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116th Congress   }                                     {  Rept. 116-43
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                     {        Part 2

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



 
    PROVIDING THAT THE RULE ENTITLED ``SHORT-TERM, LIMITED DURATION 
               INSURANCE'' SHALL HAVE NO FORCE OR EFFECT

                                _______
                                

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

                                _______
                                

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

                              R E P O R T

                             together with

                            DISSENTING VIEWS

                        [To accompany H.R. 1010]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 1010) to provide that the rule entitled ``Short-
Term, Limited Duration Insurance'' shall have no force or 
effect, having considered the same, report favorably thereon 
without amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
   I. Purpose and Summary.............................................2
  II. Background and Need for the Legislation.........................2
 III. Committee Hearings..............................................3
  IV. Committee Consideration.........................................3
   V. Committee Votes.................................................3
  VI. Oversight Findings..............................................5
 VII. New Budget Authority, Entitlement Authority, and Tax Expenditure5
VIII. Congressional Budget Office Estimate............................5
  IX. Federal Mandates Statement......................................8
   X. Statement of General Performance Goals and Objectives...........8
  XI. Duplication of Federal Programs.................................8
 XII. Committee Cost Estimate.........................................8
XIII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits.....8
 XIV. Advisory Committee Statement....................................8
  XV. Applicability to Legislative Branch.............................8
 XVI. Section-by-Section Analysis of the Legislation..................8
XVII. Changes in Existing Law Made by the Bill, as Reported...........8
XVIII.Dissenting Views................................................9


                          PURPOSE AND SUMMARY

    H.R. 1010, a bill to provide that the rule entitled `Short-
Term, Limited-Duration Insurance' shall have no force or 
effect, was introduced on February 6, 2019, by Reps. Castor (D-
FL), Barragan (D-CA), Horsford (D-NV), Moore (D-WI), Underwood 
(D-IL), and DeSaulnier (D-CA), and referred to the Committee on 
Energy and Commerce.
    The goal of H.R. 1010 is to prohibit the Department of 
Health and Human Services (HHS), Department of Treasury (the 
Treasury), and the Department of Labor (DOL) from taking any 
action to implement, enforce, or otherwise give effect to the 
Short-Term, Limited Duration Insurance (STLDI) final rule. The 
bill would also prohibit the Secretaries of HHS, the Treasury, 
and DOL from promulgating any substantially similar guidance or 
rule.

                  BACKGROUND AND NEED FOR LEGISLATION

    On August 3, 2018, HHS, the Treasury, and DOL issued the 
STLDI final rule to expand the availability of STLDI plans.\1\ 
The final rule extended the maximum duration of STLDI plans 
from 3 months to up to 12 months. The final rule allows 
insurers to renew STLDI plans further for up to 36 months.
---------------------------------------------------------------------------
    \1\Department of Health and Human Services, Department of the 
Treasury, and Department of Labor, Short-Term, Limited-Duration 
Insurance, 83 Fed. Reg. 38212 (Aug. 03, 2018).
---------------------------------------------------------------------------
    STLDI plans are exempt from all of the consumer protection 
provisions and benefit standards contained in Title I of the 
ACA. These plans are exempt from the ACA's guaranteed 
availability and renewability provisions, community rating, ban 
on discrimination based on health status, and the prohibition 
on pre-existing conditions exclusions. STLDI plans are also not 
subject to the ACA's prohibition on annual and lifetime 
coverage limits, and annual out-of-pocket limits. Lastly, STLDI 
plans are not required to cover the ACA's ten categories of 
essential health benefits, including prescription drugs, 
hospitalization, maternity coverage, and mental health and 
substance use disorder treatment.
    The August 2018 final rule also allows STLDI plans to be 
sold alongside insurance plans that comply with the ACA's 
consumer protections contained in Title I. In the final rule, 
HHS, DOL, and the Treasury all conclude that the policy changes 
``could lead to further worsening of the risk pool by keeping 
healthy individuals out of the individual market for longer 
periods of time, increasing premiums for individual market 
plans and may cause an increase in the number of individuals 
who are uninsured.\2\ The final rule estimated that 200,000 
individuals previously enrolled in the ACA marketplace coverage 
will purchase STLDI instead in 2019, causing average individual 
market premiums to increase. Other nonpartisan estimates, 
including the Congressional Budget Office, projected a more 
significant impact on the individual market.\3\
---------------------------------------------------------------------------
    \2\Id.
    \3\Congressional Budget Office, How CBO and JCT Analyzed Coverage 
Effects of New Rules for Association Health Plans and Short-Term Plans 
(Jan. 2019) (https://www.cbo.gov/system/files?file=2019-01/54915-
New_Rules_for_AHPs_STPs.pdf).
---------------------------------------------------------------------------

                           COMMITTEE HEARINGS

    For the purposes of section 103(i) of H. Res. 6 of the 
116th Congress, the following hearing was used to develop or 
consider H.R. 1010:
    On February 13, 2019, the Subcommittee on Health held a 
hearing on H.R. 1010, entitled ``Strengthening Our Health Care 
System: Legislation to Reverse ACA Sabotage and Ensure Pre-
Existing Conditions Protections.'' The Subcommittee received 
testimony from the following witnesses:
           Katie Keith, Associate Research Professor 
        and Adjunct Professor of Law, Georgetown University;
           Jessica Altman, Commissioner, Pennsylvania 
        Insurance Department; and
           Grace-Marie Turner, President, Galen 
        Institute.

