H.R. 9641, H.R. 3108, H.R. 9642, H.R. 9468, H.R. 3514, H.R. 9644, and H.R. 9645

The committee will come to order. Before we begin, I want to um acknowledge the passing of a former Chairman of the Ways and Means Committee, Mister Bill Archer. Archer was the first Republican Republican Chairman after the Republican Revolution in in nineteen ninety-four. when when Republicans returned to the House majority for the first time in forty years, um, and he is tied, in fact, for the the longest serving Republican chairman, um, with six consecutive years leading the best committee in Congress. Chairman Archer was instrumental in advancing fiscally conservative tax reforms and his legacy, his legacy lives on today in policies like the child tax credit which he helped create as chairman. Chairman Archer lived to be ninety-eight years old, which I think we all can agree, in a bipartisan fashion, that is something we should all aspire to. Um,

God, this is so long.

So

So, I'd like I I'd now like to recognize the ranking member, Mister Neal.

Thank you, Chairman. Uh I served with Bill Archer, probably the only one here now. You know, Bill Archer was a principled conservative. He was well-regarded and well-liked by the t- the minority. When I came to the committee, we had a substantial majority. And the other interesting part about Bill Archer was the fact that he was a man of this institution and a man of this committee. I think it would have been very difficult for any president, and I mean of either party, to convince him of something that he didn't believe in. He gave one of the most stirring speeches on the House floor against term limits. I believe he was against the ballot's budget amendment because he thought that was the job of Congress. He was a committed free trader. And I think in one of the more spirited debates that took place here late one evening, he pointed out that coming from Houston and having succeeded George Bush senior in that congressional district, that in his mind, corn was good for one thing and one thing only, eating. And he made that point, uh, pretty aggressively here as we finished one evening. And uh to say that, uh, it was a chance for Democrats to pile on, we were all only too helpful to him that evening when he he brought it up. Funny, he would enjoy his company socially. And I think that, uh, he certainly was from a different era. He had a lot of Democratic friends, a lot of Republican friends, was very well regarded, and, uh, President Bush always referred to him as Bill. And when we were in those conversations in some very difficult times, uh, Bill Archer, uh, time and again used his institutional knowledge and kindness as he led this committee. So I think that we wanna wish our best to him and to his family. Uh. On a note that I think is also very important, when the Archer Center was being dedicated and opened, he called me. He said, " Will you be one of the speakers?" I said, " I'll be there." And, uh, I think after he left here, there was one of the groups that he was involved in, and they needed a Democrat to oppose some of the views of the group that was doing the honors. He chose me to come and give a contrary opinion, but I think it was part of a time in which we functioned based on principle and beliefs. So thank you for yielding, Mr. Chairman.

Thank you, Mr. Neal. One one out of every five dollars in our economy is on health care. And, and for their money, Americans get a system where the prices are hidden and the decisions that matter most get made behind closed doors by everyone except the patient. The committee has been working to expand access to quality, more affordable health care, particularly in rural and underserved areas. We've identified specific failures and today we are taking decisive steps to hold hold health care empires accountable and improve the health of our communities. The bills before us share a common goal, put the American people in charge of their own health care. President Trump's great health care plan rightly calls for real transparency and real accountability. This committee intends to deliver on it. Among the lessons learned from the COVID-19 pandemic was how many states discouraged visitation or banned it completely outright, leading to heartbreaking stories of seniors enduring loneliness and even facing their final days without loved ones present. Representatives Tenney and Larson have introduced bipartisan legislation that prevents this from happening again. Their bill enshrines seniors' visitation rights at nursing homes and other kinds of facilities during an emergency by requiring nursing homes to admit essential caregivers who have who provide seniors critical assistance and support. Next, the committee will consider legislation to protect patient access in rural and underserved areas to remote health monitoring services while acknowledging that disparities exist in access in access to this lifesaving technology. Representative Kustoff's bipartisan legislation ensures that Medicare beneficiaries in rural and underserved communities are not left behind by advances in digitally assisted care I once had a healthcare innovator tell me that he is paid between two to three times as much for remote patient monitoring in San Francisco as he is in rural Missouri for the exact same service and device. Since health care always follows the dollar, a disparity that wide is creating a huge access issue. Requiring Medicare to adequately reimburse for these services will give rural and underserved patients and their physicians access to a more a more complete view of a patient's health. This can be transform- transformative and even life-saving when it comes to treating chronic diseases. Our next piece of bipartisan legislation, introduced by Representative Molinar, recognizes the need for preser- preserving anesthesia services and surgeries in rural areas by addressing a Medicare payment disparity for rural anesthesiologists. Rural communities already suffer from a lack of medical professionals. Eighty-one percent of rural communities lack an anesthesiologist, and more than half have no access to such services. Protecting access to anesthesia s- services will protect access to surgical procedures in rural communities and underserved communities. This bill will incentivize anesthesiologists who live in urban areas to enroll hospitals by extending them the same bonus payment currently offered to anesthesia nurses, sustaining access to care for patients. Long-term care hospitals serve patients with a serious injury or illness that requires prolonged inpatient treatment. However, current law requires patients who need this long-term care to check Medicare by spending a certain number of days in a hospital, ICU, or a certain number of hours on a ventilator before they can access this care. In many cases, this is a needless delay when years of experience have taught providers how to spot patients who will need long-term acute care. Legislation we are considering today, championed by Representatives Hearn, Miller of West Virginia, and Smucker, allows providers to acce- a- a- access early on whether a patient will need long-term care and get those patients the care that they need without wasting their time. This bill also treats rural critical access hospitals the same as standard hospitals so patients in rural and underserved areas are not forced to travel long distances to an urban facility before they can be given the same diagnosis and transferred to a long-term care. In short, this bill gets patients to the care that they need sooner rather than later, while freezing up hospital beds and providers to treat other incoming patients. The need is dire. Already of the four hundred and twenty-one LTACs that existed in two thousand and twelve, eighty-three have closed, including one in my district. We must act before patients lose access altogether to a critical source of care for some of the most critical critically ill patients. Next, the committee will consider legislation authored by Tax Subcommittee Chairman Kelly alongside Representative Del Bene that enjoys broad bipartisan support in the House of Representatives. This bill tackles a chronic problem affecting seniors in all our communities as threatening access to care while enriching insurers, prior authorization and Medicare Advantage. For the nearly thirty-three million seniors on Medicare Advantage, over half of all Medicare beneficiaries, the prior authorization process has become a barrier to timely health care services. Members of this committee have expressed well-founded concerns that insurance companies are abusing this process. Particularly when nearly eighty-one percent, eighty-one percent of authorization denials that are appealed are later overturned. This bill follows the great work that President Trump and HHS HHS Secretary Kennedy and CMS Administrator Doctor Oz have have championed. Securing commitments from the nation's largest health insurers to improve this arcane process and puts the President's great health care plan into law. This bill will force insurers to be transparent about their prior authorization practices. It also requires them to invest in new electronic prior authorization tools to ease burden for physicians and hospitals benefitting patients. Our next bill brings transparency to health insurer finances and enrolled benefit information. Medicare Advantage insurers are some of the most profitable companies around. with one insurer posting more than six billion dollars in profit in the first quarter of this year alone. Yet basic information is still unavailable to the public. At the same time, insurers add to patient confusion when they don't display benefit information clearly. Representative Moran's bill shines light onto these financial windfalls. It requires Medicare Advantage insurers to publicly post their revenue and spending on medical services compared with administrative cost and profits while requiring them to better display benefit information to patients. Seniors and taxpayers deserve to know this information before they hand over their money. Our last piece of legislation insures hospitals and insurance companies Tell Americans the price of care before they owe a dime. Where I come from, you know what a truck costs before you drive it off the lot. Health care is the only thing in America you buy blind. That's not a mistake. It's how the system was built. The hospital knows the price. The insurance company knows the price. The middleman They know the price. The only person who doesn't is the patient getting stuck with an unexpectedly high bill months after a procedure. This legislation builds upon the work this committee has done through hearings, including the CEOs of the nation's largest health insurers and health systems, and markups and field hearings focused on greater access and affordability. In its first term, President Trump made hospitals and insurers post their prices. Then the last administration slow-walked enforcement and looked the other way while hospitals and insurers fell to live up to their commitments to be more open and honest with patients. My legislation codifies and strengthens President Trump's rules to hold hospitals and insurance companies accountable for delivering transparency to patients. So much of the work this committee does reflects bipartisan consensus. We all have seniors and families in our district who will benefit from greater health care price transparency and improved access to care, particularly those Americans in rural and underserved communities. Today's mark-up is another opportunity to show how we can bring bipartisanship to solving real challenges facing the American people. I'm now pleased to recognize the ranking member Um, from Massachusetts, Mr. Nilfer's opening statement.

Thank you, Chairman. Uh, it seems to be groundhog day again in the House. The American people continue to pay the price for failed Republican policies. They're losing their health care. They're paying more at the grocery store, more at the gas pump, and struggling to make ends meet. Our colleagues on the other side are once again trying to distract from this record. and have tried very hard to get away from even some of the votes that they have cast. A fifty billion dollar sludge fund for hospitals after they're cutting billions and billions of dollars, up to a trillion dollars, from Medicaid. They're finding this opportunity to try to patch together solutions to the problems that their big bill created. Republicans found more than thirty-eight billion dollars to fund Trump's out-of-control ICE in their last budget. Didn't do much for working families who continue to struggle. At a moment when the nation has been shaken by two more ICE-related killings in the span of a week, the idea that Congress continues to pour money into the President's extreme agenda is unconscionable. A year ago, our House Republican colleagues and President Trump twisted arms and rammed through the " marquee" legislation, as they call it, much of it done under the cover of darkness. siding on the record with the wealthiest among us over working families. We called it a betrayal then, and we know it to be now a failure. Since then, more than eight million Americans. Eight million Americans are losing their health insurance. Millions on the brink, watching their costs rise and coverage put further out of reach. Inflation has reached its highest level in years. Jobs are evaporating. Families are draining their savings just to stay afloat. Instead of helping those families to get ahead, our Republican colleagues chose to sacrifice their wallets and health care to give the wealthiest among us more handouts that they weren't even asking for. The Republican health care crisis is only getting worse as the full ramifications of their one trillion dollars in cuts to the system begin to take hold. Hundreds of hospitals around the country are wondering will they be able to keep the lights on. And patients in need of care are wondering if they'll still be able to access doctors and medicines that they rely upon. There remains nothing on this agenda to fix any of it. They'd rather spend the rest of Congress struggling to advance anything on the floor, flood committees across the chamber with busy work that won't put health care back in reach for working moms, won't lower the cost of prescription drugs, and won't keep rural hospitals from shuttering their doors. The truth is, that they created the crisis and they have very few answers for the problem they have put together. The legislation we are considering today will not undo the harm that has been done. Their cuts have caused the greatest loss of health care in history. They continue to threaten the progress that we made to get twenty-one million Americans covered with health insurance, and we delivered historic savings for out-of-pocket costs in prescription medications. Every promise they have made to lower costs on their websites, doesn't seem to be consistent with the service that the President has offered to cut health care from the American family. Our friends and colleagues across the Republican caucus, they know that America is poorer and sicker because of what they've denied the American people that was carefully negotiated over decades and decades. Families deserve better than the deal that they've been handed by the Trump agenda. Democrats are gonna keep fighting for a better course to deliver results that the American people are demanding. And with that, I yield back the balance of my time. Thank you, Chairman.

Thank you. Our first order of business is H R ninety-six forty-one, the Essential Care Caregivers Act, introduced by Representatives Tinney and Larson. Representative Tinney saw firsthand the pain caused by family members and caregivers being denied access to their loved ones in nursing homes during the COVID-19 pandemic. And she understands the importance of protecting seniors and families and communities throughout upstate New York and the country. This legislation recognizes an essential truth. A loved one does not stop being a caregiver simply because a family member moves into a nursing home. I appreciate Representative Tenney's leadership in ensuring that nursing home residents are treated with dignity and compassion. I urge my colleagues to support this legislation. I'm pleased to recognize the gentlelady from New York, Miss Tinney, for an opening statement.

Thank you so much, Mister Chairman, I am just grateful that we're finally getting to uh have the essential caregivers in committee. I want to thank your committee staff, uh all the diligent work uh and to bring this really long-standing priority of mine is one of my top priorities in Congress. As a New Yorker, the Essential Caregivers Act is H R ninety-six forty-one. Uh, it's so important that we mark up this bill, and I also want to thank my colleague, uh, Mister Larson from Connecticut for his partnership. We've been at this for a long time and, uh, we're finally, uh, getting this to fruition. We also have Senate cosponsors, uh, Senator Blumenthal and Senator Cornyn, and we appreciate their commitment for making sure this is a truly bipartisan effort. And, uh, in terms of bipartisanship, I wanted to say as of today, We have a hundred and sixty-one bipartisan cosponsors on this bill in the House, and I want to thank everyone uh for being behind this effort and and for really helping. I also want to help uh uh recognize uh some other people that have been, you know, instrumental in this and been with me from the beginning uh during this whole COVID nightmare. And that's advocates Dori Carlone, Voices for Senior, Irma Rapoport, and my friend Carla Donley uh from uh from my hometown. And just want to thank them for their relentless advocacy and all their their friends and everyone who's contributed so much to this, but uh this bill has a simple premise rooted in a very painful lesson. During the COVID-19 pandemic, nursing home residents, our parents, grandparents, and our most vulnerable neighbors were cut off from the people who loved them and cared for them the most. Families were locked out, residents declined rapidly, people died alone, and while the pandemic was unprecedented, it illustrated the gaping hole in existing statute that could The Essential Caregivers Act fixes all of this. What this bill does is very straightforward. It amends the Social Security Act to require skilled nursing facilities, nursing facilities, long-term care hospitals, and patient rehabilitation facilities to implement and maintain an essential caregivers program in any regular visitation that in in any time regular visitation is sup- suspended. This codifies visitation rights for two essential caregivers and must guarantee that those caregivers in person access their loved one. This bill also provides common sense guardrails to ensure that health and safety standards of its residents are maintained. It incorporates new infection control measures in cases of public health emergencies, or it otherwise implements necessary accommodations to facilitate access for these families. This is not a partisan issue. Families in every district and every state watched their loved ones suffer from isolation that was preventable and hum- inhumane. What this bill does is take the hard lessons of COVID and write them into federal law so that no future administration no emergency declaration, and no sub-regulatory guidance memo can strip nursing home residents of their right to have a loved one by their side. Loved ones are not visitors. They're caregivers, advocates. They're lifelines. And this bill acknowledges their rights in times of crisis. I urge my colleagues on both sides of the aisle to support this legislation. I look forward to seeing it moved through this committee and to the floor, and ultimately to the President's desk for signature. And with that, I thank again my cosponsor, Mister Larson from Connecticut, and I thank the Chairman and our staff on wheezy means for bringing this to the uh, to the committee. We're grateful. Thanks so much. I yield back.

Thank you. I now recognize a ranking member from Massachusetts.

Thank you. Let me yield my time, Mister Chairman, to the gentleman from Connecticut.

I thank the ranking member and the chairman and uh wanna underscore what Representative Tenney has said. I credit her uh for her hard work uh but I doubt that there's a person on this committee who didn't witness what transpired uh during the pandemic when as uh Representative Tenney has uh indicated one of the most inhumane things that could possibly happen is the inability to meet with a dying loved one because of an outdated, outmoded, uh, lack of humanity piece of legislation, uh, that we seek to correct in the Essential Caregivers Act. Uh, I would also like to underscore that, uh, I'm sure for most members on this committee and I know for Claudia and I, that, uh, we got this information from our constituents. And we learned firsthand, and - and I would like to thank as well Irma Rapoport, Liz Stern, Amy Budini, and also, uh, the long-term care, um, budsman in the state of Connecticut, Mubraid Painter, for her continuous advocacy. Uh, uh, I think, uh, Mr. Chairman, as you know, that it's great when, uh, you have a piece of legislation and, um, you're able to put your name on it. But in truth, it's those individuals, it's the citizens that get involved, it's the citizens that get the ear of their elected members of Congress. In a representative form of government, this is essential in order for a democracy to succeed. Uh, as Miss Tenney uh uh underscored, uh, it's taken too long uh to get here to this point, but I think as she indicated with the number of people bipartisanly who have already signed on, that this bill is moments away from uh being passed. And as she also indicated, Senator Blumenthal and others in the Senate are also sponsoring this bill uh because it is straightforward and common sense the Essential Caregivers Act is a lesson learned in this pandemic that puts a system into place that ensures this can never happen again. And so, um, I think all that needs to be said has been said and underscored. And of course, I think most legislation that's common sense and impacts the constituents re-represent and serve uh, is the kind of legislation that the American people want to see, and especially they want to see Democrats and Republicans working together. Uh, I want to align myself with the remarks of, uh, ranking member Neal, and also the chairman at the start of this, talking about how when we have an opportunity to work together to get things done, we should. I think the misnomer out there in America is that this never happens. The truth of the matter is it happens far more often than not. There are still major differences, et cetera. And as we talk about the number of Americans in the wealthiest nation in the world, the only modern-day industrial economy and country in the world that does not have health care for all of its citizens demonstrates that the work that still needs to be done in this lies ahead of us. This bill incrementally is an important and good step, common sense, but it's also common sense, I believe, as we go forward to make sure that now the business community is waking up and seeing the extraordinary cost of health care and health care delivery. And so how do we as a nation and a committee work to do that? Well, just as we were successful in lowering prescription drug cost, we still need to do more, but as importantly, we are a nation that needs to have all of our citizens insured. We mentioned our most significant program for the elderly. In Medicare, it's long overdue for Medicare for all. Again, I want to commend Claudia Tenney for her work and the other members on this uh on this committee who heard from their constituents as well, about the importance and significance of this uh legislation. With that, I yield back.

