Greg Walden

Mr. WALDEN

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

Mr. WALDEN. Mr. Chair, I yield 2 minutes to the gentleman from Michigan (Mr. Walberg), a very important member of our Energy and Commerce Committee.

Mr. WALDEN. Mr. Chairman, I yield 2 minutes to the gentleman from Kansas (Mr. Marshall).

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

Mr. WALDEN. Mr. Chair, I appreciate the gentleman's amendment. Look, we all care deeply about getting mental health services into our community. In fact, under Republican leadership on the Energy and Commerce Committee a few years ago, we rewrote America's mental health laws for the first time since John Kennedy signed the last bill into law before he was tragically assassinated in Texas. It was a lot of work, but it was bipartisan work. Not only did we look at those mental health laws that were on the books, because what happens around here is somebody comes up with a new idea, so you put a new program in place, and you give an authorization. Maybe it gets funded, maybe it doesn't. A year goes by. Somebody has a new idea. Put another one on the books. Nobody ever goes back and looks at what worked and what didn't. So our colleague, Dr. Murphy, at the time, who is a psychologist and a terrific leader in this area, really drove this review and said, look, we have to help kids with mental illness, and we need to help adults. We could deal with a lot of the violence in America if you got people care. It is not that everybody with mental illness goes violent, but we do know that mental health services help people in every way and that the programs we had--we had a lot of them--weren't funded, weren't funded properly, or didn't work. Some worked better than others. We had this comprehensive review in the Energy and Commerce Committee of these different programs the Federal Government has. Then we said, going forward--kind of what you are trying to do with this GAO report in a little different way--let's measure the efficacy of the programs we do have. Let's find out what is working in our communities, and then let's get aid into our communities directly. Let's cut out the middle bureaucracy and get assistance, financial assistance into our communities. So we passed that. That is now the law of the land. And I think last year we were able to get money into that, finally, and I hope we can do more going forward, because we know that--I am being a little sarcastic here, but it is an extraordinary finding. Guess what? Your brain and your physical body are connected. Who knew, right? And we have all known that. So I supported the effort to get the same treatment under insurance for mental health as physical health because they are completely connected. So going forward, we have got to make sure that that bond is strengthened, not weakened, and that people continue to get help for mental health. I am a big believer in that. I know it works. It is fascinating to see, with the whole genome project, now they can do a genetic test and figure out which mental health drug will work in your body or my body. We didn't know that before, and now they can figure out which one will actually work for you or me or whomever. I hope we have lifted the stigma on people needing mental health services. We are just a big bag of chemicals, and things get out of balance. So I hope that we have lifted that as we did, I believe, on addiction. There are a lot of people, and over time people evolve their views and get better understandings, and I think over time we realized that people with drug addictions--especially this came out through our opioids work--weren't necessarily criminals. They weren't to be shunned from society. What we learned in the course of our work on opioids was, when I talked to parents whose kids had a high school football injury or something and the doctor gave them a painkiller, all of a sudden, this stuff is so addictive, a few treatments and they are hooked, and then they need more and more and more and more. I always remember my friend Mr. Rush from the Chicago area, when we were talking about treatment for opioids, said: That is great you are doing that. When the people I represented had issues in terms of crack cocaine and all, you just called them druggies and you put them in prison. That affected what we wrote and how we legislated, and we moved away from calling it treatment for opioids to people with substance abuse because we realized we needed to think broader as a country and as a Congress, and we did that and we changed the law. All that now is law to deal with opioids and mental health services. So, Mr. Chairman, I don't have an objection to this amendment, but there is a lot we have done and a lot more we need to do, and I will talk about some of the things we need to do going forward. Mr. Chairman, I yield back the balance of my time.

Mr. WALDEN. Now, Mr. Chair, I was willing to withdraw the amendment. That takes unanimous consent, and I just would attempt to do that again. I don't know if my colleague cares about that or not.

