[Pages H2260-H2267]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

PROVIDING FOR CONSIDERATION OF H.R. 1101, SMALL BUSINESS HEALTH
FAIRNESS ACT OF 2017

Mr. BYRNE. Mr. Speaker, by direction of the Committee on Rules, I
call up House Resolution 210 and ask for its immediate consideration.
The Clerk read the resolution, as follows:

H. Res. 210

Resolved, That upon adoption of this resolution it shall be
in order to consider in the House the bill (H.R. 1101) to
amend title I of the Employee Retirement Income Security Act
of 1974 to improve access and choice for entrepreneurs with
small businesses with respect to medical care for their
employees. All points of order against consideration of the
bill are waived. In lieu of the amendment recommended by the
Committee on Education and the Workforce now printed in the
bill, an amendment in the nature of a substitute consisting
of the text of Rules Committee Print 115-9 shall be
considered as adopted. The bill, as amended, shall be
considered as read. All points of order against provisions in
the bill, as amended, are waived. The previous question shall
be considered as ordered on the bill, as amended, and on any
further amendment thereto, to final passage without
intervening motion except: (1) one hour of debate equally
divided and controlled by the chair and ranking minority
member of the Committee on Education and the Workforce; (2)
the further amendment printed in the report of the Committee
on Rules accompanying this resolution, if offered by the
Member designated in the report, which shall be in order
without intervention of any point of order, shall be
considered as read, shall be separately debatable for the
time specified in the report equally divided and controlled
by the proponent and an opponent, and shall not be subject to
a demand for a division of the question; and (3) one motion
to recommit with or without instructions.

The SPEAKER pro tempore. The gentleman from Alabama is recognized for
1 hour.
Mr. BYRNE. Mr. Speaker, for the purpose of debate only, I yield the
customary 30 minutes to the gentleman from Colorado (Mr. Polis),
pending which I yield myself such time as I may consume. During
consideration of this resolution, all time yielded is for the purpose
of debate only.

General Leave

Mr. BYRNE. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days to revise and extend their remarks.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Alabama?
There was no objection.
Mr. BYRNE. Mr. Speaker, House Resolution 210 provides for
consideration of H.R. 1101, the Small Business Health Fairness Act of
2017.
President Trump promised to repeal and replace ObamaCare, which is
negatively affecting our economy and causing great hardship on the
American people. Congress is responding this week with multiple bills
to do just that.
After years of endless premium increases, we must take steps to make
health insurance more accessible and affordable, including for small
businesses that employ the majority of Americans. H.R. 1101, the Small
Business Health Fairness Act, will do just

[[Page H2261]]

that by helping to level inequalities between large and small
employers, ultimately making health insurance more affordable for
millions of Americans.
Simply put, the Small Business Health Fairness Act will empower small
businesses to band together through association health plans to
purchase health insurance. This will allow them to increase their
bargaining power, negotiating for lower health insurance rates on
behalf of their employees, just like their large competitors do.
Additionally, the bill will allow their plans to fall under the
Employee Retiree Income Security Act of 1974, or ERISA, and the
Department of Labor, just like the large self-funded employer plans,
preempting a myriad of State regulations that often make insurance
unaffordable for small businesses.
The usefulness of this legislation is easy to imagine. For example, a
small accounting firm might employ just three or four people while the
largest firms employ tens of thousands. If that small firm could join
together with others just like it to provide health insurance through
their national association, it could have the same bargaining power and
be subject to the same regulation as the firm with thousands of
employees. This parity means more options and lower costs for employers
and employees.
Mr. Speaker, our Nation's small businesses were hit especially hard
by the passage of ACA. In fact, a 2016 survey by the National
Federation of Independent Businesses found that small businesses
identified the cost of health care as their number one challenge.
An estimated 300,000 small-business jobs were destroyed, and an
estimated 10,000 small businesses closed altogether due to the failed
ObamaCare policies.
Since 2008, 36 percent of all small businesses with fewer than 10
employees have stopped offering healthcare coverage. This has resulted
in less overall healthcare options for working families.
ObamaCare's compliance costs and mandates have resulted in $19
billion in lost wages for small-business employees.
The bottom line is that small businesses--the backbone of our
Nation's economy--and their employees are feeling the pain of
ObamaCare's failures and broken promises.
I meet with these small-business owners from south Alabama every day.
They want to take care of their employees and provide them with high-
quality health insurance. Through enacting the Small Business Health
Fairness Act, we can help thousands of small businesses achieve that
goal.
Mr. Speaker, I also want to point out that this legislation includes
strong protections to ensure association health plans are solvent and
that the families covered by them are indeed protected. A sponsor of a
plan must be a bona fide trade, industry, or professional organization
and can't be established for the purpose of providing medical care.
The sponsor must have existed for a period of at least 3 consecutive
years before providing group health insurance coverage. The association
health plan must be operated by a board of trustees and will be
supervised by the Department of Labor. This will include minimum
capital requirements and a requirement that plans have a stop-loss and
solvency insurance.
Finally and most importantly, the bill prohibits association health
plans from discriminating based upon health status and preexisting
conditions.
Mr. Speaker, the Small Business Health Fairness Act is about ensuring
our Nation's small businesses are afforded the same opportunities given
to large corporations and labor unions. When similar legislation has
been brought to the floor in the past, it has received strong
bipartisan support, as I hope this bill will today.
Ultimately, this bill is just one part of our larger plan to rescue
the American people from the failures of ObamaCare. This week, the
House intends to vote to repeal ObamaCare, along with its mandates and
its taxes.
But we do also understand that the pre-ObamaCare status quo is not
acceptable. That is why the House is already moving to consider bills
to give Americans the freedom, choices, and control they deserve.
Our solutions are built on free market and patient-centered
principles. By getting the government out of the way and increasing
competition, we can draw down costs and help Americans obtain health
care that actually works for them.
Mr. Speaker, I urge my colleagues to support House Resolution 210 and
the underlying bill.
Mr. Speaker, I reserve the balance of my time.

