Jim McGovern

Mr. McGOVERN

Mr. McGOVERN. Mr. Speaker, I would respond to the gentleman from Alabama with the words of another Alabama Member, Congressman Mo Brooks, who this morning said: This is one of the worst bills I've seen in my 30 years in Congress. Mr. Speaker, I yield 1 minute to the gentleman from Michigan (Mr. Kildee).

Mr. McGOVERN. Mr. Speaker, I hear my friend talking about what came out of the Ways and Means Committee. I will tell you what came out of Ways and Means Committee: a $1 trillion tax cut for the wealthy. Mr. Speaker, I yield 2 minutes to the gentleman from Colorado (Mr. Polis), a distinguished member of the Rules Committee.

Mr. McGOVERN. Mr. Speaker, I yield an additional 30 seconds to the gentleman from Florida.

Mr. McGOVERN. Mr. Speaker, I just want to say to my colleague from Texas, he said this bill was talked to death. It was talked to death by politicians. There were no hearings on this bill, so no experts came to testify, and none of these people who are now writing to us in opposition had the opportunity to be able to come before us and tell us how awful this bill is. Mr. Speaker, I yield 3 minutes to the gentleman from Florida (Mr. Hastings), a distinguished member of the Rules Committee.

Mr. McGOVERN. Mr. Speaker, I want to thank the gentleman from Texas (Mr. Sessions), my friend, for yielding me the customary 30 minutes. Mr. Speaker, the majority is rushing to congratulate itself for finally having a bill to repeal the Affordable Care Act. For 7 years, Republicans had nothing to actually replace the law with, but that didn't stop them from making one empty political promise after another. And after all that, what do we have in front of us today? This bill will take away health care from 24 million hardworking Americans. It forces families to pay higher premiums and deductibles, increasing out- of-pocket costs. It is a crushing age tax, forcing Americans age 50 to 64 to pay premiums five times higher than what others pay for health coverage, no matter how healthy they are. Not to mention the $880 billion cut to Medicaid or the fact that it steals from Medicare, shortening the life of the Medicare trust fund by 3 years and ransacking funds that seniors depend on to get the long-term care they need. I don't see anything there to be excited about. But then again, I come from the old-fashioned school of thought that we should actually take care of our fellow citizens as they grow older, rather than tossing them off the ship without a life preserver. It is no wonder that after developing such an ill-conceived and far- reaching bill on the fly, the majority has had to try and jam this legislation through our Chamber. First, they rushed this bill through the committee process without holding a single hearing, and without the benefit of a nonpartisan Congressional Budget Office score outlining its costs and impacts. Then the majority came out of a back room somewhere and filed four managers' amendments in the dark of night to try to appease the conservative and moderate holdouts, including the infamous Buffalo bribe. The Republican leadership has been trying to strong-arm their conference into voting for this bill all week, and nobody knows how today's vote will go. The only thing we do know is that this is a terrible bill that is only getting worse, not better. This thing has been a mess from beginning to end. Now, I know our President prides himself on his negotiating skills, but this seems more like the art of no deal to me, no matter what the final vote tally looks like. That brings us to this early morning, when we met at 7 a.m. in the Rules Committee to report out this rule, which rewrites the bill to make it far worse. Last night, we were presented with a provision, concocted in some back room, that boggles the mind with its cynicism. So what is this mysterious grand bargain that will appease the Republican Conference and finally buy Speaker Ryan enough votes to pass this disaster of a bill? Well, Mr. Speaker, it is so cartoonishly malicious that I can picture someone twirling their mustache as they drafted it in their secret Capitol lair last night. Republicans are killing the requirements that insurance plans cover essential health benefits--essential health benefits. Now, perhaps you are wondering: What are these so-called essential benefits? Well, I will give you a partial list: emergency room trips, maternity care, mental health care and substance abuse treatment, and prescription drugs. These are the types of exotic, extravagant benefits that Republicans apparently don't think are important for working Americans to be able to afford. It would be literally unbelievable if we weren't here considering it right now, Mr. Speaker. Now, I have been awake since before dawn-- thanks to our Rules Committee meeting--so I know that this isn't a nightmare. We are actually voting on a bill with a backroom deal, made in the dark of night, that would take away any guarantee that plans would cover these basic essential benefits. And, of course, we have no idea what the costs will be or how many people it will affect. We can't know those things until we get an analysis from the nonpartisan Congressional Budget Office, which, obviously, we will not have before we vote on this reckless legislation. And that is the real problem. Because every time you come out of a back room, this bill gets worse. For the sake of our country, maybe we should consider putting locks on the back rooms you huddle in. President Trump keeps talking about crowd size. My colleagues across the aisle keep talking about page size. This morning, in the Rules Committee, Republicans kept saying that the fifth manager's amendment is only 4 pages long. How bad could it be? Well, they need to stop worrying about size and pay more attention to how this bill will affect regular, working Americans. These 4 pages are the worse 4 pages on this planet because of the terrible consequences it will have on real people. It will be devastating for millions and millions of Americans. So, Mr. Speaker, instead of rushing this horrendous bill, patched together with backroom deals, to the floor and voting on it just hours after seeing the final product, we should be working together in a bipartisan way to improve people's lives, and certainly not putting them at risk. My colleagues seem too concerned about winning at any cost to stop and think about the consequences for millions upon millions of Americans. This is a lousy bill. Mr. Speaker, I reserve the balance of my time.