Mr. WALDEN. Madam Chair, I yield myself such time as I may consume. Madam Chair, I do not oppose this amendment because this amendment does not do anything the law already, I think, requires. Section 1332 does not permit States to waive preexisting condition protections. Section 1332 already requires that the State plan will provide coverage that is at least as comprehensive as the essential health benefits and will provide coverage and cost-sharing protections against excessive out-of-pocket spending. That is what the underlying law already does. We have the assurance from the CMS Administrator saying, once again, to be clear: ``The 2018 guidance does nothing to erode the PPACA's preexisting condition provisions, which cannot be waived under section 1332.'' She is the one who makes the decision. By the way, I would just point out that no State has come to the Trump administration under this new authority that we are aware of and said: ``Please approve our plan.'' Junk plans--and we will hear more about that term of art. By the way, those junk plans were allowed for under the Obama administration and under the ACA. At that time, they were only allowed for 3 months. There seemed to be a lot of interest in a variety of options for citizens to take advantage of that covered their needs. So the Trump administration said, well, if they are good for 3 months, what if we extend them to 12 months or just at 12 months? That is what they did. They were junk plans under Trump; they were wonderful options under Obama. It is the same set of plans. You can always go on the exchange, and you can always find other coverage that fits your need. We are trying to not have just one plan that nobody can afford. That is what you are seeing in this situation that Ms. Seema Verma put forward, Madam Chair, the head of the CMS, the Administrator for the Centers for Medicare and Medicaid Services. She uses, as an example, this situation in Grand Island, Nebraska. It is not Oregon; it is Nebraska. A $70,000-a-year, 60-year-old couple are paying $38,000 a year for their insurance with an $11,100 deductible. Now, how is that affordable? Does anybody in here think that is a great idea? That is what you are saying: Don't innovate. We have got it covered. The ACA has it covered. There is no need for innovation here, nothing to see. The plan works great. Then we know, from the Kaiser Foundation study, people are saying: I can't afford it. So I will jack up my credit card, and I will wipe out my savings. All this is going on. The ACA did not solve every problem. It expanded coverage. You can't help but do that, spend that much money. States like mine took full advantage of it. But we are left with these pockets and problems in America that I think States could assist us in if we gave them expanded authority under 1332 waivers to say: Hey, guess what, Washington? We have a better idea here. Here it is. Take a look at it, and make sure it fits the Federal guidelines and law, but let us innovate. Oregon did that. Under the prior 1332 approval process, insurance rates went down 6 percent; Wisconsin down 10.6; New Jersey, 15; Maryland, 43; Maine, 9.4; Minnesota, 20; Alaska, 34.7. Using this sort of ``Mother May I'' approval, that is what you have to do. I remember when Oregon did the Oregon health plan. I was in the State legislature then, and we had to plead and beg with the administration at the time to get approval to try and experiment on Medicaid coverage to expand coverage and improve access to care. We couldn't do it without Mother Washington, Father Washington, or Brother Washington, whoever, back here, saying: Yeah, okay. We will let you try that. We should be in partnerships with our States. By the way, States can pass a law and say: We are not going down this path. They have every right to do it. New Jersey has done it, and California has done it: None of these short-term duration plans, we are not going to be a part of that. Every State has that right. But there are a lot of States that look at their citizens and say: $38,000 a year for your insurance and $11,000 for your deductible; you are making $70,000; you are 60 years old. That is not working real well either. So maybe we can find a product that would work for you and help you out. So we are talking about a range of options and choices. America has always done well and markets do better when we have more choices. That is what we are talking about here. The gentleman's amendment I don't object to at all. I think it is the underlying law as described by the head of the Department who would have to approve all these 1332 waivers. Madam Chair, I yield back the balance of my time.