Thank you. The committee will now proceed to consideration of H R ninety-six forty-one, the Essential Caregivers Act of twenty twenty-six. Without objection, the measure will be considered as read and open for amendment at any point. And at this time I offer an amendment in the nature of a substitute, which was distributed in advance along with a green sheet explaining it. Without objection, the amendment and the nature of a substitute shall be considered as read and open for amendment at any point and considered base text for purpose of amendment. I will now turn to Patrick Dumas, Health Subcommittee Staff Director, to pro- provide a technical description of the amendment and the nature of a substitute with an emphasis on the changes made since introduction. I ask that members hold their questions until after his presentation.

Thank you, Chairman Smith, Ranking Member Neal. H R ninety-six forty-one, the Essential Caregivers Act, contains Section one provides for the short title of the bill. Section two amends sections eighteen nineteen and nineteen nineteen of the Social Security Act to require nursing homes and other similar care facilities to allow visitation from a resident's essential caregiver during any period in which regular visitation is suspended including audio-visual visitation during an initial seven day period when in-person visitation is suspended, and facilities must allow for in-person visitation for end of life situations. The amendment in the amendment in the nature of a substitute makes a technical change to the bill draft this concludes the technical walkthrough.

Thank you. Are there any technical questions about the amendment in the nature of a substitute? Seeing none, we will move to strike the last word. Does anyone wish to strike the last word? Mister Thompson.

Thank you, Mister Chairman, I move to strike the last word. Uh, I appreciate uh this bill and the work of my colleagues, uh Miss Tenney and uh Mister Larson to make sure that this important issue uh is addressed. I strongly support the Essential Caregivers Act uh to make certain that long-term care facility residents can spend time in person with a loved one, during public health emergencies. I too have heard from constituents who very sadly couldn't visit their family during COVID, and the loneliness their loved ones felt due to this separation. It's understandable and commendable to try and protect the health and the safety of our most vulnerable during a public health emergency. However, as millions of Americans know all too well, mental health is just as important as physical health. And isolation and loneliness have significant impacts to a person's well-being and to their mental health. This bill protects a person's mental health while also ensuring their physical health remains at a reduced risk. I urge my colleagues to join in in supporting this bill, and I thank my colleagues for the hard work that they did to bring it forward and I yield back to balance my time.

Additional members wish to strike the last word.

Sanchez.

Miss Sanchez.

Thank you, Mr. Chairman. I stand in strong support of the Essential Caregivers Act. Caregivers play an essential part of a patient's health. They are important in terms of the staff in long-term care facilities and critical to the life the quality of life of a patient. I commend Miss Tenney and Mister Larson for this bill. Um, you know, the COVID pandemic showed the dangers of isolating seniors from those who care for them the most. And I know firsthand how parents and loved ones can decline rapidly due to social isolation. While I would have liked to see this bill's guidance applied to individuals who have elected hospice under Medicare, this bill is a major step in ensuring that caregivers have access to visit their loved ones. And that's why I will be supporting this legislation. And I urge my colleagues to support it as well. And with that, I yield back.

Thank you. Are there additional members that wish to strike the last word? Seeing none, are there any amendments to the amendment in the nature of a substitute? If there are no amendments, the question is on the adoption of the amendment in the nature of a substitute. All those in favor, signify by saying aye.

Aye. Aye.

Those opposed, say no. In the opinion of the chair, the ayes have it, and the amendment in the nature of a substitute is agreed. I will now recognize Mister Buchanan for the purpose of offering a motion.

Mister Chairman, I move the committee favorably report HR ninety-six forty-one as amended to the House of Representatives.

The question is on the motion to favorably report HR ninety-six forty-one as amended to the House of Representatives. The clerk will call the roll.

Mister Buchanan.

Yes.

Mister Buchanan, yes. Mister Smith of Nebraska.

Yes.

Mister Smith of Nebraska, yes. Mister Kelly.

Yes.

Mister Kelly. Yes. Mister Schweikert. Mister Schweiker, yes. Mister LaHood. Mister Arrington. Mister Estes.

Yes.

Mister Estes, yes. Mister Schmucker. Mister Schmucker, yes. Mister Hern. Mister Hern, yes. Mrs. Miller.

Yes.

Mrs. Miller, yes. Doctor Murphy. Doctor Murphy, yes. Mister Kustoff. Mister Kustoff, yes. Mister Fitzpatrick,

Yes.

Mister Fitzpatrick, yes. Mister Stuebe.

Yes.

Mister Stuebe, yes. Mister Tenney, Mister Tenney, yes. Mister Svishbak, Mister Svishbak, yes. Mister Moore,

Yes.

Mister Moore, yes. Mister Van Duyn, Mister Van Duyn, yes. Mister Feenstra, Mister Feenstra, yes. Mister Maliatakis. Mister Kelly.

Yes.

Mister Kelly, yes. Mister Yockem.

Mister Yes. Yockem.

Mister Yockem, yes. Mister Miller.

Yes.

Mister Miller, yes. Mister Bean.

Yes.

Mister Bean, yes. Mister Moran.

Yes.

Mister Moran, yes. Mister Neal. Mister Neal, yes. Mister Doggett. Mister Thompson. Mister Thompson, yes. Mister Larson.

Yes.

Mister Larson, yes. Mister Davis. Mister Davis, yes. Miss Sanchez. Miss Sanchez, yes. Miss Sewell. Miss DelBene. Miss DelBene, yes. Miss Chu. Miss Moore. Miss Moore, yes. Mister Boyle. Mister Boyle, yes. Mister Beier.

Yes.

Mister Beier, yes.

Mister Boyle.

Mister Evans. Mister Evans, yes. Mister Schneider.

Yes.

Mister Schneider, yes. Mister Panetta. Mister Gomez. Mister Horsford. Mister Horsford, yes. Miss Plaskett. Mister Swasey. Mister LaHood. Mister Arrington. Miss Maliatakis. Miss Maliatakis, yes. Mister Doggett. Miss Sewell. Miss Chu. Miss Chiu, yes. Mister Panetta. Mister Gomez. Miss Plaskett. Mister Swasey. Chairman Smith.

Yes.

Chairman Smith, yes.

How is Mister Swasey recorded?

Mister Swasey is not recorded.

I am.

Mister Swasey, yes.

Nice meeting you, man.

Will the clerk report the vote?

Mister Chairman, the yeses are thirty eight and the noes are zero.

There being thirty-eight yeses and zero noes,

Thirty eight.

the motion is agreed to in H R ninety six forty one. Okay. one as amended is ordered favorably reported to the house. With that objection I ask that staff be authorized to make technical and conforming changes to H R ninety six forty one and that members have two additional days to file with the committee clerk supplemental additional dissenting or minority views. Our next order of business is H R thirty one O eight, the Rural Patient Monitoring Access Act, bipartisan legislation introduced by Representative Kustoff. Representative Kustoff has long been focused on ensuring that rural and underserved communities in West Tennessee have access to quality health care. His district currently borders Missouri's eighth, and patients share many of the same challenges. Rural patients are at greater risk of developing serious chronic diseases, like heart failure, diabetes, diabetes, and hypertension, yet are thirty-three percent less likely to use remote monitoring technology that has been a critical tool to treat and manage chronic disease. I thank Congressman Kustoff for standing up for rural Americans and underserved communities and ensuring that they are not left behind as healthcare continues to evolve. I urge my colleagues to support this legislation. I'm pleased to recognize the gentleman from from from Tennessee, Mister Kustoff, for an opening statement.

Thank you, Mister Chairman, and thank you for holding this bipartisan mark-up with this bipartisan piece of legislation. Mister Chairman, as you mentioned, I I represent the eighth congressional district of Tennessee. That does include a lot of rural West Tennessee. And I think we all know that rural Medicare patients

Yeah.

face the highest rates of chronic diseases like heart failure and hypertension and diabetes. We all know that managing multiple chronic conditions is difficult when providers only have a snapshot of a patient's health in the context of a short visit every few months. For patients that are diagnosed with multiple chronic diseases, in order for them to get healthier, lifestyle improvements and other therapies, along with new health care delivery technology, should be leveraged. Remote patient monitoring uses digital devices like glucose monitors, blood pressure cuffs, pulse, uh, uh, uh, measuring devices, to keep track of a patient's vitals in real time. The importance of it is that the technology gives clinicians a clear picture of a patient's day-to-day health trends and helps them detect and and address dangerous patterns before they could lead to hospitalizations. Now, Mister Chairman, we've seen incredible results on health outcomes and savings from studies on this technology. If I if I could, just a few stats. A twenty-seven percent reduction in hospital admissions, a fifty percent reduction in heart attack, in stroke, in patients with hypertension. One program lowered spending by fifty-two percent for Medicare beneficiaries with heart failure. When we talk about health care providers in rural areas, They should have access to cutting-edge tools to keep an eye on patients in between visits to the doctor's office. The problem is the current Medicare reimbursement structure for remote patient monitoring disadvantages the very same rural communities it's meant to serve. Medicare effectively gives a pay cut, if you will, to uh to these RPM providers in rural and underserved areas, including the districts of a number of my colleagues here on the dais. And as a result, rural patients have a thirty-three percent lower use for for remote monitoring. It's really an access problem. So I think it's crucial that we close this disparity by encouraging the d- the adoption of rural patient monitoring in areas that need it the most. This bill, the Rural Patient Monitoring Access Act, will stop Medicare from cutting these payments due to geography. Mr. Chairman, we've already seen interest from across the nation in expanding access to remote monitoring in rural areas. In fact, forty-seven states have including have included this RPM in telehealth expansion as key components of their strategies under the Rural Health Transformation Program, included in part of the Working Families Tax Cuts Act. I think that this legislation will provide the certainty that these providers need to invest in rural America and strengthen our efforts to combat chronic disease. And with that, Mr. Chairman, I'll yield back.

Thank you. I now recognize a ranking member.

Thank you. Uh, let me yield my time to the gentleman from Nevada, Mister Horsford.

I thank the ranking member and thank you, Mister Chairman. Uh, when people think of Nevada, they usually picture the Las Vegas Strip. But what mem- many don't realize is that more than eighty percent of our state is rural, the highest share of any state in the country. Uh, my congressional district is one of the twenty largest in Amar- in America. In fact, only one member of this committee, Congressman Adrian Smith, represents more square miles than I do. So many of my constituents drive two, three, or even four hours uh to get to the care that they need. At the end of the day, there is no distinction between rural health care and health care. It is simply the care that people depend on to get the uh families the health that they need. Here's another figure worth noting. Nevada also has the sixth highest uninsured rate in the nation. And it used to be worse. Before twenty fourteen, we had the second highest uninsured rate in America, behind only Texas. What changed? Medicaid expansion. Uh, when I served as Majority Leader of the Nevada State Senate, I worked alongside then-Republican Governor Brian Sandoval to expand Medicaid under the Affordable Care Act. It wasn't about politics, it was about doing what was right for Nevada's families. That decision reduced Nevada's uninsured rate by more than five percentage points, and it extended health care coverage to roughly a hundred and thirty-five thousand Nevadans. That's why I was so disappointed to see my Republican colleagues move in the opposite direction. The changes that have been enacted through the one big, ugly bill are expected to affect health care coverage for more than a hundred and forty-seven thousand and threaten hundreds of health care jobs all across my state. In fact, in one of the rural counties in Nye County, I don't have a um birthing center. And there's very limited OBGYN services throughout rural Nevada. And Nevada is hardly alone. The Medicaid cuts are projected to remove roughly a hundred and fifty-five billion dollars from rural communities over the next decade. One in five rural adults and nearly forty percent of rural children depend on Medicaid. Those dollars don't just insure patients. They keep rural hospitals open. They sustain EMS services. They support community health centers. And they help long-term care facilities keep their doors open. That is why we as members of Congress should be doing everything in our power to expand coverage in rural America, not restricting it. But instead, we are barreling towards a real coverage gap. Americans will lose their insurance and their access to affordable care. That brings me to today's bill. While I appreciate the int- intent beh- behind the RPM access act, remote patient monitoring only works if patients have coverage. providers, and reliable internet access. Take any one of those out of the equation and the promise of telehealth falls short. While not in our committee's jurisdiction, reliable broadband connectivity is the backbone of telehealth. And yet, Speaker Johnson allowed the affordable connectivity program to expire, a program that was found to increase rural broadband connectivity by seven percent. Without affordable access, rural families will continue to lose access not only to telehealth, but also to education, employment, and economic opportunities at large. So to be clear, yes, I will vote for this bill. But let's not confuse passing one telehealth bill without a comprehensive commitment to health care in rural America. Rural America needs providers, it needs hospitals, it needs broadband, and a above all it needs affordable health coverage. And until we protect all of those pieces, our work is not finished. With that, I yield back.

Thank you. The committee will now proceed to consideration of HR thirty-one O eight, the Rural Patient Monitoring Access Act. Without objection, the measure will be considered as read and open for amendment at any point. And at this time I offer an amendment in the nature of a substitute, which was distributed in advance along with a green sheet explaining it. Without objection, the amendment in the nature of a substitute shall be considered considered as read, open for amendment at any point, and considered base text for the purpose of amendment. I will now turn to Patrick Dumas, Health Subcommittee Staff Director, to provide a technical description of the amendment in the nature of a substitute with an emphasis. On the changes made since introduction, I ask that members hold their questions until after his presentation.

Thank you, Chairman Smith, Ranking Member Neal. H R thirty-one zero eight, the Rural Patient Monitoring Access Act contains Section one provides for the short title of the bill. Section two amends section eighteen forty-eight of the Social Security Act to establish establish a floor of one point O for practice expense and malpractice insurance geographic practice cost indices for payment of remote physiological monitoring services beginning January twenty twenty eight and ending December twenty thirty two. Section three amends section eighteen thirty-four of the Social Security Act to clarify

Thank you. Are there any technical questions about the amendment and the nature of a substitute? Seeing none, does any member wish to strike the last word? Oh, Mister Murph- Doctor Murphy.

Thank you, Mister Chairman, I wanna commend my good friend uh Representative Kustolf for um putting this forward. As we come into the age of artificial intelligence and with electronic monitoring, making sure that we do this right is crucial and making sure that it is funded is crucial also. Uh, in eastern North Carolina, we have a fantastic uh cardiac program which monitors patients from hours away and is able to see things before they happen and especially again with the age of uh artificial intelligence we're gonna be able to pick up things far bef- far long before they become a problem so supporting this effort, I think, from on a national level is critical, I think it leads to better howco- health outcomes, I think in the end it absolutely is cheaper and we need to make sure that it is funded And I appreciate his hard work on this endeavor and urge everyone to vote in favor of this. Thank you. He'll back.

Thank you. Are there additional members that wish to strike the last word? Seeing none, are there any amendments to the amendment in the nature of a substitute, Mister Beyer?

Mr. Chairman, I reserve point order.

A point of order has been reserved. Will the gentleman suspend while the amendment is distributed?

Yes, sir.

Proceed, Mister Baier.

Yeah, thank you, Mister Chairman. Um, first I wanna emphasize this is a friendly amendment. I share my colleagues' enthusiasm for finding ways to find new technology to improve the efficiency and efficacy of healthcare. And I celebrate the bipartisan appetite for he- telehealth flexibilities. And these are especially helpful for people who manage complex and chronic conditions. Those conditions frequently come with many, many doctors' visits, and those visits take a real physical and psychological toll and a huge amount of time. Anything we can do to reduce that burden is gonna help countless people. But when, and when most of patient monitoring help that helps collect important clinical data outside of a physician's office is indeed transformative. Like telehealth, I think the remote patient monitoring can be a step forward, but it also needs to be used appropriately to improve patient care, not supplant appropriate care and surveillance by trained professionals. We need reasonable guardrails. So in twenty twenty four and twenty twenty five, the HHS Inspector General released recommendations for oversight of remote remote monitoring. They were motivated to put out those recommendations because they saw that more and more patients would use remote patient monitoring, just as this bill intends. The Inspector General's proposals are simple and common sense. They don't reduce access to RPM, they just make sure that the technology is being used and paid for appropriately. For instance, right now Medicare doesn't require that R PM services be ordered by a physician, or that claims tell CMS who that physician is. That's a gap in the system that makes it harder for CMS and for this committee to make sure the technology is being used appropriately. We need to know what health data is being monitored, education and training is happening for providers to be able to bill for R PM, and to be able to track claims submitted for R PM and by whom. There's a real appetite to codify requirements like that. And that's what my amendment does. I understand by the way that CMS, this CMS agrees. Yesterday, CMS proposed changes to RPM services as part of the twenty twenty-seven physician fee schedule and their proposed changes respond to the same OIG concerns as my amendment when we adopt promising new technologies we need to make sure we put in place reasonable guardrails especially when they don't impact care. As to what my amendment does, I urge all of my colleagues to vote yes. Thank you, Mr. Chairman.

Are there, is there any further discussion on the amendment? Seeing Mr. Kustoff.

Mr. Chairman, if I could move to strike the last word, and I um needless to say I appreciate the uh the nature of the amendment. I think that uh I think we all share the desire for guardrails. I I do think in what was what's been submitted, uh, that there are sufficient guardrails. And it's very possible that if we had a- been able to review this language prior to today's hearing, that we might could have come to some agreement, but I - I am going to oppose the amendment. With that said, uh, we know that this is going to work its way to the House floor and it may be that, uh, that Mister Beier and I can uh can try to work on something uh after it passes the committee and before it gets to the to the house floor but if this time based on the way uh our uh bill is currently drafted and the sufficient guardrails I would oppose the amendment and I uh yield back.

Further discussion on the amendment. See seeing none, the question is on on agreeing to the amendment offered by uh Mr.

Mister Buchanan. Mister Buchanan, no. Mister Smith, Nebraska. Mister Kelly. Mister Kelly, no. Mister Schweikert. Mister Schweikert, no. Mister LaHood. Mister LaHood, no. Mister Arrington. Mister Estes. Mister Estes, no. Mister Smucker. Mister Smucker, no. Mister Hern.

No.

Mister Hern, no. Mrs. Miller. Mrs. Miller, no. Doctor Murphy.

No.

