Greg Walden

Mr. WALDEN

Mr. WALDEN. Mr. Chairman, I would just say that section 1332 does not permit States to waive preexisting condition protections, period. And I would, again, cite the guidance from the CMS director, Ms. Seema Verma, where she states that. And that will be in the Record. Again, I think what we are trying to do here is give States more flexibility to bring down the cost of health insurance, while following these guidelines as outlined. As I mentioned earlier in the debate, high deductibles are pricing people out of coverage, and by that, I mean they are walking away from getting the care that they need because they can't pay for it; or they are driving up their credit card debt, wiping out their savings, they are having to take another job, they are borrowing money from others. So, what the Trump administration is trying to do is build on what the Obama administration created, 1332 waivers, that have, frankly, been very successful in many, many States. Mr. Chairman, I reserve the balance of my time.

Mr. WALDEN. Madam Chair, I seek time in opposition to the amendment.

Mr. WALDEN. Mr. Chairman, I yield back the balance of my time.

Mr. WALDEN. Madam Chair, I reserve the balance of my time.

Mr. WALDEN. Actually, I believe I get to close, don't I?

Mr. WALDEN. Mr. Chairman, I claim the time in opposition to the gentleman's amendment.

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

Mr. WALDEN. Mr. Chairman, I am not necessarily opposed to his amendment, but I do think it is important to talk about the issues that really matter when it comes to affordable healthcare. Again, when we talked about giving States the authority to innovate and to protect their citizens, we are for that. I come from a State that pioneered the Oregon Health Plan. I was there. I created a select committee when I was the Republican majority leader of the Oregon House, when we finally got the waiver from the Federal Government after a couple of years to actually implement the Oregon Health Plan. It was very creative about how to hold down healthcare costs and expand coverage and do all those things. We have worked on a lot of different issues over the years. What we did with the President today, I think, is really important and, that is, looked at this issue of surprise billing: If you follow all the rules, you go to a hospital that is in your network, and let's say some provider gets sick in the night and they substitute somebody else who doesn't turn out to be in your network and then, weeks later, you get an astronomical bill through no fault of your own. There was a parent down there whose daughter had had, I think, some sort of surgery, and the physician, on the way out, said: Oh, by the way, I want you to do just a little urine test here. We are going to run an analysis. So she did, left, and, a period of time later, got a bill for $17,000. Her dad is a doctor and said: How did this happen? Well, it turned out whoever did the test was not in the network of her insurance. She didn't know. What are you going to do? You have had whatever surgery she had, and on the way out the doctor says: Hey, by the way, give us a little sample. I just want to run a test because I have got you on this drug, and I want to make sure it is all working right. Then a $17,000 bill arrives a couple of months later. They were there with the President today in the Roosevelt Room at this bipartisan event. And her dad negotiated. He couldn't say what level, but it was certainly not what the insurer would have paid. Do you know what the insurer would have paid for that, in network? A hundred bucks. He said you can probably get the test done now for $25. A $17,000 bill arrives. This is what is happening to Americans who have insurance, and that is why we have got to deal with the surprise billing issue. It is why we have to squeeze the juice out of the middle of the healthcare delivery system. We do all these great innovations. And Republicans led the effort on the 21st Century Cures Act. We met with Dr. Francis Collins yesterday, the extraordinary leader of NIH; the longest-serving President-appointed--under Obama--NIH director in the history of our country. Because of what we put forward to dramatically increase investment in NIH--Republicans led that effort, Fred Upton, but joined with Diana DeGette, a Democrat out of Colorado, and a bunch of us--they are now finding cures. Dr. Collins said yesterday they have identified now 6,500 genetic diseases where they now can figure out, I'll say, the misspelling of the DNA code. Some of my colleagues may have seen on ``60 Minutes'' Dr. Collins talking about that they think they found a cure for sickle cell anemia. They found a misspelling--one letter misspelled in that big chain of DNA--that they were able to go in with our new technology--some of it is a result of what we have done collaboratively here--and change, alter, that letter. And they have these people now that there is no evidence of sickle cell in their blood platelets. There are 6,500 diseases that they now know the misspelling. Now they have got to figure out how to train your body, using immuno technology, to have your own cells turned on in a little different way and go after these diseases. These are remarkable advances in lifesaving medicines and treatments. We, I think, as a country, have to figure out how we pay for that, if each one of these is individualized. Our system is antiquated and doesn't deal with this effectively. We are going to have to figure that out because a lifesaving cure isn't going to cure a life if people can't afford to get the medicine. We also need to drill down on telehealth and telemedicine. One of our colleagues today was talking about mental health services. My district is bigger than any State east of the Mississippi, unless you have to count Lake Michigan with Michigan, which, of course, you do. So telehealth really matters, and we are getting great results for our veterans and for our citizens using telehealth. But our providers don't often get paid for the service they provide over telehealth. Why? That is something we have to address. You go one thing after another after another here, where we should be spending our valuable legislative time solving the problems that real Americans run into every day of the week: How do I pay the bill? You tell me I have insurance, and I do, and I pay a record--I don't know whose premium under ObamaCare went down $2,500 a month, but I will talk about this more. Mr. Chair, I yield back the balance of my time.

