Diane Black

Mrs. BLACK

Mrs. BLACK. Mr. Speaker, I yield 2 minutes to the gentleman from Wisconsin (Mr. Grothman), who is also a member of the Budget Committee.

Mrs. BLACK. Mr. Speaker, I yield an additional 30 seconds to the gentleman.

Mrs. BLACK. Mr. Speaker, I yield 2 minutes to the gentleman from Kansas (Mr. Marshall), who is a physician.

Mrs. BLACK. Mr. Speaker, I yield myself such time as I may consume. Mr. Speaker, I want to remind my fellow colleagues that, currently, when we look at the access to care for people, one-third of our counties only have one provider; two-thirds of our counties only have two providers. In my State of Tennessee, there are 14 counties where they will have no insurance provider on the marketplace. So when we talk about people losing their insurance, they are losing their insurance by not having access to even purchase the insurance. One of my former colleagues, the gentleman from Minnesota, asked: What are my colleagues on the other side of the aisle trying to preserve? I want to point to this chart here to ask that question, because these are the broken promises of ObamaCare. Why are you trying to preserve something where they say premiums will decrease by $2,500, and we see the average family premiums have soared by $4,300, making insurance unaffordable for many families? Another broken promise: the cost of health care will go down. We see some deductibles that have gone up as much as 60 percent. In my own State, they have gone up by 63 percent, making coverage unaffordable. You can keep your doctor--70 percent of the plans consist of narrow networks, which means they cannot keep their doctor. I cannot tell you the number of people who have called me because their doctor was not on their inept plan. Finally, ``middle class Americans won't see a tax increase.'' This was a promise by former President Obama. ObamaCare penalties were put in place, so people are receiving a tax penalty. These are the broken promises that the other side of the aisle wants to continue to protect. As opposed to that, we want a system that is going to be open with patient care and give affordability so people can get the services that they want with a cost that they can afford. I also thank the Budget Committee for the work that they have done, and all the staff that have worked endless hours to make it possible for this to be here on the floor today. Mr. Speaker, I yield 30 minutes to the gentleman from Oregon (Mr. Walden), and I ask unanimous consent that he may control that time.

Mrs. BLACK. Mr. Speaker, I yield 30 minutes to the gentleman from Texas (Mr. Brady), and I ask unanimous consent that he may control that time.

Mrs. BLACK. Mr. Speaker, I yield myself such time as I may consume. I include in the Record a letter dated March 7, 2017, from Dr. Thomas Price, the Secretary of Health and Human Services, who sent a letter of support for the American Health Care Act to Chairmen Walden and Brady. The Secretary of Health and Human Services, Washington, DC, March 7, 2017. Hon. Greg Walden, Chairman, Committee on Energy & Commerce, Washington, DC. Hon. Kevin Brady, Chairman, Committee on Ways & Means, Washington, DC. Dear Chairman Walden and Chairman Brady: On behalf of the Trump Administration, I am writing in support of the reconciliation recommendations recently released for consideration by your Committees. Together, they align with the President's goal of rescuing Americans from the failures of the Affordable Care Act. These proposals offer patient- centered solutions that will provide all Americans with access to affordable, quality healthcare, promote innovation, and offer peace of mind for those with pre-existing conditions. Your legislative proposals are consistent with the President's commitment to repeal the Affordable Care Act; provide advanceable, refundable tax credits for Americans who do not already receive such tax benefits through health insurance offered by their employers; put Medicaid on a sustainable path and remove burdensome requirements in the program to better target resources to those most in need; empower patients and put healthcare dollars and decisions back into their hands by expanding the use of health savings accounts; ensure a stable transition away from the Affordable Care Act; and protect people with pre-existing conditions. Achieving all of the President's goals to reform healthcare will require more than what is possible in a budget reconciliation bill, as procedural rules on this type of legislation prevent inclusion of key policies such as selling insurance across state lines, lowering drug costs for patients, providing additional flexibility in Medicaid for states to manage their programs in a way that best serves their most vulnerable citizens, or medical legal reforms. Your proposals represent a necessary and important first step toward fulfilling our promises to the American people. We look forward to working with you throughout the legislative process, making necessary technical and appropriate changes, and ensuring eventual arrival of this important bill on the President's desk. Yours truly, Thomas E. Price, M.D., Secretary.

