tv U.S. House of Representatives U.S. House of Representatives CSPAN July 25, 2018 3:59pm-6:00pm EDT
health outcomes and reduce costs. today, medical homes serve individuals of all ages and income in at least 47 states. this legislation simplifies existing i.r.s. regular you layings and clarifies that direct primary care medical homes are qualified health expenses, medical services, and not a health plan. i personally questioned the i.r.s. ruling. we have debated with them, but we have lost that. we fix it with this legislation. as more individuals and employers seek to utilize the direct primary care delivery model, it is important that this important tax barrier not get in the way of patients accessing this successful model. the lemmings will allow plans to cover onsite employee clinics. think about the nursing stations
that we have here in the house of representatives to provide that service. they can offer physical exams, over the counter drugs and testing, hearing and vision screening and other minor care services to help employees assemble a benefits package that is practical and give them a competitive edge. allowing employees to access this at work doesn't disrupt the work. it is better for them and the employer. . this allows individuals to streamline the conversion of a medical savings account, flexible savings account, or h.s.a. so they won't lose savings when they change jobs. these reasonable changes will help consumers make the most of their employer-sponsored coverage. now, make no mistake, while
this legislation will certainly help some consumers, it doesn't atone for the systemic sabotage that we've seen of the affordable care act by the administration and some of my republican colleagues. by zeroing out the mandate penalty estimates of insurance premiums will rise 15%. none of these bills before us today undo that premium hike that's visited upon our constituents unnecessarily. and these premium increases are coming after republicans gave insurance companies billions in tax cuts in the tax bills. republican attempts to expand h.s.a.'s no replacement for the affordable care act's financial assistance. attempts to expand h.s.a. reas a continuation of a platform of -- h.s.a.'s are a continuation of a platform of shifting families into health plans which include higher out-of-pocket costs while
providing greater tax benefits for those who need them least. h.s.a. and high deductible health care plans shift costs to consumers without bending the cost curve or addressing underlying costs of medical care in the united states. i think we can and should do etter. for instance, the president has suggested lowering drug costs. this does nothing to lower the cost of drugs consumers buy and seeks to move people into plans that provide only catastrophic coverage. exposing more people to pay the full weight of drug price hikes. now, we have legislation before our committees that could move forward to do something about this. and i am saddened, despite trump's talking about it, that we've really not taken action to do so. and we could on a bipartisan basis if we were enabled to do so. the collection of bills on the
floor this week will reduce federal revenues by about $90 billion. and will do nothing to reduce the number of uninsured people that will increase as a result of policy changes my republican friends have done in this congress. their sabotage efforts under the trump administration has caused millions of people to lose coverage and millions more will do so in the future. now we're seeing, in their budget proposal, my republican friends proposing to cut medicare and medicaid by nearly $1 trillion, to try and pay for the deficits that have been exacerbated by tax cuts enacted. the bills that we will be considering, especially the next one, will only add fuel to that fire. so i am pleased that wove got some bob: pieces that we can move forward -- bob: pieces -- bipartisan
pieces that we can move forward. i'm hopeful that we don't abandon a sense of fiscal responsibility. and admiral hinton: that we can encourage some of my friends on -- we can encourage some of my friends on the other side of the aisle the assault on the affordable care act and especially by the administration. so that we don't destabilize the system further, drive up costs, and increase the number of uninsured. mr. speaker, i will reserve the alance of my time. the speaker pro tempore: the gentlewoman from kansas is recognized. mr. jenkins: i yield to the gentleman from south carolina. the speaker pro tempore: the gentleman is recognized for three minutes. mr. rice: mr. speaker, i'm proud to stand before you today to discuss two bills that xpand choice and offer lower costs. and lower cost and choice are what are needed in health care. back home in south carolina,
the average premium before obamacare in 2013 in the ndividual market was $233. in 2017, premiums were set before the president took office, before the quote-unquote assault on obamacare that my colleague was speaking of, the premium reached $512. that is a $279 per month increase in three years or four years. 120% increase from 2013 to 2017. my folks back home, you know, before obamacare, 85% of the people in the country were covered by health insurance. at the peak, under the affordable care act, 91% were covered. so we covered 6% more people. that's a good thing. but what was the cost of that?
to cover 6% more of our who ation, the other 85% were already covered, either by medicare, medicaid or private nsurance, had to pay another 120% on their premiums. in south carolina, 105% nationwide. and the premiums are going to go up double digits again this year. we need lower costs and we need choice. in south carolina, all of the insurance companies have pulled out of the exchanges except for one. in fact, 40% of the counties in the country have only one choice for health insurance. and that's no choice at all. it's either health insurance or nothing. you select from that one company or you get nothing. we need lower costs and we need choice. these bills today, by allowing
more liberal contributions to health savings accounts, by allowing easier access to health savings accounts, by allowing health savings accounts to be used for more purposes, like private family care, or for nonprescription drugs, over-the-counter drugs, they are serving the exact causes, the exact purposes that i hear the most complaints about back home. you know, my folks back home are saying, how can i afford these insurance policies, and with the high deductibles that are being forced on us by these insurance companies, even if i have the insurance company, i mean, the insurance policy, i can not -- i cannot afford to use it. mr. speaker, i'm proud to stand before you today to recommend these bills and i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentlewoman from kansas reserves. the gentleman from oregon is recognized. mr. blumenauer: thank you, mr.
speaker. i am pleased to yield four minutes to congressman kind from wisconsin. a senior member of ways and means, author of several of these reform provisions, champion of value over volume in health care, as well as fiscal restraint. the speaker pro tempore: the gentleman from wisconsin is recognized for four minutes. mr. kind: thank you, mr. speaker. i thank my friend and colleague from oregon for yielding me this time. i agree with my colleague. i rise in opposition to this package of legislation. not because of the policy initiatives underlined in these bills but because of how fiscally irresponsible it's being done. this week, out of the ways and means committee, we have 10 bills to be debated and voted on on the house floor, at a toe cal cost of roughly -- total cost of roughly $90 billion. there was no effort to maintain fiscal discipline in this place. and that's problematic. because we keep digging the hole deeper. but my name is on a few of these bills. yesterday we had the repeal of medical device tax, legislation that i had authored with my friend from minnesota, erik
paulsen. but that came at a cost of $20 billion, no offset, no pay-for. just borrow more money from china and let future generations wrestle with it. but it made sense policy-wise to try to repeal that in a fiscally responsible manner because we were taxing these manufacturers, whether they were making a profit or not. in fact, the pre-revenue companies were getting hit by the same tax policy-wise that didn't make a lot of sense. and now today i was happy to introduce legislation from our friend and colleague, ms. jenkins, on the restoring access to medication act. this will make it easier for patients that purchase over-the-counter medicine with their h.s.a. and f.s.a. account money, without having to first run to their doctor to get a prescription. just for the sake of efficiency , that makes sense. but the legislation comes with a cost. and there was no effort to pay for. that also part of this package -- for that. also part of this package is legislation i introduced called the personal health investment today act or the fit act.