Mr. WALDEN. Madam Chair, I would like to point out a couple of things. One, I have introduced legislation to protect people with preexisting conditions. I did that because I knew this lawsuit is pending. We can argue about the ACA and the lawsuit and all that, but the long and short of it is that if the court rules the ACA gets thrown out as unconstitutional, which may happen, people with preexisting conditions would be exposed, and I don't want that to happen. That is why I introduced legislation. I would be honored if we could take that up in the Energy and Commerce Committee that I used to chair and put it on the House floor. I tried to bring it here as an amendment and it was denied by the Democrat majority, so we can't even have a debate here about it. If it is not everything it should be, then I am happy to work with people to try and make it as durable and robust as it needs to be. So that is one. When we talk about insurance--and there is kind of silence on the other side--2.5 million Americans since President Trump have gotten healthcare insurance through their employer. We have one of the most robust economies most Americans have ever seen: 3.2 percent, I think, GDP growth the first quarter. Some have said, you need fairy dust to do that. Well, that is not true. You need good economic policy. We have that in America: the lowest unemployment for African Americans, Hispanic Americans, all Americans. Incredible numbers, incredible growth. As a result, people are getting off government subsidized healthcare, or fully funded healthcare, onto private health insurance, which Democrats want to wipe out. One hundred and fifty-eight million Americans get their health insurance through their employer or through their union. And when it comes to the Affordable Care Act, that is what put in place the big cuts that are coming to our hospitals, the DSH cuts, that I held off as chairman of the Energy and Commerce Committee. We passed legislation to prevent the DSH cuts from hitting our disproportionate share of hospitals, those that deal with more lower income folks. We are going to have to do that again. Because ObamaCare says you got to hit your hospital with a big cost increase, if you will, or take away a subsidy. The Cadillac tax. I met with building trade folks in my State. These people bargained away, potentially, wages for better benefits. And then along comes ObamaCare, the Affordable Care Act, that says: Oh, by the way, if you have got too generous a plan, according to the government, you are going to have to pay a 40 percent tax on that plan. And, by the way, it was never indexed for inflation. And guess what, healthcare costs continue to go up and premiums go up. More and more Americans' health insurance is going to fall into this so-called Cadillac tax. There will be a 40 percent tax on those plans. The working men and women, who are part of a union or in the private sector and who have good, generous healthcare benefits, the Federal Government, the Democrat-driven plan that is totally partisan passed, it says, we are going to whack you with a 40 percent tax. How fair is that, Madam Chair? I don't think it is. We have kept that tax from taking effect as Republicans. We will see what this Congress does. But, moreover, we fully funded our community health centers. We, under Republicans, funded the children's health insurance program, a Republican creation, for a decade. I led that effort. Most Democrats consistently voted against funding children's health insurance time and time again. It had never been funded for more than 5 years ever in its history. One hundred and twenty-two thousand, seven hundred Oregonian kids and pregnant moms get their health insurance through CHIP. It is a marvelous program. Republicans led the effort, because I did it. We first tried to get 5, then 6, and then eventually we got 10 years funded. That is locked into law. We need to go back and fund our community health centers. I told people that if I were chairman, my palms would be getting a little sweaty now at the list of things we need to get done--I am looking at my friends. In Oregon, in my district, I think we had 63 delivery sites and 12 community health centers. We fully funded those centers at a record level in the last Congress, because I believe fully in that network of the delivery of healthcare. It is extraordinarily important. We should be doing that today, but we are not. We have got the National Health Service Corps, special diabetes programs for Indians, special diabetes programs for type I diabetes, teaching health centers, personal responsibility education programs, sexual risk avoidance education grants, and family-to-family health information centers. We have demo programs, increased access to dental healthcare services, and delay in authority to terminate contracts for Medicare Advantage plans. We have protection for recipients of HCBS against spousal impoverishment. We have demonstration of approved community behavioral health clinics, Medicaid funding for territories, delay in effective date for Medicaid amendments related to beneficiary liability settlements, DSH allotment, and money follows the person. All those expire at the end of this fiscal year. We have real work we need to get done, Madam Chair. Madam Chair, I yield back the balance of my time.

