mr. walden: thank you, mr. chairman. i seek time in opposition to the gentlelady's amendment. the chair: the gentleman is recognized for five minutes. mr. walden: i reserve the balance of my time. the chair: the gentleman reserves the balance of his time. the gentlewoman from ennsylvania. ms. scanlon: i urge members from both sides of the aisle to support this bill. and with that, i yield back the remainder of my time. the chair: gentlewoman yields. the gentleman from oregon. mr. walden: i thank the gentlelady from pennsylvania for her amendment. we're not going to object to the amendment. the states do a lot of this reporting. more information is better than less. i want to talk about these state regulated limited duration insurance policies. we have a chart here and will put it in the record, 27 of our states, 27, that have decided that short-term plans are good for their people to be able to take advantage of and states

from alaska to wyoming, kansas, idaho and pennsylvania. go up to 364 days. there are 12 other states that have said, you know, we want to limit these to six months. that includes places like colorado, arizona, oklahoma, north dakota. and there are states that said no, we want three months. we think that's all we need in places like hawaii, wyoming and new mexico. and four states, cal, massachusetts, new jersey and new york that said no, we aren't going to allow any of these options in our state. that's federalism, they get it right. my friends on the other side would like to take away ability short-term duration state-regulated plans and remove options from consumers and i don't think that's the way to go. it's an honest disagreement we

have here between the parties. i have seen a lot of innovation came out of oregon. i was meeting with a former governor talking about the coordinated care organizations and they have been able to bend the cost curve and improve access to liberty of care by having the flexibility some cases through waivers to bring providers together, match them up with patients, deliver care more fort worthly and more effectively and with better outcomes and that should be what we are debating today is how do we get to better outcomes. we should be debating how we get down health care costs and we are doing that with the drug bills. it's unfortunate it didn't have to be this way that it got made into a partisan issue because there is no partisan divide on those business. you bail out some of these programs in obamacare that are so expensive.

$2.40uld we when it costs for enrollee for agents and brokers to assist in enrollment d $767, if you spent $62.5 million in grants and enrolled 181,000 individuals and averages out to $700, why are we putting more money into the navigateors and say by the way, agents and brokers can't do anything to keep them out of this. the trump administration expanded the authority for the agents and brokers to be involved. leveraging that private sector help -- and you know what? they support 3,660,000 and that is 42% of the plan's enrollment on the 2018 planned enrollment fed ex changes. and-a-half depateors do 1% and my friends on the other side of

the aisle want to keep dumping more money into the navigator program. we found all kinds of wasteful spending. it's an issue about spending. we know the results and know there is a much better way to do this. i'm not going to oppose this particular amendment. it's fine. and more information is better than less. and i would yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the question is on the amendment offered by the gentlewoman from pennsylvania. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. he amendment is agreed to. it is now in order to consider number amendment 11 printed in house report 116-61. for what purpose does the gentleman from new york seek recognition? mr. morelle: mr. chairman, i

have an amendment at the desk. the clerk: amendment number 11 printed in house report 116-61 offered by mr. morelle of new york. the chair: pursuant to house resolution 377, the gentleman from new york, mr. morelle, and a member opposed, each will control five minutes. the chair recognizes the gentleman from new york. mr. morelle: i rise today to offer an amendment intended to detail the full harm done to our nation by the white house's sabotage of the affordable care act. last summer the centers for medicaid and medicare services announced a cut of $26 million to the navigateors' program that provides assistance for people who wish to sign up. funding has plummeted from $62.5 million to $10 million. the president cut tv and radio advertising reducing investment from $100 million to $10 fer 10

million. this leaves for the states to fill in the depaps and puts on them the burden for the success of federal and state exchanges. my amendment wants a a study of these cuts to show how these cuts have harmed. funding for a.c.a. outreach is essential to ensuring that america caps know their options and health care benefits. without public messaging campaigns people have been left confused about the open enrollment process and the deadline for enrolling before the new year. as we approach planning for the 2020 enrollment season, we need to understand the results of the cuts to outreach and advertising and that is what my amendment seeks to do. i thank my co-sponsor, representative wexton. and i resevere the balance of my time. the chair: the gentleman from new york reserves.

mr. walden: i seek time in opposition to the gentleman's amendment. and i reserve the balance of my time. the chair: the gentleman from oregon reserves. the gentleman from new york. mr. morelle: thank you, mr. chairman. i would like to yield the remapeder of my time, the gentlewoman from virginia, ms. wexton. the chair: the gentlewoman from virginia is recognized. ms. wexton: i thank the representative for offering this amendment and for yielding. this amendment which requests a g.a. ofrlt report of how funding cuts to the navigator program and outreach have impacted health insurance enrollment and the cost of coverage in the individual market. navigator programs provide critical assistance by raising awareness about the availability of marketplace plans assisting people as they apply for federal subsidies and providing impartial information about different marketplace plans. importantly, these programs help

otherwise hard to reach groups get health insurance groups including in rural and underserved communities. the trump administration has made cuts to the navigator program providing only $10 million in funding and 80% reduction. and-a-half depator funding in my home state of virginia has been reduced by 76% between 2016 and 2018. $525,000 n in 2016 to in 2018. programs laid off staff, close up offices. the administration's cuts hamper navigator's ability to do their jobs. and as a result, people may not obtain coverage on the individual market causing people who do get coverage to see their premiums increase. people rely on navigateors to

enroll in the best health care plans for them. we need to know how the administration's funding cuts have impacted the individual markets and this amendment will allow us to do that. thank you and i yield back. the chair: the gentlewoman yields. the gentleman from new york is recognized. mr. morelle: i reserve. the chair: the gentleman reserves the balance of his time. mr. walden: i reserve. the chair: the gentleman from oregon reserves. the gentleman from new york is recognized. mr. morelle: i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from oregon is recognized. mr. walden: it's interesting prior amendment that passed added $25 million more to this navigator program and for the planned year 2017, navigateors received $62.5 million in grants and enrolled 81,426 individuals. that is less than 1% of the

total enrollees. the issue here isn't whether we should or shouldn't enroll more people, the issue is who is most efficient with the private sector or taxpayer dollars to do that. we keep pouring more money into this navigator program and we know -- i guess i'm going to call it waste and i don't know it's fraud, but holy smokes. one grantee according to the "wall street journal" took in $200,000 and enrolled one person. one person. you want to have a government accountability office report an investigation. let's look at the underlying program and how in the heck that could happen. and then they also found the top 10 expensive navigateors collected $2.77 million and signed up 314. these aren't my numbers but the

"wall street journal" investigative reporters and the press. these are facts. the navigator scheme is a make work government job arrive with scam artists. not my words. that's the press. i have a journalism degree and i have great respect for the press and what they right. i don't always agree with them. but when you take these independent reviews and you look at what's happening there. they -- c.m.s. reported 17 of those navigateors enrolled fewer than 100 people at an average cost of $5,000 per enrollee. and my friends on the other side of the aisle want to shovel more money into that program. that's the height of fiscal irresponsibility. would rather, if 2.7 million

and put that into community health centers, you know how many people we could cover? we could take care of 20,000 patients according to one estimate. health centers are really important to me and my constituents. we have 63 different places in my district where people get their health care in our communities. we have to re-authorize this year by the end of september our community health centers. when i was chairman, we did that at a record level, because they deliver record good health care. we have had no plan yet to figure out how to pay for that and dump $25 million more in this navigator program. why don't we put it into actual health care. we re-authorized the children's health insurance program and funded it for 10 years. the longest we have done it was for five years. and my friends on the other side

of the aisle voted no. 122,700 gon, we have children and expectant moms that rely on crip for health insurance. there is a lot of things we could invest in from the savings from the drug bills. but investing in the navigator program? $5,000 per enrollee. 100 navigateors, that's all they did? enrolled one person? come on. there has to be a better way to spend the taxpayer money than that. i think you look at the incredible growth in men and women and working america getting bigger paychecks and health care, 2.5 million since president trump took office and

pro-growth regulatory policies and jobs are coming up. the biggest issue i run into with employers, not overregulation but where do we find people to work. but this amendment i think is frankly from my perspective, all due respect, g.a.o. doesn't need to waste their time on this nor the taxpayers' money and especially after $25 million signed up to 63 million. enormous amount of money that i think has a lot of problems. and editorial review writers said highly susceptible to scam artists. so i oppose the amendment and i yield back. the chair: the gentleman's time has expired. the question is on the amendment offered by the gentleman from new york. those in favor say aye. those opposed, no. in the opinion of the chair, the

ayes have it and the amendment is agreed to. it's now in order to consider amendment number 12 printed in house report 116-61. for what purpose does the gentlewoman from california seek recognition? ms. waters: i have an amendment at the desk. the chair: the clerk will designate the amendment. the clerk: amendment number 12 fingerprinted in house report 116 -- printed in house report 116-61 offered by ms. waters of california. the chair: pursuant to house resolution 377, the gentlewoman from california, ms. waters, and a member opposed each will control five minutes. the chair recognizes the gentlewoman from california. ms. waters: thank you very much, mr. chairman. my amendment requires the department of health and human services to submit to congress a report on the extent to which increases in prescription drug prices may have caused medicare beneficiaries to forego recommended treatment, including failing to fill their prescriptions. drug prices have increased

significantly over the past year. the center for american progress reported that nearly 30 drug companies announced last year that price increases would take effect in january. one announced it would raise the prices of 41 different drugs. critical medications including insulin and opioid addiction treatments have already been -- have already seen dramatic price increases this year. these price increases are taking a toll on patients. the keizer family foundation reported that among those currently taking prescription drugs, 24% of adults and 23% of seniors, say it is difficult to afford their prescription drugs. this includes about one in 10 respondents who say it is very difficult. the keizer family foundation also found that certain groups are much more likely to report difficulty affording medication.

