individual.
    \8\Section 162(l) allows a deduction to a self-employed individual 
for the cost of health insurance.
---------------------------------------------------------------------------
    For purposes of the excise tax, the cost of applicable 
employer-sponsored coverage is generally determined under rules 
similar to the rules for determining the applicable premium for 
purposes of COBRA continuation coverage,\9\ except that any 
portion of the cost of coverage attributable to the excise tax 
is not taken into account. Cost is determined separately for 
self-only coverage and other coverage. Special valuation rules 
apply to retiree coverage, certain health FSAs, and 
contributions to HSAs and Archer MSAs.
---------------------------------------------------------------------------
    \9\Sec. 4980B(f)(4).
---------------------------------------------------------------------------

Calculation of excess benefit and imposition of excise tax

    In determining the excess benefit with respect to an 
employee (i.e., the amount by which the cost of applicable 
employer-sponsored coverage for the employee exceeds the 
threshold amount), the aggregate cost of all applicable 
employer-sponsored coverage of the employee is taken into 
account. The threshold amount for self-only coverage generally 
applies to an employee. The threshold amount for other coverage 
applies to an employee only if the employee and at least one 
other beneficiary are enrolled in coverage other than self-only 
coverage under a group health plan that provides minimum 
essential coverage and under which the benefits provided do not 
vary based on whether the covered individual is the employee or 
other beneficiary. For purposes of the threshold amount, any 
coverage provided under a multiemployer plan is treated as 
coverage other than self-only coverage.\10\
---------------------------------------------------------------------------
    \10\As defined in section 414(f), a multiemployer plan is generally 
a plan to which more than one employer is required to contribute and 
that is maintained pursuant to one or more collective bargaining 
agreements between one or more employee organizations and more than one 
employer.
---------------------------------------------------------------------------
    The excise tax is imposed on the coverage provider.\11\ In 
the case of insured coverage (i.e., coverage under a policy, 
certificate, or contract issued by an insurance company), the 
health insurance issuer is liable for the excise tax. In the 
case of self-insured coverage, the person that administers the 
plan benefits (``plan administrator'') is generally liable for 
the excise tax. However, in the case of employer contributions 
to an HSA or an Archer MSA, the employer is liable for the 
excise tax.
---------------------------------------------------------------------------
    \11\The excise tax is allocated pro rata among the coverage 
providers, with each responsible for the excise tax on an amount equal 
to the total excess benefit multiplied by a fraction, the numerator of 
which is the cost of the applicable employer-sponsored coverage of that 
coverage provider and the denominator of which is the aggregate cost of 
all applicable employer-sponsored coverage of the employee.
---------------------------------------------------------------------------
    The employer is generally responsible for calculating the 
amount of excess benefit allocable to each coverage provider 
and notifying each coverage provider (and the IRS) of the 
coverage provider's allocable share. In the case of applicable 
employer-sponsored coverage under a multiemployer plan, the 
plan sponsor is responsible for the calculation and 
notification.\12\
---------------------------------------------------------------------------
    \12\The employer or multiemployer plan sponsor may be liable for a 
penalty if the total excise tax due exceeds the tax on the excess 
benefit calculated and allocated among coverage providers by the 
employer or plan sponsor.
---------------------------------------------------------------------------

                           REASONS FOR CHANGE

    The Committee believes the excise tax on high-cost 
employer-sponsored health coverage was created to provide a tax 
incentive for employers to curb health care costs, including 
future increases in costs. In theory, because health benefits 
are important to employees, the excise tax on high-cost 
employer-sponsored health coverage should motivate employers 
and insurance issuers to find savings and reduce health care 
costs. While this is a worthy goal, the excise tax is poorly 
designed and disrupts the level of benefits provided to 
employees. To comply with the limits, employers will have to 
modify their health plans by either cutting benefits or 
shifting costs to employees. The Committee believes that 
postponing the punitive excise tax on employer-provided 
coverage until structural health care reform can be adopted 
will provide relief to employers and employees who are facing 
increased costs or decreased benefits and give employers more 
time to identify and implement their own measures to contain 
health care costs.

                        EXPLANATION OF PROVISION

    Under the proposal, implementation of the excise tax on 
high-cost employer-sponsored health coverage is delayed until 
after December 31, 2022.

                             EFFECTIVE DATE

    The proposal is effective for taxable years beginning after 
December 31, 2018.