Mr. WALDEN. Madam Chair, I yield myself such time as I may consume. Section 1332 already requires that the State plan will provide coverage that is at least as comprehensive as the essential health benefits, including mental health and substance use disorder services. That is already required, including behavioral health treatment, and would provide coverage to at least a comparable number of its residents. That is already in the 1332 requirements. I appreciate the gentleman's passion for dealing with the opioid epidemic. I led the effort that brought together Republicans and Democrats. We passed 60 different pieces of legislation. I think 57 of them, by the time we were done working together, passed unanimously in this House. We bundled them up into H.R. 6 because we all know the Senate can't handle 57 or 60 different pieces of legislation, but they could handle one. The work we did here and the work they did there ended up in, I would argue, the Nation's most comprehensive legislation to address a drug problem our country has ever had. And that is our law. The President of the United States, who was just disparaged here on the House floor, helped lead this effort because he passionately cares about the issue of addiction. He lost a brother, I believe, to alcoholism. He was a leader, and his team were leaders, in this effort we put together on opioids. He invited Republicans and Democrats to the White House for the bill signing. Mrs. Trump helped organize all of that. This legislation is comprehensive on opioids. It wasn't part of the ACA. You see, we can work together and improve underlying laws. We can address major problems facing the country when majorities want to do that. We did it last Congress under my leadership, and it was Republicans and Democrats. We didn't start out agreeing on some of these matters, but we ended up there, with just a couple of exceptions. I sent my friend, Madam Chair, the chairman of the Energy and Commerce Committee today, a comprehensive list of kind of what we learned in the final phase of our investigation into how America ended up in the place it was with opioids. There are some additional recommendations that I hope and assume we will get to out of that investigative report that we concluded at the end of the year. Hopefully, we will get there. I believe we need to do oversight on the legislation we passed. I have always felt that about bills we passed. We need to go take a second look. What is working? What is not? We are not going to get it right the first time, and we always know there is more to do, and we need to do more on what was H.R. 6 in the last Congress, our opioids legislation. Madam Chair, I am not opposed to the gentleman's amendment, and you have to say you are in order to get the time, I guess, but I am not. I am fully committed to making sure that people with substance abuse disorders continue to get the help they need in our communities. That is what our whole legislative thrust was about last Congress and will remain there. As I say, section 1332 already requires that in these plans. Again, remember what we are talking about here is States coming to the Federal Government saying: We have a better idea to fill a gap, so people have affordable insurance. That is what a waiver is under 1332. And, I guess, I have more confidence in my State than others must have in theirs, but I think from my own experience, Republicans and Democrats work together in Oregon to get health insurance out, and coverage out, and expand access to care. I have always continued to try to do that. I have faith that my State would do this. These plans we will hear more about next week, but they are regulated by State insurance commissioners. I am not in the school that says all of those people are bad and we are the only ones with a great idea. I want innovation. I want it from the States, and I want to drive down costs of healthcare while improving access and delivery of services. So I am not opposed to the gentleman's amendment. I do hope we can address these issues of fully funding our community health centers, our National Health Service Corps, and these diabetes programs which we reauthorized and funded in the last Congress, and which we need to do again. They are called the Special Diabetes Program for Indians and Special Diabetes Program for type 1 diabetes. We have got to get after that, too, Madam Chair. We have to find the money to do it. It is not easy. I know we have a lot of other things. I just wish we were doing those sorts of the things today because these programs expire in September, and we don't have that many legislative days left. Hopefully, we can move on to the things I know we can agree on and find solutions for, and that we do it sooner rather than later. Madam Chair, I yield back the balance of my time.

