Consideration of H.R. 1425, Patient Protection and Affordable Care Enhancement Act — Congressional Record
Summary
A page of the Congressional Record, House, dated June 29, 2020, beginning at page H2599. One-minute remarks urge help for independent restaurants under the RESTAURANTS Act, H.R. 7197, which would establish a $120 billion fund, and urge passage of the Patient Protection and Affordable Care Enhancement Act while Texas hospitals are overwhelmed, and Mr. Olson memorializes Mayor Leonard Scarcella of Stafford, Texas. Mr. Pallone, pursuant to House Resolution 1017, calls up H.R. 1425, the State Health Care Premium Reduction Act. The page then prints the bill's table of contents and opening text, including a premium assistance table that runs from 0.0 percent to 8.5 percent and a section establishing a Health Insurance Affordability Fund.
Summary drafted by a model from the document's text below and checked by script against that text before publication. It is a navigation aid, not a reading of what the document proves. Where AI is used
Cite this document
“Consideration of H.R. 1425, Patient Protection and Affordable Care Enhancement Act — Congressional Record.”
Original at www.govinfo.gov. Archived at Pandemic Darlings, https://pandemicdarlings.com/source-documents/crec-crec-2020-06-29-crec-2020-06-29-pt1-pgh2599-3-d12a0616df/
, SHA-256 ac4a848c7026181b8e5d3038d71f3645162c78d4bd9d7885d3b69368830257b7.Full text
June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2599
Madam Speaker, over 500,000 inde- 130,000 Americans and is ravaging my Sec. 103. Expanding affordability for working
pendent restaurants with 11 million home State of Texas and has left our families to fix the family glitch.
employees are going to face cata- hospitals overwhelmed right now, it is Sec. 104. Tax credit reconciliation protections
strophic consequences this year. In now more important that we do every- for individuals receiving social se-
curity lump-sum payments.
April alone, one-half of the unem- thing that we can to strengthen the
Sec. 105. Preserving State option to implement
ployed, 5.5 million people, were from ACA. This important legislation has al- health care Marketplaces.
the independent restaurants area. ready given access to millions of people Sec. 106. Establishing a Health Insurance Af-
Without special, tailored Federal help, that now have lifesaving healthcare, fordability Fund.
we are going to see 85 percent of them many who could not previously access Sec. 107. Rescinding the short-term limited du-
disappear for good. it. ration insurance regulation.
Madam Speaker, I am pleased to Madam Speaker, this legislation that Sec. 108. Revoking section 1332 guidance.
have introduced, on a bipartisan basis, I am working on now pushes critical Sec. 109. Requiring Marketplace outreach, edu-
the RESTAURANTS Act, H.R. 7197, provisions, like lowering healthcare cational activities, and annual
which would establish a $120 billion costs, strengthening protections for enrollment targets.
fund tailored to provide assistance for people with preexisting conditions, ne- Sec. 110. Report on effects of website mainte-
gotiating for lower prescription drug nance during open enrollment.
independent restaurants.
prices, and expanding healthcare by Sec. 111. Promoting consumer outreach and
I strongly urge my colleagues to talk education.
to their independent restaurants, the pressing for Medicaid expansion.
Sec. 112. Improving transparency and account-
cornerstone of a vital community. If Madam Speaker, let me tell you ability in the Marketplace.
we act now, we can save them yet this something: You don’t want to get sick Sec. 113. Improving awareness of health cov-
year, a vital element in each and every in Texas right now. You don’t want to erage options.
one of our communities. get sick in Texas right now. Our hos- Sec. 114. Promoting State innovations to ex-
Madam Speaker, the H.R. 7197, the pitals are overwhelmed because of the pand coverage.
RESTAURANTS Act, will provide mas- inaction of our Governor. It is shame- Sec. 115. Strengthening network adequacy.
sive support at a time when it is need- ful. Sec. 116. Protecting consumers from unreason-
ed. Anything that we can do here to help able rate hikes.
f
the crisis that we have back in our Sec. 117. Eligibility of DACA recipients for
State, which is also about to grip other qualified health plans offered
MEMORIALIZING MAYOR LEONARD States in this Nation, we need to act through Exchanges.
SCARCELLA on it now. TITLE II—ENCOURAGING MEDICAID EX-
(Mr. OLSON asked and was given per- Time cannot wait. PANSION AND STRENGTHENING THE
MEDICAID PROGRAM
mission to address the House for 1 f
minute and to revise and extend his re- Sec. 201. Incentivizing Medicaid expansion.
STATE HEALTH CARE PREMIUM Sec. 202. Providing 12-months of continuous eli-
marks.) REDUCTION ACT gibility for Medicaid and CHIP.
Mr. OLSON. Madam Speaker, the
Mr. PALLONE. Madam Speaker, pur- Sec. 203. Mandatory 12-months of postpartum
city of Stafford, Fort Bend County, the Medicaid eligibility.
suant to House Resolution 1017, I call
State of Texas, and all of America lost Sec. 204. Reducing the administrative FMAP
up the bill (H.R. 1425) to amend the Pa-
a great man Sunday: Mayor Leonard for nonexpansion States.
tient Protection and Affordable Care
Scarcella. Sec. 205. Enhanced reporting requirements for
Act to provide for a Improve Health In-
He was a true Texas force of nature. nonexpansion states.
surance Affordability Fund to provide
He listened to all, regardless of what Sec. 206. Primary care pay increase.
for certain reinsurance payments to
country you came from or where you Sec. 207. Permanent funding for CHIP.
lower premiums in the individual
worshipped. His life was about making Sec. 208. Permanent extension of CHIP enroll-
health insurance market, and ask for ment and quality measures.
all human life better.
its immediate consideration. Sec. 209. State option to increase children’s eli-
Madam Speaker, for 51 years as
The Clerk read the title of the bill. gibility for Medicaid and CHIP.
mayor, he did just that. He helped The SPEAKER pro tempore. Pursu-
bring Texas Instruments to Stafford in Sec. 210. Medicaid coverage for citizens of Free-
ant to House Resolution 1017, in lieu of ly Associated States.
1967, opening the door to Fort Bend to the amendment in the nature of a sub- Sec. 211. Extension of full Federal medical as-
attract corporate America. stitute recommended by the Com- sistance percentage to Indian
Not happy with the public education mittee on Energy and Commerce print- health care providers.
in Stafford, he fought for the only city- ed in the bill, an amendment in the na- TITLE III—LOWERING PRICES THROUGH
run school board in Texas. ture of a substitute consisting of the FAIR DRUG PRICE NEGOTIATION
Tired of people going to the big city text of the Rules Committee Print 116– Sec. 301. Establishing a Fair Drug Pricing Pro-
of Houston for concerts and conven- 56, modified by the amendment printed gram.
tions, Leonard opened the Stafford in part B of House Report 116–436, is Sec. 302. Drug manufacturer excise tax for non-
Centre in 2004. adopted, and the bill, as amended, is compliance.
He proudly governed without one considered read. Sec. 303. Fair Price Negotiation Implementation
penny of property tax. The text of the bill, as amended, is as Fund.
It was Leonard who brought the stun- follows: TITLE IV—PUBLIC HEALTH INVESTMENTS
ning 30,000-piece BAPS Hindu Temple H.R. 1425 Sec. 401. Supporting increased innovation.
to Stafford in 2004. Be it enacted by the Senate and House of Rep- TITLE I—LOWERING HEALTH CARE COSTS
Madam Speaker, to close, nearly 1 resentatives of the United States of America in AND PROTECTING PEOPLE WITH PRE-
million Texans in Fort Bend County Congress assembled, EXISTING CONDITIONS
are mourning now. I join them. God SECTION 1. SHORT TITLE.
SEC. 101. IMPROVING AFFORDABILITY BY EX-
bless Mayor Leonard Scarcella. This Act may be cited as the ‘‘Patient Protec- PANDING PREMIUM ASSISTANCE
f tion and Affordable Care Enhancement Act’’. FOR CONSUMERS.
SEC. 2. TABLE OF CONTENTS. (a) IN GENERAL.—Section 36B(b)(3)(A) of the
STRENGTHEN THE ACA The table of contents for this Act is as follows: Internal Revenue Code of 1986 is amended to
(Mr. VEASEY asked and was given Sec. 1. Short title. read as follows:
permission to address the House for 1 Sec. 2. Table of contents. ‘‘(A) APPLICABLE PERCENTAGE.—The applica-
minute.) TITLE I—LOWERING HEALTH CARE COSTS ble percentage for any taxable year shall be the
AND PROTECTING PEOPLE WITH PRE- percentage such that the applicable percentage
Mr. VEASEY. Madam Speaker, I rise
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EXISTING CONDITIONS for any taxpayer whose household income is
today to ask my colleagues to pass the
Sec. 101. Improving affordability by expanding within an income tier specified in the following
Patient Protection and Affordable Care premium assistance for consumers. table shall increase, on a sliding scale in a lin-
Enhancement Act. Sec. 102. Improving affordability by reducing ear manner, from the initial premium percentage
Because we are in the middle of a out-of-pocket and premium costs to the final premium percentage specified in
global pandemic that has killed almost for consumers. such table for such income tier:
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H2600 CONGRESSIONAL RECORD — HOUSE June 29, 2020
‘‘In the case of household The initial The final
income (expressed as premium premium
a percent of poverty line) percentage percentage
within the following income tier: is— is—
Up to 150.0 percent .......................................................................................................................................................................................... 0.0 0.0
150.0 percent up to 200.0 percent ....................................................................................................................................................................... 0.0 3.0
200.0 percent up to 250.0 percent ....................................................................................................................................................................... 3.0 4.0
250.0 percent up to 300.0 percent ....................................................................................................................................................................... 4.0 6.0
300.0 percent up to 400.0 percent ....................................................................................................................................................................... 6.0 8.5
400.0 percent and higher .................................................................................................................................................................................. 8.5 8.5’’.
(b) CONFORMING AMENDMENT.—Section ‘‘(ii) LUMP-SUM SOCIAL SECURITY BENEFIT PAY- SEC. 106. ESTABLISHING A HEALTH INSURANCE
36B(c)(1)(A) of the Internal Revenue Code of MENT.—For purposes of this subparagraph, the AFFORDABILITY FUND.
1986 is amended by striking ‘‘but does not exceed term ‘lump-sum social security benefit payment’ Subtitle D of title I of the Patient Protection
400 percent’’. means any payment of social security benefits and Affordable Care Act is amended by insert-
(c) EFFECTIVE DATE.—The amendments made (as defined in section 86(d)(1)) which constitutes ing after part 5 (42 U.S.C. 18061 et seq.) the fol-
by this section shall apply to taxable years be- more than 1 month of such benefits. lowing new part:
ginning after December 31, 2019. ‘‘(iii) ELECTION TO INCLUDE EXCLUDABLE ‘‘PART 6—IMPROVE HEALTH INSURANCE
SEC. 102. IMPROVING AFFORDABILITY BY REDUC- AMOUNT.—A taxpayer may elect (at such time AFFORDABILITY FUND
ING OUT-OF-POCKET AND PREMIUM and in such manner as the Secretary may pro-
COSTS FOR CONSUMERS. ‘‘SEC. 1351. ESTABLISHMENT OF PROGRAM.
vide) to have this subparagraph not apply for ‘‘There is hereby established the ‘Improve
Section 1302(c)(4) of the Patient Protection any taxable year.’’.
and Affordable Care Act (42 U.S.C. 18022(c)(4)) Health Insurance Affordability Fund’ to be ad-
(b) EFFECTIVE DATE.—The amendment made
is amended by striking ‘‘calendar year)’’ and in- ministered by the Secretary of Health and
by this section shall apply to taxable years be-
serting ‘‘calendar year, based on estimates and Human Services, acting through the Adminis-
ginning after December 31, 2019.
projections for the applicable calendar year of trator of the Centers for Medicare & Medicaid
SEC. 105. PRESERVING STATE OPTION TO IMPLE-
the percentage (if any) by which the average MENT HEALTH CARE MARKET-
Services (in this section referred to as the ‘Ad-
per enrollee premium for eligible employer-spon- PLACES. ministrator’), to provide funding, in accordance
sored health plans (as defined in section (a) IN GENERAL.—Section 1311 of the Patient with this part, to the 50 States and the District
5000A(f)(2) of the Internal Revenue Code of Protection and Affordable Care Act (42 U.S.C. of Columbia (each referred to in this section as
1986) exceeds such average per enrollee premium 18031) is amended— a ‘State’) beginning on January 1, 2022, for the
for the preceding calendar year, as published in (1) in subsection (a)— purposes described in section 1352.
the National Health Expenditure Accounts)’’. (A) in paragraph (4)(B), by striking ‘‘under ‘‘SEC. 1352. USE OF FUNDS.
SEC. 103. EXPANDING AFFORDABILITY FOR this subsection’’ and inserting ‘‘under this para- ‘‘(a) IN GENERAL.—A State shall use the funds
WORKING FAMILIES TO FIX THE graph or paragraph (1)’’; and allocated to the State under this part for one of
FAMILY GLITCH. (B) by adding at the end the following new the following purposes:
(a) IN GENERAL.—Clause (i) of section paragraph: ‘‘(1) To provide reinsurance payments to
36B(c)(2)(C) of the Internal Revenue Code of ‘‘(6) ADDITIONAL PLANNING AND ESTABLISH- health insurance issuers with respect to individ-
1986 is amended to read as follows: MENT GRANTS.— uals enrolled under individual health insurance
‘‘(i) COVERAGE MUST BE AFFORDABLE.— ‘‘(A) IN GENERAL.—There shall be appro- coverage (other than through a plan described
‘‘(I) EMPLOYEES.—An employee shall not be priated to the Secretary, out of any moneys in in subsection (b)) offered by such issuers.
treated as eligible for minimum essential cov- the Treasury not otherwise appropriated, $200 ‘‘(2) To provide assistance (other than
erage if such coverage consists of an eligible em- million to award grants to eligible States for the through payments described in paragraph (1)) to
ployer-sponsored plan (as defined in section uses described in paragraph (3). reduce out-of-pocket costs, such as copayments,
5000A(f)(2)) and the employee’s required con- ‘‘(B) DURATION AND RENEWABILITY.—A grant coinsurance, premiums, and deductibles, of indi-
tribution (within the meaning of section awarded under subparagraph (A) shall be for a viduals enrolled under qualified health plans of-
5000A(e)(1)(B)) with respect to the plan exceeds period of 2 years and may not be renewed. fered on the individual market through an Ex-
9.5 percent of the employee’s household income. ‘‘(C) LIMITATION.—A grant may not be award- change.
‘‘(II) FAMILY MEMBERS.—An individual who is ed under subparagraph (A) after December 31, ‘‘(b) EXCLUSION OF CERTAIN GRANDFATHERED
eligible to enroll in an eligible employer-spon- 2023. AND TRANSITIONAL PLANS.—For purposes of sub-
sored plan (as defined in section 5000A(f)(2)) by ‘‘(D) ELIGIBLE STATE DEFINED.—For purposes section (a), a plan described in this subsection is
reason of a relationship the individual bears to of this paragraph, the term ‘eligible State’
the following:
the employee shall not be treated as eligible for means a State that, as of the date of the enact- ‘‘(1) A grandfathered health plan (as defined
minimum essential coverage by reason of such ment of this paragraph, is not operating an Ex- in section 1251).
eligibility to enroll if the employee’s required change (other than an Exchange described in ‘‘(2) A plan (commonly referred to as a ‘tran-
contribution (within the meaning of section section 155.200(f) of title 45, Code of Federal sitional plan’) continued under the letter issued
5000A(e)(1)(B), determined by substituting ‘fam- Regulations).’’; and by the Centers for Medicare & Medicaid Services
ily’ for ‘self-only’) with respect to the plan ex- (2) in subsection (d)(5)(A)— on November 14, 2013, to the State Insurance
ceeds 9.5 percent of the employee’s household in- (A) by striking ‘‘OPERATIONS.—In establishing
Commissioners outlining a transitional policy
come.’’. an Exchange under this section’’ and inserting
for coverage in the individual and small group
(b) CONFORMING AMENDMENTS.— ‘‘OPERATIONS.—
‘‘(i) IN GENERAL.—In establishing an Ex- markets to which section 1251 does not apply,
(1) Clause (ii) of section 36B(c)(2)(C) of the In- and under the extension of the transitional pol-
ternal Revenue Code of 1986 is amended by change under this section (other than in estab-
lishing an Exchange pursuant to a grant icy for such coverage set forth in the Insurance
striking ‘‘Except as provided in clause (iii), an Standards Bulletin Series guidance issued by
employee’’ and inserting ‘‘An individual’’. awarded under subsection (a)(6))’’; and
(B) by adding at the end the following: the Centers for Medicare & Medicaid Services on
(2) Clause (iii) of section 36B(c)(2)(C) of such March 5, 2014, February 29, 2016, February 13,
Code is amended by striking ‘‘the last sentence ‘‘(ii) ADDITIONAL PLANNING AND ESTABLISH-
MENT GRANTS.—In establishing an Exchange 2017, April 9, 2018, March 25, 2019, and January
of clause (i)’’ and inserting ‘‘clause (i)(II)’’. 31, 2020, or under any subsequent extensions
(3) Clause (iv) of section 36B(c)(2)(C) of such pursuant to a grant awarded under subsection
(a)(6), the State shall ensure that such Ex- thereof.
Code is amended by striking ‘‘the 9.5 percent
change is self-sustaining beginning on January ‘‘(3) Student health insurance coverage (as
under clause (i)(II)’’ and inserting ‘‘the 9.5 per-
1, 2025, including allowing the Exchange to defined in section 147.145 of title 45, Code of
cent under clauses (i)(I) and (i)(II)’’.
charge assessments or user fees to participating Federal Regulations).
(c) EFFECTIVE DATE.—The amendments made
health insurance issuers, or to otherwise gen- ‘‘SEC. 1353. STATE ELIGIBILITY AND APPROVAL;
by this section shall apply to taxable years be-
erate funding, to support its operations.’’. DEFAULT SAFEGUARD.
ginning after December 31, 2021.
(b) CLARIFICATION REGARDING FAILURE TO ES- ‘‘(a) ENCOURAGING STATE OPTIONS FOR ALLO-
SEC. 104. TAX CREDIT RECONCILIATION PROTEC-
TIONS FOR INDIVIDUALS RECEIVING TABLISH EXCHANGE OR IMPLEMENT REQUIRE- CATIONS.—
SOCIAL SECURITY LUMP-SUM PAY- MENTS.—Section 1321(c) of the Patient Protec- ‘‘(1) IN GENERAL.—To be eligible for an alloca-
MENTS. tion and Affordable Care Act (42 U.S.C. tion of funds under this part for a year (begin-
(a) IN GENERAL.—Section 36B(d)(2) of the In- 18041(c)) is amended— ning with 2022), a State shall submit to the Ad-
ternal Revenue Code of 1986 is amended by add- (1) in paragraph (1), by striking ‘‘If’’ and in- ministrator an application at such time (but, in
ing at the end the following new subparagraph: serting ‘‘Subject to paragraph (3), if’’; and the case of allocations for 2022, not later than 90
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‘‘(C) EXCLUSION OF PORTION OF LUMP-SUM SO- (2) by adding at the end the following new days after the date of the enactment of this part
CIAL SECURITY BENEFITS.— paragraph: and, in the case of allocations for a subsequent
‘‘(i) IN GENERAL.—The term ‘modified adjusted ‘‘(3) CLARIFICATION.—This subsection shall year, not later than March 1 of the previous
gross income’ shall not include so much of any not apply in the case of a State that elects to year) and in such form and manner as specified
lump-sum social security benefit payment as is apply the requirements described in subsection by the Administrator containing—
attributable to months ending before the begin- (a) and satisfies the requirement described in ‘‘(A) a description of how the funds will be
ning of the taxable year. subsection (b) on or after January 1, 2014.’’. used; and
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2601
‘‘(B) such other information as the Adminis- retary shall, with respect to a State not de- its and annual out-of-pocket limits, that may
trator may require. scribed in section 1353(b) for such year and not increase the cost of treatment and cause finan-
‘‘(2) AUTOMATIC APPROVAL.—An application later than the date specified under subpara- cial hardship to those requiring medical care,
so submitted is approved unless the Adminis- graph (B) for such year, allocate for such State including children with complex medical needs
trator notifies the State submitting the applica- the amount determined for such State and year and disabilities and their families; and
tion, not later than 60 days after the date of the under paragraph (2). (C) excludes coverage of essential health bene-
submission of such application, that the appli- ‘‘(B) SPECIFIED DATE.—For purposes of sub- fits including hospitalization, prescription
cation has been denied for not being in compli- paragraph (A), the date specified in this sub- drugs, and other lifesaving care.
ance with any requirement of this part and of paragraph is— (3) The implementation and enforcement of
the reason for such denial. ‘‘(i) for 2022, the date that is 45 days after the the final rule weakens critical protections for up
‘‘(3) 5-YEAR APPLICATION APPROVAL.—If an date of the enactment of this part; and to 130 million Americans living with preexisting
application of a State is approved for a purpose ‘‘(ii) for 2023 or a subsequent year, January 1 health conditions and may place a large finan-
described in section 1352 for a year, such appli- of the respective year. cial burden on those who enroll in short-term
cation shall be treated as approved for such ‘‘(C) NOTIFICATIONS OF ALLOCATION limited-duration insurance, which jeopardizes
purpose for each of the subsequent 4 years. AMOUNTS.—For 2023 and each subsequent year, Americans’ access to quality, affordable health
‘‘(4) REVOCATION OF APPROVAL.—The ap- the Secretary shall notify each State of the insurance.
proval of an application of a State, with respect amount determined for such State under para- (b) PROHIBITION.—The Secretary of Health
to a purpose described in section 1352, may be graph (2) for such year by not later than Janu- and Human Services, the Secretary of the Treas-
revoked if the State fails to use funds provided ary 1 of the previous year. ury, and the Secretary of Labor—
to the State under this section for such purpose ‘‘(2) ALLOCATION AMOUNT DETERMINATIONS.— (1) may not take any action to implement, en-
or otherwise fails to comply with the require- ‘‘(A) IN GENERAL.—For purposes of paragraph force, or otherwise give effect to the rule entitled
ments of this section. (1), the amount determined under this para- ‘‘Short-Term, Limited Duration Insurance’’ (83
‘‘(b) DEFAULT FEDERAL SAFEGUARD.— graph for a year for a State described in para- Fed. Reg. 38212 (August 3, 2018));
‘‘(1) 2022.—For 2022, in the case of a State graph (1)(A) for such year is the amount equal (2) shall apply any regulation revised by such
that does not submit an application under sub- to— rule as if such rule had not been issued; and
section (a) by the 90-day submission date appli- ‘‘(i) the amount that the Secretary estimates (3) may not promulgate any substantially
cable to such year under subsection (a)(1) and would be expended under this part for such year similar rule.
in the case of a State that does submit such an on attachment range claims of individuals resid- SEC. 108. REVOKING SECTION 1332 GUIDANCE.
application by such date that is not approved, ing in such State if such State used such funds
(a) FINDINGS.—Congress finds the following:
the Administrator, in consultation with the only for the purpose described in paragraph (1)
(1) On October 24, 2018, the administration
State insurance commissioner, shall, from the of section 1352(a) at the dollar amounts and per-
published new guidance to carry out section
amount calculated under paragraph (4) for such centage specified under subparagraph (B) for
1332 of the Patient Protection and Affordable
year, carry out the purpose described in para- such year; minus
‘‘(ii) the amount, if any, by which the Sec- Care Act (42 U.S.C. 18052) entitled ‘‘State Relief
graph (3) in such State for such year. and Empowerment Waivers’’ (83 Fed. Reg.
‘‘(2) 2023 AND SUBSEQUENT YEARS.—For 2023 or retary determines—
‘‘(I) the estimated amount of premium tax 53575).
a subsequent year, in the case of a State that (2) The new guidance encourages States to
does not have in effect an approved application credits under section 36B of the Internal Rev-
enue Code of 1986 that would be attributable to provide health insurance coverage through in-
under this section for such year, the Adminis- surance plans that may discriminate against in-
trator, in consultation with the State insurance individuals residing in such State for such year
without application of this part; exceeds dividuals with preexisting health conditions, in-
commissioner, shall, from the amount calculated cluding the one in four Americans living with a
under paragraph (4) for such year, carry out ‘‘(II) the estimated amount of premium tax
credits under section 36B of the Internal Rev- disability.
the purpose described in paragraph (3) in such (3) The implementation and enforcement of
State for such year. enue Code of 1986 that would be attributable to
individuals residing in such State for such year the new guidance weakens protections for the
‘‘(3) SPECIFIED USE.—The amount described in millions of Americans living with preexisting
paragraph (4), with respect to 2022 or a subse- if such State were a State described in section
1353(b) for such year. health conditions and jeopardizes Americans’
quent year, shall be used to carry out the pur- access to quality, affordable health insurance
For purposes of the previous sentence and sec-
pose described in section 1352(a)(1) in each State coverage.
tion 1353(b)(3), the term ‘attachment range
described in paragraph (1) or (2) for such year, (b) PROVIDING THAT CERTAIN GUIDANCE RE-
claims’ means, with respect to an individual, the
as applicable, by providing reinsurance pay- LATED TO WAIVERS FOR STATE INNOVATION
claims for such individual that exceed a dollar
ments to health insurance issuers with respect UNDER THE PATIENT PROTECTION AND AFFORD-
amount specified by the Secretary for a year,
to attachment range claims (as defined in sec- ABLE CARE ACT SHALL HAVE NO FORCE OR EF-
but do not exceed a ceiling dollar amount speci-
tion 1354(b)(2)), using the dollar amounts speci- FECT.—Beginning July 1, 2020, the Secretary of
fied by the Secretary for such year, under sub-
fied in subparagraph (B) of such section for Health and Human Services and the Secretary
paragraph (B).
such year) in an amount equal to, subject to of the Treasury may not take any action to im-
‘‘(B) SPECIFICATIONS.—For purposes of sub-
paragraph (5), the percentage (specified for such plement, enforce, or otherwise give effect to the
paragraph (A) and section 1353(b)(3), the Sec-
year by the Secretary under such subparagraph) guidance entitled ‘‘State Relief and Empower-
retary shall determine the dollar amounts and
of the amount of such claims. ment Waivers’’ (83 Fed. Reg. 53575 (October 24,
the percentage to be specified under this sub-
‘‘(4) AMOUNT DESCRIBED.—The amount de- 2018)), including any such action that would re-
paragraph for a year in a manner to ensure that
scribed in this paragraph, with respect to 2022 sult in individuals losing health insurance cov-
the total amount of expenditures under this part
or a subsequent year, is the amount equal to the erage that includes the essential health benefits
for such year is estimated to equal the total
total sum of amounts that the Secretary would package (as defined in subsection (a) of section
amount appropriated for such year under sub-
otherwise estimate under section 1354(b)(2)(A)(i) 1302 of the Patient Protection and Affordable
section (a) if such expenditures were used solely
for such year for each State described in para- Care Act (42 U.S.C. 18022(a)) without regard to
for the purpose described in paragraph (1) of
graph (1) or (2) for such year, as applicable, if any waiver of any provision of such package
section 1352(a) for attachment range claims at
each such State were not so described for such under a waiver under such section 1332), includ-
the dollar amounts and percentage so specified
year. ing the maternity and newborn care essential
for such year.
‘‘(5) ADJUSTMENT.—For purposes of this sub- health benefit described in subsection (b)(1)(D)
‘‘(3) AVAILABILITY.—Funds allocated to a
section, the Secretary may apply a percentage of such section, including any such action that
State under this subsection for a year shall re-
under paragraph (3) with respect to a year that would result in a decrease in the number of such
main available through the end of the subse-
is less than the percentage otherwise specified in individuals enrolled in coverage that is at least
quent year.’’.
section 1354(b)(2)(B) for such year, if the cost of as comprehensive as the coverage defined in sec-
SEC. 107. RESCINDING THE SHORT-TERM LIMITED
paying the total eligible attachment range DURATION INSURANCE REGULA- tion 1302(a) of the Patient Protection and Af-
claims for States described in this subsection for TION. fordable Care Act (42 U.S.C. 18022(a)) compared
such year at such percentage otherwise specified (a) FINDINGS.—Congress finds the following: to the number of such individuals who would
would exceed the amount calculated under (1) On August 3, 2018, the Administration have been so enrolled in such coverage had such
paragraph (4) for such year. issued a final rule entitled ‘‘Short-Term, Lim- action not been taken, including any such ac-
‘‘SEC. 1354. ALLOCATIONS. ited-Duration Insurance’’ (83 Fed. Reg. 38212). tion that would, with respect to individuals
‘‘(a) APPROPRIATION.—For the purpose of pro- (2) The final rule dramatically expands the with substance use disorders, including opioid
viding allocations for States under subsection sale and marketing of insurance that— use disorders, reduce the availability or afford-
(b) and payments under section 1353(b) there is (A) may discriminate against individuals liv- ability of coverage that is at least as comprehen-
dlhill on DSK120RN23PROD with HOUSE
appropriated, out of any money in the Treasury ing with preexisting health conditions, includ- sive as the coverage defined in section 1302(a) of
not otherwise appropriated, $10,000,000,000 for ing children with complex medical needs and the Patient Protection and Affordable Care Act
2022 and each subsequent year. disabilities and their families; (42 U.S.C. 18022(a)) compared to the availability
‘‘(b) ALLOCATIONS.— (B) lacks important financial protections pro- or affordability, respectively, of such coverage
‘‘(1) PAYMENT.— vided by the Patient Protection and Affordable had such action not been taken, including any
‘‘(A) IN GENERAL.—From amounts appro- Care Act (Public Law 111–148), including the such action that would result, with respect to
priated under subsection (a) for a year, the Sec- prohibition of annual and lifetime coverage lim- vulnerable populations (including low-income
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H2602 CONGRESSIONAL RECORD — HOUSE June 29, 2020
individuals, elderly individuals, and individuals ‘‘(C) NON-ACA COMPLIANT HEALTH INSURANCE out each of the duties specified in paragraph
with serious health issues or who have a greater COVERAGE.—For purposes of subparagraph (B): (3);
risk of developing serious health issues), in a de- ‘‘(i) The term ‘non-ACA compliant health in- ‘‘(ii) not take into account whether or not the
crease in the availability of coverage that is at surance coverage’ means health insurance cov- entity has demonstrated how the entity will pro-
least as comprehensive as the coverage defined erage, or a group health plan, that is not a vide information to individuals relating to group
in section 1302(a) of the Patient Protection and qualified health plan. health plans offered by a group or association of
Affordable Care Act (42 U.S.C. 18022(a)) with ‘‘(ii) Such term includes the following: employers described in section 2510.3–5(b) of title
coverage and cost sharing protections required ‘‘(I) An association health plan. 29, Code of Federal Regulations (or any suc-
under section 1332(b)(1)(B) of such Act (42 ‘‘(II) Short-term limited duration insurance. cessor regulation), or short-term limited dura-
U.S.C. 18052(b)(1)(B)), including any such ac- ‘‘(D) FUNDING.—Out of any funds in the tion insurance (as defined by the Secretary for
tion that would, with respect to individuals Treasury not otherwise appropriated, there are purposes of section 2791(b)(5) of the Public
with preexisting conditions, reduce the afford- hereby appropriated for fiscal year 2022 and Health Service Act); and
ability of coverage that is at least as comprehen- each subsequent fiscal year, $100,000,000 to ‘‘(iii) ensure that, each year, the Exchange
sive as the coverage defined in section 1302(a) of carry out this paragraph. Funds appropriated awards such a grant to—
the Patient Protection and Affordable Care Act under this subparagraph shall remain available ‘‘(I) at least one entity described in this para-
(42 U.S.C. 18022(a)) compared to the afford- until expended. graph that is a community and consumer-fo-
ability of such coverage had such action not ‘‘(E) HIGH HEALTH DISPARITY AREA DEFINED.— cused nonprofit group; and
been taken, including any such action that For purposes of subparagraph (A), the term ‘‘(II) at least one entity described in subpara-
would result in higher health insurance pre- ‘high health disparity area’ means a contiguous graph (B), which may include another commu-
miums for individuals enrolled in health insur- geographic area that— nity and consumer-focused nonprofit group in
ance coverage that is at least as comprehensive ‘‘(i) is located in one census tract or ZIP code; addition to any such group awarded a grant
as the coverage defined in section 1302(b) of ‘‘(ii) has measurable and documented racial, pursuant to subclause (I).
such Act (42 U.S.C. 18022(b)), and the Secre- ethnic, or geographic health disparities; In awarding such grants, an Exchange may
taries may not promulgate any substantially ‘‘(iii) has a low-income population, as dem- consider an entity’s record with respect to
similar guidance or rule. Nothing in the pre- onstrated by— waste, fraud, and abuse for purposes of main-
vious sentence shall be construed to affect the ‘‘(I) average income below 138 percent of the taining the integrity of such Exchange.’’;
approval of waivers under section 1332 of the Federal poverty line; or (2) in paragraph (3)—
Patient Protection and Affordable Care Act (42 ‘‘(II) a rate of participation in the special sup- (A) by amending subparagraph (C) to read as
U.S.C. 18052) that establish reinsurance pro- plemental nutrition program under section 17 of follows:
grams that are consistent with the requirements the Child Nutrition Act of 1966 (42 U.S.C. 1786) ‘‘(C) facilitate enrollment, including with re-
under subsection (b)(1) of such section (42 that is higher than the national average rate of spect to individuals with limited English pro-
U.S.C. 18052(b)(1)), lower health insurance pre- participation in such program; ficiency and individuals with chronic illnesses,
miums, and protect health insurance coverage ‘‘(iv) has poor health outcomes, as dem- in qualified health plans, State medicaid plans
for people with preexisting conditions. onstrated by— under title XIX of the Social Security Act, and
(c) GAO REPORT ON AFFECT OF STATE INNO- ‘‘(I) lower life expectancy than the national State child health plans under title XXI of such
VATION WAIVERS ON COVERAGE OF INDIVIDUALS average; or Act;’’;
AND ON MENTAL HEALTH HEALTH CARE TREAT- ‘‘(II) a higher percentage of instances of low (B) in subparagraph (D), by striking ‘‘and’’ at
MENT.—Not later than 1 year after the date of birth weight than the national average; and the end;
the enactment of this Act, the Comptroller Gen- ‘‘(v) is part of a Metropolitan Statistical Area (C) in subparagraph (E), by striking the pe-
eral of the United States shall submit to Con- identified by the Office of Management and riod at the end and inserting ‘‘; and’’;
gress a report on the number of individuals ex- Budget. (D) by inserting after subparagraph (E) the
pected to lose access to health insurance cov- ‘‘(5) ANNUAL ENROLLMENT TARGETS.—For plan following new subparagraph:
erage (as defined in section 2791 of the Public year 2021 and each subsequent plan year, in the ‘‘(F) provide referrals to community-based or-
Health Service Act (42 U.S.C. 300gg–91)) if sub- case of an Exchange established or operated by ganizations that address social needs related to
section (b) were not enacted and waivers under the Secretary within a State pursuant to this health outcomes.’’; and
section 1332 of the Patient Protection and Af- subsection, the Secretary shall establish annual (E) by adding at the end the following flush
fordable Care Act (42 U.S.C. 18052) were ap- enrollment targets for such Exchange for such left sentence:
proved under the guidance described in such year.’’. ‘‘The duties specified in the preceding sentence
subsection (b). Such report shall include an (b) STUDY AND REPORT.—Not later than 30 may be carried out by such a navigator at any
analysis of the expected effect such waivers ap- days after the date of the enactment of this Act, time during a year.’’;
proved under such guidance would have on the Secretary of Health and Human Services (3) in paragraph (4)(A)—
mental health care treatment. shall release to Congress all aggregated docu- (A) in the matter preceding clause (i), by
SEC. 109. REQUIRING MARKETPLACE OUTREACH,
ments relating to studies and data sets that were striking ‘‘not’’;
EDUCATIONAL ACTIVITIES, AND AN- created on or after January 1, 2014, and related (B) in clause (i)—
NUAL ENROLLMENT TARGETS. to marketing and outreach with respect to quali- (i) by inserting ‘‘not’’ before ‘‘be’’; and
(a) IN GENERAL.—Section 1321(c) of the Pa- fied health plans offered through Exchanges (ii) by striking ‘‘; or’’ and inserting a semi-
tient Protection and Affordable Care Act (42 under title I of the Patient Protection and Af- colon;
U.S.C. 18041(c)), as amended by section 105(b), is fordable Care Act (42 U.S.C. 18001 et seq.). (C) in clause (ii)—
further amended by adding at the end the fol- SEC. 110. REPORT ON EFFECTS OF WEBSITE (i) by inserting ‘‘not’’ before ‘‘receive’’; and
lowing new paragraphs: MAINTENANCE DURING OPEN EN- (ii) by striking the period and inserting a
‘‘(4) OUTREACH AND EDUCATIONAL ACTIVI- ROLLMENT. semicolon; and
TIES.— Not later than 1 year after the date of the en- (D) by adding at the end the following new
‘‘(A) IN GENERAL.—In the case of an Exchange actment of this Act, the Comptroller General of clauses:
established or operated by the Secretary within the United States shall submit to Congress a re- ‘‘(iii) maintain physical presence in the State
a State pursuant to this subsection, the Sec- port examining whether the Department of of the Exchange so as to allow in-person assist-
retary shall carry out outreach and educational Health and Human Services has been con- ance to consumers; and
activities for purposes of informing individuals ducting maintenance on the website commonly ‘‘(iv) receive opioid specific education and
about qualified health plans offered through the referred to as ‘‘Healthcare.gov’’ during annual training that ensures the navigator can best
Exchange, including by informing such individ- open enrollment periods (as described in section educate individuals on qualified health plans
uals of the availability of coverage under such 1311(c)(6)(B) of the Patient Protection and Af- offered through an Exchange, specifically cov-
plans and financial assistance for coverage fordable Care Act (42 U.S.C. 18031(c)(6)(B)) in erage under such plans for opioid health care
under such plans. Such outreach and edu- such a manner so as to minimize any disruption treatment.’’; and
cational activities shall be provided in a manner to the use of such website resulting from such (4) in paragraph (6)—
that is culturally and linguistically appropriate maintenance. (A) by striking ‘‘FUNDING.—Grants under’’
to the needs of the populations being served by SEC. 111. PROMOTING CONSUMER OUTREACH and inserting ‘‘FUNDING.—
the Exchange (including hard-to-reach popu- AND EDUCATION. ‘‘(A) STATE EXCHANGES.—Grants under’’; and
lations, such as racial and sexual minorities, (a) IN GENERAL.—Section 1311(i) of the Pa- (B) by adding at the end the following new
limited English proficient populations, individ- tient Protection and Affordable Care Act (42 subparagraph:
uals in rural areas, veterans, and young adults) U.S.C. 18031(i)) is amended— ‘‘(B) FEDERAL EXCHANGES.—For purposes of
and shall be provided to populations residing in (1) in paragraph (2), by adding at the end the carrying out this subsection, with respect to an
high health disparity areas (as defined in sub- following new subparagraph: Exchange established and operated by the Sec-
dlhill on DSK120RN23PROD with HOUSE
paragraph (E)) served by the Exchange, in addi- ‘‘(C) SELECTION OF RECIPIENTS.—In the case of retary within a State pursuant to section
tion to other populations served by the Ex- an Exchange established and operated by the 1321(c), the Secretary shall obligate $100,000,000
change. Secretary within a State pursuant to section out of amounts collected through the user fees
‘‘(B) LIMITATION ON USE OF FUNDS.—No funds 1321(c), in awarding grants under paragraph on participating health insurance issuers pursu-
appropriated under this paragraph shall be used (1), the Exchange shall— ant to section 156.50 of title 45, Code of Federal
for expenditures for promoting non-ACA compli- ‘‘(i) select entities to receive such grants based Regulations (or any successor regulations), for
ant health insurance coverage. on an entity’s demonstrated capacity to carry fiscal year 2022 and each subsequent fiscal year.
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2603
Such amount for a fiscal year shall remain (1) the division of spending on individual ad- offered through such Exchange, including the
available until expended.’’. vertising platforms, including television and requirement for such a qualified health plan to
(b) EFFECTIVE DATE.—The amendments made radio advertisements and digital media, to raise provide coverage for essential health benefits (as
by this section shall apply with respect to plan consumer awareness of open enrollment; defined in section 1302(b) of such Act (42 U.S.C.
years beginning on or after January 1, 2021. (2) the division of spending on individual out- 18022(b)) and the requirements applicable to
SEC. 112. IMPROVING TRANSPARENCY AND AC- reach platforms, including email and text mes- such a qualified health plan under part A of
COUNTABILITY IN THE MARKET- sages, to raise consumer awareness of open en- title XXVII of the Public Health Service Act (42
PLACE. rollment; and U.S.C. 300gg et seq.); and
(a) OPEN ENROLLMENT REPORTS.—For plan (3) whether the Secretary conducted targeted (5) information on the availability of financial
year 2021 and each subsequent year, the Sec- outreach to specific demographic groups and ge- assistance with respect to enrolling in a quali-
retary of Health and Human Services (referred ographic areas. fied health plan, including the maximum income
to in this section as the ‘‘Secretary’’), in coordi- (b) PROMOTING TRANSPARENCY AND ACCOUNT- limit for eligibility for a premium tax credit
nation with the Secretary of the Treasury and ABILITY IN THE ADMINISTRATION’S EXPENDI- under section 36B of the Internal Revenue Code
the Secretary of Labor, shall issue biweekly TURES OF EXCHANGE USER FEES.—For plan year of 1986.
public reports during the annual open enroll- 2021 and each subsequent plan year, not later (b) NAME OF NOTICES.—In addition to updat-
ment period on the performance of the federally than the date that is 3 months after the end of ing the model COBRA continuation coverage
facilitated Exchange operated pursuant to sec- such plan year, the Secretary of Health and general notice and the model COBRA continu-
tion 1321(c) of the Patient Protection and Af- Human Services shall submit to the appropriate ation coverage election notice under paragraph
fordable Care Act (42 U.S.C. 18041(c)). Each committees of Congress and make available to (1), the Secretary of Labor shall rename each
such report shall include a summary, including the public an annual report on the expenditures such notice as the ‘‘model COBRA continuation
information on a State-by-State basis where by the Department of Health and Human Serv- coverage and Affordable Care Act coverage gen-
available, of— ices of user fees collected pursuant to section eral notice’’ and the ‘‘model COBRA continu-
(1) the number of unique website visits; 156.50 of title 45, Code of Federal Regulations ation coverage and Affordable Care Act cov-
(2) the number of individuals who create an (or any successor regulations). Each such report erage election notice’’, respectively.
account; for a plan year shall include a detailed account- (c) CONSUMER TESTING.—Prior to making pub-
(3) the number of calls to the call center; ing of the amount of such user fees collected licly available the model COBRA continuation
(4) the average wait time for callers contacting during such plan year and of the amount of coverage general notice and the model COBRA
the call center; such expenditures used during such plan year continuation coverage election notice updated
(5) the number of individuals who enroll in a for the federally facilitated Exchange operated under paragraph (1), the Secretary of Labor
qualified health plan; and pursuant to section 1321(c) of the Patient Pro- shall provide an opportunity for consumer test-
(6) the percentage of individuals who enroll in tection and Affordable Care Act (42 U.S.C. ing of each such notice, as so updated, to ensure
a qualified health plan through each of— 18041(c)) on outreach and enrollment activities, that each such notice is clear and understand-
(A) the website; navigators, maintenance of Healthcare.gov, and able to the average participant or beneficiary of
(B) the call center; operation of call centers. a group health plan.
(C) navigators; SEC. 113. IMPROVING AWARENESS OF HEALTH (d) DEFINITIONS.—In this subsection:
(D) agents and brokers; COVERAGE OPTIONS. (1) CONTINUATION COVERAGE.—The term ‘‘con-
(E) the enrollment assistant program; (a) IN GENERAL.—Not later than 90 days after tinuation coverage’’, with respect to a group
(F) directly from issuers or web brokers; and the date of the enactment of this Act, the Sec- health plan, has the meaning given such term in
(G) other means. retary of Labor, in consultation with the Sec- section 602 of the Employee Retirement Income
(b) OPEN ENROLLMENT AFTER ACTION RE- retary of Health and Human Services, shall up- Security Act of 1974 (29 U.S.C. 1162).
PORT.—For plan year 2021 and each subsequent date, and make publicly available in a promi- (2) GROUP HEALTH PLAN.—The term ‘‘group
year, the Secretary, in coordination with the nent location on the website of the Department health plan’’ has the meaning given such term
Secretary of the Treasury and the Secretary of of Labor, the model Consolidated Omnibus in section 607 of such Act (29 U.S.C. 1167).
Labor, shall publish an after action report not Budget Reconciliation Act of 1985 (referred to in (3) QUALIFIED BENEFICIARY.—The term
later than 3 months after the completion of the this section as ‘‘COBRA’’) continuation cov- ‘‘qualified beneficiary’’ has the meaning given
annual open enrollment period regarding the erage general notice and the model COBRA con- such term in such section 607.
performance of the Exchange described in sub- tinuation coverage election notice developed by (4) QUALIFIED HEALTH PLAN.—The term
section (a) for the applicable plan year. Each the Secretary of Labor for purposes of facili- ‘‘qualified health plan’’ has the meaning given
such report shall include a summary, including tating compliance of group health plans with such term in section 1301 of the Patient Protec-
information on a State-by-State basis where the notification requirements under section 606 tion and Affordable Care Act (42 U.S.C. 18021).
available, of— of the Employee Retirement Income Security Act SEC. 114. PROMOTING STATE INNOVATIONS TO
(1) the open enrollment data reported under of 1974 (29 U.S.C. 1166). In updating each such EXPAND COVERAGE.
subsection (a) for the entirety of the enrollment notice, the Secretary of Labor shall include in- (a) IN GENERAL.—Subject to subsection (d),
period; and formation regarding any Exchange established the Secretary of Health and Human Services
(2) activities related to patient navigators de- under title I of the Patient Protection and Af- shall award grants to eligible State agencies to
scribed in section 1311(i) of the Patient Protec- fordable Care Act (42 U.S.C. 18001 et seq.) enable such States to explore innovative solu-
tion and Affordable Care Act (42 U.S.C. through which a qualified beneficiary may be tions to promote greater enrollment in health in-
18031(i)), including— eligible to enroll in a qualified health plan, in- surance coverage in the individual and small
(A) the performance objectives established by cluding— group markets, including activities described in
the Secretary for such patient navigators; (1) the publicly accessible Internet website ad- subsection (c).