{time} 1400

Mr. POLIS. Mr. Speaker, I yield myself such time as I may consume,
and I thank the gentleman for yielding me the customary 30 minutes.
Mr. Speaker, I rise in opposition to this rule today that provides
for consideration of H.R. 1101, the so-called Small Business Health
Fairness Act of 2017.
This bill, first of all, from a procedural basis, did not allow even
a discussion of the amendments that my Democratic colleagues brought
forward to improve the bill. This rule has something called the
structured amendment process, which basically means that Democrats are
locked out from presenting our ideas for improving this bill. We are
not even allowed a 10-minute debate or a vote on any of the ideas that
many of my colleagues brought forward.
The gentlewoman from Oregon (Ms. Bonamici) proposed an amendment to
require the legislation only take effect if the Congressional Budget
Office determined premiums for older workers wouldn't increase. Sounds
like a reasonable idea to at least debate for an hour, 10 minutes. It
is important to do.
The gentlewoman from California (Mrs. Torres) offered an amendment
that would have required all association health plans to continue the
10 essential health benefits of the Patient Protection and Affordable
Care Act to obtain State certification--again, not even allowed to vote
on her amendment.
The gentleman from New York (Mr. Espaillat) offered an amendment to
allow States to continue regulating any association health plan,
including regulations related to benefits, consumer protections, and
rating restrictions--not allowed.
These amendments would have improved the underlying legislation. They
should have been allowed to proceed to the floor. Unfortunately, the
only amendment that made it in was from the Republican side of the
aisle, and all of the great ideas that Members on my side of the aisle
offered were prevented from being even allowed to be debated under this
restrictive rule.
I find it very troubling that my colleagues on the other side seem to
prefer a partisan vote to collaboration and to considering valuable
proposals that might help improve the quality of health care just
because they happen to come from Democrats.
But there is a bigger issue here. Of course, in addition to the
faulty process, the bill is simply a bad bill and does nothing to
address the problems with the repeal of the Affordable Care Act, which
is pending before this body.
One of the issues raised under this bill is it could lure away young
and healthy workers, creating a distortion in the market. The ACA
changed that practice by requiring health insurance sold through an
association to meet the same insurance standards of coverage sold to
the individual and small group market, preventing cherry-picking and
providing a basic level of protection for consumers. This bill would
roll back that progress, creating a separate set of rules for
association health plans, essentially exempting them from complying
with State regulations.
There is also little evidence that it has even been effective to
expand coverage. That is why many consumer and advocacy groups,
including, for instance, the National Association of Insurance
Commissioners, have come out opposed to this bill.
But even more disturbing is the fact that we are considering a bill
that even its proponents would agree does not in any way, shape, or
form replace the protections of the Affordable Care Act. This is a bill
that is narrow in scope. In fact, when we marked it up in our
committee, the Education and the Workforce Committee, that very same
day, the Energy and Commerce and Ways and Means Committees were marking
up a bill to create a brand-new entitlement program, remove health care

[[Page H2262]]

from 24 million Americans who have it today, and increase costs by 15
to 20 percent for those who are paying for their insurance today.
At that time, the Republican healthcare bill had only been public for
24 hours. When the committees marked it up, we didn't even know how
much the bill cost or how many people would lose coverage as a result.
That information only came later, after committee members voted to
amend or not amend the bill.
Frankly, it is unconscionable to deny people healthcare insurance. It
may be a life-or-death proposition, and we need to do a better job
understanding bills before we vote on them, which is one of the reasons
that we need to make sure we know the cost of this so-called manager's
amendment, these midnight changes to the repeal of the Affordable Care
Act.
What is interesting with this proposed American Health Care Act the
Republicans plan to bring to the floor, it was just reported--and I
will be submitting the article for the Record--that the Republican bill
actually results in more people being uninsured than if ObamaCare were
simply repealed outright.
So rather than repealing it outright, what Republicans are doing is
giving a tax break to billionaires, creating a brand-new entitlement
program, throwing 24 million people off the insurance rolls, and
increasing costs by 15 to 20 percent. It would actually throw less
people off insurance if they simply repealed ObamaCare.
Mr. Speaker, I include in the Record an article from The New York
Times.

[From The New York Times, Mar. 21, 2017]

The Upshot--Public Health

Fewer Americans Would Be Insured With G.O.P. Plan Than With Simple
Repeal

(By Margot Sanger-Katz)