Mr. McGOVERN. Mr. Speaker, I yield myself such time as I may consume. (Mr. McGOVERN asked and was given permission to revise and extend his remarks.)

Mr. McGOVERN. Mr. Speaker, I include in the Record a letter from the AARP; a letter from the National Rural Health Association; a letter from the American Society of Addiction Medicine; and a letter from the American Medical Association--all strongly opposed to the Republican bill.

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

Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentleman from Virginia (Mr. Connolly).

Mr. McGOVERN. Mr. Speaker, I yield 30 seconds to the gentleman from Florida (Mr. Crist).

Mr. McGOVERN. Mr. Speaker, I yield 30 seconds to the gentleman from California (Mr. Panetta).

Mr. McGOVERN. Mr. Speaker, I yield myself the balance of my time. Mr. Speaker, I include in the Record a letter from 87 patient and provider organizations, including the Cystic Fibrosis Foundation, which is strongly opposed to this bill. March 20, 2017. Hon. Mitch McConnell, Senate Majority Leader, Washington, DC. Hon. Paul Ryan, Speaker of the House, Washington, DC. Dear Leader McConnell and Speaker Ryan: The undersigned organizations write to express grave concern about proposals put forth in the American Health Care Act (AHCA) to alter the fundamental structure and purpose of Medicaid, a vital source of health care for patients with ongoing health needs. We feel compelled to speak out against proposals to phase out Medicaid expansion and implement per capita caps, which threaten the ability of Medicaid to provide critical health care services to many of our most vulnerable citizens. These proposals aim to achieve cost savings of approximately $880 billion, according to the Congressional Budget Office, at the expense of tens of millions of patients who rely on Medicaid for life-sustaining care. While we appreciate the opportunities we have had to work with your staff, we cannot support the Medicaid provisions in this bill and cannot accept policies that prioritize cutting costs by limiting patients' access to care. Medicaid is Critical for Patients Medicaid is a crucial source of coverage for patients with serious and chronic health care needs. Pregnant women depend on Medicaid, which covers roughly 50 percent of all births including many high-risk pregnancies. Medicaid covers cancer patients: nearly one-third of pediatric cancer patients were enrolled in Medicaid in 2013 and approximately 1.52 million adults with a history of cancer were covered by Medicaid in 2015. Over fifty percent of children and one-third of adults living with cystic fibrosis rely on Medicaid to get the treatments and therapies they need to preserve their health. Nearly half of children with asthma are covered by Medicaid or CHIP and adults with diabetes are disproportionally covered by Medicaid as well. The patients we represent are eligible for Medicaid through various pathways, including through income-related and disability criteria. Reject Per Capita Caps The proposal to convert federal financing of Medicaid to a per capita cap system is deeply troubling. This policy is designed to reduce federal funding for Medicaid, forcing states to either make up the difference with their own funds or cut their programs by reducing the number of people they serve and the health benefits they provide. For patients with ongoing health care needs, this means that Medicaid may no longer cover the care and treatments they need, including breakthrough therapies and technology. In order to save money, the per capita caps are set to grow more slowly than expected Medicaid costs under current law. As the gap between the capped allotment and actual costs increases over time, states will be forced to constrain eligibility, reduce benefits, lower provider payments, or increase cost-sharing. Moreover, by capping the federal government's contribution to Medicaid in this manner, states will be less able to cover the cost of new treatments. This could be devastating for people with serious diseases, for whom groundbreaking treatments represent a new lease on life. For people with cystic fibrosis, cancer, and other diseases, new therapies can be game changers that improve quality of life and increase life expectancy. In fact, we have already seen Medicaid programs respond to current budget constraints by using clinically inappropriate criteria to restrict access to therapies old and new. A per capita cap will only exacerbate the downward pressure on Medicaid budgets and will further reduce access to these therapies for patients. Pairing financing reforms with increased flexibility, as has often been proposed, would further undermine Medicaid's role as a safety net for patients. Without current guardrails provided by federal requirements--coupled with reduced federal funding--states will have the authority to reduce benefits and eligibility as they see fit and to impose other restrictions, such as waiting periods and enrollment caps. These policies have serious implications for patients--for a