America's Small Business Tax Relief Act of 2015

Floor Speech

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Mr. HOEVEN. Madam President, I rise to encourage support for the Hoeven-Tester air ambulance relief amendment, which is legislation of importance to people living in both rural and urban communities who need urgent and timely medical care. The need for this amendment arises from the fact that Federal law preempts States from regulating air ambulance services pursuant to the Airline Deregulation Act, which was passed in 1979.

While some air ambulance providers enter into agreements with insurers, a growing number have decided to operate as out-of-network providers and practice what is known as balance billing. That means consumers, not the insurance companies, are responsible for the majority of the medical bill.

In recent years, State insurance departments have been fielding consumer complaints related to large balances left to them from charges not covered by insurance providers for air ambulance services. Patients in need of lifesaving air medical services have been left with balances of more than $25,000 when an air medical provider opts out of agreements with insurance providers.

Let me share a couple of examples of what I am talking about with my colleagues. In one case, a young couple had a premature child who was in need of intensive care at another hospital. The couple was insured and assumed that the 1-hour helicopter flight to the other hospital was covered by their insurance. The air ambulance company presented them with a bill for almost $40,000, but because the company had not entered into an agreement with the couples' insurance company, they were reimbursed only about $15,000 of that bill, leaving them $24,000 that they needed to pay when they thought they had insurance coverage for the bill.

In another case, a woman suffered a snowmobiling accident and was airlifted off a mountain. The charge was $40,000. Her insurance paid about $15,000, and so she was responsible for the $25,000 balance to the company. Now, in that case she negotiated with the company and got it down to a balance of $13,000, but that $13,000 she then had to pay.

In a third case, a father and his daughter were airlifted from the hospital where they were to another hospital because they needed additional care. The young person's condition was deteriorating and she needed specialized care so they had to airlift her to another hospital. They had a single pilot who took them on the flight. After they returned home by car, they got a check from the insurance company for $6,800, so the insurance company paid $6,800. That left them with the balance of a bill that was almost $70,000. Again, they thought they were covered under their insurance. So my colleagues can see that this is a real concern and a real issue.

Many consumers with health insurance coverage assume these medical bills will be taken care of and don't think to ask if the air transportation company is a participating provider because obviously they are in an emergency situation. Unfortunately, as a result, after the patient has stabilized and is in recovery, they learn they will be faced with an expensive medical bill they hadn't anticipated.

In the last session of our State legislature in our State, the State legislature made an effort to address this problem in State law. What essentially the State law said was that the hospitals would have a list of providers that accept insurance as payment in full and insurance companies that do this balance billing, so then the hospital and the patient can be informed and make their decision as to the air ambulance provider. The problem is the State law was struck down in Federal court because the Airline Deregulation Act of 1978 took precedence, meaning it is a Federal issue, which we understand. Obviously, airplanes cross State lines, so we understand there is a Federal aspect to it.

Our amendment would allow hospitals to provide information so patients could determine which air ambulance providers accept the insurance payment as payment in full and which ones don't. Then hospitals could have that information available and patients could make their decisions accordingly.

It is a very simple, straightforward amendment that would allow State legislatures to make sure that information is available for patients in their State.

There are a number of organizations that are supporting this commonsense amendment, including the National Association of Insurance Commissioners, the American Health Insurance Plans, Blue Cross Blue Shield Association, American Heart Association, American Stroke Association, Consumers Union, and Families USA.

That is the legislation in a nutshell, and I have taken a minute to explain it.

Now I wish to turn to my colleague from the State of Montana and ask him--as a cosponsor of this legislation I know he has run into this problem with his constituents. So I would ask him to comment both in terms of the situations he has run into in Montana and his thoughts on how we can best address it.

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Mr. HOEVEN. Certainly.

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Mr. HOEVEN. Madam President, I would respond to the good Senator from Montana that I think we have both described the importance in terms of the costs that people may face, particularly in a time when they are in an emergency or crisis situation. It is very difficult for them already. So, look, we need to do everything we can to make sure they can get quality medical care and that they are as informed as possible in making those decisions and trying to make those decisions easier for them, particularly at a time when they are faced with a life-threatening situation or crisis situation.

The good Senator from Montana really put his finger on it when he said that we are not asking for a Federal one-size-fits-all solution. Instead, we are saying: Let's empower the States to do what they can in terms of helping people when they are faced with this kind of emergency situation.

So if one really looks at this amendment--and we have done a fair amount of work on it with health care providers, talking to the ambulance association and others, and we will continue to work on it. But essentially we are saying: Make sure people have that information readily available so that when they are in an emergency or crisis situation, they can make a quick and good decision that fits their needs, and let the providers compete for the business.

