Custom Health Option and Individual Care Expense Arrangement Act

Floor Speech

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Mr. DOGGETT. Mr. Chair, I yield myself such time as I may consume.

Millions of Americans are finding the security and the peace of mind that comes from having access to a family physician through the Affordable Care Act. If the gentleman has been listening to the American people, he has turned a tin ear to the 16 million Americans that have now enrolled in the marketplaces under the Affordable Care Act.

Republicans, unwilling to accept the success of what they demeaned as ObamaCare, Republicans who failed more than 60 times in this House to repeal ObamaCare, who failed three times in the Supreme Court to undermine ObamaCare, have now embarked on a new strategy, which is to circumvent and undermine the invaluable protections of the Affordable Care Act.

With this bill, Republicans are demanding that every individual who gets stuck in one of these newfangled plans that they have is denied protection from having their insurer exclude preexisting conditions, no assurance of coverage for essential medical care, and no assurance of affordability.

I offered an amendment to correct one part of this defective bill to give Americans statutory protection, so they are not back in the old pre-Affordable Care Act period of losing coverage when they needed it most because they had something the insurance company defined as a preexisting condition, but that was rejected.

At the time, they claimed that was their intent, but when you look at the specific statutory language, there is no doubt that the protection for preexisting conditions and essential conditions is excluded from their legislation.

These so-called Individual Coverage Health Reimbursement Arrangements, ICHRAs, are about as convoluted as the name suggests. They are as my grandson, Canyon, would say, they are icky.

Handing people a voucher and telling them to go shop for coverage follows the same ill-conceived Republican approach to sabotage Medicare, which they continue to promote in their latest budget. Instead of giving Medicare beneficiaries guaranteed coverage, they would give seniors a voucher with declining value and tell them to go find coverage.

Instead of the guaranteed, comprehensive coverage workers now receive, this bill would force so many people to find healthcare in a sea of junk, exposing them to misleading marketing and aggressive brokers. An estimated 2 million workers would be immediately impacted by this sorry bill, and with another provision that is in the bill that directs the Treasury Department to go out and promote access to junk plans, we could expect these numbers of impacted workers to increase.

Inevitably, the result is bare-bones, junk insurance that misleads on coverage, has high out-of-pocket costs, and abandons those with preexisting conditions. The policy's fine print takes away all the bold promises of the marketing. Those who need coverage the most will be unable to afford it or receive minimal junk coverage.

In a Nation that is as rich as America, going broke shouldn't be a side effect of trying to get healthcare, but exposing more people to financial ruin is exactly what this kind of legislative approach will achieve.

This misguided scheme suffers, I think, from a form of preexisting condition itself. It is called amnesia, because they forget the conditions that existed for so many Americans in this country before the Affordable Care Act became law. Situations like those who contacted me from Texas: Someone who had been a victim of domestic violence declared to have a preexisting condition; an infant born with some preexisting condition denied the coverage that they need; any number of excuses when coverage was needed the most because of preexisting conditions.

That is why I thought it was so important to amend this legislation, and the refusal of my Republican colleagues to clarify that now sends forward loud and clear that that is their objective.

There is even more ick to the ICHRA bill that is being introduced, and that is the opportunity that is created for class discrimination. This bill legalizes that discrimination. My amendment would have prevented that also.

Employees that are out there on the assembly line; those who are in the chicken processing plant, or the meat-packer, or out in the cornfields; they are in the dirtiest, most difficult, and usually the lowest-paid jobs. They can be treated one way under this bill, while the executives sitting off in the office tower are treated another and getting an entirely different kind of coverage because of the way they have written their bill.

Lower-wage workers who would be eligible, in fact, for a better policy under the Affordable Care Act with a no-premium or low-premium policy, would instead be required to search for a policy with more holes than safety net.

Finally, we discover something on which Republicans are pro-choice. I didn't think they were pro-choice on anything, but the genuine choice they provide is to the employer, not to the employee, a choice to divide employees into the haves and the have-nots; providing employer coverage to some and leaving others to fend for themselves.