this would allow dollars being used for -- phit act. this would allow dollars being used for physical exercise, keeping people healthy in lair life. rather than the hundreds of billions of dollars at the back end dealing with chronic disease management. policy-wise that makes sense. but the legislation, again, comes with a cost, no attempt to pay for it. and i think that's fiscally irresponsible. at a time when we worked on and passed the affordable care act, president obama had one major request, that all of it had to be paid for, all of it had to be offset. we worked hard to accomplish it and in fact we did. and then some. we did not add one nickel to our budget deficit or the future budget debt forecast. because of how we dealt with that in a fiscally responsible manner. all we're asking is that our colleagues on the other side, who in charge now and running this place -- who are in charge now and running that place, try to have some of that fiscal discipline we showed with the
passage of the affordable care act. we ought to be working together, find out what's working with the health care system and fixing what isn't. what's not working is the elimination of cost-sharing reduction payments that help health insurance providers spread the risk in the health insurance exchanges. it's one of the reasons why premiums are being driven up right now. what's not working is refusing to fund funding to the navigators that help people make the choices with the health plans that they have available. or undercutting funding for any education outreach with patients. or the elimination of the individual responsibility component. so that young and healthy people don't get to sit around and wait until they get sick or injured and then go out and acquire health insurance. that's not how insurance markets work. and what also doesn't work is an administration that's trying to undermine the protections that are in place under the affordable care act with people with pre-existing conditions. there's a lawsuit pending right now, this administration should be defending that pre-existing condition exclusion and they're
refusing to do so and that will implicate millions of lives throughout our country. so there's a lot that we can and should be working on together to improve the health care system, to reduce health care costs for all americans. but this approach, this piecemeal approach, while policy, there's a lot of justification and explanation for what's happening, is being done in a very fiscally irresponsible manner. just piling on the debt. this comes -- may i have one additional minute? mr. blumenauer: i yield the gentleman an additional minute. the speaker pro tempore: the gentleman is recognized for an additional minute. mr. kind: this comes, by the way, on the heels in this session of congress with passage of a major tax cut last year that will add over $2 trillion to our national debt over the next 10 years because, again, there was no attempt to pay for it. it comes on the heels of the passage of a two-year budget that will increase spending by over half a trillion dollars, none of it paid for, none of it offset. and just yesterday, president
trump just announced a 12ds billion subsidy bailout program -- $12 billion subsidy bailout program for our family farmers because of the adverse effects they're feeling due to his tariffs and that is going to be borrowed money from china again, to pay our farmers, because they can't now sell their product, guess where, into the chinese market. how crazy is this? i hope we're not in an era now where budget deficits and debt only matters when there's a democrat in the white house. but over the last year and a half, that certainly seems to be the case in this congress. i yield back. the speaker pro tempore: the gentleman yields back the balance of his time. the gentleman from oregon reserves. the gentlewoman from kansas is recognized. ms. jenkins: thank you, mr. speaker. i appreciate my friend's point of view on the other side of the aisle, mr. kind. -- mr. kind and i have worked really hard on this legislation for many years. i want to remind folks that this bill is simply allowing people to keep more of their hard-earned money. letting people keep their own money is not government spending that needs to be
offset. each of these bills contained in this package were authored with our democrat colleagues, without an offset. each of these bills went through committee with bipartisan support without an offset. it's ironic that democrats want to all of a sudden claim to be fiscally conservative. this is the same democrat party that passed the stimulus in 2009. remember that bill added nearly $800 billion to the deficit. and with that, mr. speaker, i'm pleased to yield three minutes to a real leader on these issues, on the house ways and means committee, the gentleman from pennsylvania, mr. kelly. the speaker pro tempore: the gentleman from pennsylvania is recognized for three minutes. mr. kelly: mr. speaker, i thank the gentlelady for including my bill, h.r. 6305, the bipartisan h.s.a. improvement act of 2018, in h.r. 61 9, the restoring ac -- 6199, the restoring access to medication and modernizing
health savings accounts act. this expands access to and enhances the utility of health savings accounts, also known as h.s.a.'s. my legislation gives employers more flexibility to offer quality health care in the setting that's best for them. like onsite or retail -- onsite or retail clinics. employers around the country are offering innovative ways to deliver health care to their associates. and this provision makes sure that individuals' health savings accounts can utilize these same services. it also fixes the spouse penalty by allowing individuals to make health savings account contributions if a spouse has a flexible spending account, while preventing double dipping in tax benefits. lastly, it makes it easier for people to save for their health care by streamlining and the conversion of other tax-preferred accounts to health savings accounts. ultimately this bill modernizes health care delivery and gives employers the freedom to innovate and improve their employees' health. i'm also very pleased to see that the phit act was included
in this package. i strongly support adding more of an emphasis on exercise and wellness to build a healthy american population. we spend an incredible amount of money on health care but very little on maintenance like exercise and wellness before we get sick. the phit act will better incentivize healthy lifestyles. mr. speaker, we're trying to improve health care for all americans. this means giving consumers a choice in their health care, by incentivizing wellness and exercise. this is a preemptive effort to build a healthier, stronger america and the freedom to design insurance products that work best for them. if you want to keep health care costs down, make sure people are healthier. i like this debate because we talk about how the deficit has grown. for my colleagues on the other side, i wasn't here at the time, but i watched the deficit grow at the beginning of the obama administration from $9 trillion to $20 trillion. i'm glad there's finally somebody has awakened to the
fact we are working with huge deficits. now, this bill was passed by ways and means committee in a bipartisan fashion, and i want to thank my friend, earl blumenauer, for working on this issue. this issue is extremely important for the 175 million americans who get their health insurance from their employer. i strongly urge my colleagues on both sides of the aisle to vote in favor of h.r. 6199. i thank you and i yield back. the speaker pro tempore: the gentleman yields back. the gentlewoman from kansas reserves. the gentleman from oregon is recognized. mr. blumenauer: thank you, mr. speaker. i yield myself one minute just to respond briefly. i was here in 2009. the very month president obama took office, there were 700,000 jobs lost. there was great fear that we were going to have a complete collapse of the auto industry. there were a whole range of things that we were in an emergency situation, in the
worst economic crisis since the great depression. as it were, a major portion of that bill were tax cuts to try to stimulate the economy. i do point out as we move forward, our health care bill was entirely paid for. and that's what we need to get back to. i would like to, mr. speaker, yield three minutes to mr. davis, the gentleman from illinois, a champion of health care, dealing with disparities in the health care system, a champion for balance and vision, and i appreciate him being here. the speaker pro tempore: the gentleman from illinois is recognized for three minutes. mr. davis: thank you, mr. speaker. and i want to thank my olleague, who demonstrates with regularity the intensification of real care for the people. today, we take up another bill that does nothing to make up for the long-term republican
sabotage of the affordable care act. tens of millions of working families will see their health care costs skyrocket due to the repeated republican efforts to undermine the health care system. tens of millions of americans with pre-existing conditions will still feel the loss of guaranteed health protections with the horrible choice of loss of health insurance or untenable premiums. the republican sabotage will cost the typical family of four in my congressional district $2,250 more in insurance premiums in 2019. the republicans' sabotage will cost a typical 55-year-old couple in my congressional in 2019. 3,570 more
the 2019 premium hikes follow an average 37% increase in 2018. these premium hikes are especially disturbing when contrasted with the billions of tax cuts the republicans gave to insurance companies in their tax law. h.r. 6199 makes a small change to health savings accounts used exclusively by the healthy. many of my constituents have trouble paying for basic living costs, like heat, food, and housing. they ask me regularly for a few hundred dollars to help their kids stay in college. the vast majority of my constituents can't satisfy tens of thousands of dollars to pay for their medical care out of pocket in a health savings account. this legislation does nothing to increase coverage, improve affordability, or change the
skyrocketing cost of health care. i ask my colleagues to strongly reject this bill and i urge my republican colleagues to bring up meaningful legislation to improve coverage and lower costs to help the tens of millions of americans in need. and i yield back. the speaker pro tempore: the gentleman yields back. the gentleman from oregon reserves. the gentlewoman from kansas is recognized. ms. jenkins: i'm pleased to yield three minutes to my friend and colleague from kansas, mr. estes. the speaker pro tempore: the gentleman is recognized for three minutes. mr. estes: i rise in support of two bills as part of our overall goal to improve health care for families across the country. currently, obamacare is broken. from 2010 to 2016 health insurance premiums increased by nearly $4,400 per family.
this year, health insurance costs rose about 30% and are expected to go up an additional 10% to 20% in 2019. these skyrocketing costs are not due to some sabotage, as some folks suggested. instead, they are product of a system that was designed and destined to fail. today we all recognize that obamacare has failed to provide insurance for all americans. rather than create more government-run health care, we need competition and free market solutions like health savings accounts to put patients in control of their own health care. that's why i'm proud to support h.r. 6199, the restoring access to medication act of 2018, sponsored by representative lynn jenkins and representative grace meng. h.r. 6199 repeals provisions of the affordable care act that restricted health savings accounts, medical savings accounts, health flexible spending arrangements and health reimbursement arrangements to only be used for prescription drugs or
insulin. removing these restrictions will allow people to use such accounts for over-the-counter drugs. i'm also proud to support h.r. 6311, the increasing access to lower premium plan act of 2018, sponsored by representatives peter roskam and michael burgess. h.r. 3111 provides relief from obamacare's rising premiums and limited choices by allowing the premium tax credit to be used for plans offered outside of obamacare exchanges. the bill also expands access to the lowest premium plans for people purchasing coverage in the individual market and allows the premium tax credit to be used to offset the cost of such plans. these measures increase competition for consumers and seek to drive down the cost of health insurance. i want to thank the ways and means committee for bringing forward thoughtful health care solutions that will help american families. i urge my colleagues to support both bills, and i yield back the balance of my time. the speaker pro tempore: the gentleman yields back. the gentlewoman from kansas reserves. the gentleman from oregon is recognized. mr. blumenauer: thank you, mr. speaker.
