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116th Congress   }                                  {     Rept. 116-53
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                  {           Part 1

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



 
 MARKETING AND OUTREACH RESTORATION TO EMPOWER HEALTH EDUCATION ACT OF 
                                  2019

                                _______
                                

  May 10, 2019.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Pallone, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                             together with

                            DISSENTING VIEWS

                        [To accompany H.R. 987]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 987) to amend the Patient Protection and 
Affordable Care Act to provide for Federal Exchange outreach 
and educational activities, having considered the same, report 
favorably thereon with an amendment and recommend that the bill 
as amended do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for the Legislation..........................     2
Committee Hearings...............................................     3
Committee Consideration..........................................     4
Committee Votes..................................................     4
Oversight Findings...............................................     6
New Budget Authority, Entitlement Authority, and Tax Expenditures     6
Congressional Budget Office Estimate.............................     6
Federal Mandates Statement.......................................     9
Statement of General Performance Goals and Objectives............     9
Duplication of Federal Programs..................................     9
Committee Cost Estimate..........................................     9
Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......     9
Advisory Committee Statement.....................................     9
Applicability to Legislative Branch..............................     9
Section-by-Section Analysis of the Legislation...................     9
Changes in Existing Law Made by the Bill, as Reported............    10
Dissenting Views.................................................    13

    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 ``Marketing and Outreach Restoration to 
Empower Health Education Act of 2019'' or the ``MORE Health Education 
Act''.

SEC. 2. FEDERAL EXCHANGE OUTREACH AND EDUCATIONAL ACTIVITIES.

  Section 1321(c) of the Patient Protection and Affordable Care Act (42 
U.S.C. 18041(c)) is amended by adding at the end the following new 
paragraph:
          ``(3) 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 this 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. 3. 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.

                          Purpose and Summary

    H.R. 987, the ``Marketing and Outreach Restoration to 
Empower Health Education Act of 2019'' or the ``MORE Health 
Education Act'', was introduced on February 6, 2019, by Reps. 
Blunt Rochester (D-DE), Castor (D-FL), McBath (D-GA), and 
Kildee (D-MI), and referred to the Committee on Energy and 
Commerce.
    The goal of H.R. 987 is to require the Department of Health 
and Human Services (HHS) to conduct consumer outreach and 
enrollment educational activities for the Affordable Care Act 
(ACA) Federally-Facilitated Marketplace (FFM) and fund these 
activities at $100 million per year. H.R. 987 further prohibits 
HHS from expending the funds on promoting non-ACA compliant 
insurance coverage, including short-term, limited duration 
insurance (STLDI) plans and association health plans.