Predictably, that burden will fall on the low-wage workers and the sick employees that employers don't want to cover. One survey already of employers found that 60 percent of large firms intended to offer ICHRA to only low-wage workers. That is icky.

To prohibit discrimination by employers and junk plans alike, the amendment I offered would have offered protection. This bill, as it stands, does not. It should be rejected.

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Mr. DOGGETT. Mr. Chairman, I yield myself such time as I may consume.

The gentleman has repeated his stated intent to provide the protection that his bill denies, and I would refer him, again, to page 3, line 2 of this bill as it was presented in committee, and the failure to refer to section 2791(b)(5) of the Public Health Service Act means that that protection will not be there. It could easily have been added if that were the true intent. It is omitted.

Same page, line 12, the failure to include guarantees against nondiscrimination is not there.

He is concerned about federalizing healthcare. Well, all that I want to do is set a minimum Federal standard that no person in this country will be denied because of a preexisting condition the healthcare that they deserve. That is what the Affordable Care Act was designed to achieve, not only for those in the marketplace, but beyond.

Secondly, I want to ensure that different classes of employees are not treated differently. Let me just describe a little more of what is involved there.

Just as they would allow insurers to discriminate against a newborn with a heart murmur and call that a preexisting condition, their bill would permit an employer to discriminate against their own employees.

Just to give you a practical example. We have a lot of chicken processing plants down in northeast Texas. If there is a facility out there where the chicken pluckers are chasing the chickens, removing the feathers that are flying, those tough, dirty, hot jobs processing them may be managed by a group in some high-rise in Dallas or Tyler.

Well, this bill, as it is written, will allow those executives to get their group health insurance policy with all the protections against preexisting conditions and being able to see, perhaps, a concierge service for their healthcare. But the folks that are down there chasing the chickens and plucking the chickens, they get an ICHRA. All they get is ick. That is wrong.

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Mr. DOGGETT. Mr. Chairman, I continue to reserve the balance of my time.

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Mr. DOGGETT. Mr. Chairman, I yield myself such time as I may consume.

Let me respond to the gentleman from Pennsylvania. He says there is nothing in this bill about preexisting conditions and discrimination, and he is absolutely right. That is the whole failing of this bill. It does not include the protections that are necessary to ensure that no American is discriminated against on the basis of preexisting conditions and that no employer can discriminate among groups of its employees.

He also says this is going to open more opportunities for more people to get health coverage. I would point out that studies have shown that 95 percent of the people who are in these icky plans now once had good group health coverage. My concern is that we will see even more people lose their good group health coverage and be put into an icky plan.

As for the Small Business Flexibility Act, I am for the Treasury and others educating all employers and employees about their rights and opportunities, but I think this part of the overall package is very slanted. Treasury needs to be out there educating employers, some of whom may not know themselves the limitations that these junk plans have and how much they will disserve their employees. We need education of employees on how to understand whether their employer's offer of coverage meets the minimum standard and is truly affordable for the purposes of being able to otherwise enroll in subsidized marketplace coverage. I think there are limitations on that portion of the bill as well and that it, therefore, should be rejected.

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Mr. DOGGETT. Mr. Chairman, I yield myself such time as I may consume.

The chairman of our committee says that there were great gifts to insurance companies. What the Build Back Better bill did was to give individuals additional tax credits. Some Republicans call those tax cuts, but they were credits given to people to be able to afford insurance. As a result of that improvement, many more Americans got the insurance that they need.

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Mr. DOGGETT. Mr. Chairman, I yield myself such time as I may consume.

I say to the chairman, he is absolutely correct. I referred to the Build Back Better instead of the American Rescue Plan. It is easy to get confused about them. The American Rescue Plan was, of course, signed into law and has helped so many Americans. However, we always know that whatever the name, Republicans are against all of them, as they were, and voted unanimously against all of the opportunity that they created for millions more Americans to get and keep health insurance and provide themselves security.

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Mr. DOGGETT. Mr. Chairman, I yield myself the balance of my time to close.

