Jim McGovern

Mr. McGOVERN

Mr. McGOVERN. Mr. Speaker, I include in the Record a letter from the National Education Association in strong opposition to this bill. May 3, 2017. Hon. James P. McGovern, House of Representatives, House Office Building, Washington,

Mr. McGOVERN. Mr. Speaker, I include a letter from the American Academy of Pediatrics, American College of Nurse-Midwives, American College of Physicians, American Congress of Obstetricians and Gynecologists, National Association of Nurse Practitioners in Women's Health, National Partnership for Women & Families, and Planned Parenthood Federation of America. May 1, 2017. Hon. Paul Ryan, Speaker, House of Representatives, Washington, DC. Hon. Nancy Pelosi, Minority Leader, House of Representatives, Washington, DC. Dear Speaker Ryan and Leader Pelosi: On behalf of physicians, certified nurse-midwives/certified midwives, and nurse practitioners who provide care for the women of America, along with our patient partners, we stand together for women and families and against House passage of the MacArthur (R-NJ) Amendment to the American Health Care Act (AHCA, H.R. 1628). Rather than support recent gains in women's access to healthcare and coverage, the MacArthur Amendment and AHCA turn back the clock and reverse hard-won progress. We stand ready to continue work with Congress to advance legislation that promotes women's health, healthcare and coverage. In our letter of March 22, 2017, we expressed opposition to the AHCA because it threatened women's access to care protected by Essential Health Benefits (EHBs) requirements, eliminated the Medicaid expansion, cut qualified providers at Planned Parenthood from the Medicaid program, and made severe reductions to Medicaid and other programs critical to women and newborns. We said that important health initiatives for women and newborns should be built upon and improved--not rolled back. However, the MacArthur Amendment to AHCA places women's health and coverage at even greater risk. The MacArthur Amendment would enable states to waive EHBs including those for maternity and newborn care, preventive services, and services for mental health and substance use disorders; to waive community rating rules; and to shunt patients with costly healthcare conditions or illnesses into unproven government high risk pools. Supporters of the bill claim this bill maintains protections for those with preexisting conditions, but allowing states to waive coverage of EHB and charge people more based on their health status renders the promise of coverage for preexisting conditions to be meaningless. If all that the Secretary may require of a state waiver application is an un-validated attestation that the purpose of their requested waiver is to reduce premium costs, increase the number of persons with healthcare coverage, or advance another benefit to the public interest in the state, including the guarantee of coverage for persons with pre- existing medical conditions, it is meaningless in protecting health, quality healthcare and coverage. Women and families must not be made to suffer, lose access to care and coverage, and pay higher healthcare costs. EHB is a critical protection that ensures women have guaranteed access to a robust set of health care services. Making certain categories of coverage optional--such as maternity care--would not substantially lower the premiums that people pay for health coverage. For example, the requirement for maternity care as an EHB is not a source of health cost growth. Rather, by sharing risk across a broad population of beneficiaries it provides vital protection for women and families from the risk of tens of thousands of dollars of out-of-pocket costs associated with normal physiologic labor and delivery, cesarean section, and birth complications. In exchange for monthly premium costs of just $8-14 according to one recent analysis, the maternity care EHB provides significant security for people wishing to grow their families in the U.S. Furthermore, since everyone is at some point a newborn, childbirth affects all of us. Enabling exclusion of maternity care from health coverage denies people access to the care that everyone deserves for the best start in life. Congress should move to protect and advance health, quality care and coverage, particularly for women and newborns, and not to endanger them as the AHCA and the MacArthur Amendment would do. Americans of both parties agree. A recent Kaiser Family Foundation poll found ``relatively few Americans want to see the president and Congress decrease funding for a variety of different health priorities--including spending for reproductive health services for lower-income women (21 percent).'' When women have access to quality, evidence-based, affordable care throughout their lives, they enrich our workforce, achieve higher levels of education, reach their goals, and actively contribute to the success of their families and their communities. We urge the U.S. House in the strongest possible terms to get it right, not fast. The AHCA and the MacArthur Amendment turn the clock back on women's health and should not move forward. We stand ready to continue assisting Congress in advancing health policy that supports women's access to high quality healthcare and coverage, and is effective at controlling and reducing the costs that people pay for their healthcare. Sincerely, American Academy of Pediatrics, American College of Nurse- Midwives, American College of Physicians, American Congress of Obstetricians and Gynecologists, National Association of Nurse Practitioners in Women's Health, National Partnership for Women & Families, Planned Parenthood Federation of America.

Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentlewoman from Texas (Ms. Jackson Lee).

Mr. McGOVERN. Mr. Speaker, I include in the Record a letter from the National Rural Health Association opposed to this bill. [From the National Rural Health Association] Vote NO to the American Health Care Act The National Rural Health Association urges a NO vote on the American Health Care Act (AHCA). Rural Americans are older, poorer and sicker than other populations. In fact, a January 2017 CDC report pronounced that life expectancies for rural Americans have declined and the top five chronic diseases are worse in rural America. The AHCA does nothing to improve the health care crisis in rural America, and will lead to poorer rural health outcomes, more uninsured and an increase in the rural hospital closure crisis. Though some provisions in the modified AHCA bill improve the base bill, NRHA is concerned that the bill still falls woefully short in making health care affordable and accessible to rural Americans. For example, the modified bill contains a decrease in the Medical Expense Deduction threshold from 10% to 5.8% in an attempt to assist Americans between the ages of 50 and 64 who would see their premiums skyrocket under the current plan. However, this deduction is not a credit and therefore would be of little use to low income seniors that are in very low tax brackets or do not pay income tax at all. Additionally, the new amendments to freeze Medicaid expansion enrollment as of Jan. 1, 2018, and reduce the Medicaid per-capita growth rate will disproportionately harm rural Americans. The AHCA will hurt vulnerable populations in rural Americans, leaving millions of the sickest, most underserved populations in our nation without coverage, and further escalating the rural hospital closure crisis. According to the Wall Street Journal, the ``GOP health plan would hit rural areas hard . . . Poor, older Americans would see the largest increase in insurance-coverage costs.'' The LA Times reports ``Americans who swept President Trump to victory-- lower-income, older voters in conservative, rural parts of the country--stand to lose the most in federal healthcare aid under a Republican plan to repeal and replace the Affordable Care Act.'' Let's be clear--many provisions in the ACA failed rural America. The lack of plan competition in rural markets, exorbitant premiums, deductibles and co-pays, the co-op collapses, lack of Medicaid expansion, and devastating Medicare cuts to rural providers--all collided to create a health care crisis in rural America. However, it's beyond frustrating that an opportunity to fix these problems is squandered, and instead, a greater health care crisis will be created in rural America. Congress has long recognized the importance of the rural health care safety net and has steadfastly worked to protect it. And now, much of the protections created to maintain access to care for the 62 million who live in rural America are in jeopardy. We implore Congress to continue its fight to protect rural patients' access to care. Three improvements are critical for rural patients and providers: 1. Medicaid--Though most rural residents are in non- expansion states, a higher proportion of rural residents are covered by Medicaid (21% vs. 16%). Congress and the states have long recognized that rural is different and thus requires different programs to succeed. Rural payment programs for hospitals and providers are not `bonus' payments, but rather alternative, cost-effective and targeted payment formulas that maintain access to care for millions of rural patients and financial stability for thousands of rural providers across the country. Any federal health care reform must protect a state's ability to protect its rural safety net providers. The federal government must not abdicate its moral, legal, and financial responsibilities to rural, Medicaid eligible populations by ensuring access to care. Any federal health care reform proposal must protect access to care in Rural America, and must provide an option to a state to receive an enhanced reimbursement included in a matching rate or a per capita cap, specifically targeted to create stability among rural providers to maintain access to care for rural communities. Enhancements must be equivalent to the cost of providing care for rural safety net providers, a safeguard that ensures the enhanced reimbursement is provided to the safety net provider to allow for continued access to care. Rural safety net providers include, but not limited to, Critical Access Hospitals, Rural Prospective Payment Hospitals, Rural Health Clinics, Indian Health. Service providers, and individual rural providers. 2. Market Reform--Forty-one percent of rural marketplace enrollees have only a single option of insurer, representing 70 percent of counties that have only one option. This lack of competition in the marketplace means higher premiums. Rural residents average per month cost exceeds urban ($569.34 for small town rural vs. $415.85 for metropolitan). Rural Americans are more likely to have obesity, diabetes, cancer, and traumatic injury; they are more likely to participate in high risk health behaviors including smoking, poor diet, physical inactivity, and substance abuse. Rural Americans are more likely to be uninsured or underinsured and less likely to receive employer sponsored health insurance. Rural communities have fewer health care providers for insurers to contract with to provide an adequate network to serve the community. Any federal health care reform proposal must address the fact that insurance providers are withdrawing from rural markets. Despite record profit levels, insurance companies are permitted to cherry pick profitable markets for participation and are currently not obliged to provide service to markets with less advantageous risk pools. Demographic realities of the rural population make the market less profitable, and thus less desirable for an insurance company with no incentive to take on such exposure. In the same way that financial service institutions are required to provide services to underserved neighborhoods, profitable insurance companies should be required to provide services in underserved communities. 3. Stop Bad Debt Cuts to Rural Hospitals--Rural hospitals serve more Medicare patients (46% rural vs. 40.9% urban), thus across-the-board Medicare cuts do not have across the board impacts. A goal of the ACA was to have hospital bad debt decrease significantly. However, because of unaffordable health plans in rural areas, rural patients still cannot afford health care. Bad debt among rural hospitals has actually increased 50% since the ACA was passed. According to MedPAC ``Average Medicare margins are negative, and under current law they are expected to decline in 2016'' has led to 7% gains in median profit margins for urban providers while rural providers have experienced a median loss of 6%. If Congress does not act, all the decades of efforts to protect rural patients' access to care, could rapidly be undone. The National Rural Health Association implores Congress to act now to protect rural health care across the nation.