including those who are spending $100 or more a month on their prescriptions. that is 58%. those who report being in fair or poor health, about 49%. those who take four or more prescription drugs, 35%. and those with incomes less than $40,000 per year, representing 35%. furthermore, 29% of all adults report not taking their medicines as prescribed at some point in the past year because of the cost. and 8% say their condition got worse as a result of not taking their prescriptions as recommended. needless to say, when medicare beneficiaries cannot afford their medications, their health will suffer. my amendment requires h.h.s. to study the impact of increases in prescription drug prices on medicare beneficiaries and their health. i urge my colleagues to support

my amendment and i reserve the balance of my time. the chair: the gentlewoman from california reserves. for what purpose does the gentleman from oregon rise? mr. walden: i rise in opposition to the amendment but i'm not necessarily opposed to the amendment. and i reserve. the chair: without objection, the gentleman is recognized for five minutes. mr. walden: thank you. i'll reserve my time. the chair: the gentleman reserves the balance of his time. the gentlewoman from california. ms. waters: thank you very much, mr. chairman. we have had ex tensive discussions throughout this congress about the polite of those who cannot -- plight of those who cannot afford prescription drugs. we know what the statistics are. we know the harm that is being caused to families and we know that there are preventable deaths if in fact people could afford their prescription drugs. and so i would expect all of the members of the house of representatives, knowing this information, understanding all of the research that has been done, the data that has been collected, to simply support

this amendment in order to save lives. and with that, i yield back the balance of my time. the chair: the gentlewoman from california yields. the gentleman from oregon is recognized. mr. walden: thank you. we support this amendment and i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the question is on the amendment offered by the gentlewoman from california. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. he amendment is agreed to. it is now in order to consider amendment number 13 printed in house report 116-61. for what purpose does the gentlewoman from texas seek recognition? ms. johnson: i have an amendment at the desk. the chair: the clerk will designate the amendment. the clerk: amendment number 13 printed inous report 116-61 offered by ms. johnson of texas. the chair: pursuant to house resolution 377, the gentlewoman from texas, ms. johnson, and a member opposed will each control

five minutes. the chair recognizes the gentlewoman from texas. ms. johnson: thank you, mr. chairman. i rise today to support this amendment. the amendment requires navigators to receive training on how to assist consumers with medicaid and chip enrollment. this amendment has also been scored by the congressional -- congressional budget office to have no effect on direct spending or revenue. the health insurance navigators program was created by the affordable care act to assist individuals with selecting and enrolling in health insurance coverage plans. they were intended to carry out public education activities, provide information to perspective enroll e.s.a. about insurance options, -- enrollees about insurance options, and assistance, and other state or health care programs. fundamentally, their responsibility was to help people make the best health care

decisions for them and their families. unfortunately this essential program has been targeted in recent years, among others, the administration has slashed the open enrollment period in half, slashed funding for consumer outreach and enrollment education activities by 90%, and slashed funding for navigators by 84%. because of this intentional sabotage, enrollment in the federal marketplace has dropped each year under this president. in my home safety texas, we are unfortunately deeply familiar with the consequences of the lack of health insurance. texas has the highest rate of uninsured people in the nation. with 4.7 million people lacking coverage and adequate access to health care. as representatives of americans from all corners of the country, we have a responsibility to ensure that our constituents and communities are knowledgeable and can access the health

insurance coverage best suited for the individual health needs. by voting in favor of this amendment, congress will ensure that navigators are fully equipped and informed to assist our families and children with their potential options within the medicaid and chip programs. i appreciate my colleagues for -- on the committee of energy and commerce, and their partnership in expanding training requirements for navigators and in strengthening health care and lowering prescription drug costs act. i urge my colleagues to support this amendment and i reserve the balance of my time. the chair: the gentlewoman reserves the balance of her time. for what purpose does the gentleman from oregon rise? mr. walden: thank you, mr. chairman. i seek time in opposition to the gentlelady's amendment. the chair: without objection, the gentleman is recognized for five minutes. mr. walden: i reserve. the chair: the gentleman from oregon reserves. the gentlewoman from texas. ms. johnson: i have no further statements. i yield back. the chair: the gentlewoman yields back the balance of her time. the gentleman from oregon is recognized. mr. walden: thank you, mr. chairman.

i thank the gentlelady for her amendment. i find it a bit interesting, though, that under the navigator program, on the one hand, my friends on the other side of the aisle say, look, you can't talk about -- in fact, you can't tell anybody about association health plans and those options. you can't educate the public, the consumers about an opportunity to save money by having a state regulated plan. no, not under the navigator, you can't do that. and yet with this amendment, they want to expand that knowledge so they can get training on the other government plans, medicaid and chip enrollment. and that's not necessarily a bad thing. i'm not saying that's a bad thing. but what i am saying is, why wouldn't we want full education? why would we want basically a gag order here that prevents the navigators from telling the consumers, here's some other options you might want to look at? now, they have limitations,

they're regulated by your state, you need to be full informed. in fact, really informed because some of them don't cover everything, as we've heard. that was how it was designed under president obama's plan, that there would be these options and they wouldn't be the fully covering plans. but they were ok. because they would fill a gap. and those are the same plans we've heard a lot about today, that states regulate. and i would go back to the fact that in some states it's three months, in some states it's -- well, in 27 states they go up to almost a year, including states such as rhode island and tennessee, even texas and virginia, georgia, idaho. in 12 states they go up to six months. in eight state, including mine, we said in oregon, just three months. that's all we're going to do on short-term duration plans. california, massachusetts, new york, new jersey said, nope, zero. we're not going to allow them. that's ok. that's federalism. but why, why in the navigator program would we say, you can't talk about things?

i got a degree in journalism a long time ago at the university of oregon and i believe in the facts and i believe marketplaces and consumers are better served when they have complete information. to make choices. and i know that these insurance products that are on the market, some are fine, people like them, others say, and i get these letters, one from tom ined meford that talked about how his in medford that talked about how that emium -- ined meford talked about how his -- in medford that talked about how his premium raised. we know from the "wall street journal," one grantee took 2ds00,000, enrolled one person -- $200,000, enrolled one person. if you're the grantee, that's a pretty good deal. all you have to do is find one person to enroll and you get $200,000. to me that sounds like a big waste of taxpayer dollars. the 10 most expensive navigators collected $2.77 million, signed up 314 people. we heard about how the government needs to spend --

borrow and spend more taxpayer dollars or at least spend more taxpayer dollars and do more education, because the enrollment in the government plans has gone down by, i think the figure was $1 million -- one million or so. what isn't mentioned, however, mr. chairman, is that under president trump and the policies republicans put into law, the economy took office. the economy took office. thank goodness the economy took office. and 2.5 million americans now get their insurance, more, get their insurance through an employer. they got a job, they got a paycheck, they got insurance through their employer. my guess is that accounts for some of that down turn. they don't have to come to the government to get their insurance. they're getting it through their employer. so you might have had like a million rolloff on the exchanges, but you had a 2.5 million pickup in the private insurance side. i think that's pretty cool. i mean, that's important. and i know that my friends on

the other side of the aisle, with their national takeover of health insurance, want to abolish obamacare and replace it with a single payer system, which sounds sort of simple on its face, but we know that means you'd have to double the personal income tax, double the corporate tax, and our doctors and hospitals, they'd have to take like a 40% reduction. i might yield to my friend, a doctor from texas, the former chairman of the health subcommittee, if he wants to make some comments, such time as he may consume. mr. burgess: thank you. i thank the ranking member for the recognition. the fact is there was a hearing on this one-size-fits-all government takeover top-down soviet-style health care system that's been proposed by the other side of the aisle and yet that bill was not heard in the committee on energy and commerce, it wasn't heard in the ways and means committee. it was heard in the rules committee. the speaker's committee. this is a high priority for the speaker, this bill was heard in the speaker's committee.

that tells me that this is something that's highly likely to come forward. unfortunately it's just not a very good plan and the gentleman's right, doctors would be required to take -- mr. walden: i yield back. the chair: the gentleman's time has expired. the question yields. the question is -- the gentleman yields. the question is on the amendment offered by the gentlewoman from texas. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. he amendment is agreed to. it is now in order to consider amendment number 14 printed in house report 116-61. for what purpose does the gentleman from massachusetts eek recognition? mr. lynch: good afternoon. i have a couple of amendments at the desk. the clerk: amendment number 14 printed in house report 116-61 offered by mr. lynch of massachusetts. the chair: pursuant to house resolution 377, the gentleman from massachusetts, mr. lynch, and a member opposed each will control five minutes. the chair recognizes the

gentleman from massachusetts. mr. lynch: thank you very much, mr. chairman. i yield myself such time as i may consume. the chair: the gentleman is recognized. mr. lynch: mr. chairman, my amendment would extend by one year the deadline by which states may apply for federal grant assistance to set up state-based health insurance markets. moving the deadline from december 31, 2022, to december 31, 2023. my amendment would also extend by one year the corresponding date by which the exchanges must be self-sustaining. from january 1, 2024, to january 1, 2025. currently 11 states and the district of columbia have such health insurance exchanges. however, no health exchanges have been established since the a.c.a.'s original deadline of 2015. and while i do support h.r. 987's language that provides an additional two-year window for

states to establish their own insurance exchanges, given the complexity of the current debate with the possibility of single-payer out there and also medicare for all, it is my hope and expectation that by extending these bills' applications periods from two to three years, more states will have the opportunity to weigh those outstanding options and explore the option to establish their own state-based exchanges. . the governor of new jersey has announced his state would seek to establish its own state-based health exchange by 20216789 it's possible that may have held off in setting up similar exchange marketplaces and are contemplating those other possibilities could also be reconsidering setting up an exchange and that is the reason for my amendment.

