Earl Blumenauer

Mr. BLUMENAUER

Mr. BLUMENAUER. Madam Speaker, today I introduced the Public Buildings Renewal Act (PBRA) of 2019. This bipartisan legislation will spur private investment in public building infrastructure throughout the United States by creating $5 billion in Private Activity Bonds for the development of government-owned public buildings. In every American community, there are serious concerns about the condition of our schools, public hospitals, justice facilities, universities, police and fire stations. With state and local budgets becoming increasingly strained, officials have chosen to save money by steadily reducing capital investment in public buildings. But years of underinvestment have led to facilities that are inadequately maintained, fail to comply with current codes or disability requirements, and do not have adequate security--endangering the general public. Throughout the country, the average public-school building is at least 40 years old, and the current backlog of maintenance and repair projects adds up to more than $45 billion annually in unmet funding needs. The Public Buildings Renewal Act will reverse this trend by unlocking private sector capital for the public's benefit. It is past time that we upgrade our public buildings to provide a safe, modern, and efficient experience from coast to coast. While this legislation is not a panacea to solve all of our infrastructure needs, it is an important aspect of our strategy to rebuild and renew America. I look forward to working with my colleagues on both sides of the aisle to pass it into law.

Mr. BLUMENAUER

Mr. BLUMENAUER. Madam Speaker, today I am pleased to introduce the Promoting Access to Diabetic Shoes Act, which would remove an unnecessary burden, allowing a nurse practitioner or physician assistant to prescribe diabetic shoes. According to the American Diabetes Association, 1.5 million Americans are diagnosed with diabetes every year, and it is a condition that affects approximately 9 percent of the population. Both Type 1 and Type 2 diabetics are faced with a high lifetime risk of developing foot ulcers. Specialized insoles and footwear are required to prevent further breakdown and injury, and to ensure that recurring ulcers do not develop. If these ulcers are allowed to recur multiple times, patients can lose toes or feet entirely. Currently, nurse practitioners and physician assistants, who often act as primary care providers for many patients with diabetes, are required to refer diabetic Medicare patients who need therapeutic shoes to a physician for further certification. The patient must then refer to the physician going forward. In addition to accruing unnecessary fees, this process delays patients from getting efficient and time- sensitive care. Timely access to diabetic shoes is crucial, and is well within the scope of treatment that nurse practitioners and physician assistants should be able to prescribe. That is why I am proud to sponsor the Promoting Access to Diabetic Shoes Act, and I urge all of my colleagues to join me to pass this important piece of legislation.