Mr. McGOVERN. Mr. Speaker, I include in the Record a letter from the American Thoracic Society opposed to this bill. American Thoracic Society, April 27, 2017. Dear Representative: On behalf of the 16,000 members of the American Thoracic Society (ATS), I want to voice my grave concerns with the latest legislative proposal developed to repeal and replace the Affordable Care Act (ACA). While CBO estimates are not yet available for the most recent legislation proposal being considered in the House, we remain concerned that the bill, if enacted, will result in a loss of health insurance for millions of Americans. Should the proposal come up for a vote in the near future, we urge you to vote ``NO'' on the American Health Care Act. The ATS opposes any legislation that does not ensure affordable health insurance coverage for Americans currently insured under the ACA. We are concerned that allowing states to waive important insurance reforms in the Affordable Care Act will lead to reduced coverage for many Americans and significant price increases for patients with pre-existing conditions. Further, we are concerned that reliance on ``high risk pools'' will not adequately meet the health insurance needs of many Americans with pre-existing conditions. We note that previous attempts at implementing state-based high risk pools have been largely unsuccessful. Members of the ATS serve a large and diverse patient population, including patients with respiratory diseases, critical illnesses and sleep disorders such as asthma, COPD, pneumonia, sepsis and obstructive sleep apnea. Our patients cannot afford to lose affordable health insurance coverage for any period of time. The ATS looks forward to working with Congress to improve our health care system and ensure health insurance coverage for all Americans. If you have questions or need additional information, please contact Nuala S. Moore, Associate Director of Government Relations. Sincerely, David Gozal, MD, MBA, President.

Mr. McGOVERN. Mr. Speaker, I include in the Record a statement from the Children's Hospital Association in opposition to this bill. [From Children's Hospital Association, Apr. 27, 2017] Children's Hospitals Urge House to Vote Against Amended AHCA Lawmakers should know bill is bad for kids Washington, DC.--On behalf of our nation's children's hospitals and the patients and families they serve, Children's Hospital Association (CHA) continues to oppose the newly modified American Health Care Act (AHCA) and strongly urges the House of Representatives to reject the bill. Recently adopted changes only worsen the AHCA by putting children with preexisting conditions at increased risk of losing health care coverage and failing to correct the Medicaid cuts that would impact over 30 million kids. The legislation the House might consider for a vote as early as the weekend would impose over $800 billion in cuts on states by fundamentally changing Medicaid--a program over 40 percent of the children across the country depend on for their health care coverage and access to medical care. Under the bill, Medicaid would no longer be able to flex with the needs of enrollees, instead becoming a severely restricted system of per capita caps or block grants. The block grant option in particular would be devastating to children as it eliminates Medicaid's EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) benefit which ensures children receive immunizations, mental health assessments and vision, eye and hearing exams as well as other medical services they might need. A block grant would also remove cost-sharing protections for children, essentially creating new barriers to care for low-income, working families. CHA urgently asks members of Congress to vote against the AHCA. Medicaid must be maintained to ensure children receive the coverage and medical care that return lifelong benefits into adulthood. Investing in children's health advances a better future for our nation.