person with cancer, enrollment freezes and waiting lists could mean a later-stage diagnosis when treatment costs are higher and survival is less likely. For a person with diabetes, this would risk the ability to adequately manage the disease. Many of our patients rely on costly services that will be quickly targeted for cuts if states are given such flexibility, so it is imperative that current federal safeguards remain in place. Maintain Medicaid Expansion While the AHCA has been described as preserving Medicaid expansion for those already enrolled in coverage, we are concerned that estimates show that eliminating the enhanced match for any enrollee with even a small gap in coverage would actually result in millions of people losing coverage. By eliminating the enhanced federal match for any enrollee with a gap in coverage, eventually states will be on the hook for billions of dollars to continue covering this population--an insurmountable financial hurdle. Additionally, seven states have laws that would effectively end Medicaid expansion immediately or soon thereafter when the expansion match rate is eliminated. Nearly half of adults covered by the Medicaid expansion are permanently disabled, have serious physical or mental conditions--such as cancer, stroke, heart disease, arthritis, pregnancy, or diabetes--or are in fair or poor health. Repealing Medicaid expansion will leave these patients without coverage they depend upon to maintain their health. The proposed financing reforms are a fundamental shift away from Medicaid's role as a safety-net for some of the most vulnerable members of our society. Repealing Medicaid expansion would leave millions without the health care they rely on. Our organizations represent and provide care for millions of Americans living with ongoing health care needs who rely on Medicaid and we cannot support policies that pose such a grave risk to patients. We hope that we can continue our dialogue as you move forward in this process to arrive at solutions that provide all Americans with high-quality, affordable care regardless of an individual's income, employment status, health status, or geographic location. Sincerely, ADAP Advocacy Association; AIDS Action Baltimore; The AIDS Institute; Alpha-1 Foundation; Alport Syndrome Foundation; ALS Association; American Academy of Pediatrics; American Behcet's Disease Association; American Congress of Obstetricians and Gynecologists; American Diabetes Association; American Lung Association; American Parkinson Disease Association; American Society of Hematology; American Thoracic Society; Amyloidosis Support Groups Inc.; ARPKD/CHF Alliance; Arthritis Foundation; Batten Disease Support & Research Association; Bladder Cancer Advocacy Network. Bridge the Gap--SYNGAP Education and Research Foundation; Bronx Lebanon Hospital Center Department of Family Medicine; CADASIL Together We Have Hope Non-Profit; Cancer Support Community; Child Neurology Foundation; Children's Cause for Cancer Advocacy; Children's Dental Health Project; Chronic Illness and Disability Partnership; Community Access National Network; Congenital Adrenal Hyperplasia Research Education & Support Foundation, Inc.; COPD Foundation; Cure HHT; Cutaneous Lymphoma Foundation; Cystic Fibrosis Foundation; Cystinosis Research Network; debra of America; Endocrine Society; Fibrous Dysplasia Foundation; First Focus Campaign for Children. FORCE: Facing Our Risk of Cancer Empowered; Foundation for Prader-Willi Research; Friedreich's Ataxia Research Alliance (FARA); Genetic Alliance; Hannah's Hope Fund; Hide & Seek Foundation for Lysosomal Disease Research; Hispanic Health Network; Hope for Hypothalamic Hamartomas; Huntington's Disease Society of America; Immune Deficiency Foundation; The International Pemphigus and Pemphigoid Foundation; Kids v Cancer; Latino Commission on AIDS; LFS Association (Li- Fraumeni Syndrome Association); Liver Health Connection; March of Dimes; Medicare Rights Center; MLD Foundation. Moebius Syndrome Foundation; Muscular Dystrophy Association (MDA); NASTAD (National Alliance of State & Territorial AIDS Directors); National Alliance on Mental Illness; National Coalition for Cancer Survivorship; National Health Law Program; National Hemophilia Foundation; National Multiple Sclerosis Society; National Organization for Rare Disorders; National Patient Advocate Foundation; National Tay-Sachs & Allied Diseases Association (NTSAD); National Urea Cycle Disorders Foundation; National Viral Hepatitis Roundtable; NBIA Disorders Association; Needle Exchange Emergency Distribution (NEED); Parent Project Muscular Dystrophy (PPMD); Parkinson Alliance; The PCD (Primary Ciliary Dyskinesia) Foundation; Polycystic Kidney Disease Foundation; Pulmonary Fibrosis Foundation. PXE International; Rett Syndrome Research Trust; Scleroderma Foundation; The Sudden Arrhythmia Death Syndromes Foundation; T1D Exchange; Trisomy 18 Foundation; Tuberous Sclerosis Alliance; United Way Worldwide; VHL Alliance; Wilson Disease Association; Wishes for Elliott: Advancing SCN8A Research.