Mr. BLUMENAUER

Mr. BLUMENAUER. Madam Speaker, today I am pleased to introduce the Comprehensive Care for Seniors Act of 2019. This legislation would direct CMS to promulgate the long overdue Programs of All-Inclusive Care for the Elderly (PACE) final rule by April 1, 2019. PACE is a proven care model delivering high-quality, comprehensive, integrated and coordinated community-based care to both Medicare and Medicaid beneficiaries 55 years of age or older, who meet the criteria for a nursing home level of care, but wish to live at home. Multiple studies show that people receiving care from PACE organizations live longer, experience better health, have fewer hospitalizations and spend more time living at home than those receiving care through other programs. PACE is a comprehensive, capitated, fully integrated, provider-based health plan. At present, there are 124 PACE organizations operating in 31 states, serving over 45,000 elders and those living with disabilities every day. PACE operates based on the fundamental principle that it is preferable in terms of quality of life, quality of care, and costs to public and private payers for PACE-eligible individuals to be served in the community whenever possible. Ninety- five percent live at home in their communities. The PACE organization assesses each individual upon enrollment and develops a personalized care plan, implemented primarily by PACE staff across all settings of care twenty-four hours a day, seven days a week, 365 days a year. Most PACE participants, 90 percent, are dually eligible for Medicare and Medicaid. The average participant is 76 years of age, and lives with multiple chronic, complex medical conditions, which often significantly limit activities of daily living. Approximately half live with dementia. Thus, PACE organizations enroll an exclusively high-risk, high-cost population, with 85 percent being at least 65 years of age, and 15 percent between the ages of 55 and 64. When individuals with chronic and medically complex conditions do not have access to care, their quality of life is diminished, which over time leads to increased expenditures. PACE deliberately was constructed to address the chronic care needs of individuals by providing timely and clinically appropriate treatments and social supports. Currently, PACE programs operate under outdated regulations from 2006. It is critically important that CMS issue the PACE final rule, which will bring much needed regulatory flexibility, allowing PACE organizations to innovate and grow to best serve their participants, their families, and their communities. I urge all of my colleagues to join me to pass the Comprehensive Care for Seniors Act of 2019.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, today the House voted on a motion to suspend the rules and pass H.J. Res. 30, disapproving the President's proposal to take an action relating to the application of certain sanctions with respect to the Russian Federation (Roll Call no. 42). I strongly support this legislation that prevents the Trump administration from terminating certain sanctions on three companies, including aluminum giant Rusal, controlled by Oleg Deripaska, a Russian oligarch and close ally of Vladimir Putin. These sanctions were imposed under a comprehensive sanctions law passed by Congress in response to Russian interference in the 2016 election. There are far too many unanswered questions about this decision by the Trump administration. Congress must fully vet whether these companies are no longer owned and operated by Deripaska or his compatriots. Russia must be held accountable for their actions.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, had I been present for the vote today on H.J. Res. 30, I would have voted ``aye'' to retain these sanctions. Stated against:

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, had I been present for the vote today on the enrollment correction to H.R. 4174, the Foundations for Evidence- Based Policymaking Act of 2017 (Roll no. 483), I would have voted ``aye.'' On concurring in the Senate Amendment to H.R. 4174, the Foundations for Evidence-Based Policymaking Act of 2017 (Roll no. 484), I would have voted ``aye.'' On S. 3277, the Space Frontier Act of 2018 (Roll no. 485), I would have voted ``no.'' On the House Amendment to S. 3661, the 75th Anniversary of World War II Commemoration Act (Roll no. 486), I would have voted ``aye.'' On concurring in the Senate Amendment to H.R. 2200, the Frederick Douglass Trafficking Victims Prevention and Protection Reauthorization Act of 2018 (Roll no. 487), I would have voted ``aye.'' On S. 1023, the Tropical Forest Conservation Reauthorization Act of 2018 (Roll no. 488), I would have voted ``aye.'' On S. 1158, the Elie Wiesel Genocide and Atrocities Prevention Act of 2018 (Roll no. 489), I would have voted ``aye.'' On S. 1580, the Protecting Girls' Access to Education in Vulnerable Settings Act (Roll no. 490), I would have voted ``aye.'' On S. 1862 the Trafficking Victims Protection Reauthorization Act of 2017, as amended (Roll no.491), I would have voted ``aye.'' On S. 3247, the Women's Entrepreneurship and Economic Empowerment Act of 2018 (Roll no.492), I would have voted ``aye.'' On S. 512, the Nuclear Energy Innovation and Modernization Act (Roll no. 493), I would have voted ``aye.'' On S. 1934, the Alaska Remote Generator Reliability and Protection Act (Roll no. 494), I would have voted ``no.'' On concurring in the Senate Amendment to H.R. 6287, the 9/11 Memorial Act (Roll no. 495), I would have voted ``aye.'' On S. 3456, a bill to redesignate Hobe Sound National Wildlife Refuge as the Nathaniel P. Reed Hobe Sound National Wildlife Refuge, and for other purposes (Roll no. 496), I would have voted ``aye.'' On H.R. 7388, a bill to extend the National Flood Insurance Program, and for other purposes, (Roll call no. 497) I would have voted ``no.'' On the Motion to Fix the Convening Time (Roll call. no 498) I would have voted ``no.'' On H. Con. Res. 148, the enrollment correction to S. 3628, a bill to reauthorize the National Flood Insurance Program (Roll call. no 499) I would have voted ``aye.'' Additionally, had I been present for the vote on S. 3628, a bill to reauthorize the National Flood Insurance Program (Roll call. no 500) I would have voted ``aye.''

