Frank Pallone

Mr. PALLONE

Mr. PALLONE. Mr. Chairman, I yield 1 minute to the gentleman from Maryland (Mr. Hoyer), our majority leader.

Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman from California (Ms. Matsui).

Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Vermont (Mr. Welch), a member of the committee.

Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman from New York (Ms. Clarke), the vice chair of the Energy and Commerce Committee.

Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentlewoman from Michigan (Mrs. Dingell).

Mr. PALLONE. Mr. Chairman, I yield 1\1/2\ minutes to the gentleman from Virginia (Mr. Beyer).

Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman from Texas (Ms. Jackson Lee).

Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentleman from Connecticut (Mr. Courtney).

Mr. PALLONE. Mr. Chair, may I inquire how much time remains?

Mr. PALLONE. Mr. Chair, I yield myself such time as I may consume. Mr. Chair, I wanted to mention this issue of reinsurance. Some of the Republicans have brought up the fact that in the last few years under the Obama administration, actually before President Trump, certain States--I believe there are eight now, including my own--applied for 1332 waivers because they wanted to put in place reinsurance programs. I want to assure everyone that those types of waivers that are granted for reinsurance would continue and that this legislation in no way impacts that. Keep in mind, we are not opposed to 1332 waivers. But pursuant to the Affordable Care Act, which I helped draft, those waivers, when granted, have to maintain affordability and comprehensiveness of coverage and keep the same number of people insured as under the ACA. When my State and others have applied for waivers for reinsurance programs, it is because the ACA reinsurance funding was discontinued at some point under the original bill. Those States want to, among other things, make sure that there is competitiveness in the marketplace by providing some kind of reinsurance or risk protection so that more insurers come into the marketplace in those States and create more competition and lower prices. When you ask the Federal Government for a reinsurance waiver, you are still maintaining affordability, probably making things even more affordable because of competition. You are still maintaining the comprehensiveness of the coverage because you have to provide policies that have all the essential benefits. You are keeping the same number of people insured. In fact, what you are probably doing is having more people insured. The difference between that and the section 1332 guidance that the Trump administration is now putting forth is that none of those things are guaranteed under the waivers that the Trump administration is proposing with their guidance. For one thing, they are saying you can sell a junk plan that doesn't have hospitalization, that doesn't have essential benefits, so you violate the section 1332 provision. You also end up having fewer people insured because the Trump administration says you don't have to have the same number of people covered. All you have to do is have access. Lastly, affordability, sure, they will argue that somehow it is more affordable because a junk plan doesn't cost as much, but that is sort of a misnomer because the comprehensiveness of the coverage disappears. I want everyone to understand, a State that applies to have reinsurance as part of their program and gets a waiver, that is in no way impacted by what we are proposing here today with Ms. Kuster's bill. In fact, reinsurance reinforces the very things that the 1332 waivers are seeking to guarantee. So that is a very false bit of information that my colleagues on the other side are trying to put out here today. I wanted to explain that. Mr. Chair, I reserve the balance of my time.

Mr. PALLONE. Mr. Chair, I yield 1\1/2\ minutes to the gentlewoman from Michigan (Ms. Slotkin).

Mr. PALLONE. Mr. Chair, I yield myself such time as I may consume. I am still waiting for one of our other speakers. Mr. Chair, I want to respond to my colleague, the ranking member, whom I respect a great deal. He has several times today, as well as in committee and as a representative at the Rules Committee, talked about this amendment that he has on preexisting conditions. First of all, the reality is that the ACA guarantees people coverage with preexisting conditions. The problem here is not that we need to restate that, but that the section 1332 guidance that the Trump administration has proposed would undermine it. On its surface, Mr. Walden's amendment appears to maintain protections for preexisting conditions, but, again, that is not the issue because he is not getting rid of the guidance that the Trump administration has put forward under 1332. What does that mean? It means that even with his amendment, the Trump administration, under their guidance, would allow insuring companies to not offer basic services such as hospitalization, maternity coverage, mental health, and substance abuse disorders. Insurance companies would no longer have to offer these benefits to people with preexisting conditions who need those benefits. Mr. Walden's amendment also does not include prohibitions on annual and lifetime limits, which are critical protections for individuals with preexisting conditions. These limits, which were commonplace prior to the ACA, are a threat to the life and health of individuals with serious medical conditions. The Walden amendment would also allow insurance companies to charge women more than men and put a significant financial burden on older Americans. We are not interested in these half measures that would leave Americans worse off. Mr. Chair, I yield such time as he may consume to the gentleman from California (Mr. Harder).