Mr. McGOVERN. Mr. Speaker, I include a statement from Families USA in opposition to this bill. [From FAMILIESUSA] Latest House GOP Proposal--``Upton Amendment''--Still Leaves People with Pre-Existing Conditions Out in the Cold Washington, DC.--Republicans in the House today are discussing a so-called compromise that ostensibly adds $8 billion to their Affordable Care Act (ACA) repeal bill in an attempt to appease members worried that the bill strips coverage guarantees for people with pre-existing conditions. Below is a statement from Families USA Executive Director Frederick Isasi. ``Despite today's wheeling and dealing, the GOP repeal bill still drops the coverage guarantee for people with pre- existing conditions, strips coverage from millions, and drives up costs for millions more. A measly $8 billion handout isn't going to change that. The bill also decimates Medicaid--more than $800 billion in cuts. That hurts seniors, people with disabilities, and children like Jimmy Kimmel's son who he so eloquently spoke of Monday night. Remember, half of the births in America are reimbursed through Medicaid. ``The Upton $8 billion is a non-solution--money thrown at `high-risk pools' that experts on both sides of the aisle have warned lead to higher costs, fewer benefits, and waiting lists rationing care for those with pre-existing conditions. ``Republicans in the House can do all the backroom vote- trading they want; their bill will still harm millions and millions of people in America and breaks President Trump's promise to cover everybody and protect people with pre- existing conditions. This isn't what people in America want. It is time for the GOP to drop this deeply flawed legislation and move on to efforts that will help, and not hurt, America's families.''

Mr. McGOVERN. Mr. Speaker, I include a statement from the Association of American Medical Colleges in opposition to this bill. [From AAMC, May 2, 2017] AAMC Statement on the MacArthur Amendment to the American Health Care Act AAMC (Association of American Medical Colleges) President and CEO Darrell G. Kirch, MD, issued the following statement regarding the amendment to the American Health Care Act (AHCA) introduced by Rep. Tom MacArthur (R-N.J.): ``This week, the House could vote on a new version of the American Health Care Act that includes the MacArthur amendment. Unfortunately, the amendment does not address the limitations in the original measure, such as making high- quality, affordable health insurance available to all, and maintaining programs to support the health care safety net-- at least at current levels--until other comparable coverage expansions are available. The amendment's treatment of essential health benefits and health status underwriting dilutes protections for many Americans and would leave individuals with preexisting conditions facing higher premiums and reduced access to vital care. The shortcomings in the underlying bill remain the same. The original analysis from the Congressional Budget Office indicated that 14 million Americans would lose their health insurance coverage as early as next year, and as many as 24 million by 2024. Nothing in the bill has changed that alters the fact that this legislation would lead to fewer Americans with quality insurance, less affordable coverage for those who have it, and the destabilization of the current Medicaid program. We continue to urge members of Congress to engage with the nation's medical schools and teaching hospitals and other stakeholders to find ways to achieve high quality health care for all Americans.''

Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentlewoman from California (Ms. Judy Chu of California.)

Mr. McGOVERN. Mr. Speaker, maybe the gentleman hasn't been listening to all the organizations and healthcare advocates who have come out strongly opposed to the Republican bill, that I have read into the Record, who know a lot more about health care than anybody in this House, who spend their lives protecting people and protecting people's healthcare rights. They are all in strong opposition to the Republican bill because you take away the protections for preexisting conditions, plain and simple. Mr. Speaker, I yield 1 minute to the gentleman from Oregon (Mr. Blumenauer).

Mr. McGOVERN. Mr. Speaker, I yield 30 seconds to the gentlewoman from Wisconsin (Ms. Moore).

Mr. McGOVERN. Mr. Speaker, I yield 30 seconds to the gentleman from Vermont (Mr. Welch).

Mr. McGOVERN. May I inquire of the gentleman how many more speakers he has?

Mr. McGOVERN. Well, I am not really prepared to close because my side has a ton more to say, but I am out of time.