The Congressional Budget Office recently said that around
24 million fewer Americans would have health insurance in
2026 under the Republican repeal plan than if the current law
stayed in place.
That loss was bigger than most experts anticipated, and led
to a round of predictable laments from congressional
Democrats--and less predictable ones from Republican
senators, including Bill Cassidy of Louisiana and John Thune
of South Dakota, who told reporters that the bill needed to
be ``more helpful'' to low-income people who wanted
insurance.
But one piece of context has gone little noticed: The
Republican bill would actually result in more people being
uninsured than if Obamacare were simply repealed. Getting rid
of the major coverage provisions and regulations of Obamacare
would cost 23 million Americans their health insurance,
according to another recent C.B.O. report. In other words, 1
million more Americans would have health insurance with a
clean repeal than with the Republican replacement plan,
according to C.B.O. estimates.
The C.B.O. estimated what would happen after a simple
repeal when it considered a bill that Congress passed last
year. (President Obama later vetoed that bill.) The bill left
parts of Obamacare in place, so the 23 million estimate
didn't come with the kind of detailed analysis that
accompanied last week's score of the American Health Care
Act. But the similarity of the two estimates highlights some
of the difficulties of the current proposal, both for
Democrats, who are strongly criticizing potential coverage
losses, and for the repeal-or-die crowd, who hate the
structure of this new bill.
``It's reaffirmed how exceedingly complicated and
convoluted the approach the House leadership took,'' said Dan
Holler, the vice president for communications and government
relations at Heritage Action, an advocacy group firmly in the
repeal-or-die camp.
Late Monday, House leadership revealed a set of amendments
to the bill, which will be considered when the bill comes up
for a vote. But, if they are adopted, the changes are
unlikely to have major effects on overall coverage numbers.
If anything, the changes might lead to a larger increase in
the number of Americans without health insurance.
The people who would end up without health insurance are
slightly different in the two cases. The current bill would
cause more people to lose employer insurance, while a
straight repeal bill would most likely cause more people who
buy their own coverage to become uninsured. A simple repeal
would be worse for Americans with pre-existing conditions,
but the current bill would be worse for older Americans who
are relatively healthy. Both approaches would lead to major
reductions in the number of Americans covered by Medicaid.
The bill that Congress passed in 2016 is the third
scenario. It would have kept Obamacare's major insurance
regulations on the books, including its rule that health
insurers need to sell insurance at the same price to healthy
and sick customers of the same age. It would have removed
funding for the expansion of Medicaid, dropped subsidies to
help people buy health coverage, and eliminated the
individual and employer mandates in the law.
The results of those changes would be drastic: In a decade,
32 million more people would be without health insurance,
according to the estimates. The C.B.O. essentially said it
was a policy combination that would break the insurance
market, resulting in substantially more people losing
coverage than gained it under Obamacare.
The kind of full repeal that some Republicans are calling
for would, of course, be hard to pass. Even if every member
of their caucus supported the approach, most experts believe
that repealing Obamacare's major insurance provisions would
require a type of legislation that would be vulnerable to a
Senate filibuster, and would thus require at least eight
Democratic votes.
All three approaches would result in meaningful reductions
in the number of Americans with health coverage. But, in the
end, it appears that the long-term effects of the current
Republican plan don't look that different from full repeal.

Mr. POLIS. Mr. Speaker, Margo Sanger-Katz said, in part: ``But one
piece of context has gone little noticed: The Republican bill would
actually result in more people being uninsured than if ObamaCare were
simply repealed. Getting rid of the major coverage provisions and
regulations of ObamaCare would cost 23 million Americans their health
insurance. . . . In other words, 1 million more Americans would have
health insurance with a clean repeal than with the Republican
replacement plan, according to CBO estimates.''
So it is just unclear what the Republicans are trying to do here. If
the goal was to come up with something worse than repealing the
Affordable Care Act, they certainly reached that goal: less people will
have coverage, more tax breaks for billionaires, higher rate increases
for most Americans. On every account, it actually underperforms a
cleaner repeal.
What Democrats wanted to do is improve the Affordable Care Act. And I
want to be clear, none of us have ever argued the Affordable Care Act
is perfect. I pushed for fixes. So many of my Democratic and Republican
colleagues have pushed for fixes to strengthen the law, like repealing
the medical device tax, which adds cost to health care, and altering
the Cadillac tax on insurance premiums.
In the Education and the Workforce Committee, I actually offered
three amendments to show some of the ideas that I and some of my
colleagues had to improve the Affordable Care Act. They offered an
amendment to establish a public option in the exchange, to provide a
baseline of competition in every ZIP Code in this country--defeated on
a partisan vote. I should add that my proposal for a public option--and
I am a cosponsor of the bill to do the same--would actually reduce the
budget deficit by over $50 billion.
I also offered an amendment for pricing transparency to help make the
market in health care work. One of the major market fallacies in health
care is a Byzantine pricing structure where, frequently, different
entities and people are paying different amounts for the same thing. If
we had simple pricing transparency and quality transparency, we would
go a long way towards making markets work in health care--defeated on a
party vote.
Finally, I offered an amendment that would have allowed reimportation
of prescription drugs. When you have a situation where--we have a
popular example of this in the EpiPen, costing Americans who need
access to the EpiPen over $400, and yet in neighboring countries--
Canada, Australia--EpiPens cost $40 or $50, one-tenth as much.
It is not unique to the EpiPen. By no means is that an exception to
the rule. In fact, it is the rule. By allowing reimportation of
prescription drugs, a proposal that was backed in the Senate in a
bipartisan way by many of my Democratic and Republican colleagues as a
budget amendment, we could actually reduce costs in health care, making
the goal of expanding coverage even easier with those reduced costs.
You know, when I think about health care, I think it is important to
think about who in our districts and States it most affects. I think of
Pat Hayward, a constituent in my district who lives in Loveland.
Pat has so many family members who would be directly impacted by the
repeal of the ACA. For instance, her husband has melanoma and over the
years has needed several procedures to remove cancerous cells from his
skin.