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, I listened to my friend from Pennsylvania talking about bipartisan opportunities, things we agree on. You know, the railroad tax credit is something that we could have done in a heartbeat, but unfortunately, it is wrapped into a really embarrassing piece of legislation, which is a fitting symbol to the wrap-up of 8 years of Republican rule of the House Ways and Means Committee. We are in the process of again making the Tax Code more complex, which they have done every year they have been in control: talk about tax simplification, make it more complex. Those complexities were for people who actually needed it the least. We have lavished massive tax cuts on the most well-off in this country and done nothing to reduce the growing income inequality. They have assaulted the Affordable Care Act and actually put it at risk. I hear about the improvement of IRS customer service. For 8 years, they have assaulted the IRS in their war against taxes, and they have used taxpayers as the hostages. Employees there haven't had the resources to be able to deal meaningfully with the ever-increasing Tax Code to help taxpayers with their premiums. They have had no time to listen to the American public. You have seen major tax bills after major tax bills with no public hearings, no expert witnesses, no opportunity to really try that bipartisanship. Mr. Speaker, I reflect now on our friend Paul Ryan, who is leaving office, and what a sad note to end on. The Federal Government in November spent twice as much as it took in.

Mr. BLUMENAUER. Mr. Speaker, after hearing Paul Ryan talk for years about deficits on the Ways and Means Committee and on the Budget Committee, he leaves a legacy of exploding deficits. You talk about burdens for our children: $2.3 trillion extra of national debt. Think for a moment: We can't balance the budget when times are as good as they are and unemployment is as low. We have had 8 years of increasing employment. I was just in the Cloakroom while Donald Trump was spouting off on TV, and I was watching as the Dow Jones plunged over 500 points. It is a verdict on the reckless Republican leadership in tax and spending, and they are leaving Democrats with serious problems to address. But I know, under our chairman and Democratic leadership, we will at least listen to the American public.