i take modest exception to the notion that somehow the affordable care act failed. it represents the largest expansion of health care that we've seen in decades. it is so popular and important that when my republican friends attempted to repeal it, something they had been working on for seven years, it blew up in their face. even president trump said their bill was mean and it continues even though they are working to dismantle it bolt by bolt. i would hope that we will return to sanity to be able to work, to be able to move forward on things like some of the elements in this bill here today that we agree upon that could move us forward rather than the continued battle over the notion that the affordable care act is something that needs to be destroyed. the american people deserve better. and i reserve the balance of my time. the speaker pro tempore: the gentleman from oregon reserves.
the gentlewoman from kansas is recognized. ms. jenkins: mr. speaker, i yield two minutes to the gentleman from illinois, mr. roskam, who has provided great leadership in this area. the speaker pro tempore: the gentleman from illinois is recognized for two minutes. mr. roskam: thank you, madam chairman. thank you, mr. speaker. i'm pleased to see the inclusion of the promoting high-value health care through flexibility for deductible health plans in this bill today. this is legislation that's bipartisan, that i introduced along with congressman thompson of california, that gives consumers the choice and flexibility that they need to be engaged in their health care. in a nutshell, the bill allows plans to cover -- to offer coverage for high-value, low-cost services, like telehealth, chronic disease management, such as diabetic testing strips, or primary care visits below the deductible. in a nutshell, what we're trying to do is give patients more choices, more capacity, to be more demonstrative about
navigating through their own health care needs. this is a good bipartisan approach. i thank the gentlelady for including it, and i thank her for the time. i urge its passage, and i yield back. the speaker pro tempore: the gentleman yields back. the gentlewoman from kansas reserves. the gentleman from oregon is recognized. mr. blumenauer: reserves. the speaker pro tempore: the gentleman from oregon reserves. the gentlewoman from kansas is recognized. jenkjnk -- ms. jenkins: mr. speaker, i yield two minutes to the gentleman from minnesota, mr. paulsen, who has worked tirelessly in this area. the speaker pro tempore: the gentleman from minnesota is recognized for two minutes. mr. paulsen: thank you, mr. speaker. i thank the chairwoman for yielding. mr. speaker, as an advocate for giving consumers more choice for health care and lowering costs, i support this bill, which also gives more flexibility for those who have health care savings accounts as well as some of the other provisiones that were already previously mentioned. i do want to -- provisions that were already previously mentioned. i dwoont to talk -- i do want to talk using those accounts
for direct primary care. it's supported by a lot of family doctors, a lot of primary care doctors, people that pay a monthly fee to see their physician in this area anytime they choose, over the phone, through telemedicine, in person and they get a whole host of services. it's really important for strengthening the doctor-patient relationship, and it means that more people will have access to primary care services instead of just going to the emergency room in order to get care. but unfortunately, the i.r.s. has stated that direct primary care arrangements are essentially health insurance, and they categorize them in this way so you cannot use your h.s. are a.'s and those -- h.s.a.'s and those to pay for direct primary care. that's why congressman blumenauer and i authored legislation to fix this and allow h.s.a.'s, health savings accounts, to be used for direct primary care and i'm pleased it's in this bill. another reform will allow direct arrangements to employees that have an h.s.a.
also. this will let more people have access to direct primary care through their health care savings accounts, allowing family practice doctors, like dr. julie anderson in minnesota, to expand their practice. without having to worry about the headache of filling out mountains of paperwork and excessive insurance forms because it lets the doctor work directly with the patient and you don't have to go through extensive billing services and insurance. health care savings accounts, mr. speaker, have already been proven to help lower health care costs and expanding them, giving consumers more flexibility and more choices will mean families will be better off. so let's allow health care savings accounts to be used for direct primary care and support the underlying bill and i yield back. the speaker pro tempore: the gentleman yields back. the gentlewoman from kansas reserves. the gentleman from oregon is recognized. . blumenauer: mr. speaker, i have no further requests for time, so i'm prepared to conclude when my friend from kansas is -- to close when
she's ready. ms. jenkins: mr. speaker, i have no further speakers. i reserve. mr. blumenauer: ok. the speaker pro tempore: the gentleman from oregon is recognized to close. mr. blumenauer: thank you. i appreciate the opportunity for us to have the discussion. it's been fun working with mr. paulsen from minnesota on this notion of direct primary care. it's a simple notion that run the thwart i.r.s. regulations. i still don't fully understand why these should be classified as health plans rather than payment for service, but nonetheless, we were able to work together in a bipartisan basis to move this forward. it's not expensive. the score is less than $2 billion out of $90 billion that we're tossing around here, and i personally believe that it will result in substantial savings in order to provide more efficient coverage. but i must say that i am a little troubled by the continuing assault on what we're doing with the fiscal future of this country.
we saw just the latest reports that because of what my republican friends have done with the budget and with the tax bill we've doubled the deficit this year. it's doubled. now, when there was complaints from my friend from kansas about deficit spending when president obama took office, remember, he lost 700,000 jobs the first -- actually, he was only president for 1/3 of that month, lost 700,000 jobs. the economy was in freefall. absolutely we took steps -- cutting taxes and moving in areas to try to strengthen parts of the economy that was posing huge problems for people across the board. and this was and this was broadly supported by people in business, economic experts actually agree that probably we didn't do enough
and that slowed the economic recovery. but the economy has recovered. we have seen nine consecutive years of private sector job growth. that's what trump inherited. ver seven years of job growth. the economy was strong. it wasn't in freefall. yet in that strong position, we're doubling the deficit this year. we're looking at trillion-dollar deficits as far as the eye can see. and we just had the president announce that he wants to spend $12 billion more, not because we're in economic freefall, but because his ruinous trade policies have resulted in losses to the farming sector and they're going to provide extra government bailout, not
because farmers want it, but because they're being injured by these ruinous trade policies. and there was a time when most of my republican friends would rise up in opposition. certainly if these were offered by bill clinton or barack obama they'd be screaming at the top of their lungs. most of them are strangely silent now. but it's another $12 billion to try and fix a problem that trump has created by starting trade wars with our friends, trying to punish china and in fact we're punishing our allies . and somehow auto imports are national security? this is embarrassing. that we're in this situation. but it's not just embarrassing, it's dangerous. we're weakening ourselves economically while we pick
fights with our allies like canada and the european union. mr. speaker, on all of this, on top of all of this, we're going to advance legislation today that have some nuggets of positive things. i've worked with my colleagues on some of them. they are important advances. but they are coming at a price of $90 billion added to the deficit, with not even an attempt to work with to us offset. i think we could have offset the direct primary care piece that we're talking about here. it's relatively small potatoes compared to $90 billion. and compared to $12 billion for tariff relief for a trade war we didn't need. mr. speaker, i enjoy the conversation about some of
these items. i think it's important to spotlight them. but i'm hopeful that we are able to return to fiscal stability, not having bailouts for farmers that they don't want, and wouldn't need if we had a rational tariff policy. i'm hopeful that we're not going to have a parade of other things that undermine the affordable care act and add unnecessary costs to the deficit. on that note, mr. speaker, i will conclude and yield back the balance of my time. the speaker pro tempore: the gentleman from oregon yields back. the gentlewoman from kansas is recognized. ms. jenkins: mr. speaker, i yield myself as much time as i may consume. the speaker pro tempore: the gentlewoman is recognized. ms. jenkins: we've heard my friends on the other side of the aisle suggest here this afternoon that this bill might in some way hurt people with pre-existing conditions. however, we know that is simply not true. this bill doesn't touch pre-existing conditions. it doesn't raise costs or premiums on families.