Doctor Murphy, no. Mister Kustoff. Mister Kustoff, no. Mister Fitzpatrick. Mister Fitzpatrick, no. Mister Steube. Mr. Steube, no. Miss Tenney. Miss Tenney, no. Mrs. Fischbach.

No.

Mrs. Fischbach, no. Mr. Moore. Miss Van Duyn. Miss Van Duyn, no. Mister Feenstra. Mister Feenstra, no. Miss Maliatakis. Miss Maliatakis, no. Mister Kelly. Mister Kelly, no. Mr. Yockem.

No.

Mr. Yockem, no. Mr. Miller. Mr. Bean. Mr. Bean, no. Mr. Moran.

No.

Mr. Moran, no. Mr. Neal. Mr. Neal, yes. Mr. Doggett. Mr. Thompson.

Aye.

Mr. Thompson, yes. Mister Larson.

Yes.

Mister Larson, yes. Mister Davis.

Yes.

Mister Davis, yes. Miss Sanchez. Miss Sanchez, yes. Miss Sewell. Miss DelBene. Miss Chu. Miss Chu, yes. Miss Moore. Miss Moore, yes. Mister Boyle.

Aye.

Mister Boyle. Yes, Mr. Beier. Mr. Beier, yes. Mr. Evans.

Yes.

Mr. Evans, yes. Mr. Schneider.

Yes.

Mr. Schneider, yes. Mr. Panetta.

Yes.

Mr. Panetta, yes. Mr. Gomez.

Yes.

Mr. Gomez, yes. Mr. Horsford.

Yes.

Mr. Horsford, yes. Miss Plaskett. Mister Swasey.

Yes.

Mister Swasey, yes. That's well recorded. Mister S-

Oh, go ahead.

Mister Smith, Nebraska.

No.

Mister Smith, Nebraska, no. Mister Arrington. Mister Moore.

Aye.

Mister M- Mister Moore, no. Mister Miller.

No.

Mister Miller, no. Mister Doggett. Miss Sewell. Miss DelBene. Miss Plaskett. Chairman Smith.

No.

Chairman Smith, no.

Clerk will report the vote.

Mister Chairman, the yeses are fifteen and the nos are twenty-five.

there being fifteen yeses and twenty-five noes, the amendment is not agreed to. Are there additional amendments? Seeing no further amendments, the question is on the adoption of the amendment in the nature of a substitute. All those in favor signify by saying aye.

Aye.

Those opposed say no. And the opinion of the chair, the ayes have it, and the amendment in the nature of a substitute is agreed to. I will now recognize Mister Buchanan for the purpose of offering a motion.

Mister Chairman, I move the committee favorably report H R thirty one O eight as it meant, to the House of Representatives.

The question is on the motion to favorably report HR thirty-one O eight as amended to the House of Representatives the clerk will call the roll.

Mr. Buchanan.

Yes.

Mr. Buchanan, yes. Mr. Smith of Nebraska. Mr. Smith of Nebraska, yes. Mr. Kelly. Mr. Kelly, yes. Mr. Schweikert. Mr. LaHood. Mr. LaHood, yes. Mr. Arrington. Mister Estes. Mister Estes, yes. Mister Smucker. Mister Smucker, yes. Mister Hern.

Yes.

Mister Hern, yes. Mrs. Miller. Yes. Mrs. Miller, yes. Doctor Murphy. Doctor Murphy, yes. Mister Kustoff. Yes. Mister Kustoff, yes. Mister Fitzpatrick. Yes. Mister Fitzpatrick, yes. Mister Steube. Yes. Mr. Steube, yes. Miss Tenney. Miss Tenney, yes. Mrs. Fischbach,

Yes.

Mrs. Fischbach, yes. Mister Moore. Miss Van Duyn, Miss Van Duyn, yes. Mister Feenstra, mister Feenstra, yes. Miss Malia Takis, Miss Malia Takis, yes. Mister Carey. Mr. Carey, yes. I'm gonna take it. I'm gonna take it. Mr. Yakym,

Yes.

Mr. Yacoum, yes. Mr. Miller,

Yes.

Mr. Miller, yes. Mr. Bean,

Yes.

Mr. Bean, yes. Mr. Moran,

Yes.

Mr. Moran, yes. Mr. Neal, Mr. Neal, yes. Mr. Doggett. Mr. Thompson, Mr. Thompson, yes. Mr. Larson. Mister Larson, yes. Mister Davis. Mister Davis, yes. Miss Sanchez. Miss Sanchez, yes. Miss Sewell. Miss Sewell, no.

That

Miss Sanchez, no. Miss Sewell. Miss Del Bene. Miss Chu. Miss Chu, yes. Miss Moore. Miss Moore, yes. Mister Boyle. Mister Boyle, yes. Mister Beyer.

Yes. Yes.

Mister Mister Beyer, yes. Mister Evans.

Yes.

Mister Evans, yes. Mister Schneider.

Yes.

Mister Schneider, yes. Mister Panetta. Mr. Panetta, yes. Mr. Gomez. Mr. Gomez, yes. Mr. Horsford. Mr. Horsford, yes. Miss Plaskett. Mr. Swazi.

Aye.

Mr. Swazi, yes. Mr. Schweikert. Mr. Schweikert, yes. Mr. Arrington. Mister Moore. Mister Doggett. Miss Sewell. Miss DelBene. Miss Plaskett. Chairman Smith.

Yes.

Chairman Smith, yes.

This is really good.

Two minutes.

Mister Chairman?

Yes.

How am I recorded?

How is Miss Sanchez recorded?

Sanchez, no.

Ye-

Miss Sanchez, no.

That should be yes.

Miss Sanchez, yes.

The clerk will report the vote.

Mr. Chairman, the yeses are thirty-nine and the noes are zero.

There being thirty-nine yeses and zero noes, the motion is agreed to in H R thirty-one O eight as amended, as ordered favorably reported to the house. Without objection, I ask that staff be authorized to make technical and conforming changes. to hr thirty one O eight and that members have two additional days to file with the committee clerk supplemental additional dissenting or minority views. Our next order of business is hr ninety six forty two, the Medicare access to Rural Anesthesiology Act, introduced by Representative Molinar, who has long been focused on ensuring rural seniors have access to quality health care closer to home. This legislation builds on the previous efforts by allowing rural hospitals to use a Medicare payment model to hire a contract with anesthesiologists, expanding the types of providers available in these rural hospitals. I also want to recognize Doctor Murphy, who has been a champion of this legislation and brings firsthand experience with the challenges rural communities face in recruiting specialty providers. I'm pleased to recognize a gentleman from North Carolina, Doctor Murphy, for an opening statement.

Thank you, Mr. Chairman, and I want to thank uh my friends, Mister Kelly and Mister Albany for bringing this uh this policy forward. I I will tell you just as a surgeon who's worked in a lot of different hospitals, um it is a real challenge for rural hospitals to keep their operating rooms going, which is the real main point of resources that are for rural hospitals. And while um our nurse anesthetists have done a fantastic job in keeping a lot of the places open, keeping the ORs open, I think opening the avenue also, not, this is not a scope of practice issue, um, also for surgeon, I mean, for anesthesiologists is critical. Having patients and their physicians jump through so many hoops and wait several weeks and months to overturn insurance companies' denials uh when they can't get uh, excuse me, I'm sorry, when they can't get um access to uh some of the places that need to be in rural areas is critical. This simply allows uh anesthesiologists to just be back on par with our nurse anesthetists to allow them to get access to smaller hospitals. Um, I will tell you, doing very difficult cases um in smaller hospitals, I personally wouldn't want to do them um without an anesthesiologist present. Um, I as a surgeon have enough time worrying about what's going on on one side of the screen and not having to worry about what's going on on the other side of the screen. It is challenging because insurance companies um oftentimes will put liability on the surgeon for the anesthesia part um if a nurse anesthetist is on the other side. So again, this is not a scope of practice bill. This is merely just allowing anesthesiologists to come and um use their trades in rural areas. We're helping actually offset a lot of the things that go on where the main operating rooms and some of the big huge medical centers are taking up so uh so fully and help offload some of the cases that that done in rural areas again to keep our rural hospitals open. So I'm thankful for the opportunity this legislation comes forward, and I urge everyone to give a positive vote. Thank you.

I now recognize the ranking member.

Thank you. There's a real crisis happening for our rural hospitals right now, right at this moment. And I understand why this is on the minds of every member, regardless of party. The truth is, hospitals are under attack. But let's not pretend this problem appeared out of nowhere, or that it is isolated to only a certain few parts of medicine. Hospitals across the country, rural and urban alike, are under enormous strain because of the greatest loss of health care that the big bill offered, when it was embraced by the majority on this committee. We were told not to worry last fall, or a year ago, And now we're starting to see the results. More than one thousand hospitals, clinics and health facilities are closing their doors. They're shuttering services or they are on the verge and at risk of doing precisely that. The Trump administration's Medicaid regulations are strangling straight fu- uh funding for the programs and their charges and changes to section eleven fifteen waivers are going to make it harder for states that want to innovate and to support local hospitals, or that are already doing so. In Massachusetts, our uncompensated care pool that helps hospitals deliver care to the uninsured and underinsured patients is in in is in jeopardy because of these changes. The eru- Republican assault on the Affordable Care Act has led to eight million people losing their health care. And for those who have any any understanding of how insurance works in the risk pool, What's in front of us is clearly this. Healthy people are walking away because of the premium increases when Republicans decided to take away those tax credits. Their assault on the Affordable Care Act is unending. It's not just their refusal to extend the tax credits that make coverage affordable, but they're taking a regulatory action to high cost on those who rely on Marketplace coverage, emphasis on Marketplace coverage. Patients are saddled with more medical debt and the costs are being shifted to hospitals in the form of uncompensated care. So I have an ask. We want to help anesthesiologists, but why only anesthesiology? Why only certain rural hospitals? Why not maternity care? Why not mental health? Why not embrace the DocFix to take care of those who offer such important consideration every day in the healthcare arena? And why not helping safety-net hospitals that serve our cities and our underserved communities? Republicans have helped to fracture and break the health care system, and now they're offering selective crumbs to paper over the damage that was done. Instead of addressing the root cause, they're picking winners and losers while hospitals across the country are losing. It's not enough to stop the damage. that we're embracing at this moment, we need to get on to a more comprehensive effort in our health care system. And with that, I yield back the balance of my time.

The committee will now proceed to consideration of H R ninety-six forty-two, the Medicare access to rural anesthesiology act. Without objection, the measure will be considered as read and open for amendment at any point. At this time, I offer an amendment in the nature of a substitute, which was distributed in advance, along with a green sheet explaining it. Without objection, the amendment in the nature of a substitute shall be considered as read, open for amendment in at any point and considered base text for purpose of amendment. I will now turn to Patrick Dumas, Health Subcommittee Staff Director, to provide a technical description of the amendment in the nature of a substitute with an emphasis on the changes made since introduction. I ask that members hold their questions until after his presentation.

Thank you, Chairman Smith, Ranking Member Neal. H R ninety-six, forty-two, the Medicare Access to Rural Anesthesiology Act contains two sections. Section one provides for the short title of the bill. Section two amends sections eighteen eighty-six and eighteen sixty-one of the Social Security Act to provide certain rural hospitals and critical access hospitals with a pass-through payment for anesthesia services furnished by an anesthesiologist so long as the hospital is geographically rural, performs less than eight hundred surgical procedures annually, and each contracted anesthesiologist agrees not to bill Medicare part B for such services. The amendment in the nature of a substitute revises the effective date of the bill. This concludes the technical walkthrough.

Thank you. Are there any technical questions about the amendment in the nature of a substitute? Seeing none, we will move to strike the last word. Mister Davis is recognized.

Thank you, Mr. Chairman. I move to strike the last word. I appreciate Congressman Mulder's efforts to address the challenges facing rural hospitals. Rural America deserves access to quality, And there's no question that many rural providers struggle to recruit and retain physicians, including anesthesiologists. However, this bill addresses only one part of a much larger problem, while leaving behind many of the hospitals and patients facing the very same challenges in underserved urban communities. Several years ago, this committee established a bipartisan Rural and Underserved Communities Health Task Force, which I had the privilege of co-leading. Through that work, Republicans and Democrats reached a common conclusion. Rural and underserved urban communities face many of the same barriers to quality health care. Those barriers include physician shortage, graduate medical education caps, transportation challenges, limited access to specialty care, aging facilities, workforce shortages, medical deserts, and the impact of social determinants of health. The difference is often geography, not need. Yet this legislation creates a benefit for one group of hospitals while excluding many urban safety-net hospitals that serve equally vulnerable populations. In my congressional district, several safety-net hospitals care for patient populations where more than seventy percent are covered by Medicaid. These hospitals provide care regardless of a patient's ability to pay. Yet Medicaid reimbursement often falls far below the actual cost of providing care. Many are operating on razor-thin margins while trying to g- meet growing demand for complex medical services. I have at least five hospitals in my district that are struggling financially and urgently need support simply to keep the doors open. I understand the needs of rural communities. I grew up in rural Arkansas, where my family often traveled more than a hundred miles for my mother to receive hospital care. So I know firsthand the importance of investing in rural health care. But I also know that underserved urban communities deserve that same commitment. This should not be either our conversation. Congress should be investing in both rural hospitals and urban safety-net hospitals because both are essentially e- assuring that Americans have access to quality health care. Unfortunately, this legislation comes at a time when hospitals across the country are already under enormous stress. following more than one million to reduce in reductions to federal health care spending. Millions of Americans have lost Medicaid, chip, all forward care coverage, all face significantly higher health coverage and higher costs for health care. This bill and the other pieces of legis- legislation do not address those problems. These institutions deserve the same considerations we are giving rural hospitals. So, Mr. Chairman, I believe that we can do better. We should pursue policies that strengthen the entire health care safety net, rural and urban alike, because every American deserves timely access to quality care regardless of where they live. So I urge my colleagues to work toward a more comprehensive and equitable solution that recognize the needs of all underserved communities. I thank you, Mr. Chairman, and I yield back.

Thank you, Mr. Estes. Let's recognize and strike the last word.

Thank you, Mr. Chairman. I'm able to strike the last word. I rise in strong support of H. R. ninety-six forty-two, the Medicare Access to Rural Anesthesiology Act. In my district, the legislation would directly empower seven eligible rural hospitals to provide comprehensive care to our communities. Rural hospitals face profound challenges in recruiting and retaining physician anesthesiologists. Today, eighty-one percent of rural counties lack a physician anesthesiologist and more than half has no anesthesiologist provider at all. Even more concerning, forty-nine percent of rural Medicare patients now bypass their local hospital's entirety for surgical services forcing seniors to travel long distances. for essential care. Currently, approximately six hundred rural hospitals qualify for a pass-through program, allowing them to use part A funds to hire anesthesiologist professionals. Unfortunately, CMS currently prohibits these uh facilities from using pass-through funds to hire physician anesthesiologists, restricting them solely to non-physician professionals. H R ninety-six forty-two addresses this long-standing oversight in the Medicare uh payment policy. Specifically, the bill opens the Pass-Fu program, allowing eligible hospitals to use funds for all anesthesiological professionals, including physicians, anesthesiologists. Provides a cost-based bonus program to anesthesiologists delivering services in certain low-volume rural hospitals, stabilizes rural surgical capacity, obstetric care, and trauma response. Crucially, this bill does not mandate who a hospital must hire, it simply gives them the choice. Empowering a rural hospital to bring on a physician anesthesiologist can completely transform the level of care they provide. I urge all my colleagues to support H R ninety-six forty-two to protect patient safety and maintain surgical access in rural America. Thank you, Mr. Chairman, and I yield back.

Thank you. Are there additional members that wish to strike the last word? Doctor Murphy.

Thank you, Mr. Chairman. I I want to correct, I think, some misconceptions about this. Under current law, anesthesiologists are precluded from participating in this pass-through program, the whole purpose of which was to incentivize hospitals and nurse anesthetists to deliver care in rural areas that had low surgical volume. When you're talking about these safety-net urban hospitals, they're two differe- they're two entirely different things. They're - they're - they're not low-volume places, and anesthesiologists are already there at those places. So, this bill allows the anesthesiologist basically then just to tap into these, pass-through programs that ensure rural communities have access to their services. And again, just as a reminder, hospitals, their primary source of revenue, how they stay open, is oftentimes, and i- it is, through the operating room. So expanding access to anesthesia services in the rural areas allows patients not only to receive higher levels of care, but receive it closer to home rather than traveling, um, hours and hours to medical centers, which a lot of us have. Again, not having anything to do with urban hospitals because they already have anesthesiologists at those places. And good, bad, or indifferent, again, this is not a scope issue. Um, some surgeons do not feel comfortable operating on patients without an anesthesiologist present. And so, again, just trying to maintain our rural hospitals to stay open, keeping the engines that keep hospitals open, the operating room, um, and allowing surgeons and anesthesiologists to function in those areas, literally just providing another avenue, does not hurt safety access hospitals, um, does not hurt, I'm sorry, does not hurt urban uh, hospitals that are safety net hospitals at all. Doesn't affect them because they already have anesthesiologists present at this point in time. Just opens up another avenue to keep rural hospitals open. And so I would urge my colleagues, just as a point of clarification, uh, to vote uh, uh, in the affirmative. Thank you. You're back.

Further, uh, additional members wish to strike the last word. Seeing none, are there any amendments to the amendment in the nature of a substitute? If there are no amendments, the question is on the adoption of the amendment in the nature of a substitute. All those in favor signify by saying aye. Those opposed say no. In the opinion of the chair, the ayes have it, and the amendment in the nature of a substitute is agreed to. I will now recognize Mister Buchanan for the purpose of offering a motion.

Mister Chairman, I move the committee favorably report H R ninety-six forty-two as amended to the House of Representatives.

The question is on the motion to favorably report H R ninety-six forty-two as amended to the House of Representatives. The clerk will call the roll.

Mister Buchanan.

Yes.