Mr. McGOVERN. Mr. Speaker, I yield myself the balance of my time, and given the fact there were no hearings or anything else, it would have been nice to have a little bit more time. Mr. Speaker, if we defeat the previous question, I will offer an amendment to the rule that would change the rules of the House to prevent this bill or any other healthcare-related legislation from being considered if it does not have a CBO cost estimate or if it would deny health coverage or require higher premiums due to preexisting conditions; impose lifetime limits on health coverage; prevent individuals under age 26 from being covered under their parents' plan; reduce the number of people receiving health care under the Affordable Care Act; increase costs to seniors by reopening the doughnut hole and raising prescription drug costs; require people to pay for preventive services, including cancer screenings; reduce Medicare solvency or change the Medicare guarantee; or reduce Federal taxes on the 1 percent of the population with the highest incomes or increase taxes on the 80 percent of hardworking Americans earning moderate to low incomes. Mr. Speaker, I ask unanimous consent to insert the text of my amendment in the Record, along with extraneous materials, immediately prior to the vote on the previous question.

Mr. McGOVERN. Mr. Speaker, none of us on this side are claiming that the Affordable Care Act is perfect. In fact, for 7 years, we have been prepared to work with our Republican colleagues in a bipartisan way to make it even better, to cover more people, to find ways to lower costs; but for 7 years, my Republican colleagues had no interest in doing that. All they wanted to do was repeal the bill, repeal the bill, repeal the bill and offer no alternative. Now we see their alternative, and it is an awful alternative. It is a disaster. It is an alternative that came not out of a deliberative process, but out of some back room somewhere. People haven't even read this bill. They don't even know what it does because we are not even waiting for a CBO score. This is a pathetic process that everybody should be ashamed of. Let me just say, to claim or to imply that the Republican plan covers people with preexisting conditions, it is a lie. It is a lie. Let's be honest about it. This does not cover people with preexisting conditions. To come on the floor and say it does, to try to fool people, well, you may get away with it in the short term, you may get a headline, but I will tell you, people will figure out soon enough when they are denied healthcare coverage, when they see their costs rise and rise and rise. To have a healthcare bill that throws 24 million Americans off of health insurance, you should be ashamed. To have a healthcare bill that cuts Medicaid by $880 billion to give a tax cut to the wealthiest people in this country, you should be ashamed. I spent a good deal of my time reading letters from organizations like the National Farmers Union, the AARP, the Cystic Fibrosis Foundation, Paralyzed Veterans of America, March of Dimes, the American Medical Association, on and on and on, organizations that have dedicated their lives to helping people in this country that know something about this subject. And when it comes down to who do I trust, them or you, on whether or not your bill covers people with preexisting conditions, there is no contest. I trust them. They see what you are trying to do. They understand that this bill is a fraud. It is unconscionable to not only me and to people on our side, but to people who are watching this debate--Democrats, Republicans, and independents alike--that we would be spending time debating a healthcare bill that will make life worse for people in this country. Any kind of healthcare bill that came to this floor ought to be about expanding coverage and lowering cost. We want to work with you on that. Instead, you come to a bill that is going to rip health care away from tens of millions of people. How can you do this? How can you do this to the American people? How can you do this to your constituents? This is a terrible bill. You should vote ``no'' on it or, better yet, pull it. Mr. Speaker, I yield back the balance of my time.

Mr. McGOVERN. Mr. Speaker, on that I demand the yeas and nays.

Mr. McGOVERN. Mr. Speaker, I demand a recorded vote.

Mr. McGOVERN. I yield to the gentleman from Georgia.

Mr. McGOVERN. Mr. Speaker, I feel bad for the gentleman because it appears as if he only has one speaker supporting this rule and the bill, and nearly our entire caucus wants to speak on this against the Republican healthcare repeal bill. So I was wondering whether the gentleman might consider sharing some time with us?

Mr. McGOVERN. Mr. Speaker, I yield 3 minutes to the distinguished gentlewoman from New York (Ms. Slaughter), the ranking member of the Rules Committee.

Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the distinguished gentleman from Michigan (Mr. Levin). (Mr. LEVIN asked and was given permission to revise and extend his remarks.)