it doesn't take away anyone's choice of health care plans. millions of americans use tax advantage health care accounts to save and pay for health care expenses. in fact, there are twice as many americans with an h.s.a. than those that get coverage on the affordable care act's exchanges. almost 22 million people had an h.s.a. in 2017. and there's only about 10 million people enrolled on the exchanges in 2018. 44% of all civilian workers had ccess to a health flexible spending arrangement in 2017. the provisions in this bill allow more things to be paid for out of these accounts, like over-the-counter drugs, feminine products and fitness activities. this means people are paying less because they're able to use pre-tax dollars or take a deduction for their contribution. as a reminder, the policies in
the bill are all bipartisan. they are all bipartisan. we've worked together to write and advance them. this bill helps middle class families afford their health care expenses. and i hope my colleagues will continue to support this legislation. with that, mr. speaker, i yield back the balance of my time. the speaker pro tempore: the gentlewoman yields back the balance of her time. all time for debate has expired. pursuant to house resolution 10 12 the previous question is order -- 1012 the previous question sworded on the bill as amended. the question is on third reading of the bill. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. third reading. the clerk: a bill to amend the internal revenue code of 1986 to include certain over-the-counter medical products as qualified medical expenses. the speaker pro tempore: the question is on the passage of
the bill. those in favor say aye. those opposed, no. the opinion of the chair -- in the opinion of the chair, the ayes have it. mr. blumenauer: mr. speaker, i would request the yeas and nays. the speaker pro tempore: the yeas and nays are requested. all those in favor of taking this vote by the yeas and nays will rise and remain standing until counted. a sufficient number having arisen, the yeas and nays are ordered. pursuant to clause 8 of rule 20, further proceedings on this uestion will be postponed. for what purpose does the gentleman from alabama seek recognition? >> mr. speaker, i send to the desk a rived report from committee -- privileged report from the committee on rules for filing a report under the rule. the clerk: report to accompany house resolution 1027. resolution providing for consideration of the conference report to accompany the bill, h.r. 5515, to authorize appropriations for fiscal year 2019 for military activities of
the department of defense, for military construction, and for defense activities of the department of energy, to prescribe military personnel strengths for such fiscal year, and for other purposes. the speaker pro tempore: referred to the house calendar and ordered printed. for what purpose does the gentleman from illinois, mr. roskam, seek recognition? mr. roskam: i ask unanimous consent to inearth is into the record an -- insert into the letters. pursuant to house resolution 1011, i call up the bill, h.r. 6311, the increasing access to lower premium plans and expanding health cavings -- savings accounts act of 2018 and ask for its immediate consideration. the speaker pro tempore: the clerk will report the title of the bill. the clerk: h.r. 6311. a bill to amend the internal
venue code of 1986 and the patient protection and affordable health act, and to allow individuals purchasing health insurance in the individual market to purchase a lower premium copper plan. the speaker pro tempore: pursuant to house resolution 1011, in lieu of the amendment in the nature of a substitute recommended by the committee on ways and means, an amendment in the nature of a substitute consisting of the text of rules committee print 115-83 is adopted and the bill as amended is considered read. the bill shall be debatable for one hour equally divided and controlled by the chair and ranking member and minority member of the committee on ways and means. the gentleman from illinois, mr. roskam, and the gentleman from michigan, mr. levine, will each control 30 -- levin, will
each control 30 minutes. the chair recognizes the gentleman from illinois. mr. roskam: i ask unanimous consent that all members have five legislative days to revise and extend their remarks and include extraneous materials on the bill currently under consideration. the speaker pro tempore: without objection. mr. roskam: mr. speaker, i yield myself such time as i may consume. the speaker pro tempore: the gentleman is recognized. mr. roskam: mr. speaker, i chair the health subcommittee at the ways and means committee and i've had the opportunity, like many of my colleagues, to hear from physicians and hospitals and patient advocates and i've heard a lot of stories about increased costs which are exacerbating the coverage and access challenges that we currently face. there's a broad consensus that health care in the united states needs to move towards a system that provides greater access to affordable care. so the question is, how do we get that done? the a.c.a., government-approved, government-mandated, one size fits all d insurance has dramatically -- one-size-fits-all insurance has dramaly decreased the market.
here's what's happening close to home. mr. speaker, in our home state, the department of health and human services released a report that shows between 2013 and 2017 the average monthly premium for coverage in the individual market in illinois increased 108%. or by $3,228 a year. i have five counties in my constituency. in two of those five counties, there's only one insurer which is offering plans on the individual exchange. that's not a choice. that's a government mandate. that's a government monopoly. it's time to drive a discussion around empowering individuals and their families to make health care decisions for themselves based on their needs and based on their budgets. so, the policies that are included in h.r. 6311 ex pabbed access to consumer -- expand access to consumer directed health plans with tax favored accounts like h.s.a.'s. this bill increases choice,
lowers premiums, lets more families save more money to pay for their health care costs. my friends across the aisle will, without question, get up this afternoon and say that this bill doesn't do anything to help people. that instead of these policies, we should drop everything and work and fix the very broken, flawed plan that is the a.c. a. here's the thing. there are twice as many people who have an h.s.a. than those who are covered under the exchanges. let me say that again. twice as many americans are covered under h.s.a.'s than under the affordable care act. 21.8 million people, mr. speaker, had a health savings account in 2017 and there's only 10.6 million who are enrolled in the exchanges in 2018. 2-1. the bill makes smart changes to help families save more pre-tax for their health care.
it changes the so-called use it or lose it nature of flexible spending arrangement, f.s.a.'s, by you a low -- by allowing balances to roll over to the next year. it doubles the amount of money people can put into a health savings account so they can save enough to cover their exposure to out of pocket d costs and -- out of pocket d costs and they're increasingly vulnerable to these out of pocket costs. my friends on the other side may say they want to talk about and driss tact -- distract from some of these commonsense solutions and say that somehow some subpar insurance is being promoted. well, even africansling millions of health care plans that people had and that people liked, notwithstanding the president's promise that if you like your coverage you get to keep your coverage, you remember that, mr. speaker, notwithstanding that, democrats, god bless them, they still they they know what type of health care is best for everyone. they haven't learned yet that individuals and families are
the best ones to make these decisions. not politicians, not bureaucrats in washington. so we think people should be able to purchase the type of coverage they want and the type of coverage they can afford. and one of the provisions in this bill allows everyone to purchase a catastrophic plan, a plan that was designed by obamacare. these plans offer the lowest premiums and we think everyone should have access to them. and even better, because these plans have average deductibles of $6,000, we think we should allow catastrophic and bronze plans to qualify for an h.s.a. as well. this means people can get breaks in taxes for the money that they save, for their huge obamacare deductibles. this is real savings to real people who are struggling under the current health care law. it allows working seniors with h.s.a.-eligible coverage who are enrolled in medicare part a to contribute to an h.s.a., which can be provided, which
can provide an added benefit for seniors and an incentive for them to stay on their employer-sponsored plan over medicare if they choose. makes perfect sense. it increases utility and flexibility through allowing both spouses to make catch-up contributions into the same h.s.a. if they're over age 55. finally, it delays obamacare's health insurance tax for an additional two years, and it -- i which would otherwise increase the cost of insurance premiums through a nearly $27 billion excise tax. this is a flawed tax that gets passed on to american families who are purchasing in the individual market, it gets passed on to seniors in medicare advantage, it gets passed on to small businesses and it gets passed on in medicaid programs. i look forward to this afternoon's debate. i want to thank chairman brady
for his leadership in driving this discussion and i reserve the balance of my time. the speaker pro tempore: the gentleman reserves the balance of his time. the gentleman from michigan, mr. levin. mr. levin: thank you, mr. speaker. i yield myself as much time as i may consume. the speaker pro tempore: the entleman is recognized. be mr. levin: i think we need to ask ourselves, what is this bill all about? why are we here today? h.r. 6311 sat final of three bills -- is the final of three bills regarding health savings accounts and health taxes that we will be considering this week. i find it sad we're not spending our time today addressing the most pressing concerns of americans struggling to make ends meet because of the republican sabotage of health care coverage. nothing in h.r. 6311 or any other bill we have considered
this week undoes the ongoing harm caused by the actions of the trump administration or this republican congress. for example, earlier this month, the administration created needless confusion by refusing to make legally required risk adjustment ayments until when there was major protests. it reversed course last night under public pressure. but in june, the justice department refused to defend protection for the 130 million americans living with pre-existing health conditions. last fall, the president terminated cost sharing reduction payments for 250% ns earning 100% to of the federal poverty level. the g.o.p. tax bill gutted the individual responsibility
requirement, causing a 15% spike in premiums, according to c.b.o. recently, the administration, again, cut funding for navigator organizations to just $10 million for the upcoming open enrollment period. saw at home what these navigator provisions meant to nonprofit organizations who were reaching out to people who wanted information in health care. cut, cut, cut is the administration's answer, and this congress' response to that administration action is zero, silence, silence, silence. these and so many other actions by republicans have led to direct increases in had premiums and out-of-pocket costs for middle-class
families. expanding h.s.a.'s and shifting more americans into catastrophic coverage, as h.r. 6311 does, will not meaningfully help middle-class families, harmed by republican sabotage of a.c.a. instead, it will primarily benefit wealthy americans and large insurance companies. according to data from the joint committee on taxation, more than 80% of the tax benefit for health savings accounts goes to individuals earning more than $100,000 annually. we pointed that out in committee. what was the response? obfuscation. obfuscation. that is a fact and analysis given to us by the joint committee on taxation.