Mr. WALDEN. Madam Speaker, this bill is blatantly political in its title. The misleading title of the bill confirms the Democratic majority's passion to score political points instead of governing. Madam Speaker, they claim the agenda is ``for the people.'' This bill is ``for the politics'' and the TV ads. This motion to recommit is simple, Madam Speaker. First, it strikes the Democrats' misleading title, and it includes findings to make clear that, under current law, Health and Human Services cannot waive protections for individuals with preexisting conditions, period. They are protected. Second, Madam Speaker, the motion to recommit would prohibit the Secretaries of HHS and Treasury from reissuing substantially similar guidance, including guidance that allows the State to waive guaranteed availability and renewability of health insurance, the prohibition on using health status to vary premiums, and the prohibition on preexisting conditions exclusions. Madam Speaker, the Trump administration guidance does not amend section 1332. It does not permit the Secretary of Health and Human Services to waive protections for individuals with preexisting conditions, like guaranteed availability and renewability of health insurance, like the prohibition on using health status to vary premiums, and the prohibition on preexisting conditions exclusions. Moreover, the President's guidance stipulates that any section 1332 waiver will need to carefully account for any impact on the individual market risk pool and guarantee--guarantee--that access to coverage is at least as comprehensive and as affordable as would exist without the waiver. Now, this is fully explained, Madam Speaker, in the letter I have here from the head of CMS, Seema Verma, and I want to quote directly from it because I think it is important for our Members to understand the facts of the matter here, because facts matter. ``To be very clear, the 2018 guidance does nothing to erode,'' I am going to say ObamaCare or the Affordable Care Act's ``preexisting condition provisions''--nothing--``which cannot be waived under section 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.'' Now why are we here? Why are we having this discussion? Because people at home can't afford the health insurance they are being peddled, and we want States to be able to innovate and cut costs for consumers. That is why we are here. That is what we are for. Democrats don't want that. Democrats are opposed to letting States innovate, apparently. And let's look at what happens. Madam Speaker, according to Health and Human Services Administrator Seema Verma, Grand Island, Nebraska, a 60-year-old couple making $70,000 a year is paying about $38,000 for their insurance premiums, and that plan, under ObamaCare, gets them an $11,100 deductible. $38,000 in premiums, $11,000 in deductibles, and they call that coverage. I call that unaffordable. Now, meanwhile, we have seven States that have used the authority under the last administration. See, ObamaCare allows this 1332; Trump expands it. They have been able to drive down premiums by 19.9 percent. My State, it is 6 percent; other States have been more. Alaska, New Jersey, other States have taken advantage of this. Republicans and Democrats agree we will always protect people with preexisting conditions. We will always do that. They can run their ads; they can deceive people; they can mislead people, Madam Speaker; but we will always fight to protect people with preexisting conditions-- always. Our plan last year did it. Our plan this year does it. I will tell you what, Madam Speaker. We would have a vote today on the House floor to do that, to actually enshrine in statute, irrespective of the lawsuit, protections for Americans with preexisting conditions, except the Democrats and the Rules Committee refuse to allow that amendment to be considered on the House floor. They would not do that, because it was my amendment; it is my bill. I have been pleading to have this bill considered so we can lock into statute protections for Americans' preexisting conditions. They want the argument. They want the politics. They don't want the policy. We are for innovation; we are for lower premiums; we are for more consumer choice; and we are for driving down the cost of healthcare in America so people have coverage they can afford, Madam Chair. That is what our motion to recommit will do, and I urge our support. Madam Speaker, I yield back the balance of my time.

Mr. WALDEN. Mr. Chairman, I would just suggest that it was Seema Verma who is the head of CMS who issued the guidance, so I think she is in a position to have a say about what she believes the guidance allows or doesn't. To be clear, to quote her letter again: ``The 2018 guidance does nothing to erode the PPACA's preexisting condition provisions.'' That is what she is saying. So I think that letter is important. She put it in writing. She has said that repeatedly, and so I take her at her word. I do. I include her letter in the Record. Centers for Medicare & Medicaid Services, Washington, DC, May 7, 2019. Hon. Greg Walden, Ranking Member, House Committee on Energy and Commerce, House of Representatives, Washington, DC. Dear Representative Walden: Thank you for your continued interest in new state flexibility available under guidance recently issued interpreting section 1332 of the Patient Protection and Affordable Care Act (PPACA) (the 2018 guidance). Working within the limitations of the PPACA, this 2018 guidance is an important element of the