i believe that ensuring that states have the time to consider and plan setting up such an exchange, it's the right thing to do. and my amendment does not seek additional funding during that time period, so it will not increases the costs. it simply gives states additional time. i urge my colleague to support my amendment and the underlying bill and i reserve. the chair: the gentleman reserves the balance of his time. for what purpose does the gentleman from oregon seek recognition? mr. walden: i seek time in opposition to the gentleman's amendment. the chair: the gentleman is recognized for five minutes. mr. walden: i reserve. the chair: the gentleman from oregon reserves. the gentleman from massachusetts. mr. lynch: it's a technical amendment and i yield the balance of my time. the chair: the gentleman yields back the balance of his time. the gentleman from oregon is recognized. mr. walden: this section requires $200 million in state-based marketplaces and

they could establish it or use the federal marketplace. my own state blew through cost to $300 million trying to create its own exchange and it was a terrible financial disaster and couldn't get it going and finally closed the thing up but $300 fore blowing through million. every state except for squea for these grants. other states returned some of the grant money they received but also kept some. this would have been under the obama administration when they were enacting obamacare. no funding was expended after 2014. bases andhad facility five states used the federal platform. committee on energy and commerce

issued a staff report entitled implementing obamacare on the state-based ex changes. it is important to share with my colleagues key findings were that c.m.s. is not confident that the remaining state-based exchanges would be sustainable in the long term and every state-based exchange relies on federal establishment grant funds 20 months after the state-based exchanges were to be self-sustaining. could join so they ealthcare.gov. now here we are five years after the funding has expired to consider a bill to reopen grants for states to establish state-based marketplaces and we have seen a spotty record here.

aybe it is a coincidence, $200 million is being made available because my friends on the other side set the agenda and want to continue pushing out this idea. on friday, politico reported that new jersey is proposing to create a state-based health exchange. they have told us they don't need federal money for that. but any way, i don't think we are dealing with earmarks here, but earmarking here to help states create their own marketplaces isn't what we should be here. i don't think this is a garden state giveaway. but it is interesting. that's all i got to say. and i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the question is on the amendment offered by the gentleman from massachusetts. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it and the amendment s agreed to.

now in order to consider amendment number 15 printed in house report 116-61. for what purpose does the gentleman from massachusetts seek recognition? mr. lynch: i have an amendment at the desk. the clerk: amendment number 15 printed in house report 116-61 offered by mr. lynch of massachusetts. the chair: pursuant to house resolution 377, the gentleman from massachusetts, mr. lynch and a member opposed each will control five minutes. the chair recognizes the gentleman from massachusetts. mr. lynch: i yield myself such time as i may consume. my amendment directs the government accountability office to prepare a cost benefit analysis of a state's-sponsored public options for states who want to public options. a state-run public option would allow individual states to offer very basic, low-cost insurance

plans without the high costs of commercial advertising and other overhead costs could add as much as 30% to some health insurance plans or perhaps states could optimize the use of community ealth centers that we all love so much. once these plans are on the market, private insurance companies would be forced to compete with that lower price by offering similarly low cost plans. state-sponsored public options could address the lack of competition that is driving up the cost of health care in many states where one or two insurance companies are allowed to dominate the market due to the fact that the affordable care act currently exempts insurance companies from antitrust laws. while these were a feature in the original version, the house version of the a.c.a. which i supported, senate action deleted that from the final version of the a.c.a., which eventually

passed and i opposed. i believe the information that this study will provide will be an important resource for states looking for more health care options. one of the loudest messages that came out of the last midterm election, nine years after the passage of the a.c.a., the american people want us to fix their broken health care system. for many people, the affordable care act is not affordable but i believe it is fixable. many supporters of the a.c.a. are disappointed with the lack of success in reaching the goals of the a.c.a. and now supporting efforts in single pair or medicare for all proposal. i believe there are some significant changes that could be made to the a.c.a. to make it work. this study will be a way to provide our states with guidance that can help them determine whether a public option may be right for them. i urge my colleagues to support this amendment and the

underlying bill and i reserve. the chair: the gentleman reserves the balance of his time. for what purpose does the gentleman from oregon seek recognition? mr. walden: i seek time in opposition to the gentleman's amendment. the chair: the gentleman is recognized for five minutes. mr. walden: i reserve. the chair: the gentleman reserves the balance of his time. the gentleman from massachusetts is recognized. mr. lynch: i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from oregon is recognized. mr. walden: i yield myself such time as i may consume. this amendment is pretty straightforward in asking the g.a.o. to do this evaluation and it is important to have cost benefit analyses for states who may want to offer a public option. again, here we have a situation where states are experimenting and they are -- there are great laboratories for reform. the gentleman comes from a state and republican governor helped lead that offer, governor romney and senator romney from a

different state. my state did a lot of reform work as well and we are trying to figure out how do we get health care to people in a timely way that is affordable and we share that goal. unfortunately, some of the promises of obamacare turned out not to be the case and peoples' insurance premiums did not go down $2,000 500. at my town meetings, some are well served but a lot of them are out in the cold. one of my town halls, i had a couple say we can't afford health insurance and decided to go barren. they looked at premiums and deduct i believe so and said we can't pen i will -- pence i will it out. some of these options are important to look at and states can do it. and that's what president trump tried to do is take what

president obama had agreed to with the short-term plans regulated by states to fill gaps to make health insurance options more available and health insurance more affordable and he said if it is good for three months, what's wrong with 364 days. as a result, you've got 27 states that go up to a year, and four say not in our state at all. i think the report is going to give us some valuable information. mr. chairman, i intend to -- i convinced myself that i'm going to support this despite my initial reservations and i yield back. the chair: the gentleman yields back the balance of his time. the question is on the amendment offered by the gentleman from massachusetts. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. he amendment is agreed to. it is now in order tore consider amendment number 16 printed in

house report 116-61. for what purpose does the gentleman from illinois seek recognition? mr. lipinski: i have an amendment at the desk. the clerk: amendment number 16 printed in house report 116-61 offered by mr. lipinski of illinois. the chair: pursuant to house resolution 377, the chair recognizes the gentleman from illinois. mr. lipinski: i yield myself uch time as i may consume. american families struggle with rising health care costs. that's why i'm pleased to support the underlying bill which contains commonsense provisions which will protect consumers, lower drug prices and stabilize individual insurance markets providing families with some needed relief. the amendment i'm offering will further help americans purchase health insurance on healthcare.gov.

americans in 39 states depend on healthcare.gov to purchase insurance during open enrollment. this past year over 8.4 million plans were made on this website. over the past two years, the department of health and human ervices has aflounced ol healthcare.gov for up to 12 hours every sunday during open enrollment. i'm an engineer. i understand the complexity of this website and heavy volume of users which means routine maintenance is necessary even during open enrollment. however, i want to ensure that h.h.s. can ensure that this maintainance is conducted in a way that has the least impath on consumers. families need a.m. will time to choose. should we make sure that enrollment is not being

negatively impacted. my requirement would determine if healthcare.gov outages are having a negative impact. they say they schedule them during low site traffic. when i'm using the online exchange to purchase my insurance each year, i try to do it on a sunday when i have free time. this may be an anomaly. we need to figure this out. what the g.a.o. study would provide is clarity on the best time. this would make sure that h.h.s. is doing right by americans as they navigate the complex process of buying health insurance. mr. chairman, i urge a yes vote on this amendment and i reserve the balance of my time. the chair: the gentleman from illinois reserves. the gentleman from oregon.

mr. walden: i seek time in opposition to the amendment. i reserve the balance of my time. the chair: the gentleman from illinois is recognized. mr. lipinski: i yield myself the remapeder of the time. this is a commonsense amendment to ask the g.a.o. to look at this study and say what is the healthcare.govke for maintenance. as an engineer, i think most companies would look at it this way. so i urge my colleagues to support this amendment and i yield back. the chair: the gentleman yields back the balance of his time. the gentleman from oregon is recognized. mr. walden: i thank the gentleman for bringing his amendment as well. he is a distinguished member of our house of representatives and an engineer and i appreciate his intellectual horsepower on this issue. as he was talking about having the g.a.o. have to do an audit to figure out the best time for routine maintenance to provide the least disruption to

consumers, this is what happens when you have a government-run system. you have to have your independent auditors figure out how the system can keep current and not disrupt consumers. we don't have too many amendments that say g.a.o. audit amazon's website to deal with consumers or your local -- whatever you go to on to get your hotels or your rental cars. nobody is saying you have to have a government entity look at best time or worst time to disrupt consumers on the afe is website or enterprise, but we have to do here because it is one website. we lived through with the initial rollout of this website. so to your point, mr. chairman, my friend from illinois' point, it is important we give consumers the best possible experience when they are trying to sign up because we have had

to deal with it. in its initial days, man, it was a mess. i remember all those problems. we did hearings and oversight hearings in the energy and commerce committee on it. mr. chairman, this is probably a good idea to do. and with that, i yield back. the chair: the question is on the amendment offered by the gentleman from illinois. those in favor say aye. those opposed, no. in the opinion of the chair, the yeas have it and the amendment is agreed to. . it is now in order to consider amendment number 17. the clerk will designate the amendment. the clerk: amendment number 17 printed in house report 116-61 offered by mr. deutch of florida. the chair: pursuant to house resolution 377, the gentleman from florida, mr. deutch, and a member opposed each will control five minutes. the chair recognizes the gentleman from florida. mr. deutch: thank you, mr. chairman.