so all these crocodile tears from mainly middle-class families, i think, are shown for what they are. very few families with modest incomes can afford the high out-of-pocket expenses required in order to participate in h.s.a. doubling the amount that individuals can contribute to tax-free, tax-free, as this bill does, will make no difference to the millions of working families who don't have thousands of dollars available to contribute to an h.s.a. in the first place. i suggest that everybody go home and talk to the general public. in addition, a two-year delay of the health insurance provider fee will have on a minimal impact on premiums. indeed, this provision will mainly benefit insurance companies while adding more than $25 billion to the
deficit. not only do the bills we have considered this week not address these pressing issues, they also recklessly add to the deficit. republicans have failed to produce even $1 for the enormous costs of these bills. so i said to the chairman of the committee that i once chaired, i was sometimes asked that question, will you pay for it, and i said, yes. i asked the chairman, will you pay for this? at first it was said, well, we don't have to do that in committee. i said, will you do it on the floor? yes or no? he said, no. so here we are. although we do not yet have a final analysis from the congressional budget office or tax, int committee on past estimates or analysis have
shown us this, h.r. 184, which will repeal the medical device tax, will cost about $20 billion over 10 years. .r. 6199, which would expand h.s.a.'s to include over-the-counter medications and gym memberships, will cost roughly $20 billion. and this bill, which expands h.s.a.'s and delays a tax on the health insurance industry, would increase the deficit the most. is is, in a few words, a rusty roskam bill that will cost up to $50 billion. $50 billion. when all is said and done, our actions this week could add up to $90 billion to our nation's debt, increasing pressure to cut vital programs, like
medicare. this comes just months after a tax cut bill that would add an additional $2 billion to the debt. so, look, we need to come and ask ourselves, why are we here? these bills will not likely pass the senate or become law. so here we are. we're going to recess, adjourn tomorrow for five weeks or so. i think the reality is that these bills, which will not likely pass the senate, ever become law. i think it's likely that they have a different purpose, and i think that was described in a recent article in "the hill." and i read it because i want the public to question what we do. and i quote, the bills on the
house floor next week could give victories to the bills' sponsors who are also vulnerable in november. the chairman of the subcommittee, where i'm ranking member, is facing -- this article says -- a tough re-election race in his suburban district. but overall, the measures slated for consideration are minor and won't make a major dent in premiums, according to joe antos, a health care expert at the right-leaninging american enterprise institute. -- leaning american enterprise institute. i will say that again. these measures slated for consideration are minor and won't make a major dent in premiums, according to joe antos, a health care expert at the right-leaning american enterprise institute, end quote. so i think that's what really
this is all about. it's a political exercise. it's aimed to help people who are in a vulnerable political position, but that's not a reason to bring up these bills today when as i described earlier, there are so many issues relating to health care coverage and the republicans have undertaken these last months under this administration to do everything they can to sabotage health care for americans. as a result, three million people less have health insurance. but a.c.a. works so well that 20 million people received health care coverage they did not have. so this is is kind of a sad moment. e're turning this place into a
campaign entity. we should not be doing that when it comes to health care coverage. we tried in recent times to say to the republicans, if you want o improve a.c.a., we're ready. never has there been any offer to do that. instead, it was, repeal, repeal, repeal. i won't say that 55 times. but that's how often it happened. nd more recently, it was sabotage, sabotage, sabotage. that isn't what we should be doing for what is so dear to americans, health care coverage. so i rise -- it's a sad day, i said earlier, we are here when so much needs to be done and this essential lisa political
exercise -- essentially a political exercise. the speaker pro tempore: the gentleman reserves. the gentleman from illinois is recognized. mr. roskam: mr. speaker, the gentleman from michigan asks the rhetorical question, why are we here? i will tell you why we're here. i have an independent recollection of being in my car on michigan avenue in chicago listening then to president obama give a speech to i think it was the american medical association and i was listening on the radio and he said, i think -- i may be conflating here. he said, if you like your coverage, you can keep your coverage. if you like your doctor, you get to keep your doctor. i think during the course of the health care discussion, the obama administration made this explicit promise to the american people. you're going to save $2,500 per family. and it was going to be great. it was going to solve all the problems, and yet, that didn't happen. that's why we're here. i've got a constituency where two counties have one insurer. that's why we're here. and now i yield to mr. paulsen
for two minutes to tell us why we're here. the speaker pro tempore: the gentleman is recognized for two minutes. mr. paulsen: i thank the gentleman for yielding and just to follow-up, mr. speaker, there are too many families that continue to suffocate under the high premiums and high deductibles that we have from the affordable care act. n contrast to the top-down one-size-fits-all of obamacare, sports utility vehicles puts consumers in charge of their -- health savings accounts puts consumers in charge of their health care. 20 million americans have health savings accounts. that's twice as many as the number of people that are getting plans for the obamacare exchanges. that's not even close. in minnesota alone, more than a million, 1.2 million people and families are eligible for h.s.a. plans. now, the bill before us today, it supports the continued growth of health savings accounts and includes a couple provisions that i helped author, including allowing working seniors to contribute to an h.s.a., increasing the limits that individuals and families can contribute to
their h.s.a.'s, and allowing married couples the opportunity to make larger catch-up contributions to their health savings accounts and then it creates a grace period to help pay for medical expenses that some may have occurred before they actually set up their health savings account. these are all important improvements that will help provide value in health care and help lower prices. so let's let people purchase the type of coverage that they want and that they can afford. i'm really pleased that the bill before us today makes these very smart, strategic, calculated reforms. and i ask my colleagues for their support and yield back. the speaker pro tempore: the gentleman reserves. the gentleman from michigan is recognized. mr. levin: you know, i've heard this so-called fact that more people have h.s.a.'s than those who are covered by obamacare. that's simply is not true. obamacare includes expanded medicaid. so if you want to talk about
more than in the exchanges, we can discuss that and argue it, but don't come here and minimize the impact of a.c.a. we worked hard on it, and we meet so many people, so many people who benefited from what we, democrats, did, and the public more and more is expressing that. you were on the wrong side of history, and you're now on the wrong side of public opinion, the wrong side. it is now my pleasure to yield two minutes, or more if he'd like, to such an ktive member of our committee the gentleman from new york, congressman davis. the speaker pro tempore: the gentleman is recognized for two minutes. mr. davis: health savings accounts, while it may help
people manage their health care costs marginally, the sad truth is this legislation will do nothing, nothing to lower health care costs and to improve health care quality. the legislation also does nothing, nothing to protect people with pre-existing conditions. in 40 -- and 40% of americans between the ages of 50 and 464 -- and 64 1/2 have pre-existing conditions. the legislation before us will increase the deficit by tens of billions of dollars. mr. higgins: and will threat then long-term viability of social security and medicare. because of recent actions by the trump justice department and house republicans, millions of americans between the ages of 50 and 64 1/2 who buy their health insurance on the individual market are about to get clobbered. with double digit, multiyear health insurance premium increases. and this congress is doing
nothing, nothing to help. this population needs the protection of medicare now. medicare at 50 would allow people to buy, to buy medicare as their health insurance. medicare is affordable care act compliant with essential benefits. it has high patient satisfaction ratings. has full access to primary care and physician specialists. and always, always covers pre-existing conditions. medicare at 50 also is thousands of dollars cheaper when compared with the gold plan on the individual market. mr. speaker, medicare is the best public option that already xists. and the best public option that already exists should be available to millions of americans ages 50 to 64 1/2. i yield back.
the speaker pro tempore: the gentleman reserves. the gentleman from illinois is recognized. >> i'm pleased to yield two minutes to the gentlelady from indiana, mrs. walorski. the speaker pro tempore: the gentlelady is recognized for two minutes. ms. walorski: thank you, mr. speaker. i rise in support of h.r. 6311, the increasing access to lower premium plans and expanding health savings account act. this includes a two-year delay of the health insurance tax. like the medical device tax which the house voted yesterday to repeal, the h.i.t. is yet another damaging tax from obamacare. it raises premiums for family, for maul small businesses and seniors and the disabled enrolled in medicare advantage. in fact, the h.i.t. could raise annual premiumers in typical medical advantage -- medicare . vantage couple i'm thrilled this bill we're
voting for today includes the nosh delay the h.i.t. i look forward to the day when we can repeal this tax that falls on the back of seniors, disabled, small businesses and hardworking families. until then i urge my colleagues to support delaying itism yield back. the speaker pro tempore: the gentleman from michigan is recognized. mr. levin: it is my pleasure to yield three minutes to the gentlelady from california who so active and there all the time, ms. chu. the speaker pro tempore: the gentlelady is recognized for three minutes. ms. chu: mr. speaker, i rise today in strong opposition to h.r. 6311 which contrary to its name would do very little to help americans access quality health care coverage. instead, it would force families to accept low quality, catastrophic health plans or junk coverage that does not meet health care needs and leaves ordinary americans to foot the bill when something gos wrong.