(B) the number of consumers enrolled by such dress for such Exchange; (b) ELIGIBILITY.—For purposes of subsection
a patient navigator; (2) the publicly accessible Internet website ad- (a), eligible State agencies are Exchanges estab-
(C) an assessment of how such patient naviga- dress for the Find Local Help directory main- lished by a State under title I of the Patient
tors have met established performance metrics, tained by the Department of Health and Human Protection and Affordable Care Act (42 U.S.C.
including a detailed list of all patient naviga- Services on the healthcare.gov Internet website 18001 et seq.) and State agencies with primary
tors, funding received by patient navigators, (or a successor website); responsibility over health and human services
and whether established performance objectives (3) a clear explanation that— for the State involved.
of patient navigators were met; and (A) an individual who is eligible for continu- (c) USE OF FUNDS.—For purposes of sub-
(D) with respect to the performance objectives ation coverage may also be eligible to enroll, section (a), the activities described in this sub-
described in subparagraph (A)— with financial assistance, in a qualified health section are the following:
(i) whether such objectives assess the full plan offered through such Exchange, but, in the (1) State efforts to streamline health insurance
scope of patient navigator responsibilities, in- case that such individual elects to enroll in such enrollment procedures in order to reduce bur-
cluding general education, plan selection, and continuation coverage and subsequently elects dens on consumers and facilitate greater enroll-
determination of eligibility for tax credits, cost- to terminate such continuation coverage before ment in health insurance coverage in the indi-
sharing reductions, or other coverage; the period of such continuation coverage ex- vidual and small group markets, including auto-
(ii) how the Secretary worked with patient pires, such individual will not be eligible to en- matic enrollment and reenrollment of, or pre-
navigators to establish such objectives; and roll in a qualified health plan offered through populated applications for, individuals without
(iii) how the Secretary adjusted such objec- such Exchange during a special enrollment pe- health insurance who are eligible for tax credits
tives for case complexity and other contextual riod; and under section 36B of the Internal Revenue Code
factors. (B) an individual who elects to enroll in con- of 1986, with the ability to opt out of such en-
(c) REPORT ON ADVERTISING AND CONSUMER tinuation coverage will remain eligible to enroll rollment.
dlhill on DSK120RN23PROD with HOUSE
OUTREACH.—Not later than 3 months after the in a qualified health plan offered through such (2) State investment in technology to improve
completion of the annual open enrollment pe- Exchange during an open enrollment period and data sharing and collection for the purposes of
riod for plan year 2021, the Secretary shall issue may be eligible for financial assistance with re- facilitating greater enrollment in health insur-
a report on advertising and outreach to con- spect to enrolling in such a qualified health ance coverage in such markets.
sumers for the open enrollment period for plan plan; (3) Implementation of a State version of an in-
year 2021. Such report shall include a descrip- (4) information on consumer protections with dividual mandate to be enrolled in health insur-
tion of— respect to enrolling in a qualified health plan ance coverage.
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H2604 CONGRESSIONAL RECORD — HOUSE June 29, 2020
(4) Feasibility studies to develop comprehen- mentation, or as soon as possible thereafter, (1) by striking ‘‘or an alien lawfully present in
sive and coherent State plan for increasing en- through mechanisms such as— the United States’’ and inserting ‘‘, an alien
rollment in the individual and small group mar- ‘‘(A) denying rates; lawfully present in the United States, or a
ket. ‘‘(B) modifying rates; or DACA recipient’’; and
(d) FUNDING.—For purposes of carrying out ‘‘(C) requiring rebates to consumers. (2) by adding at the end the following: ‘‘For
this section, there is hereby appropriated, out of ‘‘(5) NONCOMPLIANCE.—Failure to comply with
purposes of the previous sentence, the term
any funds in the Treasury not otherwise appro- any corrective action taken by the Secretary
‘DACA recipient’ means an individual who was
priated, $200,000,000 for each of the fiscal years under this subsection may result in the applica-
granted deferred action pursuant to the De-
2022 through 2024. Such amount shall remain tion of civil monetary penalties under section
ferred Action for Childhood Arrivals Program
available until expended. 2723 and, if the Secretary determines appro-
announced in the memorandum of the Secretary
priate, make the plan involved ineligible for
SEC. 115. STRENGTHENING NETWORK ADEQUACY. of Homeland Security dated June 15, 2012, and
classification as a qualified health plan.’’.
(a) IN GENERAL.—Section 1311(d) of the Pa- (b) CLARIFICATION OF REGULATORY AUTHOR- for whom such grant remains valid.’’.
tient Protection and Affordable Care Act (42 ITY.—Such section is further amended— (b) APPLICATION OF REDUCED COST-SHARING.—
U.S.C. 18031(d)) is amended by adding at the (1) in subsection (a)— Section 1402(e)(2) of the Patient Protection and
end the following new paragraph: (A) in the heading, by striking ‘‘PREMIUM’’ Affordable Care Act (42 U.S.C. 18071(e)(2)) is
‘‘(8) NETWORK ADEQUACY STANDARDS.— and inserting ‘‘RATE’’; amended by adding at the end the following: ‘‘A
‘‘(A) CERTAIN EXCHANGES.—In the case of an (B) in paragraph (1), by striking ‘‘unreason- DACA recipient (as defined in section 1312(f)(3))
Exchange operated by the Secretary pursuant able increases in premiums’’ and inserting ‘‘po- shall be treated as lawfully present for purposes
section 1321(c)(1) or an Exchange described in tentially excessive, unjustified, or unfairly dis- of this section.’’
section 155.200(f) of title 42, Code of Federal criminatory rates, including premiums,’’; and (c) ELIGIBILITY FOR ADVANCE PAYMENTS.—
Regulations (or a successor regulation), the Ex- (C) in paragraph (2)— Section 1412(d) of the Patient Protection and Af-
change shall require each qualified health plan (i) by striking ‘‘an unreasonable premium in- fordable Care Act (42 U.S.C. 18082(d)) is amend-
offered through such Exchange to meet such crease’’ and inserting ‘‘a potentially excessive, ed by adding at the end the following: ‘‘For
quantitative network adequacy standards as the unjustified, or unfairly discriminatory rate’’; purposes of the previous sentence, a DACA re-
Secretary may prescribe for purposes of this sub- (ii) by striking ‘‘the increase’’ and inserting cipient (as defined in section 1312(f)(3)) shall be
paragraph. ‘‘the rate’’; and treated as lawfully present in the United
‘‘(B) STATE EXCHANGES.—In the case of an Ex- (iii) by striking ‘‘such increases’’ and insert-
States.’’.
change not described in subparagraph (A), the ing ‘‘such rates’’; and
(2) in subsection (b)— (d) VERIFICATION OF ELIGIBILITY.—Section
Exchange shall establish quantitative network (A) by striking ‘‘premium increases’’ each 1411(c)(2)(B) of the Patient Protection and Af-
adequacy standards with respect to qualified place it appears and inserting ‘‘rates’’; and fordable Care Act (42 U.S.C. 18081(c)(2)(B)) is
health plans offered through such Exchange (B) in paragraph (2)(B), by striking ‘‘pre- amended—
and require such plans to meet such stand- mium’’ and inserting ‘‘rate’’. (1) in clause (i)(I), by inserting ‘‘or a DACA
ards.’’. (c) CONFORMING AMENDMENTS.—Title XXVII recipient (as defined in section 1312(f)(3))’’ after
(b) EFFECTIVE DATE.—The amendment made of the Public Health Service Act (42 U.S.C. 300gg ‘‘an alien lawfully present in the United
by this section shall apply with respect to plan et seq.) is amended— States’’; and
years beginning on or after January 1, 2022. (1) in section 2723 (42 U.S.C. 300gg–22), as re- (2) in clause (ii), by inserting ‘‘or a DACA re-
SEC. 116. PROTECTING CONSUMERS FROM UN- designated by the Patient Protection and Af- cipient (as defined in section 1312(f)(3))’’ after
REASONABLE RATE HIKES. fordable Care Act— ‘‘an alien lawfully present in the United
(a) PROTECTION FROM EXCESSIVE, UNJUSTI- (A) in subsection (a)— States’’.
FIED, OR UNFAIRLY DISCRIMINATORY RATES.— (i) in paragraph (1), by inserting ‘‘and section
2794’’ after ‘‘this part’’; and (e) APPLICATION OF TAX CREDIT FOR COV-
The first section 2794 of the Public Health Serv- ERAGE UNDER A QUALIFIED HEALTH PLAN.—Sec-
ice Act (42 U.S.C. 300gg–94), as added by section (ii) in paragraph (2), by inserting ‘‘or section
2794’’ after ‘‘this part’’; and tion 36B(e)(2) of the Internal Revenue Code of
1003 of the Patient Protection and Affordable 1986 is amended by adding at the end the fol-
Care Act (Public Law 111–148), is amended by (B) in subsection (b)—
(i) in paragraph (1), by inserting ‘‘and section lowing: ‘‘A DACA recipient (as defined in sec-
adding at the end the following new subsection: tion 1312(f)(3) of the Patient Protection and Af-
‘‘(e) PROTECTION FROM EXCESSIVE, UNJUSTI- 2794’’ after ‘‘this part’’; and
(ii) in paragraph (2)— fordable Care Act) shall be treated as lawfully
FIED, OR UNFAIRLY DISCRIMINATORY RATES.—
(I) in subparagraph (A), by inserting ‘‘or sec- present for purposes of this section.’’.
‘‘(1) AUTHORITY OF STATES.—Nothing in this tion 2794 that is’’ after ‘‘this part’’; and (f) EFFECTIVE DATE.—The amendments made
section shall be construed to prohibit a State (II) in subparagraph (C)(ii), by inserting ‘‘or by this section shall take effect on January 1,
from imposing requirements (including require- section 2794’’ after ‘‘this part’’; and 2021.
ments relating to rate review standards and pro- (2) in section 2761 (42 U.S.C. 300gg–61)—
cedures and information reporting) on health (A) in subsection (a)— TITLE II—ENCOURAGING MEDICAID EX-
insurance issuers with respect to rates that are (i) in paragraph (1), by inserting ‘‘and section PANSION AND STRENGTHENING THE
in addition to the requirements of this section 2794’’ after ‘‘this part’’; and MEDICAID PROGRAM
and are more protective of consumers than such (ii) in paragraph (2)— SEC. 201. INCENTIVIZING MEDICAID EXPANSION.
requirements. (I) by inserting ‘‘or section 2794’’ after ‘‘set
forth in this part’’; and (a) IN GENERAL.—Section 1905(y)(1) of the So-
‘‘(2) CONSULTATION IN RATE REVIEW PROC-
(II) by inserting ‘‘and section 2794’’ after ‘‘the cial Security Act (42 U.S.C. 1396d(y)(1)) is
ESS.—In carrying out this section, the Secretary
requirements of this part’’; and amended—
shall consult with the National Association of
Insurance Commissioners and consumer groups. (B) in subsection (b)— (1) in subparagraph (A), by striking ‘‘2014,
‘‘(3) DETERMINATION OF WHO CONDUCTS RE- (i) by inserting ‘‘and section 2794’’ after ‘‘this 2015, and 2016’’ and inserting ‘‘each of the first
VIEWS FOR EACH STATE.—The Secretary shall de-
part’’; and 3 consecutive 12-month periods in which the
(ii) by inserting ‘‘and section 2794’’ after State provides medical assistance to newly eligi-
termine, after the date of enactment of this sec-
‘‘part A’’. ble individuals’’;
tion and periodically thereafter, the following: GRANDFATHERED
(d) APPLICABILITY TO (2) in subparagraph (B), by striking ‘‘2017’’
‘‘(A) In which markets in each State the State PLANS.—Section 1251(a)(4)(A) of the Patient
insurance commissioner or relevant State regu- and inserting ‘‘the fourth consecutive 12-month
Protection and Affordable Care Act (Public Law period in which the State provides medical as-
lator shall undertake the corrective actions 111–148), as added by section 2301 of the Health
under paragraph (4), based on the Secretary’s sistance to newly eligible individuals’’;
Care and Education Reconciliation Act of 2010 (3) in subparagraph (C), by striking ‘‘2018’’
determination that the State regulator is ade- (Public Law 111–152), is amended by adding at
quately undertaking and utilizing such actions and inserting ‘‘the fifth consecutive 12-month
the end the following: period in which the State provides medical as-
in that market. ‘‘(v) Section 2794 (relating to reasonableness
‘‘(B) In which markets in each State the Sec- sistance to newly eligible individuals’’;
of rates with respect to health insurance cov-
retary shall undertake the corrective actions (4) in subparagraph (D), by striking ‘‘2019’’
erage).’’.
under paragraph (4), in cooperation with the (e) AUTHORIZATION OF APPROPRIATIONS.— and inserting ‘‘the sixth consecutive 12-month
relevant State insurance commissioner or State There are authorized to be appropriated to carry period in which the State provides medical as-
regulator, based on the Secretary’s determina- out this Act such sums as may be necessary. sistance to newly eligible individuals’’; and
tion that the State is not adequately under- (f) EFFECTIVE DATE.—The amendments made (5) in subparagraph (E), by striking ‘‘2020 and
taking and utilizing such actions in that mar- by this section shall take effect on the date of each year thereafter’’ and inserting ‘‘the sev-
ket. enactment of this Act and shall be implemented enth consecutive 12-month period in which the
‘‘(4) CORRECTIVE ACTION FOR EXCESSIVE, UN- with respect to health plans beginning not later State provides medical assistance to newly eligi-
ble individuals and each such period there-
dlhill on DSK120RN23PROD with HOUSE
JUSTIFIED, OR UNFAIRLY DISCRIMINATORY than January 1, 2022.
RATES.—In accordance with the process estab- SEC. 117. ELIGIBILITY OF DACA RECIPIENTS FOR after’’.
lished under this section, the Secretary or the QUALIFIED HEALTH PLANS OFFERED (b) EFFECTIVE DATE.—Beginning on January
relevant State insurance commissioner or State THROUGH EXCHANGES. 1, 2022, the amendments made by subsection (a)
regulator shall take corrective actions to ensure (a) IN GENERAL.—Section 1312(f)(3) of the Pa- shall take effect as if included in the enactment
that any excessive, unjustified, or unfairly dis- tient Protection and Affordable Care Act (42 of the Patient Protection and Affordable Care
criminatory rates are corrected prior to imple- U.S.C. 18032(f)(3)) is amended— Act (Public Law 111–148).
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2605
SEC. 202. PROVIDING 12-MONTHS OF CONTIN- SEC. 203.MANDATORY 12-MONTHS OF provides such assistance to such individuals
UOUS ELIGIBILITY FOR MEDICAID POSTPARTUM MEDICAID ELIGI- under such plan or waiver on the date of the en-
AND CHIP. BILITY.
actment of this subsection.’’.
(a) REQUIREMENT OF 12-MONTH CONTINUOUS (a) EXTENDING CONTINUOUS MEDICAID AND (2) CHIP.—Section 2112 of the Social Security
ENROLLMENT UNDER MEDICAID.—Section CHIP COVERAGE FOR PREGNANT AND Act (42 U.S.C. 1397ll), as amended by subsection
1902(e)(12) of the Social Security Act (42 U.S.C. POSTPARTUM WOMEN.— (b), is further amended by adding at the end the
1396a(e)(12)) is amended to read as follows: (1) MEDICAID.—Title XIX of the Social Secu- following subsection:
‘‘(12) 12-MONTH CONTINUOUS ENROLLMENT.— rity Act (42 U.S.C. 1396 et seq.) is amended— ‘‘(g) MAINTENANCE OF EFFORT.—For calendar
Notwithstanding any other provision of this (A) in section 1902(l)(1)(A), by striking ‘‘60- quarters beginning on or after the effective date
title, a State plan approved under this title (or day period’’ and inserting ‘‘365-day period’’; described in section 203(d) of the Patient Protec-
under any waiver of such plan approved pursu- (B) in section 1902(e)(6), by striking ‘‘60-day tion and Affordable Care Enhancement Act, and
ant to section 1115 or section 1915), shall provide period’’ and inserting ‘‘365-day period’’; before January 1, 2023, no payment may be
that an individual who is determined to be eligi- (C) in section 1903(v)(4)(A)(i), by striking ‘‘60- made under section 2105(a) with respect to a
ble for benefits under such plan (or waiver) day period’’ and inserting ‘‘365-day period’’; State child health plan if the State—
shall remain eligible and enrolled for such bene- and ‘‘(1) has in effect under such plan eligibility
fits through the end of the month in which the (D) in section 1905(a), in the 4th sentence in standards, methodologies, or procedures for tar-
12-month period (beginning on the date of deter- the matter following paragraph (30), by striking geted low-income pregnant women that are more
mination of eligibility) ends.’’. ‘‘60-day period’’ and inserting ‘‘365-day pe- restrictive than the eligibility standards, meth-
riod’’. odologies, or procedures, respectively, under
(b) REQUIREMENT OF 12-MONTH CONTINUOUS
(2) CHIP.—Section 2112 of the Social Security such plan that are in effect on the date of the
ENROLLMENT UNDER CHIP.—
Act (42 U.S.C. 1397ll) is amended by striking enactment of this subsection; or
(1) IN GENERAL.—Section 2102(b) of the Social ‘‘60-day period’’ each place it appears and in- ‘‘(2) provides pregnancy-related assistance to
Security Act (42 U.S.C. 1397bb(b)) is amended by serting ‘‘365-day period’’. targeted low-income pregnant women under
adding at the end the following new paragraph: (b) REQUIRING FULL BENEFITS FOR PREGNANT such plan at a level that is less than the level
‘‘(6) REQUIREMENT FOR 12-MONTH CONTINUOUS AND POSTPARTUM WOMEN.— at which the State provides such assistance to
ENROLLMENT.—Notwithstanding any other pro- (1) MEDICAID.— such women under such plan on the date of the
vision of this title, a State child health plan (A) IN GENERAL.—Paragraph (5) of section enactment of this subsection.’’.
that provides child health assistance under this 1902(e) of the Social Security Act (24 U.S.C. (d) EFFECTIVE DATE.—
title through a means other than described in 1396a(e)) is amended to read as follows: (1) IN GENERAL.—Except as provided under
section 2101(a)(2), shall provide that an indi- ‘‘(5) Any woman who is eligible for medical paragraph (2), the amendments made by sub-
vidual who is determined to be eligible for bene- assistance under the State plan or a waiver of sections (a) and (b) shall take effect on (and the
fits under such plan shall remain eligible and such plan and who is, or who while so eligible effective date described in this subsection shall
enrolled for such benefits through the end of the becomes, pregnant, shall continue to be eligible be) the first day of the calendar quarter during
month in which the 12-month period (beginning under the plan or waiver for medical assistance which the last day of the emergency period de-
on the date of determination of eligibility) through the end of the month in which the 365- scribed in section 1135(g)(1)(B) of the Social Se-
ends.’’. day period (beginning on the last day of her curity Act (42 U.S.C. 1320b–5(g)(1)(B)) occurs.
(2) CONFORMING AMENDMENT.—Section pregnancy) ends, regardless of the basis for the (2) EXTENSION OF EFFECTIVE DATE FOR STATE
2105(a)(4)(A) of the Social Security Act (42 woman’s eligibility for medical assistance, in- LAW AMENDMENT.—In the case of a State plan
U.S.C. 1397ee(a)(4)(A)) is amended— cluding if the woman’s eligibility for medical as- under title XIX or State child health plan under
(A) by striking ‘‘has elected the option of’’ sistance is on the basis of being pregnant.’’. title XXI of the Social Security Act (42 U.S.C.
and inserting ‘‘is in compliance with the re- (B) CONFORMING AMENDMENT.—Section 1396 et seq.; 42 U.S.C. 1397aa et seq.) which the
quirement for’’; and 1902(a)(10) of the Social Security Act (42 U.S.C. Secretary of Health and Human Services deter-
(B) by striking ‘‘applying such policy under 1396a(a)(10)) is amended in the matter following mines requires State legislation (other than leg-
its State child health plan under this title’’ and subparagraph (G) by striking ‘‘(VII) the medical islation appropriating funds) in order for the re-
inserting ‘‘in compliance with section 2102(b)’’. assistance’’ and all that follows through ‘‘com- spective plan to meet the additional requirement
(c) EFFECTIVE DATE.— plicate pregnancy,’’. imposed by the amendments made by subsection
(2) CHIP.—Section 2107(e)(1) of the Social Se- (a) or (b), respectively, the respective plan shall
(1) IN GENERAL.—Except as provided in para- curity Act (42 U.S.C. 1397gg(e)(1)) is amended—
graph (2) or (3), the amendments made by sub- not be regarded as failing to comply with the re-
(A) by redesignating subparagraphs (H) quirements of such title solely on the basis of its
sections (a) and (b) shall apply to determina- through (S) as subparagraphs (I) through (T),
tions (and redeterminations) of eligibility made failure to meet such applicable additional re-
respectively; and quirement before the first day of the first cal-
on or after the date that is 12 months after the (B) by inserting after subparagraph (G), the
last day of the emergency period described in endar quarter beginning after the close of the
following: first regular session of the State legislature that
section 1135(g)(1)(B) of the Social Security Act ‘‘(H) Section 1902(e)(5) (requiring 365-day con-
(42 U.S.C. 1320b–5(g)(1)(B)). begins after the date of enactment of this Act.
tinuous coverage for pregnant and postpartum For purposes of the previous sentence, in the
(2) EXTENSION OF EFFECTIVE DATE FOR STATE women).’’. case of a State that has a 2-year legislative ses-
LAW AMENDMENT.—In the case of a State plan (c) MAINTENANCE OF EFFORT.— sion, each year of the session is considered to be
under title XIX or State child health plan under (1) MEDICAID.—Section 1902 of the Social Se- a separate regular session of the State legisla-
title XXI of the Social Security Act (42 U.S.C. curity Act (42 U.S.C. 1396a) is amended— ture.
1396 et seq.; 42 U.S.C. 1397aa et seq.) which the (A) in paragraph (74), by striking ‘‘subsection SEC. 204. REDUCING THE ADMINISTRATIVE FMAP
Secretary of Health and Human Services deter- (gg); and’’ and inserting ‘‘subsections (gg) and FOR NONEXPANSION STATES.
mines requires State legislation (other than leg- (qq);’’; and Section 1903 of the Social Security Act (42
islation appropriating funds) in order for the re- (B) by adding at the end the following new U.S.C. 1396b) is amended—
spective plan to meet the additional requirement subsection: (1) in subsection (a)(7), by inserting ‘‘sub-
imposed by the amendment made by subsection ‘‘(qq) MAINTENANCE OF EFFORT RELATED TO section (bb) and’’ before ‘‘section 1919(g)(3)(B)’’;
(a) or (b), respectively, the respective plan shall LOW-INCOME PREGNANT WOMEN.—For calendar and
not be regarded as failing to comply with the re- quarters beginning on or after the effective date (2) by adding at the end the following new
quirements of such title solely on the basis of its described in section 203(d) of the Patient Protec- subsection:
failure to meet such applicable additional re- tion and Affordable Care Enhancement Act, and ‘‘(bb) REDUCTION OF FEDERAL PAYMENTS FOR
quirement before the first day of the first cal- before January 1, 2023, no Federal payment CERTAIN ADMINISTRATIVE COSTS OF NONEXPAN-
endar quarter beginning after the close of the shall be made to a State under section 1903(a) SION STATES.—
first regular session of the State legislature that for amounts expended under a State plan under ‘‘(1) IN GENERAL.—In the case of a State that
begins after the date of enactment of this Act. this title or a waiver of such plan if the State— does not provide under the State plan of such
For purposes of the previous sentence, in the ‘‘(1) has in effect under such plan eligibility State (or waiver of such plan) for making med-
case of a State that has a 2-year legislative ses- standards, methodologies, or procedures for in- ical assistance available in accordance with sec-
sion, each year of the session is considered to be dividuals described in subsection (l)(1) who are tion 1902(k)(1) to all individuals described in
a separate regular session of the State legisla- eligible for medical assistance under the State section 1902(a)(10)(i)(VIII) for a calendar quar-
ture. plan or waiver under subsection ter beginning on or after October 1, 2022, the
(3) OPTION TO IMPLEMENT 12-MONTH CONTIN- (a)(10)(A)(ii)(IX) that are more restrictive than Secretary may reduce the percentage specified
UOUS ELIGIBILITY PRIOR TO EFFECTIVE DATE.—A the eligibility standards, methodologies, or pro- in subsection (a)(7) for amounts described in
State may elect through a State plan amend- cedures, respectively, for such individuals under such subsection expended during such quarter
dlhill on DSK120RN23PROD with HOUSE
ment under title XIX or XXI of the Social Secu- such plan or waiver that are in effect on the by such State by the number of percentage
rity Act (42 U.S.C. 1396 et seq.; 42 U.S.C. 1397aa date of the enactment of this subsection; or points specified in paragraph (2) for such quar-
et seq.) to apply the amendment made by sub- ‘‘(2) provides medical assistance to individuals ter.
section (a) or (b), respectively, on any date prior described in subsection (l)(1) who are eligible for ‘‘(2) AMOUNT OF REDUCTION.—For purposes of
to the date specified in paragraph (1), but not medical assistance under such plan or waiver paragraph (1), the number of percentage points
sooner than the date of the enactment of this under subsection (a)(10)(A)(ii)(IX) at a level specified in this paragraph for a calendar quar-
Act. that is less than the level at which the State ter is the following:
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H2606 CONGRESSIONAL RECORD — HOUSE June 29, 2020
‘‘(A) For the calendar quarter beginning on ‘‘(C) A comprehensive listing of State income ‘‘(aa) a physician that satisfies the criteria
October 1, 2022, 0.5. eligibility criteria for all mandatory and op- specified in subclause (I) or (II); or
‘‘(B) For a calendar quarter beginning on or tional Medicaid eligibility groups for which the ‘‘(bb) a nurse practitioner or a physician as-
after January 1, 2023, and ending before July 1, State plan provides medical assistance (other sistant (as such terms are defined in section
2027, the number of percentage points specified than with respect to individuals described in 1861(aa)(5)(A)) who is working in accordance
under this paragraph for the previous quarter, clause (i)(II), (ii)(VI), or (ii)(XXII) of section with State law, or a certified nurse-midwife (as
plus 0.5. 1902(a)(10)(A)). defined in section 1861(gg)) who is working in
‘‘(C) For a calendar quarter beginning on or ‘‘(D) The total amount of hospital uncompen- accordance with State law;
after July 1, 2027, 10. sated-care costs and a breakdown of the source ‘‘(IV) by a rural health clinic, Federally-
‘‘(3) DEFINITION.—For purposes of this sub- of such costs, as well as a breakdown for rural qualified health center, or other health clinic
section, the term ‘State’ means a State that is and non-rural hospitals. that receives reimbursement on a fee schedule
one of the 50 States or the District of Colum- ‘‘(4) PERCENTAGE DESCRIBED.—For purposes of applicable to a physician, a nurse practitioner
bia.’’. paragraph (1), a calendar quarter described in or a physician assistant (as such terms are de-
SEC. 205. ENHANCED REPORTING REQUIRE- this paragraph, with respect to a fiscal year, fined in section 1861(aa)(5)(A)) who is working
MENTS FOR NONEXPANSION and the percentage points described in this in accordance with State law, or a certified
STATES. paragraph for such quarter, with respect to a nurse-midwife (as defined in section 1861(gg))
Section 1903 of the Social Security Act (42 State, are— who is working in accordance with State law,
U.S.C. 1396b), as amended by section 204, is fur- ‘‘(A) for the calendar quarter beginning on for services furnished by a physician, nurse
ther amended— the April 1 occurring during such fiscal year, 0.5 practitioner, physician assistant, or certified
(1) in subsection (a)(7), by striking ‘‘sub- percentage points; nurse-midwife, or services furnished by an ad-
section (bb)’’ and inserting ‘‘subsections (bb) ‘‘(B) for the calendar quarter beginning on vanced practice clinician supervised by a physi-
and (cc)’’; and the July 1 occurring during such fiscal year, 1.0 cian described in subclause (I)(aa) or (II)(aa),
(2) by adding at the end the following new percentage point; and another advanced practice clinician, or a cer-
subsection: ‘‘(C) for the calendar quarter beginning on tified nurse-midwife; or
‘‘(cc) REDUCTION OF FEDERAL PAYMENTS FOR the October 1 occurring during the subsequent ‘‘(V) by a nurse practitioner or a physician
CERTAIN ADMINISTRATIVE COSTS OF NONEXPAN- fiscal year, 1.5 percentage points. assistant (as such terms are defined in section
SION STATES THAT DO NOT SATISFY REPORTING 1861(aa)(5)(A)) who is working in accordance
‘‘(5) PAYMENT IN CASE OF REPORTING STATE.—
REQUIREMENTS.— The expenses incurred by a non-expansion with State law, or a certified nurse-midwife (as
‘‘(1) IN GENERAL.— State, with respect to any calendar quarter with defined in section 1861(gg)) who is working in
‘‘(A) REDUCTION.—In the case of a nonexpan- accordance with State law, in accordance with
respect to a fiscal year (beginning with 2021),
sion State, with respect to a fiscal year (begin- procedures that ensure that the portion of the
for carrying out subparagraphs (A) through (C)
ning with fiscal year 2023) that does not satisfy payment for such services that the nurse practi-
of paragraph (2) shall, for purposes of section
the reporting requirement under paragraph (2) tioner, physician assistant, or certified nurse-
1903(a)(7), be considered to be expenses nec-
for such fiscal year, the percentage specified in midwife is paid is not less than the amount that
essary for the proper and efficient administra-
subsection (a)(7) for amounts described in such the nurse practitioner, physician assistant, or
tion of the State plan under this title.
subsection expended by such State during a cal- certified nurse-midwife would be paid if the
‘‘(6) NONEXPANION STATE DEFINED.—For pur-
endar quarter described in paragraph (4) with services were provided under part B of title
poses of this subsection, the term ‘nonexpansion
respect to such fiscal year, subject to subpara- XVIII;’’.
State’ means, with respect to a fiscal year, a
graph (B), shall be reduced by the number of (2) CONFORMING AMENDMENTS.—Section
State that as of the first quarter of such fiscal
percentage points specified in paragraph (4) for 1905(dd) of the Social Security Act (42 U.S.C.
year does not provide under the State plan of
the respective calendar quarter. 1396d(dd)) is amended—
such State (or waiver of such plan) for making
‘‘(B) EXCEPTION.—In the case of a nonexpan- (A) by striking ‘‘Notwithstanding’’ and insert-
medical assistance available in accordance with
sion State that is subject to a reduction under ing the following:
section 1902(k)(1) to all individuals described in
subparagraph (A) for the calendar quarter de- ‘‘(1) IN GENERAL.—Notwithstanding’’;
section 1902(a)(10)(i)(VIII).’’.
scribed in paragraph (4)(A) with respect to a fis- (B) by inserting ‘‘or furnished during the ad-
SEC. 206. PRIMARY CARE PAY INCREASE.
cal year, if the State satisfies the criteria de- ditional period specified in paragraph (2),’’ after
scribed in subparagraphs (A), (B), and (C) of (a) RENEWAL OF PAYMENT FLOOR; ADDITIONAL
‘‘2015,’’; and
paragraph (2) (without regard to the dates spec- PROVIDERS.—
(C) by adding at the end the following:
ified in such subparagraph (A) and (C)) before (1) IN GENERAL.—Section 1902(a)(13) of the So- ‘‘(2) ADDITIONAL PERIOD.—For purposes of
the beginning of a subsequent calendar quarter cial Security Act (42 U.S.C. 1396a(a)(13)) is paragraph (1), the additional period specified in
described in paragraph (4) with respect to such amended by striking subparagraph (C) and in- this paragraph is the period that begins on the
fiscal year, then such State shall not be subject serting the following: first day of the first month that begins one year
to a reduction under subparagraph (A) for such ‘‘(C) payment for primary care services (as de- after the date of enactment of the Patient Pro-
subsequent calendar quarter. fined in subsection (jj)) at a rate that is not less tection and Affordable Care Enhancement
‘‘(2) REPORTING REQUIREMENT.—For purposes than 100 percent of the payment rate that ap- Act.’’.
of paragraph (1), a nonexpansion State satisfies plies to such services and physician under part (b) IMPROVED TARGETING OF PRIMARY CARE.—
the reporting requirement under this paragraph B of title XVIII (or, if greater, the payment rate Section 1902(jj) of the Social Security Act (42
for a fiscal year, if the nonexpansion State— that would be applicable under such part if the U.S.C. 1396a(jj)) is amended—
‘‘(A) by not later than January 1 of such conversion factor under section 1848(d) for the (1) by redesignating paragraphs (1) and (2) as
year, posts on the public website of the State year involved were the conversion factor under subparagraphs (A) and (B), respectively and re-
agency administering the State plan, the infor- such section for 2009), and that is not less than aligning the left margins accordingly;
mation described in paragraph (3) with respect the rate that would otherwise apply to such (2) by striking ‘‘For purposes of’’ and insert-
to such State for the previous year; services under this title if the rate were deter- ing the following:
‘‘(B) provides for at least a 30-day period for mined without regard to this subparagraph, and ‘‘(1) IN GENERAL.—For purposes of’’; and
notice and comment on such information; and that are— (3) by adding at the end the following:
‘‘(C) by not later than March 1 of such year, ‘‘(i) furnished during 2013 and 2014, by a phy- ‘‘(2) EXCLUSIONS.—Such term does not include
submits to the Secretary a complete report in- sician with a primary specialty designation of any services described in subparagraph (A) or
cluding such information, comments submitted family medicine, general internal medicine, or (B) of paragraph (1) if such services are pro-
pursuant to subparagraph (B), and a response pediatric medicine; or vided in an emergency department of a hos-
by the State to each such comment. ‘‘(ii) furnished during the period that begins pital.’’.
‘‘(3) INFORMATION DESCRIBED.—The informa- on the first day of the first month that begins (c) ENSURING PAYMENT BY MANAGED CARE EN-
tion described in this paragraph, with respect to one year after the date of enactment of the Pa- TITIES.—
a State and year, is the following: tient Protection and Affordable Care Enhance- (1) IN GENERAL.—Section 1903(m)(2)(A) of the
‘‘(A) The the estimated number of individuals ment Act and ends September 30, 2024— Social Security Act (42 U.S.C. 1396b(m)(2)(A)) is
who were uninsured for at least 6 months, ‘‘(I) by a physician with a primary specialty amended—
shown by age-groups of 0 to 18 years of age and designation of family medicine, general internal (A) in clause (xii), by striking ‘‘and’’ after the
of 19 years of age to 64 years of age, as well as medicine, or pediatric medicine, but only if the semicolon;
a detailed description of the basis for the esti- physician self-attests that the physician is (B) by realigning the left margin of clause
mates. Board certified in family medicine, general in- (xiii) so as to align with the left margin of
‘‘(B) The estimated number of the individuals ternal medicine, or pediatric medicine; clause (xii) and by striking the period at the end
estimated under subparagraph (A) in the State ‘‘(II) by a physician with a primary specialty of clause (xiii) and inserting ‘‘; and’’; and
dlhill on DSK120RN23PROD with HOUSE
who would be eligible for medical assistance designation of obstetrics and gynecology, but (C) by inserting after clause (xiii) the fol-
under the State plan if the State were to make only if the physician self-attests that the physi- lowing:
medical assistance under the State plan avail- cian is Board certified in obstetrics and gyne- ‘‘(xiv) such contract provides that (I) pay-
able in accordance with section 1902(k)(1) to all cology; ments to providers specified in section
individuals described in section ‘‘(III) by an advanced practice clinician, as 1902(a)(13)(C) for primary care services defined
1902(a)(10)(i)(VIII), and a detailed description defined by the Secretary, that works under the in section 1902(jj) that are furnished during a
of the basis for the estimates. supervision of— year or period specified in section 1902(a)(13)(C)
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2607
and section 1905(dd) are at least equal to the (1) IN GENERAL.—Section 2105(d)(3) of the So- (2) in paragraph (3)(A)—
amounts set forth and required by the Secretary cial Security Act (42 U.S.C. 1397ee(d)(3)) is (A) by striking ‘‘fiscal years 2024 through
by regulation, (II) the entity shall, upon re- amended— 2026’’ and inserting ‘‘beginning with fiscal year
quest, provide documentation to the State, suffi- (A) in the paragraph heading, by striking 2024’’; and
cient to enable the State and the Secretary to ‘‘THROUGH SEPTEMBER 30, 2027’’; and (B) by striking ‘‘2023, or 2027’’ and inserting
ensure compliance with subclause (I), and (III) (B) in subparagraph (A), in the matter pre- ‘‘, or 2023’’.
the Secretary shall approve payments described ceding clause (i)— SEC. 209. STATE OPTION TO INCREASE CHIL-
in subclause (I) that are furnished through an (i) by striking ‘‘During the period that begins DREN’S ELIGIBILITY FOR MEDICAID
on the date of enactment of the Patient Protec- AND CHIP.
agreed upon capitation, partial capitation, or
other value-based payment arrangement if the tion and Affordable Care Act and ends on Sep- Section 2110(b)(1)(B)(ii) of the Social Security
capitation, partial capitation, or other value- tember 30, 2027’’ and inserting ‘‘Beginning on Act (42 U.S.C. 1397jj(b)(1)(B)(ii)) is amended—
the date of the enactment of the Patient Protec- (1) in subclause (II), by striking ‘‘or’’ at the
based payment arrangement is based on a rea-
tion and Affordable Care Act’’; end;
sonable methodology and the entity provides
(ii) by striking ‘‘During the period that begins (2) in subclause (III), by striking ‘‘and’’ at the
documentation to the State sufficient to enable
on October 1, 2019, and ends on September 30, end and inserting ‘‘or’’; and
the State and the Secretary to ensure compli- (3) by inserting after subclause (III) the fol-
ance with subclause (I).’’. 2027’’ and inserting ‘‘Beginning on October 1,
lowing new subclause:
(2) CONFORMING AMENDMENT.—Section 1932(f) 2019’’; and ‘‘(IV) at the option of the State, whose family
of the Social Security Act (42 U.S.C. 1396u–2(f)) (iii) by striking ‘‘The preceding sentences
income exceeds the maximum income level other-
is amended by inserting ‘‘and clause (xiv) of sec- shall not be construed as preventing a State
wise established for children under the State
tion 1903(m)(2)(A)’’ before the period. during any such periods from’’ and inserting
child health plan as of the date of the enact-
SEC. 207. PERMANENT FUNDING FOR CHIP. ‘‘The preceding sentences shall not be construed
ment of this subclause; and’’.
(a) IN GENERAL.—Section 2104(a) of the Social as preventing a State from’’.
SEC. 210. MEDICAID COVERAGE FOR CITIZENS OF
Security Act (42 U.S.C. 1397dd(a)) is amended— (2) CONFORMING AMENDMENTS.—Section
FREELY ASSOCIATED STATES.
(1) in paragraph (26), by inserting at the end 1902(gg)(2) of the Social Security Act (42 U.S.C.
(a) IN GENERAL.—Section 402(b)(2) of the Per-
‘‘and’’; 1396a(gg)(2)) is amended—
sonal Responsibility and Work Opportunity
(2) by amending paragraph (27) to read as fol- (A) in the paragraph heading, by striking
Reconciliation Act of 1996 (8 U.S.C. 1612(b)(2)) is
lows: ‘‘THROUGH SEPTEMBER 30, 2027’’; and
amended by adding at the end the following
‘‘(27) for each fiscal year beginning with fiscal (B) by striking ‘‘through September 30’’ and
new subparagraph:
year 2024, such sums as are necessary to fund all that follows through ‘‘ends on September 30, ‘‘(G) MEDICAID EXCEPTION FOR CITIZENS OF
allotments to States under subsections (c) and 2027’’ and inserting ‘‘(but beginning on October FREELY ASSOCIATED STATES.—With respect to eli-
(m).’’; and 1, 2019,’’. gibility for benefits for the designated Federal
(3) by striking paragraph (28). (d) QUALIFYING STATES OPTION.—Section
program defined in paragraph (3)(C) (relating to
(b) IN GENERAL.—Section 2104(a)(28) of the So- 2105(g)(4) of the Social Security Act (42 U.S.C.
the Medicaid program), section 401(a) and para-
cial Security Act (42 U.S.C. 1397dd(a)(28)) is 1397ee(g)(4)) is amended—
graph (1) shall not apply to any individual who
amended to read as follows: (1) in the paragraph heading, by striking
lawfully resides in 1 of the 50 States or the Dis-
‘‘(28) for fiscal year 2027 and each subsequent ‘‘FOR FISCAL YEARS 2009 THROUGH 2027’’ and in-
trict of Columbia in accordance with the Com-
year, such sums as are necessary to fund allot- serting ‘‘AFTER FISCAL YEAR 2008’’; and
pacts of Free Association between the Govern-
ments to States under subsections (c) and (m).’’. (2) in subparagraph (A), by striking ‘‘for any
ment of the United States and the Governments
(c) ALLOTMENTS.— of fiscal years 2009 through 2027’’ and inserting
of the Federated States of Micronesia, the Re-
(1) IN GENERAL.—Section 2104(m) of the Social ‘‘for any fiscal year after fiscal year 2008’’.
public of the Marshall Islands, and the Republic
Security Act (42 U.S.C. 1397dd(m)) is amended— (e) OUTREACH AND ENROLLMENT PROGRAM.—
of Palau and shall not apply, at the option of
(A) in paragraph (2)(B)(i), by striking ‘‘,, Section 2113 of the Social Security Act (42 U.S.C.
the Governor of Puerto Rico, the Virgin Islands,
2023, and 2027’’ and inserting ‘‘and 2023’’; 1397mm) is amended—
Guam, the Northern Mariana Islands, or Amer-
(B) in paragraph (7)— (1) in subsection (a)—
(A) in paragraph (1), by striking ‘‘during the ican Samoa as communicated to the Secretary of
(i) in subparagraph (A), by striking ‘‘and end-
period of fiscal years 2009 through 2027’’ and in- Health and Human Services in writing, to any
ing with fiscal year 2027,’’; and
serting ‘‘, beginning with fiscal year 2009,’’; individual who lawfully resides in the respective
(ii) in the flush left matter at the end, by
(B) in paragraph (2)— territory in accordance with such Compacts.’’.
striking ‘‘or fiscal year 2026’’ and inserting ‘‘fis-
(b) EXCEPTION TO 5–YEAR LIMITED ELIGI-
cal year 2026, or a subsequent even-numbered (i) by striking ‘‘10 percent of such amounts’’
BILITY.—Section 403(d) of such Act (8 U.S.C.
fiscal year’’; and inserting ‘‘10 percent of such amounts for
1613(d)) is amended—
(C) in paragraph (9)— the period or the fiscal year for which such
(1) in paragraph (1), by striking ‘‘or’’ at the
(i) by striking ‘‘(10), or (11)’’ and inserting ‘‘or amounts are appropriated’’; and
end;
(10)’’; and (ii) by striking ‘‘during such period’’ and in- (2) in paragraph (2), by striking the period at
(ii) by striking ‘‘2023, or 2027,’’ and inserting serting ‘‘, during such period or such fiscal the end and inserting ‘‘; or’’; and
‘‘or 2023’’; and year,’’; and (3) by adding at the end the following new
(D) by striking paragraph (11). (C) in paragraph (3), by striking ‘‘For the pe- paragraph:
(2) CONFORMING AMENDMENT.—Section riod of fiscal years 2024 through 2027, an ‘‘(3) an individual described in section
50101(b)(2) of the Bipartisan Budget Act of 2018 amount equal to 10 percent of such amounts’’ 402(b)(2)(G), but only with respect to the des-
(Public Law 115–123) is repealed. and inserting ‘‘Beginning with fiscal year 2024, ignated Federal program defined in section
SEC. 208. PERMANENT EXTENSION OF CHIP EN- an amount equal to 10 percent of such amounts 402(b)(3)(C).’’.
ROLLMENT AND QUALITY MEAS- for the period or the fiscal year for which such (c) DEFINITION OF QUALIFIED ALIEN.—Section
URES. amounts are appropriated’’; and 431(b) of such Act (8 U.S.C. 1641(b)) is amend-
(a) PEDIATRIC QUALITY MEASURES PRO- (2) in subsection (g)— ed—
GRAM.—Section 1139A(i)(1) of the Social Security (A) by striking ‘‘2017,,’’ and inserting ‘‘2017,’’; (1) in paragraph (6), by striking ‘‘; or’’ at the
Act (42 U.S.C. 1320b–9a(i)(1)) is amended— (B) by striking ‘‘and $48,000,000’’ and insert- end and inserting a comma;
(1) in subparagraph (C), by striking at the end ing ‘‘$48,000,000’’; and (2) in paragraph (7), by striking the period at
‘‘and’’; (C) by inserting after ‘‘through 2027’’ the fol- the end and inserting ‘‘, or’’; and
(2) in subparagraph (D), by striking the pe- lowing: ‘‘, $12,000,000 for fiscal year 2028, and, (3) by adding at the end the following new
riod at the end and insert a semicolon; and for each fiscal year after fiscal year 2028, the paragraph:
(3) by adding at the end the following new amount appropriated under this subsection for ‘‘(8) an individual who lawfully resides in the
subparagraphs: the previous fiscal year, increased by the per- United States in accordance with a Compact of
‘‘(E) for fiscal year 2028, $15,000,000 for the centage increase in the consumer price index for Free Association referred to in section
purpose of carrying out this section (other than all urban consumers (all items; United States 402(b)(2)(G), but only with respect to the des-
subsections (e), (f), and (g)); and city average) over such previous fiscal year’’. ignated Federal program defined in section
‘‘(F) for a subsequent fiscal year, the amount (f) CHILD ENROLLMENT CONTINGENCY FUND.— 402(b)(3)(C) (relating to the Medicaid pro-
appropriated under this paragraph for the pre- Section 2104(n) of the Social Security Act (42 gram).’’.
vious fiscal year, increased by the percentage U.S.C. 1397dd(n)) is amended— (d) APPLICATION TO STATE PLANS.—Section
increase in the consumer price index for all (1) in paragraph (2)— 1902(a)(10)(A)(i) of the Social Security Act (42
urban consumers (all items; United States city (A) in subparagraph (A)(ii)— U.S.C. 1396a(a)(10)(A)(i)) is amended by insert-
average) over such previous fiscal year, for the (i) by striking ‘‘and 2024 through 2026’’ and ing after subclause (IX) the following:
purpose of carrying out this section (other than inserting ‘‘beginning with fiscal year 2024’’; and ‘‘(X) who are described in section 402(b)(2)(G)
dlhill on DSK120RN23PROD with HOUSE
subsections (e), (f), and (g)).’’. (ii) by striking ‘‘2023, and 2027’’ and inserting of the Personal Responsibility and Work Oppor-
(b) EXPRESS LANE ELIGIBILITY OPTION.—Sec- ‘‘, and 2023’’; and tunity Reconciliation Act of 1996 and eligible for
tion 1902(e)(13) of the Social Security Act (42 (B) in subparagraph (B)— benefits under this title by reason of application
U.S.C. 1396a(e)(13)) is amended by striking sub- (i) by striking ‘‘2024 through 2026’’ and insert- of such section;’’.
paragraph (I). ing ‘‘beginning with fiscal year 2024’’; and (e) CONFORMING AMENDMENTS.—Section 1108
(c) ASSURANCE OF AFFORDABILITY STANDARD (ii) by striking ‘‘2023, and 2027’’ and inserting of the Social Security Act (42 U.S.C. 1308) is
FOR CHILDREN AND FAMILIES.— ‘‘, and 2023’’; and amended—
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H2608 CONGRESSIONAL RECORD — HOUSE June 29, 2020
(1) in subsection (f), in the matter preceding TITLE III—LOWERING PRICES THROUGH ‘‘(i) an individual who is entitled to benefits
paragraph (1), by striking ‘‘subsections (g) and FAIR DRUG PRICE NEGOTIATION under part A of title XVIII or enrolled under
(h) and section 1935(e)(1)(B)’’ and inserting SEC. 301. ESTABLISHING A FAIR DRUG PRICING part B of such title if such selected drug is cov-
‘‘subsections (g), (h), and (i) and section PROGRAM. ered under the respective part; and
1935(e)(1)(B)’’; and (a) PROGRAM TO LOWER PRICES FOR CERTAIN ‘‘(ii) an individual who is enrolled under a
(2) by adding at the end the following: HIGH-PRICED SINGLE SOURCE DRUGS.—Title XI group health plan or health insurance coverage
‘‘(i) EXCLUSION OF MEDICAL ASSISTANCE EX- of the Social Security Act (42 U.S.C. 1301 et seq.) offered in the group or individual market (as
PENDITURES FOR CITIZENS OF FREELY ASSOCI- is amended by adding at the end the following such terms are defined in section 2791 of the
ATED STATES.—Expenditures for medical assist- new part: Public Health Service Act) with respect to which
ance provided to an individual described in sec- ‘‘PART E—FAIR PRICE NEGOTIATION PRO- there is in effect an agreement with the Sec-
tion 431(b)(8) of the Personal Responsibility and GRAM TO LOWER PRICES FOR CERTAIN retary under section 1197 with respect to such
Work Opportunity Reconciliation Act of 1996 (8 HIGH-PRICED SINGLE SOURCE DRUGS selected drug as so furnished or administered.