Mister Buchanan, yes. Mister Smith of Nebraska. Mister Smith of Nebraska, yes. Mister Kelly. Mister Schweikert. Mister Schweikert, yes. Mister LaHood.

Yes.

Mister LaHood, yes. Mister Arrington. Mister Estes. Mister Estes, yes. Mister Schmucker. Mister Schmucker, yes.

Yes.

Mister Hern. Mister Hern, yes. Mrs. Miller. Mrs. Miller, yes. Doctor Murphy. Doctor Murphy, yes. Mister Custoff,

Yes.

Mister Custoff, yes. Mister Fitzpatrick, Mister Fitzpatrick, yes.

Yes.

Mister Steube,

Yes.

Mister Steube, yes. Miss Tenney, Miss Tenney, yes. Misses Fischbach,

Yes.

Misses Fischbach, yes. Mister Moore,

Yes.

Mister Moore, yes. Miss Van Duyn, Miss Van Duyn, yes. Mister Feenstra. Mister Feenstra, yes. Miss Maliatakis. Miss Maliatakis, yes. Mister Kelly.

Yes.

Mister Mister Kelly, yes. Mister Joachim.

Yes.

Mister Joachim, yes. Mister Miller.

Yes.

Mister Miller, yes. Mister Bean.

Yes.

Mister Bean, yes. Mr. Moran.

Mm-hmm. Yeah.

Mr. Moran, yes.

Check. Should be.

Mr. Neal.

Yes.

Mr. Neal, yes. Mr. Doggett. Mr. Thompson. Mr. Thompson, yes. Mr. Larson.

Yes.

Mr. Larson, yes. Mr. Davis.

Yes.

Mr. Davis, yes. Miss Sanchez. Miss Sanchez, yes. Miss Sewell. Miss Del Bene. Miss Chu. Miss Chu, yes. Miss Moore.

Aye.

Miss Moore, yes. Mister Boyle.

Aye.

Mister Boyle, yes. Mister Beyer.

Aye.

Mister Beyer, yes. Mister Evans.

Yes.

Mister Evans, yes. Mister Schneider.

Yes.

Mister Schneider, yes. Mister Panetta. Mister Panetta, yes. Mister Gomez. Mister Gomez, yes. Mister Horsford. Mister Horsford, yes. Miss Plaskett. Mister Swazi.

Aye.

Mister Swazi, yes. Mister Kelly. Mister Kelly, yes. Mister Arrington. Mister Arrington, yes. Mister Doggett. Miss Sewell. Miss DelBene. Miss Plaskett. Chairman Smith.

Yes.

Chairman Smith, yes.

The clerk will report the vote.

I know, I know. That was the by-product of the meeting.

Mr. Chairman, the yeses are forty-one and the noes are zero.

There being forty-one yeses and zero noes, the motion is agreed to in H R ninety six forty two. as amended as ordered favorably reported to the house. Without objection, I ask that staff be authorized to make technical and conforming changes to H R ninety six forty two and the members have two additional days to file with the committee clerk supplemental additional dissenting or minority views. Our next order of business is H R ninety four sixty eight, the saving today's acute care resources or or star act introduced by representative Hearn representatives Hearn Miller and Smucker have been advocates for ensuring Medicare works better for patients and providers. Mister Hern in particular has been a tireless voice advocating for better health care access for rural Americans and has long championed these long-term care hospitals as a necessary setting for patients with complex needs. I appreciate Representative He- Representative Hearn's leadership in improving access to care for America's seniors, and urge my colleagues to support this legislation. I'm pleased to recognize The gentleman from Oklahoma, Mister Hern, for an opening statement.

Thank you, Chairman Smith, for holding this mark up. Long-term acute care hospitals known as LTACs are a vital part of the health care system. These facilities care for the sickest of the sick, with an average length of stay of greater than twenty-five days. Those who are admitted into the LTAC have a long recovery journey ahead of them. Patients with third degree burns, those who were on ventilators, or those who have been in an accident and have to be relearned, how to walk are the types of patients LTACs see on a daily basis. This is because LTACs provide highly specialized care and solely focus on the most medically complex patients that regular inpatient hospitals cannot provide. A recent study of Medicare beneficiaries found that medically complex patients discharged to non-LTAC setting remained in the hospital for seven additional days compared to those who were transferred to the LTAC directly. We know that no longer patients The long the longer patients wait to get the care they need, the less likely they are to recover to the best of their ability. This is where the value of care L tax provide cannot be overstated. But for the past decade or so, outdated Medicare rebu reimbursement policies have put L tax in a vulnerable financial state. More than twenty-five percent have closed over the past ten years, and many closures happened where no alternatives existed. Nearly half of affected communities and counties were left without LTACs, leaving patients in these counties with limited access to care. That's why I introduced the Saving Today's Acute Care R- Resources or the STAR Act. And I'm pleased that this bill is included in today's mark-up. Under the current Medicare rules, medically complex patients are forced to stay in the ICU for three nights to qualify for full LTAC payment rates, straining already scarcely available resources. This means patients are pressured to make medically unnecessary inpatient stays even though an LTAC is the most clinically appropriate setting for them. This policy helps both LTAC patients get the care they require while allowing hospitals to keep ICU beds available for other patients who need them. This bill creates a high acuity exception so those patients who we know need LTAC care can get it immediately. The bill also extends site-neutral payment rates to twenty thirty-two, ensuring non-LTAC patients are not receiving the higher reimbursement rate when it is not clinically necessary, a common sense budgetary safeguard for all. This also allows patients in critical access hospitals to transfer directly to health tax. For many rural areas, such as those in Oklahoma, a critical access hospital is the only Medicare hospital within a clinically relevant transfer distance. And current law limits access for these patients to get admitted into an health tax, even if the care is needed. This bill helps reach a goal that Congress should be chasing. getting patients directly to the right side of care at the right time, which improves healthy outcomes and gives them the best chance at a full recovery. This is what American patients deserve, and I urge all of my colleagues to support this bill. Thank you, Mr. Chairman. I yield back.

I now recognize a ranking member from Massachusetts.

Let me yield my time, Mr. Chairman, to the gentleman from California, Mister Thompson.

I thank the gentlemen uh for yielding. And uh I really wish we were here today to take on some of the health care issues that were created by our friends in the majority, uh that are really uh hammering health care uh throughout all of our districts. Uh but uh the bills that we have are are fine and dandy, but there's some underlying issues that are really uh causing serious health care problems. uh, for all of our constituents. Uh, Mr. Chairman, without objection, I'd like to, uh, uh, uh, submit this article to the record regarding Medicare insolvency.

Without objection.

Uh, and, uh, this bill today is about payments for long-term care hospitals, but it doesn't matter what the payment rate is if people don't have health insurance coverage. The Medicare trust fund is set to run out in twenty Thirty-three. That's seven years away. So if you're fifty-eight years old and have been paying into Medicare for the last forty years Medicare won't have the funds to pay your hard-earned benefits. All because of the Republicans' big ugly bill. That bill moved closer by twelve years Medicare's insolvency uh date. Twelve years. Mr. Chairman, I also ask unanimous consent to enter this Kaiser Family Foundation article into the record regarding people losing their health uh insurance.

Without objection.

Thank you. Thank you. Uh, already three million people have lost their health coverage because congressional Republicans refused to extend the Affordable Care Act, enhance premium credits. And more could soon lose their insurance. According to the Kaiser Family Foundation, seventeen percent of Americans enrolled in the ACA marketplace are not sure that they can afford their premiums for the rest of the year. That means another two million people are highly likely to lose their insurance this year. We've spent more on this president's illegal war with Iran than we would have spent providing five million hard-working Americans quality, affordable health care. Congressional Republicans have shown where their priorities lie. Are my colleagues on the majority side of this aisle okay with spending fifty billion dollars to wage an illegal war against another country but not willing to step up and provide what's necessary to provide hard-working Americans affordable health care insurance? Mr. Chairman, a record forty percent of Americans are now enrolled in bronze plans on the ACA Marketplace which have the lowest premiums but the highest deductibles. Despite this, Americans' ACA Marketplace insurance premiums have risen fifty-eight percent on average compared to last year. And because of the Congressional Republicans' policies, Premiums are only going to increase further next year. Americans are paying more for worst health care coverage. Mister Chairman, members, we can do better. It doesn't matter what imber- reimbursement rates we set, if the Republican bankrupt, if the Republicans bankrupt our health care system with disastrous policies just to give their billionaire donors a tax break. Billionaires don't need a tax break, but hard-working Americans need health care. And when Democrats are back in control of this committee and the next Congress, we'll show those hard-working American families what our priorities are, their health care, not the billionaires'. I yield back.

Thank you. The committee n- will now proceed to consideration of H. R. ninety-four sixty-eight, the Saving Today's Acute Care Resources Star Act. Without objection, the measure will be considered as read and open for amendment at any point. At this time, I offer an amendment in the nature of a substitute, which was distributed in advance along with a green sheet explaining it. Without objection, the amendment in the nature of a substitute shall be considered as read, open for amendment at any point, and considered base text for purpose of amendment. I will now turn to Patrick Dumas, Health Subcommittee Staff Director, to provide a technical description of the amendment in the nature of a substitute with an emphasis on the changes made since introduction. I ask the members hold their questions until after his presentation.

Thank you, Chairman Smith, Ranking Member Neal. H R ninety-four sixty-eight, the Saving Today's Acute Care Resources Act contains two sections. Section one provides for the short title of the bill. Section two amends section eighteen eighty-six of the Social Security Act to increase and extend a payment reduction for non-compliant admissions to long-term, acute care hospitals, or LTACs. The section also creates an expedited LTAC admission pathway, for p- Medicare patients meeting a certain diagnosis severity threshold, effectively allowing for the sickest Medicare patients to be directly admitted into an LTAC, without first staying three days in an intensive care unit, or ninety-six hours on a ventilator in a standard hospital. The section also modifies existing payment criteria for LTACs to allow Medicare beneficiaries discharged from a critical access hospital to be directly admitted to an LTAC without an intervening stay in a standard hospital. The amendment in the nature of a substitute revises the payment reduction and diagnosis severity threshold value in the bill. This concludes the technical walkthrough.

Thank you. Are there any technical questions about the amendment in the nature of a substitute? Seeing none, does any member wish to strike the last word? Uh, Mister Smucker.

Thank you, Mr. Chairman. I, uh, speak today in support of this bill, uh, the Saving Today's Acute Care Resources Act, uh, legislation that, uh, I was proud to co-lead with, uh, Mr. Hern. Mr. Hern has already talked about the vital role that the LTACs, uh, have in our health care hospital system. Uh, they care for some of Medicaid six patients, Um, and, uh, the- these are individuals who, uh, often need extended hospital care, uh, after a serious, uh, illness or injury. Um, and by transferring patients to the long-term care hospitals where they receive the care they really need, uh, at that point in their illness or injury. Uh, it also, an additional benefit, it frees up, uh, what are often scarce beds in the acute care. hospitals, so they're really important for a number of reasons. Uh, but unfortunately, again as Mister Hern uh described, uh the Medicare payment rules um at times have created uh what I think are unnecessary barriers that can delay the right care, delay the transfer to the LTCH uh for the patient who needs that care. Today some uh seniors uh with medical complexities are required to remain in an intensive care unit or be transferred between other hospitals simply to satisfy reimbursement requirements uh not because of what's best for that particular patient at that time. Um and so this bill provides a a common sense solution to that uh problem. It creates a new pathway so that these patients, the sickest uh patients can access long-term hair long-term care without um unnecessary delays and it allows eligible patients treated at critical access hospitals in rural communities to transfer directly uh to a LTCH hospital uh instead of making unnecessary steps along the way. So it's it's not about expanding bureaucracy, it's not about creating a new entitlement, it's simply about removing outdated government barriers that stand between seniors and the appropriate care that they need and deserve. Helps patients receive treatment in the most appropriate setting, frees up hospital capacity, I mentioned, and supports providers that care for our most medically complex, uh, patients, including these, uh, long-term care hospitals that serve communities across uh my district and of course in many others. So I want to thank Congressman Hern, also Congressman Miller, uh, has been an important part of the work on this legislation. And, uh, I urge my colleagues to support, uh, this act. Thank you, Mr. Chairman.

Thank you. Miss Miller.

Thank you, Mr. Chairman. I move to strike the last word. It was wonderful to join my colleagues, Congressman Herndon-Smoeker, in introducing the STAR Act. Long-term care hospitals play a critical role in our health care system by providing specialized care for some of Medicare's most medically challenged and complex patients. The STAR Act makes important updates to the Medicare long-term care hospital payment system by extending current site-neutral payment provisions, ensuring that hospitals caring for the highest acuity patients continue to receive appropriate reimbursement. For communities like those in West Virginia where the access to quality health care can be challenging maintaining a strong network of providers capable of treating complex patients is essential. After a serious illness or hospitalization, our rural patients should not face additional barriers when they need specialized care. I encourage my colleagues to vote yes on the legislation, and I thank Congressman Hernd for his leadership on this issue. I yield back.

Thank you. Are there additional members that wish to strike the last word? Seeing none, are there any amendments to the amendment in the nature of a substitute? Seeing no um no amendments, the question is on the adoption of the amendment in the nature of a substitute. All those in favor signify by saying aye.

Aye.

Those opposed say no. In the opinion of the chair, the ayes have it, and the amendment in the nature of a substitute is agreed to. I will now recognize Mister Buchanan for the purpose of offering a motion.

Mister Chairman, I move the committee favorably report H R ninety-four sixty eight as amended to the House of Representatives.

The question is on the motion to favorably report H R ninety-four sixty eight.

Mister Buchanan.

Yes.

Mister Buchanan, yes. Mister Smith, Nebraska. Mister Kelly. Mister Kelly, yes. Mister Schweiker. Mister LaHood.

Yes.

Mister LaHood,

Yes.

yes. Mister Arrington. Mister Estes. Mister Estes, yes. Mister Schmucker. Mister Schmucker,

Is he?

yes. Mister Hern.

Errington.

Mister Hern, yes. Mrs. Miller. Mrs. Miller, yes. Dr. Murphy.

Yeah, I can do that.

Dr. Murphy, Mrs. Metz. yes. Mister Kustoff. Yes. Mister Kustoff, yes. Mister Fitzpatrick. Yes. Mister Fitzpatrick, yes. Um. So, so, yes. Mister Steube. Mister Steube, Yes. yes. Miss Tenney. Yes. Miss Tenney, yes. Mrs. Fischbach. Yes. Mrs. Fischbach, yes. Mister Moore. I think that's it. It's the other one. Mister Moore, yes. Miss Van Duyn. Yes. Miss Van Duyn, yes.

Miss Van Duyn.

Mister Feenstra. Mister Feenstra, yes. Miss Malia Takis. Miss Malia Takis, yes. National? Mister Kelly. National. Yeah. Yes. Mister Kelly, yes. Mister Joachim. Yes. Mister Joachim, yes. Mister Miller. Yeah. Mister Miller, yes. Mister Bean. Seven, eight, nine, ten, eleven, twelve, three, four, four, five, six, seven, eight, nine, ten, eleven, ten, eleven, ten, Mister Moran.

Yes.

Mister Moran, yes.

Turn around.

Mister Neal. Mister Neal, yes. Mister Doggett. Mister Thompson. Mister Thompson, yes. Mister Larson.

Yes.

Mister Larson,

Sanchez.

yes. Mister Davis.

Yeah.

Mister Davis, yes. Miss Sanchez, yes. Hey, hey, hey, hey, hey, hey, hey, hey, hey. Miss Sewell. Miss Del Bene. Oh, yeah, Miss Del Bene. Miss Del Bene, yes. Miss Chu. Um Miss Chu, yes. Miss Moore. Miss Moore, yes. Mister Boyle.

I'm

Mister Boyle, yes.

I'm sorry.

Mister Beyer. Mister Evans.

Yes.

Mister Evans. Yes, Mr. Schneider. Yes. Yes. Mr. Schneider, yes. Mr. Panetta. Yes. Mr. Gomez. Yes. Mr. Gomez, yes. Mr. Horsford. Mr. Horsford, yes. Miss Plaskett. Mr. Swazi.

Wow. You have

Mister Swasey, yes. Mister Smith of Nebraska.

Yeah.

Mister Smith of Nebraska, yes. Mister Schwe- Mister Schweikert.

Yes.

Mister Schweikert, yes. Mister Arrington.

Yes.

Mister Arrington, yes. Mister Doggett.

I think I did a really beautiful job.

Miss Sewell.

I think I just missed. Okay, too bad.

Mister Beier.

And literate.

Mister Panetta. Miss Plaskett. Chairman Smith.

Yes.

Chairman Smith, yes.

The clerk will report the vote.

Mister Chairman, the yeses are forty and the noes are zero.

There being forty yeses and zero noes, the motion is agreed to in H R ninety-four sixty-eight, as amended, as ordered favorably reported to the house. Without objection, I ask that staff be authorized to make technical and conforming changes to H R ninety-four sixty-eight and that members have two additional days to file with the committee clerk supplemental additional dissenting or minority views. Our next order of business is H R thirty five four teen the improving seniors timely access to care act, introduced by tax subcommittee chairman Kelly. Chairman Kelly has been a leading voice to improving Medicare services and in standing up to insurance company abuses on behalf of patients. This legislation builds on the work this committee has done to bring greater transparency and streamline the prior authorization

Well, uh, thank you, Chairman. Uh, I also wanna look down the dais to my colleague, uh, Mr. Albany.

Thank you.