                  Background and Need for Legislation

    On August 31, 2017, the Department of Health and Human 
Services reduced funding for the ACA's 2018 Open Enrollment 
consumer outreach and enrollment educational activities from 
$100 million to $10 million, a 90 percent cut from the previous 
year.\1\ HHS continued to fund outreach and enrollment 
education activities at $10 million during the 2019 Open 
Enrollment period.\2\ About 8.4 million people enrolled in the 
FFM during the 2019 Open Enrollment period, compared to 9.2 
million during the 2017 Open Enrollment period.\3\ Studies have 
shown that outreach efforts expand the number of Americans with 
comprehensive health insurance, improving the makeup of the 
insurance risk pool and reducing premiums for all enrollees.\4\
---------------------------------------------------------------------------
    \1\Centers for Medicare & Medicaid Services, Policies Related to 
the Navigator Program and Enrollment Education for the Upcoming 
Enrollment Period (Aug. 31, 2017) (www.cms.gov/CCIIO/Programs-and-
Initiatives/Health-Insurance-Marketplaces/Downloads/Policies-Related-
Navigator-Program-Enrollment-Education-8-31-2017pdf.pdf).
    \2\Inside Health Policy, CMS Not Increasing ACA Marketing And 
Outreach Budget For 2019 (Sept. 21, 2018) (https://
insidehealthpolicy.com/daily-news/cms-not-increasing-aca-marketing-and-
outreach-budget-2019).
    \3\Centers for Medicare & Medicaid Services, Final Weekly 
Enrollment Snapshot for the 2019 Enrollment Period (Jan. 03, 2019) 
(www.cms.gov/newsroom/fact-sheets/final-weekly-enrollment-snapshot-
2019-enrollment-period).
    \4\Covered California, Marketing Matters: Lessons From California 
to Promote Stability and Lower Costs in National and State Individual 
Insurance Markets (Sept. 2017) (https://hbex.coveredca.com/data-
research/library/CoveredCA_Marketing_Matters-9-17.pdf).
---------------------------------------------------------------------------
    There has been a significant decline in new enrollment in 
the FFM since 2017. Approximately one million fewer new 
consumers enrolled in marketplace plans during the 2019 Open 
Enrollment period than in 2016.\5\ Studies indicate that 
reductions in funding for outreach and enrollment depresses new 
consumer enrollments.\6\ A study conducted by the Commonwealth 
Fund found that 40 percent of uninsured adults are still 
unaware of the ACA marketplaces and the law's tax credits that 
help make coverage affordable.\7\
---------------------------------------------------------------------------
    \5\Centers for Medicare & Medicaid Services, Biweekly Enrollment 
Snapshot (Feb. 03, 2019) (www.cms.gov/newsroom/fact-sheets/biweekly-
enrollment-snapshot-4).
    \6\Center on Budget and Policy Priorities, Strong Demand Expected 
for Marketplace Open Enrollment, Despite Administration Actions (Oct. 
31, 2018) (www.cbpp.org/research/health/the-outlook-for-marketplace-
open-enrollment).
    \7\The Commonwealth Fund, Following the ACA Repeal-and-Replace 
Effort, Where Does the U.S. Stand on Insurance Coverage? (Sept. 7, 
2017) (www.commonwealthfund.org/publications/issue-briefs/2017/sep/
following-aca-repeal-and-replace-effort-where-does-us-
stand?redirect_source=/publications/issue-briefs/2017/sep/post-aca-
repeal-and-replace-health-insurance-coverage).
---------------------------------------------------------------------------

                           Committee Hearings

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 987:
    On February 13, 2019, the Subcommittee on Health held a 
legislative hearing entitled ``Strengthening Our Health Care 
System: Legislation to Reverse ACA Sabotage and Ensure Pre-
Existing Conditions Protections'' that focused on H.R. 987 and 
three other bills. The Subcommittee received testimony from the 
following witnesses:
           Katie Keith, Associate Research Professor 
        and Adjunct Professor of Law, Georgetown University;
           Jessica Altman, Commissioner, Pennsylvania 
        Insurance Department; and
           Grace-Marie Turner, President, Galen 
        Institute.

                        Committee Consideration

    H.R. 987, the ``Marketing and Outreach Restoration to 
Empower Health Education Act of 2019'' or the ``MORE Health 
Education Act'' was introduced on February 6, 2019, by Rep. 
Blunt Rochester (D-DE), and referred to the Committee on Energy 
and Commerce. The bill was subsequently referred to the 
Subcommittee on Health on February 7, 2019. Following 
legislative hearings, on March 26, 2019, the Subcommittee met 
in open markup session, pursuant to notice, for consideration 
of the H.R. 987. An amendment by Rep. Shimkus (R-IL) and an 
amendment by Mr. Carter (R-GA) were each defeated by a voice 
vote. Subsequently, the Subcommittee on Health agreed to a 
motion by Ms. Eshoo, Chairwoman of the Subcommittee, to 
favorably forward H.R. 987 to the full Committee on Energy and 
Commerce, without amendment, by a voice vote.
    On April 3, 2019, the full Committee on Energy and Commerce 
met in open markup session, pursuant to notice, to consider 
H.R. 987, as introduced. During markup, an amendment offered by 
Rep. Blunt Rochester was agreed to by a voice vote. Also, an 
amendment offered by Rep. Carter (R-GA) was defeated by a voice 
vote. At the conclusion of consideration of the bill, the 
Committee on Energy and Commerce agreed to a motion by Mr. 
Pallone, Chairman of the Committee, to order H.R. 987 favorably 
reported to the House, amended, by a record vote of 30 yeas to 
22 nays.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that a record vote was taken on final passage 
of H.R. 987. A motion by Mr. Pallone to order H.R. 987 
favorably reported to the House, amended, was agreed to by a 
record vote of 30 yeas to 22 nays. The following is that record 
vote taken during Committee consideration, including the names 
of those members voting for and against:

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                           Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1) 
of rule X of the Rules of the House of Representatives, the 
oversight findings and recommendations of the Committee are 
reflected in the descriptive portion of the report.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    Pursuant to 3(c)(2) of rule XIII of the Rules of the House 
of Representatives, the Committee adopts as its own the 
estimate of new budget authority, entitlement authority, or tax 
expenditures or revenues contained in the cost estimate 
prepared by the Director of the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974.

                  Congressional Budget Office Estimate

    With respect to the requirements of clause (3)(c)(3) of 
rule XIII of the Rules of the House of Representatives and 
section 402 of the Congressional Budget Act of 1974, the 
Committee has received the following cost estimate for H.R. 987 
from the Director of the Congressional Budget Office:

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, April 25, 2019.
Hon. Frank Pallone, Jr.,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 987, the MORE 
Health Education Act.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Kevin 
McNellis.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    H.R. 987 would appropriate $100 million each year beginning 
in 2020 for the Centers for Medicare & Medicaid Services (CMS) 
to expand advertising and outreach programs that promote 
nongroup insurance coverage sold through the marketplaces 
established by the Affordable Care Act. CBO and JCT estimate 
that spending for those purposes would increase enrollment in 
nongroup insurance coverage and Medicaid by about 500,000 each 
year over the 2020-2029 period. The increase in spending for 
that coverage would be partially offset by an estimated decline 
in average nongroup premiums of about 1 percent, which would 
lower the average subsidy in the marketplaces. That decline is 
the result of the agencies' expectation that the people who 
purchase nongroup coverage as result of CMS's expanded 
advertising and outreach activities would likely be healthier, 
on average, than the average nongroup enrollee who would enroll 
under current law.
    On net, CBO and JCT estimate that enacting H.R. 987 would 
increase the deficit by $13.5 billion over the 2019-2029 
period. That amount includes an $11.8 billion increase in 
direct spending and a $1.7 billion decrease in revenues.
    Details of the estimated budgetary effect of H.R. 987 are 
shown in Table 1. The costs of the legislation fall within 
budget function 550.
    The CBO staff contact for this estimate is Kevin McNellis. 
The estimate was reviewed by Leo Lex, Deputy Assistant Director 
for Budget Analysis.

                                                                        TABLE 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 987
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                               By fiscal year, millions of dollars--
                                                                 -------------------------------------------------------------------------------------------------------------------------------
                                                                    2019     2020     2021     2022     2023      2024      2025      2026      2027      2028      2029    2019-2024  2019-2029
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  INCREASES OR DIRECT SPENDING
 
Estimated Budget Authority......................................        0      117      425      785     1,049     1,268     1,418     1,512     1,611     1,747     1,865      3,645     11,797
Estimated Outlays...............................................        0      117      425      785     1,049     1,268     1,418     1,512     1,611     1,747     1,865      3,645     11,797
 
                                                                                      DECREASES IN REVENUES
 
Estimated Revenues..............................................        0       -7      -51      -99      -135      -159      -180      -236      -271      -288      -302       -451     -1,728
 