I focused on one part of this entire package of bills, but together it is truly a thinly veiled attempt to circumvent the Affordable Care Act. Being unable to repeal it, having nothing but nothing care to replace it with is really kind of a death by a thousand cuts, making healthcare less accessible and affordable for so many at-risk workers.

The bills in this package include a codification of the Trump-era rule that allows employers to offer these ICHRA plans to their employees instead of employer-sponsored health plans.

Under this plan, employers may offer a voucher and force their employee to shop for their own coverage.

Under this bill, employers are permitted to pick and choose among their employees and discriminate against some with their vouchers.

This bill also includes an expansion of the association health plans, which my colleague from Virginia will discuss at greater length. That has been a standard tenet of Republicans' assault on the Affordable Care Act. It is a provision that would allow self-employed individuals and small businesses to circumvent the guarantees of the Affordable Care Act and steer consumers into shoddy coverage that does not cover the healthcare they most need when they need it, the essential health benefits.

It also does not offer them protection against preexisting conditions or age or the fact that before the Affordable Care Act was adopted, women were discriminated against at a great rate and often denied the coverage that they needed or it was priced so high they could not afford it.

The bill would also preempt State regulation of association health plans and disrupt risk pools as these plans do not have to follow standard premium-setting rules and risk adjustment. This bill is similar to the Trump administration rule that was struck down in 2019.

If you are beginning to recognize a pattern here, this is all Trump, Trump, Trump because he is still the Pied Piper for the Republican Conference, as we just saw in this disgraceful presentation about our honorable colleague Adam Schiff.

This package also contains a provision to encourage employers to offer self-funded plans, which are not required to comply with ACA protections, again, on preexisting conditions, on essential health benefits, and more. Most employers do not want to take on the risk of offering a self-funded plan. However, by expanding stop-loss coverage, which sets a catastrophic amount the employer will be responsible for, and then covers any other costs that may come up from covering their employees, self-funded plans will be more attractive.

This legislation prevents Federal and State governments from regulating stop-loss coverage and risks more employers opting for self- funded plans that do not protect healthcare consumers.

Finally, without providing any additional resources, this legislative package tells the Treasury Department to educate employers about how great these new icky plans are and their health reimbursement accounts, which would bar workers from more affordable coverage under the marketplace already available.

At the heart of this effort is just the perpetual push by House Republicans to weaken the protections of the Affordable Care Act, which have prevented financial ruin for so many people and assured access to healthcare for so many people.

Under the provisions of this bill, employers can form association health plans to skirt some of the requirements of the ACA like the essential health benefits. State and Federal regulators will be hamstrung in their ability to protect small businesses and workers in self-funded plans.

Utilizing these icky ICHRA plans, employers can also push those with preexisting conditions, women, and older workers into the individual market with vouchers while keeping their younger and healthier employees on employee-sponsored insurance. Therefore, the sick get treated differently. Those who have disabilities, who have had long-term chronic conditions, could be treated very differently and put at great risk.

I think for all these reasons that this legislation should be soundly rejected. This is an opportunity to defend all that the Affordable Care Act has meant to Americans and offer that opportunity to more people rather than deception that is the hallmark of this bill and following the Trump approach that junk insurance is what would be most available to Americans.

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

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Mr. DOGGETT. Madam Chair, I would say to the gentleman from Michigan, I am sure there are many Republicans who want to assure good healthcare to all people. The problem is with this specific bill.

The one-page amendment that I offered could have guaranteed these ICHRA employees that they would face no discrimination among classes of employees and no barrier of preexisting conditions.

That clarification would have solved this problem, and their failure repeatedly to accept that one-page amendment, with no explanation other than that they wanted to do the same thing, or that it was duplicative, betrays the promise of this bill and suggests that discrimination and denial of coverage based on preexisting conditions is what Americans in these plans will face.

The chairman of the Ways and Means Committee, our colleague from Missouri (Mr. Smith) closed by saying that his goal is to cut red tape. Well, that is a goal that I think all of us can share, but I am afraid that this bill, as written, will only throw more Americans into the red and into medical debt, which is already high despite the protections that we have provided to date.

