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[House Report 116-61]
[From the U.S. Government Publishing Office]

116th Congress   }                                           { Report
                         HOUSE OF REPRESENTATIVES
 1st Session     }                                           { 116-61

======================================================================

 
     PROVIDING FOR CONSIDERATION OF THE BILL (H.R. 5) TO PROHIBIT 
    DISCRIMINATION ON THE BASIS OF SEX, GENDER IDENTITY, AND SEXUAL 
ORIENTATION, AND FOR OTHER PURPOSES; PROVIDING FOR CONSIDERATION OF THE 
 BILL (H.R. 312) TO REAFFIRM THE MASHPEE WAMPANOAG TRIBE RESERVATION, 
  AND FOR OTHER PURPOSES; AND PROVIDING FOR CONSIDERATION OF THE BILL 
 (H.R. 987) TO AMEND THE PATIENT PROTECTION AND AFFORDABLE CARE ACT TO 
    PROVIDE FOR FEDERAL EXCHANGE OUTREACH AND EDUCATIONAL ACTIVITIES

                                _______
                                

May 14, 2019.--Referred to the House Calendar and ordered to be printed

                                _______
                                

               Ms. Scanlon, from the Committee on Rules, 
                        submitted the following

                              R E P O R T

                       [To accompany H. Res. 377]

    The Committee on Rules, having had under consideration 
House Resolution 377, by a record vote of 9 to 4, report the 
same to the House with the recommendation that the resolution 
be adopted.

                SUMMARY OF PROVISIONS OF THE RESOLUTION

    The resolution provides for consideration of H.R. 5, the 
Equality Act, under a closed rule. The resolution provides 90 
minutes of debate equally divided and controlled by the chair 
and ranking minority member of the Committee on the Judiciary. 
The resolution waives all points of order against consideration 
of H.R. 5. The resolution provides that the amendment in the 
nature of a substitute recommended by the Committee on the 
Judiciary now printed in the bill shall be considered as 
adopted and the bill, as amended, shall be considered as read. 
The resolution waives all points of order against provisions in 
H.R. 5, as amended. The resolution provides one motion to 
recommit with or without instructions. The resolution further 
provides for consideration of H.R. 312, the Mashpee Wampanoag 
Tribe Reservation Reaffirmation Act, under a closed rule. The 
resolution provides one hour of general debate equally divided 
and controlled by the chair and ranking minority member of the 
Committee on Natural Resources. The resolution waives all 
points of order against consideration of H.R. 312. The 
resolution provides that the amendment in the nature of a 
substitute recommended by the Committee on Natural Resources 
now printed in the bill shall be considered as adopted and the 
bill, as amended, shall be considered as read. The resolution 
waives all points of order against provisions in the bill, as 
amended. The resolution provides for one motion to recommit 
with or without instructions. The resolution provides for 
consideration of H.R. 987, the Strengthening Health Care and 
Lowering Prescription Drug Costs Act, under a structured rule. 
The resolution provides 90 minutes of general debate with 60 
minutes equally divided and controlled by the chair and ranking 
minority member of the Committee on Energy and Commerce and 30 
minutes equally divided and controlled by the chair and ranking 
minority member of the Committee on Education and Labor. The 
resolution waives all points of order against consideration of 
the bill. The resolution provides that an amendment in the 
nature of a substitute consisting of the text of Rules 
Committee Print 116-14 shall be considered as adopted and the 
bill, as amended, shall be considered as read. The resolution 
waives all points of order against provisions in H.R. 987, as 
amended. The resolution makes in order only those amendments 
printed in this report. Each such amendment may be offered only 
in the order printed in this report, may be offered only by a 
Member designated in this report, shall be considered as read, 
shall be debatable for the time specified in this report 
equally divided and controlled by the proponent and an 
opponent, shall not be subject to amendment, and shall not be 
subject to a demand for division of the question. The 
resolution waives all points of order against the amendments 
printed in this report. The resolution provides one motion to 
recommit with or without instructions.

                         EXPLANATION OF WAIVERS

    The waiver of all points of order against consideration of 
H.R. 5 includes a waiver of clause 3(d)(1) of rule XIII, which 
requires the inclusion of a committee cost estimate in a 
committee report.
    Although the resolution waives all points of order against 
provisions in H.R. 5, as amended, the Committee is not aware of 
any points of order. The waiver is prophylactic in nature.
    The waiver of all points of order against consideration of 
H.R. 312 includes waivers of the following:
           Clause 3(d)(1) of rule XIII, which requires 
        the inclusion of a committee cost estimate in a 
        committee report.
           Clause 3(c)(4) of rule XIII, which requires 
        committee reports to include a statement of general 
        performance goals and objectives.
    Although the resolution waives all points of order against 
provisions in H.R. 312, as amended, the Committee is not aware 
of any points of order. The waiver is prophylactic in nature.
    The waiver of all points of order against consideration of 
H.R. 987 includes a waiver of clause 12(a)(1) of rule XIII, 
which prohibits consideration of a bill unless there is a 
searchable electronic comparative print that shows how the bill 
proposes to change current law.
    The waiver of all points of order against provisions of 
H.R. 987, as amended, includes waivers of the following:
           Clause 4 of rule XXI, which prohibits a bill 
        carrying an appropriation from being reported by a 
        committee not having jurisdiction to report an 
        appropriation.
           Clause 5(a) of rule XXI, which prohibits a 
        bill carrying a tax or tariff measure from being 
        reported by a committee not having jurisdiction to 
        report a tax or tariff measure.
    Although the resolution waives all points of order against 
the amendments printed in this report, the Committee is not 
aware of any points of order. The waiver is prophylactic in 
nature.