                                                    NET INCREASE OR DECREASE (-) IN THE DEFICIT FROM CHANGES IN DIRECT SPENDING AND REVENUES
 
Effect on the Deficit...........................................        0      124      476      885     1,185     1,428     1,598     1,748     1,883     2,034     2,167      4,097     13,525
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Components may not sum to totals because of rounding.
Sources:Congressional Budget Office; staff of the Joint Committee on Taxation.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

         Statement of General Performance Goals and Objectives

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to require 
HHS to conduct consumer and enrollment educational activities 
for the ACA marketplaces and fund these activities at $100 
million per year. The legislation would further prohibit HHS 
from expending the funds on promoting non-ACA compliant 
insurance coverage, including STLDI plans and association 
health plans.

                    Duplication of Federal Programs

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 987 is known to be duplicative of another Federal program, 
including any program that was included in a report to Congress 
pursuant to section 21 of Public Law 111-139 or the most recent 
Catalog of Federal Domestic Assistance.

                        Committee Cost Estimate

    Pursuant to clause 3(d)(1) of rule XIII, the Committee 
adopts as its own the cost estimate prepared by the Director of 
the Congressional Budget Office pursuant to section 402 of the 
Congressional Budget Act of 1974.

      Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 987 contains no earmarks, limited tax 
benefits, or limited tariff benefits.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates that the Act may be cited as the 
``Marketing and Outreach Restoration to Empower Health 
Education Act of 2019'' or the ``MORE Health Education Act''.

Section 2. Federal exchange outreach and educational activities

    Section 2 amends Section 1321 of the ACA and requires HHS 
to conduct outreach and educational activities for the purposes 
of informing individuals about the ACA marketplaces. The 
section requires HHS to conduct outreach and educational 
activities in a manner that is culturally and linguistically 
appropriate to needs of the populations on the marketplaces. 
The section prohibits HHS from expending the funds on promoting 
non-ACA compliant coverage and defines non-ACA compliant 
coverage as STLDI plans and association health plans. The 
section appropriates $100 million per year beginning fiscal 
year 2020 for the purposes of carrying out this section.

Section 3. Determination of budgetary effects

    Section 3 establishes that for the purposes of compliance 
with the Statutory Pay-As-You-Go Act of 2010, the budgetary 
effects of the legislation shall be determined by reference to 
the latest statement titled ``Budgetary Effects of PAYGO 
Legislation'' for this Act.

         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 (new matter is 
printed in italic and existing law in which no change is 
proposed is shown in roman):

               PATIENT PROTECTION AND AFFORDABLE CARE ACT



           *       *       *       *       *       *       *
TITLE I--QUALITY, AFFORDABLE HEALTH CARE FOR ALL AMERICANS

           *       *       *       *       *       *       *


Subtitle D--Available Coverage Choices for All Americans

           *       *       *       *       *       *       *


            PART 3--STATE FLEXIBILITY RELATING TO EXCHANGES

SEC. 1321. STATE FLEXIBILITY IN OPERATION AND ENFORCEMENT OF EXCHANGES 
                    AND RELATED REQUIREMENTS.