U.S.C. 1641(b)(8)) shall not be taken into ac- ‘‘(2) MAXIMUM FAIR PRICE.—The term ‘max-
‘‘SEC. 1191. ESTABLISHMENT OF PROGRAM.
count for purposes of applying payment limits imum fair price’ means, with respect to a plan
under subsections (f) and (g).’’. ‘‘(a) IN GENERAL.—The Secretary shall estab- year during a price applicability period and
(f) EFFECTIVE DATE.—The amendments made lish a Fair Price Negotiation Program (in this with respect to a selected drug (as defined in
by this section shall apply to benefits for items part referred to as the ‘program’). Under the section 1192(c)) with respect to such period, the
and services furnished on or after the date of program, with respect to each price applicability price published pursuant to section 1195 in the
the enactment of this Act. period, the Secretary shall— Federal Register for such drug and year.
‘‘(1) publish a list of selected drugs in accord- ‘‘(3) AVERAGE INTERNATIONAL MARKET PRICE
SEC. 211. EXTENSION OF FULL FEDERAL MEDICAL
ASSISTANCE PERCENTAGE TO IN-
ance with section 1192; DEFINED.—
DIAN HEALTH CARE PROVIDERS. ‘‘(2) enter into agreements with manufacturers
‘‘(A) IN GENERAL.—The terms ‘average inter-
of selected drugs with respect to such period, in
(a) IN GENERAL.—Section 1905 of the Social national market price’ and ‘AIM price’ mean,
accordance with section 1193;
Security Act (42 U.S.C. 1396d) is amended— with respect to a drug, the average price (which
‘‘(3) negotiate and, if applicable, renegotiate
(1) in subsection (a), by amending paragraph shall be the net average price, if practicable,
maximum fair prices for such selected drugs, in
(9) to read as follows: and volume-weighted, if practicable) for a unit
accordance with section 1194; and
‘‘(9) clinic services furnished by or under the (as defined in paragraph (4)) of the drug for
‘‘(4) carry out the administrative duties de-
direction of a physician, without regard to sales of such drug (calculated across different
scribed in section 1196.
whether the clinic itself is administered by a ‘‘(b) DEFINITIONS RELATING TO TIMING.—For dosage forms and strengths of the drug and not
physician, including— purposes of this part: based on the specific formulation or package
‘‘(A) such services furnished outside the clinic ‘‘(1) INITIAL PRICE APPLICABILITY YEAR.—The size or package type), as computed (as of the
by clinic personnel to an eligible individual who term ‘initial price applicability year’ means a date of publication of such drug as a selected
does not reside in a permanent dwelling or does plan year (beginning with plan year 2023) or, if drug under section 1192(a)) in all countries de-
not have a fixed home or mailing address; and agreed to in an agreement under section 1193 by scribed in clause (ii) of subparagraph (B) that
‘‘(B) such services provided outside the clinic the Secretary and manufacturer involved, a pe- are applicable countries (as described in clause
on the basis of a referral from a clinic adminis- riod of more than one plan year (beginning on (i) of such subparagraph) with respect to such
tered by an Indian Health Program (as defined or after January 1, 2023). drug.
in paragraph (12) of section 4 of the Indian ‘‘(2) PRICE APPLICABILITY PERIOD.—The term ‘‘(B) APPLICABLE COUNTRIES.—
Health Care Improvement Act, or an Urban In- ‘price applicability period’ means, with respect ‘‘(i) IN GENERAL.—For purposes of subpara-
dian Organization as defined in paragraph (29) to a drug, the period beginning with the initial graph (A), a country described in clause (ii) is
of section 4 of such Act that has a grant or con- price applicability year with respect to which an applicable country described in this clause
tract with the Indian Health Service under title such drug is a selected drug and ending with with respect to a drug if there is available an
V of such Act;’’. the last plan year during which the drug is a se- average price for any unit for the drug for sales
(2) in subsection (b), by inserting after ‘‘(as lected drug. of such drug in such country.
defined in section 4 of the Indian Health Care ‘‘(3) SELECTED DRUG PUBLICATION DATE.—The ‘‘(ii) COUNTRIES DESCRIBED.—For purposes of
Improvement Act)’’ the following: ‘‘; the Federal term ‘selected drug publication date’ means, this paragraph, the following are countries de-
medical assistance percentage shall also be 100 with respect to each initial price applicability scribed in this clause:
per centum with respect to amounts expended as year, April 15 of the plan year that begins 2 ‘‘(I) Australia.
medical assistance for services which are re- years prior to such year. ‘‘(II) Canada.
ceived through an Urban Indian organization ‘‘(4) VOLUNTARY NEGOTIATION PERIOD.—The ‘‘(III) France.
(as defined in section 4 of the Indian Health term ‘voluntary negotiation period’ means, with ‘‘(IV) Germany.
Care Improvement Act) that has a grant or con- ‘‘(V) Japan.
respect to an initial price applicability year with
tract with the Indian Health Service under title ‘‘(VI) The United Kingdom.
respect to a selected drug, the period—
V of such Act’’. ‘‘(4) UNIT.—The term ‘unit’ means, with re-
‘‘(A) beginning on the sooner of—
(b) EXTENSION OF FULL FEDERAL MEDICAL AS- ‘‘(i) the date on which the manufacturer of spect to a drug, the lowest identifiable quantity
SISTANCE PERCENTAGE TO SERVICES FURNISHED the drug and the Secretary enter into an agree- (such as a capsule or tablet, milligram of mol-
BY NATIVE HAWAIIAN HEALTH CARE SYSTEMS.— ment under section 1193 with respect to such ecules, or grams) of the drug that is dispensed.
(1) IN GENERAL.—Beginning on the date of en- drug; or ‘‘SEC. 1192. SELECTION OF NEGOTIATION-ELIGI-
actment of this Act— BLE DRUGS AS SELECTED DRUGS.
‘‘(ii) June 15 following the selected drug publi-
(A) for purposes of section 1905(a)(9) of the cation date with respect to such selected drug; ‘‘(a) IN GENERAL.—Not later than the selected
Social Security Act (42 U.S.C. 1396d(a)(9)), serv- and drug publication date with respect to an initial
ices described in subsection (b) that are fur- ‘‘(B) ending on March 31 of the year that be- price applicability year, subject to subsection
nished in any location shall be deemed to be gins one year prior to the initial price applica- (h), the Secretary shall select and publish in the
clinic services; and bility year. Federal Register a list of—
(B) notwithstanding section 1905(b) of the So- ‘‘(c) OTHER DEFINITIONS.—For purposes of ‘‘(1)(A) with respect to an initial price appli-
cial Security Act (42 U.S.C. 1396d(b)), the Fed- this part: cability year during 2023, at least 25 negotia-
eral medical assistance percentage with respect ‘‘(1) FAIR PRICE ELIGIBLE INDIVIDUAL.—The tion-eligible drugs described in subparagraphs
to amounts expended as medical assistance for term ‘fair price eligible individual’ means, with (A) and (B), but not subparagraph (C), of sub-
such services shall be 100 percent. respect to a selected drug— section (d)(1) (or, with respect to an initial price
(2) SERVICES DESCRIBED.—The services de- ‘‘(A) in the case such drug is furnished or dis- applicability year during such period beginning
scribed in this subsection are services for which pensed to the individual at a pharmacy or by a after 2023, the maximum number (if such number
payment is available under the State plan under mail order service— is less than 25) of such negotiation-eligible drugs
title XIX of the Social Security Act (42 U.S.C. ‘‘(i) an individual who is enrolled under a for the year) with respect to such year; and
1396 et seq.) of Hawaii (or any waiver of such prescription drug plan under part D of title ‘‘(B) with respect to an initial price applica-
plan) that— XVIII or an MA–PD plan under part C of such bility year during 2024 or a subsequent year, at
(A) are furnished on or after the date of en- title if coverage is provided under such plan for least 50 negotiation-eligible drugs described in
actment of this Act; such selected drug; and subparagraphs (A) and (B), but not subpara-
(B) are furnished to an individual who— ‘‘(ii) an individual who is enrolled under a graph (C), of subsection (d)(1) (or, with respect
(i) is a Native Hawaiian; and group health plan or health insurance coverage to an initial price applicability year during such
(ii) is eligible for medical assistance under offered in the group or individual market (as period, the maximum number (if such number is
such plan; and such terms are defined in section 2791 of the less than 50) of such negotiation-eligible drugs
dlhill on DSK120RN23PROD with HOUSE
(C) are furnished by an Indian health care Public Health Service Act) with respect to which for the year) with respect to such year;
provider (as such term is defined in section there is in effect an agreement with the Sec- ‘‘(2) all negotiation-eligible drugs described in
1932(h)(4)(A) of the Social Security Act (42 retary under section 1197 with respect to such subparagraph (C) of such subsection with re-
U.S.C. 1396u–2(h)(4)(A)) or a Native Hawaiian selected drug as so furnished or dispensed; and spect to such year; and
health care system (without regard to whether ‘‘(B) in the case such drug is furnished or ad- ‘‘(3) all new-entrant negotiation-eligible drugs
such services are furnished through an Indian ministered to the individual by a hospital, phy- (as defined in subsection (g)(1)) with respect to
Health Service facility). sician, or other provider of services or supplier— such year.
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2609
Each drug published on the list pursuant to the shall publish in the Federal Register a list of ne- selected drug publication date, based on the pro-
previous sentence shall be subject to the nego- gotiation-eligible drugs with respect to such se- jected spending under title XVIII or in the
tiation process under section 1194 for the vol- lected drug publication date. United States on such drug. For purposes of this
untary negotiation period with respect to such ‘‘(e) QUALIFYING SINGLE SOURCE DRUG.—For paragraph the term ‘United States’ includes the
initial price applicability year (and the renegoti- purposes of this part, the term ‘qualifying single 50 States, the District of Columbia, and the ter-
ation process under such section as applicable source drug’ means any of the following: ritories of the United States.
for any subsequent year during the applicable ‘‘(1) DRUG PRODUCTS.—A drug that— ‘‘(h) CONFLICT OF INTEREST.—
price applicability period). In applying this sub- ‘‘(A) is approved under section 505(c) of the ‘‘(1) IN GENERAL.—In the case the Inspector
section, any negotiation-eligible drug that is se- Federal Food, Drug, and Cosmetic Act and con- General of the Department of Health and
lected under this subsection for an initial price tinues to be marketed pursuant to such ap- Human Services determines the Secretary has a
applicability year shall not count toward the re- proval; and conflict, with respect to a matter described in
quired minimum amount of drugs to be selected ‘‘(B) is not the listed drug for any drug that paragraph (2), the individual described in para-
under paragraph (1) for any subsequent year, is approved and continues to be marketed under graph (3) shall carry out the duties of the Sec-
including such a drug so selected that is subject section 505(j) of such Act. retary under this part, with respect to a nego-
to renegotiation under section 1194. ‘‘(2) BIOLOGICAL PRODUCTS.—A biological tiation-eligible drug, that would otherwise be
‘‘(b) SELECTION OF DRUGS.—In carrying out product that— such a conflict.
subsection (a)(1) the Secretary shall select for ‘‘(A) is licensed under section 351(a) of the ‘‘(2) MATTER DESCRIBED.—A matter described
inclusion on the published list described in sub- Public Health Service Act, including any prod- in this paragraph is—
section (a) with respect to a price applicability uct that has been deemed to be licensed under ‘‘(A) a financial interest (as described in sec-
period, the negotiation-eligible drugs that the section 351 of such Act pursuant to section tion 2635.402 of title 5, Code of Federal Regula-
Secretary projects will result in the greatest sav- 7002(e)(4) of the Biologics Price Competition and tions (except for an interest described in sub-
ings to the Federal Government or fair price eli- Innovation Act of 2009, and continues to be section (b)(2)(iv) of such section)) on the date of
gible individuals during the price applicability marketed under section 351 of such Act; and the selected drug publication date, with respect
period. In making this projection of savings for ‘‘(B) is not the reference product for any bio- the price applicability year (as applicable);
drugs for which there is an AIM price for a logical product that is licensed and continues to ‘‘(B) a personal or business relationship (as
price applicability period, the savings shall be be marketed under section 351(k) of such Act. described in section 2635.502 of such title) on the
projected across different dosage forms and ‘‘(3) INSULIN PRODUCT.—Notwithstanding
date of the selected drug publication date, with
strengths of the drugs and not based on the spe- paragraphs (1) and (2), any insulin product that respect the price applicability year;
cific formulation or package size or package is approved under subsection (c) or (j) of section ‘‘(C) employment by a manufacturer of a ne-
type of the drugs, taking into consideration both 505 of the Federal Food, Drug, and Cosmetic Act gotiation-eligible drug during the preceding 10-
the volume of drugs for which payment is made, or licensed under subsection (a) or (k) of section year period beginning on the date of the selected
to the extent such data is available, and the 351 of the Public Health Service Act and con- drug publication date, with respect to each price
amount by which the net price for the drugs ex- tinues to be marketed under such section 505 or applicability year; and
ceeds the AIM price for the drugs. 351, including any insulin product that has been ‘‘(D) any other matter the General Counsel
‘‘(c) SELECTED DRUG.—For purposes of this deemed to be licensed under section 351(a) of the determines appropriate.
part, each drug included on the list published Public Health Service Act pursuant to section ‘‘(3) INDIVIDUAL DESCRIBED.—An individual
under subsection (a) with respect to an initial 7002(e)(4) of the Biologics Price Competition and described in this paragraph is—
price applicability year shall be referred to as a Innovation Act of 2009 and continues to be mar- ‘‘(A) the highest-ranking officer or employee
‘selected drug’ with respect to such year and keted pursuant to such licensure. of the Department of Health and Human Serv-
each subsequent plan year beginning before the For purposes of applying paragraphs (1) and
ices (as determined by the organizational chart
first plan year beginning after the date on (2), a drug or biological product that is mar-
of the Department) that does not have a conflict
which the Secretary determines two or more keted by the same sponsor or manufacturer (or
under this subsection; and
drug products— an affiliate thereof or a cross-licensed producer
‘‘(B) is nominated by the President and con-
‘‘(1) are approved or licensed (as applicable)— or distributor) as the listed drug or reference
firmed by the Senate with respect to the posi-
‘‘(A) under section 505(j) of the Federal Food, product described in such respective paragraph
tion.
Drug, and Cosmetic Act using such drug as the shall not be taken into consideration.
‘‘SEC. 1193. MANUFACTURER AGREEMENTS.
listed drug; or ‘‘(f) INFORMATION ON INTERNATIONAL DRUG
PRICES.—For purposes of determining which ne- ‘‘(a) IN GENERAL.—For purposes of section
‘‘(B) under section 351(k) of the Public Health
gotiation-eligible drugs to select under sub- 1191(a)(2), the Secretary shall enter into agree-
Service Act using such drug as the reference
section (a) and, in the case of such drugs that ments with manufacturers of selected drugs with
product; and
‘‘(2) continue to be marketed. are selected drugs, to determine the maximum respect to a price applicability period, by not
‘‘(d) NEGOTIATION-ELIGIBLE DRUG.— fair price for such a drug and whether such later than June 15 following the selected drug
‘‘(1) IN GENERAL.—For purposes of this part, maximum fair price should be renegotiated publication date with respect to such selected
the term ‘negotiation-eligible drug’ means, with under section 1194, the Secretary shall use data drug, under which—
respect to the selected drug publication date relating to the AIM price with respect to such ‘‘(1) during the voluntary negotiation period
with respect to an initial price applicability drug as available or provided to the Secretary for the initial price applicability year for the se-
year, a qualifying single source drug, as defined and shall on an ongoing basis request from lected drug, the Secretary and manufacturer, in
in subsection (e), that meets any of the fol- manufacturers of selected drugs information on accordance with section 1194, negotiate to deter-
lowing criteria: the AIM price of such a drug. mine (and, by not later than the last date of
‘‘(A) COVERED PART D DRUGS.—The drug is ‘‘(g) NEW-ENTRANT NEGOTIATION-ELIGIBLE such period and in accordance with subsection
among the 125 covered part D drugs (as defined DRUGS.— (c), agree to) a maximum fair price for such se-
in section 1860D–2(e)) for which there was an es- ‘‘(1) IN GENERAL.—For purposes of this part, lected drug of the manufacturer in order to pro-
timated greatest net spending under parts C and the term ‘new-entrant negotiation-eligible drug’ vide access to such price—
D of title XVIII, as determined by the Secretary, means, with respect to the selected drug publica- ‘‘(A) to fair price eligible individuals who with
during the most recent plan year prior to such tion date with respect to an initial price appli- respect to such drug are described in subpara-
drug publication date for which data are avail- cability year, a qualifying single source drug— graph (A) of section 1191(c)(1) and are furnished
able. ‘‘(A) that is first approved or licensed, as de- or dispensed such drug during, subject to sub-
‘‘(B) OTHER DRUGS.—The drug is among the scribed in paragraph (1), (2), or (3) of subsection paragraph (2), the price applicability period;
125 drugs for which there was an estimated (e), as applicable, during the year preceding and
greatest net spending in the United States (in- such selected drug publication date; and ‘‘(B) to hospitals, physicians, and other pro-
cluding the 50 States, the District of Columbia, ‘‘(B) that the Secretary determines under viders of services and suppliers with respect to
and the territories of the United States), as de- paragraph (2) is likely to be included as a nego- fair price eligible individuals who with respect
termined by the Secretary, during the most re- tiation-eligible drug with respect to the subse- to such drug are described in subparagraph (B)
cent plan year prior to such drug publication quent selected drug publication date. of such section and are furnished or adminis-
date for which data are available. ‘‘(2) DETERMINATION.—In the case of a quali- tered such drug during, subject to subparagraph
‘‘(C) INSULIN.—The drug is a qualifying single fying single source drug that meets the criteria (2), the price applicability period;
source drug described in subsection (e)(3). described in subparagraph (A) of paragraph (1), ‘‘(2) the Secretary and the manufacturer
‘‘(2) CLARIFICATION.—In determining whether with respect to an initial price applicability shall, in accordance with a process and during
a qualifying single source drug satisfies any of year, if the wholesale acquisition cost at which a period specified by the Secretary pursuant to
the criteria described in paragraph (1), the Sec- such drug is first marketed in the United States rulemaking, renegotiate (and, by not later than
retary shall, to the extent practicable, use data is equal to or greater than the median house- the last date of such period and in accordance
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that is aggregated across dosage forms and hold income (as determined according to the with subsection (c), agree to) the maximum fair
strengths of the drug and not based on the spe- most recent data collected by the United States price for such drug if the Secretary determines
cific formulation or package size or package Census Bureau), the Secretary shall determine that there is a material change in any of the
type of the drug. before the selected drug publication date with factors described in section 1194(d) relating to
‘‘(3) PUBLICATION.—Not later than the se- respect to the initial price applicability year, if the drug, including changes in the AIM price
lected drug publication date with respect to an the drug is likely to be included as a negotia- for such drug, in order to provide access to such
initial price applicability year, the Secretary tion-eligible drug with respect to the subsequent maximum fair price (as so renegotiated)—
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H2610 CONGRESSIONAL RECORD — HOUSE June 29, 2020
‘‘(A) to fair price eligible individuals who with manufacturer price (as defined in section ‘‘(A) RESEARCH AND DEVELOPMENT COSTS.—
respect to such drug are described in subpara- 1927(k)(1)) for such dosage strength and form The factor described in paragraph (1)(A) of sub-
graph (A) of section 1191(c)(1) and are furnished for the drug during the period beginning with section (d).
or dispensed such drug during any year during the first plan year for which the drug is in- ‘‘(B) MARKET DATA.—The factor described in
the price applicability period (beginning after cluded on the list of negotiation-eligible drugs paragraph (1)(B) of such subsection.
such renegotiation) with respect to such selected published under section 1192(d) and ending with ‘‘(C) UNIT COSTS OF PRODUCTION AND DIS-
drug; and the last plan year during the price applicability TRIBUTION.—The factor described in paragraph
‘‘(B) to hospitals, physicians, and other pro- period for such drug with respect to which there (1)(C) of such subsection.
viders of services and suppliers with respect to is no AIM price available for such drug. ‘‘(D) COMPARISON TO EXISTING THERAPEUTIC
fair price eligible individuals who with respect ALTERNATIVES.—The factor described in para-
‘‘(B) AMOUNT MULTIPLIER AFTER AIM PRICE
to such drug are described in subparagraph (B) AVAILABLE.—For purposes of paragraph (1), the
graph (2)(A) of such subsection.
of such section and are furnished or adminis- ‘‘(3) REQUIREMENT.—
amount described in this subparagraph for a se- ‘‘(A) IN GENERAL.—In negotiating the max-
tered such drug during any year described in lected drug described in such paragraph, is the imum fair price of a selected drug, with respect
subparagraph (A); amount equal to 200 percent of the AIM price to an initial price applicability year for the se-
‘‘(3) the maximum fair price (including as re- for such drug with respect to the first plan year lected drug, and, as applicable, in renegotiating
negotiated pursuant to paragraph (2)), with re- during the price applicability period for such the maximum fair price for such drug, with re-
spect to such a selected drug, shall be provided drug with respect to which there is an AIM spect to a subsequent year during the price ap-
to fair price eligible individuals, who with re- price available for such drug. plicability period for such drug, in the case that
spect to such drug are described in subpara- ‘‘(d) CONFIDENTIALITY OF INFORMATION.—In- the manufacturer of the selected drug offers
graph (A) of section 1191(c)(1), at the pharmacy formation submitted to the Secretary under this under the negotiation or renegotiation, as appli-
or by a mail order service at the point-of-sale of part by a manufacturer of a selected drug that cable, a price for such drug that is not more
such drug; is proprietary information of such manufacturer than the target price described in subparagraph
‘‘(4) the manufacturer, subject to subsection (as determined by the Secretary) may be used (B) for such drug for the respective year, the
(d), submits to the Secretary, in a form and only by the Secretary or disclosed to and used Secretary shall agree under such negotiation or
manner specified by the Secretary— by the Comptroller General of the United States renegotiation, respectively, to such offered price
‘‘(A) for the voluntary negotiation period for or the Medicare Payment Advisory Commission as the maximum fair price.
the price applicability period (and, if applicable, for purposes of carrying out this part. ‘‘(B) TARGET PRICE.—
before any period of renegotiation specified pur- ‘‘(e) REGULATIONS.— ‘‘(i) IN GENERAL.—Subject to clause (ii), the
suant to paragraph (2)) with respect to such ‘‘(1) IN GENERAL.—The Secretary shall, pursu- target price described in this subparagraph for a
drug all information that the Secretary requires ant to rulemaking, specify, in accordance with selected drug with respect to a year, is the aver-
to carry out the negotiation (or renegotiation paragraph (2), the information that must be age price (which shall be the net average price,
process) under this part, including information submitted under subsection (a)(4). if practicable, and volume-weighted, if prac-
described in section 1192(f) and section ‘‘(2) INFORMATION SPECIFIED.—Information ticable) for a unit of such drug for sales of such
1194(d)(1); and described in paragraph (1), with respect to a se- drug, as computed (across different dosage
‘‘(B) on an ongoing basis, information on lected drug, shall include information on sales forms and strengths of the drug and not based
changes in prices for such drug that would af- of the drug (by the manufacturer of the drug or on the specific formulation or package size or
fect the AIM price for such drug or otherwise by another entity under license or other agree- package type of the drug) in the applicable
provide a basis for renegotiation of the max- ment with the manufacturer, with respect to the country described in section 1191(c)(3)(B) with
imum fair price for such drug pursuant to para- sales of such drug, regardless of the name under respect to such drug that, with respect to such
graph (2); which the drug is sold) in any foreign country year, has the lowest average price for such drug
‘‘(5) the manufacturer agrees that in the case that is part of the AIM price. The Secretary as compared to the average prices (as so com-
the selected drug of a manufacturer is a drug shall verify, to the extent practicable, such sales puted) of such drug with respect to such year in
described in subsection (c), the manufacturer from appropriate officials of the government of the other applicable countries described in such
will, in accordance with such subsection, make the foreign country involved. section with respect to such drug.
any payment required under such subsection ‘‘(f) COMPLIANCE WITH REQUIREMENTS FOR ‘‘(ii) SELECTED DRUGS WITHOUT AIM PRICE.—In
with respect to such drug; and ADMINISTRATION OF PROGRAM.—Each manufac- applying this paragraph in the case of negoti-
‘‘(6) the manufacturer complies with require- ating the maximum fair price of a selected drug
turer with an agreement in effect under this sec-
ments imposed by the Secretary for purposes of for which there is no AIM price available with
tion shall comply with requirements imposed by
administering the program, including with re- respect to the initial price applicability year for
the Secretary or a third party with a contract
spect to the duties described in section 1196. such drug, or, as applicable, renegotiating the
under section 1196(c)(1), as applicable, for pur-
‘‘(b) AGREEMENT IN EFFECT UNTIL DRUG IS NO maximum fair price for such drug with respect
poses of administering the program.
LONGER A SELECTED DRUG.—An agreement en- to a subsequent year during the price applica-
tered into under this section shall be effective, ‘‘SEC. 1194. NEGOTIATION AND RENEGOTIATION
PROCESS.
bility period for such drug before the first plan
with respect to a drug, until such drug is no year for which there is an AIM price available
longer considered a selected drug under section ‘‘(a) IN GENERAL.—For purposes of this part, for such drug, the target price described in this
1192(c). under an agreement under section 1193 between subparagraph for such drug and respective year
‘‘(c) SPECIAL RULE FOR CERTAIN SELECTED the Secretary and a manufacturer of a selected is the amount that is 80 percent of the average
DRUGS WITHOUT AIM PRICE.— drug, with respect to the period for which such manufacturer price (as defined in section
‘‘(1) IN GENERAL.—In the case of a selected agreement is in effect and in accordance with 1927(k)(1)) for such drug and year.
drug for which there is no AIM price available subsections (b) and (c), the Secretary and the ‘‘(4) ANNUAL REPORT.—After the completion of
with respect to the initial price applicability manufacturer— each voluntary negotiation period, the Secretary
year for such drug and for which an AIM price ‘‘(1) shall during the voluntary negotiation shall submit to Congress a report on the max-
becomes available beginning with respect to a period with respect to the initial price applica- imum fair prices negotiated (or, as applicable,
subsequent plan year during the price applica- bility year for such drug, in accordance with renegotiated) for such period. Such report shall
bility period for such drug, if the Secretary de- this section, negotiate a maximum fair price for include information on how such prices so nego-
termines that the amount described in para- such drug for the purpose described in section tiated (or renegotiated) meet the requirements of
graph (2)(A) for a unit of such drug is greater 1193(a)(1); and this part, including the requirements of this sub-
than the amount described in paragraph (2)(B) ‘‘(2) as applicable pursuant to section section.
for a unit of such drug, then by not later than 1193(a)(2) and in accordance with the process ‘‘(c) LIMITATION.—
one year after the date of such determination, specified pursuant to such section, renegotiate ‘‘(1) IN GENERAL.—Subject to paragraph (2),
the manufacturer of such selected drug shall such maximum fair price for such drug for the the maximum fair price negotiated (including as
pay to the Treasury an amount equal to the purpose described in such section. renegotiated) under this section for a selected
product of— ‘‘(b) NEGOTIATING METHODOLOGY AND OBJEC- drug, with respect to each plan year during a
‘‘(A) the difference between such amount de- TIVE.— price applicability period for such drug, shall
scribed in paragraph (2)(A) for a unit of such ‘‘(1) IN GENERAL.—The Secretary shall develop not exceed 120 percent of the AIM price applica-
drug and such amount described in paragraph and use a consistent methodology for negotia- ble to such drug with respect to such year.
(2)(B) for a unit of such drug; and tions under subsection (a) that, in accordance ‘‘(2) SELECTED DRUGS WITHOUT AIM PRICE.—In
‘‘(B) the number of units of such drug sold in with paragraph (2) and subject to paragraph the case of a selected drug for which there is no
the United States, including the 50 States, the (3), achieves the lowest maximum fair price for AIM price available with respect to the initial
District of Columbia, and the territories of the each selected drug while appropriately reward- price applicability year for such drug, for each
United States, during the period described in ing innovation. plan year during the price applicability period
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paragraph (2)(B). ‘‘(2) PRIORITIZING FACTORS.—In considering before the first plan year for which there is an
‘‘(2) AMOUNTS DESCRIBED.— the factors described in subsection (d) in negoti- AIM price available for such drug, the maximum
‘‘(A) WEIGHTED AVERAGE PRICE BEFORE AIM ating (and, as applicable, renegotiating) the fair price negotiated (including as renegotiated)
PRICE AVAILABLE.—For purposes of paragraph maximum fair price for a selected drug, the Sec- under this section for the selected drug shall not
(1), the amount described in this subparagraph retary shall, to the extent practicable, consider exceed the amount equal to 85 percent of the av-
for a selected drug described in such paragraph, all of the available factors listed but shall erage manufacturer price for the drug with re-
is the amount equal to the weighted average prioritize the following factors: spect to such year.
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2611
‘‘(d) CONSIDERATIONS.—For purposes of nego- turer of such selected drug shall submit to the are described in subparagraph (B) of section
tiating and, as applicable, renegotiating (in- Secretary such requested information in such 1191(c)(1)), the maximum fair price for the se-
cluding for purposes of determining whether to form and manner as the Secretary may require. lected drug is provided to such hospitals, physi-
renegotiate) the maximum fair price of a selected The Secretary shall request, from the manufac- cians, and other providers of services and sup-
drug under this part with the manufacturer of turer or others, such additional information as pliers (as applicable) with respect to such indi-
the drug, the Secretary, consistent with sub- may be needed to carry out the negotiation and viduals and providing that such maximum fair
section (b)(2), shall take into consideration the renegotiation process under this section. price is used for determining cost-sharing under
factors described in paragraphs (1), (2), (3), and ‘‘(f) DISCLOSURE OF INFORMATION.—For pur- the respective part, plan, or coverage for the se-
(5), and may take into consideration the factor poses of this part, the Secretary of Veterans Af- lected drug.
described in paragraph (4): fairs may disclose to the Secretary of Health ‘‘(C) The establishment of procedures (includ-
‘‘(1) MANUFACTURER-SPECIFIC INFORMATION.— and Human Services the price of any negotia- ing through agreements and contracts described
The following information, including as sub- tion-eligible drug that is purchased pursuant to in subparagraphs (A) and (B)) to ensure that,
mitted by the manufacturer: section 8126 of title 38, United States Code. not later than 90 days after the dispensing of a
‘‘(A) Research and development costs of the ‘‘SEC. 1195. PUBLICATION OF MAXIMUM FAIR selected drug to a fair price eligible individual
manufacturer for the drug and the extent to PRICES. by a pharmacy or mail order service, the phar-
which the manufacturer has recouped research ‘‘(a) IN GENERAL.—With respect to an initial macy or mail order service is reimbursed for an
and development costs. price applicability year and selected drug with amount equal to the difference between—
‘‘(B) Market data for the drug, including the respect to such year, not later than April 1 of ‘‘(i) the lesser of—
distribution of sales across different programs the plan year prior to such initial price applica- ‘‘(I) the wholesale acquisition cost of the
and purchasers and projected future revenues bility year, the Secretary shall publish in the drug;
for the drug. ‘‘(II) the national average drug acquisition
Federal Register the maximum fair price for
‘‘(C) Unit costs of production and distribution cost of the drug; and
such drug negotiated under this part with the
of the drug. ‘‘(III) any other similar determination of
‘‘(D) Prior Federal financial support for novel manufacturer of such drug.
pharmacy acquisition costs of the drug, as de-
therapeutic discovery and development with re- ‘‘(b) UPDATES.—
termined by the Secretary; and
spect to the drug. ‘‘(1) SUBSEQUENT YEAR MAXIMUM FAIR ‘‘(ii) the maximum fair price for the drug.
‘‘(E) Data on patents and on existing and PRICES.—For a selected drug, for each plan year ‘‘(D) The establishment of procedures to en-
pending exclusivity for the drug. subsequent to the initial price applicability year sure that the maximum fair price for a selected
‘‘(F) National sales data for the drug. for such drug with respect to which an agree- drug is applied before—
‘‘(G) Information on clinical trials for the ment for such drug is in effect under section ‘‘(i) any coverage or financial assistance
drug in the United States or in applicable coun- 1193, the Secretary shall publish in the Federal under other health benefit plans or programs
tries described in section 1191(c)(3)(B). Register— that provide coverage or financial assistance for
‘‘(2) INFORMATION ON ALTERNATIVE PROD- ‘‘(A) subject to subparagraph (B), the amount the purchase or provision of prescription drug
UCTS.—The following information: equal to the maximum fair price published for coverage on behalf of fair price eligible individ-
‘‘(A) The extent to which the drug represents such drug for the previous year, increased by uals as the Secretary may specify; and
a therapeutic advance as compared to existing the annual percentage increase in the consumer ‘‘(ii) any other discounts.
therapeutic alternatives and, to the extent such price index for all urban consumers (all items; ‘‘(E) The establishment of procedures to enter
information is available, the costs of such exist- U.S. city average) as of September of such pre- into appropriate agreements and protocols for
ing therapeutic alternatives. vious year; or the ongoing computation of AIM prices for se-
‘‘(B) Information on approval by the Food ‘‘(B) in the case the maximum fair price for lected drugs, including, to the extent possible, to
and Drug Administration of alternative drug such drug was renegotiated, for the first year compute the AIM price for selected drugs and
products. for which such price as so renegotiated applies, including by providing that the manufacturer of
‘‘(C) Information on comparative effectiveness such renegotiated maximum fair price. such a selected drug should provide information
analysis for such products, taking into consider- ‘‘(2) PRICES NEGOTIATED AFTER DEADLINE.—In for such computation not later than 3 months
ation the effects of such products on specific the case of a selected drug with respect to an after the first date of the voluntary negotiation
populations, such as individuals with disabil- initial price applicability year for which the period for such selected drug.
ities, the elderly, terminally ill, children, and maximum fair price is determined under this ‘‘(F) The establishment of procedures to com-
other patient populations. part after the date of publication under this sec- pute and apply the maximum fair price across
In considering information described in sub- tion, the Secretary shall publish such maximum different strengths and dosage forms of a se-
paragraph (C), the Secretary shall not use evi- fair price in the Federal Register by not later lected drug and not based on the specific formu-
dence or findings from comparative clinical ef- than 30 days after the date such maximum price lation or package size or package type of the
fectiveness research in a manner that treats ex- is so determined. drug.
tending the life of an elderly, disabled, or termi- ‘‘(G) The establishment of procedures to nego-
‘‘SEC. 1196. ADMINISTRATIVE DUTIES; COORDINA-
nally ill individual as of lower value than ex- TION PROVISIONS. tiate and apply the maximum fair price in a
tending the life of an individual who is younger, manner that does not include any dispensing or
‘‘(a) ADMINISTRATIVE DUTIES.—
nondisabled, or not terminally ill. Nothing in similar fee.
‘‘(1) IN GENERAL.—For purposes of section
the previous sentence shall affect the applica- ‘‘(H) The establishment of procedures to carry
1191, the administrative duties described in this
tion or consideration of an AIM price for a se- out the provisions of this part, as applicable,
section are the following:
lected drug. with respect to—
‘‘(A) The establishment of procedures (includ-
‘‘(3) FOREIGN SALES INFORMATION.—To the ex- ‘‘(i) fair price eligible individuals who are en-
tent available on a timely basis, including as ing through agreements with manufacturers
rolled under a prescription drug plan under part
provided by a manufacturer of the selected drug under this part, contracts with prescription
D of title XVIII or an MA–PD plan under part
or otherwise, information on sales of the se- drug plans under part D of title XVIII and MA–
C of such title;
lected drug in each of the countries described in PD plans under part C of such title, and agree-
‘‘(ii) fair price eligible individuals who are en-
section 1191(c)(3)(B). ments under section 1197 with group health
rolled under a group health plan or health in-
‘‘(4) VA DRUG PRICING INFORMATION.—Infor- plans and health insurance issuers of health in-
surance coverage offered by a health insurance
mation disclosed to the Secretary pursuant to surance coverage offered in the individual or
issuer in the individual or group market with re-
subsection (f). group market) under which the maximum fair
spect to which there is an agreement in effect
‘‘(5) ADDITIONAL INFORMATION.—Information price for a selected drug is provided to fair price
under section 1197; and
submitted to the Secretary, in accordance with a eligible individuals, who with respect to such ‘‘(iii) fair price eligible individuals who are
process specified by the Secretary, by other par- drug are described in subparagraph (A) of sec- entitled to benefits under part A of title XVIII
ties that are affected by the establishment of a tion 1191(c)(1), at pharmacies or by mail order or enrolled under part B of such title.
maximum fair price for the selected drug. service at the point-of-sale of the drug for the ‘‘(I) The establishment of a negotiation proc-
‘‘(e) REQUEST FOR INFORMATION.—For pur- applicable price period for such drug and pro- ess and renegotiation process in accordance
poses of negotiating and, as applicable, renego- viding that such maximum fair price is used for with section 1194, including a process for ac-
tiating (including for purposes of determining determining cost-sharing under such plans or quiring information described in subsection (d)
whether to renegotiate) the maximum fair price coverage for the selected drug. of such section and determining amounts de-
of a selected drug under this part with the man- ‘‘(B) The establishment of procedures (includ- scribed in subsection (b) of such section.
ufacturer of the drug, with respect to a price ap- ing through agreements with manufacturers ‘‘(J) The provision of a reasonable dispute res-
plicability period, and other relevant data for under this part and contracts with hospitals, olution mechanism to resolve disagreements be-
purposes of this section— physicians, and other providers of services and tween manufacturers, fair price eligible individ-
‘‘(1) the Secretary shall, not later than the se- suppliers and agreements under section 1197 uals, and the third party with a contract under
dlhill on DSK120RN23PROD with HOUSE
lected drug publication date with respect to the with group health plans and health insurance subsection (c)(1).
initial price applicability year of such period, issuers of health insurance coverage offered in ‘‘(2) MONITORING COMPLIANCE.—
request drug pricing information from the man- the individual or group market) under which, in ‘‘(A) IN GENERAL.—The Secretary shall mon-
ufacturer of such selected drug, including infor- the case of a selected drug furnished or adminis- itor compliance by a manufacturer with the
mation described in subsection (d)(1); and tered by such a hospital, physician, or other terms of an agreement under section 1193, in-
‘‘(2) by not later than October 1 following the provider of services or supplier to fair price eligi- cluding by establishing a mechanism through
selected drug publication date, the manufac- ble individuals (who with respect to such drug which violations of such terms may be reported.
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H2612 CONGRESSIONAL RECORD — HOUSE June 29, 2020
‘‘(B) NOTIFICATION.—If a third party with a agreement under the program under this part ‘‘(1) The selection of drugs for publication
contract under subsection (c)(1) determines that with a group health plan or health insurance under section 1192(a).
the manufacturer is not in compliance with such issuer offering group or individual health insur- ‘‘(2) The determination of whether a drug is a
agreement, the third party shall notify the Sec- ance coverage with respect to a price applica- negotiation-eligible drug under section 1192(d).
retary of such noncompliance for appropriate bility period and a selected drug with respect to ‘‘(3) The determination of the maximum fair
enforcement under section 4192 of the Internal such period if such a plan or issuer affirma- price of a selected drug under section 1194.
Revenue Code of 1986 or section 1198, as applica- tively elects, through a process specified by the ‘‘(4) The determination of units of a drug for
ble. Secretary, not to participate under the program purposes of section 1191(c)(3).
‘‘(b) COLLECTION OF DATA.— ‘‘(e) COORDINATION.—In carrying out this part
with respect to such period and drug.
‘‘(1) FROM PRESCRIPTION DRUG PLANS AND MA– with respect to group health plans or health in-
‘‘(b) PUBLICATION OF ELECTION.—With respect
PD PLANS.—The Secretary may collect appro- surance coverage offered in the group market
to each price applicability period and each se-
priate data from prescription drug plans under that are subject to oversight by the Secretary of
lected drug with respect to such period, the Sec-
part D of title XVIII and MA–PD plans under Labor or the Secretary of the Treasury, the Sec-
retary and the Secretary of Labor and the Sec-
part C of such title in a timeframe that allows retary of Health and Human Services shall co-
retary of the Treasury, as applicable, shall
for maximum fair prices to be provided under ordinate with such respective Secretary.
make public a list of each group health plan ‘‘(f) DATA SHARING.—The Secretary shall
this part for selected drugs. and each health insurance issuer offering group share with the Secretary of the Treasury such
‘‘(2) FROM HEALTH PLANS.—The Secretary may or individual health insurance coverage, with information as is necessary to determine the tax
collect appropriate data from group health respect to which coverage is provided under imposed by section 4192 of the Internal Revenue
plans or health insurance issuers offering group such plan or coverage for such drug, that has Code of 1986.
or individual health insurance coverage in a elected under subsection (a) not to participate ‘‘(g) GAO STUDY.—Not later than December
timeframe that allows for maximum fair prices under the program with respect to such period 31, 2025, the Comptroller General of the United
to be provided under this part for selected drugs. and drug. States shall conduct a study of, and submit to
‘‘(3) COORDINATION OF DATA COLLECTION.—To ‘‘SEC. 1198. CIVIL MONETARY PENALTY. Congress a report on, the implementation of the
the extent feasible, as determined by the Sec- ‘‘(a) VIOLATIONS RELATING TO OFFERING OF Fair Price Negotiation Program under this
retary, the Secretary shall ensure that data col- MAXIMUM FAIR PRICE.—Any manufacturer of a part.’’.
lected pursuant to this subsection is coordinated selected drug that has entered into an agree- (b) APPLICATION OF MAXIMUM FAIR PRICES
with, and not duplicative of, other Federal data ment under section 1193, with respect to a plan AND CONFORMING AMENDMENTS.—
collection efforts. year during the price applicability period for (1) UNDER MEDICARE.—
‘‘(c) CONTRACT WITH THIRD PARTIES.— (A) APPLICATION TO PAYMENTS UNDER PART
such drug, that does not provide access to a
‘‘(1) IN GENERAL.—The Secretary may enter B.—Section 1847A(b)(1)(B) of the Social Security
price that is not more than the maximum fair
into a contract with 1 or more third parties to Act (42 U.S.C. 1395w–3a(b)(1)(B)) is amended by
price (or a lesser price) for such drug for such
administer the requirements established by the inserting ‘‘or in the case of such a drug or bio-
year—
Secretary in order to carry out this part. At a logical that is a selected drug (as defined in sec-
‘‘(1) to a fair price eligible individual who
minimum, the contract with a third party under tion 1192(c)), with respect to a price applica-
with respect to such drug is described in sub-
the preceding sentence shall require that the bility period (as defined in section 1191(b)(2)),
paragraph (A) of section 1191(c)(1) and who is
third party— 106 percent of the maximum fair price (as de-
furnished or dispensed such drug during such
‘‘(A) receive and transmit information be- fined in section 1191(c)(2) applicable for such
year; or
tween the Secretary, manufacturers, and other drug and a plan year during such period’’ after
‘‘(2) to a hospital, physician, or other provider
individuals or entities the Secretary determines ‘‘paragraph (4)’’.
of services or supplier with respect to fair price
appropriate; (B) EXCEPTION TO PART D NON-INTER-
eligible individuals who with respect to such
‘‘(B) receive, distribute, or facilitate the dis- FERENCE.—Section 1860D–11(i) of the Social Se-
drug is described in subparagraph (B) of such
tribution of funds of manufacturers to appro- curity Act (42 U.S.C. 1395w–111(i)) is amended
section and is furnished or administered such
priate individuals or entities in order to meet the by inserting ‘‘, except as provided under part E
drug by such hospital, physician, or provider or
obligations of manufacturers under agreements of title XI’’ after ‘‘the Secretary’’.
supplier during such year; (C) APPLICATION AS NEGOTIATED PRICE UNDER
under this part;
‘‘(C) provide adequate and timely information shall be subject to a civil monetary penalty PART D.—Section 1860D–2(d)(1) of the Social Se-
to manufacturers, consistent with the agreement equal to ten times the amount equal to the dif- curity Act (42 U.S.C. 1395w–102(d)(1)) is amend-
with the manufacturer under this part, as nec- ference between the price for such drug made ed—
essary for the manufacturer to fulfill its obliga- available for such year by such manufacturer (i) in subparagraph (B), by inserting ‘‘, sub-
tions under this part; and with respect to such individual or hospital, phy- ject to subparagraph (D),’’ after ‘‘negotiated
‘‘(D) permit manufacturers to conduct peri- sician, provider, or supplier and the maximum prices’’; and
odic audits, directly or through contracts, of the fair price for such drug for such year. (ii) by adding at the end the following new
data and information used by the third party to ‘‘(b) VIOLATIONS OF CERTAIN TERMS OF subparagraph:
determine discounts for applicable drugs of the AGREEMENT.—Any manufacturer of a selected ‘‘(D) APPLICATION OF MAXIMUM FAIR PRICE
manufacturer under the program. drug that has entered into an agreement under FOR SELECTED DRUGS.—In applying this section,
‘‘(2) PERFORMANCE REQUIREMENTS.—The Sec- section 1193, with respect to a plan year during in the case of a covered part D drug that is a se-
retary shall establish performance requirements the price applicability period for such drug, that lected drug (as defined in section 1192(c)), with
for a third party with a contract under para- is in violation of a requirement imposed pursu- respect to a price applicability period (as de-
graph (1) and safeguards to protect the inde- ant to section 1193(a)(6) shall be subject to a fined in section 1191(b)(2)), the negotiated prices
pendence and integrity of the activities carried civil monetary penalty of not more than used for payment (as described in this sub-
out by the third party under the program under $1,000,000 for each such violation. section) shall be the maximum fair price (as de-
this part. ‘‘(c) APPLICATION.—The provisions of section fined in section 1191(c)(2)) for such drug and for
1128A (other than subsections (a) and (b)) shall each plan year during such period.’’.