Mr. McGOVERN. Mr. Speaker, I include in the Record an article in The Wall Street Journal today stating: ``. . . employers looking to lower their costs could impose lifetime limits and eliminate the out-of- pocket cost cap from their plans under the GOP legislation.'' [From the Wall Street Journal] Little-Noted Provision of GOP Health Bill Could Alter Employer Plans Last-minute amendment would allow states to obtain waivers from certain Affordable Care Act requirements (By Stephanie Armour and Michelle Hackman) Many people who obtain health insurance through their employers--about half of the country--could be at risk of losing protections that limit out-of-pocket costs for catastrophic illnesses, due to a little-noticed provision of the House Republican health-care bill to be considered Thursday, health-policy experts say. The provision, part of a last-minute amendment, lets states obtain waivers from certain Affordable Care Act insurance regulations. Insurers in states that obtain the waivers could be freed from a regulation mandating that they cover 10 particular types of health services, among them maternity care, prescription drugs, mental health treatment and hospitalization. That could also affect plans offered by large employers, health analysts said. The ACA prevents employer plans from putting annual limits on the amount of care they will cover, and it bars lifetime limits on the 10 essential benefits. But in 2011, the Obama administration issued guidance stating that employers aren't bound by the benefits mandated by their state and can pick from another state's list of required benefits. That guidance was mostly meaningless because the ACA established a national set of essential benefits. Under the House bill, large employers could choose the benefit requirements from any state--including those that are allowed to lower their benchmarks under a waiver, health analysts said. By choosing a waiver state, employers looking to lower their costs could impose lifetime limits and eliminate the out-of-pocket cost cap from their plans under the GOP legislation. The measure would give employers added flexibility to take steps that could lower costs by limiting more-expensive coverage areas. And it would lessen the federal regulation of insurers, a goal of GOP lawmakers who believe the ACA is an example of government overreach. The impact on employer plans expands the scope of the health bill to affect, potentially, everyone not insured by Medicare or small-business plans, since the bill also includes cuts to Medicaid and changes to the individual market. Employer health plans are the single largest source of health insurance in the country, with about 159 million Americans receiving coverage through their jobs. ``It's huge,'' said Andy Slavitt, former acting administrator of the Centers for Medicare and Medicaid Services under President Barack Obama. ``They're creating a backdoor way to gut employer plans, too.'' But some experts say the impact could be less. ``The real question is, would employers do this? Many wouldn't,'' said Larry Levitt, a senior vice president at the Kaiser Family Foundation. ``Many employers offer quality benefits to attract employees. But employers are always looking for ways to lower costs.'' Fifty-nine percent of employers had a lifetime limit on how much their insurance plans would cover before the ACA, Mr. Levitt said. The potential impact on large-employer plans was picked up on by health analysts including Matthew Fiedler, a fellow at the Brookings Institution. It is possible the Trump administration could minimize the impact by barring employers from picking plans across state lines, he said, but there is no sign that that would occur. ``The core goal of insurance is to ensure that people are protected if the worst happens, and these protections are crucial to achieving that goal,'' Mr. Fiedler said. Potentially, the new provision could play out this way: If a state did away with a requirement to provide mental health and substance abuse services, employer plans using that benchmark could impose lifetime caps on the amount of mental health coverage they are willing to pay for. One trade group representing employers said the amendment's effects on people with employer-sponsored health coverage would be minimal. Most large employers didn't impose annual or lifetime limits before the ACA was implemented, according to James Gelfand, senior vice president of health policy at the Erisa Industry Committee. ``Even if self-insured health plans are no longer banned from imposing annual or lifetime limits, they're unlikely to attempt to squeeze the toothpaste back into the tube,'' he said. ``The benefits of reimposing limits are questionable.''