Mrs. BLACK. Mr. Speaker, I include in the Record a letter that comes from 24 of our Governors in support of the repeal of ObamaCare, and I would like to read just two quick paragraphs out of the letter: ``We support efforts to Reform the system. ``To provide access to affordable and quality health care, we must reform the system. We support a plan that gives state governments maximum flexibility to reform Medicaid and the system surrounding it. The states are more effective, more efficient and more accountable to the people. What works in one state may not work in another location, and true reform will allow states to recognize and meet the unique needs of the people all across America. ``We recognize that a vote in the House of Representatives is the first step in the Repeal, Replace and Reform process. The members of the United States Senate will undoubtedly make additional improvements before final approval by the President. We also recognize that the Secretary of Health and Human Services is committed to working with state leaders to provide maximum flexibility for true reform.'' March 24, 2017. Hon. Mitch McConnell, Majority Leader, U.S. Senate, Washington, DC. Hon. Paul D. Ryan, Speaker, House of Representatives, Washington, DC. Dear Leader McConnell and Speaker Ryan: Thank you for your service to our country. Please allow us to offer our thoughts about the pending vote on the American Health Care Act. Americans want personalized, patient-centered healthcare that treats them as individuals not a statistic, and that demands we repeal Obamacare, replace it, and reform the system. We support the Repeal of Obamacare Obamacare is collapsing. If we do nothing, people will lose access to health care coverage. As it stands now, one-third of the counties nationwide have only a single insurance carrier. Americans in these areas have essentially no choices, while they watch their premiums rise dramatically. The Congressional Budget Office estimates that 28 million Americans will lose coverage over the next decade if changes are not made to the Affordable Care Act. As the Affordable Care Act continues to deteriorate, and as insurance premiums skyrocket across the nation, opposition to this failed policy grows. Governor Mark Dayton (D-MN) said, ``the Affordable Care Act is no longer affordable.'' Similarly, Bill Clinton called ObamaCare, ``. . . the craziest thing in the world.'', adding that people ``wind up with their premiums doubled and their coverage cut in half.'' The President and Congress must act now to repeal the Affordable Care Act to protect the citizens we serve in the states. We support efforts to Replace Obamacare Most Americans receive their health insurance coverage through their employer or through Medicare. These individuals will not see a direct change from the repeal of Obamacare. For those Americans who do not receive coverage through their employer, Medicare or Medicaid, we support a refundable tax credit they can use to obtain affordable health care coverage within the marketplace. We support efforts to Reform the system To provide access to affordable and quality health care, we must reform the system. We support a plan that gives state governments maximum flexibility to reform Medicaid and the system surrounding it. The states are more effective, more efficient and more accountable to the people. What works in one state may not work in another location, and true reform will allow states to recognize and meet the unique needs of people all across America. We recognize that a vote in the House of Representatives is the first step in the Repeal, Replace and Reform process. The members of the United States Senate will undoubtedly make additional improvements before final approval by the President. We also recognize that the Secretary of Health and Human Services is committed to working with state leaders to provide maximum flexibility for true reform. Governors are pleased to have an administration and a Congress willing to collaborate with the states to address the legitimate needs of our people. We have compassion for those concerned about the uncertainty surrounding the changes. This is why it is imperative that the Congress act quickly on Repeal, Replace and Reform. This is a multi-stage process. There is much more work to be done, and process can only begin with a vote in the House of Representatives. With this in mind, we humbly request that you vote to repeal and replace Obamacare and to reform the system going forward. Thank you. Sincerely, Governor Scott Walker, Wisconsin; Governor Robert Bentley, Alabama; Governor Rick Scott, Florida; Governor C.L. ``Butch'' Otter, Idaho; Governor Eric Holcomb, Indiana; Governor Terry E. Branstad, Iowa; Governor Sam Brownback, Kansas; Governor Matt Bevin, Kentucky; Governor Paul R. LePage, Maine; Governor Phil Bryant, Mississippi; Governor Eric R. Greitens, Missouri; Governor Pete Ricketts, Nebraska; Governor Christopher T. Sununu, New Hampshire; Governor Doug Burgum, North Dakota; Governor Ralph Torres, Northern Mariana Islands; Governor Mary Fallin, Oklahoma; Governor Henry McMaster, South Carolina; Governor Dennis Daugaard, South Dakota; Governor Bill Haslam, Tennessee; Governor Gary R. Herbert, Utah; Governor Matthew H. Mead, Wyoming.