                      III. VOTES OF THE COMMITTEE

    In compliance with clause 3(b) of rule XIII of the House of 
Representatives, the following statement is made concerning the 
vote of the Committee on Ways and Means during the markup 
consideration of H.R. 4616, the ``Employer Relief Act of 
2018,'' on July 11, 2018.
    H.R. 4616 was ordered favorably reported to the House of 
Representatives as amended by an amendment in the nature of a 
substitute offered by Mr. Roskam by a roll call vote of 22 yeas 
to 15 nays. The vote was as follows:

----------------------------------------------------------------------------------------------------------------
          Representative             Yea      Nay     Present      Representative      Yea      Nay     Present
----------------------------------------------------------------------------------------------------------------
Mr. Brady........................       X   .......  .........  Mr. Neal...........  .......       X   .........
Mr. Johnson......................       X   .......  .........  Mr. Levin..........  .......       X   .........
Mr. Nunes........................       X   .......  .........  Mr. Lewis..........  .......       X   .........
Mr. Reichert.....................       X   .......  .........  Mr. Doggett........  .......       X   .........
Mr. Roskam.......................       X   .......  .........  Mr. Thompson.......  .......       X   .........
Mr. Buchanan.....................       X   .......  .........  Mr. Larson.........  .......       X   .........
Mr. Smith (NE)...................       X   .......  .........  Mr. Blumenauer.....  .......       X   .........
Ms. Jenkins......................       X   .......  .........  Mr. Kind...........  .......       X   .........
Mr. Paulsen......................       X   .......  .........  Mr. Pascrell.......  .......       X   .........
Mr. Marchant.....................       X   .......  .........  Mr. Crowley........  .......       X   .........
Ms. Black........................  .......  .......  .........  Mr. Davis..........  .......       X   .........
Mr. Reed.........................       X   .......  .........  Ms. Sanchez........  .......  .......  .........
Mr. Kelly........................       X   .......  .........  Mr. Higgins........  .......       X   .........
Mr. Renacci......................       X   .......  .........  Ms. Sewell.........  .......       X   .........
Ms. Noem.........................  .......  .......  .........  Ms. DelBene........  .......       X   .........
Mr. Holding......................       X   .......  .........  Ms. Chu............  .......       X   .........
Mr. Smith (MO)...................       X   .......  .........
Mr. Rice.........................       X   .......  .........
Mr. Schweikert...................       X   .......  .........
Ms. Walorski.....................       X   .......  .........
Mr. Curbelo......................       X   .......  .........
Mr. Bishop.......................       X   .......  .........
Mr. LaHood.......................       X   .......  .........
Mr. Wenstrup.....................       X   .......  .........
----------------------------------------------------------------------------------------------------------------

                     IV. BUDGET EFFECTS OF THE BILL


               A. Committee Estimate of Budgetary Effects

    In compliance with clause 3(d) of rule XIII of the Rules of 
the House of Representatives, the following statement is made 
concerning the effects on the budget of the bill, H.R. 4616, as 
reported.
    The bill, as reported, is estimated to have the following 
effect on Federal fiscal year budget receipts for the period 
2019-2028:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                Fiscal Years--Millions of Dollars
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                        Item                              2019         2020        2021       2022       2023       2024       2025       2026       2027       2028      2019-23      2019-28
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Moratorium on Employer Mandate 1....................      -12,111      -10,169     -3,630  .........  .........  .........  .........  .........  .........  .........      -25,910      -25,910
Delay in Implementation of Excise tax on High-Cost    ...........  ...........  .........     -7,822     -5,766  .........  .........  .........  .........  .........      -13,588      -13,588
 Employer Sponsored Health Coverage 1,2,3...........
    Total...........................................      -12,111      -10,169     -3,630     -7,822     -5,766  .........  .........  .........  .........  .........      -39,498      -39,498
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
NOTE: Details may not add to totals due to rounding.
\1\ Estimate provided by the staff of the Joint Committee on Taxation and the Congressional Budget Office.