‘‘SEC. 1197.VOLUNTARY PARTICIPATION BY
apply to a civil monetary penalty under this (D) INFORMATION FROM PRESCRIPTION DRUG
OTHER HEALTH PLANS.
section in the same manner as such provisions PLANS AND MA–PD PLANS REQUIRED.—
‘‘(a) AGREEMENT TO PARTICIPATE UNDER PRO- (i) PRESCRIPTION DRUG PLANS.—Section 1860D–
GRAM.—
apply to a penalty or proceeding under section
1128A(a). 12(b) of the Social Security Act (42 U.S.C.
‘‘(1) IN GENERAL.—Subject to paragraph (2), 1395w–112(b)) is amended by adding at the end
under the program under this part the Secretary ‘‘SEC. 1199. MISCELLANEOUS PROVISIONS.
the following new paragraph:
shall be treated as having in effect an agree- ‘‘(a) PAPERWORK REDUCTION ACT.—Chapter ‘‘(8) PROVISION OF INFORMATION RELATED TO
ment with a group health plan or health insur- 35 of title 44, United States Code, shall not MAXIMUM FAIR PRICES.—Each contract entered
ance issuer offering group or individual health apply to data collected under this part. into with a PDP sponsor under this part with
insurance coverage (as such terms are defined in ‘‘(b) NATIONAL ACADEMY OF MEDICINE respect to a prescription drug plan offered by
section 2791 of the Public Health Service Act), STUDY.—Not later than December 31, 2025, the such sponsor shall require the sponsor to pro-
with respect to a price applicability period and National Academy of Medicine shall conduct a vide information to the Secretary as requested
a selected drug with respect to such period— study, and submit to Congress a report, on rec- by the Secretary in accordance with section
‘‘(A) with respect to such selected drug fur- ommendations for improvements to the program 1196(b).’’.
nished or dispensed at a pharmacy or by mail under this part, including the determination of (ii) MA–PD PLANS.—Section 1857(f)(3) of the
order service if coverage is provided under such the limits applied under section 1194(c). Social Security Act (42 U.S.C. 1395w–27(f)(3)) is
plan or coverage during such period for such se- ‘‘(c) MEDPAC STUDY.—Not later than Decem- amended by adding at the end the following
lected drug as so furnished or dispensed; and ber 31, 2025, the Medicare Payment Advisory new subparagraph:
‘‘(B) with respect to such selected drug fur- Commission shall conduct a study, and submit ‘‘(E) PROVISION OF INFORMATION RELATED TO
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nished or administered by a hospital, physician, to Congress a report, on the program under this MAXIMUM FAIR PRICES.—Section 1860D–
or other provider of services or supplier if cov- part with respect to the Medicare program 12(b)(8).’’.
erage is provided under such plan or coverage under title XVIII, including with respect to the (2) UNDER GROUP HEALTH PLANS AND HEALTH
during such period for such selected drug as so effect of the program on individuals entitled to INSURANCE COVERAGE.—
furnished or administered. benefits or enrolled under such title. (A) PHSA.—Part A of title XXVII of the Pub-
‘‘(2) OPTING OUT OF AGREEMENT.—The Sec- ‘‘(d) LIMITATION ON JUDICIAL REVIEW.—The lic Health Service Act is amended by inserting
retary shall not be treated as having in effect an following shall not be subject to judicial review: after section 2729 the following new section:
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2613
‘‘SEC. 2729A. FAIR PRICE NEGOTIATION PROGRAM having in effect an agreement with the Sec- ‘‘SEC. 9816. FAIR PRICE NEGOTIATION PROGRAM
AND APPLICATION OF MAXIMUM retary under the Fair Price Negotiation Program AND APPLICATION OF MAXIMUM
FAIR PRICES. FAIR PRICES.
under part E of title XI of such Act, with re-
‘‘(a) IN GENERAL.—In the case of a group spect to a price applicability period (as defined ‘‘(a) IN GENERAL.—In the case of a group
health plan or health insurance issuer offering in section 1191(b) of such Act) and a selected health plan that is treated under section 1197 of
group or individual health insurance coverage drug (as defined in section 1192(c) of such Act) the Social Security Act as having in effect an
that is treated under section 1197 of the Social with respect to such period with respect to agreement with the Secretary under the Fair
Security Act as having in effect an agreement which coverage is provided under such plan or Price Negotiation Program under part E of title
with the Secretary under the Fair Price Negotia- XI of such Act, with respect to a price applica-
coverage—
tion Program under part E of title XI of such bility period (as defined in section 1191(b) of
‘‘(1) the provisions of such part shall apply, such Act) and a selected drug (as defined in sec-
Act, with respect to a price applicability period
as applicable— tion 1192(c) of such Act) with respect to such pe-
(as defined in section 1191(b) of such Act) and
a selected drug (as defined in section 1192(c) of ‘‘(A) if coverage of such selected drug is pro- riod with respect to which coverage is provided
such Act) with respect to such period with re- vided under such plan or coverage if the drug is under such plan—
spect to which coverage is provided under such furnished or dispensed at a pharmacy or by a ‘‘(1) the provisions of such part shall apply,
plan or coverage— mail order service, to the plans or coverage of- as applicable—
‘‘(1) the provisions of such part shall apply— fered by such plan or issuer, and to the individ- ‘‘(A) if coverage of such selected drug is pro-
‘‘(A) if coverage of such selected drug is pro- uals enrolled under such plans or coverage, dur- vided under such plan if the drug is furnished
vided under such plan or coverage if the drug is ing such period, with respect to such selected or dispensed at a pharmacy or by a mail order
furnished or dispensed at a pharmacy or by a drug, in the same manner as such provisions service, to the plan, and to the individuals en-
mail order service, to the plans or coverage of- apply to prescription drug plans and MA–PD rolled under such plan during such period, with
fered by such plan or issuer, and to the individ- plans, and to individuals enrolled under such respect to such selected drug, in the same man-
uals enrolled under such plans or coverage, dur- prescription drug plans and MA–PD plans dur- ner as such provisions apply to prescription
ing such period, with respect to such selected ing such period; and drug plans and MA–PD plans, and to individ-
drug, in the same manner as such provisions ‘‘(B) if coverage of such selected drug is pro- uals enrolled under such prescription drug plans
apply to prescription drug plans and MA–PD vided under such plan or coverage if the drug is and MA–PD plans during such period; and
‘‘(B) if coverage of such selected drug is pro-
plans, and to individuals enrolled under such furnished or administered by a hospital, physi-
vided under such plan if the drug is furnished
prescription drug plans and MA–PD plans dur- cian, or other provider of services or supplier, to
or administered by a hospital, physician, or
ing such period; and the plans or coverage offered by such plan or
other provider of services or supplier, to the
‘‘(B) if coverage of such selected drug is pro- issuers, to the individuals enrolled under such
plan, to the individuals enrolled under such
vided under such plan or coverage if the drug is plans or coverage, and to hospitals, physicians,
plan, and to hospitals, physicians, and other
furnished or administered by a hospital, physi- and other providers of services and suppliers
providers of services and suppliers during such
cian, or other provider of services or supplier, to during such period, with respect to such drug in
period, with respect to such drug in the same
the plans or coverage offered by such plan or the same manner as such provisions apply to the
manner as such provisions apply to the Sec-
issuers, to the individuals enrolled under such Secretary, to individuals entitled to benefits
retary, to individuals entitled to benefits under
plans or coverage, and to hospitals, physicians, under part A of title XVIII or enrolled under
part A of title XVIII or enrolled under part B of
and other providers of services and suppliers part B of such title, and to hospitals, physi-
such title, and to hospitals, physicians, and
during such period, with respect to such drug in cians, and other providers and suppliers partici-
other providers and suppliers participating
the same manner as such provisions apply to the pating under title XVIII during such period;
under title XVIII during such period;
Secretary, to individuals entitled to benefits ‘‘(2) the plan or issuer shall apply any cost- ‘‘(2) the plan shall apply any cost-sharing re-
under part A of title XVIII or enrolled under sharing responsibilities under such plan or cov- sponsibilities under such plan, with respect to
part B of such title, and to hospitals, physi- erage, with respect to such selected drug, by such selected drug, by substituting an amount
cians, and other providers and suppliers partici- substituting an amount not more than the max- not more than the maximum fair price nego-
pating under title XVIII during such period; imum fair price negotiated under such part E of tiated under such part E of title XI for such
‘‘(2) the plan or issuer shall apply any cost- title XI for such drug in lieu of the drug price drug in lieu of the drug price upon which the
sharing responsibilities under such plan or cov- upon which the cost-sharing would have other- cost-sharing would have otherwise applied, and
erage, with respect to such selected drug, by wise applied, and such cost-sharing responsibil- such cost-sharing responsibilities with respect to
substituting an amount not more than the max- ities with respect to such selected drug may not such selected drug may not exceed such max-
imum fair price negotiated under such part E of exceed such maximum fair price; and imum fair price; and
title XI for such drug in lieu of the drug price ‘‘(3) the Secretary shall apply the provisions ‘‘(3) the Secretary shall apply the provisions
upon which the cost-sharing would have other- of such part E to such plan, issuer, and cov- of such part E to such plan and such individ-
wise applied, and such cost-sharing responsibil- erage, and such individuals so enrolled in such uals so enrolled in such plan.
ities with respect to such selected drug may not plans. ‘‘(b) NOTIFICATION REGARDING NONPARTICIPA-
exceed such maximum fair price; and TION IN FAIR PRICE NEGOTIATION PROGRAM.—A
‘‘(3) the Secretary shall apply the provisions ‘‘(b) NOTIFICATION REGARDING NONPARTICIPA-
TION IN FAIR PRICE NEGOTIATION PROGRAM.—A group health plan shall publicly disclose in a
of such part E to such plan, issuer, and cov- manner and in accordance with a process speci-
erage, such individuals so enrolled in such plans group health plan or a health insurance issuer
offering group health insurance coverage shall fied by the Secretary any election made under
and coverage, and such hospitals, physicians, section 1197 of the Social Security Act by the
and other providers and suppliers participating publicly disclose in a manner and in accordance
with a process specified by the Secretary any plan to not participate in the Fair Price Nego-
in such plans and coverage. tiation Program under part E of title XI of such
‘‘(b) NOTIFICATION REGARDING NONPARTICIPA- election made under section 1197 of the Social
Security Act by the plan or issuer to not partici- Act with respect to a selected drug (as defined
TION IN FAIR PRICE NEGOTIATION PROGRAM.—A
pate in the Fair Price Negotiation Program in section 1192(c) of such Act) for which cov-
group health plan or a health insurance issuer erage is provided under such plan before the be-
offering group or individual health insurance under part E of title XI of such Act with respect
to a selected drug (as defined in section 1192(c) ginning of the plan year for which such election
coverage shall publicly disclose in a manner and was made.’’.
in accordance with a process specified by the of such Act) for which coverage is provided
under such plan or coverage before the begin- (ii) APPLICATION TO RETIREE AND CERTAIN
Secretary any election made under section 1197 SMALL GROUP HEALTH PLANS.—Section 9831(a)(2)
of the Social Security Act by the plan or issuer ning of the plan year for which such election
was made.’’. of the Internal Revenue Code of 1986 is amended
to not participate in the Fair Price Negotiation by inserting ‘‘other than with respect to section
Program under part E of title XI of such Act (ii) APPLICATION TO RETIREE AND CERTAIN 9816,’’ before ‘‘any group health plan’’.
with respect to a selected drug (as defined in SMALL GROUP HEALTH PLANS.—Section 732(a) of (iii) CLERICAL AMENDMENT.—The table of sec-
section 1192(c) of such Act) for which coverage the Employee Retirement Income Security Act of tions for subchapter B of chapter 100 of such
is provided under such plan or coverage before 1974 (29 U.S.C. 1191a(a)) is amended by striking Code is amended by adding at the end the fol-
the beginning of the plan year for which such ‘‘section 711’’ and inserting ‘‘sections 711 and lowing new item:
election was made.’’. 716’’.
‘‘Sec. 9816. Fair Price Negotiation Program and
(B) ERISA.— (iii) CLERICAL AMENDMENT.—The table of sec- application of maximum fair
(i) IN GENERAL.—Subpart B of part 7 of sub- tions for subpart B of part 7 of subtitle B of title prices.’’.
title B of title I of the Employee Retirement In- I of the Employee Retirement Income Security (3) FAIR PRICE NEGOTIATION PROGRAM PRICES
come Security Act of 1974 (29 U.S.C. 1181 et. Act of 1974 is amended by adding at the end the INCLUDED IN BEST PRICE AND AMP.—Section 1927
seq.) is amended by adding at the end the fol- following: of the Social Security Act (42 U.S.C. 1396r–8) is
lowing new section: amended—
‘‘Sec. 716. Fair Price Negotiation Program and
dlhill on DSK120RN23PROD with HOUSE
‘‘SEC. 716. FAIR PRICE NEGOTIATION PROGRAM (A) in subsection (c)(1)(C)(ii)—
AND APPLICATION OF MAXIMUM
application of maximum fair
(i) in subclause (III), by striking at the end ‘‘;
FAIR PRICES. prices.’’.
and’’;
‘‘(a) IN GENERAL.—In the case of a group (C) IRC.— (ii) in subclause (IV), by striking at the end
health plan or health insurance issuer offering (i) IN GENERAL.—Subchapter B of chapter 100 the period and inserting ‘‘; and’’; and
group health insurance coverage that is treated of the Internal Revenue Code of 1986 is amended (iii) by adding at the end the following new
under section 1197 of the Social Security Act as by adding at the end the following new section: subclause:
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H2614 CONGRESSIONAL RECORD — HOUSE June 29, 2020
‘‘(V) in the case of a rebate period and a cov- ‘‘SEC. 4192. SELECTED DRUGS DURING NON- tax imposed by this section, the Secretary may
ered outpatient drug that is a selected drug (as COMPLIANCE PERIODS. treat such sale as occurring during a day de-
defined in section 1192(c)) during such rebate ‘‘(a) IN GENERAL.—There is hereby imposed on scribed in subsection (b).’’.
period, shall be inclusive of the price for such the sale by the manufacturer, producer, or im- (b) NO DEDUCTION FOR EXCISE TAX PAY-
drug made available from the manufacturer dur- porter of any selected drug during a day de- MENTS.—Section 275 of the Internal Revenue
ing the rebate period by reason of application of scribed in subsection (b) a tax in an amount Code of 1986 is amended by adding ‘‘or by sec-
part E of title XI to any wholesaler, retailer, such that the applicable percentage is equal to tion 4192’’ before the period at the end of sub-
provider, health maintenance organization, the ratio of— section (a)(6).
nonprofit entity, or governmental entity within ‘‘(1) such tax, divided by (c) CONFORMING AMENDMENTS.—
the United States.’’; and ‘‘(2) the sum of such tax and the price for (1) Section 4221(a) of the Internal Revenue
(B) in subsection (k)(1)(B), by adding at the which so sold. Code of 1986 is amended by inserting ‘‘or 4192’’
end the following new clause: ‘‘(b) NONCOMPLIANCE PERIODS.—A day is de- after ‘‘section 4191’’.
‘‘(iii) CLARIFICATION.—Notwithstanding scribed in this subsection with respect to a se- (2) Section 6416(b)(2) of such Code is amended
clause (i), in the case of a rebate period and a lected drug if it is a day during one of the fol- by inserting ‘‘or 4192’’ after ‘‘section 4191’’.
covered outpatient drug that is a selected drug lowing periods: (d) CLERICAL AMENDMENTS.—
(as defined in section 1192(c)) during such re- ‘‘(1) The period beginning on the June 16th (1) The heading of subchapter E of chapter 32
bate period, any reduction in price paid during immediately following the selected drug publica- of the Internal Revenue Code of 1986 is amended
the rebate period to the manufacturer for the tion date and ending on the first date during by striking ‘‘Medical Devices’’ and inserting
drug by a wholesaler or retail community phar- which the manufacturer of the drug has in ‘‘Other Medical Products’’.
macy described in subparagraph (A) by reason place an agreement described in subsection (a) (2) The table of subchapters for chapter 32 of
of application of part E of title XI shall be in- of section 1193 of the Social Security Act with such Code is amended by striking the item relat-
cluded in the average manufacturer price for respect to such drug. ing to subchapter E and inserting the following
‘‘(2) The period beginning on the April 1st im- new item:
the covered outpatient drug.’’.
mediately following the June 16th described in
(4) FEHBP.—Section 8902 of title 5, United ‘‘SUBCHAPTER E. OTHER MEDICAL PRODUCTS’’.
paragraph (1) and ending on the first date dur-
States Code, is amended by adding at the end (3) The table of sections for subchapter E of
ing which the manufacturer of the drug has
the following: chapter 32 of such Code is amended by adding
‘‘(p) A contract may not be made or a plan agreed to a maximum fair price under such
agreement. at the end the following new item:
approved under this chapter with any carrier
‘‘(3) In the case of a selected drug with respect ‘‘Sec. 4192. Selected drugs during noncompli-
that has affirmatively elected, pursuant to sec-
to which the Secretary of Health and Human ance periods.’’.
tion 1197 of the Social Security Act, not to par- (e) EFFECTIVE DATE.—The amendments made
Services has specified a renegotiation period
ticipate in the Fair Price Negotiation Program by this section shall apply to sales after the date
under such agreement, the period beginning on
established under section 1191 of such Act for of the enactment of this Act.
the first date after the last date of such renego-
any selected drug (as that term is defined in sec-
tiation period and ending on the first date dur- SEC. 303. FAIR PRICE NEGOTIATION IMPLEMEN-
tion 1192(c) of such Act).’’. TATION FUND.
(5) OPTION OF SECRETARY OF VETERANS AF- ing which the manufacturer of the drug has
agreed to a renegotiated maximum fair price (a) IN GENERAL.—There is hereby established
FAIRS TO PURCHASE COVERED DRUGS AT MAX-
under such agreement. a Fair Price Negotiation Implementation Fund
IMUM FAIR PRICES.—Section 8126 of title 38,
‘‘(4) With respect to information that is re- (referred to in this section as the ‘‘Fund’’). The
United States Code, is amended—
quired to be submitted to the Secretary of Health Secretary of Health and Human Services may
(A) in subsection (a)(2), by inserting ‘‘, subject
and Human Services under such agreement, the obligate and expend amounts in the Fund to
to subsection (j),’’ after ‘‘may not exceed’’;
(B) in subsection (d), in the matter preceding period beginning on the date on which such Sec- carry out this title (and the amendments made
paragraph (1), by inserting ‘‘, subject to sub- retary certifies that such information is overdue by such title).
and ending on the date that such information is (b) FUNDING.—There is authorized to be ap-
section (j)’’ after ‘‘for the procurement of the
so submitted. propriated, and there is hereby appropriated,
drug’’; and
(C) by adding at the end the following new ‘‘(5) In the case of a selected drug with respect out of any monies in the Treasury not otherwise
subsection: to which a payment is due under subsection (c) appropriated, to the Fund $3,000,000,000, to re-
‘‘(j)(1) In the case of a covered drug that is a of such section 1193, the period beginning on the main available until expended, of which—
selected drug, for any year during the price ap- date on which the Secretary of Health and (1) $600,000,000 shall become available on the
plicability period for such drug, if the Secretary Human Services certifies that such payment is date of the enactment of this Act;
overdue and ending on the date that such pay- (2) $600,000,000 shall become available on Oc-
determines that the maximum fair price of such
ment is made in full. tober 1, 2020;
drug for such year is less than the price for such
‘‘(c) APPLICABLE PERCENTAGE.—For purposes (3) $600,000,000 shall become available on Oc-
drug otherwise in effect pursuant to this section
of this section, the term ‘applicable percentage’ tober 1, 2021;
(including after application of any reduction
means— (4) $600,000,000 shall become available on Oc-
under subsection (a)(2) and any discount under
‘‘(1) in the case of sales of a selected drug dur- tober 1, 2022; and
subsection (c)), at the option of the Secretary, in (5) $600,000,000 shall become available on Oc-
ing the first 90 days described in subsection (b)
lieu of the maximum price (determined after ap- tober 1, 2023.
with respect to such drug, 65 percent,
plication of the reduction under subsection ‘‘(2) in the case of sales of such drug during (c) SUPPLEMENT NOT SUPPLANT.—Any
(a)(2) and any discount under subsection (c), as the 91st day through the 180th day described in amounts appropriated pursuant to this section
applicable) that would be permitted to be subsection (b) with respect to such drug, 75 per- shall be in addition to any other amounts other-
charged during such year for such drug pursu- cent, wise appropriated pursuant to any other provi-
ant to this section without application of this ‘‘(3) in the case of sales of such drug during sion of law.
subsection, the maximum price permitted to be the 181st day through the 270th day described in TITLE IV—PUBLIC HEALTH INVESTMENTS
charged during such year for such drug pursu- subsection (b) with respect to such drug, 85 per-
ant to this section shall be such maximum fair SEC. 401. SUPPORTING INCREASED INNOVATION.
cent, and
price for such drug and year. ‘‘(4) in the case of sales of such drug during (a) IN GENERAL.—The Secretary of Health and
‘‘(2) For purposes of this subsection: any subsequent day, 95 percent. Human Services, acting through the Director of
‘‘(A) The term ‘maximum fair price’ means, ‘‘(d) SELECTED DRUG.—For purposes of this the National Institutes of Health, shall continue
with respect to a selected drug and year during section— to support and to expand, as applicable, bio-
the price applicability period for such drug, the ‘‘(1) IN GENERAL.—The term ‘selected drug’ medical research carried out through the Na-
maximum fair price (as defined in section means any selected drug (within the meaning of tional Institutes of Health innovation projects
1191(c)(2) of the Social Security Act) for such section 1192 of the Social Security Act) which is described in section 1001(b)(4) of the 21st Cen-
drug and year. manufactured or produced in the United States tury Cures Act (Public Law 114–255). The Sec-
‘‘(B) The term ‘negotiation eligible drug’ has or entered into the United States for consump- retary shall ensure that any such research (and
the meaning given such term in section tion, use, or warehousing. related activities) is conducted in compliance
1192(d)(1) of the Social Security Act. ‘‘(2) UNITED STATES.—The term ‘United States’ with section 492B of the Public Health Service
‘‘(C) The term ‘price applicability period’ has, has the meaning given such term by section Act (42 U.S.C. 289a–2) (relating to the inclusion
with respect to a selected drug, the meaning 4612(a)(4). of women and members of minority groups in re-
given such term in section 1191(b)(2) of such ‘‘(3) COORDINATION WITH RULES FOR POSSES- search).
Act. SIONS OF THE UNITED STATES.—Rules similar to (b) AUTHORIZATION OF APPROPRIATIONS.—To
‘‘(D) The term ‘selected drug’ means, with re- the rules of paragraphs (2) and (4) of section carry out this subsection, in addition to funds
spect to a year, a drug that is a selected drug 4132(c) shall apply for purposes of this section. made available under paragraph (2) of section
dlhill on DSK120RN23PROD with HOUSE
under section 1192(c) of such Act for such ‘‘(e) OTHER DEFINITIONS.—For purposes of 1001(b) of the 21st Century Cures Act (Public
year.’’. this section, the terms ‘selected drug publication Law 114–255), there is authorized to be appro-
SEC. 302. DRUG MANUFACTURER EXCISE TAX FOR date’ and ‘maximum fair price’ have the mean- priated, and there is appropriated to the NIH
NONCOMPLIANCE. ing given such terms in section 1191 of the Social Innovation Account established under such sec-
(a) IN GENERAL.—Subchapter E of chapter 32 Security Act. tion 1001(b), out of any moneys in the Treasury
of the Internal Revenue Code of 1986 is amended ‘‘(f) ANTI-ABUSE RULE.—In the case of a sale not otherwise obligated, $2,000,000,000 for fiscal
by adding at the end the following new section: which was timed for the purpose of avoiding the year 2021, to remain available until expended.
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2615
The SPEAKER pro tempore. The bill, verse these trends. This legislation is a Mr. WALDEN. Madam Speaker, I
as amended, shall be debatable for 3 commonsense, fiscally responsible one- yield myself such time as I may con-
hours equally divided among and con- two punch that uses the Federal Gov- sume.
trolled by the respective chairs and ernment’s savings from lowering pre- Madam Speaker, our constituents are
ranking minority members of the Com- scription drug costs to lower health in- looking for us to put aside partisan
mittee on Education and Labor, the surance costs for Americans. politics. They want us not to play po-
Committee on Energy and Commerce, The bill does this by empowering the litical games, and they want us to find
and the Committee on Ways and Secretary of Health and Human Serv- common ground to address the unprec-
Means. ices to negotiate a fair price for pre- edented deadly challenges caused by
The gentleman from Virginia (Mr. scription drugs. This legislation stops COVID–19.
SCOTT), the gentlewoman from North the gouging at the pharmacy counter We need to work together to lower
Carolina (Ms. FOXX), the gentleman and ensures that Americans no longer prescription drug prices. We need to
from New Jersey (Mr. PALLONE), the pay 4 or 5 or 10 times the amount peo- work together to aid States in stabi-
gentleman from Oregon (Mr. WALDEN), ple in other countries pay for the exact lizing health markets damaged by the
the gentleman from Massachusetts same drug. This negotiation not only ACA. We need to work together to
(Mr. NEAL), and the gentleman from levels the playing field, but it also lower out-of-pocket costs for patients,
Texas (Mr. BRADY) each will control 30 saves hundreds of billions of dollars. including capping seniors’ drug costs
minutes. H.R. 1425 will then reinvest these sav- under Medicare, encourage participa-
The Chair recognizes the gentleman tion of private health insurance, and
ings to lower healthcare costs for con-
from New Jersey (Mr. PALLONE). we really need to fund our community
sumers and to expand access to afford-
GENERAL LEAVE
able care. More middle-class Americans health centers. We need to increase the
Mr. PALLONE. Madam Speaker, I would receive financial assistance with options available through the market
ask unanimous consent that all Mem- monthly premiums. A family of four, and end surprise medical billing. We
bers may have 5 legislative days in for example, with an annual income of could do all of that. We could do it to-
which to revise and extend their re- $60,000 would save $2,000 annually, and gether, and it could become law.
marks and add extraneous material on a family of four with an annual income Unfortunately, instead, here we are
H.R. 1425, the Patient Protection and of $100,000, who previously did not qual- wasting time on a partisan bill that
Affordable Care Enhancement Act. ify for subsidies, would save $8,000 has zero chance of becoming law. This
The SPEAKER pro tempore. Is there is no way to govern at any time, but
every year.
objection to the request of the gen- especially in a pandemic.
tleman from New Jersey? Now, this is in addition to the sav-
ings that they also had under the un- At a time when we are asking our Na-
There was no objection. tion’s innovators to find new cures and
Mr. PALLONE. Madam Speaker, I derlying ACA. This is, under this bill,
in addition to what they normally treatments to address COVID–19 at
yield myself such time as I may con- record speed and with record invest-
sume. saved—and that is real savings to hard-
working families. ment, Democrats want to enact a so-
Madam Speaker, as Americans con- cialist drug pricing scheme that could
tinue to face the COVID–19 pandemic This legislation also lowers Ameri-
devastate this country’s innovation in
and a severe economic downturn, they cans’ healthcare costs by reversing
the middle of a global pandemic.
are justifiably concerned about their some of the worst sabotage from the
Frankly, it is unconscionable.
health and their financial future. Trump administration. It reverses the
This legislation before us today pro-
Today, we are here to provide more administration’s expansion of junk in-
vides $100 billion in bailouts for insur-
relief to the American people, and I surance plans that leave patients sad-
ance companies at a time when insur-
rise in strong support of H.R. 1425, the dled with thousands of dollars in med-
ers are not paying for elective proce-
Patient Protection and Affordable Care ical debt. It restores critical outreach
dures due to COVID. Now, we all want
Enhancement Act, legislation that will in enrollment funding that was gutted
to make premiums more affordable,
make healthcare and prescription by the Trump administration, and it
but all signs are insurers do not need a
drugs more affordable and will expand reduces racial and ethnic healthcare
bailout right now.
access to health coverage. disparities. Wouldn’t that money be better spent,
Madam Speaker, this legislation H.R. 1425 also builds on the ACA’s Madam Speaker, on funding our Na-
strengthens the Affordable Care Act for Medicaid expansion and further tion’s community health centers, giv-
the future, which is critical at a time strengthens this important program ing them certainty, rather than letting
when the Trump administration and and provides for additional incentives their funding run out in just a matter
Republicans continue to support a law- to States that stubbornly refuse to ex- of months? They are on the front lines
suit before the Supreme Court that pand their programs. And for political of this fight in our communities. They
would strike down the entire ACA. reasons, many of the red States have
These actions could result in 23 mil- are on the front lines of the fight on
done that; they just refuse to expand testing and treating patients in rural
lion Americans losing their health cov- Medicaid. But these holdout States, if
erage and the elimination of critical and underserved communities.
they expand Medicaid, 4.8 million peo- Shouldn’t we fund them, give them sta-
consumer protections for more than 130 ple would gain Medicaid coverage over-
million people with preexisting condi- bility and certainty?
night, including 2.3 million uninsured And speaking of monies poorly spent,
tions during the middle of a pandemic. Americans. today Democrats are proposing we
Sadly, this is nothing new. This bill also takes an important
Madam Speaker, over the last 4 spend $400 million to prop up
step to address the country’s maternal ObamaCare’s enrollment. This includes
years, much of the ACA’s progress has mortality crisis by extending Medicaid
been halted and, in some cases, re- $100 million for the failed and discred-
postpartum coverage from 60 days to 1 ited Navigator Program; $100 million
versed by the Trump administration’s year. Simply put, this policy will save
sabotage campaign. for outreach and marketing, only for
lives. ACA-compliant plans, not any of the
Thanks to the ACA, the uninsured
rate fell to a historic low. However, the Madam Speaker, the Patient Protec- more affordable alternatives; and $200
Trump administration’s actions have tion and Affordable Care Enhancement million for States to boost enrollment,
driven up the uninsured rate. Today, Act lowers healthcare and prescription with no strings attached—no trans-
millions more Americans are uninsured drug costs, expands coverage for mil- parency, no accountability.
and afraid they will not be able to af- lions of Americans, and reverses the This law has been on the books for 10
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ford the cost of care if they become Trump administration’s years-long ef- years, and we must spend nearly half a
sick. fort to undermine Americans’ access to billion dollars to make it look like it is
quality and affordable healthcare. working?
b 1015 Madam Speaker, I strongly urge my In this bill, Democrats want to force
The Patient Protection and Afford- colleagues to support this bill, and I re- States to expand Medicaid, allowing
able Care Enhancement Act will re- serve the balance of my time. expansion States to get 100 percent of
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H2616 CONGRESSIONAL RECORD — HOUSE June 29, 2020
Federal Medicaid payments, while pun- of the provisions we put in months ago in Medicaid, regardless of their income
ishing, in the middle of a pandemic, have been signed into law, proving that changes, they will be covered for a full
taking money away from, nonexpan- it is, indeed, a bipartisan package. year.
sion States, taking it away from their Instead of pursuing proven bipartisan The bill ends the Trump administra-
Medicaid. That is what this bill does. If solutions, unfortunately, Democrats tion’s expansion of junk insurance
they don’t expand, the Federal Govern- again are forcing partisan politics on plans, which exclude coverage of rou-
ment’s heavy hand comes in and takes this House and this country, fewer op- tine care—imagine that; what kind of
money back out of Medicaid. It is vin- tions for patients at a time when we policy doesn’t cover routine care?—and
dictive, and it is probably unconstitu- need more treatments and more cures has left patients on the hook for thou-
tional. than most. sands of dollars in medical bills, and it
You know, the Supreme Court, This bill is a perfect illustration why reinstates critical funding for out-
Madam Speaker, said expansion is the Americans are so cynical about Wash- reach, marketing, and enrollment so
States’ decision. This legislation vio- ington. The American people deserve more Americans can easily sign up for
lates that. We need to work together better. insurance.
with the States as partners, not treat Madam Speaker, I urge a ‘‘no’’ vote, I am very proud that many parts of
them like subordinates. and I reserve the balance of my time. this bill originated in the Health Sub-
Now, in the last Congress, I advo- Mr. PALLONE. Madam Speaker, I committee, which I chair, where my
cated for multiple policies that would yield 2 minutes to the gentlewoman first hearings as chair examined how to
help States stabilize health markets from California (Ms. ESHOO), a long- strengthen the ACA.
damaged by the ACA. But, unfortu- time champion of the ACA. This is good for the American people,
nately, House Democrats repeatedly Ms. ESHOO. Madam Speaker, I rise especially during this crisis of a pan-
blocked our ideas. in support of H.R. 1425, the Patient demic and a recession.
We all want patients to have access Protection and Affordable Care En- Mr. WALDEN. Madam Speaker, I
to high-quality and affordable health hancement Act. yield 3 minutes to the gentleman from
coverage, but this measure doubles Today, we deliver on our promise to Texas (Mr. BURGESS), the ranking
down on policies that have already the American people to undo the member and former chairman of the
failed. Trump administration’s total sabotage Health Subcommittee on the Energy
One thing is clear: We need to make of the Affordable Care Act and make and Commerce Committee.
our healthcare system work better for healthcare affordable for every Amer- Mr. BURGESS. Madam Speaker, the
all Americans. That is why our goal ican. Affordable Care Act, for the last 10
should be to advance solutions to pro- Since the ACA was signed into law, years, really has been anything but af-
tect patients, to stabilize healthcare 23 million Americans have been in- fordable. Prices have gone up every
markets, to encourage greater flexi- sured, every person with a preexisting year in spite of what we were promised.
bility for States, and to promote poli- condition was protected, and children It has only been the last 2 years that
cies to help Americans get and keep could stay on their parents’ health in- premiums have actually begun to re-
coverage. surance policy until they turned 26. duce, and that is because of some of the
Madam Speaker, I have great respect Now, in the middle of a pandemic and policies enacted by the current admin-
for the chairman. We have worked to- a recession, the Trump administration istration expanding the usability of
gether on a number of different issues and congressional Republicans are sup- limited duration plans, expanding asso-
in the Congress with great success at porting a lawsuit before the Supreme ciation health plans.
the Energy and Commerce Committee. Court—imagine this—to strike down So when we talk about this bill to ex-
Unfortunately, our bipartisan work to the entirety of the ACA. I think that pand the Affordable Care Act, what we
lower drug prices was derailed by the there is one word for this: cruel. are really doing is increasing the
Speaker in December when she decided H.R. 1425 does the opposite. It unaffordability of healthcare in this
to force politics over real progress. strengthens the ACA and makes country.
I recently read an article about a healthcare affordable by lowering pre- Now, H.R. 1425 establishes a new rein-
man suffering from ALS who has dedi- miums and reducing drug prices. surance program, and it is going to
cated his life to finding a cure. And The bill ensures that no American cost $10 billion per year forever. There
like Americans with ALS, there are will pay more than 8.5 percent of their is no end date.
millions of Americans suffering from income for insurance premiums, bene- This reinsurance program does not
other life-threatening or debilitating fiting approximately 20 million Ameri- include some of the longstanding pro-
diseases, like cancer or sickle cell ane- cans. tections that ensure that Federal fund-
mia. They are hoping, and their fami- The bill allows Medicare to directly ing cannot be used to pay for abor-
lies are hoping, that one day there will negotiate the price of the costliest tions.
be a cure. drugs, and the lower prices will be If we want to pass a bipartisan rein-
Now, it is not debatable the bill be- available to every American, including surance policy, Energy and Commerce
fore us today will reduce the number of those who receive their health insur- Republicans have a bill, H.R. 1510,
new treatments in the future, new ance through their employer. which includes reinsurance coupled
medicines, new lifesaving medicines, H.R. 1425 extends coverage to nearly with structural reform of the Afford-
perhaps. The Council of Economic Ad- 5 million Americans by pushing the able Care Act and gives States more
visers found there could be more than holdout States to finally expand Med- choice on how to repair their markets
100 fewer treatments, fewer medicines, icaid. This would be such a blessing to that have been damaged by the Afford-
that would never be invented, never be people in those States whose Governors able Care Act, and it is offset by stop-
discovered, if this legislation we are denied them health insurance cov- ping bad actors from gaming the sys-
going to vote on becomes law—100 erage. tem. Importantly, it does include the
fewer. It also mandates 12 months of Med- Hyde protections and, therefore, pro-
We can lower drug prices while pre- icaid coverage for eligible postpartum tects life.
serving the hope those praying for a mothers. H.R. 1425 also punishes States that
cure have. There is common ground to The SPEAKER pro tempore. The choose not to expand Medicaid by cut-
be had here, and I have offered many time of the gentlewoman has expired. ting their Federal share of Medicaid
times to work on bipartisan legislation Mr. PALLONE. Madam Speaker, I funding.
to lower drug costs without limiting— yield an additional 1 minute to the So let’s be very clear about this. A
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perhaps, even ending—innovation. gentlewoman from California (Ms. State such as mine that did not expand
H.R. 19 is a bill comprised entirely of ESHOO). Medicaid reevaluates year by year, but
bipartisan policies. That is our Repub- Ms. ESHOO. Madam Speaker, it man- if they choose not to expand, if they
lican alternative. But it is not just a dates 12 months of Medicaid coverage say they can’t afford what this expan-
Republican alternative. Everything in for eligible postpartum mothers and sion would bring to the State, now this
there is bipartisan. And already, seven ensures that, once a person is enrolled bill proposes to reduce the funding, the
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2617
Federal match, for the traditional are already doing it, and provide other What if that new drug was a cure for
Medicaid populations. And who are States additional opportunity to afford Alzheimer’s, sickle cell anemia, cancer,
they? Blind, aged, disabled, medically this type of program. ALS, or maybe even a vaccine for
fragile, children, women. While the impact of the marketplace COVID–19?
b 1030 may not be seen immediately, we know If Democrats want to get serious
that the uncertainty around COVID–19 about addressing our Nation’s
Why would we want to do that? Now, will likely drive rates up and may con- healthcare problems and lowering pre-
look, remember the reason that we solidate the options available in the scription drug prices, a good place to
have some States expanding Medicaid marketplace that we have worked so start would be H.R. 19, bipartisan legis-
and some not is because of a Supreme hard to build robust, quality options lation that would lower out-of-pocket
Court case, National Federation of for coverage. spending, protect access to new and in-
Independent Business v. Sebelius, Since the ACA went into effect, we novative cures, and increase trans-
which ruled that threatening States’ have seen positive trends in coverage parency.
Medicaid funding for not expanding is and utilization. We must continue to We can turn America’s healthcare
unconstitutional. Sections 204 and 205 build on the parts we know that are system around with common sense, pa-
of this bill would violate those very working, and in no small part, it is the tient-centered solutions. Sadly, H.R.
same principles and coerce States rath- Medicaid expansion that is helping so 1425 puts the Federal Government at
er than incentivize them to expand many. All of our States are facing the center, not the patient.
Medicaid. This will be struck down by budget crises right now, and more folks Madam Speaker, I urge my col-
the Supreme Court as well. are shifting over to Medicaid as they leagues to vote ‘‘no.’’
Lastly, this bill uses offsets that lose their jobs. While providing Mr. WALDEN. Madam Speaker, I re-
would actively harm our Nation’s healthcare is an investment upfront, it serve the balance of my time.
coronavirus response by using offsets pays dividends on the back end by driv- Mr. PALLONE. Madam Speaker, I
from H.R. 3 that would require the gov- ing preventative care and reducing yield 2 minutes to the gentleman from
ernment to set prices and confiscate costly treatments. Massachusetts (Mr. KENNEDY), a mem-
dollars from pharmacologic developers. Madam Speaker, I encourage my col- ber of the Energy and Commerce Com-
The Congressional Budget Office anal- leagues on both sides of the aisle to mittee.
ysis found that such policies would consider supporting the comprehensive Mr. KENNEDY. Madam Speaker, yes-
lead to substantially fewer new drugs bill before us today. terday afternoon I spent a few mo-
coming to market. We really can’t af- Mr. WALDEN. Madam Speaker, I ments on the porch of a woman named
ford a world without the next yield 2 minutes to the gentleman from Therese in Lowell, Massachusetts.
remdesivir. Indiana (Mr. BUCSHON), a member of Through an oxygen tube and a mask,
Mr. WALDEN. Madam Speaker, I the Energy and Commerce Committee. and surrounded by four generations of
would just point out that as we sit here Mr. BUCSHON. Madam Speaker, first her family, she told me the challenges
today, Oklahoma, under a Republican of all, I want to echo all the points of living with COPD, even though she
Governor, has chosen to expand Med- made by Mr. WALDEN in his opening never smoked a cigarette.
icaid coverage. That is how it should statement. Her mother and her brother both
work, not a penalizing system. A decade ago, ObamaCare became the passed away in that home. She was ad-
Madam Speaker, I reserve the bal- law of the land. This massive, near gov- amant that she would, too. She was
ance of my time. ernment takeover of our Nation’s hoping to make it for just a few more
Mr. PALLONE. Madam Speaker, I healthcare system came full of empty months, but that survival, Madam
yield 2 minutes to the gentleman from promises. Speaker, was contingent on having ac-
Oregon (Mr. SCHRADER), a member of President Obama and Congressional cess to healthcare. Access that our
the Energy and Commerce Committee. Democrats famously promised Ameri- President, in court just this last week,
Mr. SCHRADER. Madam Speaker, I cans that if you liked your doctor, you was still trying to take away.
rise today to speak in favor of H.R. can keep your doctor. That turned out Madam Speaker, how is our country
1425, the Patient Protection and Af- not to be true. Millions of Americans made stronger by taking away
fordable Care Enhancement Act. lost access to their doctors as insur- Therese’s healthcare? What kind of
The bill before us today has a variety ances have resorted to narrowing net- person, let alone administration, looks
of provisions that I have been a long- works. to the wreckage of nearly over 120,000
time supporter of, and now, given the And instead of seeing premiums de- lives lost, 21⁄2 million infected by a pan-
current healthcare crisis with COVID– crease by $2,500, as President Obama demic, and decides that the best re-
19, many of these provisions are more promised, American families have seen sponse is to take away healthcare from
important than ever before. Negoti- premiums and deductibles skyrocket. millions more?
ating drug prices to save people money, Americans deserve an accessible and What is great about an administra-
we do it in all aspects of our life, we affordable healthcare system that pro- tion that idly watches 40 million Amer-
need to do it here. motes quality care and peace of mind, icans lose their jobs, and then tries to
I am also proud to colead an effort not a system that is a downpayment on take away their healthcare, too? How
with Representative HARDER, included socialized, one-size-fits-all single-payer morally bankrupt that we can lavish
in today’s bill, to ensure that folks who healthcare system that would put the praise on essential workers, and then
are losing their employer-sponsored government in charge of one of the thank them by trying to strip away
healthcare coverage are aware that op- most personal decisions families will their access to medicine? All so that
tions to maintain that healthcare in- ever make. the rich can become richer, the power-
clude both COBRA and the market- Rather than working to find bipar- ful more powerful, backed up by a mas-
place. It also maintains State flexi- tisan solutions for patients, Democrats sive tax cut and aggregation of cor-
bility and has a mechanism to ensure are choosing to double-down on porate power.
resources get to the individuals that ObamaCare’s biggest flaws. I will focus Madam Speaker, this moment has
need the help the most. on drug pricing. proved, like many other moments of
My home State of Oregon has a State They are planning to give Wash- truth in our Nation, that our fates are
innovation waiver reinsurance program ington the power to set drug prices. linked. That our future is shared and
under Section 1332 of the ACA, and Well, we know that nonpartisan anal- uncertain. We have a choice to advance
within the first year it already started ysis has determined that this would re- together or to scramble for our own.
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saving money for families by pre- sult in fewer medicines being developed Four generations of Therese’s family
venting a 10 to 15 percent premium in- and fewer cures. know the answer. We know that an-
crease. As a physician, I have had to share swer. Today is our chance to prove it.
These reinsurance provisions in H.R. bad news with families. I know all too Mr. WALDEN. Madam Speaker, one
1425, widely bipartisan, will bolster and well that by eliminating just one new of the greatest tragedies for Therese’s
augment efforts States like mine who drug, how devastating that would be. family, and that of all other families in
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H2618 CONGRESSIONAL RECORD — HOUSE June 29, 2020
America, is what the Congressional passage of the historic Patient Protec- healthcare system. Our problem is not
Budget Office tells us this bill will do, tion and Affordable Care Act, which ex- that the electorate doesn’t care about
and that is, 38 fewer cures. 38. What if panded healthcare to 20 million Ameri- healthcare. They do. The need for
one of those was a cure for COPD? cans. And now this administration is at healthcare is nonpartisan.