Mr. BLUMENAUER. Mr. Speaker, we will allow the public to know what we are voting on, and we will actually be able to start building on the foundation of things that make a difference: rebuilding and renewing America, closing the income gap, allowing those most fortunate in our economy to be able to pay a little more so that we don't have to sacrifice services for the elderly, the poor, and students, and be able to rebuild and renew this country. I am looking forward to that opportunity for Democrats to take control, and this sorry Congress cannot end fast enough. Mr. Speaker, I urge rejection of this proposal.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, I acknowledge that Ranking Member Collin Peterson on the committee has done a good job balancing many special interests that are profoundly affected by the farm bill; solving a delicate series of political problems; and holding firm, protecting vital nutrition programs and things that I care about, that I have been working on for years, like hemp. But unfortunately, the bill is not addressing the crisis in American agriculture. I published a book earlier this year. The Fight for Food had an alternative farm bill. Some of the provisions have found their way into it. But this bill does not affect the crisis that we are facing in American agriculture; having small and medium-sized producers being squeezed out; the battle in terms of the chemical warfare in parts of America with Monsanto products that are threatening agriculture production; and we are actually seeing violence break out in terms of being unable to deal with this. We have a profound problem in terms of the environmental context that farmers face. Only one in four farmers are going to get access to the environmental programs they need. Now, there are some improvements in there, things I have been working on for years, but the fundamental problem, by flatlining it, we are not meeting the needs and, in fact, it is going to represent a reduction in absolute terms. It does nothing to address the crisis that agriculture is facing because of climate change and carbon pollution. We have a crop insurance program that doesn't work for most farmers and ranchers, and it is grotesquely expensive. We have had efforts in Congress, committees, outside experts, that point to ways we can rein in these unjustified subsidies, save money, and have a program that works for most farmers and ranchers. But sadly, that will have to wait for another day. We are not investing in the future. We are not investing in farmers and ranchers who need the help the most, accelerating research, accelerating environmental programs, accelerating and investing more in beginning farmers. Mr. Speaker, it is not good enough to be able to solve the political problem, to solve the bill, and prevent the worst abuses that were being proposed. We need a farm and food bill for Americans who eat, who pay taxes, and for farmers and ranchers who want to practice on a sustainable basis on the smaller scale, not massive agricultural industrial production. This bill is a missed opportunity. And even though it has got some good things in it, I am going to vote against it because it is not nearly good enough.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, I appreciate the gentleman's courtesy in permitting me to speak on the bill. I commend Mr. Peterson, in particular, for guiding this important piece of legislation that actually includes many provisions that I have been working with for over 12 years. He has been successful in protecting key Democratic priorities, especially nutrition, and avoiding damaging, poison-pill provisions. Near and dear to my heart are the reforms for hemp. But, I am concerned that it does not adequately address the growing crisis in American agriculture. I spent 3 years going around Oregon talking to people, putting together our little ``Fight for Food'' booklet and legislation. We are not dealing with the chemical welfare inspired by Monsanto/ Bayer. We have the Trump tariffs and climate devastation that is getting more serious by the month. We have a crop insurance program that is not just wasteful, but fails most farmers and ranchers that I represent and, indeed, in most States. While I appreciate the legislative accomplishment that are represented here, I look forward to starting the next Congress with then-Chairman Peterson to see if we can build on this foundation to narrow differences, broaden areas of agreement, do better for our farmers and ranchers, better for the environment, better for taxpayers and everyone who eats.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, no wonder Republicans are afraid to even debate their latest tax bill. As their 8-year grip on tax policy comes to an end, it is a story of failure, missed opportunities, and making a broken tax system worse. The Tax Code under the Republicans was made more complex and more unfair every year they were in charge. They showered more tax breaks on the wealthy and corporations, and enhanced income inequality. They had an iron grip on the average taxpayer, denying even basic customer service through the IRS. They exploded the deficits--a trillion dollars a year for as far as the eye can see--and refused to enforce the Tax Code on people who cheat, leaving hundreds of billions of uncollected tax dollars unavailable to reduce the deficit or fund government service. For 8 years, they even refused to listen to the vast array of infrastructure stakeholders on how to rebuild and renew America, a sorry legacy I am confident we will improve upon as Democrats. We couldn't do any worse.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, I appreciate the gentleman's courtesy in allowing me to speak on this bill. Mr. Speaker, I hear my friend from Texas talking about the booming stock market and the increase in employment. Actually, the statistics will bear out that the increase in employment has been a steady line through the Obama administration. It hasn't spiked. It is just kind of continuing the slow recovery. About that stock market, now maybe my friend was distracted for the last few weeks, but the gains for the entire year disappeared in a couple of weeks. The uncertainty troubles people who care about the future of this country. As the 115th Congress staggers to its conclusion, this rule enshrines the failure of the Republicans to deal meaningfully with America's scandalous Tax Code, although promising to reform the Tax Code. I was one of the people on the Ways and Means Committee who worked the 8 years they were in charge to try and find areas of bipartisan cooperation, but they have repeatedly failed at reform. Instead, every year, they made the Tax Code more complicated and less fair. That came to a glorious conclusion with their tax scam which made a hash out of the Tax Code. It means that millions of people actually will pay more. Irony of irony, Americans trying to deal with a more complicated Tax Code won't even be able to deduct the accounting expenses to deal with this monstrosity. The centerpiece of the 8 years in charge was the tax scam costing taxpayers $2.3 trillion of additional debt. Now, you would think if we were going to borrow $2.3 trillion and lavish tax breaks, admittedly on people who need them the least, that you would think that would at least be popular. My friend from Massachusetts cited some of the perceptions of the American public. But what I think is most telling is that their tax cut that costs the American taxpayer $2.3 trillion in additional debt was less popular than Bill Clinton's tax increase. What was supposed to be the centerpiece of a ride to victory in November ended up being the largest net increase for Democrats since Watergate, and at the end they weren't touting it. They weren't campaigning on it.