[[Page H2263]]

Had those procedures not been done in a timely and efficient manner, it
could cause major complications, including premature death for Pat's
husband.
Prior to the Affordable Care Act, when they tried to change insurance
carriers, her husband was told that any coverage would exclude coverage
of cancers, the very type of coverage he needed, because it was a
preexisting condition. They literally would have had to choose between
bankruptcy or being forced out of their home and into destitution or
not getting the lifesaving melanoma treatments that he needed.
But it is not just Pat's husband who has benefited and perhaps is
alive and thriving today because of the protections of the Affordable
Care Act. Pat's eldest son took advantage of a provision that allowed
him to stay on his parents' plan until he got a job with health
insurance at age 25.
Their younger son has struggled with anxiety and panic attacks, but
thanks to comprehensive mental health treatment and the protections of
the mental health parity that are in the Affordable Care Act--and being
rolled back under the American Health Care Act, the Republican bill to
replace it--their son is now back in college and thriving.
Pat, herself, expressed gratitude. The Affordable Care Act covers
wellness visits and tests like mammograms, which can detect problems
early, reduce costs, and save lives.
I share this story--and Pat wanted me to share her story--because
families like the Haywards are like families in every State, in every
county, in every ZIP Code in the country. American families have faced
their share of medical challenges, as have mine, and I am sure that
yours has as well, Mr. Speaker. Medical challenges crop up
unexpectedly. They don't have any bias toward a political party. They
affect Democrats and Republicans and Independents and Greens and
apathetic voters and diligent participants in our civic system. They
make no distinction.
But the Affordable Care Act is there to make it easier for families
across our country to stay healthy, to get better, to save their lives
so that kids can grow up with their parents healthy, kids can grow up
and be able to go to school and get good jobs.
And like so many of my constituents, Pat told me she would rather see
the current system improved than thrown out entirely, and I agree. That
is why I offered the pricing transparency amendment, the public option
amendment, and the reimportation of prescription drug amendment; and
there are dozens of other ideas to improve the Affordable Care Act from
my side of the aisle. I offered amendments in committee that would have
codified these provisions into law.
I plan to continue to fight to improve access and lower healthcare
costs, but dismantling the Affordable Care Act is simply
counterproductive towards that end.

The Republican proposal to create a brand-new entitlement program
would cause 24 million Americans to lose their insurance--over 1
million more than repealing the Affordable Care Act. For those who are
lucky enough to still have their insurance, it would increase rates by
15 to 20 percent.
It would also, for reasons unknown, have an enormous tax cut for
billionaires and millionaires. We know Republicans want to do that, but
they should do that through a tax bill, not through something that is
supposed to be a healthcare bill--enormous tax cuts. We are not even
talking the wealthiest 1 percent. Most of those tax cuts go to the
wealthiest one-tenth of 1 percent of Americans. That certainly doesn't
help reduce the cost of health care.
Again, this bill can be debated, and, frankly, many of us feel it
presents a problem in the risk pools that remove consumer protections.
There is a solvency issue around some of these groups. There is a
legitimate debate to be had, but we certainly haven't heard anybody
present that somehow this bill is any kind of answer to making health
care more affordable or expanding coverage.
What we have before us over the next couple of days is a bill that
not only is the answer, but is a bill that creates an even bigger
problem. The Republican healthcare bill would dig us in a deeper hole
with regard to health care, leaving more Americans without coverage,
creating a costly, brand-new entitlement program, and raising rates for
those Americans who are lucky enough to still have their insurance
after the Republicans remove it from tens of millions of people.
If that bill is the answer, what is the question?
Is the question, Mr. Speaker: How do we make health care cost more
for American families?
Is the question, Mr. Speaker: How do we have less people covered and
throw 20 million people off of health care insurance?
Is the question, Mr. Speaker: How do we make sure that, rather than
work hard and try to get a raise or work two jobs, Americans are forced
to quit their jobs and be lazy and not work just so that they can have
Medicaid eligibility, which is what the brand-new Republican
entitlement program would do?
Or, is the answer to move forward in a bipartisan way to improve the
Affordable Care Act, a discussion that so many of us are excited to
have.
I was disappointed that my three amendments were shut out in partisan
votes in committee, and I am hopeful that by resetting this process, we
can work together to reduce costs and expand coverage. Defeating the
rule today will be the first step towards accomplishing that.
Mr. Speaker, I reserve the balance of my time.
Mr. BYRNE. Mr. Speaker, I yield myself such time as I may consume.
My colleague from Colorado raised an important question: What are the
Republicans trying to accomplish here? It is pretty simple. We are
trying to give freedom and choice back to the American people who lost
their freedom and choice and control over their healthcare plans, who
lost freedom and control over their health care because of an ill-
considered law passed by this Congress several years ago.
He talked about the cost to American consumers. If you want to pass
something that is going to increase cost to American consumers, this
Congress did that several years ago. Look at the dramatic increase in
healthcare insurance premiums, the dramatic increase in people's
deductibles that have occurred since the Affordable Care Act--the so-
called Affordable Care Act--was passed here in Congress several years
ago.
We are trying to reverse that. We are trying to get control back.
And, in fact, we know from the Congressional Budget Office score that
it will lower premiums by 10 percent. We haven't seen premiums go lower
in years. So if they want to know what we are trying to accomplish, it
is plain on its face.
The gentleman referred to some amendments that he offered in
committee. Every one of those amendments was ruled nongermane.
And for those of us that maybe don't understand a lot about what
``germane'' means, it is pretty simple. You can't offer amendments to a
bill that aren't related to the subject matter of the bill.
The chairwoman of the committee ruled that he offered amendments that
weren't germane to the bill that we have today. So the gentleman didn't
lose because people were trying to lock him out of the process. He just
offered amendments that had nothing to do with the underlying bill.
He talked about the fact that this underlying bill for the rule we
have today will lure away young and healthy workers.