Madam Speaker, I yield 2 minutes to the Supreme Court trying to repeal it, There are no Republican, Democrat,
the gentleman from Georgia (Mr. CAR- and it has been 4 years since our col- or Independent strains of cancer, forms
TER), our pharmacist on the com- leagues, who say they will protect peo- of dementia, types of diabetes, or hos-
mittee. ple, have done anything. They have not pitals that check your political party
Mr. CARTER of Georgia. Madam given us anything else. All they do is registration when you arrive at the
Speaker, I rise today in opposition to take knocks. emergency room.
this ObamaCare wish list legislation. Many forget that when that bill Our primary problem with fixing
I want to start off by saying, Madam passed the reforms ended lifetime lim- healthcare for America is that we have
Speaker, how disappointed I am. How its. People could not get health insur- pushed and continue to push partisan
disappointed I am that this comes— ance if they couldn’t afford it, if they solutions for a nonpartisan issue.
this partisan healthcare legislation is had pre-existing conditions. It allowed Have we in both parties not learned
being moved at such a serious time in States to expand Medicaid and provide that this will not work? We both paid
our Nation’s response to the pandemic. access to both quality, affordable the price for our failures on healthcare,
This bill was developed and written healthcare and protection from crip- but the folks who have lost the most
without Republican input, which seems pling medical bills. are our constituents, the American
to be the thing to do these days. I was In my home State, the bipartisan ex- citizens that sent us here.
up here last week talking about the po- Let’s be honest, face our past, learn
pansion under Governor Rick Snyder, a
licing bill, same thing, no Republican from it, and craft a better healthcare
Republican Governor, Healthy Michi-
input. Now we are talking about the future. The record is clear.
gan, currently covers 650,000 In 2008, the Democratic Party con-
healthcare bill. No Republican input. Michiganders, and supports rural hos- trolled the House, the Senate, and the
Partisan legislation, at a time when pitals in Michigan that would other- White House. You passed the Afford-
our country needs bipartisan solutions. wise face a significant financial hard- able Care Act on straight party lines. If
You know, when a bill is developed ship. The reforms in today’s bill, the it were the correct solution to Amer-
and written without Republican input, Patient Protection and Affordable Care ica’s healthcare problems, we wouldn’t
that is usually a good sign that there is Enhancement Act, build on these suc- be here today with your bill to fix it.
no real intention of moving this legis- cesses. Fast forward to 2017. My Republican
lation; and there is not. The other side, The legislation would reduce Party had majorities in the House, the
Madam Speaker, knows that this is not healthcare premiums for Americans by Senate, and controlled the Presidency.
going to move. expanding existing subsidies under the We failed to even get the American
Unfortunately, Americans are suf- Affordable Care Act to those that need Healthcare Act on the President’s
fering right now, they are suffering the help. It would also support out- desk.
from COVID–19. We should be working reach and enrollment efforts and roll Both of these attempts at solving
together, Republicans and Democrats, back the current administration’s healthcare failed, just like any other
to create solutions that benefit every plans to promote junk insurance plans partisan attempt to solve healthcare
American. Unfortunately, this bill has that lack the coverage of basic bene- will fail.
many issues, it is a big government- fits. The issue is so partisan that both
controlled healthcare agenda. Finally, it would save Americans bil- parties had to ultimately resort to the
Once again, Democrats are trying to lions of dollars annually by allowing parliamentary gymnastics of budget
mandate the price of drugs, or tax the Secretary of Health and Human reconciliation to have a prayer of get-
manufacturers out of the U.S. market Services, a Republican right now, to ting a bill on President Obama’s or
if they don’t comply, at a time when negotiate drug prices. The Congres- President Trump’s desk.
we need to be bringing back manufac- sional Budget Office also estimates We know that budget reconciliation
turing to the United States. Now we that the drugs subject to negotiation creates too many limits to implement
are doing just the opposite with this would reduce prices by 55 percent. the best solutions for healthcare pol-
partisan legislation. Madam Speaker, I urge my col- icy. We know that you can pass what-
My colleagues across the aisle want leagues to support this bill. ever healthcare legislation you dream
fewer cures during the pandemic. Mr. WALDEN. Madam Speaker, may up with a simple majority here in the
Fewer cures during the pandemic. Are I inquire as to how much time each House.
you kidding me? That is the last thing side has remaining? We also know that partisan bill from
America needs right now. The SPEAKER pro tempore. The gen- the House will not get past the 60-vote
This legislation also expands tleman from Oregon has 161⁄2 minutes cloture threshold in the Senate, much
ObamaCare subsidies, allowing some of remaining. The gentleman from New less get signed into law by the Presi-
the wealthiest Americans to get sub- Jersey has 17 minutes remaining. dent of the opposing party.
sidies for insurance paid for by the Mr. WALDEN. Madam Speaker, I Must we continue learning our les-
hard-earned taxpayers’ dollars. yield 4 minutes to the gentleman from sons in Congress at the expense of the
This is not the time to be partisan, Arkansas (Mr. WESTERMAN). American citizenry? Let’s work on
Madam Speaker, this is a time for us to healthcare legislation that can get a
work together. I hope my colleagues b 1045
veto-proof vote in the House and 60
across the aisle can set aside these ef- Mr. WESTERMAN. Madam Speaker, votes in the Senate, regardless of
forts and work with us to pass mean- I am grateful that we are finally hav- which party controls each Chamber.
ingful, bipartisan legislation. ing a discussion on the important issue Let’s pass a healthcare bill that is
Mr. WALDEN. Madam Speaker, I re- of healthcare. More than a decade of too good for a President of either party
serve the balance of my time. healthcare conflict has squandered tril- not to sign into law.
Mr. PALLONE. Madam Speaker, I lions of dollars, driven up our national After the Republican failure to pass
yield 2 minutes to the gentlewoman debt, done relatively little to improve the American Health Care Act in 2017,
from Michigan (Mrs. DINGELL), another healthcare, and destroyed the public’s I called my staff together and told
member of the committee. confidence in either party’s ability to them, ‘‘Even though we failed to pass a
Mrs. DINGELL. Madam Speaker, I fix the system. We can do better, yet bill and moved on to the next issue, the
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rise in support of the Patient Protec- we don’t. problems with healthcare did not go
tion and Affordable Care Enhancement As an engineer, I learned that the away and we are not going to stop
Act. first step to solving a problem is iden- working on the issue.’’
And, yes, I agree with my colleagues, tifying and defining the problem. Our We decided to reverse engineer legis-
this is not the time for partisan poli- problem is not that we lack creative lation with the final goal being some-
tics. It has been over 10 years since the solutions to the issues that plague the thing that everyone could agree upon,
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2619
a bipartisan bill that covered pre- The Patient Protection and Afford- cies, the anguish from severe illness
existing conditions, insured more peo- able Care Act is immensely personal to and death that could have been pre-
ple, lowered cost, and gave Americans me. See, I grew up for a portion of my vented if only the patient had routine
a fair shot at healthcare. childhood without health insurance. I care and health insurance.
After 11⁄2 years of hard work, the re- also spent more than 20 years working That is why today, for the patients
sult was the Fair Care Act of 2019. in two healthcare manufacturing com- who need to see a doctor and get treat-
After another year of work, scrutiny, panies and was responsible for pro- ment, for the recently laid-off workers
and more good ideas, we are close to viding healthcare to 18,000 Americans who just lost their health insurance,
filing the Fair Care Act of 2020 with at a U.S. company. for the families struggling economi-
both a House and Senate version. These experiences and the stories I cally, I ask you to join me in voting for
It has more than 50 bipartisan bills have heard across my district are why H.R. 1425, the Patient Protection and
from the House and Senate in the lan- I am here today working to reduce out- Affordable Care Enhancement Act.
guage, and a few of the bipartisan bills of-pocket costs and the price of pre- This bill would lower healthcare pre-
from the 2019 bill have already been scription drugs. miums for middle-class families; en-
signed into law. We should follow this Today, Les and his family, they farm courage States to expand Medicaid;
pattern. in my district. They pay over $20,000 a lower the cost of prescription drugs;
Hopefully, you will be pleased to and strengthen protections for pre-
year in premiums with a $12,000 deduct-
know that several of the provisions of existing conditions, the same ones that
ible.
your Affordable Care Enhancement Act render a person more likely to die from
Another family farms by flashlight
can be found in the Fair Care Act. COVID–19.
and works another job during the day,
However, no one reached out to me for The American people need our help in
just for the family health insurance.
input on your bill. this moment, and they need this bill.
I am reaching across the aisle and These examples show the heart of the
problem: If healthcare isn’t affordable, Mr. WALDEN. Madam Speaker, I re-
asking you to consider working with us serve the balance of my time.
in cosponsoring the Fair Care Act or it is not accessible.
I am proud that the base of this bill Mr. PALLONE. Madam Speaker, I
other bills with bipartisan policy. yield 2 minutes to the gentlewoman
The American citizenry and I am is my bipartisan bill, H.R. 1425, the
State Health Care Premium Reduction from Illinois (Mrs. BUSTOS).
tired of partisan healthcare in action. Mrs. BUSTOS. Madam Speaker, I
Will you please join us to change that? Act, the first healthcare legislation
thank the gentleman for yielding.
Mr. PALLONE. Madam Speaker, I that I authored as a Member of Con- I rise today to support the Patient
yield 2 minutes to the gentlewoman gress. This bill will allow States to Protection and Affordable Care En-
from Illinois (Ms. KELLY), who is a lower the cost of premiums in the indi- hancement Act.
member of the committee and chairs vidual marketplace and to expand ac- So many in our Nation are facing ex-
the CBC Brain Trust. cess to healthcare to more Americans. treme financial insecurity and extreme
Ms. KELLY of Illinois. Madam I am also pleased that this package in- worry surrounding this global pan-
Speaker, I rise today in support of H.R. cludes the transformational drug price demic. And the Trump administration
1425. negotiation mechanism from the Elijah is trying to eliminate protections for
Since enactment of the ACA, mil- E. Cummings Lower Drug Costs Now people and families with preexisting
lions of Americans have gained health Act, which finally takes on the high conditions and leave millions of Ameri-
coverage, but too many families have cost of prescription drugs. cans without care. This includes more
been left behind by GOP Governors and For the 51 percent of nonelderly with than 730,000 Illinoisans.
legislatures more interested in playing preexisting conditions in my congres- A man from the congressional dis-
politics than helping families. sional district, the ACA was a lifeline. trict I serve named Robert wrote to me
Today, we build on that success. This is a moment that requires us to about his family’s rising healthcare
Each year, more than 700 American come together as Americans to costs. Robert and his wife have both
women die from pregnancy complica- strengthen the ACA and reduce the worked hard almost their entire lives.
tions, and more than half of these cost and increase the access to
deaths are entirely preventable. Robert’s first job went back to the age
healthcare. of 17. His wife started working when
Tragically, Black moms die at three Mr. WALDEN. Madam Speaker, I re-
to four times the rate of White moms, she was 16.
serve the balance of my time. Today, they are in their early sixties
but passing this bill will help address Mr. PALLONE. Madam Speaker, I ne-
that by allowing new moms to remain and they are facing skyrocketing pre-
glected to mention that Ms. CRAIG is miums and astronomical deductibles.
on Medicaid for the entire postpartum actually the prime sponsor of this leg-
period. And this piece of legislation Robert currently pays more than $2,500
islation. each and every month for just his pre-
left the Committee on Energy and I yield 2 minutes to the gentleman
Commerce with many Republican miums. That, along with his
from California (Mr. RUIZ), who is a deductibles, cost his family about a
votes. member of the Energy and Commerce
This portion is just one example of quarter of all they earn every month.
Committee and has long worked on the He has even been told that because of
the good in this bill and the lives it ACA enhancement.
will save. We cannot allow preventable his age and his wife’s age they are
Mr. RUIZ. Madam Speaker, I rise in lucky to get coverage at all.
deaths to continue in this country. We support of H.R. 1425, the Patient Pro-
must do more. It was safer for me to Working your whole life and having
tection and Affordable Care Enhance- to struggle so much just to afford a ne-
have my daughter than it is for my
ment Act. cessity like healthcare, that is not
daughter now to have a baby. We are in the middle of a global pan-
I hope my colleagues will join me in what the American Dream is all about.
demic that has infected millions of Robert said to me, ‘‘I am hoping
supporting this lifesaving legislation.
There is a lot of talk about how we Americans, left millions more unem- more than lip service will happen in
should care about the health of the ployed and struggling to pay their Washington, D.C.’’ For Robert and his
American citizens, and one thing that bills, and underscored the American wife and so many other Americans, we
we all can do is wear a mask. people’s need for quality, affordable must pass this bill to lower the cost of
Mr. WALDEN. Madam Speaker, I re- healthcare. healthcare and the cost of prescription
serve the balance of my time. It is precisely during this time; it is drugs, and also to protect people with
Mr. PALLONE. Madam Speaker I precisely in our moment of history, preexisting conditions.
yield 2 minutes to the gentlewoman during American families’ hardships Mr. WALDEN. Madam Speaker, I re-
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from Minnesota (Ms. CRAIG). and agony; it is precisely now that we serve the balance of my time.
Ms. CRAIG. Madam Speaker, I thank must act for the people and fight to Mr. PALLONE. Madam Speaker, I
the gentleman for yielding. make healthcare more affordable and yield 2 minutes to the gentleman from
I ask you: What good is a cure if you accessible. New Jersey (Mr. MALINOWSKI).
can’t access it because you can’t afford As an emergency physician, I have Mr. MALINOWSKI. Madam Speaker,
it? seen the faces of failed healthcare poli- 40 million Americans have lost their
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H2620 CONGRESSIONAL RECORD — HOUSE June 29, 2020
jobs in the biggest global pandemic in what the Trump administration wants ber of Congress because, 3 years ago, I
modern history. Not long ago, most of us to do and rip away health coverage watched as this body took a vote to re-
them would have lost their health in- for millions of Americans. peal the Affordable Care Act, which
surance, too. I bet that in the last 3 A constituent of mine put it best. He would have ripped healthcare away
months every single one of us, Repub- said to me: ‘‘You know, Donald Trump from tens of thousands of constituents
lican and Democrat, in private or pub- is bad for my health.’’ in my district and over 2 million Flo-
lic moments with our constituents has I am sure all of us here came to Con- ridians in my home State.
reassured them that at least the Af- gress to make a positive difference in This was an unconscionable move
fordable Care Act is there for you, you the lives of our constituents. that would have taken away protec-
do not have to lose your health insur- In my district, there are 325,000 peo- tions for millions with preexisting con-
ance in the middle of this crisis. ple enrolled in Medicare, Medicaid, and ditions, like my constituent Michelle
So how can it be that at this very CHIP. Almost 27,000 individuals, hard- Garcia, who still suffers after a faulty
moment when the value of the ACA is working individuals, got their health medical device left broken pieces in her
so plainly obvious to tens of millions of insurance through the ACA, through that, to this day, cause her chronic
Americans, the administration is in ObamaCare. But what this administra- pain that requires persistent treat-
court trying to strike it down? The tion and congressional Republicans ment.
President has told us repeatedly he want to do and what they are telling It is because of the ACA that her cov-
wants to protect people with pre- me is that these citizens and 23 million erage is protected.
existing conditions, but right there in other Americans don’t deserve It is because of the ACA that dispari-
his brief to the Supreme Court, it ex- healthcare. ties in coverage for Latino commu-
plicitly says that should be struck My Democratic colleagues and I feel nities and African-American commu-
down, too. differently. We are standing up to the nities have narrowed.
And when we ask him, What will you Trump administration’s attempts to It is because of the ACA that insur-
do to replace the ACA if it is struck kill the Affordable Care Act. We are ance plans can’t deny or make
down? He says, I won’t tell you until not going to let this happen, not today, healthcare more expensive because of
after the election. Come on. not on our watch. someone’s gender.
Now, today we are going to pass the That is why I am glad the House It is because I watched my colleagues
Patient Protection Act, which means, Democrats have reintroduced this leg- across the aisle try to take the ACA
unlike the President, we are willing to islative package that will make away that I ran for Congress and am
tell the American people, now, exactly healthcare and prescription drugs more here fighting to protect their care.
how we plan to improve healthcare in affordable for American families. Today’s vote is very important to
America. This is commonsense legislation that me. While the President continues his
We believe that the ACA should be is a win for all Americans. efforts to take away much-needed
improved, not taken away. The Con- This bill lowers health insurance pre- healthcare, especially during a pan-
gressional Budget Office says that this miums and makes prescription drugs demic, we are making quality care
plan for doing so will lower premiums more affordable by empowering Medi- more affordable and accessible while
Americans pay by 10 percent. care to negotiate for lower prices, removing junk plans. We are lowering
We want what President Trump said which is something we all know we health insurance premiums and pre-
he wanted in the 2016 election, to let should do. It is way past time to stop scription drug prices. We are also put-
Medicare negotiate the price of pre- letting drug companies rip off Ameri- ting in incentives for States like Flor-
scription drugs which will save Ameri- cans by allowing them to charge us ida so that they can expand Medicaid
cans money and save the government more than other countries for the same and bring care to millions who need it.
over $500 billion. drugs. It is simple. We shouldn’t be taking
And we want to eliminate the junk This bill also strengthens the critical care away from anyone right now, not
insurance plans that the administra- outreach and enrollment funding that ever. We shouldn’t be making quality
tion wants all those folks who are los- has been gutted by the Trump adminis- care more expensive.
ing their jobs to take, even though tration. We need to make it more accessible.
they don’t cover essential services like This is a personal passion of mine. We need to make it more affordable.
prescription drugs and maternity care. Last year, I offered an amendment to That is why I am proud to vote ‘‘yes’’
I hope everyone will vote for this bill. H.R. 987 that would ensure that com- on today’s legislation, and, Madam
If there are Members who disagree, so munities with high unemployment Speaker, I urge my colleagues to do the
be it. I would just ask, Madam Speak- were prioritized in outreach, education, same.
er, that they please be honest. Don’t and enrollment assistance to Ameri- Mr. WALDEN. Madam Speaker, I re-
say you want to protect people with cans shopping for healthcare. And let serve the balance of my time.
preexisting conditions if you won’t me tell you, it works. In California, we Mr. PALLONE. Madam Speaker, I
vote to do so or put forward a plan to are enrolling more people, who pay yield 2 minutes to the gentlewoman
do so. Don’t advise your constituents less, because of widespread enrollment. from Texas (Ms. JACKSON LEE).
to take advantage of the ACA if you We all deserve healthcare. That is Ms. JACKSON LEE. Madam Speaker,
are not going to do anything while the our right as Americans. I thank the chairman of the Energy
President tries to strike it down. Madam Speaker, I urge my col- and Commerce Committee for his dy-
b 1100 leagues to support this bill. namic leadership.
Mr. WALDEN. Madam Speaker, I re- Mr. WALDEN. Madam Speaker, may Let me indicate that I stand here
serve the balance of my time. I inquire as to the amount of time re- today in the midst of a catastrophic
Mr. PALLONE. Madam Speaker, I maining and if my friend has any other pandemic of COVID–19 in the State of
yield 2 minutes to the gentleman from speakers. We do not, on our side. Texas and in my congressional district
California (Mr. COX). The SPEAKER pro tempore. The gen- in Houston and Harris County. Over
Mr. COX of California. Madam tleman from Oregon has 121⁄2 minutes the last couple of days, we have had up-
Speaker, I am honored to be here today remaining. The gentleman from New wards of 900 cases.
to speak about the Patient Protection Jersey has 6 minutes remaining. There are 2.5 million cases over the
and Affordable Care Enhancement Act. Mr. WALDEN. Madam Speaker, I be- Nation and growing, with 126,000 who
As the COVID–19 pandemic and the lieve the gentleman has other speak- have died. In the last 3 days of last
related recession causes massive suf- ers, so I reserve the balance of my week, there were 45,000 new cases. Most
dlhill on DSK120RN23PROD with HOUSE
fering across the country, we have a time. of them were in Texas, California, and
duty to act. Government has a duty to Mr. PALLONE. Madam Speaker, I Arizona.
act so as to minimize human suffering, yield 2 minutes to the gentlewoman That is why I am absolutely baffled
not to exacerbate it. from Florida (Ms. MUCARSEL-POWELL). and saddened by the fact that this ad-
We must strengthen and enhance the Ms. MUCARSEL-POWELL. Madam ministration would go to the Supreme
Affordable Care Act rather than do Speaker, I stand here today as a Mem- Court to cut off, deny, extinguish, put
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2621
in harm’s way Americans who need delivers immense savings to taxpayers, em- affordable, high quality, accessible health care
health insurance and who have pre- ployers, workers and patients by preventing available to everyone, including those with
existing conditions. Americans from having to pay so much more pre-existing conditions, to the well-being of
This is legislation that is a lifeline. for our medicines than pharmaceutical compa- American families.
We are saving lives. nies charge for the same drugs overseas. Because of the passage of the Affordable
A family of four earning $40,000 would Madam Speaker, this legislation strongly en- Care Act, the national uninsured rate has
save nearly $1,600. They may have a courages Medicaid expansion to hold-out been slashed from 14.8 in 2012 to 8.8 percent
COVID patient in their family. A 60- states like my home state of Texas to recon- in 2018.
year-old earning $57,000 would save sider by renewing the ACA’s original ex- Texas has long led the nation in rate of un-
$8,000. panded federal matching for states that adopt insured so the comparable rates are 24.6 and
It takes into account people who are the Medicaid expansion and progressively re- 15 percent, respectively.
unemployed by replacing insurance ducing administrative FMAP for those who Madam Speaker, I distinctly recall a can-
that they have lost. continue to refuse. didate for the highest public office in the land
It takes into account the great need Currently, nearly 5 million Americans have saying ‘‘Obamacare is a disaster’’ and appeal-
for drug price negotiation under the been cruelly excluded from coverage because ing for voters to support him with this ques-
Elijah E. Cummings Lower Drug Costs states have refused to expand Medicaid. tion: ‘‘What have you got to lose?’’
Now Act, something that we have all Madam Speaker, this legislation provides The question deserves a response so I
been fighting for, for a very long time. necessary funding for critical federal and state hope that person, who occupies the Oval Of-
Why can’t we negotiate drug prices efforts to increase health coverage enrollment, fice, is listening to my answer.
just like they do in Medicare? educate consumers of their health care rights, The Affordable Care Act, or ‘‘Obamacare,’’
I am pleased that this legislation and help individuals navigate the health insur- has been an unmitigated success to the more
protects vulnerable populations from ance system. than 20 million Americans who for the first
losing health coverage by ensuring And it delivers funding for states who want time now have the security and peace of mind
that Medicaid and CHIP beneficiaries to establish their own statebased Market- that comes with affordable, accessible, high
receive a full 12 months of coverage places. quality health care.
once enrolled, protecting them from Madam Speaker, the COVID–19 pandemic Madam Speaker, Tip O’Neill used to say
interruption due to fluctuations in has laid bare the racial and ethnic inequalities that ‘‘all politics is local’’ so let me share with
their income throughout the year. and disparities in our health care delivery sys- you how Obamacare has dramatically
That has happened to a lot of hard- tem. changed lives for the better for the people in
working parents. That is why I am pleased that the legislation my home state of Texas.
In addition, it improves Medicaid before us protects vulnerable populations from 1.874 million Texans gained coverage since
beneficiaries’ access to primary care. losing health coverage by ensuring that Med- the ACA was implemented but could lose their
And, yes, for those States that did not icaid and CHIP beneficiaries receive a full 12 coverage if the ACA is entirely or partially re-
do the right thing, it encourages Med- months of coverage once enrolled, protecting pealed or invalidated.
icaid expansion. It gets rid of junk poli- them from interruptions due to fluctuations in 508,000 kids in Texas who have gained
cies. their income throughout the year. coverage since the ACA was implemented are
Madam Speaker, let us vote for this And it improves Medicaid beneficiaries’ ac- also at risk of having their coverage rolled
bill because it stops the devastation. cess to primary care physicians, by reauthor- back.
Madam Speaker, as a senior member of izing the ACA’s increased payments to pri- 205,000 young adult Texans who were able
this body and an original cosponsor of the leg- mary care physicians who treat Medicaid re- to stay on a parent’s health insurance plan
islation, I rise in strong and enthusiastic sup- cipients. thanks to the ACA now stand to lose coverage
port of H.R. 1425, the ‘‘Patient Protection and Also, very important is that the legislation if the ACA is struck down, eliminating the re-
Affordable Care Enhancement Act,’’ which ex- addresses the maternal mortality epidemic by quirement that insurers allow children to stay
pands tax credits to lower Americans’ Market- requiring states to extend Medicaid or CHIP on their parents’ plans until age 26.
place health insurance premiums and allow coverage to new mothers for 1-year post- 646,415 Texans who received cost-sharing
more middle-class individuals and families to partum. reductions to lower out-of-pocket costs such
qualify for subsidies and know the peace of Finally, Madam Speaker, H.R. 1425 cracks as deductibles, co-pays, and coinsurance but
mind that comes with access to affordable, down on junk plans & strengthens protections are now at risk of having healthcare become
high quality health care. for people with pre-existing conditions and re- unaffordable if the Trump Administration has
This legislation is especially needed in these verses the Trump Administration’s expansion its way in the Supreme Court.
dark and troubling times when the COVID–19 of junk health insurance plans that do not pro- 10.28 million Texans who now have private
pandemic has already claimed the lives of vide coverage for essential medical treatments health insurance that covers preventive serv-
more than 128,000 Americans and over 40 and drugs, and that are allowed to discrimi- ices without any co-pays, coinsurance, or
million have lost their jobs because of the Ad- nate against people with preexisting medical deductibles stand to lose this access if the
ministration’s catastrophic response to the cri- conditions. provisions in the ACA requiring health insurers
sis. And it curtails the Trump Administration’s to cover important preventive services without
Specifically, Madam Speaker, I support H.R. pernicious practice of giving states waivers to cost-sharing is stricken.
1425 because under this legislation: undermine protections for people with pre-ex- 913,177 individuals Texans who received fi-
1. A family of four earning $40,000 would isting conditions and weaken standards for es- nancial assistance to purchase Marketplace
save nearly $1,600 in premiums each year. sential health benefits. coverage in 2016, averaging $271 per indi-
2. A 64-year-old earning $57,420 would Madam Speaker, to stroll down memory vidual, are at risk of having coverage become
save more than $8,700 in premiums each lane for those of us who remember how things unaffordable if the ACA is not protected.
year. were before the enactment of the Affordable Madam Speaker, millions more Texans
3. A single adult with income of $31,900 Care Act, dozens of our committees, including could have insurance if all states adopted the
would see premiums cut in half. the Judiciary Committee, heard the pain of ACA’s Medicaid expansion.
4. An adult earning $19,140 would see pre- people whose family members had died be- Women in Texas who can now purchase in-
miums cut to zero, saving $800 dollars a year. cause they had no access to healthcare and/ surance for the same price as men are at risk
Additionally, the legislation ensures that or they had junk policies. of being charged more for insurance if the
families who do not have an offer of affordable Access to affordable, high quality health in- ACA’s ban on gender rating in the individual
family coverage from an employer can qualify surance because of the ACA was a game and small group markets is invalidated.
for subsidies in the Marketplaces and it pro- changer or persons with preexisting conditions Before the ACA, women paid up to 56 per-
vides funding for reinsurance initiatives to fur- like Sickle Cell anemia, triple negative breast cent more than men for their health insurance.
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ther lower premiums, deductibles, and other cancer, and diabetes which plague commu- Roughly 4.5 million Texans who have pre-
out-of-pocket costs. nities like the ones I represent. existing health conditions are at risk of having
Importantly, included in the legislation is the As a member of Congress who voted their coverage rescinded, being denied cov-
drug price negotiation mechanism from H.R. 3, against each of the dozens of Republican ef- erage, or being charged significantly more for
the transformational Elijah E. Cummings forts to repeal the Affordable Care Act, I know coverage if the ACA’s ban on preexisting con-
Lower Drug Costs Now Act, (H.R. 3), which first-hand how important and critical access to ditions is struck down.
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H2622 CONGRESSIONAL RECORD — HOUSE June 29, 2020
346,750 Texas seniors who have saved an those scientists we are all turning to on policy and move those forward into
average of $1,057 each as a result of closing right now, Madam Speaker, these bril- law while we debate the things where
the Medicare prescription drug ‘‘donut hole’’ liant young men and women in labora- we have a disagreement and work to
gap in coverage stand to lose this critical help tories all across America, especially try and find common ground? But that
going forward. those out in California at California is not what is happening today.
1.75 million Texas seniors who have re- Life Sciences Association, said this The navigator program, the bill
ceived free preventive care services thanks to legislation, H.R. 3, part of which is in- dumps $100 million more into the ex-
ACA provisions requiring coverage of annual corporated in this bill, could lead to as change user fee program, into the
wellness visits and eliminating cost-sharing for much as a 58 percent reduction in rev- failed navigator program. Let’s talk
many recommended preventive services cov- enue, which would significantly reduce about that a minute.
ered by Medicare Part B, such as cancer investment in partnerships, licensing Navigators enroll less than 1 percent
screenings, are at risk of losing access to agreements, and emerging companies, of total enrollees, according to one re-
these services if the ACA is not protected. and, therefore, lead to an 88 percent re- port. In fact, one awardee of the navi-
The Affordable Care Act works and has duction in new medicines developed by gator program had an enrollment goal
made a life-affirming difference in the lives of small U.S. biotech companies. That of 2,000. It kind of missed their goal,
millions of Americans, in Texas and across the number was an 88 percent reduction. Madam Speaker. They enrolled one
country. Further, they expect it to eliminate person.
This is what happens when a visionary 80,000 high-paying biotech and R&D
president cares enough to work with a com- b 1115
jobs nationwide. Why would you do
mitted and empathetic Congress to address that now? Why would you knowingly They eventually enrolled a total of 67
the real issues facing the American people. enact a provision in legislation that for $2,300 per enrollee. And in the pri-
The Republicans have NO vision whether it is would cut 80,000 American high-tech vate sector, they do that for about
for Obamacare (ACA) or Medicare for all— and R&D jobs in the healthcare field, $2.40, not $2,300.
they are denying health coverage to the most where we are pleading for a cure. We The top 10 navigators signed up just
vulnerable American families and Americans are, dare I say, praying for a cure or a 317 people in 2017. We are going to
with pre-existing conditions. Vote for this bill. treatment not only for COVID but for pump far more money into that. This
You want to know why the American people legislation would do that. We have
these other diseases. The legislation
have Obamacare? heard about some of that.
It is because Obama cared. before us today would do that.
We have heard a lot about inter- The subsidies in here for some of the
The same cannot be said about this Repub- wealthiest Americans—kind of ironic
lican president and congressional Republicans national price controls this legislation
would put in place, government price that the Democrats would be doing this
who have made careers of attacking and un- in their legislation, but they removed
dermining the Affordable Care Act’s protec- setting. Now, let’s talk about what
that means. the subsidy cap that diverts taxpayer
tions and benefits for the American people. dollars for some of the highest earners
I urge all Members to vote for H.R. 1425 For example, when looking at a sam-
ple of 270 new medicines launched in in the country.
and send a powerful message to the President There is a blank check for insurance
and the American people that this House will the United States from 2011 to 2018, of
those available in the United States companies. I have talked about the loss
not stand idly by as this Administration tries to of cures, up to 38 in the next 20 years.
take away health care from more than 130 under our formula, 67 percent are avail-
able in Germany, 64 percent in the Remember, the 10- and 20-year pipe-
million persons. lines here, there are some estimates
Mr. WALDEN. Madam Speaker, I be- U.K., 48 percent in Japan, 53 percent in
France, about 52 percent in Canada, 41 that there could be hundreds of new
lieve neither of us has any more speak-
percent in Australia. drugs.
ers. I yield myself such time as I may
Even in countries where treatment When I think about the farmer in
consume to close.
Madam Speaker, we have had a good may have been launched, patients often Minnesota we heard about with $20,000
debate here on the floor. Unfortu- have to wait months, sometimes years, in premiums per year and $12,000 co-
nately, it is not a debate over a bipar- before they get access to that treat- payments, that is what America got
tisan piece of legislation. It is a debate ment. Compared to the United States, from the ‘‘Affordable Care Act.’’ That
over a partisan bill that will never be- in Australia, it takes an average of 19 is what ObamaCare delivered. It didn’t
come law. The President’s office has months longer for medicines to become do anything to go after the costs of
issued a recommendation that he available to patients. healthcare.
would veto this bill, should it ever get By the way, this is the scheme that The Trump administration, con-
out of the Senate and to his desk. this legislation wants to put into the versely, has done a lot to go after the
Beyond that, let’s talk about what United States. cost of healthcare. I have been with the
impact this will have in this pandemic. Compared to the U.S., in Canada, it President when he announced initia-
We have heard a lot about drugs. We takes an average of 14 months longer tives to make hospitals disclose their
know from the Congressional Budget for medicines to become available to costs so Americans could shop and we
Office that this legislation will reverse patients. could get competition. We had no more
the gains and innovation made in the More than a year is a long time to left the Roosevelt Room and returned
bipartisan 21st Century Cures Act, that wait if you know there is a medicine to the Oval Office when the Secretary
it would result in fewer new drug prod- that could help you with some disease of Health and Human Services an-
ucts developed and coming to market. and that medicine has just been devel- nounced the American Hospital Asso-
In fact, the Congressional Budget Of- oped, and you can get it in America to- ciation already filed suit to stop that
fice estimates that up to 38 fewer medi- morrow and wait 14 months in Canada. transparency in disclosure.
cines would be developed to cure dis- In the U.K., it could be 11 months By the way, the administration just
eases. longer. won a judgment in court that they can
My friend from Massachusetts talked It doesn’t have to be that way. We proceed to get that disclosure so con-
about Therese on the doorstep in Low- have H.R. 19. We introduced it at the sumers can know what things cost and
ell, Massachusetts, with COPD. What a beginning of this debate some time make informed decisions.
tragedy it would be if one of those 38 ago. I think there were seven different We worked together across the aisle
medicines under development happened provisions that have already become when I was chairman of the Energy and
to cure COPD. law. Everything in that legislation is Commerce Committee on really power-
Maybe it is a cure for COVID–19. bipartisan. ful legislation to address the opioid cri-
dlhill on DSK120RN23PROD with HOUSE
Maybe it is a cure for ALS or Alz- Look, there are going to be dif- sis in America. We put enormous
heimer’s or some form of cancer, like ferences of opinion among really good amounts of money into our community
the ovarian cancer that claimed my people that I work with on a regular health centers. We fully funded, for a
mother. basis, and we just disagree on policy. decade, the Children’s Health Insur-
What we do know is it puts a dagger But wouldn’t it make more sense to ance Program, and we did all of that in
in the heart of innovation. In fact, take the things upon which we do agree a very, very bipartisan way.
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2623
We, in the last few years, under the new medicines and put 88,000 jobs in Americans having health insurance
Republican majorities, rewrote Amer- the high-tech world of innovation in when President Obama left office. That
ica’s mental health laws. We all know medicine, that bill is going nowhere. number is going down. Last week, the
there is more to be done to get mental This bill is going nowhere. The police Trump administration filed a brief
health services into our communities, reform bill is going nowhere. again to repeal the Affordable Care
but we have put an unprecedented What a tragedy. What a lot of oppor- Act.
amount of support into mental health tunity. Because there are many, many The tragedy is what he has done,
services. of us on this side of the aisle, as the what President Trump has done to en-
Meanwhile, our community health Speaker knows, who stand ready to courage junk plans, which basically
centers, under the Democrats, continue work in a bipartisan way to get good don’t allow people with preexisting
to get an every-couple-of-month infu- policy and to solve problems for the conditions to even get health insur-
sion of money, which is enormously American people. ance. This is the tragedy. And we in
frustrating for them. I know when I Madam Speaker, it is unfortunate we this Congress are doing things to re-
was chairman, it made national head- find ourselves here today when Ameri- verse this sabotage of the Trump ad-
lines that there were some levels of cans expect so much more out of this ministration, beginning today, again,
delay in fully funding our community institution. I hope people will show up with this enhancement act.
health centers, and we ended up get- and we can actually do our work and Now, I just want to say that one of
ting them a 2-year, fully funded, at the actually do it in a way that will bring the things that we are doing here that
highest level ever, funding guarantee. a positive view on this House and on is so important is reversing the Trump
Their money runs out in November. our ability to solve these enormous administration’s pushing of these junk
Why are we doing that? Why aren’t we problems that the American people are plans. The Energy and Commerce Com-
taking that up? facing, whether they are suffering from mittee did a report investigation of it
The President led the effort on sur- COPD or simply higher insurance pre- last year, and what we found was that
prise medical billing so that, even if miums and deductibles. these junk plans discriminate against
you have insurance and you end up like What good is your insurance plan if people with preexisting conditions.
a woman in Colorado who, a few years you can’t afford to use it, or when you They rescind coverage if they have to
back, gave birth to her second son. think you followed all of the rules to pay out too much. They limit coverage.
That child, born in a hospital, covered use it and then find out they con- Remember, the Affordable Care Act
by her insurance, doctors covered by tracted out the emergency room and provided an essential benefit package,
her insurance, had a medical issue nobody covers the costs there? robust coverage, that you would have
after birth and had to go to the neo- So let’s defeat this now. Let’s go to a
mental health coverage, that you
natal intensive care unit—just down room where we can work these things
would have hospitalization, that you
the hall, by the way. It turned out that out, we can find common ground here
would have the things that people ex-
that hospital had contracted out that that won’t put a dagger in the heart of
innovative jobs in America, that won’t pect to have in their insurance policy;
neonatal intensive care unit, and it
slow innovation in medicine and med- but instead, the Trump administration
turns out it wasn’t in her insurance at
ical devices, lifesaving medicines, but is pushing out to millions of people—
all. Now, how in the heck does a con-
that will bring better healthcare for and the numbers keep growing every
sumer know that?
We have bipartisan surprise billing Americans. year—these junk plans that discrimi-
legislation. It passed out of the Energy Finally, on the issue of preexisting nate and do the opposite.
and Commerce Committee a year ago conditions, the President has been very And we are going to bring down pre-
and has yet to come to the floor of the clear he supports protecting people scription drugs.
House under the Democrats. So, mean- with preexisting conditions, as do I, Madam Speaker, I urge support of
while, consumers are getting stuck going back to when I was in the State this bill, and I yield back the balance
with surprise bills when they are play- legislature in Oregon. We made efforts of my time.
ing by the rules. It continues and it to do that. The SPEAKER pro tempore. The
shouldn’t. Hopefully, we can get that I have had legislation since the open- time for the Committee on Energy and
legislation to the President’s desk. He ing day of this Congress to make sure, Commerce has expired.
is ready to sign it. regardless of how the lawsuit comes The gentleman from Massachusetts
Meanwhile, we have made record in- out, that we protect people with pre- (Mr. NEAL) and the gentleman from
vestments at NIH, and we reauthorized existing conditions. The Democrats Texas (Mr. BRADY) each will control 30
the user fee agreement so that FDA, won’t let us bring this bill to the floor. minutes.
the Food and Drug Administration, our So, Madam Speaker, I urge a ‘‘no’’ The Chair recognizes the gentleman
innovators, can bring their drugs and vote on this legislation, and I yield from Massachusetts.
new medical devices to market faster back the balance of my time. Mr. NEAL. Madam Speaker, I yield
than any time and still safe. We did Mr. PALLONE. Madam Speaker, I myself such time as I may consume.
that under Republican legislation and yield myself the balance of my time. Madam Speaker, I am really pleased
signed by President Trump. Madam Speaker, I respect, greatly, today to join with the Speaker and
President Trump invoked the Defense my colleague, the ranking member, but other committee chairs to have suc-
Production Act when we didn’t have I have to say, the tragedy that we face cessfully introduced the Patient Pro-
enough ventilators or masks or gowns is the President, President Trump, who tection and Affordable Care Enhance-
to order companies to make swabs, to has totally neglected the situation ment Act and welcome the measure’s
make ventilators and move forward here. consideration in this House today.
and continued that investment. The tragedy is not this Congress. Hearing the former chairman of the
And that was in a bipartisan way, by This Congress passed the HEROES Act, Energy and Commerce Committee a
the way, with the CARES Act. We can but we have a President who simply ig- few minutes ago, a decent guy, he said
do bipartisan work. We are just not nores the COVID crisis, who doesn’t that there was room for bipartisanship
doing it today. want to take the bull by the horns and in the healthcare debate. I mean, I
The choice to do partisan or bipar- actually do something nationally to have been here for a long time. Where
tisan work is always made by the ma- deal with testing, to deal with medical was the bipartisanship—and I am going
jority. When I was chairman I could supplies, to deal with what needs to be to submit something. Republicans, in
move anything I wanted, generally done, and continues to suggest that all the years I have been in this House,
speaking, at any time, but I chose to somehow the pandemic has gone away. they have not agreed amongst them-
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try and make the bulk of our work— This Congress took action with the selves on healthcare, never mind agree-
nearly all of our work—bipartisan be- HEROES Act. The tragedy is a Presi- ing with Democrats on healthcare.
cause I actually wanted it to become dent who continues to seek repeal of So, for years, we have worked to ex-
law. the Affordable Care Act. pand access. That is what this argu-
The drug bill Democrats passed ear- The Affordable Care Act, Madam ment is about today. We want to make
lier this year that takes away access to Speaker, had led to over 90 percent of sure that affordable healthcare exists
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H2624 CONGRESSIONAL RECORD — HOUSE June 29, 2020
for the American family and to build duced consumers’ deductibles, encour- Your healthcare costs will go down
upon the coverage gains of the Afford- aged more States to expand Medicaid by $2,500 a year? Big false.
able Care Act. and establish their own ACA market- No American making less than
The COVID–19 crisis only adds ur- place, and to put an end to the expan- $250,000 a year will see a tax increase?
gency to an already pressing problem sion of junk insurance plans. False.
for millions of American families, a Notably, this legislation reduces the ObamaCare won’t add a dime to the
problem that has been consistently ex- number of uninsured Americans by Federal deficit? False.
acerbated by the Trump administra- more than 4 million people. These are By the way, it will add over $1.5 tril-
tion’s relentless crusade to dismantle issues that matter to everyday Ameri- lion in debt this decade.
the American healthcare system. cans perhaps now in this COVID crisis Here we are battling the coronavirus
Recall on the campaign trail when more than ever. Ensuring all Ameri- and hoping against hope as companies
President Trump was asked by report- cans can access quality healthcare partnering with the government are
ers what he intended to replace without risking their family’s financial racing heroically to bring new treat-
ObamaCare with, and he said: Don’t security really shouldn’t be a partisan ments and medicines that will save our
worry, pal, you are going to love it. issue. lives and prevent Americans from
That was the answer. After almost 70 votes on Republican being infected.
Just last week, under the cover of bills to repeal or undermine the ACA, I Yet today, House Democrats are un-
night and while many Americans were am really happy to stand on this floor believably advancing a bill with provi-
likely sleeping, the Trump administra- today in support of this legislation sions that the Congressional Budget
tion took another step toward invali- that will continue to build on the gains Office and the Council of Economic Ad-
dating our healthcare laws. They filed of the ACA, for legislation that in- visers predicts will stop as many as 100
a brief with the Supreme Court in sup- creases access to affordable, quality lifesaving cures from ever getting to
port of undoing the ACA and ending healthcare, and for legislation that is the patients who need them most.
protections for nearly 130 million for the American people. The California Life Sciences Associa-
Madam Speaker, I urge my col- tion says that the Pelosi plan for gov-
Americans with preexisting conditions.
leagues to vote in favor of this timely ernment setting medicine prices would
I helped to write this law. I am really
legislation, and I reserve the balance of mean nearly nine of ten new drugs
proud of it.
my time. would never be made available—
They staked out this position during Mr. BRADY. Madam Speaker, I yield
a pandemic, when millions of Ameri- never—from their researchers in small
myself such time as I may consume. biotech companies. These are the medi-
cans need healthcare more than ever. Madam Speaker, as a Republican in
Our new Patient Protection and Af- cines that could be the answer to some
Congress, I am proud of our Republican
fordable Care Enhancement Act is uti- of the most heartbreaking and dev-
congressional efforts creating the
lized to expand tax credits for lower astating diseases—including COVID–
Medicare part D prescription drug pro-
premium costs for the American con- 19—that our children, seniors, and fam-
gram for seniors which then-Leader
sumer. For the first time in the history ilies are facing.
NANCY PELOSI and Democrats tried to
of the ACA, no one will pay more than As this pandemic makes urgently
kill. You may remember that Speaker
8.5 percent of their income on a silver clear, we need more cures, not fewer.
PELOSI famously predicted that cre-
plan through the marketplace. Fewer cures means more lives cut
ating the crucial part D prescription
short. Yet leading Democrats shrugged
b 1130 plan for the elderly ‘‘would end Medi-
off these research experts and say: We
care as we know it.’’
I will quickly share the other sce- are fine with that.
Can you imagine how many seniors’
narios that people will witness savings Although the Affordable Care Act has
lives would have been lost if she had
through: improved under President Trump—no
succeeded in stopping the affordable
A family of four earning $40,000 would sabotage—prices went down in most
Medicare drug program 43 million sen-
save nearly $1,600 in premiums each States, insurance companies have sta-
iors have come to depend on today?
year. We are in the middle of an unprece- bilized, and many families see more
An adult earning about $19,000 would dented national pandemic. Americans choices today. But it remains fatally
see premiums cut to zero, saving $800 a are worried about their health and flawed.
year. their jobs. Yet here we go again in the Here is proof: two out of three Ameri-
And a 64-year-old earning $57,000 a Democratic House, another partisan cans eligible for ObamaCare are turn-
year would save more than $8,700 in bill with no input from Republicans ing it down—two out of three. They say
premiums each year. but lots of input from campaign that it is healthcare they don’t want,
These are significant savings that operatives and special interest groups. they can’t afford, and it doesn’t work
would make a big difference for Ameri- The American people are sick and tired for them.
cans particularly during the current of this partisanship. Unbelievably, Democrats are so hell-
health and economic crisis that we find To my Democratic colleagues and bent on forcing Americans on to the
ourselves in. friends, I say: Stop playing political ACA, today they are threatening to
I want to thank Representative games with healthcare. slash State support for Medicaid unless
UNDERWOOD for her tireless work on Madam Speaker, this bill is dan- States buckle to expand ObamaCare.
these provisions and advocating for the gerous to your health in three key Holding the poor hostage, threat-
millions of Americans who will see ways: It stops lifesaving cures from ening to defund the operations of Med-
their premium costs go down, recalling getting to the patients who need them icaid at the State level? That is im-
that when the ACA was offered and em- most. It blocks Americans from buying moral. Maybe they don’t remember
braced 20 million Americans received affordable, short-term health plans that the Supreme Court quickly struck
health insurance. that cover them in between jobs. And down their last scheme to extort
I want to thank Representative WILD it threatens to slash State support for States.
for leading the effort to remove a long- Medicaid for the most vulnerable and Finally, despite the claims they are
standing barrier for families with an poor. As if that isn’t enough, it doubles expanding healthcare choice, this mis-
offer of affordable family coverage, as down on the most unpopular guided bill blocks Americans from buy-
well as Representative NEGUSE for his healthcare plan in modern history: the ing legal, affordable, short-term plans
work on behalf of Social Security bene- Affordable Care Act. often used by small business workers
ficiaries who were at risk of losing pre- Madam Speaker, you remember that and Americans who are out of work or
dlhill on DSK120RN23PROD with HOUSE
mium tax credits for the time they disaster. It broke every promise Demo- in between jobs. Yes, these health
were covered by the ACA marketplace. crats made to the American public. plans aren’t for everyone. But to the 3
These tax credits aren’t the only ben- Do you remember: If you like your million Americans with these life-
efits consumers can expect under this healthcare plan you can keep it? False. saving plans, Democrats say: Tough. If
very important legislation. We also If you like your doctors, you can you don’t like your plan, or even if you
slashed prescription drug costs, we re- keep them? False. do, you can’t keep it.
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2625
There is a better way than this dan- member of the Ways and Means Com- symptoms through the years have in-
gerous, partisan waste of time. Real mittee. cluded being blood transfusion depend-
people are hurting. We should work to- Mr. KELLY of Pennsylvania. Madam ent for several years, the inability to
gether in Congress to make affordable, Speaker, the objective of this bill is to heal after sun exposure damage, be-
patient-centered healthcare a reality prop up the Affordable Care Act, so we coming type 1 diabetic, progressively
for Americans. want to pump money into Medicaid the losing her hearing and her vision, kid-
Last year Republicans proposed legis- program and then impose price con- ney failure, and several other daily
lation that brought together ideas and trols on prescription drugs. complications including developmental
bills from Members of Congress from H.R. 1425 lifted the provision in delays when having a body that runs on
both parties to lower drug prices and Speaker PELOSI’s drug bill, H.R. 3, that limited energy. It has been truly heart-
accelerate new cures. Healthcare pol- gives the Secretary of HHS the power breaking to see her endure this disease,
icy fails when it is partisan. We must to set Medicare drug price controls for but she continues to defy the odds.’’
work together now to make drugs more pharmaceutical manufacturers and use This child is a 10-year-old.
affordable, to expand access to quality it as a pay-for. The savings from this The SPEAKER pro tempore. The
care, and, yes, to lower costs. This bill price-setting power is meant for the ex- time of the gentleman has expired.
doesn’t achieve any of those goals. It is pansion of the Affordable Care Act. Mr. BRADY. Madam Speaker, I yield
partisan business as usual during a Now, the facts are clear. Private in- the gentleman an additional 30 sec-
time when our Nation calls out for so vestment in drug research and develop- onds.
ment fuels the innovation ecosystem Mr. KELLY of Pennsylvania. ‘‘My
much more.
for the new medicines. It is just that simple message to you, Mr. Kelly, and
I reserve the balance of my time,
simple. the rest of the committee’’—and the
Madam Speaker.