Mr. McGOVERN. Mr. Speaker, I include in the Record a letter from The Jewish Federations of North America opposed to this bill. The Jewish Federations of North America, Washington, DC, May 2, 2017. Hon. Paul Ryan, Speaker, House of Representatives, Washington, DC. Hon. Nancy Pelosi, Minority Leader, House of Representatives, Washington, DC. Dear Speaker Ryan and Leader Pelosi: The Jewish Federations of North America (JFNA) remains staunchly opposed to the American Health Care Act of 2017 (AHCA), even with the recently released amendment proposed by Representative Tom MacArthur (R-NJ). We are disappointed that AHCA retains the devastating cuts to Medicaid included in the earlier version of the legislation, cuts which are the result of the legislation's proposal to dramatically restructure Medicaid's federal financing structure and roll back coverage for 14 million people covered by the state Medicaid expansions. The amendment does nothing to alleviate these concerns. JFNA represents 148 Jewish federations and 300 network communities that together support 15 leading academic medical centers/health systems, 100 Jewish nursing homes, and 125 Jewish family & children's agencies, providing health care for more than one million clients, Jewish and non-Jewish alike. Medicaid is a lifeline for more than 80 million people, including low-income children, older adults, and people with disabilities nationwide. Medicaid is a vital program for Jewish federations throughout the country and particularly for our communal health and long-term care partners that care for the most vulnerable in our communities. JFNA is deeply troubled by the findings of the Congressional Budget Office (CBO) that AHCA will cause $839 billion in reductions--about 25 percent--to federal Medicaid funding and a loss in coverage for more than 14 million Medicaid beneficiaries. We believe that converting Medicaid to a block grant or per capita cap will cause irreparable harm not only to the millions who depend on the program, but also to our large network of providers who care for them. AHCA would convert the long-standing and fundamental federal-state partnership of the Medicaid program to a block grant or per capita cap system. Under either approach, states would receive a limited amount of federal money for their Medicaid programs. As CBO found, even under a per capita cap system, the federal share is lower than the average annual increase in Medicaid spending and will not be sufficiently flexible to address a variety of key factors affecting Medicaid spending, including major disasters, economic downturns, unexpected health care cost increases, and demographic changes, such as the rapidly aging baby boomer generation. CBO projected that AHCA's $839 billion cut in federal Medicaid funding will shift substantial costs to state and local governments, our providers, and our patients, thus exacerbating the existing strain on the program. We agree with CBO's conclusion that, due to these reductions in funding, states will be left with no choice but to reduce Medicaid enrollment, eligibility for Medicaid benefits, and payment rates. Many people who now qualify for Medicaid could end up uninsured or losing access to critical health and long-term care services. JFNA is concerned by many of the unintended consequences of this legislation, such as: People who desperately need Medicaid and who are currently eligible will become uninsured; States will be forced to cut back on crucial Medicaid services, such as home and community-based services, effectively forcing people who are capable of living in the community with proper home and community-based services into nursing homes; States will be forced to reduce already low provider payment rates, thus further decreasing the pool of providers serving Medicaid beneficiaries and increasing waiting times for services; and, Health care providers and entities that care for these vulnerable populations will suffer additional financial strain. As a result, these agencies will be forced to lay off staff or close their doors altogether, resulting in significant job losses and further hurting state economies. For these reasons, we must oppose the legislation as currently written and urge the House of Representatives to reconsider moving forward with it. We stand ready to work with you, in tandem with our Jewish communal health and long- term care providers, to promote more targeted ways to reduce Medicaid spending and develop a new framework of policies to improve Medicaid quality, efficiency, and sustainability. Sincerely, William C. Daroff, Senior Vice President for Public Policy & Director of the Washington Office.

Mr. McGOVERN

Mr. McGOVERN. Mr. Speaker, I rise today to recognize and celebrate Saul Ramos from my hometown of Worcester, Massachusetts, who was recently named the 2017 National Education Association Education Support Professional, or ESP, of the year. This honor is awarded annually to the ESP who best demonstrates leadership in his or her classroom, school, and community. Saul began his career in 1999 as a personal aide to a visually impaired kindergarten student. To allow this student to work on classroom materials alongside his peers, Saul taught himself to read and write in braille so he could transcribe these materials for his student. Saul continued to help this student for 12 years--supporting and encouraging him until he graduated from high school. In his current capacity as an ESP at Burncoat High School, Saul has taken it upon himself to integrate braille into the curriculum not only to help students with visual impairments, but also to allow other students to develop a stronger understanding of alternative learning methods. Raised in both Puerto Rico and Worcester, Saul founded and now serves as the artistic director of a nonprofit called Arte Latino of New England to encourage Latinos in our community, especially those in their youth, to embrace their cultural heritage through art. Just one of his many creative initiatives aimed at helping Latino students to build confidence and embrace their roots, Saul wrote and produced a bilingual adaptation of ``Romeo and Juliet.'' Beyond the classroom, Saul is an incredible activist for teachers and students. He is the vice president of his local teachers union and is an active member on four committees of the Massachusetts Teachers Association, which recognized Saul as last year's most valuable educator in the state. Saul fights tirelessly for the rights of teachers and students. Nationally, Saul is a member of the National Education Association's Paraeducator Institute Working Group, the Sexual Orientation and Gender Identity Committee, and is the Northeast regional director of the Hispanic Caucus. Our public schools promise to provide equal educational opportunities for all students, no matter their race, religion, or ability. This promise relies on dedicated, compassionate ESPs like Saul Ramos. On behalf of the teachers and students of Worcester, Massachusetts, and those all across the country, I thank Saul Ramos for his commitment to this noble profession.