Mr. McGOVERN. Mr. Speaker, I would say to my colleagues that this is a sad day for this institution. This process has been awful. But this is even a sadder day for the American people. I remind my colleagues that we are supposed to care about one another, especially the most vulnerable in our society. In this era of Trump, Washington has become a mean place. It is a place where it has become unfashionable to worry about the poor, about older Americans, and about those who struggle. There is absolutely no justification for giving huge tax breaks to billionaires--$1 trillion in tax breaks to millionaires and billionaires, and at the same time throwing 24 million people off of health care and denying millions more essential healthcare protections. Twenty-four million people--my Republican colleagues have lost their human ability to feel what that means. That is the entire population of Australia. Mr. Speaker, I have a great deal of respect for my colleagues, but when I look at this bill and I read this bill, I have to wonder: What are you thinking? How could you do this? I have come to the conclusion there are only two reasons--there are only two ways you can vote for this bill. One is you don't know what is in the bill; or two is you have to have a heart of stone, because this bill is shameful. It is going to hurt people. It is going to hurt your constituents. Withdraw this bill or vote ``no'' on this bill, but this bill cannot become law. The health care and healthcare protections for the American people are too important. Mr. Speaker, I urge all my colleagues--both Democrats and Republicans--reject this. Vote ``no.'' Mr. Speaker, I yield back the balance of my time.

Mr. McGOVERN. Mr. Speaker, I yield 30 seconds to the gentlewoman from New Hampshire (Ms. Kuster).

Mr. McGOVERN. Mr. Speaker, I yield 2 minutes to the gentlewoman from Connecticut (Ms. DeLauro).

Mr. McGOVERN. This analysis confirms that the Republicans will give a trillion-dollar tax break to the wealthiest people in this country, and they will kick 24 million Americans off their health insurance. I will say that is why we are packed with speakers on this side, and there is probably only a couple of people on the gentleman's side, because we are standing with the American people who are outraged by this bill. Mr. Speaker, I yield 1 minute to the gentleman from Rhode Island (Mr. Cicilline).