  (a) Establishment of Standards.--
          (1) In general.--The Secretary shall, as soon as 
        practicable after the date of enactment of this Act, 
        issue regulations setting standards for meeting the 
        requirements under this title, and the amendments made 
        by this title, with respect to--
                  (A) the establishment and operation of 
                Exchanges (including SHOP Exchanges);
                  (B) the offering of qualified health plans 
                through such Exchanges;
                  (C) the establishment of the reinsurance and 
                risk adjustment programs under part V; and
                  (D) such other requirements as the Secretary 
                determines appropriate.
        The preceding sentence shall not apply to standards for 
        requirements under subtitles A and C (and the 
        amendments made by such subtitles) for which the 
        Secretary issues regulations under the Public Health 
        Service Act.
          (2) Consultation.--In issuing the regulations under 
        paragraph (1), the Secretary shall consult with the 
        National Association of Insurance Commissioners and its 
        members and with health insurance issuers, consumer 
        organizations, and such other individuals as the 
        Secretary selects in a manner designed to ensure 
        balanced representation among interested parties.
  (b) State Action.--Each State that elects, at such time and 
in such manner as the Secretary may prescribe, to apply the 
requirements described in subsection (a) shall, not later than 
January 1, 2014, adopt and have in effect--
          (1) the Federal standards established under 
        subsection (a); or
          (2) a State law or regulation that the Secretary 
        determines implements the standards within the State.
  (c) Failure To Establish Exchange or Implement 
Requirements.--
          (1) In general.--If--
                  (A) a State is not an electing State under 
                subsection (b); or
                  (B) the Secretary determines, on or before 
                January 1, 2013, that an electing State--
                          (i) will not have any required 
                        Exchange operational by January 1, 
                        2014; or
                          (ii) has not taken the actions the 
                        Secretary determines necessary to 
                        implement--
                                  (I) the other requirements 
                                set forth in the standards 
                                under subsection (a); or
                                  (II) the requirements set 
                                forth in subtitles A and C and 
                                the amendments made by such 
                                subtitles;
        the Secretary shall (directly or through agreement with 
        a not-for-profit entity) establish and operate such 
        Exchange within the State and the Secretary shall take 
        such actions as are necessary to implement such other 
        requirements.
          (2) Enforcement authority.--The provisions of section 
        2736(b) of the Public Health Services Act shall apply 
        to the enforcement under paragraph (1) of requirements 
        of subsection (a)(1) (without regard to any limitation 
        on the application of those provisions to group health 
        plans).
          (3) 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 this 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.
  (d) No Interference With State Regulatory Authority.--Nothing 
in this title shall be construed to preempt any State law that 
does not prevent the application of the provisions of this 
title.
  (e) Presumption for Certain State-Operated Exchanges.--
          (1) In general.--In the case of a State operating an 
        Exchange before January 1, 2010, and which has insured 
        a percentage of its population not less than the 
        percentage of the population projected to be covered 
        nationally after the implementation of this Act, that 
        seeks to operate an Exchange under this section, the 
        Secretary shall presume that such Exchange meets the 
        standards under this section unless the Secretary 
        determines, after completion of the process established 
        under paragraph (2), that the Exchange does not comply 
        with such standards.
          (2) Process.--The Secretary shall establish a process 
        to work with a State described in paragraph (1) to 
        provide assistance necessary to assist the State's 
        Exchange in coming into compliance with the standards 
        for approval under this section.

           *       *       *       *       *       *       *


                            DISSENTING VIEWS

    This bill would provide $100 million annually for outreach 
and education. The money is strictly available for outreach and 
education about the Patient Protection and Affordable Care 
Act's (PPACA) qualified health plans (QHPs) and is prohibited 
from promoting association health plans (AHPs) and short-term, 
limited-duration insurance (STLDI) plans. The proposal is not 
paid for.
    The Centers for Medicare and Medicaid Services (CMS) 
allocated $10 million to outreach and education for plan year 
2018, consist ant with promotional spending levels on Medicare 
Advantage and Medicare Part D. While CMS devoted more than $100 
million to outreach and education for plan year 2017, or 
roughly twice as much as for plan year 2015, first-time 
enrollment numbers declined by 42 percent.
    According to CMS, for plan year 2019, the Trump 
Administration ``sent over 700 million reminder emails and text 
messages to consumers, as well as 3.2 million outreach emails 
to help Navigators, agents, and brokers assist consumers.'' 
Additional funding for outreach and education has generally 
failed to increase first-time enrollment and for $100 million 
annually in additional funds provided under the bill is not 
paid for.

                                   Greg Walden,
                                           Republican Leader, Committee 
                                               on Energy and Commerce.
                                   Michael C. Burgess, M.D.,
                                           Republican Leader, 
                                               Subcommittee on Health, 
                                               Committee on Energy and 
                                               Commerce.

                                  [all]