 
                                                          2019         2020        2021       2022       2023       2024       2025       2026       2027       2028      2019-23      2019-28
 
 2 Estimate includes the following off-budget         ...........  ...........  .........       -291       -113  .........  .........  .........  .........  .........         -404         -404
 effects............................................
 3 Estimate includes the following outlay effects...  ...........  ...........  .........     -1,359       -582  .........  .........  .........  .........  .........       -1,941       -1,941
 

    Pursuant to clause 8 of rule XIII of the Rules of the House 
of Representatives, the following statement is made by the 
Joint Committee on Taxation with respect to the provisions of 
the bill amending the Internal Revenue Code of 1986: The gross 
budgetary effect (before incorporating macroeconomic effects) 
in any fiscal year is less than 0.25 percent of the current 
projected gross domestic product of the United States for that 
fiscal year; therefore, the bill is not ``major legislation'' 
for purposes of requiring that the estimate include the 
budgetary effects of changes in economic output, employment, 
capital stock and other macroeconomic variables.

B. Statement Regarding New Budget Authority and Tax Expenditures Budget 
                               Authority

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee states that the 
bill involves no new or increased budget authority. The 
Committee further states that the revenue-reducing tax 
provision involves a new tax expenditure. See Part IV.A., 
above.

      C. Cost Estimate Prepared by the Congressional Budget Office

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, requiring a cost estimate 
prepared by the CBO, the following statement by CBO is 
provided.

H.R. 4616--Employer Relief Act of 2018

    Summary: H.R. 4616 would suspend collection of penalties 
imposed on large employers who decline to offer their employees 
health insurance coverage that meets specified standards (known 
as the employer mandate) for plan years 2015-2018. It also 
would delay implementation of the excise tax on high-premium 
insurance plans by one year. CBO and the staff of the Joint 
Committee on Taxation (JCT) estimate that enacting the 
legislation would increase federal deficits by $39.5 billion 
over the 2019-2028 period.
    Enacting H.R. 4616 would affect direct spending and 
revenues; therefore, pay-as-you-go procedures apply.
    CBO and JCT estimate that enacting H.R. 4616 would not 
increase net direct spending or on-budget deficits in any of 
the four consecutive 10-year periods beginning in 2029.
    JCT has determined that the bill contains no 
intergovernmental or private-sector mandates as defined in the 
Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary effect of H.R. 4616 is shown in the following table. 
The costs of this legislation fall within budget function 550 
(health).

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                         By fiscal year, in billions of dollars--
                                 -----------------------------------------------------------------------------------------------------------------------
                                   2018     2019      2020      2021      2022      2023     2024    2025    2026    2027    2028   2019-2023  2019-2028
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                DECREASES (-) IN REVENUES
 
Moratorium on Employer Mandate
    Estimated Revenues..........       0     -12.1     -10.2      -3.6         0         0       0       0       0       0       0      -25.9      -25.9
Delay in Implementation of
 Excise Tax on High-Premium
 Insurance Plans
    Estimated Revenues..........       0         0         0         0      -9.2      -6.3       0       0       0       0       0      -15.5      -15.5
Total Changes in Revenues.......       0     -12.1     -10.2      -3.6      -9.2      -6.3       0       0       0       0       0      -41.4      -41.4
    On-Budget...................       0     -12.1     -10.2      -3.6      -8.9      -6.2       0       0       0       0       0      -41.0      -41.0
    Off-Budgeta.................       0         0         0         0      -0.3      -0.1       0       0       0       0       0       -0.4       -0.4
 
                                                            DECREASES (-) IN DIRECT SPENDING
 
Delay in Implementation of
 Excise Tax on High-Premium
 Insurance Plans
    Estimated Budget Authority..       0         0         0         0      -1.4      -0.6       0       0       0       0       0       -1.9       -1.9
    Estimated Outlays...........       0         0         0         0      -1.4      -0.6       0       0       0       0       0       -1.9       -1.9
 
                                     NET INCREASE IN THE DEFICIT FROM DECREASES (-) IN DIRECT SPENDING AND REVENUES
 
Impact on Deficit...............       0      12.1      10.2       3.6       7.8       5.8       0       0       0       0       0       39.5       39.5
    On-Budget...................       0      12.1      10.2       3.6       7.5       5.7       0       0       0       0       0       39.1       39.1
    Off-Budgeta.................       0         0         0         0       0.3       0.1       0       0       0       0       0        0.4        0.4
--------------------------------------------------------------------------------------------------------------------------------------------------------
Annual amounts may not sum to totals because of rounding.
aAll off-budget effects would come from changes in Social Security revenues.
bFor revenues, a negative number indicates a decrease (adding to the deficit).