Madam Speaker, the Congressional rest of Congress—‘‘is: There is no cure
Mr. NEAL. Madam Speaker, I yield 2
Budget Office has already determined or treatments for Pearson’s syndrome.
minutes to the gentleman from Cali-
that H.R. 3’s negotiation provision Each day is a struggle to keep Maddie
fornia (Mr. THOMPSON).
would result in fewer cures. You have balanced so her body is able to better
Mr. THOMPSON of California.
to be especially tone deaf to introduce cope with symptoms of this terrible
Madam Speaker, I rise in strong sup-
legislation that punishes the very disorder. All we have, as well as many
port of H.R. 1425, legislation expanding
pharmaceutical companies that are other families across the world, is
and enhancing the Affordable Care Act
hope. Please, don’t let partisan bick-
and lowering healthcare costs for all going to innovate and mass-produce
ering impact the ability of researchers
Americans. the vaccine the entire world is count-
to discover and innovate new therapies
In the past 6 months over 120,000 ing on to counter the spread of COVID–
that could save Maddie’s life one day.
Americans have died due to COVID–19. 19.
The clock is ticking, and Maddie is
Millions have lost their jobs and, in Last year, we were 80 percent of the
waiting.’’
many cases, their health insurance. way there on a bipartisan measure be-
Madam Speaker, it simply comes
That is why it is so critical that we fore we got sidelined by H.R. 3 and leg- down to this: if you want to develop
strengthen and build upon the founda- islation just like this. Let’s get back to new drugs, then don’t penalize the peo-
tion of the Affordable Care Act, which the people’s work and work together on ple who develop them. Don’t hold them
is exactly what this bill does. solutions that make sense, like H.R. 19, as the bad guys when we require them.
This legislation reduces the price of drug legislation that would actually Please come up with something to ad-
expensive pharmaceuticals—including make it to the President’s desk. dress COVID–19.
insulin—saving taxpayers billions of Now, with all that in mind, let’s talk
dollars while driving down drug costs about who it is that we are really talk- b 1145
for all Americans. ing for today, who it is that we rep- Mr. NEAL. Madam Speaker, I yield 2
The bill uses those savings to lower resent on the people’s floor, and who it minutes to the gentleman from Texas
insurance premiums and expand tax is that we are looking out for because (Mr. DOGGETT).
credits, helping more Americans afford too often this becomes about November Mr. DOGGETT. Madam Speaker, ap-
the coverage that they need. 3, 2020, and not about everyday lives proaching July Fourth, we should be
This bill bolsters State Medicaid pro- back in the Districts and the folks celebrating the greatness of our coun-
grams, funds COVID–19 vaccine re- whom we represent. try. Instead, we are mired in a pan-
search, and cuts the number of unin- I want to read a letter that I have demic when we have more people in-
sured Americans by nearly 4 million. read before because I think it really de- fected and more deaths from this pan-
The President and my Republican serves to be repeated. This was sent to demic than any country in the entire
colleagues are actively trying to gut me in October of 2019. world—with President Trump floun-
protections for preexisting conditions ‘‘Dear Congressman KELLY: My name dering and whining.
and take healthcare away from mil- is Sara Stewart, and I’m from St. Pe- His approach to this pandemic—de-
lions of Americans. tersburg, Pennsylvania. It is my under- nial, delay, and ongoing deception—has
By contrast, this legislation reduces standing that the House Ways and been exposed for the fraud that it is.
healthcare costs for millions of Ameri- Means Committee is having a public And because of his multiple failures,
cans at this critical time. It is vital hearing on H.R. 3—the Lower Drug now is a time when more Americans
that we give our constituents the help Costs Now Act of 2019.’’ desperately need the opportunity to en-
they need. This is the very H.R. 3, by the way, roll in health insurance, not the junk
I heard so many of my friends on the that is being included in H.R. 1425. insurance that he has been promoting.
other side talk about how they want to ‘‘It appears this legislation does not Instead, he seeks to eliminate—as do
protect people who have preexisting have bipartisan support and needs to our Republican colleagues—the Afford-
conditions, every one of which is in take a more balanced approach. The able Care Act and the coverage that it
support of the lawsuit to repeal the Af- balance is needed for patients like my has today for millions of our citizens.
fordable Care Act, the very bill and the 10-year-old daughter Maddie. Madam Speaker, today’s bill offers a
very law that protects people who have ‘‘Maddie suffers from a rare reaffirmation that the Affordable Care
preexisting conditions. mitochondrial deletion condition Act should be strengthened, not de-
Madam Speaker, you cannot be for called Pearson’s syndrome, which is a stroyed. Strengthening that would
protecting preexisting conditions and disorder that occurs as the result of have been occurring long ago but for
for repealing the law that provides that mutated genes in the body. These genes the fanatic decade of our Republican
dlhill on DSK120RN23PROD with HOUSE
protection. impact the mitochondria of her cells colleagues in trying to destroy the Af-
Madam Speaker, I urge my col- and prevent them from producing fordable Care Act. Next year, however,
leagues to vote ‘‘yes’’ on this bill. enough energy for the body to function we have to do much more for
Mr. BRADY. Madam Speaker, I yield properly. Pearson’s syndrome is dif- healthcare than simply to return where
3 minutes to the gentleman from Penn- ficult to diagnose because it affects it should have been. Millions of Ameri-
sylvania (Mr. KELLY), who is a key each individual differently. Maddie’s cans, particularly in a State like
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H2626 CONGRESSIONAL RECORD — HOUSE June 29, 2020
Texas, which has more uninsured chil- that there is productive work already with the private market. I stand with
dren than any State in America, they done in a bipartisan fashion. you, as the people.
are still likely to be excluded because So let’s not do this bill, H.R. 1425, My Democratic colleagues, they offer
of obstructionist Republican State today. Let’s go about it in a bipartisan you a vision of healthcare defined and
leaders. And even those who have in- way where we know the American peo- controlled by the government. If you
surance, are still often the victims of ple will benefit more and our system believe the government can do a better
prescription price gouging. can support that. job with your healthcare, then so be it,
Madam Speaker, the exceedingly Mr. NEAL. Madam Speaker, I would vote with the Democratic colleagues.
modest pharmaceutical provision in to- point out that 100 percent of the chil- But if you believe in entrepreneurs, if
day’s bill excludes the uninsured and dren in Massachusetts have healthcare you believe in innovators, then vote
falls well short of what is needed to today and 97 percent of the adults. with the Republican ideas that lead to
prevent monopoly prices for drugs de- Madam Speaker, I yield 2 minutes to more innovation.
veloped at taxpayer expense. This bill the gentleman from Oregon (Mr. BLU- The bill before us today, we had a
pours more billions into pharma- MENAUER). conversation with the Health and
ceutical development with no assur- Mr. BLUMENAUER. Madam Speaker, Human Services Secretary in the Com-
ance that the prices or the resulting I listened to my colleagues cry out for mittee on Ways and Means and with
cures will be affordable. We see only a bipartisan cooperation and progress. the Congressional Budget Office inde-
today with the pricing of remdesivir, a I listened to them talk about somehow pendently confirming that there will be
drug that would have been left in the having promises not kept. dozens fewer innovations when it
scrap heap of failures but for taxpayer Think for a moment. My colleagues— comes to treatments and cures for
funding, that the same taxpayers that the promise of Donald Trump and the Americans with the passage of this bill.
developed the drugs will be charged bil- Republicans to replace and enhance the That is what you are doing—eyes
lions to get them. Affordable Care Act. They are going to wide open—and we are not going to let
Let’s look forward to a day when we eliminate it, and they are going to re- you get away with it.
have a competent and committed place it with something better. Madam Speaker, when you vote for
President to bring healthcare for all. No, they could not do it. this bill, you are dooming millions of
Mr. BRADY. Madam Speaker, I yield They have been assaulting the Af-
Americans to not have a cure for the
2 minutes to the gentleman from Ne- fordable Care Act since the moment it
disease. Vote for the bipartisan bill,
braska (Mr. SMITH), a leader in rural was passed and they got their hands on
H.R. 19, Lower Costs, More Cures. That
healthcare reform. part of the political control.
They fought to protect Big Pharma is the bill that will get through the
Mr. SMITH of Nebraska. Madam
so that we have this corrupt bargain system.
Speaker, I rise today in opposition to
Mr. NEAL. Madam Speaker, I yield 2
H.R. 1425. where Americans have to pay the high-
minutes to the gentlewoman from
I stand here somewhat surprised that est prescription drug prices in the
there is celebration of the successes of Washington State (Ms. DELBENE).
world in order to bribe pharmaceutical
Ms. DELBENE. Madam Speaker, I rise
the so-called Affordable Care Act. companies to continue research. And
today in support of the Patient Protec-
Many of my constituents are offended they wouldn’t unless Americans pay
by the mere name of the bill, the Af- tion and Affordable Care Enhancement
more than anybody else in the world—
fordable Care Act, because they don’t Act.
including, in many instances, people
The high price of prescription drugs
find it affordable. They found it quite who can’t afford their prescription
is one of the top issues I hear about
unaffordable. drugs. That corrupt bargain needs to be
I would argue that is why we are here from my constituents. In 2019, I re-
rejected.
today, with a fairly clever scheme of ceived nearly four times as many com-
Madam Speaker, now we are hearing,
taking money from here and putting it ments about prescription drug costs as
I think, starkly, the difference between
there, which likely will still drive up the year before. Now, with the COVID–
Republicans and Democrats—night and
the cost of healthcare. It is just a few 19 pandemic and resulting economic
day—that active sabotage of the Af-
different people paying for it. crisis, addressing the issue of drug pric-
fordable Care Act, today with the Re-
Madam Speaker, if we want true ing is more urgent than ever.
publican attorneys general and the full
healthcare reform, we should do that, The patient stories are numerous and
weight of the Trump administration to
but we haven’t done that. Let’s look never-ending. I would like to share just
try again to repeal it in its entirety.
for the bipartisan opportunities on Madam Speaker, our legislation one with my colleagues and the Amer-
drug costs, as mentioned earlier. Those would increase coverage for 4 million ican people to remind us why this leg-
had been advancing, but those were all people. You know, it is interesting islation is so necessary.
pushed aside for H.R. 3. watching people fight against the ef- A constituent of mine, Dana, from
H.R. 3 passed the House knowing that forts of the Trump administration and Kenmore, Washington, has lived with
it wasn’t going to go anywhere. I would the Republicans to deny them cov- type 1 diabetes for 14 years. When Dana
argue that some people probably even erage. Almost one-half million people was first diagnosed with diabetes, insu-
voted ‘‘yes’’ on H.R. 3 because they figured out a way to apply, dem- lin cost her $50 each month. Today,
knew the Senate would not take it up onstrating the need in the time of that same insulin costs over $600 per
and because they also know that it has coronavirus. month.
major problems. Madam Speaker, my Republican That is an 1,100 percent increase for
But here we are today, again, with friends have nothing to offer. They the exact same product, and there have
this scheme that I think will fail the have no plan. The Trump administra- been virtually no changes to insulin
American people, just like so much of tion only wants to destroy the Afford- since Dana’s diagnosis, so the price
the so-called Affordable Care Act has able Care Act at a time when it is more spike is inexplicable.
failed the American people in its mere important than ever. Madam Speaker, Dana is not only a
cost, not to mention other things. Madam Speaker, I strongly urge ap- diabetes patient but also a nurse prac-
Yes, I remember those comments of, proval of this package. titioner and diabetes educator. She has
‘‘If you like your healthcare plan, you Mr. BRADY. Madam Speaker, I yield told me about her patients who go to
can keep it.’’ We know that didn’t hap- 1 minute to the gentleman from New Canada, where they can get insulin for
pen. So many other promises were York (Mr. REED), a key leader of the just $40 a month. But with the border
made that were not kept. Committee on Ways and Means on closed because of the pandemic, for
And the American people want us to healthcare reform. many, that option is shut off to them.
dlhill on DSK120RN23PROD with HOUSE
work together, especially now. Prob- Mr. REED. Madam Speaker, I thank Dana has also shared stories of her
ably more than in the history of our the gentleman for yielding. own patients who can’t afford their
country, the people want us to work to- Madam Speaker, I rise today in oppo- medications and ration their insulin,
gether on bipartisan solutions. sition to the bill before us. which we know can lead to poor health,
Madam Speaker, we need to do that. The debate, America, is very simple. vision loss, kidney failure, and even
We can do that. There is even evidence I am a proud Republican, and I stand death.
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2627
Madam Speaker, I strongly support Policy on H.R. 3, the Administration ex- adopt a policy that will curtail patient
the Patient Protection and Affordable plained that these provisions would impose access to vital drugs and discourage
Care Enhancement Act, which will price controls under the guise of ‘‘negotia- the development of new, innovative
tion’’ that would ultimately ‘‘harm seniors
strengthen and improve upon the ACA treatments. Even the development of
and all who need lifesaving medicines.’’ In
and finally give the Health and Human perhaps an indication of the intentions of one less drug as a result of this policy
Services Secretary the power to nego- H.R. 1425, it does not even attempt to include is too many in the middle of a pan-
tiate a fair price for insulin, which will those provisions of H.R. 3 that had pre- demic.
dramatically help patients, like Dana, viously garnered bipartisan support, such as Madam Speaker, I urge my col-
and all the patients that Dana serves establishing a cap on out-of-pocket expenses leagues to vote ‘‘no’’ on this misguided
in my district. for all beneficiaries in Medicare Part D and bill.
Madam Speaker, I urge my col- other improvements to that program for sen- Mr. NEAL. Madam Speaker, I yield 2
leagues to support this legislation. iors. minutes to the gentleman from Illinois
While any time is an inopportune time to (Mr. SCHNEIDER).
Mr. BRADY. Madam Speaker, I in-
dramatically undermine the development of Mr. SCHNEIDER. Madam Speaker, I
clude in the RECORD a veto threat from innovative medicines, H.R. 1425 is even more
President Trump that states the ad- am proud to rise in strong support of
imprudent given the current focus on devel-
ministration strongly opposes H.R. oping vaccines and therapeutics rapidly to H.R. 1425, the Patient Protection and
1425, further demonstrating this bill help America and the world combat the Affordable Care Enhancement Act.
has no chance of becoming law. coronavirus. To take such an action simply Our country is in the midst of an un-
STATEMENT OF ADMINISTRATION POLICY to double down on the same expensive, ineffi- precedented pandemic requiring un-
H.R. 1425—PATIENT PROTECTION AND AFFORD-
cient, and bureaucratic approach to health precedented actions, like the HEROES
ABLE CARE ENHANCEMENT ACT—REP. CRAIG,
coverage that the American people endured Act the House sent to the Senate more
D–MN, AND 61 COSPONSORS
for the past decade makes it even more mis- than 6 weeks ago. Beating back this
guided and counter to the most urgent needs virus will test us in unimaginable
The Administration strongly opposes of the country.
House passage of H.R. 1425. This bill at- If H.R. 1425 were resented to the President
ways, and we cannot afford to allow
tempts to exploit the coronavirus pandemic his advisors would recommend that he veto petty politics to push us backward.
to resuscitate tired, partisan proposals that the bill. Sadly, inconceivably, that is exactly
would send hundreds of billions of dollars to what the Trump administration asked
Mr. BRADY. Madam Speaker, I yield
insurance companies in order to paper over from the Supreme Court last week
serious flaws in Obamacare. Furthermore, 2 minutes to the gentleman from North
Carolina (Mr. HOLDING), a leading when they argued to fully overturn the
H.R. 1425 would pay for this bailout by im-
posing price controls that undermine the healthcare expert in the Committee on Affordable Care Act.
American innovation the entire globe is de- Ways and Means. With more than 2.5 million infec-
pending on to deliver the vaccines and thera- Mr. HOLDING. Madam Speaker, I tions, and more than 125,000 lives trag-
peutics needed to respond to the coronavirus. thank the chairman for yielding. ically lost, we need to expand access to
Since the beginning of this crisis, the Ad- Madam Speaker, one thing that I affordable healthcare; lower the cost of
ministration has taken a whole-of-America prescription drugs; and improve out-
approach to fight the corona virus. This in-
think has become abundantly clear
during this pandemic is how important comes for those hardest hit, especially
cludes a productive partnership with both
it is to incentivize biopharmaceutical in communities of color and rural com-
houses of Congress to respond to the
healthcare needs of our citizens. The Admin- innovation. Over the past few months, munities.
istration has delivered millions of pieces of Federal officials worked tirelessly with Madam Speaker, the end of the Af-
personal protective equipment to frontline drug companies to identify and develop fordable Care Act and other actions
healthcare responders, surged hospital ca- treatments that can help mitigate the previously announced by this adminis-
pacity, and dramatically scaled up diag- effects of the coronavirus—indeed, save tration, with no plan of their own, will
nostic and surveillance testing capabilities. instead leave millions of Americans at
The Administration also launched Operation
thousands of lives.
In my district, the town of Wilson, risk of losing their insurance. It will
Warp Speed to collaborate with the private result in higher premiums for millions
sector to develop a coronavirus vaccine, North Carolina, is home to one of the
three manufacturing sites that produce of individuals and small businesses.
therapeutics, and diagnostics. Additionally,
over 40 percent of the world’s supply of Remember this: The 130,000 of us with
the Administration is working to reimburse
providers for corona virus testing and treat- dexamethasone, which has been identi- preexisting conditions, including those
ment of uninsured Americans so they do not fied as one of the first lifesaving drugs who have been infected with COVID–19,
have to worry about the financial implica- for coronavirus patients. This site in will pay the heaviest price.
tions of obtaining these services. Madam Speaker, the Affordable Care
All this was done while putting the coun- Wilson is preparing to ramp up produc-
Act is essential to ensuring Americans
try in the strongest possible position to re- tion and meet global demands.
have access to affordable and quality
bound from the most significant economic Madam Speaker, to effectively fight
healthcare. It is still under attack by
challenge since the Great Depression. Work- this pandemic, policymakers must con-
our President and his allies.
ing with Congress, the Administration has tinue working with healthcare stake- Today, I and my colleagues dem-
delivered financial relief directly to over 160 holders to spur innovation and ensure a
million Americans, over 4.5 million busi- onstrate our commitment to pro-
steady supply of vital drugs to treat tecting it. The Patient Protection and
nesses and their employees, and over one the coronavirus.
million healthcare providers. Affordable Care Enhancement Act will
Instead of building on these vital, bipar- Madam Speaker, unfortunately, we strengthen the ACA by strengthening
tisan efforts, H.R. 1425 reads as if the corona are wasting time today talking about protections for those with preexisting
virus never emerged. It repurposes failed pro- government price controls that would conditions. It will ensure that no one
posals from years past that would literally do the exact opposite. Rather than pays more than 8.5 percent of their in-
pay insurance companies more to hide the incentivize the development of a vac-
true cost of Obamacare from consumers. come for quality coverage. It will allow
cine and new and innovative treat- negotiations for lower drug costs. It
Even the additional billions of taxpayer ments, these price-setting proposals
funding is not enough to prop up Obamacare will help address the inequalities in
will discourage companies from invest- healthcare faced by so many in our
on its own, thus H.R. 1425 goes out of its way
to systematically eliminate any competition ing in new drugs, and the tax penalty country, especially communities of
by prohibiting more affordable coverage op- for noncompliance threatens to force color.
tions and the consideration of alternative companies and certain drugs out of the Madam Speaker, this is the kind of
approaches by States. At the same time, the United States entirely. bill that should receive bipartisan sup-
bill lacks any provision to ensure the Fed- That not only means that thousands port in the middle of a historic pan-
eral Government adheres to the long-held of Americans could lose access to the demic, and I urge my colleagues to
dlhill on DSK120RN23PROD with HOUSE
consensus to not fund abortion services or drugs they desperately need, but thou-
abortion coverage. vote for it.
To create a façade of ‘‘paying’’ for the re-
sands of folks in towns like Wilson
could lose their jobs as companies b 1200
vival of last decade’s most partisan project,
Obamacare, H.R. 1425 invokes another par- leave the United States. Mr. BRADY. Madam Speaker, I yield
tisan misadventure reflected in provisions of Madam Speaker, under no cir- 2 minutes to the gentleman from Ari-
H.R. 3. In its Statement of Administration cumstances—no circumstances—can we zona (Mr. SCHWEIKERT), a key member
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H2628 CONGRESSIONAL RECORD — HOUSE June 29, 2020
of the Ways and Means Committee and million Americans living in nonexpan- We must do this now, more than
a technology leader. sion States. In my State alone, over ever, with COVID–19 numbers spiking
Mr. SCHWEIKERT. Madam Speaker, 300,000 more Alabamians would qualify and an administration that is trying to
2 minutes is almost impossible to actu- for coverage from Medicaid if we had overturn the ACA and reduce
ally have an honest and detailed de- this bill passed. healthcare access rather than expand
bate/discussion in here. The writing is on the wall and the it.
But do understand—and I believe this facts are clear: Premiums and In my district on the central coast of
is a sin of both sides—we are playing healthcare costs are higher in States California, the numbers of COVID–19
this game where we are moving around that haven’t expanded Medicaid, and are growing, but impacting certain
who pays. We are doing almost nothing over 70 percent of the rural hospital communities more than others. Nearly
to actually reduce the underlying cost closures are in States that have not ex- 80 percent of all COVID cases in Mon-
of healthcare. Your bill is doing it; panded Medicaid. terey County have been found to be in
ours has done it. The public health emergency and the Latinx community.
But this bill actually has a very cyn- economic crisis that we are currently Across the Nation, Latinos make up
ical mechanism in it. This board is facing means that more uninsured and 34 percent of the cases of COVID–19, de-
being recycled from H.R. 3. We are all more unemployed constituents are spite only representing 18 percent of
familiar with the mechanism of ref- more vulnerable. the total U.S. population, while, na-
erence pricing. We have debated it Let’s pass this legislation. It will not tionally, Latinos have the highest un-
around here for years. only expand Medicaid and give Med- insured rate. H.R. 1425 would fix that
So, if you are in Great Britain and icaid expansion opportunities with by eliminating barriers to affordable
there is a new drug that gives you a equal Federal match in States like healthcare for Latinos and expanding
year of healthy life and it costs more
Alabama, but it would also decrease coverage for DACA recipients.
than $37,000, it is not purchased. That This bill would improve healthcare
prescription drug costs and protect the
pricing, that scarcity mechanism, is for all Americans by increasing protec-
preexisting conditions that are so im-
what the Democrats’ bill is importing.
portant for all Americans. tions for people with preexisting condi-
So its savings are actually very cyn-
This is an important tool, providing tions, strengthening the State market-
ical, because it is going to take away
our States with enhanced Federal places, expanded premium tax credits,
pharmaceuticals that make people
matching funds to ensure Medicaid is and helping low-income postpartum
healthy.
How could we be doing this, even one of the best tools that we have to women and children.
help the communities we represent now So I call on my colleagues to come
allow this mechanism, in a time of a
pandemic? and into the future. I urge my col- together and vote for this bill because
You are about to crush all of the lit- leagues to support this important bill. now, more than ever, it is time for us
tle biopharma companies that we are Mr. BRADY. Madam Speaker, I yield to do our job: Improve the Affordable
hoping desperately produce miracle 1 minute to the gentleman from Cali- Care Act so that we can provide the
cures, and, in a perverse way, for large fornia (Mr. NUNES), the ranking mem- necessary healthcare to those who need
pharma. You have just given them the ber of the Health Subcommittee. it the most and everybody in our Na-
market, because you have taken away Mr. NUNES. Madam Speaker, I rise tion.
those who are nipping at their heels. today in opposition to H.R. 1425. Mr. BRADY. Madam Speaker, I yield
I beg of you, think about what you Per usual, this is a partisan bill that 2 minutes to the gentlewoman from
are actually doing, because this type of will go nowhere in the Senate and the West Virginia (Mrs. MILLER).
financing mechanism will kill people. President will not sign into law. Mrs. MILLER. Madam Speaker, I rise
It will end lives, because it will create Among the various problems in this in opposition to H.R. 1425, which should
a dearth, a shortage, of the next gen- bill is the Democrats’ insistence on in- be called the expanding government
eration of cures. cluding provisions which will prevent and killing cures act.
Let’s not engage in that cruelty. scientists from finding new cures—at a With this legislation, my colleagues
There are better ways to get there. And time when our Nation is working to across the aisle are bending American
we have proposed many of them. It overcome the coronavirus. healthcare to the will of Washington
would just be nice to get heard, be- According to the California Life bureaucrats.
cause there are solutions, and this is a Sciences Association, if this bill Any way you look at this, House
really dark one. passes, 88 percent of new drugs in the Democrats took a bipartisan issue, im-
Mr. NEAL. Madam Speaker, I yield pipeline will be discontinued. That is proving healthcare and lowering prices,
11⁄2 minutes to the gentlewoman from hundreds of diseases that will not be and botched it. We are now left with
Alabama (Ms. SEWELL). cured and countless lives that will be bad policy that will stifle innovation
Ms. SEWELL of Alabama. Madam lost. That is not something that I can for new treatments and therapeutics
Speaker, I am proud to support the Pa- support. and do what government does worst:
tient Protection and Affordable Care Rather than engineer a government pick winners and losers in the private
Enhancement Act today because it is takeover of the prescription drug in- sector.
high time that we reduce prescription dustry, we can work together to pro- This absolutely will not fix
drug costs for all Americans. vide lower prices for families, and we ObamaCare’s failed policies. This bill
Likewise, this bill includes provi- can do it without reducing cures. But gives billions in taxpayer-funded bail-
sions to expand access to Medicaid and this bill we have before us today is not outs and subsidies, while doing nothing
quality healthcare insurance with ex- the answer. to streamline services, lower costs, or
panded tax credits and premium sub- I urge all of my colleagues to vote cut taxes.
sidies. ‘‘no’’ on H.R. 1425. Today, House Democrats are wasting
This bill includes a provision in the Mr. NEAL. Madam Speaker, I yield 2 everyone’s time pushing a bill with
bill—that is, the bill that I have been minutes to the gentleman from Cali- price controls, punitive taxes, blank
advocating with my colleagues JOHN fornia (Mr. PANETTA). checks, bailouts, and more red tape and
LEWIS and MARK VEASEY for some time Mr. PANETTA. Madam Speaker, I bureaucracy.
now—to ensure that all States that ex- rise today in support of H.R. 1425, the I want a bill that protects pre-
pand Medicaid coverage receive an Patient Protection and Affordable Care existing conditions, lowers drug pric-
equal Federal match for expansion, re- Enhancement Act. ing, incentivizes innovation, fixes our
gardless of when they expanded. That This comprehensive legislation will healthcare system, cuts taxes, and ac-
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means that the 14 States—like Ala- do what I have always said needs to be tually lets you keep your own doctor—
bama, that I represent—could expand done to the ACA: It won’t get rid of it, but this is not it.
Medicaid and get equal Federal cov- but it does fix it. This bill does that by For these reasons, I urge my col-
erage in their match. lowering healthcare costs and raising leagues to oppose this legislation so we
This provision incentivizes Medicaid access to quality healthcare, especially can get to work and actually pass a bill
expansion because it would help 113 for those who need it the most. that improves the lives of our citizens.
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2629
Mr. NEAL. Madam Speaker, I am people’s time, and let’s get back to going in droves to it? In fact, it works
pleased to yield 11⁄2 minutes to the gen- governing this great Nation. so poorly that, under this bill, they
tlewoman from Florida (Mrs. MURPHY). Mr. NEAL. Madam Speaker, I yield 2 have to bribe you with over $400 billion
Mrs. MURPHY of Florida. Madam minutes to gentlewoman from Cali- more in taxpayer money.
Speaker, every American should have fornia (Ms. JUDY CHU). That is how much this costs, more
affordable access to doctor care, hos- Ms. JUDY CHU of California. Madam than $400 billion to take you off the
pital care, and prescription drugs. This Speaker, last week, as COVID–19 cases private health insurance that you like.
is important in normal times and vital continued to spread, even reaching his- This is free market. If you don’t like it,
during a pandemic. toric highs, and as the number of you can go somewhere else. But most
Before COVID, Florida had one of the Americans killed by this virus rose people like their private health insur-
worst uninsured rates in the country. well above 100,000, Donald Trump asked ance, so they are going to push them
That is because State leaders refused the Supreme Court to strike down the onto this at the expense of over $400
to expand Medicaid, placing politics entire Affordable Care Act. If Trump billion.
over public health. It is also because and Republicans got their way, mil- If that isn’t bad enough, Madam
many Floridians chose not to buy a lions of Americans would immediately Speaker, what else do they do? They
marketplace plan because they lose their health insurance in the mid- pay for it—get this—by limiting the
couldn’t find an affordable option. dle of a pandemic, with no alternative amount of drugs that will come to mar-
COVID has made a bad situation available. ket. Yes. The Council of Economic Ad-
worse. In Florida, cases, hospitaliza- Ending the ACA is life-threatening, visers has advised ‘‘as many as 100
tions, and deaths are rising sharply. especially as we battle COVID–19. That fewer drugs entering the United States
Millions of workers have lost their jobs is why I am proud to support the Af- market over the next decade, or about
and their employer-sponsored health fordable Care Enhancement Act. This one-third of the total number of drugs
coverage. bill would build on the success of the expected to enter the market.’’
Passage of this bill would make an Can you believe this? In the middle of
ACA by expanding tax credits to ensure
immediate difference in the lives of my a global pandemic, when we are trying
more Americans have access to health
constituents who are really struggling. and rushing to find a cure and a vac-
insurance, not fewer. And it expands
The bill would encourage Florida and cine for COVID–19, they are going to
eligibility for these credits so that
other holdout States to expand Med- bring a bill to the floor to stop drugs
icaid by having the Federal Govern- Dreamers can access affordable
from coming to the market, over 100 of
ment pay nearly the full cost. It would healthcare as well, something we know
them.
make exchange coverage more afford- will benefit entire communities. Let’s read more. This ‘‘would reduce
able, reducing premiums and The coronavirus does not discrimi- Americans’ average life expectancy by
deductibles. It would lower the cost of nate, and neither should we. about 4 months.’’ My God, what are we
prescription drugs, which are far too Critically, this bill undoes the Trump doing, bringing a bill to the floor right
high. administration’s expansion of junk in- now when we are trying to find a cure
Finally, it would guarantee that no surance plans, which offer minimal that will make it harder to find a cure?
American can be denied coverage be- coverage and leave patients with mas- All to push more people, including
cause of a preexisting condition. This sive bills when they do get sick; be- wealthy people who would be eligible
protection is even more important cause, while access to healthcare is es- under the bill that already have pri-
than ever since there is a risk that in- sential, it must be affordable. vate insurance, onto a heavily tax-
surers could classify a COVID–19 diag- That is why it is so important that payer-subsidized program that has been
nosis as a preexisting condition. this bill also includes language from failing under its own weight, failing so
I strongly support this bill and urge H.R. 3, the Elijah Cummings Lower much they need to add $400 billion to
its passage. Drug Costs Now Act. This will lower try to entice you to take it and, in the
Mr. BRADY. Madam Speaker, I yield prescription drug prices by allowing process, limit the ability to bring life-
2 minutes to the gentleman from Texas the government to negotiate for those saving drugs, like a cure for COVID–19,
(Mr. ARRINGTON), a member of the prices, bringing our prescription drug to the market.
Ways and Means Committee. prices in line with what they cost over- This is absurd. This is psychotic that
Mr. ARRINGTON. Madam Speaker, seas. we are even debating this right now.
at a time when our Nation is reeling This bill puts the health of the Amer- We should be focusing on helping expe-
from an unprecedented public health ican people first when we need it most. dite a cure, not making it harder to
crisis and our fellow Americans are I am proud to support this legislation, bring that very cure for COVID–19 to
struggling just to survive, the Demo- and I urge my colleagues to vote ‘‘yes.’’ the market.
crat leadership is wasting precious Mr. BRADY. Madam Speaker, I yield Madam Speaker, I would strongly
time on yet another partisan mes- 3 minutes to the to gentleman from urge a ‘‘no.’’
saging bill. Louisiana (Mr. SCALISE), the Repub- Mr. NEAL. Madam Speaker, I yield 2
This legislation is going nowhere, lican whip. minutes to the gentleman from Cali-
and my friends on the other side of the fornia (Mr. GOMEZ).
b 1215
aisle know it. The name Patient Pro- Mr. GOMEZ. Madam Speaker, first, I
tection and Affordable Care Enhance- Mr. SCALISE. Madam Speaker, I want to remind my colleagues from the
ment Act is no such thing. It is the think we all remember: If you like other side of the aisle that this Presi-
protecting ObamaCare act. It is the what you have, you can keep it. Re- dent has attempted to get rid of, to
pretend we are legislating under the member that phrase? Probably the eliminate, the Affordable Care Act,
guise of partisan messaging act. It is most broken promise in political his- ObamaCare, over and over and over
the perpetuate the broken promises of tory. again. So when you pretend to care
ObamaCare act. It is empty; it is de- Millions of people lost the good about expanding healthcare or taking
void; it is going nowhere. We are wast- healthcare that they liked because care of people who don’t have
ing time in this national crisis. Washington bureaucrats came in and healthcare, it seems a little hollow to
If it did pass, it would take flexibility said not ‘‘if you like what you have, me.
and responsibility from States. It you can keep it,’’ but ‘‘if Washington That is why I am proud to stand up
would coerce States to expand Med- likes what you have, you can keep it.’’ here to support the Patient Protection
icaid—a flawed Medicaid system, I And they took it away. and Affordable Care Enhancement Act
might add—and it would allow for After that, you still see, years later, because it would invest in working
dlhill on DSK120RN23PROD with HOUSE
these monies to be used on abortion, they are trying to pull more people out families by expanding affordability,
which is a nonstarter. We know it is of the private insurance market who strengthening consumer protections,
not serious when that is in there. That actually like what they have, and say, and increasing coverage. And there is a
is a poison pill. ‘‘Get back on this.’’ lot to like in this bill.
Madam Speaker, I encourage my col- If it works so well, by the way, For the first time ever, under this
leagues to stop wasting the American Madam Speaker, wouldn’t people be legislation, doctor recipients would be
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H2630 CONGRESSIONAL RECORD — HOUSE June 29, 2020
eligible for help with their premiums Now, the bill we are debating today difference between life and death, we
for plans they purchased under Covered is another perfect example of an at- should be building on the Affordable
California or HealthCare.gov. tempt to expand Big Government, Care Act to lower health costs, not rip-
For DACA recipients, home is here. making it harder on the medical com- ping away every last benefit.
Many of them have been working as munity. In this case, it is patients who With all due respect to my colleagues
first responders and frontline health rely on prescription drugs who stand to on the other side who keep saying this
providers during the pandemic, and lose the most. bill has no chance in the Senate, who
they should have affordable healthcare In the midst of the COVID–19 out- do you work for: MITCH MCCONNELL or
like any other American. break and responses, we rush toward the American people? My constituents
Madam Speaker, I would like to finding treatments and a vaccine. My elected me to do my job, and that is to
thank Chairman NEAL for working colleagues on the other side of the aisle fight for their healthcare.
with me on this important provision. want to pass a bill that will result in Madam Speaker, I fully support the
Second, this bill makes changes so fewer cures for Americans in need. Patient Protection and Affordable Care
that Medicaid more effectively serves That is right. The CBO analysis con- Enhancement Act because we need to
its patients. cluded that this bill would result in do more to provide affordable
For instance, under the legislation, fewer cures coming to market to help healthcare and bring down the rising
Medicaid enrollees would have better the American people. Drug manufac- costs of prescription drugs.
access to primary care physicians, and turers that may feel government isn’t This bill does that, and I urge my
they won’t lose their healthcare cov- willing to pay a reasonable price for colleagues to join us. Do your job
erage just because of small fluctua- their product would have their revenue today.
tions in their income over the course of taxed at astronomical rates, essen- Mr. BRADY. Madam Speaker, I yield
a year. myself such time as I may consume.
tially coercing the drugmaker into sub-
Forty-seven percent of my congres- I have here a host of letters in oppo-
mission or cease to exist.
sional district is enrolled in Medicaid sition to this dangerous legislation,
The reason America leads the world
or Medi-Cal, so these provisions are one signed by more than 40 State and
in producing new medicines is because
crucial. regional life science organizations and
Last, this bill makes healthcare more we allow competition, competition to
drive innovation. another signed by over 130 small
affordable by increasing subsidies for
Right now, Congress needs to be fos- biotech companies, many of whom are
working families on the marketplace.
tering innovation through competition, currently working to develop COVID–19
This provision is similar to the
not imposing one-size-fits-all Wash- therapies and vaccines. In these let-
Healthcare Affordability Act of 2019
ington mandates that accomplish just ters, they emphasize that this bill will
that I introduced with Congresswoman
the opposite. deter badly needed investment that
LAUREN UNDERWOOD. This is a historic
We have already proven that we can will harm their ability to manufacture
step.
The Affordable Care Act was a big do some work together. Last year, the and produce therapies and cures for
step, but it is not done. We are going to Ways and Means Committee marked up American families.
a bipartisan drug-pricing legislation Madam Speaker, in the midst of a
keep pushing, and we are not going to
bill only to have it die because of par- pandemic, we just heard a question:
negotiate with the other side of the
tisan leadership. I know the Energy Why do we oppose this bill? In the
aisle that keeps trying to eliminate
and Commerce and Judiciary Commit- midst of a pandemic where countless
and roll back protections and afford-
tees have done the same. Let’s debate lives will depend upon the development
able healthcare for millions of Ameri-
and find compromise on that legisla- of these new cures, this cannot happen
cans.
Mr. BRADY. Madam Speaker, I yield tion, which actually stand a chance of on our watch. We will not stand idly
3 minutes to the gentleman from Ohio becoming law. by.
(Mr. WENSTRUP), a leader on the Ways I urge my friends on the other side of Madam Speaker, I include in the
and Means Committee. the aisle to work with us on bipartisan RECORD the letters, and I reserve the
Mr. WENSTRUP. Madam Speaker, I legislation that would result in finding balance of my time.
more cures for the American people be- OCTOBER 16, 2019.
thank the gentleman from Texas for Hon. MITCH MCCONNELL,
yielding and for his leadership. cause cures save money and save lives.
Majority Leader, U.S. Senate,
Madam Speaker, I rise today in oppo- I oppose this legislation.
Washington, DC.
sition to this bill. Mr. NEAL. Madam Speaker, I yield 2 Hon. CHARLES SCHUMER,
I grew up watching a show called minutes to the gentleman from Nevada Democratic Leader, U.S. Senate,
‘‘Medical Center’’ as a kid. It led me to (Mr. HORSFORD). Washington, DC.
wanting to become a doctor because I Mr. HORSFORD. Madam Speaker, I Hon. NANCY PELOSI,
wanted to help people. rise today in support of the Patient Speaker, House of Representatives,
After I graduated and completed my Protection and Affordable Care En- Washington, DC.
surgical residency, I owned a small hancement Act. Hon. KEVIN MCCARTHY,
In the middle of the historic health Republican Leader, House of Representatives,
practice with two employees. Eventu-
Washington, DC.
ally, I merged with a larger provider and financial security crisis of the DEAR SENATE MAJORITY LEADER MCCON-
group, in part because the administra- coronavirus pandemic, especially in my NELL, SENATE DEMOCRATIC LEADER SCHUMER,
tive burdens of complying with new home State of Nevada that has suffered HOUSE SPEAKER PELOSI, AND HOUSE REPUB-
laws and regulations were just too the most debilitating economic impact, LICAN LEADER MCCARTHY: As state and re-
costly for my solo practice. affordable healthcare is now more im- gional life sciences organizations across the
That wasn’t the end, though. Costs portant than ever. country, all dedicated to supporting the de-
continued to rise, and my physician- Last week, in the middle of this velopment and delivery of innovative life-en-
owned surgery center was ultimately COVID–19 crisis, President Trump peti- hancing and life-saving products, we write to
express our strong concerns about recent leg-
sold to a local hospital. Medicare reim- tioned the Supreme Court to strike
islative proposals that seek to introduce
bursement rates nearly doubled over- down every last protection and benefit international reference pricing and foreign
night, including an increase in patient of the Affordable Care Act. On Friday, price controls as a strategy to reduce pre-
co-pays. I learned that such a ruling would cost scription drug costs. We are gravely con-
When I got to Congress, I joined the 23 million Americans, including 309,000 cerned that such polices will consequentially
GOP Doctors Caucus, and I am now Nevadans, to lose their health insur- threaten patient access and choice and cede
proud to serve as the vice chair. Most ance. America’s global leadership in biomedical in-
dlhill on DSK120RN23PROD with HOUSE
of us in the Doctors Caucus agree that There is no excuse for this cruelty novation.
At the outset, we underscore our apprecia-
one of the reasons we came to Congress ever. But it is truly unconscionable at
tion for the bipartisan and bicameral efforts
is because of the mountains of red tape, a time when over 100,000 Americans underway to provide relief to patients from
red tape involved in practicing medi- have lost their lives to a virus that we unaffordable out-of-pocket costs for prescrip-
cine that has killed much of the joy of have yet to curb completely. When ac- tion drugs. This is a critical challenge for
providing care to patients. cess to quality healthcare could be the our nation, and we are committed to being
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2631
part of the solution to address it, while also Arizona: Arizona Bioindustry Association, economic and health crisis we have had
ensuring that incentives still exist to spawn Inc. (AZBio). in almost a century.
future innovation. However, we are deeply California: California Life Sciences Asso- I am mystified by the strategy of my
concerned by proposals by some in Congress ciation—CLSA, BIOCOM, SoCalBio.
to introduce price controls, particularly for- Colorado: Colorado BioScience Associa-
colleagues on the other side. What are
eign reference pricing, into government and tion. they thinking?
private healthcare programs. These pro- Connecticut: BioCT. Now, they say that they want to pro-
posals are concerning for states and regions Delaware: Delaware Bioscience Association tect people with preexisting conditions.
of the country with established life sciences (Delaware BIO). In fact, the President tweeted over the
communities, as well as for emerging bio- Florida: BioFlorida. weekend, saying he will always protect
medical innovation ecosystems working to Georgia: Georgia BIO. people with preexisting conditions. And
attract capital investment and support en- Illinois: Illinois Biotechnology Innovation
Organization (iBIO).
I have heard colleagues of mine in the
trepreneurship to build the companies and
therapies of the future. Most importantly, Indiana: Indiana Health Industry Forum Ways and Means Committee say: We
they would be devastating for those patients (IHIF). are convinced. We know now that we
hoping for medicines to treat serious, life- Iowa: Iowa Biotechnology Association have to protect people with preexisting
threatening diseases. (IowaBio). conditions.
For example, 96 percent of new cancer Kansas: Bio Kansas. Yet, what do they do? Not what they
drugs are available in the U.S., at an average Kentucky: Kentucky Life Sciences Coun- say, what do they do? Their policies
delay of 3 months. By comparison, Japanese cil.
Louisiana: Louisiana BIO.
don’t match their rhetoric.
patients have access to 50% of new medicines
and wait on average 23 months. German and Maryland: Maryland Technology Council. In 2017, they tried to repeal the ACA
Canadian patients wait four times longer, Massachusetts: MassBio. altogether, which would take away
French patients wait six times longer. None Maine: Bioscience Association of Maine people’s preexisting conditions protec-
of these countries even approach the access (BioME). tions. Now, in the midst of a pandemic
to new therapies that our patients have. Michigan: Michigan Biosciences Industry that has already killed 130,000 Ameri-
Should the U.S. implement foreign price con- Association (MichBio). cans, this administration and the Re-
trols, patient choice and access to the full Minnesota: Medical Alley Association.
publicans are pursuing a lawsuit to ac-
range of life-saving therapies would undoubt- Missouri: Missouri Biotechnology Associa-
tion (MOBIO). tually undo the Affordable Care Act.
edly be threatened.
Proposals to implement foreign price con- Montana: Montana Bioscience Association. That will get rid of preexisting condi-
trols also put at risk the U.S.’s world-leading Nebraska: Bio Nebraska. tions protections. It doesn’t make any
innovative biopharmaceutical sector that Nevada: The Nevada Biotechnology and sense.
has created nearly one million jobs across all Life Science Association. Prescription drugs, the President
50 states and represents a large portion of New Jersey: BioNJ, HealthCare Institute said during his campaign and there-
our nation’s Gross Domestic Product of New Jersey (HINJ). after, when talking about Big Pharma,
(GDP)—generating an economic output of New Mexico: NMBio.
New York: New York BIO.
he said that these guys are getting
approximately $1.3 trillion annually. As a
sector that already takes on extraordinary North Carolina: North Carolina Bio- away with murder. We should be nego-
risks and significant investments with the sciences Organization (NCBIO). tiating prescription drug prices. Yet,
hope that a few will eventually become the North Dakota: BioScience Association of we have passed the bill before. We are
next life-saving treatment for patients, the North Dakota. doing it again today, to actually nego-
looming potential of foreign price controls Ohio: BioOhio. tiate prescription drug prices, and they
brings a threat that risks the support of fu- Oregon: Oregon Bioscience Association (Or- are opposing it once again, and they
ture investment. egon BIO).
are not doing anything to try to nego-
It is also important to remember that the Pennsylvania: Life Sciences Pennsylvania
overwhelming majority—over 80 percent—of (LSPA). tiate prescription drug prices.
biopharmaceutical innovators in the US are South Carolina: SCBIO. Today, Democrats are, once again,
small, start-up, pre-revenue companies with- South Dakota: South Dakota Biotech. taking steps to reduce premiums, lower
out a single product yet on the market. A re- Tennessee: Life Science Tennessee. drug prices, and expand coverage.
cent report by IQVIA showed that emerging Texas: Texas Healthcare and Biosciences Madam Speaker, I urge my col-
biopharmaceutical (EBP) companies account Institute (THBI). leagues on both sides of the aisle to
for over 70 percent of the total late-stage Utah: BioUtah. support this bill.
R&D pipeline and were responsible for al- Virginia: VirginiaBio.
Washington: Life Science Washington.