Mr. McGOVERN. Mr. Speaker, I include in the Record the CBO score for the underlying bill and the first four manager's amendments. We just got it last night, and it is already out-of-date given the fifth manager's amendment that was just submitted late last night. U.S. Congress, Congressional Budget Office, Washington, DC, March 23, 2017. Hon. Paul Ryan, Speaker of the House, House of Representatives, Washington,

Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentleman from Rhode Island (Mr. Langevin).

Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentleman from North Carolina (Mr. Price).

Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentlewoman from Hawaii (Ms. Gabbard).

Mr. McGOVERN

Mr. McGOVERN. Mr. Speaker, I thank the gentleman from Texas (Mr. Sessions), my friend, for yielding me the customary 30 minutes. Mr. Speaker, we aren't here to debate the government healthcare repeal plan. We aren't here to debate that because Republican leadership and the White House are huddled behind closed doors as we speak, making deals that will have very real, very serious, very dangerous consequences for millions of Americans. Instead, we are here to debate a martial law rule that will allow Republicans to rush their bill with its brand-new backroom deals to the floor today without any proper deliberation. As a matter of fact, it would let them rush any bill to the floor today, or any day through Monday. It is a blanket martial law rule that lasts past the weekend--not specific to their healthcare bill, and not even specific to the topic of health care. What other bills could they be contemplating considering? We saw the Buffalo bribe is already in the manager's amendment, but this rule lets them bring up any other bill before the public has a chance to even know what it is. Maybe something on the Russia investigation, perhaps? I have seen a lot of news on that lately. Or maybe we will give President Trump's friend Putin a Congressional Gold Medal. It is the least the Republicans could do after his help with the election. But let's talk about what we have learned so far in the press. We first learned from news reports last night that Republicans were considering changes to the bill that would kill the essential health benefits in current law. Now, let me say that again. Essential, as in ``absolutely necessary; extremely important,'' as defined by the dictionary. And, sure enough, we reported out this martial law rule in the dark of night, which will allow Republicans to bring the new and unimproved version of the bill--again, now with even more backroom deals--to the Rules Committee later today, or in the dead of night, and take it straight to the floor. Apparently, there is no time to even have it sit for 1 day so that Members can read it, let alone get analysis from the nonpartisan experts at CBO. Are they hoping that if they move quickly enough, no one will figure out what they are up to? Well, let me lay it out for everybody. Essential health benefits require insurance plans to cover basic essential benefits, such as emergency services, maternity care, mental health care and substance abuse treatment, pediatric services, and prescription drugs. Now, The New York Times this morning pointed out that this late- breaking Republican proposal could lead to plans that cover aromatherapy, but not chemotherapy. I mean, really? Are Republicans seriously contemplating making a change this massive without hearings? Without a markup? No CBO estimate of the impact? No chance to read the bill? I have seen a lot in my years here, but this is truly unbelievable. You guys take my breath away. That is not even considering the already dangerous bill we were supposed to be down here considering right now. Let me just make it clear what that bill actually is. First, it is a massive tax cut for millionaires and billionaires, paid for by taking health insurance away from 24 million people, period. Anyone who takes 5 minutes to look at any unbiased analysis of the bill knows that this is true: massive tax cuts for the well-off at the expense of 24 million people. Now, let me paint a picture of how big that number is: Twenty-four million people is basically the entire population of the country of Australia. It is more people than live in the States of Kansas, New Mexico, Nebraska, West Virginia, Idaho, Hawaii, New Hampshire, Maine, Rhode Island, Montana, Delaware, South Dakota, North Dakota, Alaska, Vermont, Wyoming, and the District of Columbia, combined. You know how I know this bill is a tax giveaway for the wealthy, and it is not a healthcare bill? Because, according to the nonpartisan Congressional Budget Office--and this is truly incredible--it would actually result in more people uninsured than if the Affordable Care Act were simply repealed. Let that sink in for a minute. Second, their bill would cause people to pay more in terms of out-of- pocket expenses, and in return, they will get lower quality health insurance. That is right. Republicans are asking people to pay more for less coverage. In particular, lower income and older Americans will see their costs skyrocket--those people who can least afford to pay more. Third point, and this is a big one, the bill guts Medicaid and Medicare. Now, don't take it from me. The AARP said: ``This bill would weaken Medicare's fiscal sustainability, dramatically increase healthcare costs for Americans aged 50 to 64, and put at risk the health