Mrs. BLACK. Mr. Speaker, I include in the Record a list of groups supportive of the American Health Care Act. We have many groups, from conservative groups to pro-life groups, to industry groups; and among those would be several insurance providers, such as Blue Cross Blue Shield, Anthem, and others. Groups Supportive of the American Health Care Act conservatives American Legislative Exchange Council Americans for Tax Reform Association of Mature American Citizens Center of the American Experiment Citizens Against Government Waste Independent Women's Voice Institute for Liberty Log Cabin Republicans Market Institute National Taxpayers Union--Key Vote Obamacare Repeal Coalition Six Degrees Project Small Business & Entrepreneurship Council Taxpayers Protection Alliance Pro-life groups American Center for Law and Justice Catholic Medical Association Concerned Women for America Faith & Freedom Coalition--Key Vote National Right to Life--Key Vote Susan B. Anthony List Industry Advanced Medical Technology Association (AdvaMed) America's Health Insurance Plans (AHIP) American Benefits Council American Builders and Contractors American College of Cardiology American Supply Association Anthem Insurance Associated General Contractors of America--Key Vote Blue Cross Blue Shield Consumer Healthcare Products Association Corporate Health Care Coalition Employers Council on Flexible Compensation ERISA Industry Committee (ERIC) Food Marketing Institute Health Leadership Council HSA Council International Franchise Association (IFA) Medical Device Manufacturers Association (MDMA) National Association of Manufacturers (NAM) National Association of Wholesale Distributers (NAW)--Key Vote National Business Group on Health National Club Association National Council of Chain Restaurants National Federation of Independent Businesses--Key Vote National Grocers Association National Restaurants Association National Retail Federation--Key Vote National Roofing Contractors Association One Nation Health Self-Insurance Institute of America, Inc. The Association of Chief Human Resource Officers (HR Policy) US Chamber of Commerce--Key Vote

Mrs. BLACK. Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Hensarling), the chair of the Financial Services Committee.

Mrs. BLACK. Mr. Speaker, it is now my honor to yield 2 minutes to the gentleman from Virginia (Mr. Goodlatte), the distinguished chairman of the Judiciary Committee.

Mrs. BLACK. Mr. Speaker, I yield 1\1/2\ minutes to the distinguished gentleman from Florida (Mr. Dunn).

Mrs. BLACK. Mr. Speaker, I yield 1\1/2\ minutes to the gentleman from Louisiana (Mr. Abraham), who is a family practitioner and knows a little about medicine.

Mrs. BLACK. Mr. Speaker, I yield 2 minutes to the gentleman from Texas (Mr. Conaway), the chairman of the Agriculture Committee.

Mrs. BLACK

Mrs. BLACK. Madam Speaker, I was unavoidably detained. Had I been present, I would have voted ``yea'' on rollcall No. 179.

Mrs. BLACK

Mrs. BLACK. Mr. Speaker, on Roll Call No. 166 on Agreeing to the Takano Amendment for H.R. 1259, which took place Thursday, March 16, 2017, I am not recorded because I was unavoidably detained. Had I been present, I would have voted Nay on Roll Call No. 166 on Agreeing to the Takano Amendment for H.R. 1259.