    Basis of estimate: For this estimate, CBO assumes the 
legislation will be enacted near the end of fiscal year 2018. 
CBO and JCT estimate that enacting the legislation would 
increase federal deficits by $39.5 billion over the 2019-2028 
period; that change would result from a $1.9 billion decrease 
in outlays and a $41.4 billion decrease in revenues.
    Moratorium on Employer Mandate Penalties. Section 2 of H.R. 
4616 would suspend collection of employer mandate penalties 
related to plan years 2015 through 2018. CBO and JCT estimate 
that the moratorium on the penalties would decrease revenues by 
$25.9 billion over the 2019-2028 period.
    Under current law, large employers that do not offer health 
insurance coverage that meets certain standards under the 
Affordable Care Act will owe a penalty if they have any full-
time employees who receive a subsidy through a health insurance 
marketplace.\1\ The requirement generally applies to employers 
with at least 50 full-time equivalent employees. The Internal 
Revenue Service (IRS) is in the process of collecting penalties 
for plan year 2015. CBO and JCT estimate that, under the bill, 
any penalties that have been collected would be refunded and 
that the IRS would cease collecting penalties for plan years 
2015 through 2018. Because the penalties would not be collected 
for prior plan years and would remain in place for years after 
2018, CBO and JCT estimate that the provision would not 
significantly affect employer decisions about offering 
insurance coverage.
---------------------------------------------------------------------------
    \1\To meet the standards, the cost to employees for self-only 
coverage must not exceed a specified share of their income (which is 
9.56 percent in 2018 and is scheduled to grow over time), and the plan 
must pay at least 60 percent of the cost of covered benefits.
---------------------------------------------------------------------------
    Delaying Implementation of Excise Tax on High-Premium 
Insurance Plans. Section 3 of H.R. 4616 would delay the 
implementation of the excise tax on high-premium employment-
based insurance plans until 2023. (The tax is currently 
scheduled to take effect beginning in 2022.) CBO and JCT 
estimate that the delay would decrease outlays by $1.9 billion 
and decrease revenues by $15.5 billion over the 2019-2028 
period, resulting in an estimated $13.6 billion increase in the 
deficit.
    Current law requires providers of employment-based 
insurance to pay a federal excise tax on certain high-cost 
employment-based coverage beginning in 2022.\2\ CBO and JCT 
expect that the excise tax will cause employers and employees 
to shift to lower cost plans to avoid paying the tax or to 
reduce their taxable liability. H.R. 4616 would delay the tax 
from applying until 2023.
---------------------------------------------------------------------------
    \2\The excise tax will apply to plans that have total premiums 
above a certain threshold. The tax will be equal to 40 percent of the 
difference between the total value of the contributions and the 
applicable threshold.
---------------------------------------------------------------------------
    The estimated decrease in revenues of $15.5 billion over 
the 2019-2028 period stems from foregone excise tax receipts 
and from fewer employers and workers shifting to lower-cost 
health insurance plans to avoid paying the tax. That is, 
relative to current law, more people would remain in higher 
cost health insurance plans, and a larger share of total 
compensation would take the form of non-taxable health 
benefits, decreasing the share that takes the form of taxable 
wages and salaries. The reduction in revenues also reflects CBO 
and JCT's expectation that some employers who are projected to 
stop offering health insurance under current law would instead 
continue to offer insurance whose total value exceeds the 
specified thresholds for the excise tax. That response would 
further reduce the share of compensation taking the form of 
taxable wages and salaries.
    The estimated $1.9 billion decrease in outlays over the 
2019-2028 period is attributable to individuals who would have 
received marketplace subsidies under current law and would 
instead enroll in employment-based coverage.
    Pay-As-You-Go considerations: The Statutory Pay-As-You-Go 
Act of 2010 establishes budget-reporting and enforcement 
procedures for legislation affecting direct spending or 
revenues. The net changes in outlays and on budget revenues 
that are subject to those pay-as-you-go procedures are shown in 
the following table.

                               CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 4616, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON WAYS AND MEANS ON JULY 11, 2018
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                               By fiscal year, in millions of dollars--
                                                                    ----------------------------------------------------------------------------------------------------------------------------
                                                                      2018      2019       2020       2021       2022       2023     2024    2025    2026    2027    2028   2018-2023  2018-2028
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                      NET INCREASE OR DECREASE (-) IN THE ON-BUDGET DEFICIT
 
Statutory Pay-As-You-Go Effect.....................................       0     12,111     10,169      3,630      7,531      5,653       0       0       0       0       0     39,094     39,094
Memorandum:
    Changes in Outlays.............................................       0          0          0          0     -1,359       -582       0       0       0       0       0     -1,941     -1,941
    Changes in Revenues (on-budget)................................       0    -12,111    -10,169     -3,630     -8,890     -6,235       0       0       0       0       0    -41,035    -41,035
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