1415

Let me say it again. I said this in my principal remarks. Under this
bill, none of these association health plans can discriminate against
anybody. They can't do that. They can't say we are only going to let
young or healthy people in the plan. They have to admit everyone. So
there is no discrimination here. Everyone will be covered.
And remember how many people in America work for small businesses.
All types of Americans work for small businesses. We are not trying to
hurt them. We are trying to give them more opportunities to get better
health insurance that will cost less money.
And if there was anything in here that would cause discrimination, we
would have heard long and hard about that before this point. I would
suggest to you, Mr. Speaker, that that is not a relevant argument to
this particular bill. Every plan that is going to be

[[Page H2264]]

under this bill must comply with the regulations of the Department of
Labor, just like big corporation plans have to comply with the
regulations of the Department of Labor.
We are simply treating small businesses through these associations
the same way we treat big corporations. We have essentially denied to
the employees of small businesses the same opportunities to get good
health insurance at a lower cost that their colleagues that work for
bigger corporations get.
The reason the bigger corporations have this is because the
Department of Labor comes up with a nationwide rule so you don't have
all these different variations from State to State and allows for those
big companies to do the things that they can do so very well because of
their size to get better health care for an affordable cost for their
employees. We are giving the same thing to these small businesses
through their associations.
And remember, this is not just one bill. We actually just passed a
rule. We will be considering another bill that will exempt, from the
provisions of McCarran-Ferguson, health insurance so we get more
competition into the health insurance market.
This bill is on top of that. It is on top of the AHCA that we will be
considering later this week and other bills that will be coming,
because there are a host of things that we are doing on this side of
the aisle to make sure we restore freedom and choice and affordable
care to the people of our country.
We are not removing people from health insurance in any of the bills
that we are doing. We are giving them the freedom to choose. And that
is what America is really all about: the freedom to choose.
Right now we are coercing, by law, people to go out and buy health
insurance that they don't want. That shouldn't be done in America. We
are going to give them their freedom back. And if they chose not to buy
health insurance, that is their right as Americans. That is not taking
something away from somebody. That is giving them their freedom back.
So I would suggest to the gentleman that, if he wants to look for
something that is going to help the workers of America, this bill and
the other bills that our side of the aisle are proposing will do just
that.
Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr.
Dunn).
Mr. DUNN. Mr. Speaker, I thank my friend, the gentleman from Alabama,
for yielding me time.
Mr. Speaker, I rise today in support of H.R. 1101, the Small Business
Health Fairness Act.
As a surgeon in north Florida, I witnessed, firsthand, the disaster
that is ObamaCare. After ObamaCare was passed and implemented, small
medical practices across the country were faced with new, crippling
regulations that threatened their very existence.
I ran a small urology practice in Panama City and faced the very
devastation that these new regulations on small business imposed.
Thankfully, I was able to work with several other small practices to
create the Advanced Urology Institute, a 45-physician practice with
over 400 employees and offices throughout north Florida. Cooperation
and pooling of our resources allowed our practice to reduce costs and
to better serve our patients.
My experience underscores why the Small Business Health Fairness Act
is so crucial. The Small Business Health Fairness Act allows small
businesses to operate under the same principle when purchasing health
insurance for their employees.
By joining together across State lines through associations, small
businesses can achieve the economies of scale enjoyed by big businesses
and unions when purchasing health care. It will empower small
businesses to purchase better plans at a lower cost, which means
working families can get the care they need at a price they can afford.
It is time to put small business employees on a level playing field
with those of large businesses and those in unions. The health
insurance market and this bill does just that.
Mr. POLIS. Mr. Speaker, I yield myself as much time as I may consume.
Mr. Speaker, first of all, amendments that were brought forward by
Ms. Bonamici, germane. Republicans shut it down, didn't allow a debate.
Amendment brought forward by Norma Torres for this very bill,
germane--not allowed to be debated for not even 10 minutes, not 5
minutes, not even 1 minute. Mrs. Torres wasn't even allowed to offer
her amendment under this rule that only allowed Republican amendments.
Finally, Mr. Espaillat's amendment to this bill, yes, germane. He
was, nevertheless, shut out in a party-line vote by the Rules Committee
and not allowed to present his amendment before the floor that would
simply allow States to continue protecting the benefits and consumer
protections and rating restrictions in associated health plans, very
simply.
Mr. Speaker, we are here considering the rule for H.R. 1101 and we
still don't have a cost estimate from our nonpartisan experts at CBO.
We certainly believe this legislation will increase premiums for the
middle class and seniors, but we don't have any idea how much so. It is
becoming a pattern, Mr. Speaker.

Two weeks ago, the Republican majority pushed ahead with their
healthcare repeal bill without a cost estimate. A week later, it turned
out it will cost 24 million Americans their insurance and 15 to 20
percent increases for those who would still have it.
Late last night, there was a backroom, secretive manager's amendment
that was proposed which we don't know the cost of or how it would
affect coverage, and it is irresponsible for the Republicans to move
forward without knowing the effect of the bill as amended.
If we defeat the previous question, I will offer an amendment to the
rule that would require a CBO cost estimate that analyzes the impact of
any legislation amending or repealing the Affordable Care Act, as well
as the impact of any manager's amendment to that legislation, to be
made publicly available before the bill may be considered on the House
floor.
Mr. Speaker, I ask unanimous consent to insert the text of my
amendment in the Record, along with extraneous material, immediately
prior to the vote on the previous question.
The SPEAKER pro tempore (Mr. Mooney of West Virginia). Is there
objection to the request of the gentleman from Colorado?
There was no objection.
Mr. POLIS. Mr. Speaker, I yield 3 minutes to the distinguished
gentlewoman from California (Ms. Lee) to discuss our proposal to make
sure we actually know the cost of what is before this body.
Ms. LEE. Mr. Speaker, I first want to thank the gentleman from
Colorado for yielding and for his tireless advocacy on behalf of the
American people.
Mr. Speaker, I rise in opposition, first, to this terrible rule, of
course, which made no Democratic amendments in order, but also in
strong support of Congressman Polis' amendment that requires the
nonpartisan Congressional Budget Office to score the final bill, which
is the bill to take away health care from 24 million people, to score
it as amended by the Republican manager's amendment before the bill is
on the House floor.
This clearly is nothing new for Republicans, though. In fact, just 2
weeks ago, Republicans shamefully pushed ahead with the markup of their
terrible ACA repeal bill without a score from the Congressional Budget
Office. And this week, on the seventh anniversary of the Affordable
Care Act, Republicans' terrible plan to repeal this lifesaving
legislation will make it to the House floor.
One thing is clear. Republicans' proposals, of course written in
secret back rooms, would be a disaster for struggling families,
seniors, people with disabilities, low-income individuals, the poor,
and the middle class.
It would, yes, rip away health care from 24 million people, reduce
benefits, increase rates for those who can least afford this, and
transfer $600 billion in tax cuts to the very wealthy. That is
outrageous, but it gets even worse.
Late last night, in secret back rooms, Republicans introduced a
dangerous manager's amendment that doubles down on the war on women's
health and the poor, low-income, and struggling families.
Yes, once again, Republicans are attempting to move forward with a
vote on the final GOP's take away health