Mr. PALLONE. Mr. Chairman, I yield myself the balance of my time. Mr. Chairman, the problem is that nothing that my colleague on the Republican side says about his amendment and nothing that is in Seema Verma's letter will help a person with preexisting conditions. The bottom line is this 1332 guidance that the Trump administration has put forward allows junk plans to be sold so that people with preexisting conditions will not get the coverage they need. They can be charged more. They are not guaranteed that things like recisions and lifetime limits don't go back into place. So the problem that we face is we can't allow people with preexisting conditions to suffer and not get coverage because they are going to be charged more or because they are not going to get the coverage they need by buying a junk plan. If you really care about that and you want to make sure that people with preexisting conditions really are guaranteed good coverage and can afford their coverage, then you have to vote for Ms. Kuster's bill. That is all we are saying here. I am not saying that my colleague on the other side is not well meaning, but nothing he has said will protect the people with preexisting conditions from the problems with the Trump guidance. So I would ask my colleagues to support this bill. Mr. Chairman, I include in the Record two letters from various nonprofit health organizations supporting the bill. May 8, 2019. Hon. Greg Walden, Ranking Member, House Energy & Commerce Committee, Washington, DC. Dear Ranking Member Walden: Our 35 organizations, representing the interests of the millions of patients and consumers who live with serious, acute, and chronic conditions, have worked together for many months to ensure that patient voices are reflected in the ongoing Congressional debate regarding the accessibility of health coverage for all Americans and families. In March 2017, we identified three overarching principles to guide and measure any work to further reform and improve the nation's health insurance system. Our core principles are that health care must be adequate, affordable, and accessible. Together, our organizations understand what individuals and families need to prevent disease, manage health, and cure illness. As the 116th Congress progresses, we welcome the opportunity to work with members on both sides of the aisle on solutions that will preserve coverage for individuals who are currently covered, extend coverage to those who remain uninsured, and lower costs and improve quality for all. Prior to the Affordable Care Act (ACA), individuals who were in the most need of health insurance coverage--including older and sicker Americans and people living with pre- existing conditions--often found it difficult, if not impossible, to obtain health insurance that provided the coverage they needed. Many individuals were denied coverage due to their pre-existing conditions or were charged outrageous premiums and/or were left with inadequate benefit packages. Without access to comprehensive health coverage they could afford, many patients with serious and chronic conditions were often forced to delay or forego necessary health care. Before the patient protections provided under the ACA, more than half of heart patients reported difficulty paying for their care and of those patients more than 40 percent said they had delayed care or had not filled prescriptions. Uninsured patients with diabetes were six times as likely to forgo necessary medical care than those with coverage. Uninsured patients were less likely to be screened for cancer and more likely to be diagnosed with later stage disease which is harder to survive and more costly to treat. Individuals and families with pre-existing conditions rely on critical protections in current law to help them access comprehensive, affordable health coverage that meets their medical needs. Unfortunately, the arguments of the plaintiffs and the recent change of opinion by the Department of Justice in the Texas v. U.S. case continue to represent a serious threat to these protections. We are troubled by the argument made by the plaintiffs and DOJ that the court must invalidate the entire ACA due to Congress' repeal of the individual mandate, as many provisions of the ACA directly protect people with pre-existing conditions. Our organizations appreciate that members of Congress share our concerns about the potential impact of Texas v. U.S. on people with pre-existing conditions. Several bills have been introduced in response to this case, from H. Res. 14, which authorized the Speaker, on behalf of the House of Representatives, to intervene in the case of Texas v. United States, to S. 1125, the Protect Act, and H.R. 692, the Pre- existing Conditions Protection Act of 2019. Some of these bills--including S. 1125 and H.R. 692-- attempt to provide protection to people with pre-existing conditions should the ACA be invalidated. We recognize and appreciate the sponsors' efforts, and know that in many cases, in response to stakeholder feedback, sponsors have revised previous drafts of these bills to offer additional protections for consumers, including those with pre-existing conditions. However, we remain concerned that the policies outlined in these bills fall far short of the comprehensive protections and coverage expansion included in current law. As you are aware, current law requires issuers to comply with a set of provisions that work together to promote adequate, affordable, and accessible coverage for people with pre-existing conditions. A holistic approach that includes-- but is not limited to--community rating, guaranteed issue, essential health benefits, cost-sharing limits, a prohibition of lifetime and annual limits, allowing young people to stay on their parents' insurance to age 26, the ban on pre-existing condition exclusions, and other important provisions protect people with serious health care needs from discriminatory coverage practices and promote access to affordable coverage. Medicaid expansion also brought coverage to millions of Americans who were previously uninsured, many of whom went without vital care. These policies are inextricably linked and repealing any of them threatens access to critical care for people with life-threatening, disabling, chronic, or serious health care needs. We hope that you will keep these critical patient protections and the interlocking functions of current law that safeguard coverage for consumers, patients, and individuals with pre-existing conditions at the front of your mind during the 116th Congress. We are grateful that Congress is committed to exploring both immediate and long-term approaches that can be taken to shore up and strengthen the individual insurance market and we remain ready and willing to work with Congress to achieve that goal and provide all Americans with the health care they need and deserve. If you have any questions about this letter, please contact Katie Berge, Federal Government Relations Manager for the American Heart Association. Sincerely, United Way Worldwide, COPD Foundation, Hemophilia Federation of America, Susan G. Komen, Family Voices, American Heart Association, National Health Council, Epilepsy Foundation, March of Dimes, ALS Association, National Hemophilia Foundation, National Coalition for Cancer Survivorship, Alpha-1 Foundation, American Liver Foundation, National Multiple Sclerosis Society, WomenHeart: The National Coalition for Women with Heart Disease, American Cancer Society Cancer Action Network. Muscular Dystrophy Association, National Patient Advocate Foundation, Leukemia & Lymphoma Society, Lutheran Services in America, National Kidney Foundation, American Lung Association, Cystic Fibrosis Foundation, American Diabetes Association, National Psoriasis Foundation, National Alliance on Mental Illness, Adult Congenital Heart Association, Arthritis Foundation, Chronic Disease Coalition, Immune Deficiency Foundation, Cancer Support Community, National Organization for Rare Disorders, Pulmonary Hypertension Association, Juvenile Diabetes Research Foundation.