Uh, so, I'm kind of fascinated by Let's talk about the improving seniors timely access to care act. I'm I think that Miss DelBene and I would say it would be nice to have a quicker response to legislation that actually made a difference in everybody's life. Uh, this has been seven years, Miss DelBene. So thank you so much for hanging in there. Uh, and I and I would say as I look out into the audience and the people that are here today, in my whole life I've been in the automobile interest in the industry. So, uh, I can't imagine somebody pulling into our dealership who has warranty coverage and saying, " I am having a problem with my car." And I said, " Well, you know what, I better call the manufacturer to make sure I can get authorization to go ahead and fix your car." Or they pull into the, the body shop and they say, " I need to get my car fixed." I said, " Well, you know what, I would like to fix it today but we can't, we have to get the insurance company in here to actually give us permission to go ahead and fix your car." And they say, " Well, we, but I've been paying on an insurance policy, why do I have to wait to get it fixed?" And the answer is, " Well, that's just the way it is." Why can I tell you, Mister Albany? That's not the way it is. We both come from the private sector. It's one or two things in the private sector. You either outperform expectations or you go out of business. Uh, I would just suggest that at some point in our lives we need to take a look at things that are really important to people. This is not a, this is not uh, a Republican problem or a Democrat problem. This is an American citizen's problem. So as I as I look at what we're trying to get done today, seven years, seven years to get prior authorization, seven years to wait for us to do something legislatively, to get done what should be done automatically. And I have friends that are doctors and and nurses, and they say the most frustrating part of their job is waiting to get an OK to go ahead and take care of a patient who needs something right now. Uh, look, I I I know patience is a virtue, uh, but it's not the people who are patients that need work done. So, uh, I can't tell you how much I appreciate, Mr. Albany, thank you for being with us so time. And by the way, By the way, so people understand we never do things together, we do, and over three hundred of our colleagues also agree with what we're proposing get done. So, I'm saying enough of the waiting and holding and working about when am I gonna get coverage on this, who else do I have to have authorize it? You and I have worked on this together and our colleagues have worked on this together. This is a marvelous piece for people to see how things can work in Congress. The only thing I'm disappointed It's taken us seven years, ma'am, to get to something that should be done in seven minutes. Thank you so much. And, Chairman, I yield back my time.

Thank you. I now recognize the ranking member.

Thank you, Chairman. Let me yield my time to the gentlelady from Washington State, Miss DelBene.

Thank you, Mister Chairman, thank you, ranking member, and a huge thank you to my colleague, uh, Mister Kelly, and who has been working uh with me on this tirelessly for many years. Um, to the entire committee of the Regulatory Relief the American Medical Association for partnering um to advance this bipartisan, zero cost legislation. Um the improving seniors timely access to care act will help nearly thirty-five million seniors uh on Medicare Advantage get the care they need when they need it. Unnecessary red tape from insurance companies delays necessary care. It worsens health outcomes and forces providers to spend too much time, justifying common procedures, instead of treating patients. Three out of four patients with a Medicare Advantage plan are subject to prior authorization, and many of their claims are unnecessarily denied. In twenty twenty-four, only a small fraction, eleven point five percent, of Medicare Advantage denials were appealed. And it's a lot of work to go through an appeal. And eighty percent of those appeals were overturned, meaning they never should have been deny denied care in the first place. This is really a sign of a very deeply flawed system. Many people in this room and around the country are all too familiar with having to spend hours going back and forth on the phone or faxing documents to their insurance company just to get a standard treatment approved from themselves or a loved one and even Congress has finally moved beyond the fax machine um but insurance companies should be able to do the same in twenty twenty six. This bill will modernize outdated time-consuming processes so care is no longer unnecessarily delayed. Providers will be able to submit their requests electronically using a standardized form seniors will have more safeguards against arbitrary prior authorization requirements leading to fewer delays and denials. Insurance companies will have to provide timely responses to requests, so patients aren't stuck waiting for necessary care and plans will also have to be honest about how often they delay and deny care before choosing a plan. Seniors will be able to compare their options in one place and pick the health care that works best for them. In twenty twenty two, this common sense bill passed unanimously out of the house. It currently has nearly three hundred bipartisan cosponsors in the house and seventy cosponsors in the senate. We have the support of over three hundred national and state organizations representing patients, providers, hospitals, the Medicare Advantage plans themselves, and other leading health care stakeholders. Yet we only deliver for our constituents, we actually pass a bill through both chambers and get it signed by the president. And we are in a position to get meaningful prior authorization reform over the finish line and deliver real results for our constituents. It is critically important that we get this done, um, and it starts with advancing it through this committee today and quickly passing it on the floor of the house thanks again to my colleague, Mister Kelly, um, and I yield back, Mister Chairman.

Thank you. The committee will now proceed to consideration of HR thirty five fourteen, the improving seniors timely access to care act of twenty twenty five. Without objection, the measure will be considered as read and open for amendment at any point. At this time I offer an amendment in the nature of a substitute, which was distributed in advance along with a green sheet explaining it. Without objection, the amendment in the nature of a substitute shall be considered as read, open for amendment at any point, and considered base text. for purpose of the amendment. I will now turn to Patrick Dumas, Health Subcommittee Staff Director, to provide a technical description of the amendment in the nature of a substitute, with an emphasis on the changes made since introduction. I ask that members hold their questions until after his presentation.

Thank you, Chairman Smith, Ranking Member Neal. H R thirty-five fourteen, the Improving Seniors' Timely Access to Care Act contains two sections. Section one provides for the short title of the bill. Section two amends section eighteen fifty-three of the social sch- Security Act to require Medicare Advantage plans to establish electronic prior authorization processes, Medicare Advantage plans to submit relative prior authorization data to CMS, reports on the use of prior authorization in Medicare Advantage, and implementation of the requirements of the bill, and enrollee protections through beneficiary involvement in the development of prior authorization programs. The amendment in the nature of a substitute makes technical and clerical changes to the bill, This concludes the technical walkthrough.

Thank you. Are there any technical questions about the amendment in the nature of a substitute? Seeing none, we will move to strike the last word. Mister Thompson is recognized to strike the last word.

Thank you, uh, Mister Chairman, I move to strike the last word. And thank you, Mister Chairman, for bringing these bills, uh, to mark up today, these bipartisan bills. Um, I much appreciate that. And on this particular bill, I want to thank Mister Kelly and Mister uh for your great work making sure this bill got here, is getting marked up and will be hopefully will uh become law. I uh strongly support the improving seniors timely access to care act, to improve the prior authorization process and Medicare uh advantage. This is a key step in reducing administrative burden and ensuring our seniors get the care they need and get it when they need it. Mr. Chairman, several of the bills in today's mark-up focus on transparency, and transparency requires disclosure of information and data. And unfortunately, this administration is cutting back on that data and in doing so, hurting Americans across our country in every one of our congressional districts. One year ago this month, Secretary Kennedy's CDC stopped tracking a cyclosporine parasite. And now, a year later, we have an unchecked outbreak running across our country. Over five thousand people have become very sick because of this. Secretary Kennedy claims he wants to make our country healthier. But Americans are scared to eat salad. Once again, this administration is proving they're making diseases great again. Secretary Kennedy refuses to support the CDC and common public health measures. If he won't resign, he should be res- removed from this position as quickly as we possibly can. We need to properly fund and staff the CDC to ensure the safety of the constituents that we represent. Thank you and I yield back.

Thank you. Um, I now recognize myself for five minutes to strike the last word. Um, I I moved to strike the last word in support of the Improving Seniors' Timeliness Access to Care Act, legislation I'm proud to cosponsor. This common sense bipartisan bill is to improve care for our seniors enrolled in Medicare Advantage. Today, fifty-four percent of Medicare beneficiaries or thirty-two point eight million seniors rely on Medicare Advantage for their health coverage. For too long, an antiquated prior authorization process has stood between patients and the timely medical necessary care they deserve, burying our health care providers under heaps of unnecessary and burdensome paperwork. The data from recent years paints a concerning picture. In twenty twenty-four alone, Medicare Advantage insurers received fifty-three million prior authorization requests. Averaging one point seven requests per enrollee. Most alarmingly, of the eleven and a half percent of the denials that were appealed, nearly eighty-one percent were overturned. This high rate of overturned appeals strongly suggests that insurance may be abusing the prior authorization process, resulting in in dangerous delays in care. By establishing a standardized electronic, uh, prior authorization process, this bill cuts through that red tape. It insures timely care by requiring standard prior authorization requests to be completed in seven days, and urgent requests to be completed within seventy-two hours. It increases insurer accountability and transparency by requiring plans to publicly disclose to publicly disclose prior authorization information including the number of requests denied and approved, as well as the total time to resolution. Furthermore, it strengthens beneficiary protections by requiring enrollee involvement in prior authorization program development. The impact of this reform cannot be overstated. CMS uh Office of the Actuary previously estimated that transitioning to this electronic process would reduce the administrative bur- burden across all providers by at least two hundred and twenty million hours over ten years. This is a win for seniors, a win for clinicians, and a win for bipartisan common sense governing. I encourage my colleagues to join me in supporting this legi- legislation. And now I yield back my time, and I'll recognize Mister Davis for five minutes to strike the last word.

Thank you, Mr. Chairman. And I'm pleased to support HR thirty-five fourteen, the improvement in seniors' timely access to care act. Introduced by Representatives Mike Kelly and Suzanne DelBene. I appreciate their bipartisan leadership on this important legislation. This bill modernizes the Medicare Advantage prior authorization process. by requiring the Centers for Medicare and Medicaid Services to implement electronic prior authorization standards and establish greater transparency and accountability in how prior authorization requests are reviewed and processed. Prior authorization was originally intended to promote appropriate care and control costs. However, for too many seniors, it has become a barrier to receiving timely medical treatment. Older Americans enrolled in Medicare Advantage plans often face unnecessary delays, while physicians wait for insurers to approve procedures, medications, diagnostic tests, or medical equipment. These delays can have serious consequences. particularly for patients managing chronic illness or other time-sensitive medical conditions. The evidence is clear. According to the American Medical Association, ninety-five percent of physicians report that prior authorization delays patient care and nearly one in four physicians say those delays have resulted in a patient's hospitalization. Prior authorization also creates significant barriers to accessing prescription medications. Many beneficiaries are forced through burdensome step therapy requirements, requiring them to try less effective or inappropriate medications before gaining access to the treatment their physician originally prescribed. These requirements delay care, increase frustration, and can ultimately worsen health outcomes. H. R. thirty-five fourteen takes meaningful steps to improve this process by streamlining prior authorization, increasing transparency, and encouraging the use of electronic systems. This legislation will reduce unnecessary administrative burdens on providers while helping ensure that seniors receive timely access to the care they need. This is a practical bipartisan solution that strengthens the Medicare Advantage program. While putting patients first, I urge my colleagues to support it. And you're back to balance your matter.

Thank you. Thank you. I now recognize Mister Smith of Nebraska f- to strike the last word.

Thank you, Mister Chairman, and certainly thank you to my colleagues, uh, Mister Kelly and Mister Albany for their diligent work on this. I I don't want to repeat what's already been said. I do want to associate, uh, my comments with those that have been made that certainly, uh, emphasize that the timeliness of all of this is so important to care, to efficiencies, And uh being able to hopefully utilize new technologies to move things along more quickly I think everyone benefits from. Thank you, I yield back.

Gentlemen deals, I now recognize Miss Sewell of Alabama for five minutes to strike the last word.

Thank you, Mister Chairman, I move to strike the last word to support HR thirty five fourteen. Uh first I'd like to thank our colleagues, uh representatives Del Bene and Kelly for their leadership on this important issue. I am proud to be a cosponsor of HR thirty five fourteen, the improving seniors' timely access. to Care Act, and I am so glad that we're moving this legislation forward today. Unfortunately, too many seniors and their providers know the frustrations of prior authorizations. What was intended to be a tool to insure appropriate care has too often become a barrier between patients and the services their doctors have determined they need. As many seniors in Alabama and across the country choose to enroll in Medicare Advantage pro- plans, They should not have to navigate unnecessary delays, confusing paperwork, or a lengthy appeals process before receiving medically necessary care. These delays have real consequences. For a senior waiting for a procedure, a medication, or a critical treatment, a delay is not just an administrative inconvenience. It can mean worsening health care outcomes, increased stress, and unnecessary suffering. And this burden does not just fall on the patients. Physicians and their staff spend countless hours fighting their prior authorization uh requirements instead of spending that time caring for their patients. This bill will allow those providers to spend less time on paperwork and more time focusing on their patients. This bill also arms seniors with the information they need to make decisions about their own health care. Far too often, Medicare beneficiaries have not had enough information about how their plan handles prior authorizations. Seniors deserve to know what services require appeals and approvals, how often those requests are denied, and how their plan compares to others when they are making decisions about their health care coverage. Our seniors have earned the right to timely access to the care that they need. This bill is an important step towards putting patients first, reducing unnecessary barriers, and ensuring that health care plans are held accountable. At the end of the day, this bill is about one thing and one thing most importantly, making sure that our seniors can get the care that they need when they need it. I fully support this legislation and I ask all of my colleagues uh to do the same and I yield back the balance of my time.

Thank you. I now recognize Mr. Dr. Murphy for North Carolina for to strike the last word.

Thank you, Mr. Chairman. You know, prior authorization and denial process was done to put in checks and balances, which I'm fine with, um, to make sure uh, physicians are not ordering tests or procedures or medications that are not needed. Um, and sadly enough, we have some outliers in the physician world that do that. But sadly enough, our insurance industry, which I just remember w- had a little chat about several months ago, has taken this now to extreme, especially in the Medicare Advantage world. If you look at what's happening with prior authorization, they've weaponized this. And I will tell you, I have absolute personal knowledge in my experience as a physician that their denial process has hurt patients, and in my opinion, caused patient harms, if not patient death. So let's go through this. Let's look at who are the worst offenders are. So the industry average of denials through Medicare Advantage is around seven percent, seven and a half percent. Guess who's number one? Twelve point eight percent, UnitedHealthcare. Guess who makes the most money? UnitedHealthcare. Right right following this, Centene, twelve point three percent, CVS eleven point nine, Kaiser Permanente, ten point nine, Humana five point eight, Elevance four point two. We have some good actors. We have some really bad actors. So if United says that one out of eight of every physician's decisions is wrong, they get overturned eighty percent of the time. This is wrong. They have weaponized the system to their own profit. So, I really, really want to thank Mr. Kelly, Miss DelBene for bringing this forward. This is something that unites all patients. This is a ninety- ten issue. I've actually polled it. It's even actually a little bit higher. The patients are tired of this nonsense. Physicians are tired of this nonsense. We sit in our offices, wait, uh, in our offices, waiting to get denied, then having to go through and pay and pay and pay for administrators and nurses and other staff to go through the appeals process. which just adds more and more money and then eventually gets overturned. It's time that we took the fangs of this insurance industry, which has a stranglehold on this town, and de-fanged them. It's time to return this back to patients, put some sense in this system, stop the profit over patient margins that have just encompassed the insurance industry and get it back to affordable health care. We talk about affordability in health care all the time. The insurance industry is the leading source of the unaffiliated prices And this is a perfect example of why this is a problem. They deny, deny, deny, create a bureaucracy that costs money, costs time, and in the end causes patient harm. So I'll say this. Thank you, Mister Kel- uh, Mister Kelly, thank you, Miss DelBene for highlighting this issue. I hope we have a unanimous vote here, an unanimous vote in the House, and I hope we take the fangs out of the insurance industry, which has a stranglehold on this town. I'll yield back.

Thank you. The gentleman yields. And I recognize Miss Chu from California for five minutes, a strike to last word.

Thank you, Mister Chair. I strongly support this bill, HR thirty-five fourteen, the improving seniors' timely access to care act, and I want to thank representatives DelBene and Kelly for their leadership on this critical bipartisan legislation. I've heard from countless physicians across my district in Southern California, from large hospital systems to small independent practices, and no matter their specialty, They tell me the same thing. Prior authorization has become one of the biggest administrative burdens they face. Instead of spending time with patients, doctors and their staff spend hours every week navigating paperwork, responding to insurer requests and appealing denials for treatments they've already determined are medically necessary. And it's patients who pay the price. Too often seniors are forced to wait days or even weeks for the care they need while paperwork works its way through the system. This bill is an important step towards fixing that. It modernizes the prior authorization process by requiring electronic prior authorization, improves transparency so beneficiaries can better understand how Medicare Advantage plans use prior authorization, and gives CMS additional tools to improve the timeliness of these decisions. It also requires plans to report how often Artificial intelligence is used in prior authorization determinations, an important step as these technologies become more prevalent in our healthcare system. This bill will help reduce unnecessary administrative burdens, improve transparency, and most importantly, help seniors receive medically necessary care more quickly. And this legislation builds on reforms already underway and gives CMS additional tools to ensure medical

ensure Medicare Advantage plans are held accountable for unnecessary delays and administrative burdens. This is a common-sense bipartisan bill that will help seniors receive medically necessary care more quickly while reducing unnecessary burdens on providers. I urge my colleagues to support this bill and I yield back.

Thank you.

Thank you. I now recognize the gentleman from Nevada, Mister Horsford, for five minutes to strike the last word.