[[Page H2265]]

care from 24 million Americans, a bill that includes a manager's
amendment, without an updated Congressional Budget Office score.
The American people deserve to know the full damage of this
disastrous bill. I urge my colleagues to vote ``no'' on the previous
question and support Congressman Polis' amendment to ensure that we
have updated Congressional Budget Office scores before this bill is
brought to the House floor.
I thank the gentleman for this amendment, and I thank him for
yielding me time.
Mr. BYRNE. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, the manager's amendment that has been referred to was
put on a public website last night. Everyone in the House of
Representatives will have 3 days to read the manager's amendment. There
is nothing secret about it.
Bills are not written in front of cameras. They are written so that
they can be put on public websites for all of us to see it. This
manager's amendment was handled like many, many other manager's
amendments are handled, including the way manager's amendments have
been handled by the other side when they were in the majority.
Let's remember, in 2010 when the reconciliation bill was passed that
established the ACA, no amendments were allowed on the floor--none,
zero. So if there is a precedent that has been set in this House, it
was set by my friends on the other side of the aisle when they passed
the Affordable Care Act and wouldn't allow any amendments by any Member
of the House. That is the precedent.
There is nothing new about the way this manager's amendment was
handled. It was handled the way manager's amendments are handled
virtually all the time. Everybody in this House now has a copy of it,
has plenty of time to read it and ask questions about it. Nothing
secret going on here.
The truth of the matter is that we are moving forward with our plan,
as we said we were, to repeal and replace ObamaCare, to give freedom
and choice back to the people of America so that patients control their
health care, not a bureaucrat in Washington.
I reserve the balance of my time.
Mr. POLIS. Mr. Speaker, I yield myself as much time as I may consume.
Mr. Speaker, first of all, over 150 amendments by Democrats were
rejected to this healthcare bill before us today, contrary to the
process of 8 years ago when over 120 Republican amendments were not
only made in order, but were actually incorporated into the healthcare
bill despite the fact that, for final passage, not a single Republican
voted for it.

So when we talk about the record and the precedent, there couldn't
more of a night-and-day difference between what is occurring today
where Democrats are locked out and the effort 8 years ago where
Republican ideas were welcomed in the process.
I also want to ask my colleague from Alabama--I was hoping that he
would yield me the time to do so, and I will have to yield him time for
an answer--he mentioned that this manager's amendment has already been
posted and we will have 3 days to look at it. I just want to get his
assurance that the version that we saw posted is the actual version
that will be brought to the Rules Committee and presented on the floor
and there will be no further changes to the manager's amendment, if the
gentleman can assure me of that.
Mr. BYRNE. Will the gentleman yield?
Mr. POLIS. I yield to the gentleman from Alabama.
Mr. BYRNE. As far as I know, speaking back to the gentleman from
Colorado, the manager's amendments that were posted last night are
going to be the manager's amendments that we will consider tomorrow in
the Rules Committee.
Mr. POLIS. Reclaiming my time, Mr. Speaker, I also would like to ask
if we are going to have a score from the Congressional Budget Office
prior to the House having to vote on that manager's amendment?
I yield, for an answer, to the gentleman from Alabama.
Mr. BYRNE. Mr. Speaker, I am ready to answer the question.
We believe that we will be receiving the CBO table prior to the vote
on the floor of the House of Representatives.
Mr. POLIS. Mr. Speaker, reclaiming my time, again, that simply
confirms what our previous question would simply require, that before
the bill is voted on we will simply know how much it costs and who it
impacts. What could be more important than finding that out.
I think it is important to note that Democrats have been shut out of
the process, at the committee level, in the amendments I offered. Even
the germane amendments of this particular bill before us today,
Democrats were locked out.
Rather than allow Members of both parties to participate in reducing
the costs of health care and increasing coverage, Republicans have come
up with a bill that actually increases costs and decreases coverage.
Mr. Speaker, I reserve the balance of my time.
Mr. BYRNE. Mr. Speaker, from what I saw in the CBO score of the bill,
the AHCA bill actually reduces government spending, reduces taxes, and
reduces health insurance premiums over the window of the CBO score.