what does a catastrophic and high deductible plan mean? it's a disaster for many. 40% of americans cannot afford even a $400 emergency expense, let alone the thousands of dollars necessary for a medical emergency which could happen to any of us. but that's the plan republicans are offering. americans would get a plan that is substandard. no one wants to have health coverage that doesn't actually cover much at all. what's more, these catastrophic and high deductible health plans are especially harm to feel women. since 50% of the pregnancies in the united states are unplanned, many parents in these plans will not have saved enough to cover these high deductibles or unexpected costs. most pregnancies last nine months and span more than one plan year. that means during the course of a single pregnancy a mother in
one of these plans would have to hit her deductible twice. maternity care services without complications can average around $10,000 per pregnancy. what would happen in a pregnancy with complications? the affordable care act was pass sod that we could move away from young flan -- junk plans that offered nothing in terms of coverage and left people with thousands of dollars in medical debt. this bill is just another attempt to undermine the a.c.a. and we cannot go back. yield back. the speaker pro tempore: the gentleman from illinois is recognized. >> every time we hear the phrase junk coverage, think obamacare. i'm not trying to be facetious because there's nothing in this bill that makes any change to any coverage. i can only assume the gentlelady is referring to catastrophic coverage that was part of the a.c.a. mr. roskam: all we're doing
today is saying with that coverage they ought not be alone they ought not be out on an ice floe all by themselves. people who have that type of catastrophic coverage that our friends when they were in the majority created, those people should simply have access to a health savings account. what's not to love about that? , when you hear junk coverage be dismissive of that it's a talking point. it's not particularly persuasive who is persuasive is the gentleman from nebraska, mr. smith, and i'm pleased to yield two minutes to him. mr. smith: thank you, mr. speaker. i rise in support of h.r. 6311, the increasing access to lower premium plans act and expanding health savings account act. this bill gives all americans the option to purchase a catastrophic plan if they so choose which under current law is restricted to a limited population. this bill will increase health insurance plan and pricing options as we continue our work to address the underlying problems of
obamacare. nebraskans continue to tell me that they are desperate for more options to buy health insurance for their families. we are down to only one insurer in nebraska, in nebraska's exchange, and with premiums for a family which can exceed $0,000 before even factoring in four and five-figure deductibles, families need more options. nebraskans need more options. the way to create access to health care for more people is by understanding better this buyer-seller relationship. if you want to reduce costs through increasing participation, whoever is doing the selling must create products that consumers are willing to buy. the more barriers wedged between the buyer and seller, the more transparency and competition will decrease and the more health care costs for consumers will increase. it is obvious that obamacare policy which is have restricted choice through one size fits all requirements for insurance products continue to fail and this bill will help give nebraskans an all american -- and all americans the choices
they need and deserve. i thank mr. roskam for bringing us this by i urge support and yield back the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from michigan is recognized. mr. levin: i yield five minutes the gentleman from texas, a true fighter. the speaker pro tempore: the gentleman is recognized for five minutes. >> trumpcare, that's what we're talking about today. what's trumpcare? it's not much care. it's mainly indifference from people that don't really care or understand the plight of thousands of families across this country working to meet -- make ends meet and suddenly somebody has an accident on the way home from work or a child is diagnosed with some dread disease and they face without access to affordable health insurance a catastrophe. mr. doggett: we know there are a significant number of american families that said they couldn't
meet a $400 or $500 emergency. think about what happens when they face a $4,000 or a $40,000 health care bill. that's what the affordable health care act has been about. today we see the chapter in the trumpcare story that mr. roskam and his colleagues are offering for trump and all of his cohorts. what is it? it is the 5% solution because we know that health savings accounts have been used by exactly 5% of those who earn ess than $100,000. as qurebl the trump approach is, let's do more for the few and to heck with the minnesota. the many are the people for whom health savings accounts offer little to no protection. it is a tax haven for some
people who are a little more prosperous, and that's fine. but i believe we need to make health care accessible to more people. then there's the additional problem that mr. roskam and his colleagues have ke sided to pay for their package of bills, $100 billion of bills, they're going to pay for it by borrowing just a little bit more after all the trillions of dollars that they have borrow fled saudis and the chinese and people here at home, wherever they can find somebody that will take their i.o.u., they want to borrow a little more money. $100 billion almost to finance this package of bills to help that 5% of the families who earn ess than $100,000. i offered an amendment recognizing it wouldn't correct all the flaws of trumpcare but would address one simple problem and that is the problem of pre-existing conditions. what's a pre-existing condition? well, it's whatever an insurance
company wants to point to to deny you coverage before the affordable care act. and i do think our republican colleagues are afflicted with a very serious pre-existing condition. it's called amnesia. they have forgotten what health care was like for families before the affordable care act came into existence and prohibited these pre-existing conditions not only for those who went to the marketplace but across the board to prevent pre-existing conditions from being used against someone to deny them coverage or to limit he coverage that they got. the kind of people i came in contact with as we worked on the affordable care act who were determined to have pre-existing conditions were a victim of domestic violence. someone born with a disability. someone who had an accident or an illness and found themselves with some lingering effects of
that and they would either be denied coverage altogether or they would find in the fine print of their insurance policy significant limitations on that insurance. the insurance would cover them for everything except what they needed insurance. and now after the republican attempt and not just one but 60 or 70 attempts to repeal the affordable care act failed in the united states senate, thanks to the courage of a few there and of the many across this country who said we don't want it repealed, now that it's failed, they have devoted the last year to doing everything in the book to try to sabotage the affordable care act. they won't stabilize health insurance markets thamplee won't focus on reducing premium they won't focus on strengthening and correcting any of the shortcomings within the affordable care act like the need to rein in prescription price -- drug price gouging so instead of expanding accessible
coverage, what they do is to expand a health care tax shelter for a few people. having done so much harm, they ll us today that they're not advocating junk snunches. let's talk about junk insurance. i think they're right in the junkyard on it. president trump's administration is out there telling the courts that they cannot defend the protections in the affordable care act. mr. levin: i yield the gentleman two minutes. mr. doggett: they can't defend and prere-fuse to defend the pre-existing condition provisions, in texas it's almost half the population said to have some kind of pre-existing condition. the administration won't protect those with pre-existing conditions. they're hoping to erode that protection and when i offered a one paragraph amendment, republicans refused it without any decent explanation in our
committee to ensure that pre-existing condition provision was in any policy that would be purchased under this plan. so what you'll be left with as my colleague from california explained are junk insurance plans. they're the kind that promise great coverage by down in the fine print of the policy, you don't have coverage when you need it. they're skinny insurance plans that aren't about the size of the person, but the size of the coverage. it doesn't cover very much. and those kind of plans are the kind that will end up -- that we'll end up having. we have a saboteur in chief, not only when it comes to our military alliances and our friends abroad, but with this president, with reference to health care, and these bare bones junk insurance policies will not get the job done. i think i think of the many people i represent in central texas, and i'm sure they are not unlike people in the suburbs of chicago. they are people like colin
who's a bookkeeper. she adopted her son through the foster care system when he was 18 months old. unbeknownst to her he had a pre-existing condition and she had a pre-existing condition and she said, the affordable care act made my family possible. i think of people like theresa in san antonio who says that before the affordable care act, she found herself repeatedly digging out of medical debt because of her pre-existing conditions. i think of a constituent who called me during the debate of the affordable care act because sher sister could not get -- because her sister could not get coverage for cancer. do you have another 30 seconds? mr. levin: an additional 30 seconds. mr. doggett: she could not get coverage though she had extensive chemotherapy coverage. it was not enough to cover the full amount of treatment she needed. we cannot go back. these folks would drag us back along with the chief saboteur of health care in this country. we don't want to return to the
fine print restrictions, to the clever caveats. we need comprehensive coverage. the affordable care act can be made better, and i believe we're going to have a congress that will just do that if we defeat this effort. thank you. the speaker pro tempore: the gentleman's time has expired. the gentleman from michigan reserves. the gentleman from illinois is recognized. mr. roskam: thank you, mr. speaker. let's talk about the 5% solution. so if you're in the 5%, you need a solution. 5% of this country is millions of people who are in h.s.a.'s and the characterization of something as a tax shelter, as the gentleman from texas just characterized, is a completely loaded and per jor tiff term. where do we go with some level of clarity? let's go to the joint committee on taxation and the question that was posed to them was, show us the tax returns of people who take advantage or who are in a health savings account? in 2015, 71% of returns reported in income of $200,000
or less. are those rich people? i don't think so. in addition, 28% reported in income of $75,000 or less. so the hyperbole, the overstatement, the mischaracterization i think is rich. did you notice something, mr. speaker? i laid out the president's promise, you like your coverage, you get to keep your coverage. you like your doctor, you get to keep your doctor, and we're going to save $2,500 per year per family, and there has been silence on the other side of the aisle, and i predict that won't be answered all afternoon. you want to know why? because there is no answer. but for real answers, i now yield to the gentleman from tennessee, dr. roe, for three minutes. the speaker pro tempore: the gentleman is recognized for three minutes. mr. roe: thank you, mr. speaker. i rise in support of h.r. 6311. this bill makes a number of welcomed changes to our broken health care system, to put patients back in charge of their health care. i've been a physician in rural east tennessee for over 30 years. and we heard about how, mr.