care of millions of children and adults with disabilities, and poor seniors who depend on the Medicaid program for long-term services and supports and other benefits.'' That is the AARP. In fact, Americans aged 50 to 64 will pay premiums five times higher than what others pay for health coverage no matter how healthy they are. This bill is an age tax, plain and simple, and Republicans are cutting $880 billion from Medicaid. That is a 25 percent cut in funding. All this to give tax cuts to the rich and to corporations. The bill must look like a cruel joke to the most vulnerable among us. Representative Mo Brooks, a member of the Republican Conference said just the other night: ``Quite frankly, I'm persuaded that this Republican healthcare bill . . . long-term, is a detriment to the future of the United States of America.'' Finally, even before imposing martial law last night, this process was horrendous. The Republican majority rushed their bill through the committee process without any hearings--none, zero--just holding marathon markups where no Democratic amendments were accepted--none, not one. They didn't even wait for a CBO score. Then, when the score finally came, it showed that the bill would kick 24 million people off their insurance. Did they stop then? No, of course not. Yesterday, in the Rules Committee, we rushed ahead with a cobbled- together manager's amendment--I am sorry, four cobbled-together manager's amendments since the originals had errors and, again, no CBO score on the updated bill. Didn't my colleagues learn their lesson from last week? And even worse, the main manager's amendment, which we received just 36 hours before our meeting, is so full of backroom deals, as I mentioned, like the Buffalo bribe, a cynical--likely unconstitutional-- agreement with wavering New York Republicans who know the Republican healthcare plan would devastate New York. And now they are saying: Don't worry. If you don't like this bill, it is just step one of three. You will get another chance to vote on health care during step three. Never mind that they can't give us the full slate of bills that are part of this mysterious step three. Or maybe I should just take Republican Senator Cotton's word for it. He said: ``There is no three-step plan. That is just political talk. It's just politicians engaging in spin.'' Republican Ted Cruz from my colleague's State of Texas called the third prong of this three-bucket strategy ``the sucker's bucket.'' The sucker's bucket--that is your own Member calling you a sucker if you vote for this. We heard testimony all day yesterday and well into the night about how disastrous this bill would be for hardworking Americans. We heard about how countless major health organizations oppose this plan, from the American Medical Association to the American Hospital Association, to the National Rural Health Association, to the AARP, to the American Society of Addiction Medicine, to the National Alliance on Mental Illness, and I could go on and on and on and on. This reverse Robin Hood will steal from the working class and give to the wealthy. Under the Republican plan, $2.8 billion in tax breaks will go to the 400 richest families in America each year. My colleagues on the other side of the aisle seem to be rushing this through in hopes that no one will figure out that it is a tax break for the rich masquerading as a healthcare bill. Now we find ourselves on the floor debating a martial law rule that will take that reckless process from light speed to warp speed. Let me just remind my colleagues again that we are talking about people's lives here. I am pretty sure the middle class Americans, whom Republicans claim to be helping would be okay with delaying this reckless bill for a little while to give us a chance to find out what the impacts will be. Mr. Speaker, this process is beyond the pale. I am honestly still stunned that we are even here debating a martial law rule on legislation of this magnitude when changes to people's basic, essential health benefits are being contemplated without so much as a single hearing, let alone a CBO score. And again, we have no real clue what Republicans will be bringing to the floor later today. I am just going off what I read in the news since we haven't gotten any actual updates from the other side of the aisle, but this rule would allow them to bring anything to the floor today or tomorrow or Saturday or Sunday or Monday--literally anything. Will there be a new bill? Who knows. Will it even be on health care? Beats me. What mysterious changes are they contemplating that are so broad they can't even narrow their martial law authority down to the topic of health care? Please, please, I would ask my colleagues to slow down. Be thoughtful. This is not a game. You don't get extra points for being fast. This healthcare repeal affects millions upon millions upon millions of Americans. Don't jam a disastrous bill through the House with patched-up fixes. Wait for a revised CBO score. Listen to what members of your own Conference are saying. Or better yet, don't do this at all. Let's go back to the drawing board. It is clear Republicans never really had a plan to replace the Affordable Care Act. Don't pretend you did and then make our most vulnerable pay the consequences. This is a sad day. This is a sad day for this institution, but it is even a sadder day for the American people. Mr. Speaker, I reserve the balance of my time.