Mr. PALLONE. Mr. Chair, I yield back the balance of my time.

Mr. PALLONE. Mr. Chair, I object.

Mr. PALLONE. Mr. Chair, I claim the time in opposition to the amendment.

Mr. PALLONE. Mr. Chairman, I claim the time in opposition to the gentleman from Oregon's amendment.

Mr. PALLONE. Mr. Chairman, it disturbs me, I guess, that my colleague on the other side, whom I greatly respect, keeps mentioning this letter from Seema Verma, the CMS Administrator. Nothing that she says in her letter is in any way going to change the guidance that she and the Trump administration have put forward that would undermine people with preexisting conditions' ability to get good insurance if this guidance is allowed to continue and States get waivers pursuant to the guidance, because of, again, the issue of affordability. You see, the problem is that the 1332 waivers, the way they are set out in the ACA, have certain guardrails, if you will, to prevent waivers that would allow for junk insurance and other policies that would undermine people with preexisting conditions from getting good insurance. Those guardrails say that any kind of waiver has to guarantee affordability, has to guarantee comprehensive coverage, the essential benefits package, robust coverage, and also not reduce the number of people who are insured. This guidance that Seema Verma and the Trump administration have put forward does exactly the opposite, because it allows insurance to be sold, if a State seeks to do so, that would eliminate, for example, hospitalization or eliminate mental health coverage or eliminate coverage for maternity care. Now, if you are someone with preexisting conditions and they eliminate coverage for your preexisting condition, that relates to your preexisting condition, you might as well not even have insurance, and that is why we say it is junk. It lets a waiver be granted that would allow the insurance companies of that State to charge more based on age, based on sex. I mean, the list goes on. So Seema Verma can send out all the letters she wants, but it doesn't mean anything. I like to say, you know, one of the things that disturbs me most, also, is we on the Democratic side, myself and some of the other chairmen of some of the other committees, sent a letter and a request, because it has been pointed out repeatedly that Seema Verma has been putting out contracts up to $4 million a year to basically promote herself, and that is being investigated right now as we speak. So, again, I don't like to say bad things about people, but the bottom line is she is in no position to be telling us what is in this guidance. This guidance is going to hurt people with preexisting conditions, and there is no way that she is going to get around it. Mr. Chair, I reserve the balance of my time.

Mr. PALLONE. Mr. Chair, I have no objection.

Mr. PALLONE. Mr. Chairman, I claim the time in opposition to the amendment.