speaker, how the tax bill had caused these premiums to go up. let me tell you what happened in the state of tennessee. since the a.c.a. took place, the number of options went down, and the premiums have gone up on average 175%. let me say this. in the hospital where i practiced, a university hospital, the majority of people with uncollectible debt are people with insurance. let me say that again. the majority of uncollectible debt are people with insurance. why? because the out-of-pockets and co-pays are so high that they can't afford it. that's one of the reasons we need this bill. and let me say, also, that a year ago i was facing a major operation, mr. speaker, cancer operation. i have the a.c.a. insurance. i looked at what my out-of-pocket was, what my co-pays were, what my premiums were, what my employer, the taxpayers of this country, paid for me. i would have been better off if
i had just written a check for the cost of that cancer operation that i had. i had an insurance card. i didn't have insurance coverage. that's what i had with the a.c.a. insurance. so-called insurance. now that the mandate's gone -- i want to say this -- we heard, oh, goodness, the sky is falling because premiums are going to go up. in tennessee our premiums actually went down 10% from the major insurer in the state, blue cross, and for that we're ecertainly grateful in my state. and what we want, now that the mandate's gone, this bill will help create a more affordable copper plan option that will allow the tax credit recipients to use their credit to pay for coverage. this is something we should look at to expand. in fact, senator alexander, congressman duncan, have legislation that will allow people to purchase an offmarket plan when they have limited options. in my district, in the first
district of tennessee, almost as many people within a few hundred paid the penalty tax, whatever judge roberts wanted to call it, that actually got a subsidy. almost as many people paid it. what good is it? awful these changes are long overdue. americans have dealt with the crushing costs associated with obamacare. we are trying to give them as much relief as possible. by passing this bill today, we'll return control to patients to determine what level of coverage is best for them and their families rather than the government making an arbitrary decision for them. if we had a system of health care in this country, whether it was patiented center and market driven these changes would be unnecessary. instead, we have a top-down government-knows-best approach to health care that continues to cost folks all across the country more than they can afford. i support the provisions in this bill because i've worked very hard to get -- i'll finish by saying this. mr. roskam: yield an additional 30 seconds. mr. roe: mr. speaker, the current system under obamacare is unsustainable, and we must
increase affordable options or the system will collapse. finally, i'll say, let's put it this way. we need to put patients and doctors, not insurance companies and bureaucrats, in charge of health care decisions in this country. that's what a health savings account does. i encourage all my colleagues to support this. mr. speaker, i'll yield back my time. the speaker pro tempore: the gentleman reserves. the gentleman from michigan is recognized. mr. levin: could i ask how much time we have on both sides of the aisle? the speaker pro tempore: 6 1/2 minutes remaining. 6 1/2 minutes remaining. the gentleman from illinois has 14 minutes remaining. mr. levin: has how much? the speaker pro tempore: 14 minutes remaining. you have 6 1/2, sir. mr. levin: i'll reserve. the speaker pro tempore: the gentleman reserves. the gentleman from illinois is recognized. mr. roskam: thank you, mr. speaker. i'm pleased to yield three minutes to the gentleman from ohio, general stivers. the speaker pro tempore: the gentleman is recognized for three minutes. mr. stivers: mr. speaker, i
want to thank the gentleman from illinois for yielding me time. i rise today to support h.r. 6311, and more specifically, i rise to support bipartisan language to make flexible spending accounts flexible. while 4% of americans have ack -- 44% of americans have access to flexible spending accounts, flexible spending accounts have not been flexible. there are two problems. under obamacare, flexible spending accounts contributions were capped at $2,650, and while the average american spends more than $5,700 in out-of-pocket health care costs , it's just not enough. the second problem is, flexible spending account rules make people use it or lose it at the end of the year, and they can't roll over their money. they have to spend it on things they don't need or they have to lose that money. our bipartisan solution solves those problems by doing two things. first, it increases the limit
on f.s.a. accounts by a multiple of three to $7,950. and i did the math for the ranking member. that would be over three years, if you wanted to save $50 a eek, you can accumulate $7,950 . obviously that would be if you weren't using it. so it will probably take longer than that to accumulate that kind of money. again, that's well over the average of $5,700 of out-of-pocket expenses that the average american has. and by the way, while flexible spending accounts are accessible to people, one of the reasons people like them is they make out-of-pocket expenses more affordable for individuals because those contributions are pre-tax dollars. the second thing our bipartisan language does is it allows the balance to be rolled over at the end of the year. up to that $7,950 limit. the rollover provision keeps
people from losing their money or making health care expenses that are wasteful at the end of the year. mr. speaker, i urge my colleagues to support the flexible spending account language and the underlying bill and i yield back the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from michigan is recognized. mr. levin: i yield with pleasure two minutes to the gentlelady from michigan, my colleague, brenda lawrence. the speaker pro tempore: the gentlelady is recognized for two minutes. mrs. lawrence: thank you. mr. speaker, i rise to speak against h.r. 6311. the bill does no favor for the average working american. this is yet another bill to sabotage the affordable care act and make health care more expensive for those who need it the most. expanding these health savings accounts, which are simply investment accounts, they don't cover basic human -- basic health care. it does not help the average american who needs true health
care. this republican legislation will not help my constituents in michigan, it does not serve the need access to health care to the nation's most vulnerable. it doesn't serve seniors either. it hurts them by drawing medicare recipients into a high-cost care. in michigan, 92% of medicare beneficiaries make under $50,000, and 14% are black seniors that live below the poverty line. we know seniors can't afford this. we also know this bill will drain more money from medicare by adding $60 billion to the deficit. we need affordable care for everyone, not unaffordable health plans for a few. this bill will destabilize and destroy affordable health care, and i yield back. the speaker pro tempore: the gentleman from michigan reserves. the gentleman from illinois is recognized. mr. roskam: mr. speaker, i'll yield myself such time as i may consume. there's nothing in this bill that is destructive at all.
the entire structure of the bill is invitational. the bill presumes the status quo in terms of the affordable care act, and it allows people to get in sync with the affordable care act and it allows them to save money in a tax-free manner. i'm really surprised at the hyperbole, the overstatement, and the overcharacterization. and nobody has answered either, mr. speaker, if you'll notice, my admonition about the characterization of junk insurance. to attribute that claim, which we heard from a couple of speakers this afternoon, against this bill is to attribute that claim and that criticism against the a.c.a., because the underlying bill matches exactly what the a.c.a. purports. that is, catastrophic coverage, and it simply says, if you have that coverage and your deductibles take your breath away, good news. you can save in a tax-free basis. so i think with all due respect
to the talking points writers and all due respect to the critics of this bill, i think the entire debate would be uplifted somewhat if we were debating the actual bill that's before us instead of tweets and news feeds and so forth. i reserve the balance of my time. the speaker pro tempore: the gentleman reserves. the gentleman from michigan is recognized. mr. levin: i would ask to the chairman, are you ready to close? mr. roskam: i am. mr. levin: ok. i yield myself the balance of our time. the speaker pro tempore: the gentleman is recognized. mr. levin: as i close, i think back some years when we were working on a.c.a. it was one of our proudest achievements. the republicans from day one .ere determined to destroy it c.a. can be made better, but
destruction is not improvement. this bill, when you put it together, is not only unpaid for, but would be a step to try to undermine the basic thrust f a.c.a., to replace these basic provisions with something much less. in a word, the republicans are on the wrong side of history, and the clock is ticking. and these bills, when you put them all together, essentially way to se are another undercut a.c.a. this is a very, very weak, and i think, worse than a set of
new alternatives. they have never came up with a comprehensive bill, and this effort is the opposite. as we have mentioned, relatively few people with lower income can access these. so many of the people who access h.s.a.'s are people who can afford it. we can make it better, but don't come here when you've had no alternative, to say this is something that could replace a.c.a. and you don't pay for it. you're reckless. as i said earlier, it's a reckless bill of the chairman of our subcommittee. so i urge my colleagues to reject this, to not be fooled.