Mrs. BLACK

Mrs. BLACK. Madam Speaker, I include in the Record 3 letters, one from myself and Senator Joni Ernst, a letter from the Family Research Council, and one from 25 outside organizations, which support H.J. Res. 43. Congress of the United States, Washington, DC, September 23, 2016. Hon. Sylvia Mathews Burwell, Secretary, U.S. Department of Health and Human Services, Washington, DC. Dear Secretary Burwell: We write to express our strong opposition to the Department of Health and Human Services (HHS) September 7, 2016, notice of proposed rulemaking titled ``Compliance with Title X Requirements by Project Recipients in Selecting Subrecipients.'' Although we appreciate the Department's intent to follow proper regulatory procedure pursuant to the Administrative Procedure Act, HHS's purpose for engaging in the rulemaking appears on its face to be an attempt to subvert the will of elected representatives. Moreover, apart from the Department's impetus for the notice of proposed rulemaking, we also question whether the Department's stated rationale adequately supports its conclusion that providers with a reproductive health focus are more ``effective'' than other health providers that offer comprehensive care for women and men. Nowhere in the proposed notice of rulemaking does HHS clearly define what it means to provide Title X services in an ``effective'' manner. It does appear to assert that a number of factors--such as the range of contraceptive methods on-site, the number of clients in need of publicly funded family planning services served, and the availability of preconception care--distinguish providers with a reproductive health focus as more ``effective'' and ``high quality'' than other types of providers. However, that list of factors falls far short of all of the attributes and recommendations included in the Centers for Disease Control and Office of Population Affairs report entitled ``Providing Quality Family Planning Services: Recommendations of CDC and the U.S. Office of Population Affairs.'' To further complicate the argument about quality and effectiveness, the data cited in the notice of proposed rulemaking is not adequate for determining patient outcomes. The Department relies heavily on utilization and demographic statistics, but appears to lack hard data regarding actual patient outcomes and need, as the Department does not require grantees to track patients or verify their income. As you know, the issue of inadequate data has previously been raised by the Institute of Medicine (IOM), after the HHS Office of Family Planning in 2007 asked IOM to provide a critical review of the Title X Family Planning Program. In addition to finding ``no clear, evidence-based process for establishing or revising program priorities and guidelines,'' IOM stated the following in its May 2009 Report Brief: ``The committee concludes that the program does not collect all the data needed to monitor and evaluate its impact. Therefore, the committee proposes a comprehensive framework to evaluate the program and assess how well clinics meet the family planning needs of the program's clients. The committee concludes that additional data will be needed in the areas of client needs, structure, process, and outcomes in order to assess the program's overall progress.'' We welcome evidence that this recommendation has been fully adopted, but are unaware of any clear evidence confirming that to be the case. If HHS cannot clearly define an ``effective'' or ``high quality'' provider, it is unclear to us how state and local project grantees are supposed to do so in order to comply with this proposed rule. It is also therefore unclear how HHS will be able to accurately determine in every case whether state or local project recipients--who are generally closer to and more familiar with subrecipients and the patient base in their geographical region--have considered inappropriate criteria in evaluating subrecipients. Rarely do the American people benefit when the federal government attempts to substitute its judgment for that of state or local governments--particularly when the criteria used to inform that judgment are unclear, and that judgment is not supported by coherent and impartial facts. Finally, if HHS is going to assert the authority to adapt its rules in order to address changing circumstances, we implore HHS to consider the recent general shift in health care policy toward comprehensive care. As HHS states on its website, in addition to assisting individuals and couples in planning and spacing births, part of the mission of Title X is to contribute to ``improved health for women and infants.'' HHS's suggestion that subrecipients like federally qualified health centers--which provide greater preventive and primary health care services than providers with a reproductive health focus--are per se less ``effective'' than providers with a reproductive health focus does not comport with that stated mission. We urge HHS to reconsider this overreaching and ill- supported rule. We will continue to closely monitor this proposed rulemaking, and intend to submit this letter as a formal comment. We look forward to a detailed response from your Department. Sincerely, Joni K. Ernst, United States Senator. Diane Black, United States Congressman.