{time} 1430

So it does the exact opposite of what the gentleman suggested. It
does exactly what the American people sent us here to do.
Mr. Speaker, I reserve the balance of my time.
Mr. POLIS. Mr. Speaker, I yield myself the balance of my time.
Mr. Speaker, the statistics we are talking about, the fact that it
will cost Americans 15 to 20 percent more to get health care, the fact
that it will cost 24 million Americans their insurance, these are not
statistics that are made up by some group that wants to oppose the
Republican effort. They are facts that are arrived upon by the
Congressional Budget Office, the head of which was appointed by a
Republican. They do diligent work to determine how much bills cost and
what their effect is.
Now, of course, you know, those are best estimates. Maybe, instead of
24 million people who will lose coverage under the Republican
healthcare bill, maybe it will be 25 million, maybe it will be 23
million. There is always a little bit of variation on what those
predictions are.
But whether it is 23 million or 25.6 million, the fact that
Americans--millions, tens of millions of Americans--will lose coverage
under this Republican bill should be a flashing warning sign that it is
time to slow down and work in a collaborative manner to improve the
Affordable Care Act, rather than create a brand new entitlement program
that throws 24 million people off the insurance rolls, and increases
the cost for those who remain by 15 to 20 percent.
This bill immediately before us is a diversion from the real story in
health care. In my home State alone, 600,000 Coloradans would likely
lose coverage if the American Health Care Act is rammed through
Congress, as my Republican colleagues intend to do.
The American Health Care Act would roll back important protections
and coverage gains. It would create a brand new entitlement program,
while delivering record tax breaks for billionaires in New York and
California.
It is clear that this bill threatens the health and welfare of
hundreds of thousands of families in Colorado alone, tens of millions
across the country. It is time that we get this process right and slow
down, rather than cramming a midnight bill through the House of
Representatives that we don't even know the cost of, before we are
voting on it.
This is simple, Mr. Speaker. Democrats are excited to roll up our
sleeves and work together to create a plan that will reduce healthcare
costs. If you don't like the amendment I offered for allowing
reimportation of prescription drugs, let's talk about other options.
What about Medicare negotiating prescription drug rates? What about
removing tax deductibility for the advertisements for pharmaceutical
companies?
What about expediting approval process at the FDA, which President
Trump himself mentioned in this very Chamber as a proposal that can
reduce the cost of approving drugs from the $1.2 billion it costs
today, which is passed along to consumers, to a much lower cost,
thereby passing the savings along to consumers.

[[Page H2266]]

There are plenty of good ideas the Democrats and Republicans can work
together on. None of them are this bill before us today. None of them
are in the repeal of the Affordable Care Act. So let's just stop this
ridiculous partisan process.
I don't want 24 million Americans to be victims of partisanship in
Washington. I don't want other Americans who pay for their healthcare
insurance to be victims of partisanship in Washington.
I want to make sure that people in my district who are working hard
and only able to afford coverage under the Affordable Care Act because
of the healthcare subsidies are not forced into medical bankruptcy and
to give up their jobs and rely on Medicaid because of Republican
efforts to ram through this brand new entitlement program.
Let's get this right. There is plenty of opportunity to work together
to reduce costs and expand coverage. The American Health Care Act does
the exact opposite. It increases costs and reduces coverage.
And instead of these incremental bills, like this so-called Small
Business Health Fairness Act, which actually winds up removing
protections and pushing more costs onto working families and seniors,
we should improve upon and fix the Affordable Care Act that we put in
place 7 years ago. We should support innovation to produce healthier
outcomes, to reduce costs, and, yes, to expand coverage across our
country.
We have a unique opportunity in this Congress to put partisanship
behind us, to work together to make affordable health care a reality
for every American family. Because you know what? When you have a
preexisting condition, like I talked about Pat's husband in my district
who suffers from melanoma, it doesn't matter whether he is a Republican
or a Democrat or Independent or whether he is not even registered at
all.
What matters is that he is a father to two children, a husband to his
wife, and he wants the ability to work with dignity, support himself,
and have medical insurance to receive his lifesaving monthly injections
that allow him to maintain his quality of life and continue to work and
pay taxes and support his kids and family. That is what healthcare
coverage is all about.
So let's stop this silly partisanship. This Republican American
Health Care Act actually kicks more people off of the healthcare rolls
than simply repealing ObamaCare. By creating this brand new entitlement
program, they are actually costing an additional 1 millions Americans
their healthcare insurance.
But the answer is not to cost 23 million people their healthcare
insurance. It is not to take it away from 24 million people. You know
what the answer is, Mr. Speaker, is to provide a way that more people
can work hard and pay into the system, and that we decrease the number
of Americans who lack access to healthcare insurance which, in turn,
reduces the costs for the rest of us because of the cost shifting that
occurs within health care.

Mr. Speaker, I know so many of my friends on the Republican and
Democratic side of the aisle, dedicated public servants with thoughtful
ideas that they have based on their life experiences, that they want to
present before this body to reduce the cost of health care. Let's let
them do it. Let's have an open process.
So, 150 amendments from Democrats were shot down in committees, not
even allowed to be debated, not even allowed to be included in this
healthcare bill. Three of mine were shot down. In this very rule today,
amendments by Mr. Espaillat and Ms. Bonamici were not even allowed to
be debated.
The American people want health care to be affordable, and they want
Republicans and Democrats to work together to accomplish that end.
Let's vote ``no'' on this rule. Let's reset the process. Let's fix
health care. Let's expand coverage. Let's reduce costs. I look forward
to working with my colleagues on both sides of the aisle to accomplish
those important goals that my constituents have sent me here to work
on.
I urge my colleagues to vote ``no'' on the previous question so we
can know the cost of any manager's amendment before we vote on it; to
vote ``no'' on the rule, and to vote ``no'' on the underlying bill.
Mr. Speaker, I yield back the balance of my time.
Mr. BYRNE. Mr. Speaker, I yield myself such time as I may consume.
I certainly agree with my colleague from Colorado that we should
avoid silly partisanship, and I hope that that means we won't see silly
partisan procedural motions and points of order between now and the end
of the week. We have seen plenty of those up until this point in time
by our friends on the other side of the aisle, and I hope that his
statement means we won't see any more since he believes that silly
partisanship is bad for this body and the consideration of these
important healthcare bills.
We are not here today to talk about the AHCA. We are here today to
talk about the Small Business Health Fairness Act. That is what this
rule covers.
Let me go over again what has happened to small businesses, but, more
importantly, what has happened to the people who work for small
businesses. An estimated 300,000 small-business jobs were destroyed by
ObamaCare; 10,000 small businesses closed because of ObamaCare.
Since 2008, 36 percent of small businesses that have fewer than 10
employees have stopped offering healthcare coverage altogether.
ObamaCare's compliance costs and mandates have resulted in $19 billion
in lost wages for small-business employees.
The majority of people in this country work for small businesses. We
are trying to give them a fair shake. We are trying to give them their
freedom and their choice back. We are trying to give them affordable
care because their freedom and their choice and the affordability of
their care has evaporated over the last several years.
Ask anybody in America. They come up to me all the time in my
district and tell me this.
We, through this bill and the other bills we are considering, are
repairing the damage done to the people of America by ObamaCare.
Now, my colleagues can throw up dilatory points of order and other
procedural items later on if they want to engage in silly partisanship,
or we can get down to the business of taking care of the workers in
America.
This bill, or a concept like this bill, has been on this floor before
and enjoyed bipartisan support. If we are going to drop silly
partisanship, let's drop it right now on this rule and on this bill,
and adopt it for the good of the workers in these small businesses
throughout America.
Mr. Speaker, I again urge my colleagues to support House Resolution
210 and the underlying bill.
The material previously referred to by Mr. Polis is as follows:

An Amendment to H. Res. 210 Offered by Mr. Polis

At the end of the resolution, add the following new
section:
Sec. 2. In rule XXI add the following new clause:
13. (a) It shall not be in order to consider a measure or
matter proposing to repeal or amend the Patient Protection
and Affordable Care Act (PL 111-148) and the Health Care and
Education Affordability Reconciliation Act of 2010 (PL 111-
152), or part thereof, in the House or in the Committee of
the Whole House on the state of the Union unless an easily
searchable electronic estimate and comparison prepared by the
Director of the Congressional Budget Office is made available
on a publicly available website of the House.
(b) It shall not be in order to consider a measure or
matter proposing to repeal or amend the Patient Protection
and Affordable Care Act (PL 111-148) and the Health Care and
Education Affordability Reconciliation Act of 2010 (PL 111-
152), or part thereof, in the House or in the Committee of
the Whole House on the state of the Union, that is called up
pursuant to a rule or order that makes a manager's amendment
in order or considers such an amendment to be adopted, unless
an easily searchable updated electronic estimate and
comparison prepared by the Director of the Congressional
Budget Office reflecting such amendment is made available on
a publicly available website of the House.
(c) It shall not be in order to consider a rule or order
that waives the application of paragraphs (a) or (b).
____

The Vote on the Previous Question: What It Really Means

This vote, the vote on whether to order the previous
question on a special rule, is not merely a procedural vote.
A vote against ordering the previous question is a vote
against the Republican majority agenda and a vote to allow
the Democratic minority to

[[Page H2267]]

offer an alternative plan. It is a vote about what the House
should be debating.
Mr. Clarence Cannon's Precedents of the House of
Representatives (VI, 308-311), describes the vote on the
previous question on the rule as ``a motion to direct or
control the consideration of the subject before the House
being made by the Member in charge.'' To defeat the previous
question is to give the opposition a chance to decide the
subject before the House. Cannon cites the Speaker's ruling
of January 13, 1920, to the effect that ``the refusal of the
House to sustain the demand for the previous question passes
the control of the resolution to the opposition'' in order to
offer an amendment. On March 15, 1909, a member of the
majority party offered a rule resolution. The House defeated
the previous question and a member of the opposition rose to
a parliamentary inquiry, asking who was entitled to
recognition. Speaker Joseph G. Cannon (R-Illinois) said:
``The previous question having been refused, the gentleman
from New York, Mr. Fitzgerald, who had asked the gentleman to
yield to him for an amendment, is entitled to the first
recognition.''
The Republican majority may say ``the vote on the previous
question is simply a vote on whether to proceed to an
immediate vote on adopting the resolution . . . [and] has no
substantive legislative or policy implications whatsoever.''
But that is not what they have always said. Listen to the
Republican Leadership Manual on the Legislative Process in
the United States House of Representatives, (6th edition,
page 135). Here's how the Republicans describe the previous
question vote in their own manual: ``Although it is generally
not possible to amend the rule because the majority Member
controlling the time will not yield for the purpose of
offering an amendment, the same result may be achieved by
voting down the previous question on the rule. . . . When the
motion for the previous question is defeated, control of the
time passes to the Member who led the opposition to ordering
the previous question. That Member, because he then controls
the time, may offer an amendment to the rule, or yield for
the purpose of amendment.''
In Deschler's Procedure in the U.S. House of
Representatives, the subchapter titled ``Amending Special
Rules'' states: ``a refusal to order the previous question on
such a rule [a special rule reported from the Committee on
Rules] opens the resolution to amendment and further
debate.'' (Chapter 21, section 21.2) Section 21.3 continues:
``Upon rejection of the motion for the previous question on a
resolution reported from the Committee on Rules, control
shifts to the Member leading the opposition to the previous
question, who may offer a proper amendment or motion and who
controls the time for debate thereon.''
Clearly, the vote on the previous question on a rule does
have substantive policy implications. It is one of the only
available tools for those who oppose the Republican
majority's agenda and allows those with alternative views the
opportunity to offer an alternative plan.

Mr. BYRNE. Mr. Speaker, I yield back the balance of my time, and I
move the previous question on the resolution.
The SPEAKER pro tempore (Mr. Duncan of Tennessee). The question is on
ordering the previous question.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. POLIS. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further
proceedings on this question will be postponed.

____________________