i ask unanimous consent that the amendment be modified in the form i have placed at the desk. the chair: the clerk will report the modification. the clerk: modification to amendment number 17. printed in house report 116-61. offered by mr. deutch of florida. in lieu of the matter of -- mr. deutch: i ask to dispense with the reading. the chair: purpose the gentleman from oregon seek recognition? mr. walden: i reserve a point of order. the chair: does the gentleman reserve the right to object? mr. walden: i reserve the right to object. the chair: the gentleman is ecognized for his reservation. the gentleman from oregon is recognized on his reservation. mr. walden: mr. chairman, i appreciate that. i know there are a lot of amendments that came through the system. i'm trying to figure out what the issue is here. i know there were, you know, i think we offered 16 amendments and got one. democrats got 25 amendments.

had one technical amendment through the rules committee. and cot parliamentarians perhaps tell me -- could the parliamentarians perhaps tell me, or somebody explain what the problem is here and why we have to correct it here on the floor? guess that's my question. the chair: the gentleman may yield on his reservation. mr. walden: yes. the chair: the gentleman from florida is recognized. mr. deutch: thank you, mr. chairman. mr. walden: i yield to the gentleman from florida, is that right? the chair: yes. mr. deutch: mr. chairman, the amendment is a technical amendment to address a drafting error so that it's conforming and so that there will be no problems going forward. mr. walden: i withdraw my reservation, mr. chairman. mr. deutch: i thank my friend. the chair: the reservation is withdrawn. without objection, the reading is dispensed with. is there objection to the original request? without objection, the amendment is modified.

the gentleman from florida is recognized. mr. deutch: thank you, mr. chairman. i yield myself such time as i may need. the chair: the gentleman is recognized for five minutes. mr. deutch: thank you. i thank my florida colleague, representative castor for her leadership in protecting access to protecting high equality health care across our state and the country, to help more americans shop for and sign up for health plans on healthcare.gov. my amendment requires navigators to provide information in plain language about the 10 essential health benefits that are a part of every healthcare.gov plan. outpatient hospital care, emergency care, hospitalization, pregnancy, maternity and newborn care, mental health and substance use disorder services, prescription medicines, rehabilitative services, labs, preventive care, and pediatric care, including dental and vision services. it also requires navigators to help consumers understand their

protections under the mental health parity law. according to a survey commissioned by the american psychological association, only 4% of americans were familiar with the mental health parity law as of 2014. and just 7% were aware of mental health parity more broadly. those numbers didn't change from the time of passage of the affordable care act in 2010 through the first years of enrollment in 2014. mental health parity means insurance companies can't discriminate against americans battling addiction in the opioid crisis. parity means insurance companies can't make it harder to get care for deadly eating disorders than it is to get care for deadly cancer. parity means we treat mental health care like health care, because that's exactly what it is. the affordable care act's protections have saved lives and the financial security of millions of americans. including one family who told me the story of their battle to treat their 19-year-old daughter's eating disorder.

here's what they said. our daughter was a sophomore in college when she was diagnosed with an eating disorder. she had to take several leaves of absence from her studies to seek treatment. this would not have been financially possible without the benefits of the a.c.a. had she left school for treatment before the passage of the a.c.a., she would have been dropped from our family insurance. but because of the a.c.a. she could continue under our coverage. it was this ongoing treatment that has allowed our daughter to regain her health enough to graduate from college and maintain full-time employment. and while it's clear that parity has made improvements, we still have more to do. this week i heard from another family in my district about their daughter's struggle to get coverage and treatment. in the cycle of denials and arbitrarily reduced levels of care, her family was able to use the parity law to fight for their daughter's life in the courts. but that's not enough. parity protections have opened doors to better mental health and addiction treatment for so many americans, but as we observe mental health awareness month, it's important to

acknowledge how far we have to go. my amendment will help more americans understand the benefits and protections available to them and help them get the care they need. and i urge my colleagues to support it and i reserve the balance of my time. the chair: the gentleman from florida reserves. for what purpose does the gentleman from oregon rise? mr. walden: thank you, mr. chairman. i seek time in opposition to the gentleman's ealed. -- amendment. the chair: the gentleman is recognized. mr. walden: and i reserve the balance of my time. the chair: the gentleman reserves the balance of his time. the gentleman from florida. mr. deutch: mr. chairman, this is an important amendment so that every american understands that mental health is health and that we need to care as much about the health of our bodies, from our shoulders up, as we do from our shoulders down. that's what people need to be made aware of. so they have the ability to fight for that access to mental health care. i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the gentleman from oregon is recognized. mr. walden: thank you, mr. chairman. i appreciate that.

i appreciate the gentleman's commitment, especially on mental health and substance abuse. he's done a lot of work in this area. and i know, mr. chairman, when we in the last congress worked together in a bipartisan way, we passed 60 different bills related to the deadly scourge of opioid addiction and overdose. and in the prior congress to that, i believe is when we rewrote america's mental health laws for the first time in decades. we all have friends, family, people in our communities that need help, especially with mental health and, as we know, with substance use disorders. and we did a lot of good work, i'd say, and we've got to make sure, to the gentleman's point, that the efforts we have put forward, the programs we have initiated, and the funding we put behind it, behind those programs, actually get to the people who need the help. i might yield some time to dr. burgess of texas who was chairman of our subcommittee when we were in the majority and

is now the top republican in the health subcommittee, to talk a little bit about these issues. i yield to him. mr. burgess: i thank the gentleman for yielding. i think the kindest thing i can say about this amendment is it should not be necessary. just a brief review of the history of mental health parity as it relates to our health care system. of course those of us who were here in this congress, the day after the lehman brothers bankruptcy was declared in september of 2008, will recall patrick kennedy's bill dealing with mental health parity was used as the vehicle to provide troubled asset relief program, which followed in the wake of the lehman brothers bankruptcy. so mental health parity was actually written into law in 2008, signed by george w. bush. that was two years prior to the passage of the affordable care act so, the affordable care act comes along -- act, so the affordable care act comes along, the essential health benefits disclosed in the affordable care

act in november of 2012, about a week after election day, if i recall correctly, the mental health parity rules were not written by the department of health and human services until probably two years after that. but they were written under secretary sebelius and as a consequence those are the -- those have been the rules of the road ever since. i guess what i don't quite understand is why the navigator system constructed under the affordable care act was not constructed in a way that would have allowed this information to be part of the package of information that is disclosed by the navigators. perhaps had we had a hearing in the energy and commerce committee dealing with this, it might have been instructive. when we did the 10-year re-authorization of the state children's health insurance program a little over a year ago , the parity language was in fact included at the request of

a democratic member of the energy and commerce committee. the parity language was included in the rewriting of the re-authorization of the state children's health insurance program. but my recollection was in the navigator program, this should have been part of the basic information offered by the navigators and i guess, to sum up, i do not understand why it would now take an act of congress to get them to do what they were required to do upon the signing of the passage of the affordable care act. i yield back to the gentleman from oregon. mr. walden: i would just conclude, i appreciate the gentleman's comments. and as i look at a bunch of amendments coming up, to my colleague from texas, there are a whole bunch of these that they're saying, omb we've got to order the navarro -- oh, we've got to order the navigators to do this, do this, do that. you wonder, what is their current training? do -- that we have to pass laws telling them to kind of learn about these things and then go talk to people. this is part of my argument. we're pumping a lot of money into a program that we know there's been -- i don't know if

i can say fraud, but if you got $200,000 to enroll one person or $2.7 million to enroll 314,000, some of the nation's leading editorial writers have had strong words to say about the corruption and scam artists and that sort of thing. and we're having to pass laws that tell them, by the way, talk about mental health, talk about substance abuse, talk about referrals to community-based organizations, navigator system, vulnerable populations, all these things. holy spokes. what don't they know? and what is left out? we should have hearing on this issue in the committee as well as the medicare for all proposal. mr. chairman, i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the question is now on the amendment as modified by the gentleman from florida. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it. the amendment, as modified, is agreed to. it is now in order to consider

amendment number 18 printed in house report 116-61. for what purpose does the gentleman from maryland seek recognition? mr. brown: mr. chairman, i have an amendment at the desk. the chair: the clerk will designate the amendment. the clerk: amendment number 18 printed in house report 116-61 offered by mr. brown of maryland. the chair: pursuant to house resolution 377, the gentleman from maryland, mr. brown, and a member opposed each will control five minutes. the chair recognizes the gentleman from maryland. mr. brown: mr. chair, i yield myself 3 1/2 minutes. the chair: the gentleman is recognized. mr. brown: thank you, mr. chairman. i rise in support of my amendment and the underlying legislative effort that would lower the price of prescription drugs, crackdown on junk insurance plans being encouraged by the trump administration, and reverse the administration's irresponsible sabotage of the affordable care act. my amendment specifically would require h.h.s. secretary to

conduct educational outreach to communities with high health disparities and would thereby expand outreach efforts to increase coverage among african-americans, latinos, native americans, low-income families and rural communities. our effort to help more americans get access to affordable health care comes just as we're seeing the impact of the trump administration's efforts to undermine our health care system. this week we learned that more than a million americans lost their health insurance in the past year and the number of americans in high deductible plans reached an all-time high. black and latino americans and families living at or near the poverty line are particularly impacted by president trump's sabotage. these communities are the most at-risk of being uninsured and these communities have always faced the greatest barriers to obtaining care and have reported the poorest health outcomes. before the trump administration, we saw large gains in coverage for low-income individuals and people of color under the affordable care act.