Mr. BRADY. Madam Speaker, I yield
most two-thirds of the patents for new drugs
West Virginia: Biosciences Association of myself 30 seconds.
launched in 2018. These mostly pre-revenue
companies without a product on the market West Virginia. Madam Speaker, just a quick fact
are the ones to be most affected by fluctua- Wisconsin: BioForward Wisconsin. check, because you know the Repub-
tions in investment caused by the political Puerto Rico: Industry-University lican Congress in 1996 enacted the first
and public policy environment. (INDUNIV) Research Center Inc/Bio Alliance comprehensive protections for pre-
The recent actions taken by the Adminis- Puerto Rico. existing conditions, which cover,
tration and Congress on drug pricing are Mr. NEAL. Madam Speaker, I yield 2 today, 275 million Americans who are
seen as extremely threatening by the life minutes to the gentleman from New not affected by the lawsuit. There is
sciences sector, and we are therefore con- York (Mr. SUOZZI).
cerned that the proposed foreign price con-
simply too much fear-mongering and
Mr. SUOZZI. Madam Speaker, I rise bad information in this debate.
trols policies will scare investment away
today in strong support of H.R. 1425, Madam Speaker, I reserve the bal-
from life sciences investment, and towards
other industry sectors that pose far less risk. the Patient Protection and Affordable ance of my time.
If price controls as proposed are imple- Care Enhancement Act. Mr. NEAL. Madam Speaker, I yield 1
mented it may reduce drug pricing in the Madam Speaker, the Democrats have minute to the gentlewoman from Chi-
short term, but it will certainly result in sig- been debating internally over the past cago (Ms. SCHAKOWSKY).
nificantly reduced innovation and severely couple of years: What is the best way
restricted access to life-saving medicines. to reduce healthcare costs? What is the b 1230
On behalf of the US’s innovative life best way to provide more access to peo- Ms. SCHAKOWSKY. Madam Speaker,
sciences community, we urge you to reject
any efforts to undermine America’s global
ple? What should we be doing? I thank the chairman for yielding to
leadership in biomedical innovation through Some people push for Medicare for me.
international reference pricing or other price All. People like myself say: Let’s build I would think that my colleagues on
controls. Patients deserve access to and upon the Affordable Care Act. Let’s try the other side of the aisle, the Repub-
choice of the lifesaving therapies of today and figure out how we can provide licans, would get tired of trying to
and tomorrow. As you move forward, we more access and reduce drug costs. take healthcare away from Americans,
dlhill on DSK120RN23PROD with HOUSE
stand ready to work with you to consider al- That is what we are doing here today. particularly right now.
ternative proposals that will propel Amer- Meanwhile, our Republican col- The Patient Protection and Afford-
ican innovation forward and deliver afford-
able, accessible and innovative therapies for
leagues are continuing to hurtle down able Care Enhancement Act would ac-
patients who need them. a dark and misguided path to take tually make such incredible improve-
Sincerely, away coverage from almost 20 million ments and make healthcare more af-
Alabama: BIO Alabama. Americans in the middle of the worst fordable, but, no.
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H2632 CONGRESSIONAL RECORD — HOUSE June 29, 2020
The bill includes the No More Narrow 19, what are you thinking? Why are we As we continue to confront the worst
Networks Act that I actually intro- destroying the incentives for new medi- public health emergency in recent his-
duced that would ensure that con- cine and cures? We ought to be doing tory, our first priority must be to pro-
sumers can access more comprehen- all we can to accelerate medical inno- tect the health and safety of the Amer-
sive, equitable, and timely healthcare vation, not destroy it in this bill. ican people. But during this pandemic,
within their own insurance network Democrats would force patients to millions of people have lost their jobs
now. It also includes the Protecting choose between affordable medicines and, regrettably, in America when you
Consumers from Unreasonable Rates and lifesaving cures for Alzheimer’s lose your job you frequently lose your
Act and allows the Federal Govern- ALS, Parkinson’s, diabetes, or cancer. health insurance.
ment to help lower prices when those That is a false choice. And we are not Based on the job losses in March and
rates, those premiums are too high. talking about just a few cures for some April alone, experts estimate that over
This is a great bill. You should be for very rare diseases, we are talking 26 million people across the country
this. about up to 100 cures, dozens lost. have lost their job-based health insur-
Mr. BRADY. Madam Speaker, I yield Our country is in a time of uncer- ance.
myself the balance of my time. tainty. Millions are unemployed. With so many workers looking to
Madam Speaker, Republicans support States still have deep restrictions in turn to the Affordable Care Act mar-
children, seniors, and patients with place. For folks who are relying on ketplaces for healthcare, we must be
preexisting conditions. A Republican short-term limited plans for this period building on the progress we have made
Congress created the popular Chil- of uncertainty, why do Democrats pro- to expand access to affordable cov-
dren’s Health Insurance Program that pose to make their lives harder? erage. This is exactly what this bill
millions of families rely on today. I oppose this dangerous bill and urge
does.
A Republican Congress created the everyone to oppose it.
Madam Speaker, I yield back the bal- For example, as my colleagues have
prescription drug program and Medi- noted, under this proposal, no person
care to help seniors get the medicine ance of my time.
Mr. NEAL. Mr. Speaker, I yield my- would pay more than 8.5 percent of in-
they need, and every Democrat and come on benchmark silver plans
Speaker PELOSI tried to kill that bill. self the balance of my time.
Madam Speaker, this is very sensible through the marketplace. Moreover, we
A Republican Congress created the fix the so-called family glitch, a tech-
Medicare Advantage program that legislation. It builds upon the Afford-
able Care Act. It keeps the protections nical problem that prohibits families
serves 20 million seniors in America. from getting affordable coverage, and
And a Republican Congress created of preexisting conditions. It makes the
children’s healthcare initiative perma- we make that affordable coverage
the first law that established protec- available for millions of working fami-
tions for patients with preexisting con- nent. But most importantly, it expands
the opportunity. lies.
ditions that covered 275 million Ameri-
I am going to reiterate something I The legislation will also provide in-
cans today regardless of this ACA law-
said earlier about the experience we centives to expand Medicaid so that
suit.
have had in Massachusetts with the Af- low-income families across the country
We want people to have access to
fordable Care Act. 100 percent of the will have coverage regardless of where
quality, affordable healthcare that fits
children in Massachusetts have health they live.
their needs, not Speaker PELOSI’s. We
insurance. Ninety-seven percent of the It builds on existing patient protec-
also support cures now for serious and
adults in Massachusetts have health tions by reversing the Trump adminis-
life-threatening diseases that plague so
insurance, and it polls in the high sev- tration’s expansion of short-term so-
many families and our loved ones.
enties in terms of consumer satisfac- called junk health plans, which dis-
Eliminating the hope for those cures is
tion. It was the experiment that criminate against patients with pre-
why this bill is just so dangerous.
Let me also be clear about what isn’t worked. existing conditions and are not re-
We should be expanding healthcare quired to cover essential health bene-
in this bill, Madam Speaker. We have
opportunities for members of the fits.
heard a lot today from my friends on
American family, not trying to deny These plans raise costs for everybody
the other side of the aisle bemoaning
them. We shouldn’t be filing a lawsuit not in a plan and then abandon the pa-
the Trump administration’s effort to
in front of the Supreme Court sug- tients when they get sick and actually
root out unconstitutional laws while
gesting that we should do away with need coverage.
committing to protect people with pre-
the Affordable Care Act. Finally, the Patient Protection and
existing conditions. Last point, and I mean this very sin-
The Democrats could end this uncer- Affordable Care Enhancement Act
cerely, as long as I have been in this would save money for workers and em-
tainty now. They are in charge of the House, Republicans have never agreed
House. Bring to the floor a measure Re- ployees by cutting the cost of prescrip-
amongst themselves on health insur- tion drugs and bringing them in line
publicans support that sever the indi- ance, never mind trying to find an
vidual mandate from the rest of the with the cost people in other countries
agreement with us. They have always pay.
ACA. Bring to the floor a legislative fix disagreed sharply about the role of gov-
for your unconstitutional law. Bring to And when they talk about the loss in
ernment in health insurance. So before investments and research, listen very
the floor certainty for all Americans, they give us a lecture on how this
especially those with preexisting carefully because they are saying that
ought to proceed, perhaps they could reducing the cost of prescription drugs
health conditions. offer a competing plan that has never
But House Democrats won’t do that. is a bad thing. And second, they are
happened in my time in Congress. talking about a previous version of the
No, they find the political fear- Madam Speaker, I yield back the bal-
mongering to be too potent an elec- bill.
ance of my time.
tion-year weapon. So we continue this In this version of the bill we have an
The SPEAKER pro tempore (Mrs.
charade. amendment in here that puts more
LURIA). All time for the Committee on
Let me state it all again for all to Ways and Means has expired. money into research and NIH, so that
hear: Republicans support protections The gentleman from Virginia (Mr. those investments will continue to get
for those with preexisting conditions. SCOTT) and the gentlewoman from made.
We wrote the law that protects 275 mil- North Carolina (Ms. FOXX) each will In contrast, the Trump administra-
lion Americans today. And we warned control 30 minutes. tion has continued to aggressively pur-
Democrats about this unconstitutional The gentleman from Virginia is rec- sue the Texas v. United States lawsuit.
dlhill on DSK120RN23PROD with HOUSE
law, and we knew it would get struck ognized. Just last week, the Department of Jus-
down in court. Mr. SCOTT of Virginia. Madam tice filed briefs urging that the Su-
But we cannot have a healthy soci- Speaker, I yield myself 3 minutes. preme Court overturn the Affordable
ety, we cannot protect all Americans, Madam Speaker, I rise in support of Care Act.
if we don’t have access to lifesaving the Patient Protection and Affordable If that suit is successful, all of the
cures. As we continue to fight COVID– Care Enhancement Act. benefits of the ACA will be lost. Tens
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2633
of millions of people will lose insur- Yet today, we are debating legisla- Lowering drug costs should not be a
ance. People with preexisting condi- tion that would enlarge ObamaCare partisan issue, yet the underlying par-
tions will lose their protections. Af- even further by providing subsidies for tisan, socialist provisions in H.R. 3 are
fordability credits will evaporate. Con- some of the wealthiest Americans, pro- included in the legislation before us
sumer protections will be lost. This viding a blank check bailout for insur- today.
will happen in the middle of a public ance companies, strong-arming States Democrats are well aware that H.R. 3
health emergency. into expanding Medicaid, and elimi- will never become law. Senate Major-
And for all those on the other side nating lower cost healthcare options ity Leader MITCH MCCONNELL has said
that say that the Affordable Care Act like short-term, limited-duration in- it will go nowhere in the Senate, and
has problems, and they have a replace- surance plans. President Trump has said he will veto
ment, remember what the CBO said. Short-term insurance plans offer the bill if it comes to his desk.
The SPEAKER pro tempore. The healthcare options for Americans who Still, House Democrats continue to
time of the gentleman has expired. might find themselves between jobs or waste time during an unprecedented
Mr. SCOTT of Virginia. Madam unable to afford rising premiums in the health and economic crisis on legisla-
Speaker, I yield myself an additional 1 already expensive individual market. tion that will die after House passage.
minute. What is astonishing to me is that Their socialist drug-pricing scheme
Remember what the CBO said about Democrats conveniently failed to men- is nothing more than a leftwing down-
the bill that the Republicans passed tion that these short-term, limited-du- payment on a government-run
when they had the majority a few ration plans were legal under the healthcare system that would elimi-
years ago. They said the costs would go Obama administration and that States nate private insurance and implement
up 20 percent the first year, 20 some- still have the authority to regulate government-controlled rationing of
thing million fewer people would have prescription drugs.
these plans.
insurance, people with preexisting con- As I have said many times before,
As Republicans, we believe in fed-
ditions would lose their insurance, and governments don’t negotiate; they dic-
eralism. If States choose to limit or
the insurance you get is worse than tate. The Democrats’ radical drug-pric-
prohibit the sale of these plans, they
what you got. ing scheme will eliminate choice and
are free to do so. Instead of respecting
We can’t afford to take this major competition and jeopardize innovation,
the judgment of State lawmakers and investment, and access to future cures.
step backwards in our efforts to put local authorities to act in their States’
quality insurance within the reach of And we are considering this at a time
and constituents’ best interest, House when we are in the process of devel-
all Americans, and this is why I urge Democrats are doubling down on a one-
all of my colleagues to support the Pa- oping treatments and a vaccine for
size-fits-all Federal mandate. COVID–19.
tient Protection and Affordable Care As we have seen over and over again, This type of unprecedented govern-
Enhancement Act so that we can Washington-knows-best requirements ment interference in private market
strengthen the ACA and ensure mil- simply do not work. In the case of the negotiations and substantial increase
lions of Americans will have access to ill-advised legislation before us today, in regulatory red tape proves one
better health insurance than they have Federally dictated policies will only thing: The Democrat Party is being
now and certainly better than they lead to fewer choices and higher pre- held hostage by their most radical left-
would have if this lawsuit is successful. miums. wing Members.
Madam Speaker, I reserve the bal- Additionally, House Democrats have The American people deserve better
ance of my time. missed the mark with H.R. 1425 when it from Congress than the socialist drug-
Ms. FOXX of North Carolina. Madam comes to COBRA notices for millions of pricing scheme in the bill before us
Speaker, I yield myself such time as I workers. today. They deserve a real solution
may consume. While there is room for improvement that will lower the cost of prescription
Madam Speaker, I rise today in oppo- in this area, such as increasing trans- drugs without jeopardizing access to
sition to H.R. 1425, the so-called Pa- parency and allowing consumers to de- new treatments and cures.
tient Protection and Affordable Care cide which plans work best for them, That is why House Republicans have
Enhancement Act, the latest in a series Democrats are instead blocking con- introduced H.R. 19, the Lower Costs,
of attempts by House Democrats to sumer access to information about More Cures Act. This bill contains bi-
score cheap political points at the ex- other forms of valued coverage options partisan, bicameral measures, and it
pense of hardworking taxpayers. outside of the ACA. can become law this year. Specifically,
And speaking of scoring cheap polit- H.R. 19 will help lower out-of-pocket
ical points, I think most of my col- b 1245
costs, protect access to new medicines
leagues and I are tired of having words Just when you thought it couldn’t and cures, strengthen transparency and
put in our mouths that aren’t there. get worse, the blatantly political bill accountability, and champion competi-
We do not oppose reducing the cost of we are considering today incorporates tion.
drugs. We want that. We don’t believe Speaker PELOSI’s socialist drug-pricing Yet, House Democrats are ignoring
it is a bad thing. scheme to cover up the hundreds of bil- this bipartisan, commonsense legisla-
At a time when Congress should be lions of dollars this government tion. Clearly, they prefer politics over
united in our continued fight against healthcare expansion would cost Amer- progress.
the novel coronavirus and ensuring the ican taxpayers. Madam Speaker, I am deeply dis-
country can reopen safely, we are in- The rising costs of prescription drugs appointed that we are here today de-
stead here today debating a bill that is an issue that resonates with every- bating yet another partisan ploy from
amounts to nothing more than polit- one in this Chamber. Seventy percent my colleagues on the other side of the
ical posturing. Rather than solve any of Americans consider reducing the aisle. There are bipartisan solutions to
pressing healthcare problems, includ- price of prescription drugs to be a top many pressing issues at our fingertips,
ing the Nation’s response to the priority, and they are looking to us, including continuing to fight the
COVID–19 pandemic, this misguided their elected representatives, to get COVID–19 pandemic, but Speaker
legislation will limit healthcare op- the job done to get drug prices under PELOSI and her Democrat colleagues
tions for patients, contribute to al- control. continue to turn their backs on bipar-
ready skyrocketing healthcare costs, That is why Congress started a col- tisan legislation to help the American
and double down on the many failures laborative effort and bipartisan process people, and that is truly shameful.
of the Affordable Care Act or the ACA. last year to tackle this issue. Unfortu- Madam Speaker, I reserve the bal-
dlhill on DSK120RN23PROD with HOUSE
As the Republican leader of the Com- nately, this bipartisan collaboration ance of my time.
mittee on Education and Labor, I am was abruptly cut short by Speaker Mr. SCOTT of Virginia. Madam
committed to improving and enhancing PELOSI’s introduction of H.R. 3, which Speaker, I yield 2 minutes to the gen-
employer-sponsored healthcare options was written in secret without Member tlewoman from Florida (Ms. SHALALA),
for American workers and their fami- input or the regular committee proc- a distinguished member of the Com-
lies. ess. mittee on Education and Labor, and
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H2634 CONGRESSIONAL RECORD — HOUSE June 29, 2020
the former Secretary of the United Just like H.R. 3, this bill irrespon- help detect, diagnose, and treat poten-
States Department of Health and sibly coerces drug manufacturers into tially fatal complications.
Human Services. negotiating drug prices with the gov- By ensuring better health awareness
Ms. SHALALA. Madam Speaker, I ernment, slapping a 65 percent tax on from the beginning, we can ensure that
rise today in support of H.R. 1425, the revenue if they don’t come to terms, all babies are protected and cared for
Patient Protection and Affordable Care which increases to as much as 95 per- as they grow.
Enhancement Act. cent. When our Nation is facing a health
Our country is facing multiple inter- In any negotiations that I have been crisis, the logical reaction should be to
woven catastrophes: a global pandemic, part of, that is not how it works. strengthen healthcare, not to weaken
an economic crisis, and a reckoning In fact, according to the analysis it.
over the denial of racial justice. Our done by the Congressional Research We need to secure these smart poli-
job as Congresspeople is to help the Service, letting the government set cies to protect future Americans from
American people through these trying drug prices would violate both the the start.
times. This bill does just that, and the Fifth Amendment’s Takings Clause and Madam Speaker, I urge my col-
time to pass it is long overdue. the Eighth Amendment’s Excessive leagues to support the Affordable Care
Madam Speaker, my district has the Fines Clause. Enhancement Act.
highest enrollment in the Affordable Ms. FOXX of North Carolina. Madam
Before the pandemic, I traveled
Care Act’s marketplaces, with more Speaker, I yield 2 minutes to the gen-
across Pennsylvania’s 12th Congres-
than 100,000 people getting their health tleman from North Carolina (Mr. MUR-
sional District and met with patients
insurance from the ACA. My constitu- PHY).
and medical professionals, who have
ents are likely to have never had Mr. MURPHY of North Carolina.
told me that the best way to address
health insurance before the Affordable Madam Speaker, I rise today in opposi-
rising prescription drug costs include
Care Act became law, but there still tion to H.R. 1425.
patent reform to get generics to mar- To be honest, I am a little bit baffled.
are at least another 120,000 people in ket quickly, price transparency so con-
Miami-Dade County who do not have We are in the midst of a global pan-
sumers know the actual cost of the demic the likes of which this world has
access to health insurance because my medication they are purchasing, and
State, the State of Florida, has refused not seen in over 100 years, but sadly
incentivizing innovation to help find enough, my Democratic colleagues
to expand Medicaid. new cures.
This bill will take critical steps to think it is a good idea to pass a law
Rather than working toward fixing that would handcuff the ability of in-
improve and expand the ACA and lower
the disaster that has been brought dustry to create a vaccine and medi-
drug costs. It requires the Secretary of
about on the healthcare industry by cines to fight this disease.
HHS to negotiate with drug manufac-
ObamaCare, this bill expands its flawed Are you kidding me?
turers for affordable drugs for all
structure and attempts to force non- The price controls and regulations
Americans, a power I would have loved
Medicaid expansion States into com- proposed in this bill completely elimi-
to have had when I was Secretary. It
does exactly what the President asked plying with the radical fantasy that re- nate any incentive for these drug de-
for during his campaign. This provision sembles socialized medicine. velopers to spend money to invent new
There has been bipartisan work on drugs. Can you imagine any company,
alone will save Medicare $448 billion.
Other critical provisions include ex- healthcare reform, like H.R. 19, which pharmaceutical or not, being taxed at
panding tax credits deeper into the Republicans put forward last year. If the rate of 65 to 95 percent of what they
middle class so that everyone can get the majority were more interested in make?
affordable, comprehensive health cov- finding real results, they might have We need the next remdesivir or
erage. engaged with us in real discussions to dexamethazone to save people’s lives,
My constituents are worried about find common ground. We are interested and such policy would not allow this to
their jobs, their loved ones, their in lower prices, more cures, and a happen.
healthcare, and their country. Let’s healthier healthcare marketplace. What has happened in the past be-
help them not worry about how they Unfortunately, this legislation con- cause of overregulation of industry in
will pay for critical healthcare if they tinues us down the wrong road. For the U.S.? These companies have left
get sick. these reasons, Madam Speaker, I op- the U.S. and gone where? Gone to
Ms. FOXX of North Carolina. Madam pose H.R. 1425 and urge all others to do China. How has that worked out for us
Speaker, I yield 3 minutes to the gen- so. during this pandemic? China has thus
tleman from Pennsylvania (Mr. KEL- Mr. SCOTT of Virginia. Madam had a stranglehold on this Nation when
LER). Speaker, I yield 2 minutes to the gen- it comes to the drugs that we need.
Mr. KELLER. Madam Speaker, I urge tlewoman from California (Mrs. DAVIS), At a time of national consensus that
my colleagues to join me in opposing the chair of the Subcommittee on we need to purchase fewer drugs from
H.R. 1425. Higher Education and Workforce In- China, the Democrats want to ensure
While we can all agree that Ameri- vestment. that more of them are developed there
cans pay too much for healthcare and Mrs. DAVIS of California. Madam and that we have to respond to them.
that the rising costs of prescription Speaker, I thank the chairman for This is insanity.
drugs need to be addressed, this bill is yielding. Madam Speaker, make no mistake: I
not the answer. Usually, one’s healthcare is not top absolutely do agree that the costs of
The COVID–19 pandemic has affected of mind, until it is. This, Madam drugs in this country are too high. I am
each of our communities in different Speaker, is one of those times. a physician. I still practice. I still see
ways. We need to remain focused on We have to protect people’s patients when we are back in our dis-
helping our constituents reopen their healthcare, men and women, whether it tricts, and this is their number one
businesses, get back to work, and re- is battling the coronavirus, finding a complaint. But there are bipartisan
main protected from the virus. This cure for cancer, or even birth. and commonsense measures that we
bill does none of these things. Currently, Medicaid covers women can implement to decrease the cost of
Once again, we are wasting the for only 60 days postpartum, but life- drugs.
American people’s time debating some- threatening complications from preg- Like I have said many times before,
thing that will harm the healthcare nancy, as we all know, can continue if we want to lower the cost of drugs,
system, move us toward socialized much longer. we need pharmacy benefit manager re-
medicine, and provide fewer cures. These illnesses don’t follow the cal- form. We are the only country in the
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This is especially troubling as it is at endar. Regulations, of course, must world that allows these middlemen to
odds with the Trump administration’s align with reality. drive up costs. They cost this Nation
steadfast goal of finding treatments This needs to be changed. Fortu- over $800 million a year in unnecessary
and a vaccine for COVID–19, as well as nately, this bill would extend Medicaid drug costs.
protecting Americans from future coverage to a year postpartum and pro- This is a bipartisan and common-
pandemics. vide women with critical coverage to sense reform, rather than this nonsense
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2635
legislation, that we can work on to- tleman from North Carolina (Mr. Mr. BYRNE. Madam Speaker, I
gether to decrease the cost of drugs. BISHOP). thank the distinguished ranking mem-
Mr. SCOTT of Virginia. Madam Mr. BISHOP of North Carolina. ber for yielding.
Speaker, I yield 2 minutes to the gen- Madam Speaker, I thank the gentle- Madam Speaker, to borrow a line
tleman from Connecticut (Mr. COURT- woman for yielding. from President Reagan: Here we go
NEY), a distinguished member of the Madam Speaker, Democrats present again.
Committee on Education and Labor. a false choice: either support the ex- In the midst of a nationwide pan-
Mr. COURTNEY. Madam Speaker, pansion of an already-failed, govern- demic where there is so much work we
today, we vote on this bill that im- ment-run healthcare scheme, or let should be doing for the American peo-
proves the Affordable Care Act by cut- people go without healthcare. They ple, the Democrat majority has again
ting the cost of healthcare for families want you to think that Republicans brought a partisan messaging bill to
at an unprecedented, anxious time in and the Trump administration have no the floor of the House that is dead on
American life. ideas about how to expand coverage— arrival in the United States Senate.
More than 2.5 million Americans not the case. As the majority knows, this bill in-
have been diagnosed with COVID–19. In One of the first bills I introduced cludes numerous provisions that are
the insurance world, that means mil- after joining last September was the nonstarters for Republicans in any leg-
lions more with a preexisting condi- Increasing Health Coverage through islation related to healthcare, includ-
tion. HRAs Act. My legislation would codify ing: expanding ObamaCare, no protec-
Astonishingly, in the midst of this the Trump administration’s rule allow- tions against taxpayer-funded abor-
healthcare emergency, when we should ing employers to fund health reim- tion, the rolling back of numerous
be protecting coverage, the Trump ad- bursement arrangements for their em- Trump administration regulations that
ministration, last week, asked the Su- ployees. have made health insurance more af-
preme Court to strike down the entire Thanks to President Trump, these fordable, and financial penalties for
ACA. HRAs can now be used to purchase in- States that don’t expand Medicaid.
If Mr. Trump has his wish, those 2.5 dividual market coverage. That change Certainly, it seems bad timing to be
million Americans, along with 130 mil- is expected to lead to covering 800,000 enacting legislation that the non-
lion others with preexisting conditions, more people, all without costly and partisan Congressional Budget Office
will lose the landmark pro-patient pro- counterproductive government man- has already confirmed will lead to
tection that has been on the books for dates. fewer new drugs on the market, but the
the past 10 years, namely, the right to The American people want more Democrats have again included their
health coverage even if you have been choices, lower costs, and increased ac- socialist prescription drug bill in this
sick before and the confidence and se- cess to care, not a continued govern- legislation.
renity to know that you won’t be ment takeover. I urge Members to vote Madam Speaker, there are real areas
charged more because of an illness in against H.R. 1425 and for Democrats to where we could be working together to
your past. work with Republicans on common- find common ground in healthcare.
It is right there on the first page of sense proposals like mine. There could be common ground on re-
the ACA, section 2704: ‘‘Prohibition of Mr. SCOTT of Virginia. Madam insurance.
preexisting condition exclusions or Speaker, I yield 1 minute to the gentle- Six months ago, Republicans sug-
other discrimination based on health woman from Oregon (Ms. BONAMICI), gested over 40 bipartisan prescription
status.’’ the chair of the Subcommittee on Civil drug provisions we could actually
Yet, the administration in its brief Rights and Human Services. enact that would encourage innovation
filed with the U.S. Supreme Court a Ms. BONAMICI. Madam Speaker, this and groundbreaking new cures and pro-
few days ago says: ‘‘The entire ACA is the 10th anniversary of the Afford- mote low-cost options for patients. We
must fall.’’ That is a verbatim quote. able Care Act. Over the past 10 years, are still waiting on Speaker PELOSI to
Well, Madam Speaker, if the ACA our country has made significant take up that package of bipartisan
falls, preexisting condition protections progress in improving access to afford- bills.
fall with it, along with age-26 coverage able healthcare—despite the Trump ad- The truth is Democrats are not actu-
for dependent children and the elimi- ministration’s constant assault on the ally interested in finding solutions.
nation of lifetime limits on health cov- ACA. They are interested in ramming polit-
erage, which will devastate patients Now, in the middle of an unprece- ical legislation through the House in
with chronic illness. dented global health crisis, the admin- an effort to influence the 2020 Presi-
istration is in court trying to get rid of dential race and decry additional con-
b 1300 the ACA, including its critical protec- troversies for Democrat House Mem-
Last night, The Wall Street Journal tions for people with preexisting condi- bers to run on.
reported that the President once again tions. This threatens the health cov- Republicans are ready to have a seri-
admitted that neither he nor his Sen- erage of more than 20 million Ameri- ous conversation about making
ate majority have the slightest clue cans, nearly half a million of them Or- healthcare more affordable and acces-
what their plan is if their wrecking egonians. sible, but just like with police reform
ball of the ACA succeeds. The coronavirus pandemic has been last week, the other side is not.
Madam Speaker, during the last 4 devastating for those with underlying The American people are ready for us
months’ avalanche of layoffs, millions conditions, disproportionately harming to get back to working for them.
of Americans have desperately reached Black and Latinx people in commu- Mr. SCOTT of Virginia. Madam
out to their State’s ACA exchanges in nities of color. We should be doing all Speaker, I yield 2 minutes to the gen-
search of health coverage after losing we can to expand access to affordable tlewoman from Pennsylvania (Ms.
job-based insurance, 54,000 just in Con- healthcare for everyone, not take it WILD), a distinguished member of the
necticut alone. away. Committee on Education and Labor.
At this time of severe economic un- I strongly support the Patient Pro- Ms. WILD. Madam Speaker, I thank
certainty when a deadly virus is rav- tection and Affordable Care Enhance- the chairman for yielding.
aging communities both rural and ment Act. This bill will increase cov- I rise in support of the Patient Pro-
urban, we must do everything in our erage, lower costs, and make quality tection and Affordable Care Enhance-
power to strengthen health insurance care more accessible for all. ment Act, which builds upon the
and make it more affordable, which I urge my colleagues to join me in achievements of the ACA, including its
this bill does. To shrink from this chal- supporting this important legislation coverage of an additional 20 million
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lenge and roll back the clock on 10 to keep millions of Americans covered people.
years of progress would be a complete and build on the legacy of the Afford- I am glad to see that the bill includes
dereliction of duty. able Care Act. the tenets of H.R. 3, allowing the HHS
Vote ‘‘yes’’ on this bill. Ms. FOXX of North Carolina. Madam to negotiate prescription drug prices
Ms. FOXX of North Carolina. Madam Speaker, I yield 2 minutes to the gen- rather than continuing to pay the out-
Speaker, I yield 1 minute to the gen- tleman from Alabama (Mr. BYRNE). rageous prices set by companies that
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H2636 CONGRESSIONAL RECORD — HOUSE June 29, 2020
have long blocked competitors from legislation that would lower healthcare The scheme that the Democrats set up
the market. and drug costs without sacrificing in- to accomplish this was an individual
With the limited time I have to novation. mandate to force people to purchase in-
speak, though, I would like to high- But that is not the bill before us surance they sometimes couldn’t af-
light my appreciation that it includes today. Sadly, like last week’s police re- ford, a requirement for all plans to
my bill, the Family Health Care Af- form bill, the majority is once again cover government-mandated essential
fordability Act, which fixes the family focused on messaging, not legislating, health benefits—10 of them, to be
glitch in the ACA. and that is too bad. exact—community rating to drive
Under the Affordable Care Act, work- Mr. SCOTT of Virginia. Madam costs up for the youngest consumers,
ers are to have access to affordable Speaker, I yield 2 minutes to the gen- and massive subsidies that, today, are
healthcare plans, defined as healthcare tlewoman from Georgia (Mrs. MCBATH), available to families of four with in-
plans that cost no more than 9.56 per- a distinguished member of the Com- comes as much as $104,000.
cent of the employee’s monthly house- mittee on Education and Labor. In addition, the bill requires States
hold income. But the interpretation of Mrs. MCBATH. Madam Speaker, I to greatly expand their Medicaid pro-
‘‘affordable’’ only looks at whether thank the chair for yielding. grams, a requirement that was subse-
coverage is affordable to cover the em- Madam Speaker, I rise today in sup- quently mitigated by the Supreme
ployee, not whether it is affordable to port of H.R. 1425, the Patient Protec- Court.
cover spouses and dependents. tion and Affordable Care Enhancement What are the results? The CBO esti-
When factoring in the family unit, Act. mated 4 million individuals would re-
As a two-time breast cancer survivor, ceive coverage through the ACA. In re-
coverage can easily surpass 25 percent
I know how important it is to have ac- ality, approximately 9 million received
of household income and still be
cess to quality, affordable healthcare, coverage, 80 percent of whom are on a
deemed affordable and block the family
especially for those like me who have highly subsidized plan. Costs exploded,
from marketplace subsidies. This bill
preexisting conditions. as they tend to do with highly sub-
fixes that and makes sure that hard- This pandemic has shown us that
working families have access to cov- sidized care, and plans responded by
every American needs access to qual- raising copays and deductibles.
erage without risk of financial ruin. ity, affordable healthcare. Many Amer-
I call on my colleagues to pass this I said it before and I will say it again:
icans have lost their employer-spon- If you have a $5,000 out-of-pocket,
important bill. sored insurance and found affordable
Ms. FOXX of North Carolina. Madam Madam Speaker, for most folks, you
health coverage outside of their grasp, don’t have insurance; you have a card.
Speaker, I yield 2 minutes to the gen- outside of their own reach. Meanwhile, the competition and plan
tleman from Michigan (Mr. WALBERG). The Patient Protection and Afford- choice that was promised never mate-
Mr. WALBERG. Madam Speaker, able Care Enhancement Act rialized. Plan options have decreased
thanks to my chairman in exile. incentivizes Medicaid expansion, im- over time.
Madam Speaker, I rise in opposition proves Medicaid coverage, fixes the Seventy-five percent of the increases
to H.R. 1425, the slow coronavirus cures family glitch, and ensures that every in coverage most likely would have oc-
act. American has access to quality, afford- curred with two reforms: allowing indi-
There are many problematic provi- able healthcare. That is our right. That viduals to stay on their parents’ plan
sions in this bill, but, ultimately, it is is our right as Americans, to have af- until age 26, which I agree with, and a
yet another political ploy that will not fordable healthcare, to be able to take simple Medicaid expansion.
be considered in the Senate or become care of our loved ones, take care of our-
law, and we don’t want it to be because b 1315
selves and live a good, sustainable
it is not good. quality of life. Here we are again. Democrats appear
This bill is a step toward national- There is so much work that needs to to have learned none of the lessons
izing the drug industry and opening the be done, but this legislation truly that have become plainly evident since
door to one-size-fits-all, government- takes important steps to ensuring that they passed their first government
controlled rationing of prescription every American has the ability to be takeover of healthcare. Today we are
drugs. able to have access to health coverage. considering legislation that will sig-
Governments don’t negotiate; they Madam Speaker, I urge my col- nificantly expand premium subsidies
dictate. leagues across the aisle to vote ‘‘yes.’’ for ACA insurance while prohibiting
The radical approach taken by H.R. I am a preexisting condition, and in the 1332 waivers from States designing
1425 includes troubling and unprece- my district there are over 300,000 peo- their own plans for their populations’
dented government interference in pri- ple like me who have preexisting condi- unique needs.
vate, market negotiations, which will tions—45,000 of those in my district are One of the best examples of these
eliminate choice and competition and children under the age of 17—and we waivers is Maryland—hardly a conserv-
jeopardizes innovation and access to deserve to be cared for, and we deserve ative State—which reduced premiums
future cures. to have a good quality of life afforded for its residents an average of 13 per-
Countries that have adopted drug by affordable and good, quality cent in 2019 and an average of 10 per-
pricing systems like the one proposed healthcare. cent in 2020. The Democrats want to
in this bill face decreased access to in- Ms. FOXX of North Carolina. Madam block this. I have no Earthly idea why.
novative new medicines, increased wait Speaker, I yield 5 minutes to the dis- That is not all.
times for treatment, and supply short- tinguished gentleman from Tennessee The most outrageous aspect of this
ages for in-demand drugs. The bill will (Mr. DAVID P. ROE). legislation is that it would offset the
negatively impact investment and re- Mr. DAVID P. ROE of Tennessee. cost expansion of the ACA by allowing
search and development of future Madam Speaker, I rise today in opposi- government bureaucrats to set drug
treatments, putting breakthrough tion to H.R. 1425, which doubles down prices. This is a provision that—if it
cures for diseases like Alzheimer’s, on the flawed premise underlying the sounds familiar, it is, because it was
cancer, and sickle cell disease at risk. ACA and threatens access to lifesaving the heart and soul of H.R. 3, the Demo-
At a time when we have the best treatments in the middle of an ongoing crats’ flawed drug pricing plan from
minds urgently working on a vaccine public health epidemic. December—that would have reduced
for COVID–19, why would we want to All of us agree in this country that access to new lifesaving treatments.
slow down the development of life- there is a dire need for healthcare re- Every study that examined H.R. 3 con-
saving medications? Congress should be form. Our current system costs too cluded that it would stop cures from
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putting in place policies to incentivize much, is too complex, and often doesn’t coming to market. They only disagreed
difficult research and development for promote quality or value. This hasn’t on how many cures it would stop. Our
these rare and devastating diseases, changed since the ACA was first passed country currently leads the way in
not discouraging it. into law. bringing new medications to market. It
I stand ready to work with my Demo- Remember, the premise of the ACA would save lives and improve patients’
crat colleagues and advance bipartisan was to lower costs and increase access. quality of life.
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2637
In fact, at this very moment Amer- I also salute our freshmen who have it is central to not only the health but
ican innovators are working at light been leading the charge to lower the financial health security of Amer-
speed to develop and mass-produce a healthcare costs and strengthen ica’s working families.
COVID vaccine. The idea of passing leg- healthcare protections every step of In addition, this legislation expands
islation that discourages this type of the way from the first day they arrived coverage and pushes holdout States to
innovation is absurd. in the Congress. adopt Medicaid expansion for the 4.8
My first in-patient pediatric rotation In the election of this past 2018, million cruelly excluded from the cov-
in medical school in Memphis was at Democrats made a pledge to the Amer- erage.
St. Jude’s Children’s Hospital. At that ican people. For the people we would do It combats inequity in health cov-
time, Madam Speaker, 80 percent of three things. For the people we would erage faced by communities of color,
those children that I saw died. Today, lower the cost of healthcare by low- expands more affordable coverage to
80 percent of those children live. If we ering the cost of prescription drugs and vulnerable populations, and fights the
don’t stifle innovation, my prayer is preserving the preexisting medical con- maternal mortality epidemic.
that 100 percent of these children will dition. We are doing that today. And it cracks down on junk plans
survive in the future. For the people we would not only which are such a rip—let me just pay
While Democrats continue to double lower healthcare costs, we had bigger you all the time for my health insur-
down on the failure of ObamaCare, the paychecks by building the infrastruc- ance but you won’t be there for me
Trump administration has been work- ture of America in a green way with when I need care. So it cracks down on
ing to implement reforms that actually good paying jobs. We will be doing that those junk plans and strengthens pro-
work and has acted aggressively in the rest of the week. tections for people with preexisting
these last few months, in particular, to For the people we would be having conditions.
modernize our healthcare system and cleaner government, and that is what What is interesting in this whole de-
ensure patients continue receiving care we did the end of last week with the bate is to hear the President and Mem-
during this pandemic. The Trump ad- Justice in Policing Act, as well as part bers on the other side of the side say
ministration has been working to give of our H.R. 1, voting for statehood for that, oh, they are all for protecting
patients new insurance options the District of Columbia. There is cer- preexisting conditions.
through short-term plans which cover tainly more to come on the cleaner Oh, really?
only benefits essential to that patient. government front as we fight for voting Then why are you in the Supreme
They have a potentially game-chang- at home and removing obstacles to par- Court of the United States to overturn
ing rule to increase transparency in ticipation. them?
hospital prices. They have expanded But here today we are focused on Now, just back to this bill. According
telehealth in Medicare—which I use that first for the people priority. Ac- to analysis from the Center for Budget
today—given States the authority to cess to affordable care is a matter of and Policy Priorities, our legislation
experiment with plan design and en- life and death. That is so self-evident that we have on the floor today will
couraged States to innovate with their as we see every day during the COVID– help lower the costs for well over 17
Medicaid programs. 19 crisis which now has killed more million more Americans and safeguard
This should be a time for Congress to than 125,000 Americans, infected over the Affordable Care Act’s lifesaving
work together and pursue patient-cen- 2.5 million Americans, and left tens of protections for 130 million Americans
tered policies that will ensure we have millions of people without jobs. with preexisting conditions.
a strong healthcare system to come As Dr. Martin Luther King, Jr. once When they say they are for allowing
back to. I hope my Democratic col- said: ‘‘Of all the forms of inequality, people with preexisting conditions to
leagues will work with Republicans in injustice in health is the most shock- get coverage, they don’t say at what
a bipartisan manner to advance poli- ing and most inhuman because it often cost. This is one of the biggest dif-
cies that increase access to quality results in physical death.’’ Yes. As ferences—well, with stiff competition—
care, lower costs for all Americans, and lives and livelihoods are shattered by but one of the biggest differences be-
put patients back in charge of their the coronavirus, the protections of the tween Democrats and Republicans on
healthcare decision-making. Affordable Care Act are more impor- healthcare for Americans. We guar-
Madam Speaker, I, once again, urge tant now than ever, and this is a health antee affordability and protect the pre-
my colleagues to vote against H.R. justice issue. existing medical condition as not being
1425. Democrats with this bill will an obstacle to access. They are in
Mr. SCOTT of Virginia. Madam strengthen America’s health and finan- Court trying to overturn it.
Speaker, I yield 1 minute to the distin- cial security during this time of crisis Sadly—and this is a stark contrast,
guished gentlewoman from California and for years to come. It lowers Ameri- as I point out—as Democrats unveiled
(Ms. PELOSI), who is the distinguished cans’ healthcare coverage costs: Sig- our lifesaving legislation last week,
Speaker of the United States House of nificantly increasing the Affordable President Trump went to the Court
Representatives. Care Act’s affordability subsidies to be doubling down on his lawsuit to tear
Ms. PELOSI. Madam Speaker, I more generous and cover more middle down the ACA and dismantle every one
thank the gentleman for his tremen- class families. It negotiates lower pre- of its protections, including the pre-
dous leadership in bringing this impor- scription drug prices: Drawing from existing medical condition benefit. At
tant and historic legislation to the our H.R. 3 legislation to ensure that a time when families need healthcare
floor. He has been a part of advancing Americans no longer have to pay more more than ever, the President is trying
lower costs for healthcare and better for our medicines than Big Pharma to strip protections from about 130 mil-
benefits for all Americans in his career charges for the same drugs overseas. lion Americans with preexisting condi-
in Congress. I thank Mr. SCOTT for his This has been a long-term goal of tions and take coverage away from 23
tremendous leadership as chair of the Democrats in the Congress. In 2006 million Americans. That does not even
Education and Labor Committee and when we were running and won the ma- go into what he is trying to do to the
for the opportunity he is giving us jority, our For the People equivalent enhanced benefits that all Americans
today. I salute the gentleman and agenda was a new direction for Amer- with healthcare enjoy.
Chairman PALLONE, the chair of the ica, Six for ’06, and we had six bills We need to build on the progress of
Energy and Commerce Committee, who that we said we would pass imme- the Patient Protection and Affordable
has played such an important role in diately upon obtaining the majority. Care Act to lower health costs and pre-
all of this, as well as Mr. RICHARD We passed all six of them in the House scription drug prices, not rip away
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NEAL, chair of the Ways and Means of Representatives. Five of them be- American healthcare in the middle of a
Committee, so much an important came law. Only one of them did not, pandemic.
part. These three committees of juris- the law enabling the Secretary of HHS What sense does that make?
diction and the members of their com- to negotiate for lower prescription On day one of this Congress led by
mittees have been so essential to its drug prices. This has been a fight over Representative COLIN ALLRED, the
excellence and to its success. the years we continue to make because House voted to throw our full legal
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H2638 CONGRESSIONAL RECORD — HOUSE June 29, 2020
weight into defending this lawsuit. Yet And this thing is going nowhere. H.R. tion for 26 million Americans with pre-
more than 190 Republicans have voted 1425 is nothing more than another gov- existing conditions who otherwise
against that resolution, choosing to be ernment power grab in an attempt to would not have had access to health in-
fully complicit in the President’s at- double down on the failed policies of surance, made sure young people were
tempt to tear away health protections. ObamaCare. covered until age 26, and designated
We continue to call on the President to Remember the promise that was primary care and access to birth con-
abandon his lawsuit to destroy the Af- made to lower your premiums? Yet, trol as essential.
fordable Care Act and urge him instead they have skyrocketed. Not only does Of course, it was imperfect. It was in-
to call on the 14 States who have re- this bill rescind the Trump administra- tended to be a first step. Now, with 10
fused to expand Medicaid to do so. tion’s rule on short-term, limited dura- years of experience, we know how to
Doesn’t it just make sense at the tion insurance, which aims to provide improve it by addressing the serious
time of a pandemic? It is always impor- relief from rising premiums and flexi- issues of cost and access.
tant. bility for consumers, it also imple- The Patient Protection and Afford-
It would have been amusing if this ments government price-setting for able Care Enhancement Act does just
were not so deadly serious to hear Sen- drugs. that, with a special emphasis on chil-
ator CORNYN say: Well, these people The American people want choice, dren and communities of color who, for
who have lost their jobs because of this not one-size-fits-all, top-down, Big too long, have faced health disparities.
pandemic could always sign up for the Government programs. Why in the Also, with this bill, a family of four
Affordable Care Act. world would you send a hard-earned in my district would save an estimated
Really? tax dollar to Washington and maybe $8,000 a year on health insurance. This
But he is trying to take it down. get 20 cents back to take care of a pa- legislation provides permanent funding
The administration has a responsi- tient? for the Children’s Health Insurance
bility to defend the law of the land, not Madam Speaker, I made a promise to Program so that children will be able
to tear it down. Today, Members of the people of Georgia’s 12th District to get healthcare they need right from
Congress have a choice to strengthen that I would fight to lower drug prices, the start. I am particularly excited
America’s healthcare protections and and this bill would lead to drug price that this bill also includes the Kids’
lower healthcare costs or to be hikes and shortages. Under this pro- Access to Primary Care Act, a bipar-
complicit—once again, I use that posal, the Secretary of HHS would be tisan bill I introduced to expand pri-
word—in President Trump’s campaign required to set government rates for a mary care access for children and fami-
to dismantle families’ healthcare. number of lifesaving drugs, like insu- lies on Medicaid.
Make no mistake. A vote against this lin. The CBO estimates that price-set- By matching Medicaid reimburse-
bill is a vote to weaken America’s ting policies like these will result in ment rates to higher Medicare rates,
health and financial security during a fewer cures and treatments coming to Medicaid patients will have access to
pandemic. the market. more physicians, and children will get
When I was growing up, I remember H.R. 1425 would expand ObamaCare the care they need when they need it
my mother used to always say: If you after we spent years working to roll from their very own primary care phy-
don’t have your health, you don’t have back the burdensome mandates that sician. That kind of access to care
anything. the American people cried out for Con- should not depend on ZIP Code, in-
Health is so central. As you see, the gress to repeal. come, or skin color.
American people place a high value on As I said, the American people want The toll this pandemic has taken on
it when they say they don’t want to go choice. My Democrat colleagues have already disadvantaged communities
out too soon to jeopardize their health allowed the far-left radicals within drives home the need for everyone to
or the health of those they have at their party to take over their agenda. have affordable access to the care they
home. Let’s be clear what the Democrats need. That is why this bill, the Patient
So, in every language when people sa- want here. They want the government Protection and Affordable Care En-
lute each other they salute people to to be in charge of your healthcare, of hancement Act, is so important.
their health. The Spanish say salud, everyone’s healthcare. Democrats be- No family should ever face bank-
the Dutch say proost, the French say lieve they and their fellow bureaucrat ruptcy because of medical expenses. As
sante, the Germans say prost, the Irish friends know what is best for your one of the few doctors in Congress, I
say—now, this is hard because Gaelic is healthcare, not your doctor. I can tell will always work to ensure that every-
a hard language—slainte, the Italian I you right now that, in my district, we one can afford the care they need.
can say better, salute, and in Hebrew it know better and can see right through Ms. FOXX of North Carolina. Madam
is l’chaim. these schemes. Speaker, I yield 2 minutes to the gen-
It is all about life and health. That is Now more than ever, for the sake of tleman from Pennsylvania (Mr.
the salute. Everybody knows it is cen- our country, we must come together to SMUCKER).
trally important. With this bill Demo- provide real healthcare solutions, not Mr. SMUCKER. Madam Speaker, I
crats in the House are offering our sa- far-left political messaging bills. Un- start by wishing the ranking member
lute to good health to the American fortunately, it is business-as-usual here of the committee a very happy birth-
people, and we hope the Republicans for the Democrats, putting policies day and a wonderful day.
will join us in that salute to good over country. Madam Speaker, I rise today in oppo-
health to the American people. Madam Speaker, I urge my col- sition to H.R. 1425.