Mr. BLUMENAUER. In fact, if that was such a great idea, don't you think they would have had a hearing on this bill? Don't you think they would get their Members involved? Where are the dozens of Republicans coming to the floor to celebrate the rule for this flawed piece of legislation? It is complex, and it is unfair. It is raising taxes on millions, destabilizing our economic future, and making it harder for us to compete in the future. Mr. Speaker, reject the rule, and reject the bill.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, I really have appreciated sitting on the floor and listening to this dialogue because I think that there are some lessons here about getting things right. My friend from Virginia, my friend from Oregon have dealt with the ecological benefits of having apex predators to be able to restore ecological balance. I heard the notion of, ``Well, how would you feel if you were reintroducing wolves in metropolitan areas?'' and I just thought for a moment of listening in the past to people who are overrun with deer in Virginia suburbs, in Maryland suburbs. It is not just messing up their yards; it is killing people. We have several hundred people a year who are killed in collisions with deer. There are problems with chronic wasting disease that having an apex predator helps provide health benefits where you have healthier herds. I have watched the dynamic in Oregon, and it is complex because there are people who are ranching interests, there are people who are involved with hunting, and they want to short-circuit it, even in a State as ecologically and animal friendly as Oregon. It is a struggle. To take a step back, weakening the endangered species protections, substituting political judgments, I think, is inappropriate. I would also note no small amount of irony that, in addition to the notion that we should be here reauthorizing the Land and Water and Conservation Fund, if we want to deal with animals in the closing hours of this session of Congress, why aren't we dealing with a half dozen bills that Republicans have refused to allow us to vote on that are overwhelmingly supported by the public and are supported by a majority of our Members? It is, I think, doubly ironic that we are concluding where we have had Republican leadership forcing some of the worst animal welfare records. We lost two Republican incumbents with 50 years of service in Republican districts who had the worst animal records in Congress. I fought really hard to have animal welfare be a bipartisan issue. Taking issues like this, forcing people to make false choices that are bad for animals, bad for the environment--frankly, they are bad politics. I hope that we go through this charade, it goes nowhere, but deal with the underlying debate here about what we want in terms of ecological balance, animal protection, and rule of law. We will be better off if we do that; the species will be better off if we do that; and I think the politics will be cleaner and more productive. Mr. Speaker, I appreciate the gentleman's courtesy in allowing me to speak on this.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, I rise to commemorate the life and legacy of Mulugeta Seraw. Mulugeta came to the U.S., like many immigrants and refugees, in search of the American dream. His life however, was tragically cut short. The 28-year-old Ethiopian immigrant lost his life at the hands of white supremacists 30 years ago in my hometown of Portland. Although this event occurred three decades ago, I'm afraid we have not learned its lesson. Elements of our nation are being revealed, all at the behest of Donald Trump and his hateful rhetoric and racist policies. I fear our country stands at an inflection point. We must confront these vile forces with love and strength in these difficult times. The Urban League of Portland, which has worked tirelessly for justice and equality since 1945, is commemorating Mulugeta's life this November, which marks 30 years since his passing. This celebration brings us together and affirms our strength. It is also a sad reminder that we still have more to do to defeat senseless acts of hate and violence. This celebration shows that Mulugeta Seraw did not lose his life in vain and makes me confident that we will build a more just and compassionate community.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, I heard the gentlewoman from South Dakota talk about all the stories that she could tell. Sadly, that is what our Republican friends have done. They want to tell stories cherry-picked, but they are afraid to have hearings from the people whom this affects. We haven't heard from the experts, from the academics, and from people in business. They were afraid to have hearings on their tax bill, rushing it through, and they didn't even know what was in it. Now they are doubling down, adding another trillion dollars of debt without having a foundation factually to let the people know what is going on. Look at their budget. They have declared war on Social Security and on Medicare. They understand that it is not sustainable. The tax cuts don't pay for themselves. They are putting at risk things that America cares about like Social Security and like Medicare--fundamental issues that matter. I hope that if the American public entrusts us with the control of Congress next year that we will go forward, listen to them, make it transparent, and base it on facts.