finally having the health insurance made a key difference in determining when people got care, where they got their care, and ultimately how healthy they could be. however, this progress has been rapidly reversed over the last two years. my amendment would ensure that we aren't leaving behind those with predictably poor health outcomes, like lower life expectancy for children born with lower birth weight, we're not leaving them behind. families in high disparity areas suffer from low levels of health care, literacy, language barriers and limited awareness of the affordable care act's coverage options. . in our complicated health care system and constant fight for access to health care, knowledge is half the battle. i encourage my colleagues to support this amendment and help americans to obtain the knowledge they need and win their health care battles. and i reserve. the chair: the gentleman reserves the balance of his time.

for what purpose does the gentleman from oregon rise? mr. walden: i seek time in opposition to the gentleman's amendment. i reserve. the chair: the gentleman reserves the balance of his time. the gentleman from maryland. mr. brown: i yield one minute to the representative from illinois, mr. krishnamoorthi in a moort think. the chair: the gentleman is recognized. mr. krishnamoorthi: i rise in amendment number 18. i thank congressman brown for your partnership on this amendment, which will ensure we conduct thorough outreach to inform consumers in areas with high health disparities about their insurance options. the underlying legislation restores assistance to help americans enroll in affordable high-quality health insurance and this amendment makes sure those efforts include a particular focus on low-income areas most in need not only of health insurance but improved

health outcomes. in addition to reversing the this bill is ae, huge step forward to lower the cost of prescription drugs. for families in my district and across the country, the high cost of prescription drugs is more than a health issue, it's an economic issue. increasing competition to safe lower cost generics can save americans thousands of dollars each year at the pharmacy counter. we need to strengthen access to high quality access. i urge my colleagues to support this amendment and i yield back. the chair: the gentleman's time has expired. does the gentleman from maryland reserve? mr. brown: i yield as much time as she may consume and i yield to representative barragan.

how much time is remaining? can the chair: 1 1/2 minutes remaining. the chair: the gentlelady is recognized. ms. barragan: i join congressman brown implementing outreach activities. i know about this all too well. i represent one of these districts, a district that is majority minority. 88% latino, african-american combined. these are the types of districts where you have higher health disparities happening where latinos and african-americans have more diabetes than anybody else. my district is 357 out of 435. that is where we land as far as income. of all the congressional districts in congress where people need this information. they need the outreach, that

they know what kind of access they have to health care and so they have those options. providing opportunities to underserved communities to learn about their health care coverage options will result in more people signing up for affordable care and more people will get treated when they become sick and more people will live healthy and productive lives. i urge my colleagues to support this amendment. i yield back. the chair: the gentlelady yields. the gentleman from maryland is recognized. mr. brown: i yield back the balance of my time. the chair: the gentleman yields back the balance of his time. the chair recognizes the gentleman from oregon. mr. walden: let me just say a couple of things. one, i represent a very rural district in oregon. tw 2/3 of the land mass of the state. low income, high levels of poverty and the need for basic services and i worry a lot about making our community health

centers get funded. they run out of funding in a matter of months. the national health service corps, same thing by the end of september. i have a number of indian reservations, native americans. the teaching health centers run out of money. and today we are pouring money into a program that some of our leading editorial said it is susceptible to scam artists and susceptible to corruption. i would rather put money into our community health centers and into some of these other proven programs that were -- i think it's fine to do outreach and expand education. i do wish it was more whole some and wish there weren't a gag restriction so they can't talk about other insurance alternatives that our states

have pioneered and regulate and even the obama administration approved the short-term plans that derided today that these were approved in many cases under the last administration and this one said if they weren't good for three months and see if states want them close to six, nine or 12. and president trump did, if you think about the economy, all we ever hear on the other side is the negative. and actually the economy is dolly really well. and people are getting jobs and getting bigger paychecks and getting insurance. 2.5 million people have insurance that didn't have before through their employer through the trump administration. they need to get the facts out there because facts matter. 2.5 million people have

insurance now. that's the direction we should go. jobs, income, insurance through your employer and then what we should focus on and there is bipartisan support at this, how do we get at the cost of health care. who knows what anything cost. we are paying more out of pocket and what does an m.r.i. cost here versus here versus there. and the president is going after surprise billing and my friend and i are joined on this effort so the consumer doesn't get stuck with a bill because someone showed up to order a test that wasn't in their plan. one example there, a doctor whose daughter got care and sked to do some urine test and the doctor asked her to do it. and the lab was not in the

network of her insurance plan. she didn't know that. she followed doctor's orders. you know what the bill was? over 17,000. he brought a copy of the bill. i don't have it here. he brought it to the white house. and president trump is full throat ready to go to solve this. i don't think we have ever had a president that has leaned in more to get prescription prices down for consumers, drug prices down for consumers. and that's what's going on there in the real world. and the president and secretary ayes ar and the team at c.m.s. there are things you might like or dislike in terms of their proposals. but we never had an administration do more to try and drive out the unnecessary costs that consumers are forced to pay. that's where they are making the decision of whether they can afford to take the drugs from

the pharmacist or leave them on the counter. we have a lot of issues and some of them we are going to work out. i so regret we are here today with the funding of the navigator program, the $25 million on top of the $6 million. you can do it much more efficiently and we have proven that. c.m.s. said can do it for much less money. $2.40.7 per enrollee but who wouldn't take that deal? and so i just think there is a better way to operate. this amendment's fine. so i yield back. the chair: the gentleman yields back the balance of his time. the question is now on the amendment offered by the gentleman from maryland. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it and the amendment

is agreed to. it is now in order to consider amendment number 19 printed in house report 116-61. for what purpose does the gentleman from california seek recognition? r. gohmert: i have an -- >> i have an amendment at the desk. the clerk: amendment offered by mr. gomez of charlecoofl. the chair: the gentleman from california, mr. gomez and a member opposed each will control five minutes. the chair recognizes the gentleman from california. mr. gomez: the trump administration has taken steps to sabotage the affordable care act. my party are taking steps to reverse it. as we do so, we should address

health equity, my amendment would navigateors refer them to community-based organizations that address social needs tied to health outcomes like your zip code, income, race ethnicity, all play a may jor role. a good example in the communities i represent is housing and homelessness. at a recent round table i had with hospitals, community health centers and other medical professionals, they made clear that homelessness pro foundly impacts people and their patients' health. hospitals like l.a. county u.s.c. are looking at homelessness as a health risk factor. when you get checked into l.a. county u.s.c., they not only determine if you have a family history like heart disease and

hypertension and also have you suffered from alcoholism, they not only consider that, they put on the board right above the patient, homeless. and the reason why, you might be able to take care of their underlying condition, but if they end up back on the street days later, then their health outcomes will be negatively impacted. these organizations are not necessarily health care related, they can address health care outcomes. navigateors must understand what our constituents are facing. they are well positioned to refer them to organizations that can improve that individual's long-term health care outcome and also reduce costs. we know that the trump administration is undermining obamacare and we need to reverse it with this legislation. yet at the same time, we must improve health equities to ensure all americans have access

to meaningful care and my amendment would do just that, improve health equity, lower costs and help americans. i yield back. the chair: the gentleman yields. for what purpose does the gentleman from oregon seek recognition? mr. walden: i seek time in opposition. i will make this quick. i'm going to oppose this amendment for this reason. here we are going through to say to the health and-a-half depateors, in amendment after amendment, your job is to enroll people in health insurance. that's your job. and by the way, we are going to have to pass a law that tells you to be a and include discussions of mental health and get about substance abuse disorder benefits. putting into statutes that ought to be common sense and b, part

of an educational program for the navigateors and now, recognizing -- first of all, they are very expensive. second, that there has been at least some level of questionable activity and use of the taxpayer dollars and third they don't know what they are doing so we have to instruct them via statute and now say, by the way, do all these other things, too, that have nothing to do with enrolling people in the affordable care act. so you are going to say on one hand, we don't think you are getting it right but we are giving you knew duties to provide referrals to community-based organizations. that's all going to be in law now? really? i think this whole program the more i sit and listen to the amendment to be put into law, this was an obamacare creation,

i wouldn't say you are sabotaging obamacare with this, but certainly changing obamacare and the and-a-half depateors are looking at the cost. i think the gentleman has 40 health centers in his district and i assume you know that i get about 63 locations and i assume you know the money for those health centers runs out at the end of the fiscal year. i would rather put the money into that than into this program. mr. chairman, i oppose this amendment and i yield back. the chair: the gentleman yields back the balance of his time. the question is now on the amendment offered by the gentleman from california, those in favor say aye. those opposed, no. in the opinion of the chair, the yeas have it and the amendment is agreed to. it is now in order to consider amendment number 20 rinted in house report 116-61.