                        COMMITTEE CONSIDERATION

    H.R. 1010, a bill to provide that the rule entitled 
``Short-Term, Limited Duration Insurance'' shall have no force 
or effect, was introduced on February 6, 2019, by Rep. Castor 
(D-FL), and referred to the Committee on Energy and Commerce. 
The bill was subsequently referred to the Subcommittee on 
Health on February 7, 2019. Following legislative hearings, the 
Subcommittee met, pursuant to notice, on March 26, 2019, in 
open markup session on H.R. 1010 for consideration of the bill. 
Subsequently, the Subcommittee on Health agreed to a motion by 
Ms. Eshoo, Chairwoman of the Subcommittee, to favorably forward 
H.R. 1010 to the full Committee on Energy and Commerce, without 
amendment.
    The full Committee met in open markup session, pursuant to 
notice, on April 3, 2019, to consider H.R. 1010. An amendment 
by Mr. Johnson (R-OH) was defeated by a voice vote. At the 
conclusion of consideration and markup of the bill, the 
Committee on Energy and Commerce agreed to a motion by Mr. 
Pallone, Chairman of the Committee, to order H.R. 1010 
favorably reported to the House, as introduced, by a record 
vote.

                            COMMITTEE VOTES

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list each record vote 
on the motion to report legislation and amendments thereto. The 
Committee advises that there was one record vote taken on H.R. 
1010 on a motion by Mr. Pallone ordering H.R. 1010 favorably 
reported to the House, as introduced. The motion on final 
passage of the bill was approved by a record vote of 30 yeas to 
22 nays. The following are the record votes taken during 
Committee consideration, including the names of those members 
voting for and against:

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

                           OVERSIGHT FINDINGS

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

              NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY,
                          AND TAX EXPENDITURES

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

                  CONGRESSIONAL BUDGET OFFICE ESTIMATE

    With respect to the requirements of clause (3)(c)(3) of 
rule XIII of the Rules of the House of Representatives and 
section 402 of the Congressional Budget Act of 1974, the 
Committee has received the following cost estimate for H.R. 
1010 from the Director of the Congressional Budget Office:

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, April 25, 2019.
Hon. Frank Pallone, Jr.,
Chairman, Committee on Energy and Commerce,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1010, a bill to 
provide that the rule entitled ``Short-Term, Limited Duration 
Insurance'' shall have no force or effect.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Alice Burns 
and Kevin McNellis.
            Sincerely,
                                                Keith Hall,
                                                          Director.
    Enclosure.

[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
    
    H.R. 1010 would prevent the Administration from 
implementing or enforcing a recent regulation aimed at 
increasing the number of people with short-term limited 
duration insurance (short-term plans) and would prohibit the 
Administration from promulgating similar regulations in the 
future.
    CBO and JCT estimate that enacting the legislation would 
result in roughly 1.5 million fewer people purchasing short-
term plans each year over the 2020-2029 period. Of those, more 
than 500,000 would instead purchase nongroup coverage through 
the marketplaces established by the Affordable Care Act, a 
small number would obtain coverage through an employer, and 
about 500,000 would become uninsured. The agencies expect that 
additional enrollees in the nongroup market would have the 
effect of lowering nongroup premiums by about 1 percent on 
average because those enrollees are likely to be healthier than 
the average nongroup enrollee under current law.
    On net, CBO and JCT estimate that enacting H.R. 1010 would 
decrease the deficit by $8.9 billion over the 2019-2029 period 
primarily because premiums for subsidized nongroup insurance 
would be lower. That amount includes a $7.8 billion reduction 
in direct spending and a $1.1 billion increase in revenues.
    H.R. 1010 would impose a private-sector mandate as defined 
in the Unfunded Mandates Reform Act (UMRA) by restricting the 
terms under which insurers may offer short-term plans. CBO 
estimates the cost of the mandate, which would include the 
revenue lost as a result of the restriction, would exceed the 
private-sector threshold established by UMRA in each of the 
first five years the mandate is in effect ($164 million in 
2019, adjusted annually for inflation).
    Details of the estimated budgetary effects of H.R. 1010 are 
shown in Table 1. The costs of the legislation fall within 
budget function 550 (health).