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, I appreciate the gentleman's courtesy in permitting me to speak on this bill. I am pleased that this bill is being named after Senator McCain. It has been my privilege to work with him in one particular area: dealing with the people who worked with us in Afghanistan and Iraq on special immigrant visas. Along with the late Senator Kennedy, over the last 10 years, we worked to try and help these people who put their lives on the line to help our forces as guides, as interpreters, who are now being left to the tender mercies of people with long memories, like the Taliban and al-Qaida. Their lives are at risk, as are their family members'. We still have 17,000 applicants who want to have these visas to come to the United States to safety. I am disappointed that we have been unable to have the funding for additional visa allocations. I appreciate that due to an accounting convention, this would be at the expense of other important things that are being fought for. But I would hope that we are able to focus on what the costs would have been to us if we didn't have those people helping us in Afghanistan and Iraq. It would have been far more expensive. And like you, I have met with people whose lives were saved because they put themselves at risk, and we are leaving them behind. My friend, Kirk Johnson, wrote a book: ``To Be a Friend Is Fatal: The Fight to Save the Iraqis America Left Behind.'' And for these people, being a friend of the United States is fatal. Their lives are at risk every day. I hope, as this process goes forward, we can either deal with the accounting convention or try and find some money to rescue these people.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, every day there is a head-spinning moment with someone who is willing to push the Presidential powers to the point of abuse. Trump is undermining freedom of the press with unprecedented attacks. He cast doubt on the integrity and competence of United States intelligence services. He has an administration that is manipulating the data of a dishonest agency evaluation of the impact of monuments status that protects hundreds of thousands of acres and endangered species like the magnificent sage-grouse. Today's outrage is a plan to use the Commodity Credit Corporation to funnel another $12 billion for a bailout of American farmers. You know, most farmers and ranchers don't want a government bailout. They would like to be able to farm. They would like to be able to market. They would like to be able to sell their products without the threat of Trump's trade war. Soon after Obama took office, inheriting the worst economy since the Great Depression, we have seen steady private sector employment growth for 9 consecutive years. Now, after inheriting a strong and growing economy, Trump and his enablers in the Republican Party are threatening this progress with a trade war that increases prices for American consumers, for American businesses, and is raising their costs. It is hard to keep track of everything. Trump is involved with an all-out war on the Affordable Care Act. After utterly failing in his promise--remember, he was going to provide better healthcare for more people at lower cost. Who knew healthcare was complicated. Instead, his administration is raising insurance costs for millions in the individual market while destabilizing insurance for the rest of us. There were promises of tax reform, making it simpler and fairer. Instead, we have hopelessly complicated the Tax Code. We have given massive tax cuts for many people who didn't need them. We are going to be watching for taxes being raised on homeowners across the country over the next 10 years. And, as a result of these actions for the budget and the taxes, we have doubled the budget deficit this year, with the prospect of deficits every year of a trillion dollars or more as far as the eye can see. After Republicans have cut over $2 trillion in taxes since 2001 for just the top 1 percent, what is the solution our Republican friends are offering to deal with the consequences? Look at the budget they just passed. Mr. Speaker, $2 trillion of cuts in programs for everybody else: Social Security, Medicare, Medicaid, the Affordable Care Act. At some point, the public is going to catch on to what is happening to them. In fact, maybe they already are. Maybe that is the reason that the Republican tax cuts are less popular than Bill Clinton's tax increase. It is time that we take a step back, while we still can, and get back on the appropriate fiscal course. It does not mean trade wars and providing money for people who don't need it. Let's allow the economy to function without gimmicks and bailouts.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, today I will vote against the 39th short term extension of the National Flood Insurance Program that did not provide any reform whatsoever. I've been working to improve the flood insurance program for over 20 years. The current program is ever deeper in debt, does not provide the right incentives to move people out of harm's way, and misses an opportunity for at least a small set of incremental improvements to save money and make America's families and businesses safer. I know this extension will pass but I want to register in the strongest possible terms my insistence that we get on with the business of having a sustainable safe flood insurance program that is so important to so many Americans. The time to start this is now and this short-term extension fails that test.