Mrs. BLACK

Mrs. BLACK. Madam Speaker, I ask unanimous consent that all Members may have 5 legislative days in which to revise and extend their remarks and include extraneous materials on H.J. Res. 43, currently under consideration.

Mrs. BLACK. Madam Speaker, I yield myself such time as I may consume. Madam Speaker, I rise today in strong support of my resolution of disapproval, H.J. Res. 43, which uses the authority of the Congressional Review Act to overturn the Obama administration's 11th- hour rule forcing States like Tennessee to fund abortion providers. I want to begin today by stipulating very clearly what this resolution is about because, while I am unapologetically pro-life, you don't have to be in order to support this resolution. You just have to believe in the Tenth Amendment. Despite the histrionics you may hear on the other side of the aisle today, with today's resolution, we are not, we are not, one, voting to defund Planned Parenthood in any way, shape, or form; we are not voting to cut title X funding; and we are not voting to restrict abortion rights. Madam Speaker, we are simply voting today to affirm the rights of States to fund the healthcare providers that best suit their needs, without fear of reprisal from their own Federal Government. I didn't realize this was a partisan issue. It shouldn't be, because that is how the title X grant program functioned for more than 45 years, until the Obama administration decided to leave this parting gift to abortion industry on its way out the door. For me, this is a personal issue. As a registered nurse, I know that vulnerable women seeking true comprehensive care deserve better than abortion-centric facilities like Planned Parenthood. So, as a State legislator, I worked within my authority to make sure that Tennessee honored the will of our pro-life populace and steered our State's share of title X dollars away from healthcare providers that performed abortion. As a result, our share of title X grants have been sent exclusively to the Tennessee Department of Health, which then allocates them to the county health departments and other qualified providers that protect the lives of the most vulnerable. That was Tennessee's right, and it has been able to exercise that right while protecting access to comprehensive care for those who are most in need. As a matter of fact, according to HHS' own 2015 title X Family Planning Annual Report, our State provided care under title X to more than 75,000 Tennesseeans. That means that we served even more citizens than the more populated States like Michigan and Virginia. But in December of last year, the Obama administration decided to intervene, setting unprecedented new parameters on how States must select title X grantees that were specifically designed to prop up its political allies in the abortion industry. With my resolution, I am proposing that we go back just a few short weeks prior to December 15, 2016, the day before the Obama administration decided to reconfigure this 45-year-old program with its ill-conceived order. That is all my resolution does is to take us back 45 years to the way the program has operated. I urge my colleagues to give States the freedom and the flexibility to take care of their citizens the best way that they know how by voting ``yes'' on this H.J. Res. 43. Madam Speaker, I reserve the balance of my time.

Mrs. BLACK. Mr. Speaker, pursuant to House Resolution 123, I call up the joint resolution (H.J. Res. 43) providing for congressional disapproval under chapter 8 of title 5, United States Code, of the final rule submitted by Secretary of Health and Human Services relating to compliance with title X requirements by project recipients in selecting subrecipients, and ask for its immediate consideration.

Mrs. BLACK. Madam Speaker, I yield 2 minutes to the gentleman from New Jersey (Mr. Smith), who has been a champion for life and been fighting for life for a long time.

Mrs. BLACK. Madam Speaker, I yield 2 minutes to the gentlewoman from Alabama (Mrs. Roby), who is my classmate.

Mrs. BLACK. Madam Speaker, I yield 2 minutes to the gentleman from Kansas (Mr. Marshall), a freshman and a physician.

Mrs. BLACK. Madam Speaker, I yield 2 minutes to the gentleman from Indiana (Mr. Messer), who is the chairman of our Republican Study Committee.

Mrs. BLACK. Madam Speaker, I yield 2 minutes to the gentlewoman from South Dakota (Mrs. Noem), who is my fellow Ways and Means Committee member.

Mrs. BLACK. Madam Speaker, I yield 2 minutes to the gentlewoman from Indiana (Mrs. Walorski), who is a fellow Ways and Means Committee member and advocate for children.