Mr. WALDEN. Mr. Chairman, I yield myself the balance of my time. Mr. Chairman, let me address a few issues. First of all, my friend my New Jersey--and he is my friend--referenced my amendment. It is unfortunate that we can't debate my amendment on the floor, because the Democrats who control the Rules Committee wouldn't allow my amendment to be considered, nor would they allow us to bring a bill to the floor that I have authored that has more than 100 cosponsors that would make sure that preexisting conditions are protected in case the court decision in Texas goes against the ACA and wipes out those protections. This would be an insurance policy in public law for people with a preexisting condition. We can do that today. If it has some shortcomings, then let's have a markup on this bill and work that out. I care deeply about preexisting condition protection. I fought for it as a legislator. I helped create the high-risk pools in Oregon back in the late eighties and early nineties. I have supported it every step of the way. Let me again quote from the Department of Health and Human Services. We asked them, and they wrote back to me, about protection for preexisting conditions. Seema Verma, the Administrator, said in her letter to me: ``To be very clear, the 2018 guidance does nothing to erode PPACA's preexisting condition provisions, which cannot be waived under section 1332.'' So they cannot do that. They cannot waive those protections under 1332. ``Section 1332 does not permit States to waive Public Health Service Act requirements, such as guaranteed availability and renewability of health insurance, the prohibition on using health status to vary premiums, and the prohibition on preexisting conditions exclusions. Furthermore, a section 1332 waiver cannot be approved that might otherwise undermine these requirements. This administration stands committed to protecting people with preexisting conditions.'' That is the head of CMS. It is her agency that approves 1332 waivers. There have been no waivers so far approved under this guidance, and that is what she tells us in writing, period, because of the information that is being sent around. We do know that seven States have taken advantage of the prior 1332 process, and it has yielded more affordable insurance premiums for American citizens. Now, I find it curious. My State has been very progressive in these areas. When I was in the State legislature, I helped try to expand access to affordable healthcare. We had to come to Washington to get a waiver for the Oregon health plan and Medicaid, and we looked at all kinds of different ways to get access to affordable healthcare, and I have never let up on that. I believe strongly in helping people with preexisting conditions. Like my colleagues on the other side of the aisle, my wife and I had a son who did not survive because of a heart condition. We dealt with all of these issues leading up to his birth and eventual death. So I am fully committed to protecting people with preexisting conditions. What we are arguing about here is: Is health insurance affordable for Americans and are there better ways, using States as laboratories, to innovate and bring down costs of care and costs of insurance, because more of us are paying more out of our pocket than at any time in our history. There was a very interesting story which I will put in the Record for everyone to read, data from the Kaiser Foundation this week that ran in a publication called Axios. I just want to share some of what they found about what is really going on if you get outside of the beltway here in Washington and talk to real people. They evaluated people who had coverage under their employer, in this case, and had a chronic condition of some sort. It is not a small group. About half of Americans who have employer coverage--so that is half of 158 million--report that 6 in 10 in that group report they or a family member skipped or postponed medical care or prescription drugs they needed because of the costs, or, in some cases, they tried a home remedy. High deductibles make things worse. Among those with chronic conditions whose deductibles were at least $3,000 for an individual or $5,000 for a family, three-quarters, Mr. Chairman, 75 percent, report skipping or postponing some type of care; and about half, 49 percent, say they or a family member had problems paying medical bills or difficulty affording their premiums, deductibles, or copays in the last year. So what States--including mine, including New Jersey, including Maryland, and including Maine and Alaska--did