    Increase in long-term direct spending and deficits: CBO and 
JCT estimate that enacting the legislation would not increase 
net direct spending or on-budget deficits in any of the four 
consecutive 10-year periods beginning in 2029.
    Mandates: JCT has determined that the bill contains no 
intergovernmental or private-sector mandates as defined in 
UMRA.
    Estimate prepared by: Federal Costs: Kate Fritzsche, Emily 
Vreeland, and the staff of the Joint Committee on Taxation; 
Mandates: The staff of the Joint Committee on Taxation.
    Estimate approved by: Chad M. Chirico, Chief, Low-Income 
Health Programs and Prescription Drugs Cost Estimates Unit; 
Sarah Masi, Special Assistant for Health; Leo Lex, Deputy 
Assistant Director for Budget Analysis.

     V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF THE HOUSE


          A. Committee Oversight Findings and Recommendations

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee advises that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated into 
the description portions of this report.

        B. Statement of General Performance Goals and Objectives

    With respect to clause 3(c)(4) of rule XIII of the Rules of 
the House of Representatives, the Committee advises that the 
bill contains no measure that authorizes funding, so no 
statement of general performance goals and objectives for which 
any measure authorizes funding is required.

              C. Information Relating to Unfunded Mandates

    This information is provided in accordance with section 423 
of the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104-
4).
    The Committee has determined that the bill does not contain 
Federal mandates on the private sector. The Committee has 
determined that the bill does not impose a Federal 
intergovernmental mandate on State, local, or tribal 
governments.

                D. Applicability of House Rule XXI 5(b)

    Rule XXI 5(b) of the Rules of the House of Representatives 
provides, in part, that ``A bill or joint resolution, 
amendment, or conference report carrying a Federal income tax 
rate increase may not be considered as passed or agreed to 
unless so determined by a vote of not less than three-fifths of 
the Members voting, a quorum being present.'' The Committee has 
carefully reviewed the bill and states that the bill does not 
involve any Federal income tax rate increases within the 
meaning of the rule.

                       E. Tax Complexity Analysis

    Section 4022(b) of the Internal Revenue Service 
Restructuring and Reform Act of 1998 (``IRS Reform Act'') 
requires the staff of the Joint Committee on Taxation (in 
consultation with the Internal Revenue Service and the Treasury 
Department) to provide a tax complexity analysis. The 
complexity analysis is required for all legislation reported by 
the Senate Committee on Finance, the House Committee on Ways 
and Means, or any committee of conference if the legislation 
includes a provision that directly or indirectly amends the 
Internal Revenue Code of 1986 and has widespread applicability 
to individuals or small businesses.
    Pursuant to clause 3(h)(1) of rule XIII of the Rules of the 
House of Representatives, the staff of the Joint Committee on 
Taxation has determined that a complexity analysis is not 
required under section 4022(b) of the IRS Reform Act because 
the bill contains no provisions that amend the Internal Revenue 
Code of 1986 and that have ``widespread applicability'' to 
individuals or small businesses, within the meaning of the 
rule.

  F. Congressional Earmarks, Limited Tax Benefits, and Limited Tariff 
                                Benefits

    With respect to clause 9 of rule XXI of the Rules of the 
House of Representatives, the Committee has carefully reviewed 
the provisions of the bill and states that the provisions of 
the bill do not contain any congressional earmarks, limited tax 
benefits, or limited tariff benefits within the meaning of the 
rule.

                   G. Duplication of Federal Programs

    In compliance with Sec. 3(c)(5) of rule XIII of the Rules 
of the House of Representatives, the Committee states that no 
provision of the bill establishes or reauthorizes: (1) a 
program of the Federal Government known to be duplicative of 
another Federal program, (2) a program included in any report 
from the Government Accountability Office to Congress pursuant 
to section 21 of Public Law 111-139, or (3) a program related 
to a program identified in the most recent Catalog of Federal 
Domestic Assistance, published pursuant to section 6104 of 
title 31, United States Code.

                 H. Disclosure of Directed Rule Makings

    In compliance with Sec. 3(i) of H. Res. 5 (115th Congress), 
the following statement is made concerning directed rule 
makings: The Committee advises that the bill requires no 
directed rule makings within the meaning of such section.

       VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED


  A. Text of Existing Law Amended or Repealed by the Bill, as Reported

    In compliance with clause 3(e)(1)(A) of rule XIII of the 
Rules of the House of Representatives, the text of each section 
proposed to be amended or repealed by the bill, as reported, is 
shown below:

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, and existing law in which no 
change is proposed is shown in roman):

                     INTERNAL REVENUE CODE OF 1986




           *       *       *       *       *       *       *
Subtitle D--Miscellaneous Excise Taxes

           *       *       *       *       *       *       *


CHAPTER 43--QUALIFIED PENSION, ETC., PLANS

           *       *       *       *       *       *       *


SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS REGARDING HEALTH 
                    COVERAGE.

  (a) Large Employers Not Offering Health Coverage.--If--
          (1) any applicable large employer fails to offer to 
        its full-time employees (and their dependents) the 
        opportunity to enroll in minimum essential coverage 
        under an eligible employer-sponsored plan (as defined 
        in section 5000A(f)(2)) for any month, and
          (2) at least one full-time employee of the applicable 
        large employer has been certified to the employer under 
        section 1411 of the Patient Protection and Affordable 
        Care Act as having enrolled for such month in a 
        qualified health plan with respect to which an 
        applicable premium tax credit or cost-sharing reduction 
        is allowed or paid with respect to the employee,
then there is hereby imposed on the employer an assessable 
payment equal to the product of the applicable payment amount 
and the number of individuals employed by the employer as full-
time employees during such month.
  (b) Large Employers Offering Coverage With Employees Who 
Qualify for Premium Tax Credits or Cost-Sharing Reductions.--
          (1) In general.--If--
                  (A) an applicable large employer offers to 
                its full-time employees (and their dependents) 
                the opportunity to enroll in minimum essential 
                coverage under an eligible employer-sponsored 
                plan (as defined in section 5000A(f)(2)) for 
                any month, and
                  (B) 1 or more full-time employees of the 
                applicable large employer has been certified to 
                the employer under section 1411 of the Patient 
                Protection and Affordable Care Act as having 
                enrolled for such month in a qualified health 
                plan with respect to which an applicable 
                premium tax credit or cost-sharing reduction is 
                allowed or paid with respect to the employee,
        then there is hereby imposed on the employer an 
        assessable payment equal to the product of the number 
        of full-time employees of the applicable large employer 
        described in subparagraph (B) for such month and an 
        amount equal to \1/12\ of $3,000.
          (2) Overall limitation.--The aggregate amount of tax 
        determined under paragraph (1) with respect to all 
        employees of an applicable large employer for any month 
        shall not exceed the product of the applicable payment 
        amount and the number of individuals employed by the 
        employer as full-time employees during such month.
  (c) Definitions and Special Rules.--For purposes of this 
section--
          (1) Applicable payment amount.--The term ``applicable 
        payment amount'' means, with respect to any month, \1/
        12\ of $2,000.
          (2) Applicable large employer.--
                  (A) In general.--The term ``applicable large 
                employer'' means, with respect to a calendar 
                year, an employer who employed an average of at 
                least 50 full-time employees on business days 
                during the preceding calendar year.
                  (B) Exemption for certain employers.--
                          (i) In general.--An employer shall 
                        not be considered to employ more than 
                        50 full-time employees if--
                                  (I) the employer's workforce 
                                exceeds 50 full-time employees 
                                for 120 days or fewer during 
                                the calendar year, and
                                  (II) the employees in excess 
                                of 50 employed during such 120-
                                day period were seasonal 
                                workers.
                          (ii) Definition of seasonal 
                        workers.--The term ``seasonal worker'' 
                        means a worker who performs labor or 
                        services on a seasonal basis as defined 
                        by the Secretary of Labor, including 
                        workers covered by section 500.20(s)(1) 
                        of title 29, Code of Federal 
                        Regulations and retail workers employed 
                        exclusively during holiday seasons.
                  (C) Rules for determining employer size.--For 
                purposes of this paragraph--
                          (i) Application of aggregation rule 
                        for employers.--All persons treated as 
                        a single employer under subsection (b), 
                        (c), (m), or (o) of section 414 of the 
                        Internal Revenue Code of 1986 shall be 
                        treated as 1 employer.
                          (ii) Employers not in existence in 
                        preceding year.--In the case of an 
                        employer which was not in existence 
                        throughout the preceding calendar year, 
                        the determination of whether such 
                        employer is an applicable large 
                        employer shall be based on the average 
                        number of employees that it is 
                        reasonably expected such employer will 
                        employ on business days in the current 
                        calendar year.
                          (iii) Predecessors.--Any reference in 
                        this subsection to an employer shall 