There are so many families overwhelmed by medical debt, and some who will be denied the opportunity to get the protection they need from their healthcare providers because they simply cannot afford it.

Madam Chair, I would say at the appropriate time I will offer a motion to recommit to this bill and send it back to committee. If the House rules permit it, I would have offered this motion with an appropriate amendment to the bill.

My amendment would ensure that this bill does not take effect unless the Secretary of Health and Human Services certifies that this bill will not result in anyone losing access to coverage of essential health benefits or see their healthcare costs rise, the very objective that the gentleman from Virginia has been discussing.

Madam Chair, I include in the Record the text of this amendment.

Mr. Doggett moves to recommit the bill H.R. 3799 to the Committee on Ways and Means with instructions to report the same back to the House forthwith, with the following amendment:

Add at the end the following new title: TITLE VI--EFFECTIVE DATE SEC. 601. EFFECTIVE DATE.

Notwithstanding any other provision of this Act, the provisions of this Act and the amendments made by this Act shall not apply unless the Secretary of Health and Human Services submits to Congress a certification that such provisions and amendments will not result in--

(1) individuals losing access to coverage of essential health benefits (as defined for purposes of section 1302(b) of the Patient Protection and Affordable Care Act (42 U.S.C. 18022(b))); or

(2) higher costs to individuals for coverage that includes such benefits.

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Mr. DOGGETT. Madam Chair, I hope my colleagues will join us in supporting it, recommitting this, pursuing the objective of better healthcare for all, and protecting all Americans from preexisting condition barriers, and ensuring they are not the subject of discrimination.

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Mr. DOGGETT. Madam Chair, I rise in opposition to the amendment.

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Mr. DOGGETT. Madam Chair, I yield myself such time as I may consume.

This amendment has a rather nominal effect in not improving what is a very bad and deceptive bill.

It is appealing to talk about rural areas. I am concerned about those rural areas, about the chicken pluckers, about the meatpackers, about the field workers, and the way they will be discriminated against under this bill.

I will elaborate on that. While this is mainly a Republican caucus that follows the seditious pied piper who was our President, in this case, even under the Trump administration, when they considered this kind of proposal, the Treasury Department, the Labor Department, and the Health and Human Services Department came together and recognized the danger of discriminating against different classes of employees.

Ultimately, unfortunately, the Trump administration did not provide the protection against discrimination, so that people who are working in rural areas under this bill may be discriminated against by their employer as a result of this legislation.

It is the failure to have clear language in this bill to prevent such discrimination against rural workers, in favor of those who are in the office towers managing everything, that is at the heart of our opposition, as well as the refusal to provide protection and guarantees against people being denied as a result of their preexisting conditions.

Rural Americans are more likely to die from heart disease, cancer, stroke, unintentional injury, and respiratory disease. Yet, we would take our sickest workers, our most vulnerable low-income workers, and deny them a comprehensive employer plan with many protections and allow them to be the subject of discrimination.

There has already been too much discrimination against rural areas and rural workers. We ought to prevent it, not make it worse.

There are no guarantees that these people can find any coverage with their ICHRA plan, let alone affordable and quality coverage.

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Mr. DOGGETT. Madam Chair, I yield myself the balance of my time.

Madam Chair, I would say that the only education that would be really helpful on this bill would be to educate both employers and employees about all the shortcomings of this bill.

Educating employers that they ought not to be discriminating against classes of workers and treating the rural, hardworking employees there at lower wages differently where they get an ICHRA policy that denies them preexisting conditions, that denies them the essential benefits under the Affordable Care Act, while the folks in the city in management get treated differently--they get a concierge kind of treatment that is not available to the rural workers. Just educating about this bill, which allows that discrimination, would not accomplish much of anything.

I think what we are going to see with this kind of legislation is more and more workers in rural areas, as well as urban areas, who face discrimination and who face great medical debt because these plans are so weak. They are junk insurance that will deny the benefits that most people need.

Educating about them, if truthful education, if not the kind of deception that is buried in this bill, educating about them will only tell people the limitations and the shortcomings. Otherwise, it will be a kind of education that covers up, as this bill does, the great harm that is being done in denying folks access to a family physician with the protection that is there.