was say: Hey, Washington, D.C., give us just a little flexibility here. Let us come with up with plans that may be more affordable. They did that under the prior rules, and rates went down, on average, 19.9 percent--some States more, some less. Now, what happens when people can't afford to use their own insurance? Because that is happening with these deductibles and with these high levels, let alone the premiums. The ripple effect on family budgets, according to the story in Axios, is a substantial share of people reported taking measures such as increasing credit card debt, 28 percent; using up most of their savings, 26 percent; getting an extra job, 19 percent; borrowing money from family or friends, 14 percent. This is what we are trying to argue could be better taken care of. This is the issue that is being ignored by a Washington one size fits all. So we protect people with preexisting conditions, 1332 waivers--that law stays in effect--but we want to give States a little more flexibility to go after this to bring down the cost. Now, my friend from New Jersey and I, Mr. Chairman, are working together on some of these drug reforms so we can get drug costs down. I was at the White House today with the President on surprise billing, and I think we are going to work together on that issue, Mr. Chairman, so that no American consumer who follows the rules gets stuck with a surprise bill. What are you supposed to do, wake up in the middle of the operation and say: Hey, is everybody in this room still on my plan? If you play by the rules, you shouldn't get stuck unfairly with a surprise bill. We are going to find a solution. My State came up with a way to do that already and other States have other ideas, but we are going to protect consumers there as well. We are going to drive down the cost of drugs, and we should continue to go after this issue of the high cost of healthcare because that is what Americans in my 20 townhalls--and I don't think anybody in the House has done more. I have done 20 townhalls this year. In almost every one of them, they are asking: How do you get the costs down? Mr. Chairman, 1332 waivers gave my State the opportunity to get costs down, and we should not impede that process. We are going to debate a lot about these policies going forward, and if there are junk plans, then let's expose them for what they are, and let's pass Ms. Eshoo's bill from, I think, last Congress, which required more transparency and accountability so you don't have fraud and deception. Count me all in on that. There is a lot more we can do to drive down costs. My legislation--again, Democrats refused to bring up in committee or have on the floor--would make sure, regardless of any lawsuit, people with preexisting conditions can continue to get covered. So irrespective of the court decisions, they would get covered. If my bill were allowed to be voted on in the House, I guarantee you, we might have some issues we need to work out. I am happy to do that. If it passed, it would become law. This President is firmly committed to protecting people with preexisting conditions, so we should do that. We should also have a hearing on the Medicare for All bill that some on the other side are promoting. I have asked for that. I know there was one in the Rules Committee, but Energy and Commerce is the committee of jurisdiction for most of that. We have not seen that hearing yet. I hope, in the future, we will, because we should know the impact of wiping out Medicare Advantage plans and Medigap plans. I have been told TRICARE would go away, all private insurance would go away, and it would be a one-size-fits-all, government-run system. I am worried about the delay in access to care. I am worried about the access to the great, new innovative drugs and procedures that we would lose in America. So, Mr. Chairman, I must oppose this underlying legislation. I remain committed to protecting people with preexisting conditions, as do my colleagues on the Republican side. Then we ought to focus together, Mr. Chairman, as a Congress to do the best thing for our constituents, which is to bring the greatest leverage possible to reduce unnecessary costs in the healthcare system in America. Mr. Chairman, I ask my colleagues to oppose this bill, and I yield back the balance of my time.

Mr. WALDEN. That is what I thought. Madam Chair, I reserve the balance of my time.

Mr. WALDEN. Mr. Chairman, may I inquire as to how much time each side has remaining.

Mr. WALDEN. Mr. Chairman, I reserve the balance of my time.

Greg Walden

Speeches

Manage analytics