Mr. BLUMENAUER

Mr. BLUMENAUER. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I am pleased to be here with Ms. Jenkins, moving forward on this legislation. It represents an opportunity for us to deal with a series of, as she mentioned, bipartisan ideas, relatively simple, to enhance service delivery. I state from the outset that I am troubled that we were not able to provide opportunities to pay for these. They carry a cost. In committee, even though I thought they were a good idea, I voted against some of them because they were rather expensive. In the aggregate, these are things, moving forward, that will improve healthcare, and I am hopeful that, as we move along the process, we can find some ways to offset the costs involved. Some of us have philosophical questions about the role of HSAs and how it fits overall, but this legislation will make key consumer- friendly improvements to our existing system. Direct primary care medical homes are an important example of successful delivery reforms that will become easier to access under this legislation. DPC arrangements offer individuals access to comprehensive primary care and prevention services in a medical home setting for a flat monthly fee, as opposed to concierge services that some people have in mind. Most of these practices typically charge a low monthly fee, perhaps $50 to $100, in most cases, and they serve low- and moderate-income patients. These fees support the delivery of high- quality, coordinated care by providing better healthcare upfront in primary care settings. DPC practices reduce unnecessary hospital and specialty care, as well as administrative expenses. This empowers the doctor-patient relationship, enabling providers to resist financial incentives that distort the decisionmaking process in primary care. It also reduces the conveyor belt process, where people are typically shuttled into the office in 8-minute increments. This is not the case in direct primary care. It is not uncommon for appointments to last half an hour or even an hour. So they build a better relationship with patients, and they are able to better understand and address healthcare needs. By offering a high level of access to primary care, evidence shows that direct primary care medical homes improve health outcomes and reduce costs. Today, DPC medical homes serve individuals of all ages and income in at least 47 States. This legislation simplifies existing IRS regulations and clarifies that direct primary care medical homes are qualified health expenses-- medical services--and not health plans. I personally question the IRS ruling. We have debated with them, but we have lost that. We fix it with this legislation. As more individuals and employers seek to utilize the direct primary care delivery model, it is important that this outdated tax barrier not get in the way of patients accessing this successful model. The legislation will allow HSA plans to cover onsite employee clinics. Think for a moment about the nursing stations that we have here in the House of Representatives to provide that service. They can offer physical exams, immunization, over-the-counter drugs, drug testing, hearing and vision screening, and other minor primary care preventive services to help employers assemble a benefits package for their employees that is both practical and can give them a competitive edge. Allowing employees to access this basic healthcare service at work means it doesn't disrupt the worksite. It is more convenient for them; it is better for the employer. Another key consumer change made by this bill is to recognize that employees change jobs. This bill allows individuals to streamline the conversion of a medical savings account, flexible savings account, or HSA so they won't lose savings when they change jobs. These reasonable changes will help consumers make the most of their employer-sponsored coverage. Now--make no mistake--while this legislation will certainly help some consumers, it doesn't atone for the systematic sabotage that we have seen of the Affordable Care Act by the administration and some of my Republican colleagues. By zeroing out the mandate penalty, estimates are that insurance premiums will rise 15 percent. None of these bills before us today undo that premium hike that is visited upon our constituents unnecessarily. These premium increases are coming after Republicans gave insurance companies billions in tax cuts in their tax bills. Republican attempts to expand HSAs is no replacement for the Affordable Care Act's financial assistance. Attempts to expand HSAs are a continuation of a platform of shifting families into health plans which provide fewer health benefits and higher out-of-pocket costs, while providing greater tax benefits for those who need them least. HSAs and high-deductible healthcare plans shift costs to consumers without bending the cost curve or addressing underlying costs of medical care in the United States. I think we can and should do better. For instance, the President has promised action on lowering prescription drug costs. These bills today do nothing to lower the cost of drugs consumers buy, and seek to move more people into plans that provide only catastrophic coverage, exposing more people to pay the full freight of drug price hikes. Now, we have legislation before our committees that could move forward to do something about this, and I am saddened, despite Trump's talking about it, that we have really not taken action to do so. And we could, on a bipartisan basis, if we were enabled to do so. The collection of bills on the floor this week will reduce Federal revenues by about $90 billion and will do nothing to reduce the number of uninsured people that will increase as a result of policy changes my Republican friends have done in this Congress. Their sabotage efforts under the Trump administration have caused millions of people to lose coverage, and millions more will do so in the future. Now we are seeing, in the budget proposal, my Republican friends proposing to cut Medicare and Medicaid by nearly $1 trillion to try and pay for the deficits that have been exaggerated by tax cuts they have enacted. The bills that we will be considering, especially the next one, will only add fuel to that fire. So, I am pleased that we have got some bipartisan pieces that we can move forward. I am hopeful that we don't abandon a sense of fiscal responsibility to be able to work together to pay for them, and I hope that we can encourage some of my friends on the other side of the aisle to dial back the assault on the Affordable Care Act, especially by the administration, so that we don't destabilize the system further, drive up costs, and increase the number of uninsured. Mr. Speaker, I reserve the balance of my time.