Mr. McGOVERN. Mr. Speaker, I would be delighted if we had actual text to look at right now, but, instead, we are forced to rely on news reports, and what I am reading in the news is not good. The article that I just included in the Record also quotes a Harvard professor who says: ``Think of this as the if-you-have-rheumatoid- arthritis-you-should-pay-$30,000 provision.'' The article says that we could go back to a world where insurers could simply tell the mother of a mentally ill child that she couldn't buy insurance. It is ironic that the Republicans want to take away a woman's choice about a pregnancy, and then it looks like they are going to take away any insurance she needs for prenatal care or maternity care. What are we doing here, Mr. Speaker? What will we be asked to vote on later today? If these sorts of dangerous ideas are being considered, we, the American people, deserve to know. Twenty-four million people are going to lose their insurance under the proposal the Republicans are considering. People will pay more and get less. There will be huge tax cuts for the rich. Again, we don't even have the final text. This is awful. This is unacceptable. I will remind my colleagues that this is about the American people. Put the people of this country ahead of your party, ahead of your ideology, and ahead of this President who just discovered that health care is complicated. This is a life-or-death issue for many in this country. Health care is very personal. Don't take it away from people. Let's work in a bipartisan way to make the improvements in the Affordable Care Act that we all know need to be made, but don't just tear apart a healthcare system that is providing an additional 20 million Americans health insurance. Please don't do this. Slow down. Provide us the text of the bill. Let's have hearings. Let's bring the American people into the Congress and listen to what they have to say. Listen to what your own constituents have been saying to you in townhalls. They don't want what you are selling here today. They don't want your rescue plan. They want health care for themselves and their families, and that is what they deserve. So, please, vote down this martial law rule and go back to the drawing board. Mr. Speaker, I yield back the balance of my time.