Administration's actions to expand options and lower costs for patients around the country. I wanted to take this opportunity to set the record straight and reaffirm this Administration's commitment to lowering healthcare costs, increasing consumer choices, and protecting our most vulnerable citizens, including those who have pre-existing conditions. To be very clear, the 2018 guidance does nothing to erode the PPACA's pre-existing condition provisions, which cannot be waived under section 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 pre-existing conditions exclusions. Furthermore, a section 1332 waiver cannot be approved that might otherwise undermine these requirements. This Administration stands committed to protecting people with pre-existing conditions. Under the PPACA, we have seen dramatically higher premiums and decreased options for millions of consumers, in large part due to the law's overly prescriptive mandates and excessive Federal government takeover of areas traditionally under state oversight. In 2019, the average monthly premium for a benchmark plan for a family of four on HealthCare.gov is now over $1,500, which can easily exceed a family's mortgage. There are many areas of the country with far higher monthly premiums. For example, a 60-year-old couple living in Grand Island, Nebraska, making $70,000 a year, will need to pay over $3,000 per month for the lowest cost silver plan available. That's almost $38,000 per year for a plan with an $11,100 deductible. That's over half their income. For millions of Americans, coverage this expensive is not a realistic option, and many choose to go without coverage at all. In fact, after average premiums rose by 21 percent, 1.3 million unsubsidized people walked away from the market in 2017, the last year the prior administration oversaw open enrollment. While these higher premiums force some people to go uninsured, coverage is generally not optional for people with a pre-existing condition and so, without a subsidy, someone with a pre-existing condition must face the full burden of the PPACA's skyhigh premiums. This Administration has not forgotten the people facing this hardship. Section 1332 of the PPACA provides the discretion to approve a section 1332 state waiver plan if the following four statutory guardrails are met: affordability, comprehensiveness, coverage, and federal deficit neutrality. Section 1332 allows states to develop new healthcare programs and solutions that would be not permissible without a section 1332 waiver. Unfortunately, guidance issued under the prior Administration in December 2015 (the 2015 guidance) regarding section 1332 waivers had the effect of significantly restricting the innovation states could pursue. The prior Administration imposed a one-size-fits-all approach to these waivers, making it difficult for states to address the specific needs of their residents. In October, the Administration issued guidance under section 1332 of the PPACA to provide states with significant opportunities to chart a different course for their markets through expanded flexibility. Section 1332 and the 2018 guidance ensure that consumers who wish to retain coverage similar to that provided under the PPACA can do so, but they empower states to take steps to stabilize their markets and allow more affordable coverage options that may be more attractive to individuals and families priced out of the current market, including people with pre-existing conditions. Over the past two years, this Administration has approved seven section 1332 waivers authorizing reinsurance programs to help fund claims for people with high healthcare costs. These reinsurance programs provide much needed premium relief for people in the market and, in particular, for people with pre-existing conditions without other coverage options. These section 1332 waivers were all approved under the prior, more restrictive 2015 guidance. I believe, given the expanded flexibility discussed in the 2018 guidance, states will be able to develop additional healthcare programs and solutions that work for their residents. As you know, some have criticized the state flexibility offered under the 2018 guidance, claiming that states will pursue section 1332 waivers that undermine their own individual market risk pools and make coverage more expensive for their own residents with pre-existing conditions. Again, I want to make clear that a section 1332 waiver cannot undermine coverage for people with pre-existing conditions. Moreover, any section 1332 waiver will need to carefully account for any impact on the individual market risk pool and guarantee that access to coverage is at least as comprehensive and affordable as would exist without the waiver. So, if a state seeks to pursue the use of more affordable options, such as catastrophic plans or short-term limited duration plans, under a section 1332 state waiver plan, the state must ensure access to coverage that is overall as affordable and comprehensive for people who remain in the individual market risk pool. Thank you again for your shared interest in bringing down healthcare costs and protecting our fellow Americans with pre-existing conditions. We remain focused on improving our nation's health care system by empowering states to innovate and develop new solutions to expand access to affordable and high value coverage options, and we look forward to working with you to achieve these goals. Should you have questions, please contact the CMS Office of Legislation. Sincerely, Seema Verma.