Remember that in moving to these ICHRA plans, we already know that 95 percent of those that are in ICHRA plans today, that have this icky kind of coverage, are people who once had good group health insurance that I would like to see available to more Americans.

Again, I urge my colleagues to definitely vote ``no'' on this amendment and vote ``no'' on this sorry bill and support our motion to recommit.

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

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

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Mr. DOGGETT. Madam Chair, I rise in opposition to the amendment.

The ACTING Chair. The gentleman from Texas is recognized for 5 minutes.

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Mr. DOGGETT. Madam Chair, I yield myself such time as I may consume.

Madam Chair, I don't believe that we have noted yet in the course of this debate the great irony, the fact that this is called the CHOICE Arrangement Act, that we have some pro-choice Republicans here who want to give employers the choice and allow them to discriminate against different classes of their own employees. All of this is happening the same horrible anniversary week of the Supreme Court's wrongful decision to overturn decades of reliance upon Roe v. Wade and to eliminate the right to an abortion with an effect on women's healthcare that is so far-reaching that it is affecting our colleges of medicine across the country and delivery of healthcare to women who may never have been involved in the slightest way with an abortion.

They called this healthcare freedom today. I call it the repression and the interference with the basic healthcare rights of women.

By the terms of their own amendment, patients and doctors should make healthcare decisions, not government bureaucrats or insurance companies. The CHOICE Arrangement Act comes at the same time that they interfere with what happens in our bedrooms and our doctors' offices and, most recently, even in our kitchens.

They would sentence patients under this basic legislation with preexisting conditions to a future of very few choices and no freedom. With no choices for adequate and affordable healthcare, this legislation guarantees one kind of prescription and one kind of prescription only, and that is a prescription for personal bankruptcy and unlimited medical debt from policies that do not provide essential healthcare benefits.

It is really a shame that, in a country as wealthy as ours, we still have millions of citizens who go without health coverage. Over 30 million Americans, in fact, lack coverage, and many in our home State of Texas lack coverage because of the fact that our State legislature and Governor were never willing to provide the guarantee we anticipated with the Affordable Care Act of Medicaid expansion as most States have done.

Patients do not have a choice, do not have freedom when they suffer a heart attack or are diagnosed with a dreaded disease or a broken arm, and they lack insurance coverage that provides them the benefits that they need.

Under this amendment, which is a sense of Congress resolution that really doesn't accomplish much of anything, this bill is not improved. Americans would have so much skin in the game they would get burned just as the Republican dirty fossil fuel plan would burn up our planet.

It is not just the Affordable Care Act that is being targeted today. There is reference to socialized medicine of the kind that Newt Gingrich once attacked in this body when he suggested Medicare should ``wither on the vine.''

Contrary to Republican attacks, we have heard about public insurance programs. Seniors on Medicare value their Medicare as do the 16 million people who signed up for the Affordable Care Act this year.

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Mr. DOGGETT. Madam Chair, this is the freedom resolution on the week that we have the anniversary of the anti-choice Dobbs decision as part of the CHOICE Arrangement Act.

Well, I am reminded of the lyrics of a famous Janis Joplin song: ``Freedom is just another word for nothing left to lose.'' No choice is left. No freedom is left. This is our future under Republican plans--so much to lose, nothing left tomorrow.

We need to protect more Americans from the dangers of health debt and bankruptcy. We need to ensure broader coverage. There is a huge coverage gap that is leaving perhaps as many as 2 million Texans without coverage because of the failures and ideological objections of our State Republican government.

Those Americans deserve the same protection that 16 million Americans got when they signed up for the Affordable Care Act this year. They have access to a family physician that is so very important. They have access to the essential benefits of the Affordable Care Act, getting access to the kind of care that they need to ensure their family is secure.

I believe that there are many improvements that are necessary in the Affordable Care Act. We were limited in being able to make those improvements when all we had for more than a decade were 60-plus Republican attempts to repeal the Affordable Care Act.

Let us reject this bill and this amendment.

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

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

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