Mr. McGOVERN. Mr. Speaker, I yield myself the balance of my time. Mr. Speaker, I include in the Record the article from today's New York Times titled, ``Late GOP Proposal Could Mean Plans That Cover Aromatherapy But Not Chemotherapy.'' [From the New York Times, Mar. 23, 2017] Late G.O.P. Proposal Could Mean Plans That Cover Aromatherapy But Not Chemotherapy (By Margot Sanger-Katz) Most Republicans in Congress prefer the type of health insurance market in which everyone could ``choose the plan that's right for them.'' Why should a 60-year-old man have to buy a plan that includes maternity benefits he'll never use? (This is an example that comes up a lot.) In contrast, the Affordable Care Act includes a list of benefits that have to be in every plan, a reality that makes insurance comprehensive, but often costly. Now, a group of conservative House members is trying to cut a deal to get those benefit requirements eliminated as part of the bill to repeal and replace the Affordable Care Act moving through Congress. (The vote in the House is expected later today.) At first glance, this may sound like a wonderful policy. Why should that 60-year-old man have to pay for maternity benefits he will never use? If 60-year-old men don't need to pay for benefits they won't use, the price of insurance will come down, and more people will be able to afford that coverage, the thinking goes. And people who want fancy coverage with extra benefits can just pay a little more for the plan that's right for them. But there are two main problems with stripping away minimum benefit rules. One is that the meaning of ``health insurance'' can start to become a little murky. The second is that, in a world in which no one has to offer maternity coverage, no insurance company wants to be the only one that offers it. Here is the list of Essential Health Benefits that are required under the Affordable Care Act: Ambulatory patient services (doctor's visits) Emergency services Hospitalization Maternity and newborn care Mental health and substance abuse disorder services, including behavioral health treatment Prescription drugs Rehabilitative and habilitative services and devices Laboratory services Preventive and wellness services, and chronic disease management Pediatric services, including oral and vision care The list reflects some lobbying of the members of Congress who wrote it. You may notice that dental services are required for children, but not adults, for example. But over all, the list was developed to make insurance for people who buy their own coverage look, roughly, like the kind of coverage people get through their employer. A plan without prescription drug coverage would probably be cheaper than one that covers it, but most people wouldn't think of that plan as very good insurance for people who have health care needs. Under the Republican plan, the government would give people who buy their own insurance money to help them pay for it. A 20-year-old who doesn't get coverage from work or the government, for example, would get $2,000. If the essential health benefits go away, insurance companies would be allowed to sell health plans that don't cover, say, hospital care. Federal money would help buy these plans. But history illustrates a potential problem. In the 1990s, Congress created a tax credit that helped low-income people buy insurance for their children. Quickly, it became clear that unscrupulous entrepreneurs were creating cheap products that weren't very useful, and marketing them to people eligible for the credit. Congress quickly repealed the provision after investigations from the Government Accountability Office and the Ways and Means Committee uncovered fraud. Mark Pauly, a professor of health care management at the Wharton School of the University of Pennsylvania, who tends to favor market solutions in health care, said that while the Obamacare rules are ``paternalistic,'' it would be problematic to offer subsidies without standards. ``If they're going to offer a tax credit for people who are buying insurance, well, what is insurance?'' he said, noting that you might end up with the government paying for plans that covered aromatherapy but not hospital care. ``You have to specify what's included.'' A proliferation of $1,995 plans that covered mostly aromatherapy could end up costing the federal government a lot more money than the current G.O.P. plan, since far more people would take advantage of tax credits to buy cheap products, even if they weren't very valuable. There's another reason, besides avoiding fraud, that health economists say benefit rules are important. Obamacare requires insurers to offer health insurance to people who have preexisting illnesses at the same price as they sell them to healthy people, and the Republican bill would keep this rule. But if an insurance company designs a plan that attracts a lot of sick people, it will be very expensive to cover them, and the insurance company will either lose money or end up charging extremely high prices that would drive away any healthy customers. Sherry Glied, the dean of the Robert F. Wagner Graduate School of Public Service at New York University, who helped work on the essential health benefits in the Obama administration, raised the example of mental health benefits. Parents of adolescents with schizophrenia will be sure to buy insurance that covers only mental health services. Other parents won't care about that benefit. The result: Any company offering such benefits will end up with a lot of customers requiring expensive hospitalizations, while its competitors that drop them will get healthier customers who are cheaper to insure. If mental health services are optional, no insurance company will want to offer them, lest all the families with sick children buy their product and put them out of business. And then healthy people who develop mental illness, or drug addiction, will also learn that their illness isn't covered. The result could be a sort of market failure: ``If you don't require that these benefits are required, they often just get knocked out of the market altogether,'' she said. Before Obamacare passed, there were few federal standards for health insurance bought by individuals, and it was not uncommon to find plans that didn't include prescription drug coverage, mental health services or maternity care. But plans tended to cover most of the other benefits. That was in a world where health insurers could discriminate against sick people. In that era, insurers in most states could simply tell the mother of a mentally ill child that she couldn't buy insurance. That made it less risky for insurers to offer mental health benefits to everyone else. David Cutler, a professor at Harvard who helped advise the Obama administration on the Affordable Care Act, said he thinks the kind of insurance products that would be offered under the proposed mix of policies could become much more bare-bones than plans before Obamacare. He envisioned an environment in which a typical plan might cover only emergency care and basic preventive services, with everything else as an add-on product, costing almost exactly as much as it would cost to pay for a service out-of-pocket. ``Think of this as the if-you-have-rheumatoid-arthritis- you-should-pay-$30,000 provision,'' he said. Such a system would mean that Americans with costly problems--cancer, opioid addiction, H.I.V.--would end up paying a substantially higher share of their medical bills, while healthy people would pay lower prices for insurance that wouldn't cover as many treatments. There is most likely a middle way. Republican lawmakers might be comfortable with a system that shifts more of the costs of care onto people who are sick, if it makes the average insurance plan less costly for the healthy. But making those choices would mean engaging in very real trade- offs, less simple than their talking point.

Mr. McGOVERN. Mr. Speaker, I yield 1 minute to the gentleman from Georgia (Mr. Johnson).

Mr. McGOVERN

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