                        include a reference to any predecessor 
                        of such employer.
                  (D) Application of employer size to 
                assessable penalties.--
                          (i) In general.--The number of 
                        individuals employed by an applicable 
                        large employer as full-time employees 
                        during any month shall be reduced by 30 
                        solely for purposes of calculating--
                                  (I) the assessable payment 
                                under subsection (a), or
                                  (II) the overall limitation 
                                under subsection (b)(2).
                          (ii) Aggregation.--In the case of 
                        persons treated as 1 employer under 
                        subparagraph (C)(i), only 1 reduction 
                        under subclause (I) or (II) shall be 
                        allowed with respect to such persons 
                        and such reduction shall be allocated 
                        among such persons ratably on the basis 
                        of the number of full-time employees 
                        employed by each such person.
                  (E) Full-time equivalents treated as full-
                time employees.--Solely for purposes of 
                determining whether an employer is an 
                applicable large employer under this paragraph, 
                an employer shall, in addition to the number of 
                full-time employees for any month otherwise 
                determined, include for such month a number of 
                full-time employees determined by dividing the 
                aggregate number of hours of service of 
                employees who are not full-time employees for 
                the month by 120.
                  (F) Exemption for health coverage under 
                TRICARE or the Department of Veterans 
                Affairs.--Solely for purposes of determining 
                whether an employer is an applicable large 
                employer under this paragraph for any month, an 
                individual shall not be taken into account as 
                an employee for such month if such individual 
                has medical coverage for such month under--
                          (i) chapter 55 of title 10, United 
                        States Code, including coverage under 
                        the TRICARE program, or
                          (ii) under a health care program 
                        under chapter 17 or 18 of title 38, 
                        United States Code, as determined by 
                        the Secretary of Veterans Affairs, in 
                        coordination with the Secretary of 
                        Health and Human Services and the 
                        Secretary.
          (3) Applicable premium tax credit and cost-sharing 
        reduction.--The term ``applicable premium tax credit 
        and cost-sharing reduction'' means--
                  (A) any premium tax credit allowed under 
                section 36B,
                  (B) any cost-sharing reduction under section 
                1402 of the Patient Protection and Affordable 
                Care Act, and
                  (C) any advance payment of such credit or 
                reduction under section 1412 of such Act.
          (4) Full-time employee.--
                  (A) In general.--The term ``full-time 
                employee'' means, with respect to any month, an 
                employee who is employed on average at least 30 
                hours of service per week.
                  (B) Hours of service.--The Secretary, in 
                consultation with the Secretary of Labor, shall 
                prescribe such regulations, rules, and guidance 
                as may be necessary to determine the hours of 
                service of an employee, including rules for the 
                application of this paragraph to employees who 
                are not compensated on an hourly basis.
          (5) Inflation adjustment.--
                  (A) In general.--In the case of any calendar 
                year after 2014, each of the dollar amounts in 
                subsection (b) and paragraph (1) shall be 
                increased by an amount equal to the product 
                of--
                          (i) such dollar amount, and
                          (ii) the premium adjustment 
                        percentage (as defined in section 
                        1302(c)(4) of the Patient Protection 
                        and Affordable Care Act) for the 
                        calendar year.
                  (B) Rounding.--If the amount of any increase 
                under subparagraph (A) is not a multiple of 
                $10, such increase shall be rounded to the next 
                lowest multiple of $10.
          (6) Other definitions.--Any term used in this section 
        which is also used in the Patient Protection and 
        Affordable Care Act shall have the same meaning as when 
        used in such Act.
          (7) Tax nondeductible.--For denial of deduction for 
        the tax imposed by this section, see section 275(a)(6).
  (d) Administration and Procedure.--
          (1) In general.--Any assessable payment provided by 
        this section shall be paid upon notice and demand by 
        the Secretary, and shall be assessed and collected in 
        the same manner as an assessable penalty under 
        subchapter B of chapter 68.
          (2) Time for payment.--The Secretary may provide for 
        the payment of any assessable payment provided by this 
        section on an annual, monthly, or other periodic basis 
        as the Secretary may prescribe.
          (3) Coordination with credits, etc..--The Secretary 
        shall prescribe rules, regulations, or guidance for the 
        repayment of any assessable payment (including 
        interest) if such payment is based on the allowance or 
        payment of an applicable premium tax credit or cost-
        sharing reduction with respect to an employee, such 
        allowance or payment is subsequently disallowed, and 
        the assessable payment would not have been required to 
        be made but for such allowance or payment.
  (e) Suspension.--This section shall not apply to any month 
beginning after December 31, 2014, and before January 1, 2019.