Thank you, Mr. Chairman. I move to strike the last word. I am also a proud cosponsor of HR thirty-five fourteen, the improving seniors timely access to care act, and I appreciate the bipartisan work of Miss Delbeny and Mister Kelly in bringing this legislation before the committee. Now, health care isn't just a health issue. It's one of the biggest affordability issues facing working people and their families every day. Even when people have insurance, too many still face uns- unnecessary delays, mountains of paperwork, and uncertainty about whether they can receive the care that their doctor has already determined that they need. This isn't just a policy debate, either. As a caregiver for my own mother, I have experienced first-hand how prior authorization can delay medically necessary treatment that was recommended by her doctors and therapists but delayed because of a prior authorization denial at the very moment families should be focused on recovery and healing. Not navigating bureaucracy and filing appeals to get the care that their family member deserves and needs. They should be spending precious time caring for their loved one and not fighting paperwork. So that has to change, and I believe that this legislation is one part of that effort. I also hear the same story from constituents all across Nevada. Prior authorization is delaying medically necessary care, disrupting treatment, and creating unnecessary stress for patients, caregivers, and health care providers al- alike. And that's why when we had the CEOs of these major insurance companies, this is one of the issues that I asked for their commitment on, uh, to work to address. And now we are moving that legislation forward. Nearly sixty percent of Medicare beneficiaries in Nevada are enrolled in Medicare Advantage plans. That means a majority of our seniors can face prior authorization requirements before receiving the care that they need. When you're recovering from a stroke, managing heart disease, or living with multiple chronic conditions, delays are more than frustrating. They can lead to setbacks in recovery, avoidable hospitalizations, and unnecessary suffering. These barriers are especially challenging in Nevada, where provider shortages and long travel distances already make accessing care difficult. Patients should not travel hours to see a specialist, only to learn an insurance approval is still pending. That's wrong and that must be fixed. Our physicians and nurses are also frustrated. They spend countless hours navigating outdated fax machines, phone calls, and multiple on-line portals instead of caring for the patients that they're trusted to serve. That is time taken away from the people who need the care the most. This legislation offers a common sense, bipartisan solution. It modernizes the prior authorization process by establishing electronic prior authorization. It increases transparency. It improves accountability. And it creates a more predictable system for patients and providers alike. Importantly, the bill does not eliminate appropriate oversight. It ensures that prior authorization works for parent patients instead of against them. And when care is medically necessary, seniors deserve timely decisions, not unnecessary delays. So, this is exactly the kind of bipartisan legislation that the Amer- American people expect Congress to pass. It cuts red tape. It supports physicians. And most importantly, it helps seniors receive the care that they've already been told they need. I urge my colleagues to support H. R. thirty-five fourteen and finally get this long overdue reform across the finish line. And I hope that we will continue to work on other areas that are as critically important as this one. With that, I yield back.

Thank you.

Seeing no one else to uh strike the last word. Are there any amendments to the amendment in the nature of a substitute? If there's no amendments, the question on the adoption of the amendment in the nature of a substitute. All those in favor, signify by saying aye.

Aye.

Those opposed, no. In the opinion of the chairs, the yeses have it, and the amendment in the nature of a substitute is agreed to. I will now recognize Mister Buchanan for the purposes of offering a motion.

Mister Chairman, I move the committee favorably report H R thirty five fourteen as amended to the House of Representatives.

The question is on the motion to favorably report H R thirty five fourteen as amended to the House of Representatives. The clerk will call the roll.

Mr. Buchanan.

Yes.

Mr. Buchanan, yes. Mr. Smith-Nebraska. Mr. Smith-Nebraska, yes. Mr. Kelly. Mr. Kelly, yes. Mr. Schweikert. Mr. Schweikert, yes. Mister LaHood.

Yes.

Mister LaHood, yes. Mister Arrington. Mister Estes.

Yes.

Mister Estes, yes. Mister Smucker.

Yes. Yes.

Mister Smucker, yes. Mister Hern. Mister Hern, yes. Mrs. Miller. Doctor Murphy. Dr. Murphy, yes. Mister Kustolf,

Yes.

mister Kustolf, yes. Mister Fitzpatrick, mister Fitzpatrick, yes.

Yes.

Mister Steube,

Yes.

mister Steube, yes. Miss Tenney,

Yes.

miss Tenney, yes. Misses Fischbach,

Yes.

misses Fischbach, yes. Mister Moore, mister Moore, yes. Miss Van Duyn, miss Van Duyn, yes. Mister Feenstra, Mister Feenstra, yes. Miss Malia Takis. Miss Malitakis, yes. Mister Kelly. Mister Kelly, yes. Mister Yockem. Mister Yockem, yes. Mister Miller.

Yes.

Mister Miller, yes. Mister Bean.

Yes.

Mister Bean, yes. Mister Moran. Mister Moran, yes. Mister Neal. Mister Neal, yes. Mister Doggett. Mister Thompson. Mister Thompson, yes. Mister Larson.

Yes.

Mister Larson, yes. Mister Davis.

Yes.

Mister Davis, yes. Miss Sanchez. Aye. Miss Sanchez, yes. Miss Sewell. Aye. Miss Sewell, yes. Miss Del Bene. Aye. Miss Del Bene, yes.

So what's next?

Miss Chu. Aye. Miss Chu. Yes, Miss Moore. Miss Moore, yes. Mister Boyle. Mister Boyle, yes. Mister Beyer. Mister Evans.

Yes.

Mister Evans, yes. Mister Schneider. Yes. Mister Schneider, yes. Mister Panetta. Yes. Mister Panetta, yes. Mister Gomez. Mister Gomez, yes. Mister Horsford. Mister Horsford. Yes, Miss Plaskett. Mister Swasey. Mister Swasey, yes. Mister Arrington. Mister Arrington, yes. Mrs. Miller.

Yes.

Mrs. Miller, yes. Mister Doggett. Mister Beyer.

Yeah.

Miss Plaskett. Chairman Smith. Chairman Smith, yes.

The clerk will report the vote.

Mr. Chairman, the yeses are forty-two and the noes are zero.

There being forty-two yeses and zero noes, the motion is agreed to and H R thirty-five fourteen, as amended, is ordered favorably reported to the House. Without objection, I ask the staff be authorized to make technical and conforming changes to H R thirty-five fourteen and that members have two additional days to file with the committee clerk supplemental additional dissenting or minority views. Our next order of business is H R ninety-six forty-four, the Medicare Advantage MLR Transparency Act, introduced by Representative Moran. Representative Moran's legislation advances the goals established in President Trump's great health care plan by shining a light on large health insurance companies' finances and ensuring seniors have clearer information when choosing their health care coverage. I'm pleased to recognize the gentleman from Moran, Mister Texa- Mister Moran, for an opening statement.

Thank you, Mister Chairman. Uh, Mister Chairman, today I'm gonna speak strong. of this H R ninety-six forty-four, the Medicare Advantage MLR Transparency Act. Transparency is indeed essential to ensuring that insurers, entrusted with beneficiaries' dollars, are accountable for how those dollars are spent. The reality is that seventy-five percent of Medicare beneficiaries report that choosing a Medicare plan is confusing. And one third say that they do not have a good understanding of the differences among the Medicare Advantage That is frustrating. It's very frustrating for these beneficiaries and for folks that are trying to choose these plans not only when selecting them but also because they often lacked a adequate insight into how insurers spend the premiums that they ultimately receive. The medical medical loss ratio, also known as the MLR, was established in two thousand and ten to regulate revenue and administrative costs for insurance companies including Medicare Advantage plans. MLR rules were also designed by Congress to make sure that a majority of the patient's premium dollars are spent on their health care. But while the original intent of MLR L rules were intended to do just that, MLR reporting has become far more complicated due to its multiple revenue and spending streams, and the patient benefit goal is lost in the data and simply not clear. That's why earlier this year, President Trump announced his great health care plan, which emphasized greater transparency for patients. And today this committee has an opportunity to bring that additional transparency for millions of beneficiaries enrolled in Medicare Advantage plans. H. R. ninety-six forty-four requires Medicare Advantage plans to submit information to CMS regarding their revenues and expenditures and to make that information publicly available on their web sites. This is transparency. This is a benefit to those that are choosing these plans. It will give current and future beneficiaries greater visibility into how plans allocate their resources and it will help consumers make more informed decisions when choosing their coverage. That's a win for those on fixed incomes who are making these decisions. The bill also provides additional transparency regarding the supplemental benefits offered by each Medicare Advantage plan as well as additional reporting on encounter data by MA plans. HR ninety-six forty-four adv- advances greater transparency, it strengthens accountability, and it empowers Medicare beneficiaries and Medicare Advantage participants when with the information that they need and that is crucial to understanding that they're getting the best value and the best bang for their buck. And it's important to the taxpayers, uh, along the way. I urge my colleagues to support this bill strongly, and with

Thank you. I'd I now recognize a ranking member from Massachusetts,

Thank you, Chairman,

you know, for something.

uh, I want to yield my time to the gentlelady from California, Miss Chu.

Medicare is a federal guarantee that American workers will age with dignity and access to quality affordable health care. That guarantee is under threat as giant insurance companies profiteer off Medicare. Though initially claiming that they would be more efficient and cost so much less than traditional Medicare, MA private insurers have never saved a penny. In fact, MA Medicare Advantage actually continues to cost taxpayers tens of billions more every year. Insurers will claim that money is spent on consumers with additional benefits from groceries to pest control to rent. But hidden in the fine print that the ads and the brokers do not readily disclose, consumers often find they aren't even eligible for these benefits, or the coverage is not nearly enough to meet their needs. Ultimately, taxpayers are disadvantaged by paying more, while consumers are disadvantaged as they face care delays and denials. The only advantage in Medicare advantage goes to the private insurer. What's more? With increasing consolidation, insurers are making even bigger profits. A single insurer, United Health, now owns ten percent of all physicians and about twenty-seven hundred subsidiaries, including pharmacies, pharmacy benefit managers, telehealth platforms, urgent care clinics, hospitals, home health agencies, software, and so much more. This consolidation is manipulating the accuracy of the medical ratio calculations this bill is focused on. When an insurer is paying entities it owns for a service it gets to document it as a cost when it is really a hidden profit. This same problem exists with the supplemental benefits MA plans love to market to lure more susceptible consumers. We don't even have public data concerning how many consumers utilize these benefits, let alone the ownership, information, and payments to calculate the medical loss ratio. While this bill addresses part of the problem with requiring utilization reporting, it ignores how consolidation has become another moneymaker for these giant companies. And while transparency is good, enough is known to take meaningful action to stop, waste, fraud, and abuse in the MA program. I joined Mister Doggett in filing the Saving Medicare Act to address the many ways MA insurers are overpaid and insure it does not cost more than traditional Medicare. As the bipartisan committee for responsible f- federal budget said, the Saving Medicare Act puts forward a comprehensive plan to address the underlying causes of excessive MA costs and would substantially reduce deficits lower health care costs for seniors, extend the solvency of the Medicare Part A trust fund, and address a serious source of waste and abuse in our government. I urge you, Mister Chairman, to take a look and include this bill in our next mark-up. It's time to stop private insurers from treating Medicare as a piggy bank. And with that, I yield back.

Thank you. Committee will now proceed to consideration of H R ninety-six forty-four, the Medicare. MLR transparency act. Without objection, the measure will be considered as read and open for amendment at any time. At this time, I offer an amendment in the nature of a substitute, which was distributed in advance, along with a green sheet explaining it. Without objection, the amendment in the nature of substitute will be considered as read, open for amendment at any point, and considered base text for the purpose of the amendment. Mister Smith, excuse me. I will now turn to Patrick Dumas, uh, Health Subcommittee Staff Director to provide a technical description of the amendment in the nature of a substitute with an emphasis on the changes made since introduction. I ask that members hold their questions until after his presentation.

Thank you, Mister Estes, Ranking Member Neal, H R ninety-six forty-four, the Medicare Advantage MLR Transparency Act contains four sections, as amended, cont- contains four sections. Section one provides for the short title of the bill. Section two amends section eighteen fifty-seven of the Social Security Act to require Medicare Advantage plans to submit to the Centers for Medicare and Medicaid Services and publicly post on their website information regarding the plan's medical loss ratio. Additionally, this section requires the Secretary of Health and Human Services to align the standards of benefit information across all payer types in the Medicare and commercial markets. Section three amends section eighteen fifty-seven of the Social Security Act require Medicare Advantage plans to provide data to CMS on the supplemental benefits offered to beneficiaries. Section four amends section eighteen fifty-nine of the Social Security Act to require Medicare Advantage plans to provide detailed claims data to to CMS through the encounter data system. The amendment in the nature of a substitute amen adds sections three and four to the bill draft. This concludes the technical walkthrough.

Thank you. Are there any technical questions about the amendment in the nature of a substitute? Seeing none, does anyone wish to strike the last word?

Doctor Murphy.

Hmm? Oh, I recognize uh Doctor Murphy from North Carolina for five minutes to strike the last word.

Thank you, Mr. Chairman. You know, the whole purpose of the medical loss ratio was to keep insurance companies honest that most of the money was being spent towards patient care um again I I I I like the fact I love the fact that this is a bipartisan exercise and people understand that the insurance companies have now just taken advantage of a system that was supposed to be meant for patient care um and abused it. They manipulate the medical loss ratio. So, Right now, eighty-five percent of the revenue or premiums are supposed to be sent on direct patient care, and that fifteen percent is for quote " overhead" and for " profits" and um " compliance". I'm gonna give you a little example. My favorite friend, United Healthcare, legally manipulates the loss ratio by funneling premium dollars to its own healthcare provider subsidiary, Optum, which shifts corporate products, profits into unregulated businesses. while still counting them as medical spending on paper. Further, as our Senate colleagues investigated, UHC aggressively up-coded patients, five great articles in the Wall Street Journal a few years ago, elaborating on this, where United Healthcare made patients appear much sicker on paper to pull in billions and billions of dollars in extra government funds. So they make the pie bigger so that fifteen percent um actually changes in size. So, it it re-admitted I they artificially inflated their medical spending metrics. So, this aggressive data gaming and vertical integration strategies actually ultimately triggered the Department of Criminal Justice investigation and a million dollar fraud lawsuit from the Massachusetts Attorney General. So, I I am I I am glad that this is a bipartisan exercise. It is sad that um we had what was I thought again a good a good program by the federal meant to save uh save money but also keep patients at home, keep them healthier. But as usual uh they're now finding industries, especially now with our health insurance industry, a way of gaming the system. And that's Congress's duty. It is our duty as oversight, is to go after these bad actors whatever field they're in. And I wanna congratulate my colleague uh Mr. Moran, Judge Moran uh for putting forth this effort and I will look forward to hopefully a unanimous uh vote uh in the Oh, you're back.

Thank you. I now recognize Mister Snyder from Illinois for five minutes to strike the last word.

Um, thank you Mister Chairman. Uh, I move to strike the last word. Over the last year, the Trump administration and congressional Republicans have repeatedly chosen to squeeze health care coverage for working families, cutting access to Medicaid, refusing to have a conversation with the Affordable about the Affordable Care Act, and on and on. When in crisis, a patient should rightly assume that when they call nine one one, an ambulance will promptly arrive if necessary. This shouldn't be a question left hanging out there. Because of the impacts enacted by H R one, the public systems that show up when someone calls for help are now under serious threat. When an ambulance responds to a Medicaid patient, the fire par- department might not get dis- reimbursed enough to cover the actual expenses. for that emergency transit. States have used a supplemental p- supplemental payment program called the Ground Emergency Medical Transportation or GEMT program to close that gap, reimbursing local first responders closer to their actual documented costs of keeping the ambulance operating fully staffed fueled, and ready to respond at any hour of the day or night. This program is critical for fire departments to keep their ambulance ready to respond when emergencies happen when citizens call. When Republicans passed H. R. one just over one year ago, they voted to end Medicaid supplemental payments, including the GEMT program. To put it simply, Republicans voted to cut funding to local fire departments who are providing emergency ambul- ambulance service to the people they serve who are our constituents. The Center for Medicaid and Medicare Services is now writing a rule to carry this provision out and to eliminate the GEMT program. The rule CMS has proposed would cap reimbursement payments at the Medicare ambulance rate. This rate does not begin to cover the cost of a truck sitting ready at three AM, the crew on shift, or the equipment that has to work every single day, twenty-four hours a day, seven days a week. Instead, the administration wants to pass this cost along to local fire department, and ambulance providers. CMS has provided a pathway for a potential exemption from the Rule one F that the state uses cost-based reimbursement, if the state uses cost-based reimbursement. There is one major problem with this. CMS hasn't told anyone what cost-based actually means for purposes of that exemption. No methi- methodology, no standard, no guidance. States and EMS agencies are being asked to qualify for a lifeline without This is not a small technical gap. Fire chiefs in my district are trying to build multi-year budgets around a policy that is not at all clear or provide any certainty. If finalized without clear guidance, we won't be talking about a rounding error. We'll be talking about ambulance that can't afford to be fully staffed, response times that are increasingly longer, and already bootstrapped public safety agencies having to make up the cost difference. Before this rule is finalized, CMS needs to give the states and the S EMS agencies a clear, workable definition of what qualifies for that cost-based exemption. Our fire departments deserve a straight answer, not a guessing game, before the ambulance before the ambulance shows up short. All of this could have been easily avoided if Republicans did not vote to pass HR one and take one trillion dollars out of the health care system to give tax breaks to billionaires. I yield back the balance of my time.

Thank you. I recognize Mister Schweiker from Arizona for five minutes to strike last word.

Uh, thank you, Mister Chairman, and hopefully I can do this fairly quickly. Um, six times so far I've heard the reference back to, uh, Medicaid H R one. There's a math problem. Just this fiscal year, so we're not even done with it. Uh, Medicaid spending is already up nine point seven percent, And if you look at the curve, when we finish the fiscal year, there's a very good chance Medicaid spending, this is the federal side, not the state side, the federal side spending will be up double digits. This is the version, I'm sorry, if you actually look at the charts, it, there was an attempt to slow down the growth of spending. And whatever we did actually isn't slowing it down enough. Um, we got a math problem. We're borrowing so far this fiscal year about ninety thousand dollars a second. I understand Congress loves to spend money, but at some point here we're going to have to deal with the reality that the bills we're working on here, we have to find a way to change the cost of delivering services, particularly health care services. not just have debates on we've turned healthcare into financing, not health. And take a look at your most current budgetary updates and the spending is still exploding. Medicare itself, now Medicaid, Medicare, Medicare trust fund now is gone in, we think, less than six years. Um, demographics and reality sh- are about to kick us in the head. And with that, I yield back.

Thank you. Does anyone else wish to strike last, Ordon? Thank you. Are there any amendments to the amendment in the nature of a substitute? Mr. Chairman. Mr. Thompson, do you have a minute?

Thank you.

Thank you, Mr. Chairman. I have an amendment at the desk.

Oh.

Thank you.

Mr. Kelly. Mr. Chairman, I reserve a point of order. Point of order has been reserved. Uh, the clerk will distribute the amendment, and I ask the gentleman to suspend until the clerk distributes. The gentleman's recognized, uh,

Thank you, Mr. Chairman.

by the Minister's Commission.