This goes to empowering people in terms of choice and deciding what kind of care they want, and then they can make an informed decision about what they want. If they are in a situation where health insurance has to cover it, then they make that decision accordingly. If they want some other service in a particular circumstance and they are willing to pay out of pocket, then they can make that choice too.

This really is about making sure that people have the information, particularly at a critical time when they really need it, so they get the health care they need and they also have some of those--what costs they are going to face. That is what it is all about. That is true in our States, which are more rural States, but it is true in the urban States as well.

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Mr. HOEVEN. Again, I would like to thank the Senator from Montana for joining in this bipartisan legislation and just ask that our colleagues work with us to get a good commonsense solution to solve this very urgent need.
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Mr. HOEVEN. Madam President, I would like to speak in support of several amendments that I am offering to the FAA reauthorization bill.

You may recall that in 2011 some of my colleagues and I offered a bipartisan amendment to a section of the bill that called for the FAA to develop a process to integrate unmanned aerial systems, UAVs or unmanned aerial vehicles, into the NAS, the National Airspace System.

That legislation included drafting a plan to develop air traffic requirements for all unmanned aerial systems at test sites; certification and flight standards at nonmilitary UAS test sites, as well as the National Airspace System; and making sure that the U.S. integration plan is incorporated in NextGen, the administration's project to modernize the American air traffic control system.

Importantly, it also called for the agency to designate six test sites to help accelerate the NAS integration plan.

These test sites were established in December of 2013, following a competitive process that encouraged some of the very best in the fledgling field of unmanned aerial systems to apply and compete for the test sites.

I am proud to say that Grand Forks in my home State of North Dakota made the cut and is one of the premier test sites and hubs for UAS research and development in America. The work they have done there and at the other five sites across the Nation has been nothing less than remarkable, which is why I am here today to make the case for some additional amendments to help them maintain their momentum.

The first is Hoeven amendment No. 3500, which extends authorization for the six test sites for another 5 years. The previous FAA bill from 2012 authorized the test sites for 5 years, and the legislation before us extends that just an additional few months, through September 30, 2017. Our amendment would extend this authorization by an additional 5 years, through September 30, 2022.

The Northern Plains UAS Test Site in North Dakota has some important achievements to point to: supporting NASA's UAS-related research; research and testing at up to 1,200 feet across the entire State of North Dakota, far above the limits for commercial small unmanned aerial systems; nighttime UAS operations; and approval to fly multiple types of UAS in the same airspace. Nevertheless, there is plenty of work left to do in support of integrating UAS into the national airspace, and that will require investment and support from industry partners. They will be much more likely to use the FAA test sites if they can be sure those test sites will be operational beyond the end of next year.

My second amendment is Hoeven amendment No. 3538, the private aircraft exemption, which will help to expedite testing of private industry aircraft by not requiring them to lease their aircraft to the test site in order to fly.

The six UAS test sites are intended to work with the UAS industry to perform research necessary to integrate the UAS, unmanned aircraft, into the national airspace. What are we trying to achieve here? We are trying to achieve concurrent use of the NAS, national airspace. Right now we obviously have manned aircraft flying all over the United States, but where we are going is we will have manned and unmanned aircraft flying at the same time, concurrently in the national airspace. We have to make sure that is done safely. We have to make sure that we address the privacy issues.

There is a whole gamut of issues that have to be addressed to do this safely and well. That is what the test sites are developing so that we can move to that new paradigm. It is vitally important.

We fly unmanned aircraft all over the world through our military, but we have to figure out how to do that safely and well in our airspace with civilian aircraft. That involves a lot of things--commercial aviation, general aviation, and unmanned aircraft for a whole myriad of uses. This is not an easy proposition, so we have to figure it out.

If we don't do this, we will pay a huge price because right now the United States is the aviation technology leader in the world. The United States leads aviation technology globally, but if we don't figure out how to do this, somebody else will, and we can't afford to forfeit our leadership in aviation technology. We can't afford it from a military standpoint, and we can't afford it from a civilian standpoint if we are going to continue to lead in technology, job growth, the jobs of the future, and the strongest, most innovative, dynamic economy both now and in the future.

We are working on the test sites to make this happen, but currently you have to lease your aircraft to the test site. You can't just come to the test site and get approval to fly. That is what we need to change.

Currently, as I say, any private industry partner seeking to fly at a test site must first lease their unmanned aerial system--their plane or drone or whatever you want to call it, RPA, remotely piloted aircraft-- they have to lease that to the test site. As a public entity, it can then clear the aircraft to operate as a public aircraft while at that test site.