           *       *       *       *       *       *       *

                              ----------                              


               PATIENT PROTECTION AND AFFORDABLE CARE ACT




           *       *       *       *       *       *       *
                      TITLE IX--REVENUE PROVISIONS

                 Subtitle A--Revenue Offset Provisions

SEC. 9001. EXCISE TAX ON HIGH COST EMPLOYER-SPONSORED HEALTH COVERAGE.

  (a) In General.--Chapter 43 of the Internal Revenue Code of 
1986, as amended by section 1513, is amended by adding at the 
end the following:
[Omitted amendatory text]

           *       *       *       *       *       *       *

  (b) Clerical Amendment.--The table of sections for chapter 43 
of such Code, as amended by section 1513, is amended by adding 
at the end the following new item:

''Sec. 4980I. Excise tax on high cost employer-sponsored health 
          coverage.''.
   (c) Effective Date.--The amendments made by this section 
shall apply to taxable years beginning after [December 31, 
2021] December 31, 2022.

           *       *       *       *       *       *       *


                         VII. DISSENTING VIEWS

    H.R. 4616 (Nunes, R-CA and Kelly, R-PA) provides 
retroactive relief of the employer mandate for the tax years 
2015 through 2018 and an additional one-year delay of the high-
cost plan excise tax (often called the ``Cadillac'' tax) until 
2022.
    H.R. 4616 does not undo sabotage, premium hikes, and 
benefit cuts Republicans have caused over the past 18 months. 
This bill was one in a series of 11 bills the Committee marked 
up that Republicans claim will help lower health care costs for 
consumers. This legislation does not undo the disruption and 
sabotage on the American health care system. Democrats 
encourage the Committee to redirect its attention to 
legislation that could actually ensure that uninsured, low-
income, and vulnerable people have real access to care. For 
example H.R. 5155, sponsored by Reps. Pallone, Neal, and Scott 
would protect people with pre-existing conditions, help lower 
premiums for Americans, and improve affordability of health 
coverage.
    H.R. 4616 is a cynical attempt to address issues the 
Republicans could have easily included in their larger tax 
reform effort earlier this Congress. Yet, Republicans 
strategically left these taxes out and now only look to offer 
retroactive relief or tax delays. This is not a permanent 
solution. If Republicans truly want to help employers and 
employees, they would look at ways to address drug costs and 
other health care expenses that continue to grow faster than 
inflation. They would work to stabilize the larger health care 
marketplace and offer certainty that helps employers make the 
best decisions about how to get value for their health care 
dollar.
    Legislation busts the deficit to benefit the wealthy, 
again. Altogether the 11 bills the Committee marked up would 
add another $92 billion in unoffset tax cuts to the deficit. 
This bill comes at significant unoffset cost, nearly $39 
billion over ten years. While many Democrats are supportive of 
repealing the Cadillac tax, this bill's meager one year delay 
is unacceptable. Even the Fight 40 Coalition noted that while 
recognition of the problem is nice, failing to move forward 
with full repeal is a 306 problem, especially as Republicans 
continue to advocate for full repeal of the medical device tax, 
benefiting one particular industry, while ignoring millions of 
Americans in employer-sponsored coverage.
    The Joint Committee on Taxation estimates the cost of this 
bill to be $39.5 billion over 10 years. Specifically, the 
employer mandate relief costs $25.9 billion and high-cost plan 
excise tax delay costs $13.6 billion. With this bill, 
Republicans are adding more tax cuts and increasing the 
deficit. Republicans are using the deficit, which they keep 
making larger with cuts for the wealthy, to justify the deep 
cuts they plan to make to Medicare and Medicaid. Republicans 
already are proposing to cut Medicare and Medicaid by nearly a 
trillion dollars to try to pay for the tax cuts they have 
already enacted. This bill will only increase Republicans' call 
for further cuts to these critical programs.

                                   Richard E. Neal,
                                           Ranking Member.

                                  [all]