for what purpose does the gentlewoman from texas seek recognition? mr. escobar: mr. chairman, i have an amendment at the desk. the chair: the clerk will designate the amendment. the clerk: amendment number 20 printed in house report 116-61 offered by ms. escobar of texas. the chair: pursuant to house resolution 377, the gentlewoman from texas, ms. escobar, and a member opposed, will each ontrol five minutes. the chair recognizes the gentlewoman from texas. ms. escobar: mr. chair, i ask my amendment be modified in the form i have placed at the desk. the chair: the clerk will report the modification. the clerk: modification to amendment number 20 offered by -- printed in house report 116-61 offered by ms. escobar of texas. in lieu of the matter proposed to be inserted, insert the following. page 45, strikes line 20-24 and insert the following. a, by amending subparagraph c to read as follows -- c,

facilitate enrollment including with respect to individuals -- ms. escobar: i ask unanimous consent to dispense with the reading. the chair: the clerk will suspend. ms. escobar: we can dispense with the reading. the chair: without objection, the reading is dispensed with. is there objection to the original request? mr. walden: i reserve the right to object. the chair: the gentleman is now recognized on his reservation. mr. walden: thank you, mr. chairman. this is the second time we had to edit amendments on the house floor, if i understand what's happening. there were a lot of amendments offered in the rules committee. we were promised by the democrats at the beginning of this legislative session that this would be an open house where amendments would be considered. i know 92% of the amendments that the democrats allowed to come to the floor are democrat amendments. imagine that. we have one amendment. democrats got 25. and two of them we had to edit

here on the floor. then, we had one that was a bipartisan, just technical change, amendment. i sure hope we are not going to see that for the rest of this congress under democratic control that we are shut out of the amendment process. when the republicans were in charge, 45% or something like that amendments were minority amendments. now it's been shut down. mr. speaker, i won't object to this change. it needs to be done. i yield back and withdraw my objection. the chair: the reservation is withdrawn. without objection, the amendment is modified. the gentlelady from texas is recognized. ms. escobar: thank you, mr. chairman. i yield myself such time as i may consume. the chair: the gentlelady is recognized. ms. escobar: i rise today to offer an amendment to h.r. 987, the strengthening health care and lowering prescription drug costs act. the navigator program is crucial to communities like el

paso where we have one of the highest uninsured rates in the state of texas. navigators provide free assistance to my constituents as they maneuver through the marketplace to find a health care plan that is right for them. when funded adequately, these programs help decrease the uninsured population across the country. however, the trump administration has sought to cut funding for the navigator program in its plan to systematically undermine the affordable care act. by slashing the program's funding by 84% over the last two years, the total funds allotted for it now stands at $10 million. to exemplify these draconian cuts, consider this -- in 2017, there were nine navigator programs funded in texas and two operating in el paso county. in 2018, the number of navigator programs in texas dropped to just two, with only one now operating in el paso

county. this presents a challenge to states and districts like mine that have seen their populations increase over the past decade. the center for medicare and medicaid services has coupled these deep cuts with a rule overturning a requirement for navigator programs to train their sisters to help individuals with chronic illnesses and limited english proficiency. while the trump administration claims this will give navigators more flexibility to tailor their training for the populations they serve, it is really another attempt to scale back what has proven to be a successful program. by cutting funds and reversing this requirement, navigator programs will be forced to choose between extra training for their sisters or hiring more of them to cover counties now lacking operational programs. navigator programs that do not provide proper training could result in their sisters being underprepared when a consumer from a vulnerable population comes to them for assistance. enrolling in the marketplace

can be complex for anyone. especially for those whose primary language is not english. while h.r. 987 restores funding to the navigator program, we must ensure these programs continue to train their sisters to help underserved populations. my amendment does just that by requiring navigators to provide training for their sisters to serve vulnerable populations, including individuals with chronic illnesses and limited english proficiency. in my home county of el paso, there are almost 25,000 uninsured individuals who are not english proficient. this amendment will ensure navigator programs are able to help all el pasoans find suitable health care plans. simply put, mr. chair, access to affordable health care is a right and my amendment ensures we make every attempt to leave no one behind. i urge my colleagues to support this amendment, thanks

representatives torres and porter for thank you co-sponsorship, and reserve the balance of my time. the chair: the gentlewoman from texas reserves. for what purpose does the gentleman from oregon rise? mr. walden: thank you, mr. chairman. i seek time in opposition to the gentlelady's amendment. the chair: the gentleman is recognized for five minutes. mr. walden: thank you. i'll reserve my time. the chair: the gentleman reserves. the gentlelady from texas is recognized. ms. escobar: mr. chair, i yield back the balance of my time. the chair: the gentlewoman from texas yields. the gentleman from oregon is recognized. mr. walden: thank you, mr. chair. i know it's been a long day on the floor, and we're covering a lot of ground. we have a few more amendments to go. you know, this, again, i think as we go through these amendments and the gentlelady is spot on, we have to make sure people are trying to help people get access to insurance can speak the language, can assist in each one of our districts. but it is kind of an indictment to the existing program, if you think about it. you got to come here and

legislate this. to me, whether it's about mental health or substance abuse or this or the one before, this should be commonsense management of a program, it tells me we got a problem with the underlying navigators program. we know it's very, very expensive. we know they enroll less than 1%, less than 1%. everything we're arguing about this afternoon with all these amendments on the navigator program, both are shining a light on the shortcomings of the program itself, which i think the administration has pointed to and said this thing isn't working very well but it's at least very expensive. $767 per enrollee, it appears. in the private sector, they do it for much, much, much less. it's not that this amendment is bad or misguided. i don't think it is. i think once again it's like a bright light in the underlying program that must be fraught with all kinds of problems no, wait, ot 16 --

we have 25 amendments from my friends on the other side of the aisle, most of which are to tell the navigators how to do a better job. and put in federal statute how to basically have common sense. i didn't know you could legislate common sense. i don't know if my colleagues think of that. i do know we need to fund the diabetes programs, teaching hospitals. you know, we have this issue of the -- this will be one that will be interesting. if you don't want to change obamacare, are you going to let the cadillac tax hit insurance plans? union workers and people working in business, are you going to put off the big cuts that come -- come right at our hospitals? i had my hospitals in the other day, and they're saying, boy, i sure hope you're going to turn off those dish cuts that's headed our way. we did that last congress. i helped lead the effort on that. that's actually called for in the underlying obamacare which

by the way, disproportionate hospitals are in our rural cases. many cases have a high you portion of medicaid. -- many cases have a high portion of medicaid. as part of the grand bargain of the obama administration and democrats take these cuts. now they're coming back and say, we can't afford to take these cuts. so i don't know if you'll describe that as sabotaging obamacare, but i bet you're going to join us in trying to hold off those dish cuts that are coming at our community hospitals. so, you know, it just strikes me, again, this navigator program must be a minidisaster in the making if everybody has to come to the floor with an amendment to tell them how to do their job and to reach out and serve the very people this whole thing was intended to serve. so not that i oppose the amendment, i just think the underlying program is pretty darn expensive. you've heard me say that before, mr. chairman, a time or otwo. i yield back the balance of my time. the chair: the gentleman

yields. the question is now on the amendment, as modified, offered by the gentlewoman from texas. those in favor, signify by saying aye. those opposed, signify by saying no. in the opinion of the chair, the amendment, as modified, is agreed to. it is now in order to consider the amendment number 21 printed in the house report 116-61. for what purpose does the gentlewoman from virginia seek recognition? ms. wexton: mr. chairman, i have an amendment at the desk. the chair: the clerk will designate the amendment. the clerk: amendment number 21 printed in house report 116-61 offered by ms. wexton of virginia. the chair: pursuant to house resolution 377, the gentlewoman from virginia, ms. wexton, and a member opposed, will each control five minutes. the chair now recognizes the gentlewoman from virginia. ms. wexton: thank you, mr. chairman. i yield myself such time as i may consume. the chair: the gentlewoman is recognized. ms. wexton: mr. chairman, my

amendment includes findings about how short-term limited duration insurance weakens protections for the millions of americans living with pre-existing health conditions, including children with complex medical needs and disabilities. last year the trump administration greatly expanded the sale and marketing of short-term, limited duration insurance, also known as junk insurance plans. and these plans are junk because they don't provide critical protections laid out by the affordable care act. as my amendment points out, these plans lack important financial protections, may discriminate against individuals living with pre-existing conditions, and may exclude coverage of essential health benefits, such as prescription drug and hospitalization. the protections afforded by the affordable care act are literally lifesaving for children with complex medical needs and disabilities. these children require specialized treatment and medical care that depends on medications, therapies, and equipments such as ventilators,

oxygen tanks, feeding tubes and specialized wheelchairs. the a.c.a.'s essential health benefits ensures the plans covers these care and treatment these children may need. and children with complex medical needs often require extended hospital stays with medical care costing into the millions of dollars. families who purchase junk plans and whose children subsequently encounter medical difficulties may you soon find these insurance plans are effectively worthless. failing to cover the health care their children need and terminating their coverage if it becomes too expensive. these children could also be subject to lifetime coverage caps that they would exceed before they're old enough to go to preschool. the trump administration's actions don't hurt only families purchasing junk plans, as more people participate in these junk plans, the people that see in compliance plans, they would see the cost of their insurance premiums increase. no family should face uncertainty about whether or not their children will have access to lifesaving care when they need it most. my amendment includes findings