Uh, this month we'll celebrate sixty-one years of affordable quality health care for millions through Medicare. As designed, the program is intended to ensure that seniors and people with disabilities get the care they deserve, high quality, accessible health care. But increasingly, Medicare beneficiaries are being shifted to private Medicare Advantage plans. Since twenty twenty-three, more than half of the eligible beneficiaries have been enrolled in Mel- uh, Medicare Advantage. Those plans were billed as a way to keep people healthier and to save money. I'm deeply concerned that they do neither. New data from the Kaiser Foundation shows that Medicare Advantage enrollees generally only have access to half of the physicians in their area, compared to people in traditional Medicare. And access to doctors is even worse for people seeking specialists or urgent issues, like mental health. But despite those access issues, Medicare Advantage is also a vehicle for outsized profits. Taxpayers will spend an average of nearly twenty-seven hundred dollars more per enrollee this year than would have otherwise been spent in traditional Medicare. In fact, Medicare Advantage has the highest gross profit margin of any other insurance plan offering, nearly double the margins in the individual market and more than double enrollees in group plans. As GAO and MedPak have repeatedly made clear, this is a program in desperate need of real guardrails and oversight. This bill makes some improvements. It adds detailed reporting on medical loss cancellations supplemental benefit utilization and encounter data accuracy. But much more is needed to have the full picture of what's happening in Medicare Advantage. My amendment addresses those gaps and gets better information to both consumers and to policymakers. First, it would require information concerning supplemental benefits to be included in the Medicare plan finder so consumers have easy access. Second, it ensures enforcement of the bill's reporting requirements by establishing penalties when plans do not submit encounter data. Third, it would require plans to disclose when reported costs are payments to health care providers, telehealth platforms, and other entities that the insurance company itself owns. In an era of deeply concerning consolidation, stopping companies from hiding profits uh by paying themselves is essential. Finally, my amendment sheds light on the role of agents and brokers. The boom in Medicare Advantage enrollment has been partially driven by slick advertising and aggressive marketing. Any brokers can push plans that favor the highest bidder. rather than the bef beneficiary. My amendment would add much needed transparency into broker compensation and require plans to disclose the information to consumers prior to finalizing their enrollment. I've heard from many colleagues say that they're interested in real transparency and real savings in health care programs. We know that both are desperately needed in Medicare Advantage, And I urge all my colleagues to vote yes on this amendment, and I yield back.

Thank you. Uh, does anyone wish to strike the last word on the amendment? Mister Mister Moran of uh Texas, I recognize, five minutes, strike the last word.

Uh, thank you, Mister Chairman. Just in brief response, I I do appreciate Mister Thompson's uh willingness to bring up s- these issues, and and a number of them are very important issues. Um, uh, this is something that I would have hoped that you would have brought up in the preparation for the bill that we had. We wanna work through some of these uh these matters that you brought up. I don't think they're ready for us to include in the in the uh the bill text today. In particular I'll just mention as it relates to like the brokers uh well I agree, there's a there's a problem with uh the way the incentives are structured uh in the ACA plan for how brokers are are paid and and pushing people into MA plans in particular. And uh I I think if we're gonna get at that, we need to actually have a discussion about how to actually solve that problem, not just uh try to try to shine a little bit of a a small flashlight on it, we actually need to get at it. And getting at it requires us to change the incentive structure. Because that incentive structure in the ACA is really what's caused that that problem from the very beginning. And uh I'm glad that you know last year at our request the GAO issued a report exposing how fake identities of deceased individuals, and improper use of social security numbers were used to exploit Obamacare subsidies. Uh, I think we're gonna see a whole lot more of that uh as we delve deeper into it, but certainly this is like, it looks like a panacea of a number of issues that are just kind of thrown to the wall that we need to talk through before they're ready for inclusion in the bill today so with that, Mister Chairman, I would oppose the amendment but certainly appreciate uh the recognition that we need to change some of what was done wrong in the ACA and get it right. I appreciate the Democrats' willingness to work on that, but that I yield back.

Seeing no one else uh to strike the last word, question is on agreeing to the amendment offered by um uh Mr. Thompson. All those in favor say aye.

Aye.

All those opposed say no.

No.

Up. The clerk will call the roll.

Mister Buchanan.

No.

Mister Buchanan, no. Mister Smith of Nebraska. Mister Smith of Nebraska, no. Mister Kelly. Mister Kelly, no. Mister Schweikert. Mister Schweikert, no. Mister Lahood. Mister Arrington. Mister Estes. Mister Estes, no. Mister Smucker. Mister Smucker, no. Mister Hern. Mister Hern, no. Mrs. Miller. Mrs. Miller, no. Doctor Murphy. Doctor Murphy, no. Mister Gustav. Mister Gustav, no. Mister Fitzpatrick. Mister Fitzpatrick, no. Mister Steube. Mister Steube, no. Miss Tenney. Miss Tenney, no. Mrs. Fischbach. Mrs. Fischbach, no. Mr. Moore.

No.

Mr. Moore, no. Miss Van Duyn. Miss Van Duyn, no. Mr. Feenstra. Mr. Feenstra, no. Miss Malia Takis. Miss Malia Takis, no. Mr. Carey.

No.

Mr. Carey, no. Mr. Yackem. Mr. Yakym, no. Mr. Miller.

No.

Mr. Miller. No. Mister Bean.

No.

Mister Bean. No. Mister Moran.

No.

Mister Moran. No. Mister Neal.

Change chances.

Mister Neal. Yes. Mister Doggett. Mister Thompson. Mister Thompson. Yes. Mister Larson.

Yes.

Mister Larson, yes. Mister Davis.

Yes.

Mister Davis, yes. Miss Sanchez. Miss Sanchez, yes. Miss Sewell. Miss Del Bene. I'm Miss Del Bene, yes. still I'm Miss Chu. Miss two, yes.

Misses again, no.

Miss Moore. Miss Moore, yes. Mister Boyle.

Yes.

Mister Boyle, yes. Mister Beier. Mister Evans.

Yes.

Mister Evans, yes. Mister Schneider. Mister Schneider, yes. Mister Panetta.

Yes.

Mister Panetta, yes. Mister Gomez.

Yes.

Mister Gomez? Yes. Mister Horsford? Mister Horsford? Yes. Miss Plaskett. Mister Swazi.

Aye.

Mister Swazi? Yes. Mister LaHood. Mister LaHood? No. Mister Arrington. Mister Doggett. Miss Sewell. Mister Beyer. Miss Plaskett. Chairman Smith. Chairman Smith, no. Mister Chairman, the yeses are fifteen and the noes are twenty-five.

There being fifteen yeses and twenty-five noes, the amendment is not agreed to. Are there any other amendments to the amendment in nature of substitute? Seeing none, the question on adoption, the amendment, and the nature of a substitute. All those in favor signify by saying yes. Those opposed, no. In the opinion of the chair, yeses have it, an amendment and the nature of a substitute is agreed to. I'll now recognize Mister McKinnon for the purposes of offering a motion.

Mister Chairman, I move the committee favorably report H R ninety-six forty-four as amended to the House of Representatives.

Question is on the motion to favorably report H R ninety-six forty-four as amended to the House of Representatives. The clerk will call the roll.

Mister Buchanan.

Yes.

Mister Buchanan, yes. Mister Smith of Nebraska. Mister Smith of Nebraska, yes. Mister Kelly. Mister Kelly, yes. Mister Schweikert. Mister Schweikert, yes. Mister LaHood. Mister LaHood, yes. Mister Arrington. Mister Estes.

Yeah.

Mister Estes, yes. Mister Smucker.

You're Mr. Smucker.

Mister Smucker, yes. Mister Hern. Mister Hern, yes. Piss off. Piss off. Mrs. Miller. Mrs. Miller, yes. Yeah. Doctor Murphy. Doctor Murphy, yes. Mister Kustoff. Yes. Mister Kustoff, yes. Mister Fitzpatrick. Yes. Mister Fitzpatrick, yes. Mister Steube. Yes. Mister Steube, yes. Miss Tenney.

Ernie. Excuse me.

Yes.

Miss Tenney, yes. Mrs. Fischbach.

Yes.

Mrs. Fischbach, yes. Mister Moore.

Yes.

Mister Moore, yes. Miss Van Duyn.

Yes.

Miss Van Duyn, yes. Mister Feenstra. Mister Feenstra, yes. Miss Malia Takis. Miss Malia Takis, yes. Mister Kelly.

Yes.

Mister Kelly, yes. Mister Joachim.

Yes.

Mister Joachim, yes. Mister Miller. Yeah, I think. Mister Miller, Yeah. Yes. Mister Bean. Bean, yes. Mister Bean, yes. Mister Moran. Yeah. Mister Moran, yes. Oh, yeah. Mister Neal. Mister Neal, yes. Mister Doggett. Mister Thompson. Mister Thompson, yes. Mister Larson. Mister Larson, yes. Mister Davis.

Yeah, yeah.

Mister Davis, yes. Miss Sanchez. Miss Sanchez, yes. Miss Sewell.

Aye.

Miss Sewell, yes. Miss Del Bene. Miss Del Bene, yes. Miss Chu. Miss Chu, yes. Miss Moore. Miss Moore, yes. Mister Boyle. Mister Boyle, yes. Mister Beyer. Mister Evans. Mister Evans, yes. Mister Schneider. Mister Schneider, yes. Mister Panetta. Mister Panetta, yes. Mister Gomez. Mister Gomez, yes. Mister Horsford. Mister Horsford, yes. Miss Plaskett. Mister Swasey.

Aye.

Mister Swasey, yes. Mister Arrington.

Yes.

Mister Arrington, yes. Mister Doggett. Mister Beyer. Miss Plaskett. Chairman Smith. Chairman Smith, yes.

The clerk will report the votes.

Mister Chairman, the yeses are forty-two and the noes, are zero.

There being forty-two yeses and zero noes, the motion is agreed to and H R ninety-six forty-four as amended is ordered, favorably.

Thank you.

Uh. Are you supposed to sit next to me? I always wanna sit next to you.

Amer- Americans should know the cost of health care before they receive a bill. For too long, health care empires have kept patients in the dark, even while hospitals, insurers and other health care entities know the prices be in charge. This committee has spent years examining areas of health care that are broken. And let me tell you, there are a lot of them. After bringing in the nation's largest hospital and health insurance company CEOs, it is clear that the committee has a responsibility to lead the charge to provide more transparency for American taxpayers and patients. This legislation executes on the health care transparency efforts identified by this committee and championed by President Trump through his great health care plan. This bill requires hospitals and insurers to publish the real prices they negotiate, jump-starts true competition, and provides patients with the tools to make smart decisions. The bill increases penalties on the facilities and insurers that fail to post price prices accountability that we watched President Joe Biden ignore for years. and require CEOs of health care empires to personally certify the accuracy of their data. President Trump has the vision, and the Ways and Means Committee will deliver reforms that finally empower patients and workers with health care price certainty. I urge my colleagues on both sides to support this legislation, and I now recognize the ranking member for their o- her opening statement.

Thank you so much, Mister Chairman, and as the Vice Ranking Member, I am going to read this opening statement on behalf of the Ranking Member, Mister Neal. Mister Chairman, thank you. We're told that this bill is a pillar of President Trump's healthcare agenda. Certainly, that says a lot about the state of the agenda. This legislation won't lower costs for patients, It won't restore coverage to the more than eight million Americans who've had theirs ripped away because of Republicans. It won't help the millions facing higher premiums, larger deductibles, or mounting medical debt. All because my colleague chose to dismantle the health care system to give massive tax cuts to billionaires. And despite all the talk about transparency, this bill doesn't give patients information they actually need. Have you ever spoken to anyone who said, We don't need to know. gee, if I if I had pages and pages of negotiated rates, I would know how to make a decision? That's not consumer friendly. It's just more confusion. Congress already addressed this in the bipartisan No Surprises Act We don't need to know what happens if we have to look. by requiring advanced explanations of benefits so patients can understand what they'll actually owe before receiving care.

Mm.

Oh, yeah, oh, yeah, yeah, yeah, yeah, yeah, So, we need to make sure that we're making sure that we're making sure that we're making sure that we're not making too much of a fuss. That legislation passed out of this committee unanimously, but the law isn't being implemented. How about the administration focusing on enforcing the law, instead of creating more paperwork? On the insurer's side, much of what's here is already reported. While Republicans continue to exempt, Medicare Advantage plans from the same transparency standards they demand of everyone else. Three years ago, this committee considered a very similar bill. The difference is what Republicans have done since then. They've slashed coverage, driven up cost, and weakened hospitals across the country. Now they're asking us to believe another transparency bill is the answer. Americans don't need more paperwork. They need health care that they can afford. And with that, I yield back the balance of my time.

Thank you. The committee will now proceed to consideration of H R ninety-six forty-five, the Health Care Price Certainty for All Americans Act. Without objection, the measure will be considered as read and open for amendment at any time. At this time, I offer an amendment in the nature of a substitute, which was distributed in advance, along with a green sheet explaining it. Without objection, the amendment and the nature of its substitute shall be considered as read, open for amendment at any point, and considered base text for purposes of amendment. I will now turn to Patrick DeMoss, Head of State, excuse me, Staff Director of the Subcommittee on Health and Tom Barthold, Chief of, Chief of Staff for the Joint Committee on Taxation, to provide a technical description of the amendment and the nature of its substitute, with an emphasis on the changes made since introduction. I ask that members hold their questions until after their presentation.

Thank you, Mr. Estes, Vice Ranking Member Moore. H R ninety six forty five, the Health Care Price Certainty for All Americans Act contains six sections. Section one provides for the short title of the bill. Section two amends part E of title eighteen of the Social Sec- Security Act, to require hospitals, ambulatory surgical centers, clinical laboratories, and providers of imaging services, participating in Medicare to disclose health service price information. The amendment in the nature of a substitute amends the effective date for hospital price transparency requirements under this section. Section five amends sections eighteen fifty-seven and eighteen sixty D of the Social Security Act to require Medicare Advantage insurers and prescription drug plans to submit to the Secretary of Health and Human Services data regarding payments to medical providers and pharmacies broken out by entities that share common ownership with the insurer or prescription drug plan.

Uh, thank you. Thank you, Patrick. Uh, the members of the committee have before them joint committee document JCX, uh, uh, thirty-four, twenty-six. The legislation makes certain amendments to the internal, uh, Internal Revenue Code, and those are described in detail in that document. By way of background, under present law to be a qualifying group health plan, the plan must provide cost sharing and other information to individuals, to uh enable them to make informed decisions. The proposal before you updates and requires enhanced information for group plans uh for plans uh beginning uh or and after January first of twenty twenty nine. Uh for example, the uh enhanced information uh must uh be in plain English, deliverable in uh real time, searchable by the individual, provide information such as estimates of cost for specific items or services, uh both by provider, a provider in network, out of network, a specific drug pricing information for uh individual pharmaceuticals, including historical in- information, and also requires that the plan provide summary, a summary data file of cost by service and trends uh in pricing for those uh for those services. Failure to comply uh with providing this information is subject to penalty under the Code. The legislation provides for reports from the Government Accountability Office, also the Secretaries of Treasury, Labor and Health and Human Services, on prices and trends and with detail on prices and trends across urban areas versus rural areas, small group plans versus large group plans and other items of detail that may be of benefit to the uh members of this committee in assessing uh uh in assessing the efficacy of uh of this legislation. And lastly, uh the legislation would make health plans subject-dependently under the code if pharmacy benefit managers or pharmacies under the uh under the plan fails uh fail to meet certain standards with respect to information that may be available to individuals regarding pharmaceutical costs. The legislation in general is effective on the date of enactment. Uh, as I noted, the uh uh requirements for enhanced information uh from plans is for plans, uh, beginning on or after January first of twenty twenty nine. That uh concludes my brief description. Be happy to answer questions that the members might have.

Thank you. Are there any technical questions about the amendment in the nature of a substitute? Seeing none, are uh any members wishing to strike the last word? Seeing none. Are there any um amendments? Any amendments? I'm Mr.

I have a amendment at the desk.

Mr. Chairman, I have reserved point of order.

Point of order has been reserved. Uh the clerk will distribute the amendments. And I'll ask uh Miss Chu to suspend while the clerk distributes momentarily.

Mm-hmm.

Miss Cheegy, you may proceed.

Mister Chair, I have what I believe is the simplest amendment this committee will consider today. It does one thing, it requires HHS to publicly disclose the agreements and the key records related to those agreements in a searchable online format while allowing appropriate redactions for legitimate proprietary information. That's it. It simply says that once the agreements are signed, the American people deserve to know what was promised. Throughout today's mark-up, Republicans have argued that transparency is essential. You've asked hospitals to disclose negotiated prices, insurers to disclose more information, and for providers across our health care system to open their books. So why shouldn't the federal government be held to that very same standard when it negotiates with Big Pharma. The administration has announced a series of agreements with Big Pharma that it says will lower drug prices for Americans. If that's true, that would be welcome news. But if these agreements are truly delivering the savings the administration promises, then the American people shouldn't have to just take its word for it. Let's see the agreements. Let's see the records behind them. And let's see what commitments were actually made. If we're going to spend today's mark-up talking about transparency, then let's apply that principle consistently across our health care system, not just when it's politically convenient. And that's exactly what my amendment does, and it's exactly why I introduced the Drug Deal Disclosure Act, because Americans deserve to know not only what agreements were signed, but how those agreements came together and what commitments were made behind closed doors. If Republicans truly believe transparency is the answer, then this should be the easiest vote of all in today's mark-up. I urge adoption of my amendment and I yield back.

Thank you. Are there members wishing to strike a last word? Mister Moore is recognized.