                                                                       Table 1.--ESTIMATED BUDGETARY EFFECTS OF H.R. 1010
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                       By Fiscal Year, Millions of Dollars--
                                                  ----------------------------------------------------------------------------------------------------------------------------------------------
                                                      2019       2020       2021       2022       2023       2024       2025       2026       2027       2028       2029    2019-2024  2019-2029
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  Decreases in Direct Spending
 
Estimated Budget Authority.......................          0       -289       -632       -746       -738       -806       -883       -873       -895       -928       -963     -3,211     -7,753
Estimated Outlays................................          0       -289       -632       -746       -738       -806       -883       -873       -895       -928      1B963     -3,211     -7,753
 
                                                                                      Increases in Revenues
 
Estimated Revenues...............................          0         33         74         91         96        114        109        144        149        160        132        409      1,103
    On-Budget....................................          0          0          9         20         31         37         35         43         41         48         30         98        295
    Off-Budget...................................          0         33         66         70         64         77         74        101        108        112        103        310        808
 
                                                              Decrease in the Deficit From Changes in Direct Spending and Revenues
 
Effect on the Deficit............................          0       -322       -706       -837       -834       -920       -992     -1,017     -1,044     -1,088     -1,095     -3,619     -8,856
    On-Budget....................................          0       -289       -641       -767       -770       -843       -918       -916       -936       -976       -992     -3,309     -8,048
    Off-Budget...................................          0        -33        -66        -70        -64        -77        -74       -101       -108       -112       -103       -310       -808
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Components may not sum to totals because of rounding. All off-budget effects would come from changes in Social Security revenues.
Sources: Congressional Budget Office; staff of the Joint Committee on Taxation.

    The CBO staff contacts for this estimate are Kevin McNellis 
and Alice Burns. The estimate was reviewed by Leo Lex, Deputy 
Assistant Director for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

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

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    Pursuant to clause 3(c)(4) of rule XIII, the general 
performance goal or objective of this legislation is to 
overturn the STLDI final rule, giving it no force or effect, 
and to prohibit the Secretaries of HHS, the Treasury, and DOL 
from promulgating any substantially similar guidance or rule.

                    DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to clause 3(c)(5) of rule XIII, no provision of 
H.R. 1010 is known to be duplicative of another Federal 
program, including any program that was included in a report to 
Congress pursuant to section 21 of Public Law 111-139 or the 
most recent Catalog of Federal Domestic Assistance.

                        COMMITTEE COST ESTIMATE

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

      EARMARKS, LIMITED TAX BENEFITS, AND LIMITED TARIFF BENEFITS

    Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the 
Committee finds that H.R. 1010 contains no earmarks, limited 
tax benefits, or limited tariff benefits.

                      ADVISORY COMMITTEE STATEMENT

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

                  APPLICABILITY TO LEGISLATIVE BRANCH

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

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short-term limited duration insurance rule prohibition

    Section 1 prohibits the Secretaries of HHS, the Treasury, 
and DOL from taking any action to implement, enforce, or 
otherwise give effect to the STLDI final rule issued on August 
3, 2018. Section 1 also prohibits the Secretaries from 
promulgating any substantially similar rule or guidance.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    There are no changes to existing law made by the bill H.R. 
1010.

                            DISSENTING VIEWS

    This legislation would invalidate the Trump 
Administration's short-term, limited-duration insurance (STLDI) 
plan rule.
    In coordination with the Department of Labor and the 
Department of the Treasury, the Department of Health and Human 
Services revised the Obama Administration regulations, which 
limited STLDI plans to three months, by allowing the plans to 
be available to consumers for up to 364 days and renewable up 
to 36 months.\1\
---------------------------------------------------------------------------
    \1\26 C.F.R. Sec. 54; 29 C.F.R. Sec. 2590; 45 C.F.R. Sec. Sec. 144, 
146, 148.
---------------------------------------------------------------------------
    The Trump Administration regulation aims to provide relief 
from rising premiums and to expand access to affordable health 
care plans. According to CMS, ``[i]n the fourth quarter of 
2016, a short-term, limited-duration policy cost approximately 
$124 a month compared to $393 for an unsubsidized ACA-compliant 
plan.''\2\ The Administration projected roughly 100,000 to 
200,000 individuals would move from PPACA-compliant plans to 
STLDI. These more affordable plans may be attractive options 
for individuals who are between jobs, cannot afford Patient 
Protection and Affordable Care Act (PPACA) coverage, or cannot 
continue to see their doctor because they are out of network.
---------------------------------------------------------------------------
    \2\Centers for Medicare and Medicaid Services, Fact Sheet. Short-
Term, Limited-Duration Insurance Proposed Rule, (Feb. 20, 2018), 
available at https://www.cms.govinewsroom/fact-sheets/fact-sheet-short-
term-limited-duration-insurance-proposed-rule.
---------------------------------------------------------------------------
    Although some Democratic members claim these plans are not 
regulated, all States retain the authority to regulate these 
plans. The invalidation of the Trump Administration regulation 
that provides affordable plans will negatively impact 
individuals who could otherwise utilize STLDI, further limit 
consumer choice, and lead more Americans to face unmanageable 
costs associated with ACA plans.
                                   Greg Walden,
                                           Republican Leader, Committee 
                                               on Energy and Commerce.
                                   Michael Burgess, M.D.,
                                           Republican Leader, 
                                               Subcommittee on Health, 
                                               Committee on Energy and 
                                               Commerce.

                                  [all]