The problem is that the UAS industry is understandably reluctant to release their UAS aircraft to the test site for research work and has particular concerns about losing proprietary information through the leasing process. Remember, this is the latest, greatest new technology. Companies are investing hundreds of millions and billions of dollars in this new technology. They want to keep it proprietary. They don't want to disclose it to all of their competitors. At our test site right now, we have not only Northrup Grumman but General Atomics--manufacturers of Global Hawk, Predator, and Reaper--doing this kind of research and development. They need to protect those proprietary technology developments.

Obviously this is an important issue for them as they are working to develop the aircraft of the future. My amendment would provide an exemption for the test sites to fly civil aircraft subject to whatever terms and conditions the FAA Administrator deems appropriate for public safety and subject to the terms of the certificate of authorization already granted to the test sites.

Remember, the test sites have to get approval from the FAA to fly all of these different aircraft at the test site, so the FAA has already provided that prior authority. We don't need to have the additional work of in essence making these test aircraft public aircraft. These terms govern the airspace and conditions under which the test sites can operate with unmanned aerial systems.

This amendment is common sense. Current procedures block the test sites from assisting industry in developing technology that integrates into the national airspace. This amendment would enable the test sites to perform as originally intended; that is, as a bridge between industry and the FAA to develop concurrent airspace use for unmanned aircraft, which is a key part of the future of aviation.

Test sites will have the same responsibilities for safely managing the operation of UAS under their certificate of authorization as they do today. So this is about doing things in a more efficient way without any effect on public safety.

In addition, the FAA already grants numerous exemptions on a case-by- case basis to industry partners, known as section 333 exemptions. This amendment effectively serves as a test site 333 exemption, which should help decrease demand for the FAA to press the other exemption requests, again streamlining the process, making it work.

Finally, I filed Hoeven 3543, which leverages test site and center of excellence participation in the unmanned traffic management pilot program. The underlying FAA legislation establishes an FAA-led pilot program to develop an unmanned traffic management system, which will be essential to the final goal of integrating the UAS into the national airspace. This is how we manage traffic--manned and unmanned aircraft-- in the same airspace. How do we manage that safely and well?

The amendment would require the FAA Administrator to leverage to the maximum extent possible the capabilities of the FAA's UAS center of excellence and the six UAS test sites when developing and carrying out the pilot program. So we are saying to the FAA: Work with the test sites and the national center of excellence, which we have developed for unmanned aerial systems to move this technology forward.

Right now, the FAA is behind the curve. The technology is racing forward, and we have to maximize our use of these resources to make sure that we are developing UAS the right way, in a way that the public feels is safe, that respects privacy rights, and that addresses all of the different potential concerns. Again, it is about doing things right and well with this new technology.

Again, this is a commonsense amendment. The FAA should use the capabilities Congress has put at its disposal, along with its interagency and industry partners, to advance development of unmanned traffic management systems. My amendments give our UAS test sites the tools they need to stay up front, which will ultimately yield research benefits on behalf of our country.

We have all seen and read in the media about how these remarkable new aircraft are playing a big military role in the security of our Nation. They achieve military objectives without putting our men and women in uniform in harm's way. We are also seeing how they play an important role in border protection and other security operations. Less well known is their use in precision agriculture, disaster mitigation, traffic safety, building inspections, energy infrastructure monitoring, and many uses that have yet to be imagined.

The UAS industry is anxiously awaiting the approval of rules to begin operating small UAS at low altitudes. This is an important step, but it is just one step. It is limited, which is why we need the test sites for the research and development necessary to move forward. The UAS test sites and the center of excellence are in a position to stay ahead of the curve. Doing the research will enable the next phase in UAS integration from flying at night and beyond line of sight to flying higher and farther using larger aircraft.

These amendments are important for the success of an exciting and rapidly growing segment of aviation in our country. The goal is to make UAS a fully working component of not only America's larger aviation system but also of our economy. As I said, we are the world's leader in aviation technology. We must continue to forge ahead to maintain that leadership.

I will close by saying that almost all of us now have an iPhone or Android--some type of phone in our pocket. It is so much more, isn't it? It is a full-blown computer. Think back 10 years. We had no idea that we would all have these cell phones or that they would have all of these amazing capabilities. But look at how much we use it every day in our lives. Well, I make that analogy with unmanned aircraft. What is it going to look like 10 years from now? What is it going to be like? Well, we don't know yet. We don't know what all these applications and what all these uses are going to be. But what we do know is that the United States needs to be the leader in aviation technology development. That is what we are talking about with these test sites-- making sure that we can do it safely and well and that we can maintain that global leadership.

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