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

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

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

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

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

Mr. WALDEN. Mr. Chairman, I have an amendment at the desk. I believe it is No. 5, printed in House Report 116-51.

Mr. WALDEN. Mr. Chair, I claim the time in opposition, although I am not necessarily opposed to the gentlewoman's amendment.

Mr. WALDEN. Madam Chair, I yield myself such time as I may consume. Madam Chair, let's talk about this amendment. I have talked earlier about all the things that need to be reauthorized--community health centers, special diabetes programs, all of that which I know the committee is aware of and I hope we begin marking. I wish we were dealing with that today. I heard from the gentlewoman about Republicans and preexisting conditions and ``Where is your plan?'' It is sitting up in the Rules Committee because your party would not allow my amendment to do that and to be brought to the floor for debate today. I don't control the Rules Committee. It is 2 to 1 by the majority. It is just the way it works around here, and I respect that. But you allowed my amendments that were more in jest about the false nature of the title of the bill to be debated but not the substantive amendment I offered which does protect people with preexisting conditions in case the lawsuit were to prevail and ObamaCare is thrown out. But, no, we couldn't have that debate. I have asked for my bill to be considered in the committee of jurisdiction. That hasn't happened either. I have also asked for the Democrats' one-size-fits-all takeover of healthcare, Medicare for All, however you want to describe it, that we have a hearing in Energy and Commerce. That hasn't happened either. We are the committee of jurisdiction. You talk about working people. It is ObamaCare that puts a 40 percent tax on union plans and employer plans that exceed a certain level of costs, and they don't index it. Now, I don't know where the gentlewoman is on the Cadillac tax, but I want to repeal it. I never voted for it. So, if they want to enshrine the Affordable Care Act in its entirety and make no changes, then I guess they are for a 40 percent tax on the kind of insurance plans that my building tradespeople negotiated to get--and other unions--instead of getting wage increases. We have delayed that. And when we look at the cuts in the Affordable Care Act coming at our hospitals in rural areas that serve lower-income areas, the DSH payments, we put off those cuts to our hospitals--last cycle--under Republican leadership. And we are going to face that question in this Congress under Democrat leadership. So, a vote to delay those DSH cuts again--if one does that--is voting to repeal or delay part of ObamaCare. I hear 60, 70 votes to do these things to ObamaCare--repeal the CLASS Act, which was a long-term health insurance program that was destined for failure, and even President Obama signed its repeal. I can go through a whole list of things that got repealed. We are the only ones who ever get tagged with voting to repeal. As far as our commitment to preexisting conditions protection: It is real, it is robust, and it was always in everything we did. Yeah, I know what the political rhetoric was. I have run campaigns. I have been around that. I know how you can nuance around. But we always protected people with preexisting conditions--always, period, hard stop. Protected people with preexisting conditions, in what came out of my committee and came across this House floor, they were always covered--always. So I hear the political rhetoric, but I know the facts. See, I am an old journalism major, and I believe in facts. The facts of the matter are that 1332 waivers have given our States an opportunity to give our citizens an affordable health insurance plan, not one that I guess they will defend--$38,000 a year in premiums, $11,000 a year in deductibles, copays, out-of-pocket costs. How is that working for anybody? And shouldn't that 60-year-old couple in Nebraska have a chance to have a better plan option? Nope, guess not. Washington is going to decide it all for you. Write your check: 38 grand. That is for the premiums. And $11,000 in out-of-pocket costs, your deductibles. Then maybe you can get something covered, right? Well, what is left? We know from this Kaiser study I have cited earlier that was in Axios: People wipe out their savings. They put it on their credit cards. They borrow from their friends. Or they simply don't get coverage. That is the world they want to freeze-frame and leave in place. That is not what the Republicans are for. We want innovation. We want choice. We believe in our States having the opportunity to innovate and do it even better, not to go back to the old ways. No. That is not what we are for. I know that is what Democrats want to label us as being for, but it is not true. And we have proven results in opioids; Community Health Centers; the longest funding for Children's Health Insurance Program in the history of the United States of America, under Republican leadership--10 years. We are the ones, Republicans, who led the effort to invest in medical research at unprecedented rates under what Fred Upton put forward and what Newt Gingrich put forward.

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. Mr. Chairman, I would just say, in terms of this amendment, it is just trying to make the point that the bill we have before us today is not as described or labeled. In our opinion, it is more about politics and gotcha politics than it is about the underlying issue. We know from the Department of Health and Human Services, they have made it clear in the letter from the Director who would approve these waivers that she believes that the underlying law protects people with preexisting conditions and all the other things I talked about earlier, that they can't waive that law--they cannot. So I would enter into the Record again, Mr. Chairman, as part of my remarks, her comments about the guidance, the 2018 guidance, and where she says it does not erode ObamaCare's preexisting condition provisions. She is the one in charge of this. That is what she is saying. But I want to talk about something else she says in this letter about premiums and the costs to people getting their insurance. She says: ``Under the PPACA''--or ObamaCare or the Affordable Care Act, however you want to describe it--``we have seen dramatically higher premiums and decreased options for millions of consumers, in large part due to the law's overly prescriptive mandates and excessive Federal Government takeover of areas traditionally left under State oversight.'' She points out: ``In 2019, the average monthly premium for a benchmark plan for a family of four on HealthCare.gov is now over $1,500, which can easily exceed a family's mortgage.'' Continuing with her letter to me, she said: ``There are many areas of the country with far higher monthly premiums. For example, a of 60- year-old couple living in Grand Island, Nebraska, making $70,000 a year, will need to pay over $3,000 per month for the lowest cost silver plan available. That is almost $38,000 per year for a plan with an $11,100 deductible.'' Now, think about that, Mr. Chair. This is a couple that is making $70,000 a year. They are 60 years old. They live in Nebraska, and $3,000 a month in premiums, over $3,000, and an $11,000 deductible. That is over $48,000, and they only make $70,000 a year. This is happening in America today. Heck, it is happening in Nebraska right now. So what we are saying is people are walking away. She goes on to say: ``For millions of Americans, coverage this expensive is not a realistic option, and many choose to go without coverage at all. In fact, after average premiums rose by 21 percent, 1.3 million unsubsidized people walked away from the market in 2017.'' Those are the people we need to be helping. There is a lot more we need to be doing. I will put the rest of this in the Record. But I think everybody knows we are just trying make a point with this amendment. Mr. Chair, I ask unanimous consent to withdraw my amendment.

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

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

Mr. WALDEN. Mr. Chairman, how much time remains on each side?

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

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

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.