Mr. BLUMENAUER. Mr. Speaker, I yield 4 minutes to the gentleman from Wisconsin (Mr. Kind), a senior member of the Committee on Ways and Means, author of several of these reform provisions, and a champion of value over volume in healthcare, as well as fiscal restraint.

Mr. BLUMENAUER. Mr. Speaker, I yield the gentleman from Wisconsin 1 additional minute.

Mr. BLUMENAUER. Mr. Speaker, I yield myself 1 minute just to respond briefly. Mr. Speaker, I was here in 2009. The very month President Obama took office, there were 700,000 jobs lost. There was great fear that we were going to have a complete collapse of the auto industry. There was a whole range of things that we were in an emergency situation on, and the worst economic crisis since the Great Depression. As it was, a major portion of that bill was tax cuts to try and stimulate the economy. I do point out that as we move forward, our healthcare bill was entirely paid for, and that is what we need to get back to. Mr. Speaker, I yield 3 minutes to the gentleman from Illinois (Mr. Danny K. Davis), a champion of healthcare, dealing with disparities in the healthcare system, a champion for balance and vision, and I appreciate him being here.

Mr. BLUMENAUER. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I take modest exception to the notion that somehow the Affordable Care Act failed. It represents the largest expansion of healthcare that we have seen in decades. It is so popular and important that, when my Republican friends attempted to repeal it, something they have been working on for 7 years, it blew up in their face. Even President Trump said their bill was mean. And it continues, even though they are working to dismantle it bolt by bolt. I would hope that we will return to sanity to be able to work to be able to move forward on things like some of the elements in this bill here today that we agree upon that could move us forward rather than the continued battle over the notion that the Affordable Care Act is something that needs to be destroyed. The American people deserve better. Mr. Speaker, I reserve the balance of my time.