we democrats come to the floor with a sense of being on the right side of history. and what's being -- what's happening in this country is that more and more of the public acknowledge it. compared to when we first started, i remember going back home, there was so much opposition, so much misguided, but when people, 20 million, for the first time in most cases, had health care, the clock began to take in the direction of universal care. you are trying to turn back the clock, you republicans. but it's ticking more and more toward universality. that's what's happening in this country. and this is becoming part of the edrock, the foundations of care, of provisions for the
benefit of the american people, as social security was. as medicare was, as medicaid. you're going to pay the price for your blind opposition. the public is more and more aware, as their eyes have been opened and as their health has been protected, what this has meant to millions of families in this country. millions. i run into it every day i go home. people who come and say, without health care coverage, where would i be? not only financially but where would i be in what is so dear to me, my health and the health of our family and the health of our kids? i urge we democrats, stand up tall and say to the american public, the a.c.a. was a major
historic step in the right direction. the republicans continue to try to destroy it. history is showing that once again they were moving in the wrong direction. i urge that we reject this bill and move proudly forward. we put together this step, we're going to continue to move forward. i yield back the balance of our time. the speaker pro tempore: the gentleman yields back. members are reminded to direct their remarks to the chair. the member if illinois is recognized. mr. roskam: i served on the ways and means committee when the a.c.a. was passed and i recall then minority ranking member dave camp from michigan who went on to become the charnle later, but he offered an alternative to the a.c.a. and he inquired of then-chairman rangel, when will we get to the republican alternative? when are we going to get to the republican alternative?
i remember this because i was sitting, i think i have the same seat mr. higgins has from new york, down in front or on the left side of the dais and charlie rangel evoked an old gospel song he said, soon and very soon. which is why i remember. now, soon and very soon never came for that amendment. soon and very soon never came for the republican alternative to be considered in the ways and means committee. now what we're dealing with is the reality of the affordable care act and mr. speaker what we are proposing is to say look, we've got some suggestions. we think we can make this better. is this reckless? i think not. i fundamentally reject that. when you accept the entire premise of the current structure othey have affordable care act and you take something that pre-existed within the affordable care act that is health savings accounts, and you
attach it and expand it, where is the defensiveness? and this is what is amazing to me about this debate. this is why our country is stuck. our friends on the other side of the aisle have created the affordable care act and it is orthodoxy. to take it on and to try to make improvements they say they want improvement they say let's work together. all afternoon with ms. jenkins here on the house floor, she was managing time, a bill -- of bills that were bipartisan in nature, bipartisan as they went through the committee but you got none of that veneer of bipartisanship as they were discussed on the floor. they were perceived as a direct attack at what? orthodoxy. so not withstanding the invitation to work on both sides of the aisle, the other side is making it very clear that you can take -- they're unwilling to take the structure othey have a.c.a., to take favorable tax
treatment and help more people save their own money and spare themselves the results of a law that our friends on the other side of the aisle said you could keep your doctor, you could keep your coverage and you'd save $2,500 per person. again, i reiterate, mr. speaker, did you notice there was no answer to that charge this afternoon. i laid it out twice and now a third time i think. and absolute silence. why? because they oversold. and now when they've got friends on this side of the aisle that are saying look, we can improve this. let's work here. no, we don't like the a.c.a. but we can work through some of these things, then all of a sudden, it's stiff armed. then all of a sudden it's insincere. then all of a sudden it's political. i don't know. this is good work. this is serious work. and it's work that's designed to bring relief to people who are suffering, who have no interest
in the nature of a donkeys and elephants debate on the house floor. most people's eyes glaze over. most people say they want remedies. this is a remedy? that makes sense? this is a remedy in insouth carolina with the a.c.a. in some way absd & the responses we have heard from the other side i don't think are persuasive. i urge the -- i urge everything i'm supposed to urge right now i urge the passage of h.r. 6311 and ayield back the balance after my time. the speaker pro tempore: the gentleman yields back. all time for debate has expired. pursuant to house resolution 1011, the previous question is ordered on the bill as amended. the question is on the engrossment and third read of the bill. those in favor say aye. those opposed, no. the ayes have it. third reading. the clerk: a bill to amend the internal revenue code of 1986 and the patient protection and
affordable care act to modify the definition of qualified health plan for purposes of the health insurance premium tax credit and to allow individuals purchasing health insurance in the individual market to purchase a lower premium copper plan. the speaker pro tempore: for what purpose does the gentlewoman from florida seek recognition? >> mr. speaker, i have a motion to recommit at the desk. the speaker pro tempore: is the gentlewoman opposed to the bill? >> i'm opposed in its current form, mr. speaker. the speaker pro tempore: the gentlewoman qualifies. the clerk will report the motion. the clerk: ms. frankel of florida -- ms. frankel: i ask unanimous consent to dispense with the reading. the speaker pro tempore: without objection. the gentlewoman from florida is recognized for five minutes in support of her motion. ms. frankel: thank you, mr. speaker. this is the final amendment to the bill which will not kill the bill or send it back to committee. if adopted, the bill will immediately proceed to final passage as amended. now mr. speaker, my motion will
make this bill much better. it's going to delay this legislation from going to effect until we clean up one of the messes caused by the republican tax scam, the big giveaway to the richest few in this country at the expense of most americans. now listen to this. the 2018 medicare trust report predicts that the medicare trust fund will be depleted in 2026, three years earlier than predicted in last year's report. now mr. speaker, why is this not $2.3 urprise, the trillion republican tax cut for the benefit of corporations and billionaires has shortchanged the longevity of the fund that pays for the health care of 58 million seniors.
it's called medicare. a program that celebrates its 53rd year anniversary this month. a system that seniors have spent a lifetime paying into. just ask eve in my hometown, west palm beach who relies on skilled nursing care. like the 1.8 million eves in this country. our irving in delray who had his prostate removed. like irving, 6.6 million americans rely on medicare to pay for their hospital visits every year. medicare helps to keep our grandmothers and grandfathers healthy and repair them. when they're sick. it allows men and women who raise families and build their country to retire in dignyy -- dignity without paying every last dollar for their needed well care visit they blood pressure medicine or their hip
replacement. i urge my colleagues do the right thing. for the folks who we love and who love us. take the time to fix this legislation, put the money back into the medicare trust fund. that was cruelly, i say cruelly stolen by the republican tax scam. the giveaway to the richest 1% and the big corporate interests. let's keep medicaid alive and well. colleagues, please support this motion to recommit. mr. speaker, i yield back the balance of my time. the speaker pro tempore: the gentlelady yields back. the gentleman from illinois is recognized for five minutes. >> mr. speaker, i urge us to reject this motion to recommit. the health insurance trust fund won't be insolvent because we're freeing americans from the individual mandate. mr. roskam: i this crisis has been going on for decades. i urge a no vote and yield back. the speaker pro tempore: the gentleman yields back.
the question is on the motion to recommit. those in favor say aye. those opposed, no. the aye -- the noes have it. ms. frankel: i ask for the yeas and nays. the speaker pro tempore: the yeas and -- the yeas and nays are requested. those faring a vote by the wraze and nays will rise. a sufficient number having risen, the yeas and nays are ordered. members will record their votes by electronic device. pursuant to clause 8 and clause 9 of rule 20, the vote on the motion to recommit will be -- the 15-minute vote on the notion recommit will be followed by five-minute votes on the passage of h.r. 6311 if oordered and passage of h.r. 6199. this is a 15-minute vote. [captioning made possible by the national captioning institute, inc., in cooperation with the united states house of representatives. any use of the closed-captioned coverage of the house proceedings for political or commercial purposes is expressly prohibited by the u.s. house of representatives.]