that highlight just how harmful these junk plans are for up to the 130 million americans living with pre-existing health conditions and how they jeopardize americans' access to quality, affordable health insurance. thank you, mr. chairman. i reserve the balance of my time. the chair: jot re-- the gentlewoman reserves. for what purpose does the gentleman from oregon seek recognition? mr. walden: i rise in opposition to the gentlelady's amendment. the chair: without objection, the gentleman is recognized for five minutes. mr. walden: i reserve. the chair: the gentleman reserves. the gentlewoman from virginia is recognized. ms. wexton: junk plans circumvent crucial consumer protections afforded by the affordable care act. and are harmful to those living with pre-existing conditions. we have a responsibility to guarantee affordable, quality health insurance for every american, and i hope my colleagues agree and i urge them to support this amendment. i thank my colleagues and i yield back the balance of my time. the chair: the gentlewoman

yields back. the gentleman from oregon is recognized. mr. walden: thank you, mr. chairman. i note that the gentlelady's amendment, it's a serious amendment. we appreciate it being offered. but in her state of virginia, state of virginia has said it's ok to offer these plans up to 364 days per duration, short-term, limited duration insurance policies. it's relegated by her state. were first s approved by the obama administration pause they must have recognized there would be a need for a short-term need to fill the gap and a lot of americans take advantage of those plans. because of that, the trump administration said if they are good for three months, maybe we should let states decide up to a year, and then they could go up to a couple of years, i guess.

four states said no. three said eight months. 12-17 go up to six months. and 27 states said 364 days. the important thing here and i think we have agreement on this, if this were the amendment, should be full and complete disclosure of what these plans cover or do not cover. full and complete. completely transparent. because the last thing any of us want is someone with a pre-existing condition or some other issue or complex medical situation like the gentlelady described, from getting a plan that basically they're told covers these things when it doesn't. it's interesting, i note, dr. burgess is a distinguished member of the energy and commerce committee but one of the individuals who also serves on the rules committee and if memory serves me right, one of

our colleagues, the chair of the subcommittee on health had an ealt in rules that would require full disclosure and transparency, right? i would yield to the gentleman. mr. burgess: our committee work on these bills dealing with the affordable care act, this was one -- the chire woman on the subcommittee of health had this bill.tand alone it was not considered when we did the markup and it fell off the list that day. i don't know. i wasn't consulted or advised, but it was offered as one of the amendments up in the rules committee by a democratic member of the energy and commerce committee, the chairwoman on the subcommittee on health and the amendment was not made in order. again, i don't know why.

i was not part of the discussion or the majority to decide which amendments were going to come to the floor. perhaps a little surprising, because some of the amendments that were made in order were democratic amendments. this was a democratic amendment and the ranking member of the full committee and i agree that this is precisely the type of situation where you would want the purchaser to have complete knowledge of what they were buying. and the state commissioner in my state of texas is very clear on the website of the state of texas, you need to know what you are buying. this would be one of those cases where that disclosure would be extremely helpful to the family that is trying to make a decision. why is someone looking at buying a limited duration plan? they are looking at that because they can't afford what's being old at healthcare.gov or a temporary job transition that

they are trying to cover. the fact of the matter remains that the child described in the previous discussion would likely be covered in one of the plans sold at healthcare.gov but if the family wanted to investigate less expensive plan, that is their right to do so. probably not the best advice to buy that limited duration plan, but they should receive the information. mr. walden: back to the issue of the gentlelady's amendment. her amendment requires short-term limited duration insurance plans to carry a disclosure and provides coverage for limited benefits and that amendment wasn't made in order but should have been made in order because then we get to the other question which we agree on, that there needs to be

complete transparency in these plans because they don't cover everything. we all buy lots of insurance products for cars, houses, life insurance and all these things and i want to understand full disclosure. i yield back, mr. chairman. the chair: the gentleman's time has expired. the question is now on the amendment offered by the gentlewoman from virginia. those in favor say aye. those opposed, no. the ayes have it and the amendment is agreed to. for what purpose does the gentlewoman from virginia seek recognition? ms. wexton: request a recorded vote. the chair: pursuant to clause 6, rule 18, further proceedings on the amendment offered by the gentlewoman from virginia will e postponed. it is now in order to consider amendment number 22 printed in

house report 116-61. for what purpose does the gentleman from new hampshire seek recognition? mr. pappas: mr. chair, i have an amendment at the desk. the chair: the clerk will designate the amendment. the clerk: amendment number 22 printed in house report 116-61 offered by mr. pappas of new hampshire. the chair: pursuant to house resolution 377, the gentleman from new hampshire, mr. pappas, and a member opposed each will control five minutes. the chair recognizes the gentleman from new hampshire. mr. pappas: i yield myself such time as i may consume. i want to thank my colleagues for introducing this legislation that works to improve our health care system and lower the skyrocketing costs of prescription drugs. this will bring relief to millions of americans who are struggling to afford the need. we must move beyond a political debate. the bipartisan action that will improve coverage and lower costs. just last week i was proud to

vote to protect americans with pre-existing conditions and safeguard those suffering from substance use disorder. the amendment strengthens this legislation and the a.c.a. by ensuring that the administration is expanding americans' access to care. it requires the department of health and human services to set enrollment targets, goals that can be tracked and pursued with smart investments of resources. this was employed by the previous administration, yet the trump administration has failed to do so. while they should be promoting enrollment for affordable coverage, this has been slashed by 90% and cut in-person enrollment assistance funding. these actions have real consequences. more than 1.1 million americans lost health care coverage in 2018. in my state, more than 10,000 individuals lost coverage over the past three years. these cuts have hindered organizations such as bi-state

organization. the organization is helping nearly 100,000 granite staters and find coverage in the enrollment period which lasts only six weeks. in the words of the executive director, the loss of funding . ans loss of trusted advisers without collecting and monitoring enrollment numbers it's impossible to hold the department accountable or track how they are deploying resources. the nonpartisan g.a.o. slammed the administration by refusing set targets and no way to target performance. and we need to vertical clearly defined goals. how do you know progress or utilize your resources and how do you know you need to make a course direction. the american people need to know

their government is working to expand access to care. in the greatest nation on earth, no one should miss the opportunity to have health care and the quality of life and peace of mind that comes with it. i urge the adoption of this amendment and i reserve. the chair: the gentleman reserves the balance of his time. for what purpose does the gentleman from oregon seek recognition? mr. walden: i seek recognition in opposition to the amendment. the chair: the gentleman is recognized for file minutes. mr. walden: i thank the chairman. and i reserve the balance of my time. the chair: the gentleman reserves the balance of his time. the chair recognizes the gentleman from new hampshire. mr. pappas: i urge adoption and i yield back. the chair: the chair recognizes the gentleman from oregon. mr. walden: i'm all about holding people accountable for their goals, turns out the navigateors already tried that and didn't work that very well. so i don't know having the secretary set a goal for each of

the exchanges and all it's going to work any better. navigateors enrolled less than 1% of total enrollees. one awardey that the navigator had an enrollment goal of 2,000, well he fell short, he only enrolled one person, one person. and so that's a bit of a problem. i think goals are a good thing, but i don't know if that's going to help here. and we know how many people get enrolled. we know information around this. i don't know. once again, here we are trying to micro manage a program that clearly has a lot of flaws or we wouldn't be putting these things into statute. i don't think we were given these amendments, 25, just because they are freshmen. there are substantive issues bringing to the floor.

it is odd to micro manage a program to this level. i'm going to end up opposing this amendment, mr. chairman. and i yield back. the chair: the gentleman yields back the balance of his time. the question is now on the amendment offered by the gentleman from new hampshire. those in favor say aye. those opposed, no. in the opinion of the chair, the ayes have it and the amendment s agreed to. it is now in order to consider amendment number 23 printed in house report 116-61. for what purpose does the gentleman from california seek recognition? mr. cox: mr. speaker, i'm honored to be here today to introduce my amendment h.r. 987 strengthening health care and lowering prescription drug. my amendment -- the chair: the clerk will suspend. the clerk: amendment number 23 printed in house report 116-61

offered by mr. cox of california. the chair: pursuant to house resolution 377, the gentleman from california, mr. cox, and a member opposed each will control five minutes. mr. cox: i'm honored to be here today to introduce my amendment h.r. 987, the strengthening health care and lowering drug costs. my amendment promotes accountability to have the trump administration a.c.a. user fees. the trump administration and republicans in congress have tried and failed to repeal the a.c.a. had they been successful, 23 million would have lost their health insurance, no health squret for themselves, children or families. when those efforts didn't pan out, the trump administration turned their attention to sabotaging the a.c.a. dismantling the law piece by piece. they shorted the a.c.a.