Madam Speaker, I urge a strong vote leagues to oppose this bill. I do agree with my colleagues on
for the Patient Protection and Afford- Mr. SCOTT of Virginia. Madam both sides of the aisle that we need to
able Care Enhancement Act for the Speaker, I yield 2 minutes to the gen- enact reforms that will make health
people, for the children, and for the fu- tlewoman from Washington (Ms. insurance and access to care more af-
ture. SCHRIER), a distinguished member of fordable. I also agree that we need to
the Committee on Education and protect individuals with preexisting
b 1330 Labor. conditions. But the approach under the
Ms. FOXX of North Carolina. Madam Ms. SCHRIER. Madam Speaker, I legislation being debated today will
Speaker, I yield 2 minutes to the gen- thank the chairman for yielding. not bring us closer to a better-func-
tleman from Georgia (Mr. ALLEN). Madam Speaker, I rise in support of tioning marketplace. It is like putting
Mr. ALLEN. Madam Speaker, I am the Patient Protection and Affordable a Band-Aid on a broken system.
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really disappointed with, once again, Care Enhancement Act. To truly lower the costs of insurance
my colleagues across the aisle using As a pediatrician, and a patient with and care, we need to address the under-
this COVID–19 crisis as an opportunity type 1 diabetes, I know how important lying cost drivers of healthcare. Yet,
to push their partisan agenda. You it is to have real access to healthcare. the legislation before us today ignores
would think a crisis like this would The Affordable Care Act was a phe- what is driving prices higher. Instead,
bring us together. nomenal first step. It provided protec- it broadens government subsidies to
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2639
more individuals, including the he was celebrating with his Republican Now, having failed to produce an al-
wealthy, so that, on its face, the price colleagues. ternative, the President and his Repub-
of insurance looks cheaper. But don’t The Republicans talk a good game, lican allies are determined simply to
be fooled by generous tax credits. but they don’t play a game. It is not repeal it entirely. That has been their
These credits will be paid for by all that they don’t play a good game. They position for the last 12 years.
taxpayers when they are passed along don’t play a game. There is no bill I am proud that one of the first acts
to hardworking families in the form of coming from the President of the of our Democrat House majority was to
higher taxes. United States. defend the ACA in the Republican law-
Madam Speaker, I would welcome Madam Speaker, last week, in the suit. Indeed, Americans don’t want to
the opportunity to work with my col- middle of the worst pandemic in our scrap the law. They want to strengthen
leagues on the other side of the aisle on lifetimes, the Trump administration and expand it.
real reforms that will increase choices submitted briefs to the Supreme Court They understand that it is not an op-
for insurance and care options; that in support of a lawsuit by Republican- tion, having healthcare coverage. Pro-
will cut through healthcare monopolies led States seeking to overturn the law tecting your health is not an option.
to increase competition in the market- that provides millions of Americans When Democrats won the majority in
place; that will allow for more person- with access to affordable healthcare. the House, we did so promising to work
alized plans that will better target tax- They offer no substitute. They said to expand coverage, lower out-of-pock-
payer-funded subsidies to the poor, the they were going to, but they have et costs, and provide greater stability
sick, and the vulnerable, not high-earn- never done it. for health insurance marketplaces.
ing individuals; and that would enable In spite of a decade of Republican ef- That is what we promised, and we
a system that fosters innovation in pa- forts—a decade, 10 years—they have picked up 40 net seats. This bill is part
tient care, not stifle it through burden- had to work on this and come up with of that promise.
some government mandate. a plan that all of them are talking Now, we passed another one. It sits
Before I close, I want to touch on my about—‘‘Oh, we want to protect pre- untouched in the Senate, as some of
colleagues’ decision to include the existing conditions.’’ ‘‘We don’t want my Republican colleagues predict for
same government-controlled drug-pric- to have lifetime limits’’—you know, all this one. I understand that. The Repub-
ing scheme in this patchwork of stale these things. licans are not for healthcare being af-
Where is the bill? Where is the meat? fordable, being quality, being acces-
proposals that was passed a few months
It is not here. It hasn’t been offered.
ago. At a time when the world is fight- sible for people. At least, they haven’t
The one bill that was offered and
ing to emerge from a global pandemic, offered a bill to accomplish that objec-
passed in this House was called by the
my colleagues on the other side of the tive, notwithstanding what the Presi-
President of the United States a
aisle believe it is an appropriate time dent said.
‘‘mean’’ bill.
to raise taxes on lifesaving cures by 95 Importantly, among the other provi-
Not our President, their President—I
percent. sions that you have heard about from
mean, he is the President of all of us,
We have already worked, in a bipar- but he is a member of the Republican my colleagues this morning, this legis-
tisan manner, on policy ideas that we Party, just like Obama was a member lation addresses the racial disparities
all agree will help lower drug prices. of the Democratic Party. in healthcare that have become so
Each of those policies was included in We passed an alternative. It was starkly evident during this pandemic.
H.R. 19, the Lower Costs, More Cures signed, and the majority of the Amer- Expanding Medicaid will help close
Act. ican people supported it. As a matter of those disparities, and the bill’s provi-
Madam Speaker, I hope, one day, we fact, 53 percent of independents sup- sion to require Medicaid coverage of
can set the shenanigans aside and bring ported it. maternal healthcare for 12 months
real reforms, like those included in Madam Speaker, when the Supreme postpartum will help reduce disparities
H.R. 19, up for consideration. Court hears oral arguments in the Re- that make African-American women as
Mr. SCOTT of Virginia. Madam publican lawsuit this autumn—in the much as four times as likely to die as
Speaker, I yield 1 minute to the gen- Republicans’ lawsuit; these are Repub- a result of a birth or pregnancy com-
tleman from Maryland (Mr. HOYER), lican AGs—it will hear their arguments plication than White women.
the distinguished majority leader of for taking away protections for those Those disparities aren’t acceptable,
the United States House of Representa- with preexisting conditions, those most and our House majority is taking ac-
tives. vulnerable to COVID–19, at the very tion to address them.
Mr. HOYER. Madam Speaker, I moment healthcare experts predict an- Madam Speaker, I congratulate Mr.
thank the gentleman for yielding. other wave of infections and the start SCOTT. I congratulate Mr. PALLONE. I
Madam Speaker, I have only been on of the flu season. And where do we see congratulate Mr. NEAL. And I con-
the floor a short time, but I am sure the spike? Along the southern border: gratulate Speaker PELOSI.
there have been the repeated opposi- Texas, Florida, Arizona. Moreover, this bill would require the
tion statements that: ‘‘Oh, if only we Madam Speaker, taking away Ameri- Secretary of Health and Human Serv-
could get agreement.’’ ‘‘If only we cans’ coverage and throwing our ices to negotiate over the most expen-
could do this, we would have a wonder- healthcare system into chaos is not sive prescription drugs that do not
ful healthcare program.’’ what the American people want or need have marketplace competition, that do
Madam Speaker, frankly, my friends during this global public health and not have market competition. That is
on the other side of the aisle have had economic crisis. When President what keeps prices down, consumers
12, 14 years, at least, to come up with Trump ran for office—this was before having choices. If they don’t have
a program. he called the bill that the House passed choices, they have to take the drug, no
Madam Speaker, they did come up a ‘‘mean’’ bill, under Republican lead- matter what it costs, which is a key
with a program, and they passed it ership—President Trump falsely prom- component to lowering prices.
through the House—they were in ised that he would offer an alternative That said, I want to be clear that,
charge—and it went to the Senate. The to the Affordable Care Act that was far while we use international measures,
Republicans were in charge of the Sen- less expensive and better quality. we will continue to work with the pa-
ate. Madam Speaker, I ask any of my col- tient and disability community to en-
When they passed it through the leagues if they have seen that bill, ei- sure that our efforts to reduce out-of-
House, they all went down to the White ther side of the aisle, have they seen pocket costs do not have the unin-
House, and they had a big party. ‘‘What that bill. This President has been tended result of rationing lifesaving
dlhill on DSK120RN23PROD with HOUSE
a wonderful deal this is.’’ Lo and be- President for 3.5 years. There is no Re- and life-sustaining treatments or dis-
hold, within 2 weeks, the President, publican bill to make sure that Ameri- criminate against our most vulnerable
who was extolling that bill, called it a cans have affordable quality healthcare communities.
‘‘mean’’ bill. and have them able to get insurance ir- Madam Speaker, I thank all the
That is not me. That is the President respective of preexisting conditions. chairs and their committees that came
of the United States about the bill that There is no such legislation. together to produce this bill. I have
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H2640 CONGRESSIONAL RECORD — HOUSE June 29, 2020
mentioned Chairman PALLONE, Chair- tleman from Maryland (Mr. TRONE), a Ms. FOXX of North Carolina. Madam
man SCOTT, Chairman NEAL, and oth- distinguished member of the Com- Speaker, I reserve the balance of time.
ers, and I thank all the Members who mittee on Education and Labor. Mr. SCOTT of Virginia. Madam
were instrumental in bringing these Mr. TRONE. Madam Speaker, Speaker, I yield 2 minutes to the gen-
policies together, including the many healthcare is a human right. The Af- tleman from Rhode Island (Mr.
freshman Members who ran on fordable Care Act helped us live up to CICILLINE).
strengthening the ACA. that value by giving over 20 million Mr. CICILLINE. Madam Speaker, I
I see Ms. UNDERWOOD on the floor, American people healthcare coverage, thank the gentleman for his extraor-
but there are many others in the fresh- including millions with preexisting dinary leadership. I thank Chairman
man class who have worked very hard. conditions. SCOTT, Chairman NEAL, and Chairman
Why? Because they campaigned on For But still, too many Americans don’t PALLONE.
the People, bringing costs down. have access to good, affordable 122,000 Americans have died from
I urge every Member of the House to healthcare, and drug prices are through COVID–19, nearly 2.6 million are in-
join in supporting this bill. Now is the the roof. fected. And, in the midst of this deadly
time, Madam Speaker, to strengthen One of those Americans is Suzette and historic global health pandemic,
access to high-quality, affordable from Germantown, Maryland. Suzette with infection rates continuing to rise
healthcare, to bring costs down, and to told me that her insulin prices have all across our country, there has never
address the stark racial disparities in skyrocketed over the last year, making been a worse time to try to rip away
our healthcare system that have come it hard to afford a drug that she needs healthcare from the American people.
into full view with COVID–19. to survive. As Elijah Cummings said: But just last week, President Trump
I urge all my colleagues on both sides We are better than that. and my Republican colleagues filed a
of the aisle, if your rhetoric is about The Patient Protection and Afford- pleading in the Supreme Court to take
bringing costs down, if your rhetoric is able Care Enhancement Act will cut away healthcare from 20 million Amer-
about accessibility, if your rhetoric is premiums in half; allow negotiations icans and to gut protections for 135
about equality, walk the walk; don’t for drug prices; and expand Medicaid, a million Americans with preexisting
just talk the talk. Vote for this bill, lifeline for many who need support for conditions.
because it does what you say you want Now, more than ever, Democrats are
mental health and addiction treatment
to do. standing up to fight to protect access
services.
to quality, affordable healthcare. And
b 1345 During a global pandemic, we should
the Patient Protection and Affordable
be acting with compassion for the most
Ms. FOXX of North Carolina. Madam Care Enhancement Act does just that.
vulnerable in our country. This bill
Speaker, I reserve the balance of my It lowers healthcare costs; it protects
does just that. I urge a ‘‘yes’’ vote.
time. Ms. FOXX of North Carolina. Madam patients with preexisting conditions; it
Mr. SCOTT of Virginia. Madam expands Medicaid; and it lowers the
Speaker, I reserve the balance of time.
Speaker, I yield 2 minutes to the gen- cost of prescription drugs.
Mr. SCOTT of Virginia. Madam
tlewoman from Illinois (Ms. UNDER- Our colleagues on the other side of
Speaker, I yield 2 minutes to the gen-
WOOD), a distinguished member of the the aisle have described these ideas as
tlewoman from Nevada (Mrs. LEE), a
Committee on Education and Labor. radical. Only in the Republican Con-
Ms. UNDERWOOD. Madam Speaker, I distinguished member of the Com-
ference is expanding health coverage
rise today in strong support of the Pa- mittee on Education and Labor.
and driving down costs and covering
Mrs. LEE of Nevada. Madam Speak-
tient Protection and Affordable Care more people with preexisting condi-
er, on behalf of the people of Nevada’s
Enhancement Act. tions radical. For the rest of the Amer-
Last June, I visited Kaylee Heap at Third Congressional District, I rise
ican people, it is a basic human right:
her family’s farm in Minooka, Illinois. today to stand up for my constituents’
access to quality, affordable
Mrs. Heap told me: It would be really access to healthcare and lifesaving
healthcare. The Patient Protection and
nice to come home and work on the treatments and support the Patient
Affordable Healthcare Enhancement
farm with my husband and grow our Protection and Affordable Care En-
Act will do just that.
business, but I can’t do that until we hancement Act.
My colleagues have been on a relent-
overcome the obstacle of getting qual- A constituent of mine, Mark, wrote
less campaign to repeal the Affordable
ity, affordable health insurance. to me recently. He is retired and on
Care Act in its entirety and promised
People like Kaylee are why I intro- Medicare, and he is also a diabetic who
they were going to repeal and replace.
duced legislation, the Healthcare Af- requires insulin to survive. He told me
They have only tried to repeal. There
fordability Act, to improve premium that the cost of his insulin is going up
has never been a replacement.
tax credits to make insurance more af- 400 percent, with no warning or expla- Once again, we are stepping into the
fordable to more Americans, including nation. It is life or death for him, be- breach, building on the success of the
those who don’t currently qualify for cause he needs the insulin but can’t af- Affordable Care Act in the midst of a
tax credits. ford it. global health pandemic to drive down
This legislation would reduce pre- This moment should give us all healthcare costs, expand coverage, and
miums by hundreds or thousands of pause. Millions are out of work; thou- protect people with preexisting condi-
dollars for nearly 20 million Ameri- sands are sick and dying from a global tions.
cans, and I am so pleased that it was pandemic; yet lifesaving medications I urge my colleagues to vote ‘‘aye.’’
included in this bill today. are still out of reach for Americans Ms. FOXX of North Carolina. Madam
This bill delivers on our promise to who need them. Speaker, I yield myself the balance of
ensure that all Americans have access It is unbelievable that this adminis- my time.
to quality, affordable healthcare. I tration continues its campaign to take Madam Speaker, propagandists have
urge all of my colleagues to support away people’s healthcare. Seniors like said that if one repeats a lie often
this bill and join me in this effort. Mark deserve better, Nevadans deserve enough, people will soon believe the lie
Ms. FOXX of North Carolina. Madam better, and Americans deserve better. and not the truth. My colleagues are
Speaker, I reserve the balance of time. Medication costs, rising premiums, entitled to their own opinion but not
Mr. SCOTT of Virginia. Madam and junk insurance plans are forcing to their own facts or rewriting history.
Speaker, may I inquire as to how much people to choose between lifesaving I want to repeat some comments
time each side has remaining. treatment and paying their bills. No from my Texas colleague, Mr. BRADY,
The SPEAKER pro tempore. The gen- one in this great country should have who spoke earlier in this debate.
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tleman from Virginia has 11 minutes to make that choice. Republicans support children, sen-
remaining. The gentlewoman from I urge my colleagues to vote for the iors, and patients with preexisting con-
North Carolina has 41⁄2 minutes remain- Patient Protection and Affordable Care ditions.
ing. Enhancement Act, and give every Republicans created the popular Chil-
Mr. SCOTT of Virginia. Madam American access to affordable health dren’s Health Insurance Program that
Speaker, I yield 2 minutes to the gen- care. millions of families rely on today.
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2641
Republicans created the prescription majority and were able to pass a bill. icaid. These concrete steps will provide new
drug program in Medicare to help sen- They actually passed a bill that CBO coverage options to those navigating recent
iors get the medicine they need. scored, and they said that it would in- job loss and economic uncertainty.
Republicans created the first law crease costs 20 percent the first year, Critically, this legislation also empowers
that established protection for patients 20-some-million fewer people would be Medicare to negotiate a better deal on pre-
with preexisting conditions. That law, insured, those with preexisting condi- scription drug prices, which will bring an end
passed in 1996, is the Health Insurance tions would lose some of their protec- to price gouging of American consumers and
and Portability Act of 1996. tions, and the insurance you get is finally allow people to afford the drugs they
We want people to have access to worse than what you have. need.
high-quality, affordable healthcare We can do better than that by pass- As the pandemic continues to challenge our
that fits their needs and make their ing the Patient Protection and Afford- collective public health and well-being, now,
own choices, not what Speaker PELOSI able Care Enhancement Act, and that more than ever, American families need relief
demands for them. is what we should do today by voting from soaring health care and prescription drug
Madam Speaker, the devastating ef- ‘‘yes’’ on this legislation. costs.
fects of COVID–19 are still being felt Madam Speaker, I yield back the bal- I encourage my colleagues to support this
across our Nation, yet today Demo- ance of my time. effort to protect patients, expand access, and
crats are spending time pushing a deep- Ms. JOHNSON of Texas. Madam Speaker, lower health care costs.
ly flawed, partisan bill that is being today, I rise in support of H.R. 1425, the Pa- Mr. CURTIS. Madam Speaker, today, I rise
used to score cheap political points in- tient Protection and Affordable Care Enhance- in opposition to H.R. 1425. Right now, we
stead of working on bipartisan solu- ment Act. This bill will make critical improve- must deliver the most effective treatments to
tions like lowering drug costs, ending ments to our current health care system by patients infected with COVID–19 and all those
surprise billing, and getting our econ- ensuring affordable access to medical services suffering from other life-threatening illnesses.
omy back on its feet. and lifesaving prescriptions. By expanding the Breaking down barriers to receiving timely
We are left with H.R. 1425, a radical insurance affordability subsidies, establishing care must remain our number one priority in
bill which will limit healthcare a federal negotiating authority for lower drug order to halt transmission of the virus.
choices, increase costs, and double prices, and extending Medicaid coverage to H.R. 1425 does the opposite by dramatically
down on the failures of the Affordable crucial populations, this legislation will ensure expanding the role of government through un-
Care Act. No innovation, investment, that our communities can better withstand and constitutional inventions in our pharmaceutical
or solutions, just more of the failed recover from the seismic impact of this industry and broader healthcare system. This
status quo from House Democrats, COVID–19 pandemic. would put our brightest scientific minds in
which will go nowhere after the vote It is inacceptable that during this public handcuffs and threaten their ability to develop
today. health emergency, our federal government future cures for COVID–19 and other life-
Contrary to what Speaker PELOSI should act in any manner except to strengthen threatening diseases.
said, Democrats do not and cannot, in and protect our health system. The current ad- These are especially concerning decisions
this bill, guarantee affordability of ministration’s request last week to the Su- to make without bipartisan input. We have to
healthcare. What they do guarantee is preme Court to overturn the Affordable Care work together in order to deliver solutions that
government control with rationing, Act threatens the very protections and medical give Americans more control over how they
fewer cures, and less freedom for Amer- services that our constituents and commu- are receiving their health care. Solutions could
icans. Republicans believe in just the nities are relying on for life saving care during include expanding access to health savings
opposite. this pandemic. accounts or association health plans to be
Madam Speaker, I strongly urge a As the first registered nurse elected to Con- sold across state lines and with more port-
‘‘no’’ vote on H.R. 1425, and I yield back gress, I can attest to the importance of the Af- ability. I recently introduced legislation to in-
the balance of my time. fordable Care Act in improving our country’s crease access to both options and I encour-
Mr. SCOTT of Virginia. Madam health care, especially through the protections age my Democratic colleagues to join me as
Speaker, I yield myself the balance of for the 133 million Americans living with pre- I look for creative solutions to make health
my time. existing conditions—of which 11.5 million live care more affordable for millions of hard-work-
Madam Speaker, this bill will reduce in my home state of Texas. If our country ing Americans.
the cost of prescription drugs. Ameri- were to lose the gains of the Affordable Care Finally, I want to point out that Congress
cans pay twice as much, three times as Act, all these individuals will have to face un- has already taken unprecedented steps to in-
much, as much as 10 times more than certain insurance markets without critical pro- crease access to care for the uninsured and
those in other countries pay for the tections. It is more abhorrent for any efforts to any American household dealing with the ef-
exact same drugs. This bill will allow be made to destabilize our health system dur- fects of COVID–19. It is critical that our focus
the Department of Health and Human ing a time of crisis, especially since our com- remains defeating this virus, keeping Ameri-
Services to try to negotiate better munities of color are already facing dispropor- cans healthy, and allowing hard-working men
prices. tionate impacts of this virus through higher and women across our great nation to return
Those on the other side have criti- rates of comorbidities and higher reported to work. We cannot place greater strains on
cized reduced prices because they po- rates of hospitalizations and deaths. To further our already over-worked health care system
tentially could reduce investments and jeopardize access to existing health care serv- through one-size-fits-all policy making.
research, but this bill offsets any such ices amidst these compounding factors would Ms. ROYBAL-ALLARD. Madam Speaker,
reductions with significant increases in prove devastating for the health and wellbeing ten years ago, this March, I proudly cast my
investment in research at the National of our minority communities. vote in support of the Patient Protection and
Institutes of Health. Therefore, I am proud to support the Patient Affordable Care Act. The ACA built on the
This bill makes improvements to the Protection and Affordable Care Enhancement promise that was begun with the passage of
Affordable Care Act by reducing pre- Act, and I am committed to fighting for the Medicare in 1965, which represented a mile-
miums, expanding coverage to families, preservation of accessible and quality health stone in our nation’s history by framing
protecting those with preexisting con- care services for the families throughout North healthcare as a universal right for all Ameri-
ditions, and reducing the number of un- Texas. cans.
insured. Ms. MATSUI. Madam Speaker, I rise today Like many of my colleagues at that time, I
We have heard criticisms but no de- to support the Patient Protection and Afford- would have preferred to see the bill go much
scription of a better alternative. able Care Enhancement Act. further towards granting universal access to
We have heard about the 1996 law on This legislation is the collective achievement health care for every man, woman, and child
preexisting conditions, but that did of House Democrats from across the country in this country. Nevertheless, it was an impor-
dlhill on DSK120RN23PROD with HOUSE
nothing in the individual market. And who are working to reverse the Trump Admin- tant first step to improving the quality and af-
that is what the Affordable Care Act istration’s health care sabotage by updating fordability of health services, prioritizing pre-
protects: preexisting conditions in the and improving the Affordable Care Act. vention and the reduction of health disparities,
individual market. This bill expands eligibility for health care and taking the necessary albeit difficult steps
But look at what the CBO said about tax credits to purchase ACA plans and en- to rein in the escalating costs of health care in
the Republican bill when they had the courages remaining states to expand Med- this country.
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H2642 CONGRESSIONAL RECORD — HOUSE June 29, 2020
The intent of the Democrat Majority in the from an estimated 23 million Americans and steps towards delivering drug price relief and
111th Congress was always to build on the threaten coverage for 135 million Americans improving the health and financial security of
ACA and modify and improve its programs with pre-existing medical conditions—all while American seniors and families. Specifically,
and policies. Instead, what followed was at delivering a huge tax cut to millionaires. In my H.R. 1425 requires the federal government to
least 70 Republican led attempts over the next congressional district alone, repealing the ACA negotiate affordable prices for at least 25—
8 years to defund benefits, dismantle pro- would cause 72,000 Oregonians to lose their and eventually 50—prescription drugs, as well
grams, and repeal parts, or all, of the Afford- health insurance and threaten the coverage of as insulin, every year. It also imposes an ex-
able Care Act, with no serious effort to fix 317,000 Oregonians with pre-existing condi- cise tax on drug manufacturers who do not
problems or replace the critical law with a via- tions. This is absurd. comply with this affordable pricing provision.
ble alternative. That’s why I strongly support H.R. 1425’s While I believe these provisions will ulti-
For the last three years, Democrats have provisions to strengthen protections for individ- mately deliver relief to millions of Americans,
watched in frustration as a series of misguided uals with pre-existing conditions, as well as its including seniors, I believe Congress can and
and meanspirited Presidential executive orders reversal of the Trump administration’s expan- must do more to combat rising drug prices
have slashed funding, delayed implementation sion of junk short-term health insurance plans and price-gouging pharmaceutical companies.
of programs, and limited benefits for con- that do not provide coverage for essential To combat this ridiculous practice, I reintro-
sumers. And when President Trump’s ‘‘Repeal medical treatments and drugs—and which are duced H.R. 4640, the Affordable Drug Pricing
and Replace’’ efforts failed, his administration allowed to discriminate against people with for Taxpayer-Funded Prescription Drugs Act,
turned to the courts to declare unconstitutional pre-existing conditions. I am also pleased that which would end price-gouging on prescription
all, or parts, of the ACA. this legislation increases healthcare coverage drugs developed with taxpayer-funded re-
Today, with the Patient Protection and Af- by delivering additional support for states to search. Americans should not pay to develop
fordable Care Enhancement Act, we say expand Medicaid, establish state-based health a drug only to see it put on the shelves in the
ENOUGH IS ENOUGH. This important legisla- insurance marketplaces, and bolster efforts to U.S. at a much higher price than other na-
tion will strengthen and expand the Affordable increase enrollment and help individuals sign tions. I am also co-leading legislation, the
Care Act by including provisions to reduce the up for ACA coverage. Make Medications Affordable by Preventing
cost of prescription drugs, reduce the number I also strongly support this legislation’s ef- Pandemic Pricegouging Act, to prevent price-
of uninsured Americans, expand access to forts to lower Americans’ health insurance gouging for any taxpayer-funded drug or vac-
quality and affordable health coverage, and costs by expanding tax credits to reduce ACA cine developed to treat COVID–19.
protect people with pre-existing conditions. marketplace premiums, placing a cap on pre- Moreover, I have consistently supported leg-
The bill expands Marketplace tax credits to mium costs, allowing more individuals and islation to allow the federal government to ne-
lower health insurance premiums and allows families to qualify for ACA subsidies, and pro- gotiate affordable drug prices for Medicare
more middle-class individuals and families to viding funding for reinsurance initiatives to fur- Part D, and I am also cosponsor of legislation
qualify for subsidies. It expands Medicaid cov- to require the federal government to secure af-
ther lower premiums, deductibles, and other
erage for states who have not taken advan- fordable pricing agreements for all prescription
out-of-pocket costs.
tage of this provision and reverses the Trump This legislation also takes long-overdue drugs, as well as to approve cheaper generic
steps to help combat inequalities in health versions of drugs if manufacturers refuse to
Administration’s expansion of junk health in-
coverage faced by communities of color in Or- negotiate.
surance plans that discriminate against people
The bottom line is that seniors shouldn’t
with pre-existing conditions. The bill also re- egon and throughout the United States. This
have to ration their pills or limit their dosage
quires the federal government to negotiate includes fighting the maternal mortality epi-
because they can’t afford to pay for prescrip-
certain drug prices to ensure consumers have demic by requiring states to extend Medicaid
tions each month, and drug companies should
access to affordable and fair prices for drugs or CHIP coverage to new mothers for 1-year not be free to charge Medicare recipients—or
they depend upon to live healthy and produc- post-partum; improving Medicaid beneficiaries’ any American—prices that are higher than
tive lives. access to primary care physicians; and pro- anywhere else in the world. These practices
According to the Congressional Budget Of- tecting vulnerable populations from losing are wholly unacceptable, and I will continue
fice (CBO), this bill would reduce the number health coverage by ensuring that Medicaid fighting to ensure that every American can af-
of uninsured by 4 million below the current and CHIP beneficiaries receive a full 12 ford the prescription drugs they need.
law, and it would lower individual market pre- months of coverage once enrolled—thereby The SPEAKER pro tempore. All time
miums by 10 percent and drug prices by up to protecting them from interruptions due to fluc- for debate has expired.
55 percent. tuations in their income throughout the year. Pursuant to House Resolution 1017,
Americans have overwhelmingly told us I have always said that the ACA is not per- the previous question is ordered on the
their number one concern is access to high fect, but I believe the law should be reformed bill, as amended.
quality and affordable health care. H.R. 1425 rather than repealed. The original ACA bill that The question is on the engrossment
builds on the ACA and takes the next critical passed the House in 2009, with national ex- and third reading of the bill.
step towards reducing health disparities and changes and a government not-for-profit op- The bill was ordered to be engrossed
providing more families with affordable and tion, was far superior than the final bill that be- and read a third time, and was read the
comprehensive health insurance. I am proud came law. In my opinion, a government-run, third time.
to vote YES for the Patient Protection and Af- not-for-profit health plan would have paved the b 1400
fordable Care Enhancement Act. way to a single-payer system with more com-
Mr. DEFAZIO. Madam Speaker, today I will MOTION TO RECOMMIT
prehensive coverage at a lower cost. That’s
vote in support of H.R. 1425, the Patient Pro- why I have once again introduced legislation, Mr. WALDEN. Madam Speaker, I
tection and Affordable Care Enhancement Act. H.R. 1419, that would establish such a plan have a motion to recommit at the
I am pleased that this legislation bolsters and bring down premium costs. desk.
the Affordable Care Act (ACA) and further pro- I am also once again an original cosponsor The SPEAKER pro tempore. Is the
tects it against years of attempts by the Trump of H.R. 1384, the Medicare for All Act, which gentleman opposed to the bill?
administration and congressional Republicans Mr. WALDEN. Madam Speaker, in its
would transition the U.S. to a universal single-
to undermine and repeal this important current form, I am.
payer system to ensure that everyone has ac- The SPEAKER pro tempore. The
healthcare legislation—and thus take away cess to health insurance coverage, no matter Clerk will report the motion to recom-
health coverage and protections from millions their income. mit.
of Americans—all without ever proposing a Additionally, because of pharmaceutical The Clerk read as follows:
viable replacement. companies’ price gouging, Americans pay Mr. Walden moves to recommit the bill
The timing of this legislation could not be more out-of-pocket for prescription drugs than H.R. 1425 to the Committee on Energy and
more crucial. Just last week, in the midst of a individuals in any other country. Americans Commerce with instructions to report the
global pandemic that has killed more than need lower drug prices now, and Congress same back to the House forthwith with the
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120,000 Americans and threatened the health has the ability to enact important reforms to following amendment:
After section 2, insert the following:
insurance coverage of millions more, the deliver immediate relief. SEC. 3. EFFECTIVE DATE.
Trump administration filed a legal brief to the By incorporating provisions from H.R. 3, the This Act and the amendments made by
Supreme Court supporting a case that would Elijah E. Cummings Lower Drug Costs Now this Act shall not take effect unless the Sec-
fully repeal the ACA. This reckless and heart- Act—which passed the House in December— retary of Health and Human Services, in con-
less move would strip healthcare coverage I believe H.R. 1425 takes some important first sultation with the Commissioner of Food and
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June 29, 2020 CONGRESSIONAL RECORD — HOUSE H2643
Drugs, the Director of the National Insti- House Democrats voted to impose So, based on the claims by Repub-
tutes of Health, and the Director of the Na- these dangerous price controls with licans here today and this motion to
tional Institute of Allergy and Infectious passage of H.R. 3. recommit, my colleagues on the other
Diseases, certifies that no provision of this We also know that one of the side side of the aisle would have you believe
Act and the amendments made by this Act
benefits, shall we say, of adopting so- that we are forced to choose between
will adversely affect research on, develop-
ment of, or approval of any drug (including cialized medicine is you don’t get ac- two competing alternatives: either
any biological product) intended to treat or cess to new medicines when they do be- finding vaccines and treatments for
prevent infection with the virus that causes come available in as timely a manner diseases and viruses like COVID, or re-
COVID–19. as you do here. Compared to the U.S., ducing drug prices that are gouging
The SPEAKER pro tempore. Pursu- in Australia, it takes an average of 19 American families at the pharmacy
ant to the rule, the gentleman from Or- months longer for medicines to become counter every day. This is a false
egon is recognized for 5 minutes in sup- available to patients; for Canada, it is choice.
port of his motion. up to 14 months longer; United King- From the Republican perspective, we
Mr. WALDEN. Madam Speaker, this dom, 11 months longer for those cures have no choice but to allow the phar-
motion should be adopted. It would for cancer, those new medicines on the maceutical industry to continue to go
prevent the bill from upending the very market, revolutionary sort of new in- unchecked and rake in record profits at
progress we are all counting on for our novations we all want. the expense of those who need life-
innovators to develop new vaccines and So all we are asking for here is, be- saving medicines. But it is fear-
therapies to confront this killer fore your bill becomes law—and, by the mongering at its worst, and it is bla-
way, the administration said they will tantly untrue. This Nation can and is
coronavirus.
You see, it simply states the legisla- recommend a veto—before it moves doing both. There is more than enough
tion cannot take effect unless the Sec- through the path, let’s at least make spending in the system to reduce drug
sure that an unintended but dangerous prices and ensure we do not impact re-
retary of Health and Human Serves
consequence of this bill does not take search and development for treatments
certifies that no provision will ad-
effect, and that is let’s make sure that and cures, including a vaccine for
versely impact the research, the devel-
it will not inhibit research and innova- COVID–19.
opment, or the approval of any drug in- We know that most big pharma-
tended to treat or prevent COVID–19. tion for a treatment or cure to COVID–
19. That is what our motion asks for. ceutical companies spend more on mar-
Now, Democrats, with a straight
Madam Speaker, I urge a ‘‘yes’’ vote keting, sales, and overhead than re-
face, come to the floor today to move a search and development, and there is
bill that would do grave damage to on the motion to recommit.
Madam Speaker, I yield back the bal- no reason why American families are
medical innovation. The Congressional forced to pay 3, 5, or 10 times more for
ance of my time.
Budget Office has told us that on many Mr. PALLONE. Madam Speaker, I the same treatments as those in other
occasions. Upwards of 30 to 100 drugs, rise in opposition to the motion to re- countries. It is simply unfair.
depending upon the source, could never commit. That is why new polling has shown
make it into the pipeline. Will that be The SPEAKER pro tempore. The gen- that 9 out of 10 Americans support di-
a cure for COVID or a cure for ALS or tleman from New Jersey is recognized rect negotiations by the Federal Gov-
a cure for cancer? We don’t know, and for 5 minutes. ernment for the price of a treatment
neither do the Democrats bringing it. Mr. PALLONE. Madam Speaker, I for COVID–19 and why people are
But we do know the independent anal- urge my colleagues to vote against the scared that they are going to be gouged
yses show we will not see a lot of new Republican motion to recommit. for coronavirus treatment when it is
medicines. This motion to recommit is a distrac- available, just like they have been so
So let’s make sure one of those new tion, and it provides cover to the phar- often gouged by other drugs that their
medicines is not the cure to COVID or maceutical industry to continue to families have needed to stay healthy.
a treatment to save lives for people raise prices, just as we have seen them So the bottom line, Madam Speaker:
who are on ventilators. That is what do on thousands of drugs this year We can have innovation and lower
our motion to recommit says: Before alone. costs, and that is what this underlying
you move forward with a known inno- Moreover, my Republican colleagues bill does. This bill will establish a fair
vation killer, let’s at least exclude would have you believe that it is the price negotiating program that rewards
treatments and cures for COVID–19. pharmaceutical industry alone that is true innovation by directing the Sec-
Communities are being ravaged, we responsible for innovation and for fund- retary to prioritize a drug’s research
all know these stories. We all share ing innovation in this country, which and development spending, as well as
them with each other about incredible omits the critical role that the Federal the extent to which a drug represents a
damage done to lungs, organs, and lives Government has played and will con- true therapeutic advance over existing
as a result of COVID–19. In the wake of tinue to play in drug development and drugs.
this public health crisis, medical the discovery of novel therapies. Madam Speaker, I urge my col-
innovators have worked at an unprece- Let me be clear, Madam Speaker: leagues to reject the motion to recom-
dented speed to develop safe and effec- The investments in research for mit. We know that, in the last few
tive products so we can safely begin to COVID–19 treatments and vaccines months, drug prices have gone up tre-
open our country back up and eventu- aren’t being put on the backs of the mendously around the country, and
ally return to normal lives. pharmaceutical industry. It is Congress drug prices increasingly take a larger
We have seen public-private partner- and the American taxpayer who have percent of your healthcare cost. People
ships to a degree never seen before. Pri- made unprecedented investments as we simply can’t afford it, and that is why
vate companies are joining forces with race to find a cure for COVID–19. this bill is necessary. Do not believe
competitors, government agencies, and In response to COVID–19, Congress the false choice of my Republican col-
nonprofits, and they have taken on has invested over $8 billion for innova- leagues.
Madam Speaker, I urge my col-
substantial financial risk in order to tive biomedical research development
leagues to vote against the motion to
bring safe and effective vaccines and and the purchase of new vaccines and
recommit.
treatment to patients as quickly as therapeutics, including $4.4 billion in Madam Speaker, I yield back the bal-
possible. the CARES Act, and $3.8 billion in the ance of my time.
But now Democrats, with passage of Supplemental Appropriations Act in The SPEAKER pro tempore. Without
this bill, want to gut innovation in the last month or so. objection, the previous question is or-
America. This Enhancement Act combined dered on the motion to recommit.
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California Life Sciences tells us the with the HEROES Act, which the Sen- There was no objection.
provisions of this bill that were in- ate has still not taken up, would more The SPEAKER pro tempore. The
cluded in H.R. 3 can result in 88,000 in- than double this historic investment, question is on the motion to recommit.
novation tech jobs, R&D jobs going bringing it to over $19 billion. And the The question was taken; and the
away from America to somewhere else. manager’s amendment to this bill is Speaker pro tempore announced that
That is the price of this bill. We know another $2 billion. the noes appeared to have it.
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H2644 CONGRESSIONAL RECORD — HOUSE June 29, 2020
Mr. WALDEN. Madam Speaker, on and rent-arrears, fees charged for those ar- compliance with the formula referred to in
that I demand the yeas and nays. rears, and security and utility deposits) in subsection (h)(1)(A).
The SPEAKER pro tempore. Pursu- accordance with paragraphs (4) and (5) of sec- (e) RENT RESTRICTIONS.—
tion 415(a) of such Act (42 U.S.C. 11374(a)) and (1) INAPPLICABILITY.—Section 576.106(d) of
ant to section 3 of House Resolution this section.
965, the yeas and nays are ordered. title 24, Code of Federal Regulations, shall
(b) DEFINITION OF AT RISK OF HOMELESS-
Pursuant to clause 8 of rule XX, fur- not apply with respect to homelessness pre-
NESS.—Notwithstanding section 401(1) of the
McKinney-Vento Homeless Assistance Act vention assistance made available with
ther proceedings on this question will amounts made available under subsection
be postponed. (42 U.S.C. 11360(1)), for purposes of assistance
made available with amounts made available (a).
f pursuant to subsection (a), the term ‘‘at risk (2) AMOUNT OF RENTAL ASSISTANCE.—In pro-
of homelessness’’ means, with respect to an viding homelessness prevention assistance
EMERGENCY HOUSING PROTEC- with amounts made available under sub-
TIONS AND RELIEF ACT OF 2020 individual or family, that the individual or
family— section (a), the maximum amount of rental
Ms. WATERS. Mr. Speaker, pursuant (1) has an income below 80 percent of the assistance that may be provided shall be the
to House Resolution 1017, I call up the median income for the area as determined by greater of—
bill (H.R. 7301) to prevent evictions, the Secretary; and (A) 120 percent of the higher of—
(2) has an inability to attain or maintain (i) the Fair Market Rent established by the
foreclosures, and unsafe housing condi-
housing stability or has insufficient re- Secretary for the metropolitan area or coun-
tions resulting from the COVID–19 pan- ty; or
sources to pay for rent or utilities due to fi-
demic, and for other purposes, and ask nancial hardships. (ii) the applicable Small Area Fair Market
for its immediate consideration in the (c) INCOME TARGETING AND CALCULATION.— Rent established by the Secretary; or
House. For purposes of assistance made available (B) such higher amount as the Secretary
The Clerk read the title of the bill. with amounts made available pursuant to shall determine is needed to cover market
The SPEAKER pro tempore (Mr. subsection (a)— rents in the area.
CUELLAR). Pursuant to House Resolu- (1) each recipient of such amounts shall (f) SUBLEASES.—A recipient shall not be
tion 1017, the bill is considered read. use— prohibited from providing assistance author-
(A) not less than 40 percent of the amounts ized under subsection (a) with respect to sub-
The text of the bill is as follows: received only for providing assistance for in- leases that are valid under State law.
H.R. 7301 dividuals or families experiencing homeless-
ness, or for persons or families at risk of (g) HOUSING RELOCATION OR STABILIZATION
Be it enacted by the Senate and House of Rep-
homelessness who have incomes not exceed- ACTIVITIES.—A recipient of amounts made
resentatives of the United States of America in
ing 30 percent of the median income for the available pursuant to subsection (a) may ex-
Congress assembled,
area as determined by the Secretary; pend up to 25 percent of its allocation for ac-
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(B) not less than 70 percent of the amounts tivities under section 415(a)(5) of the McKin-
(a) SHORT TITLE.—This Act may be cited as ney-Vento Homeless Assistance Act (42
the ‘‘Emergency Housing Protections and received only for providing assistance for in-
dividuals or families experiencing homeless- U.S.C. 11374(a)(5)), except that notwith-
Relief Act of 2020’’. standing such section, activities authorized
(b) TABLE OF CONTENTS.—The table of con- ness, or for persons or families at risk of
homelessness who have incomes not exceed- under this subsection may be provided only
tents for this Act is as follows: for individuals or families who have incomes
ing 50 percent of the median income for the
Sec. 1. Short title; table of contents. not exceeding 50 percent of the area median
area as determined by the Secretary; and
TITLE I—PROTECTING RENTERS AND (C) the remainder of the amounts received income and meet the criteria in subsection
HOMEOWNERS FROM EVICTIONS AND only for providing assistance to individuals (b)(2) of this section or section 103 of the
FORECLOSURES or families experiencing homelessness, or for McKinney-Vento Homeless Assistance Act
Sec. 101. Emergency rental assistance. persons or families at risk of homelessness (42 U.S.C. 11302). This subsection shall not
Sec. 102. Homeowner Assistance Fund. who have incomes not exceeding 80 percent apply to rent-related costs that are specifi-
Sec. 103. Protecting renters and homeowners of the median income for the area as deter- cally authorized under subsection (a) of this
from evictions and foreclosures. mined by the Secretary, but such recipient section.
Sec. 104. Liquidity for mortgage servicers may establish a higher percentage limit for (h) ALLOCATION OF ASSISTANCE.—
and residential rental property purposes of subsection (b)(1), which shall not (1) IN GENERAL.—In allocating amounts
owners. in any case exceed 120 percent of the area made available pursuant to subsection (a),
Sec. 105. Rural rental assistance. median income, if the recipient states that it the Secretary shall—
Sec. 106. Funding for public housing and ten- will serve such population in its plan; and (A)(i) for any purpose authorized in this
ant-based rental assistance. (2) in determining the income of a house- section—
Sec. 107. Supplemental funding for sup- hold for homelessness prevention assist- (I) allocate 2 percent of such amount for
portive housing for the elderly, ance— Indian tribes and tribally designated housing
supportive housing for persons (A) the calculation of income performed at entities (as such terms are defined in section
with disabilities, supportive the time of application for such assistance, 4 of the Native American Housing Assistance
housing for persons with AIDS, including arrearages, shall consider only in- and Self-Determination Act of 1996 (25 U.S.C.
and project-based section 8 come that the household is currently receiv- 4103)) under the formula established pursu-
rental assistance. ing at such time and any income recently ant to section 302 of such Act (25 U.S.C. 4152),
Sec. 108. Fair Housing. terminated shall not be included; except that 0.3 percent of the amount allo-
Sec. 109. Funding for housing counseling (B) any calculation of income performed cated under this clause shall be allocated for
services. with respect to households receiving ongoing the Department of Hawaiian Home Lands;
TITLE II—PROTECTING PEOPLE assistance (such as medium-term rental as- and
EXPERIENCING HOMELESSNESS sistance) 3 months after initial receipt of as- (II) allocate 0.3 percent of such amount for
Sec. 201. Homeless assistance funding. sistance shall consider only the income that the Virgin Islands, Guam, American Samoa,
Sec. 202. Emergency rental assistance the household is receiving at the time of and the Northern Mariana Islands;
voucher program. such review; and (ii) not later than 30 days after the date of
(C) the calculation of income performed enactment of this Act, obligate and disburse
TITLE I—PROTECTING RENTERS AND the amounts allocated pursuant to clause (i)
with respect to households receiving assist-
HOMEOWNERS FROM EVICTIONS AND in accordance with such allocations and pro-
ance for arrearages shall consider only the
FORECLOSURES vide such recipient with any necessary guid-
income that the household was receiving at
SEC. 101. EMERGENCY RENTAL ASSISTANCE. the time such arrearages were incurred. ance for use of the funds; and
(a) AUTHORIZATION OF APPROPRIATIONS.— (d) 3-YEAR AVAILABILITY.— (B)(i) not later than 7 days after the date
There is authorized to be appropriated to the (1) IN GENERAL.—Each recipient of amounts of enactment of this Act and after setting
Secretary of Housing and Urban Develop- made available pursuant to subsection (a) aside amounts under subparagraph (A), allo-
ment (referred to in this section as the ‘‘Sec- shall— cate 50 percent of any such remaining
retary’’) $100,000,000,000 for an additional (A) expend not less than 60 percent of such amounts under the formula specified in sub-
amount for grants under the Emergency So- grant amounts within 2 years of the date sections (a), (b), and (e) of section 414 of the
lutions Grants program under subtitle B of that such funds became available to the re- McKinney-Vento Homeless Assistance Act
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title IV of the McKinney-Vento Homeless As- cipient for obligation; and (42 U.S.C. 11373) for, and notify, each State,
sistance Act (42 U.S.C. 11371 et seq.), to re- (B) expend 100 percent of such grant metropolitan city, and urban county that is
main available until expended (subject to amounts within 3 years of such date. to receive a direct grant of such amounts;
subsections (d) and (n) of this section), to be (2) REALLOCATION AFTER 2 YEARS.—The Sec- and
used for providing short- or medium-term as- retary may recapture any amounts not ex- (ii) not later than 30 days after the date of
sistance with rent and rent-related costs (in- pended in compliance with paragraph (1)(A) enactment of this Act, obligate and disburse
cluding tenant-paid utility costs, utility- and reallocate such amounts to recipients in the amounts allocated pursuant to clause (i)
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