Thank you, Chairman. I'll just quickly mention, uh, So, it's actually great to see uh some agreement here and particularly from my Democrat colleagues that uh President Trump and his administration is working and having su- having success to drive lower prices for the American people through these most favored nation agreements. So, good job us. We're uh on both sides of the aisle agreeing to that that concept. This, however, um, this agreement there this amendment is is flawed in one one one simple aspect. The agreement signed by President Trump and pharmaceutical manufacturers they're confidential, and public disclosure would allow foreign countries to exploit the agreement terms. So this actually could undermine the entire effort here to do what we all agree is the right direction and to lower drug prices um uh for the American people Um, the goal here of course is to have those countries pay fair market prices, benefits all Americans, benefits all of our constituents, but it is important to recognize like, we cannot let the exploitation take place from foreign governments. Um, we're working in the right direction here. This is this is something that, you know, uh, the administration I think has worked in a way that does benefit all Americans, and let's continue on that path, but doing this particular amendment would actually make that um open to some sincere concerning manipulation from uh from foreign markets. That I yield back, Chairman.

Any others wishing to strike the last word? Is there's more?

I just want to thank the author of this amendment, Miss Chu, for offering it. You know, there was a time when this amendment would not even be necessary, would Uh, this amendment, uh, but for the fact that we now have the dealmaker in the White House making all kinds of deals that financially benefit him, um, uh, deals that involve his or his family members making investments, um, he has no, um, accountability with regard to whether or not he pays taxes on that income because of the Supreme Court decisions. And I just appreciate this amendment being offered. I do appreciate Mister Moore's concern uh about uh uh uh about being able to keep some of it secretive. And I think Miss Chu has really focused on that. The amendment clearly would protect trade secrets, legitimate trade secrets, Uh, but make public those other things, um, that, uh, comprise pricing. So I would, uh, I would strongly suggest that we adopt this amendment. Uh, Miss Chu, if you would like, uh, the rest of my time, I will yield to you.

Miss Chu.

Thank you, and, uh, I think that transparency is extremely important, and certainly these deals need to come to light in terms of what is being done. Uh, and, uh, we certainly deserve to know what deals are made underneath the surface, and also who is profiting from them. With that, I yield back.

Others wishing to strike the last word? Seeing none, uh, Mr. Joachim, recognized for five minutes.

Uh, thank you, Mister Chairman. Uh, I just wanna add here that we're certainly glad to see that uh Democrats agree that President Trump is driving drug prices lower for the American people through these agreements um an- any time we can work together to reduce pricing I think that's a a good thing uh these agreements have yielded savings to patients of up to three thousand dollars per year for GLP-ones and a savings of six thousand dollars or more on fertility treatments. Additionally, state Medicaid programs could save up to two hundred and eighty million dollars a year from one manufacturer alone according to the Journal of Managed Care and Specialty Pharmacy. Yeah, Democrats have alleged that this bill does not p- require transparency into drug prices, but this bill requires the net prices of drugs that are sold in the commercial market to be publicly disclosed. Uh, and that is work that is certainly building on the Consolidated Appropriations Act of twenty twenty six, which we just passed uh this last February. So uh it's good to see again the Democrats are agreeing with us that President Trump is working hard to bring prices down, uh not just working but achieving results. And with that, Mr. Chairman, I yield back.

Thank you. Anyone else wishing to strike the last word? Seeing none, the question is on agreeing to the amendment offered, call the roll.

Mr. Buchanan.

No.

Mr. Buchanan? No. Mr. Smith of Nebraska?

No.

Mr. Smith of Nebraska? No.

No.

Mr. Kelly? Mr. Kelly? No. Mr. Schweikert? Mr. Schweikert? No. Mr. LaHood?

No.

Mister LaHood? No. Mister Arrington? Mister Estes? Mister Estes? No. Mister Smucker? Mister Hern?

No.

Mister Hern, no. Mrs. Miller. Mrs. Miller, no. Doctor Murphy.

Ernie Murphy.

Doctor Murphy, no. Mister Kustoff. Mister Kustoff, no. Mister Fitzpatrick.

No.

Mister Fitzpatrick, no. Mister Steube. Mister Steube, no. Miss Tenney. Miss Tenney, no. Misses Fischbach. Misses Fischbach, no. Mister Moore. Mister Moore, no. Miss Van Duyn. Mister Feenstra. Mister Feenstra, no. Miss Maliatakis. Miss Maliatakis, no. Mister Carey. Mister Kelly, no. Mister Yacoum. Mister Yacoum, no. Mister Miller.

No.

Mister Miller, no. Mister Bean.

No.

Mister Bean, no. Mister Moran. Mister Neal. Mister Doggett. Mister Thompson. Mister Thompson, yes. Mister Larson.

Yes.

Mister Larson, yes. Mister Davis.

Yes.

Mister Davis, yes.

Yeah.

Miss Sanchez.

Ah.

Miss Sanchez, yes. Miss Sewell. Miss Del Bene. Miss Del Bene. Yes. Missed two.

Aye.

Missed two. Yes. Missed more. Missed more. Yes. Mister Boyle. Mister Boyle. Yes. Mister Beyer. Mister Evans.

Yes.

Mister Evans, yes. Mister Schneider. Mister Schneider, yes. Mister Panetta. Mister Panetta, yes. Mister Gomez. Mister Gomez, yes. Mister Horsford. Mister Horsford. Yes. Miss Plaskett.

Yeah, I'm good.

Mister Swazi.

Aye.

Mister Swazi, yes. Mister Arrington.

How is Mister Neal recorded?

Mister Neal is not recorded. Mister Neal? Yes. Mister Smucker. Miss Van Duyn. Mister Doggett. Miss Sewell. Mister Beier. Miss Plaskett.

Mister Beyer is here.

How is Mister Beyer recorded?

Mister Beyer is not recorded.

Yeah.

Mister Beyer? Yes. Chairman Smith is not recorded. Chairman Smith? No.

Clerk report.

Mister Chairman, the yeses are sixteen and the noes are twenty-two.

There being sixteen yeses and twenty-two noes, the amendment is not agreed to. Are there additional amendments? Miss Chu.

Mister Chair, I have an amendment. Uh, yeah, I have an amendment at the desk.

Mister Buchanan.

Yeah.

Mister Chairman, I reserve a point of order.

Point of order has been reserved. The sponsor will suspend while the amendment is being distributed.

Okay.

Miss Chiu, you may proceed for five minutes.

Mister Chair, throughout today's mark-up we've heard one message over and over again. Transparency empowers patience. That's exactly what this amendment is about. Across our healthcare system, insurers are increasingly relying on artificial intelligence and automated decision-making tools to help make decisions. about whether patients receive the care their doctors recommend. Patients deserve to know when those tools are being used. My amendment does not prohibit artificial intelligence, nor does it impose new mandates on how plans use those technologies. Rather, it says that if Medicare Advantage plans or private insurers are using artificial intelligence to help make coverage decisions, they should publicly disclose it. They should tell patients what those tools are being used for. And they should report basic information about how often decisions involving these tools are denied, appealed, and ultimately overturned. Because transparency isn't just about prices, it's also about understanding how decisions are made. Congress, regulators, researchers, and patients should all have access to the information needed to evaluate whether these technologies are improving care or creating unnecessary barriers to medically necessary care. If Republicans believe transparency empowers patients when it comes to prices, then surely transparency should also apply when algorithms help determine whether a patient gets the care they need. This is a simple common sense transparency amendment, I urge my colleagues to support it. And I yield back.

Then a- any members wishing to strike the last word? Mister Kelly is recognized for his presence.

Yes, thank you, Chairman. Uh, Miss Chu, this is already included in the bill that Mr. Bell- Del Bain and I proposed today and is passed.

Is that

This, oh, if you, if

Miss Chu can respond.

That was for MA, and this also includes private insurers.

OK. All right. Just as long as you know, it cuz sitting very close to you is a lady that's worked on this for seven years, so thank you.

Thank you. Others wishing to strike the last word? Seeing none, the question is on agreeing to the amendment offered by Ms. Chu. Call the call the roll.

Mister Buchanan.

No.

Mister Buchanan, no. Mister Smith of Nebraska.

No.

Mister Smith of Nebraska, no. Mister Kelly. Mister Kelly, no. Mister Schweiker. Mister LaHood. Mister LaHood? No. Mister Arrington. Mister Estes. Mister Smucker. Mister Hern. Mister Hern, no. Mrs. Miller.

No.

Mrs. Miller, no. Doctor Murphy.

No.

Doctor Murphy, no. Mister Kustoff. Mister Kustoff, no. Mister Fitzpatrick.

No.

Mister Fitzpatrick, no. Mister Steube.

No.

Mister Steube, no. Miss Tenney. Miss Tenney? No. Mrs. Fischbach?

No.

Mrs. Fischbach?

No.

Just a second. No. Mister Moore? I'm just gonna look at it. These are the actions. Miss Van Duyn? Mister Feenstra? Mister Feenstra? No. Miss Malia Takis? Miss Malia Tauches, no. Mister Carey. Mister Carey, no. Mister Joachim. Mister Joachim, no. Mister Miller.

No.

Mister Miller, no. Mister Bean. Mister Bean, no. Mister Moran.

That's not

Mister Neal.

Yeah.

Mister Doggett. Mister Thompson. Mister Thompson, yes. Mister Larson.

Yeah.

Mister Larson, yes. Mister Davis. Mister Davis, yes. Miss Sanchez. Miss Sanchez, yes. Miss Sewell. Miss Del Bene. Miss Del Bene, yes. Miss Chu. Miss Chu, yes. Miss Moore. Miss Moore, yes. Mister Boyle. Mister Boyle, yes. Mister Beyer. Mister Beyer, yes. Mister Evans.

Yes.

Mister Evans, yes. Mister Schneider.

Go.

Mister Schneider, yes. Mister Panetta. Mister Panetta, yes. Mister Gomez. Mister Gomez, yes. Mister Horsford. Mister Horsford, yes. Miss Plaskett. Mister Swazi.

Aye.

Mister Swazi, yes. Mister Schweikert.

Uh, no.

No.

Mister Schweikert, no. I don't think they're here, so I'm gonna take this one. Mister Arrington. Mister Estes. Mister Estes, no. Mister Smucker. Mister Smucker, no. Mister Moore. Mister Moore, no. Miss Van Duyn. Mister Moran.

No.

Mister Moran, no. Mister Neal. Mister Doggett. Miss Sewell. Miss Plaskett. Chairman Smith. Chairman Smith, no.

Clerk report.

Mister Chairman, the yeses are fifteen and the nos are twenty-four.

There being fifteen yeses and twenty-four noes, the amendment is not agreed to. Are there additional amendments? Ms. Chu.

Mr. Chairman, a reserve point of order.

Mr. Buchanan reserves a point of order. Ms. Chu will suspend while the amendment is being distributed.

Thank you.

Miss Chu, you're recognized for five minutes.

Mister Chair, this is another simple transparency amendment. Artificial intelligence is increasingly being used to make decisions that profoundly affect people's lives, including decisions about whether they keep their jobs. Mister Chairman, I ask unanimous consent to enter into the record a Reuters article published yesterday detailing allegations that a major employer used artificial intelligence to identify employees with medical conditions, disabilities, pregnancy, or medical leave for layoffs.

That objection's so ordered.

No worker should have to worry that an algorithm is scanning their pregnancy, disability, chronic illness, or use of medical leave to help decide whether they should be laid off. At the very least, workers deserve to know when these systems are being used. That's exactly why transparency is so desperately needed. My amendment simply requires employers to disclose when they use AI systems, to evaluate employees' medical or health information to identify workers for termination. Throughout today's mark-up we've talked a great deal about the importance of transparency. My amendment simply applies that same principle here. If transparency ma- matters when we're talking about hospitals and insurers, it should matter just as much when artificial intelligence is being used in decisions that could cost someone their job. This is a common sense transparency amendment, and I urge my colleagues to support it. I yield back.

Ms. Chiby yields back. Are the members wishing to strike the last word? Any members wishing to strike the last word? Seeing none. Question is on agreeing to the amendment, I must choose amendment. Clerk, call the roll.

Mister Buchanan. Mister Buchanan, no. Mister Smith, Nebraska.

No.

Mister Smith, Nebraska, no. Mister Kelly. Mister Kelly, no. Mister Schweikert. Mister Schweikert, no. Mister LaHood.

No.

Mister LaHood, no. Mister Arrington. Mister Estes. Mister Estes, no. Mister Smucker. Mister Hern.

No.

Mister Hern, no. Misses Miller. Misses Miller, no. Doctor Murphy. Doctor Murphy, no. Mister Custolph. Mister Custolph, no. Mister Fitzpatrick.

No.

Mister Fitzpatrick, no. Mister Steube. Miss Tenney. Miss Tenney, no. Misses Fischbach.

No.

Misses Fischbach. No. Mister Moore. Miss Van Duyn. Mister Feenstra. Mister Feenstra, no. Miss Maliatakis. Miss Maliatakis, no. Mister Kelly. Mister Kelly, no. Mister Joachim.

No.

Mister Joachim, no. Mister Miller. Mister Miller, no. Mister Bean. Mister Bean, no. Mister Moran. Mister Neal. Mister Doggett. Mister Thompson. Mister Thompson, yes. Mister Larson.

Yes.

Mister Larson, yes. Mister Davis.

Yes.

Mister Davis, yes. Miss Sanchez. Miss Sewell. Miss DelBene. Miss DelBene, yes. Miss Chiu. Miss Chiu, yes. Miss Moore. Miss Moore, yes. Mister Boyle. Mister Boyle, yes. Mister Beyer.

Yes.

Mister Beyer, yes. Mister Evans. Mister Evans, yes. Mister Schneider. Mister Schneider, yes. Mister Panetta. Mister Panetta, yes. Mister Gomez. Mister Horsford. Mister Horsford, yes. Miss Plaskett. Mister Swasey.

I am.

Mister Swasey, yes. Mister Arrington. Mister Smucker. Mister Steube. Mister Moore. Mister Moore, no. Miss Van Duyn. Mister Moran. Mister Neal. Mister Doggett. Miss Sanchez. Miss Sanchez, yes. Miss Sewell. Mister Gomez. Miss Plaskett.

How is Miss Van Duyn recorded?

Miss Van Duyn is not recorded. Miss Van Duyn, no. Chairman Smith. I'm gonna go again. Chairman Smith, no.

No. Clerk, report.

Mr. Chairman, the yeses are fourteen and the noes are twenty-two.

There being fourteen yeses, twenty-two noes, the amendment is not agreed to. Are there additional amendments? Seeing none, if there are no further amendments, the question is on the adoption of the amendment and the nature of a substitute. All those in favor signify by saying aye. Aye. Those opposed, no.

No.

In the opinion of the chair, the ayes have it, and the amendment in the nature of a substitute is agreed to. I will now recognize Mister Buchanan for the purpose of offering a motion.

Mister Chairman, I move the committee favorably report HR ninety-six forty-five as amended to the House of Representatives.

The question is on the motion to favorably report HR ninety-six forty-five as amended to the House of Representatives. Clerk, call the roll.

Mister Buchanan.

Yes.

Mister Buchanan, yes. Mister Smith of Nebraska.

Yes.

Mister Smith of Nebraska, yes. Mister Kelly. Mister Kelly, yes. Mister Schweikert. Mister Schweikert, yes. Mister Lahood.

Yes.

Mister Lahood, yes. Mister Arrington. Mister Estes. Mister Estes, yes. Mister Smucker. Mister Hern.

Yes.

Mister Hern. Yes. Mrs. Miller. Mrs. Miller, yes. Doctor Murphy,

Yes.

Doctor Murphy, yes. Mister Custoff,

Yes.

Mister Custoff, yes. Mister Fitzpatrick,

Yes.

Mister Fitzpatrick, yes. Mister Steube. Miss Tenney,

Yes.

Miss Tenney, yes. Mrs. Fischbach.

Yes.

Mrs. Fischbach, yes. Mister Moore. Mister Moore, yes. Miss Van Duyn. Miss Van Duyn, yes. Mister Feenstra. Mister Feenstra, yes. Miss Malia Takis. Miss Malia Takis, yes. Mister Kelly.

Yes.

Mister Kelly, yes. Mister Joachim. Mister Joachim, yes. Mister Miller.

Yes.

Mister Miller, yes. Mister Bean.

Yes.

Mister Bean, yes. Mister Moran.

Yes.

Mister Moran, yes. Mister Neal. Mister Doggett. Mister Thompson.

Oh yeah.

Mister Thompson, no. Mister Larson. Mister Larson, no. Mister Davis. Mr. Davis, no. Miss Sanchez. Miss Sanchez, no. Miss Sewell. Miss Del Bene. Miss Del Bene, no. Miss Chu.

Miss N- Miss N- Miss N- Miss N- Miss N- Miss N- N- Miss N- Miss N- Miss N- Miss N-

Miss Chu, no. Miss Moore. Miss Moore, no. Mister Boyle. Mister Boyle, no. Mister Beyer.

Miss N- Miss N- Miss N- Miss N- Miss N, yeah.

Mister Beyer, no. Mister Evans.

No.

Mister Evans, no. Mister Schneider.

No. No.

No. Mister Schneider, no. Mister Panetta. Mister Panetta.

No.

No. Mister Panetta, no. Mister Gomez.

No.

Mister Horsford. Mister Horsford, no. Miss Plaskett.

No.

Mister Swazi.

No.

Mister Swazi, no. Mister Arrington. Mister Arrington, yes. Mister Smucker. Yes. Mister Smucker, yes. Stubbe. Mister Steube. Mister Steube. Yes. Mister Neal. I think I almost made it. Oh, oh, I see. Mister Neal, no. Mister Doggett. Miss Sewell. Mister Gomez. Miss Plaskett. Chairman Smith.

Yes.

Chairman Smith, yes.

Clerk report.

Mister Chairman, the yeses are twenty-five and the noes are fifteen.

There being twenty-five yeses and fifteen noes, the motion is agreed to and H R ninety-six forty-five, as amended, is favorably reported to the House. Without objection, I ask the staff to be authorized to make technical and conf- and conforming changes to H R ninety-six forty-five and that members have two additional days to file with the committee clerk supplemental additional dissenting, or minority, views. There being no further business before the committee, the committee stands adjourned.

And you're