Mr. PALLONE. Mr. Chairman, just to back up what I said previously about the implications for this Trump administration and Seema Verma's guidance that they put forward with regard to 1332, I want to read a section from a letter that was sent by 23 patient and consumer advocacy organizations in support of H.R. 986, the bill that is before us. These organizations include the Heart Association, the Lung Association, the Epilepsy Foundation, et cetera. This goes back to the guardrails. As I said, under 1332, in the ACA, there are guardrails that say that any waivers have to guarantee affordability, have to guarantee comprehensiveness of coverage, and have to, at the same time, not reduce the number of people with insurance. Nothing that Seema Verma or anything on the other side that is being said is suggesting in any way that, under this guidance, those principles wouldn't be violated. In fact, they would be violated. So this is what these 23 patient and consumer advocacy organizations say about the Trump guidance waiver: ``This gross misinterpretation of the guardrails will have real consequences for patients, steering people into substandard coverage, such as short-term, limited-duration plans and association health plans, which often do not cover the full range of benefits and services that patients rely on to manage their conditions. ``Further, policies that could be implemented under this new interpretation could fundamentally alter the risk pool for a State's individual marketplace, making comprehensive coverage unaffordable for patients who rely on it and jeopardizing the stability of the State's marketplace. The resulting lack of access to care could have devastating short- and long-term consequences for the millions of patients we represent.'' The bottom line is this is going to dramatically hurt people with preexisting conditions if they try to buy insurance that will cover the maladies that they want to cover, and they need to have covered. Again, I don't understand, Mr. Holding and, previously, Mr. Walden have these amendments that really have nothing substantive to say. All they do is talk about changing the title because they are trying to ridicule what Democrats are trying to do here, which is to guarantee that people with preexisting conditions are protected. I don't want to get upset, but I think that it is kind of inappropriate, when here we are trying to guarantee people with preexisting conditions are protected--even Republicans on the other side are saying that is important to them--and, instead of having a serious debate about this, they put forward amendments that change the title to ridicule what we are trying to do. It is just unfortunate that we are at that point now, but that is where we are. Madam Chairman, I reserve the balance of my time.

Mr. PALLONE. Madam Chair, my colleagues on the other side started out this debate on these amendments by basically saying they wanted to substitute the title rather than talking about the substance. Now, my colleague, the ranking member, starts talking about the lawsuit that would--I think he is talking about the lawsuit that would repeal the Affordable Care Act. Again, my colleagues on the other side are not looking to protect people with preexisting conditions, they are not looking to protect anybody, because now they are saying that it is a good idea to repeal the Affordable Care Act. So we are back to the basic debate about whether or not we should have the Affordable Care Act, which until President Trump came along and started sabotaging the bill, 97 percent of Americans had health insurance, an all-time high in the history of this country. So, okay, that is fine. Now we are going to say that they want to repeal the Affordable Care Act once again. This is what this is all about on their side of the aisle: repeal the act, move to court to try to get the courts to declare the act unconstitutional, no effort to worry about the millions and millions of Americans who have gotten coverage because of the Affordable Care Act. I really don't know what else I can say at this point, but at least they revealed their true motive, which is simply to repeal the whole bill. Once again, I guess there is not much to say here, other than to say that I would urge my colleagues to reject this amendment. Let's get back to talking about the substance of the bill that is before us, which would guarantee that there are protections for people with preexisting conditions. Madam Chair, I yield back the balance of my time.

Mr. PALLONE. Madam Chair, I demand a recorded vote.

Mr. PALLONE. Madam Speaker, I demand a recorded vote.

Mr. PALLONE

Mr. PALLONE. Madam Speaker, I rise today to congratulate Anna Diaz- White as she is honored by 180 Turning Lives Around at their annual celebration on May 3, 2019. Ms. Diaz-White's exemplary leadership and contributions to 180 Turning Lives Around are truly deserving of this body's recognition. For over 40 years, 180 Turning Lives Around has provided a safe outlet for victims of domestic and sexual violence, providing shelter, resources, counseling, and advocacy. The support that the agency provides to the community is truly immeasurable and Ms. Diaz-White's 35 years of service at 180 Turning Lives Around are indicative of her dedication to the agency and the care of the individuals and families they serve. Joining 180 Turning Lives Around in 1985, Anna Diaz-White brought her experience from the financial sector to the non-profit in her role as Fiscal/Grant Administrator. Less than 10 years later, Ms. Diaz-White was unanimously selected by the Board of Trustees to serve as 180's Executive Director. Under her leadership, the agency has grown immensely, serving over one million people and expanding its outreach and services. Her vision and innovative thinking have created new standards of service in the field and serve as a model for other domestic violence agencies in New Jersey. With her direction, 180 Turning Lives Around has built one of the largest and most inclusive domestic violence shelters in New Jersey, engaged and educated local law enforcement, created the Monmouth Family Justice Center, Amanda's Easel Creative Arts Therapy Program, and the Shore Regional Outreach Program, among many other programs and initiatives. Ms. Diaz-White's advocacy and professional relationships have established important partnerships within the community to enable 180 to offer integrated services that have changed countless lives. Madam Speaker, I sincerely hope that my colleagues will join me in thanking Anna Diaz-White and 180 Turning Lives Around for their invaluable impact on the community.