enrollment periods from 92 days to 45. less time to make a decision means less participation. next up was cutting funding for consumer education and outreach. not just a small cut but a reduction of 90% from $1 million to 10 million. the goal is clear, make it a secret and make it as difficult as possible to insure yourself and your family. a move that the government accountability office self-described as problematic. but it is much more than problematic, it is detrimental. it is clear that goal is to drive enrollment down to zero. last year the administration allowed to present junk insurance plans. they don't protect consumers with pre-existing conditions. now the administration is

pushing the navigateors to promote these junk plans and advertising these plans as somehow comparable to qualified a.c.a. plans. obviously consumers are going to be confused. g.a.o. found the reduction in advertising quote detracted from the 2018 enrollment. that's not likely, that's a fact. this is unacceptable and works against the intent of the law which is to get people more health care coverage. this administration thinks that having uninsured americans is a good thing. my democratic colleagues, the american public and i believe differently. we saw the value of investing in the education outreach. the way to get people covered and reduce uninsured rates is to educate consumers about their health care coverage options and know that health care insurance is affordable and within reach.

having strong outreach can lower premiums. this is what we found in california. our state program covered california estimates that its outreach activities lowered premiums up to 8% for all consumers. this is basic economics. more participants equal lower costs for everyone. that 8% reduction amounts to some $576 million in our state alone. that, my friend, is a great investment. it is a clear intent by this administration under the republican members to undermine the affordable care act by reducing vital funding for fully functioning marketplace. and who does that hurt? everyone. this administration attempts to jam the spokes on the progress the a.c.a. has made to increase the number of people covered. congress and the american people deserves answers to these attempts to subvert the a.c.a. we need to know what the

administration has been spending user fees on. we need to why they are still charging 3.5% user fee to access a federal platform if those fees aren't being used for the purposes they were collected. and we need to know why there was a 50% increase in user fees for state-based marketplaces. talk about a rate tax hike, my amendment seeks answers and requires an annual report to be submitted to congress that includes a breakdown on enrollment and the navigator ogram and the maintenance of healthcare.gov. no one should be denied coverage because they are senior, pregnant. it is a right, not a privilege. it's critical now more than us for us to receive answer how user fees were spent by this ug

administration. i urge my colleagues to support this amendment and i reserve the balance of my time. . the chair: for what purpose does the gentleman from oregon seek recognition? mr. walden: i seek recognition in opposition to the gentleman's amendment. the chair: the gentleman is recognized for five minutes. mr. walden: thank you, mr. chairman. you know, it's amazing to me that 17 navigators, according to c.m.s., during the grant year 2016 to 2017, 17 of these navigators that my friends on the other side of the aisle of had an ig friends average cost of $5,000 per enrollee. that doesn't seem to be very cost efficient to me. as i said before today, "wall street journal" investigation found one grantee got $200,000 and enrolled one person. this is a great program. you can't understand why the

trump administration wants to cut back and put some boundaries around. i can't imagine why you'd embrace that. i just don't get it. the top 10 most expensive navigators collected $2.77 million and they signed up 314 people. let that one sink in. if you want to embrace that, that's up to you. not the way i'd do business. one said the navigator scheme is a make work rife with corruption and highly susceptible to scam artists. it's a slush fund for progressive constituent groups. that's a respected newspaper. ournalists writing this. "wall street journal's" investigation. we figure out $62.5 million in grants, enrolled 89,426 individuals. that's less than 1%.

that's what your navigators, mr. chairman, what some are enthralled with. that's their body of work. $62.5 million, 1%. if you run the calculation. was spent per individual. that's a lot of money. by contrast, agents and brokers assisted with 42% of the federally facilitated enrollment for plan 2018 which st the f.f.e. only $240 -- $2.40 per enrollee to provide training, technical assistance. so we have before us this opportunity to either fund a program that there appears suss , one e -- susceptible person gets paid $200,000 to enroll one person. that's the outcome. that doesn't seem to make a lot

of sense to me. i would say to my colleague from california where they really need the transparency and accountability is on the navigators themselves. that's where we ought to be investigating. and the short-term duration plan, it's unfortunate that ms. eshoo's amendment was not made in order because i agree we need more transparency on those plans so people know what they're buying. i don't want anybody to get a plan that doesn't cover what they need. i don't think any of us does. mr. chairman, i oppose the gentleman's amendment and unless anybody else wants time i'll yield back. the chair: the gentleman yields. the question is now on the offered by the gentleman from california. all those in favor say aye. all those opposed say no. in the opinion of the chair, the ayes have it and the mendment is agreed to.

it is now in order to consider the amendment number 24 printed 61. he house report 116- for what purpose does the gentleman from california seek recognition? mr. cox: mr. speaker, i have an amendment at the desk. the chair: the clerk will now designate the amendment. the clerk: amendment number 24 printed in house report 116-61 offered by mr. cox of california. the chair: pursuant to house resolution 377, the gentleman from california, mr. cox, and a member opposed, will each control five minutes. the chair recognizes the gentleman from california. mr. cox: mr. speaker, i'm honored to be here today to introduce my amendment to h.r. 987, the strengthening health care and lowering prescription drug costs act. my amendment would ensure that communities with high unemployment numbers are prioritized in the navigator jouts reach program. -- outreach program. the affordable care act had enrollment assistance to

consumers shopping for health care coverage. the navigator program has been successful throughout the country and demonstrated meaningful benefits to our consumers. in my home state of california, we have been making these necessary investments to ensure people throughout our state get the information they need to obtain coverage, and it works. ur state marketplace cover california estimates in 2015 and 2016 increased in enrollment which reduced premiums by up to 8% for all of our enrolled members. that is some savings to all $576 ed members by some million. based on a small budget of some $56 million budgets. that is a great investment. that is a 1,000% return on investment. that is a great deal by

anyone's measure. and that is the goal to reduce the number of uninsured americans. we all know when we have insurance we stay healthy, and this strengthens our overall health care system, our communities, and our nation. that's why the navigator program is so important. and the trump administration's 84% cut to the program since 2016 is just unacceptable. it's imperative that funding is restored to the navigator programs. the navigator programs helps those with employer sponsored companies, sole proprietors, contractors and everyone that's staking their claim to the american dream. the fact is many that are eligible for financial snan through the a.c.a., which would help them get coverage, don't know they can get help. this administration wants to keep them in the dark. some 40% of consumers today don't even know there are options available. my congressional district has an unemployment rate of 17%, and this is made up of rural communities that face unique

challenges and barriers with respect to education, communication, and transportation. this makes it very difficult for my constituents to receive information on their health care insurance options, and this is so similar to many of our rural communities across the nation. for many of those communities, the navigator program is the only way they can access this vital information. everyone should have health insurance and know their health care options. health care is a right, not a privilege. your zip code should not dictate your ability to obtain insurance. my amendment would help distressed communities, like those in my district, and so many more across the nation that may not have the resources to access the full health care options. by fully funding the navigator program and by focusing our efforts on areas that have high unemployment, we can get more people covered. and that's the goal. here in america, the building blocks for success are quality education, dedication to hard

work, and good health. a healthy workforce is vital for america's success. we must fund the navigator program to help educate those who are difficult to reach geographically or who have limited access to a.c.a. resources. this is a critical and necessary investment that will build a stronger, healthier, and more productive communities in an america that demonstrates its best investment are its people. with that i urge my colleagues to support my amendment, and i reserve the balance of my time. the chair: the gentleman yields. i'm sorry. it's been a long day. the gentleman reserves. for what purpose does the gentleman from oregon seek recognition? mr. walden: mr. chairman, i seek recognition to claim the time in because we ran

out of ideas, things to putra t costs $761 for the government to run its navigator program but the private sector can do it for $2.40, you don't make it up in volume. of course, we want people to access information. i was in the radio business for 20 years. our job was to get information out to consumers. so i'm all about that. it's just amazing, though, when you see the inefficiency of a

ederal system versus the efficiency of a government initiative. we put $20 million into this program and yet we know in some cases there's ear normous costs and there appears to be, you know, i don't know, malfeasance. i don't know what it is. if the top 10 most expensive navigators collected $2.77 million to sign up 314 people, i think we're in the wrong business. i think we ought to go be navigators at that rate. that's a pretty good rate of return for them, but not for the people, the taxpayers. that, mr. chairman, i yield one minute, one minute to the republican leader of the united states house of representatives, the distinguished gentleman from california, mr. mcquarty. the chair: -- mr. walden: the gentleman from california, mr. mccarthy. the chair: the republican leader is recognized. mr. mccarthy: i want to thank

you, mr. walden. mr. chairman, i know of a bill that mr. walden has in to protect pre-existing conditions. we've asked many times to mark it up or bring it to the floor. no. not brought. it's talked about a lot, mr. speaker, but no bill to bring it here. i know your care when it comes to not just health care but the type of treatment one is able to get. the quality of care out there. mr. chairman, there are people out there that will run health facilities for the seniors, but don't do a very good job. the quality is not there. people have lost their own health care within there. people have been fined by the way they treated individuals and seniors. people have lost eyes just because treatment had been poor. mr. chairman, we are here today on this floor because we all know that drug prices are too high. that's why energy and commerce

committee worked tirelessly to pass three health care bills unanimously to address them. now, how often is that said on this floor? not very often. it was a moment that i heard from almost every member in that committee a moment of pride. we could have legislation passed in a bipartisan fashion today. we could take from that committee and bring it to the floor and we'd have the exact same thing happen. you know who wins? all of america. sadly, however, these good faith efforts have been unnecessarily thrown into a partisan and senls attempt to bail out -- senseless attempt to bail out pieces of the affordable care act. now, i don't say that, but i guess i just did, mr. chairman. i knew