                            COMMITTEE VOTES

    The results of each record vote on an amendment or motion 
to report, together with the names of those voting for and 
against, are printed below:

Rules Committee record vote No. 72

    Motion by Mr. Cole to report an open rule for H.R. 5. 
Defeated: 4-9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 73

    Motion by Mr. Cole to amend the rule to provide that after 
the Committee of the Whole completes consideration of H.R. 987 
for amendment, the question of adoption of the amendment in the 
nature of a substitute shall be divided as follows: first, 
adoption of Title I of the amendment; and second, adoption of 
the matter comprising the remainder of the amendment in the 
nature of a substitute. Defeated: 4-9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 74

    Motion by Mr. Woodall to amend the rule to H.R. 5 to make 
in order and provide the appropriate waivers to amendment #27, 
offered by Rep. McAdams (UT), which reaffirms that the public 
accommodations provisions of this Act do not apply to religious 
houses of worship, consistent with current law and practice. 
Defeated: 4-9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 75

    Motion by Mr. Woodall to amend the rule to H.R. 987 to make 
in order and provide the appropriate waivers to amendment #11, 
offered by Rep. Norman (SC), which states that funds may not be 
used for any qualified health plan offered through an Exchange 
that offers coverage for abortion. Defeated: 4-9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 76

    Motion by Mr. Woodall to amend the rule to H.R. 987 to make 
in order and provide the appropriate waivers to amendment #39, 
offered by Rep. Walden (OR), which reduces exchange user fees 
and patients' insurance premiums for three years. Defeated: 4-9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 77

    Motion by Mr. Burgess to amend the rule to H.R. 5 to make 
in order and provide the appropriate waivers to amendment #34, 
offered by Rep. Hartzler (MO), which states that nothing in 
this bill shall require medical and mental health providers to 
prescribe puberty blockers, recommend social transitioning, or 
prescribe cross-sex hormones as a treatment for gender 
dysphoria. Defeated: 4-9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 78

    Motion by Mr. Burgess to amend the rule to H.R. 5 to make 
in order and provide the appropriate waivers to amendment #1, 
offered by Rep. Norton (DC), which clarifies that D.C. 
residents may not be excluded or disqualified from jury service 
in the D.C. Superior Court based on sexual orientation or 
gender identity. Defeated: 4-9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 79

    Motion by Mr. Burgess to amend the rule to H.R. 987 to make 
in order and provide the appropriate waivers to amendment #42, 
offered by Rep. Burgess (TX), which strikes Title II--Health 
Insurance Market Stabilization--and inserts language 
reauthorizing community health centers, the national health 
service corps, and other public health priorities. Defeated: 4-
9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 80

    Motion by Mr. Burgess to amend the rule to H.R. 987 to make 
in order and provide the appropriate waivers to amendment #37, 
offered by Rep. Shimkus (IL), which allows funding for outreach 
and education for association health plans. Defeated: 4-9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

 Rules Committee record vote No. 81

    Motion by Mrs. Lesko to amend the rule to H.R. 5 to make in 
order and provide the appropriate waivers to the following 
amendments: amendment #10, offered by Rep. Lesko (AZ), which 
states that nothing in this Act or any amendment made by this 
Act may be construed to grant or secure any right relating to 
abortion or the provision or funding thereof; amendment #11, 
offered by Rep. Lesko (AZ), which ensures parents' custody of 
their child is not threatened by them simply questioning their 
child's gender identity decisions and changes; amendment #12, 
offered by Rep. Lesko (AZ), which clarifies that nothing in 
this bill can require a place of public accommodation to be 
required to convert any space separated on the basis of sex to 
a separation on the basis of gender identity; and amendment 
#22, offered by Rep. Lesko (AZ), which changes the bill's title 
to the ``Forfeiting Women's Rights Act''. Defeated: 4-9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 82

    Motion by Mrs. Lesko to amend the rule to H.R. 987 to make 
in order and provide the appropriate waivers to amendment #48, 
offered by Rep. Scalise (LA), which disqualifies states that do 
not have born alive protections from receiving funds authorized 
by the bill. Defeated: 4-9

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Nay   Mr. Cole..........................          Yea
Mrs. Torres.....................................          Nay   Mr. Woodall.......................          Yea
Mr. Perlmutter..................................          Nay   Mr. Burgess.......................          Yea
Mr. Raskin......................................          Nay   Mrs. Lesko........................          Yea
Ms. Scanlon.....................................          Nay
Mr. Morelle.....................................          Nay
Ms. Shalala.....................................          Nay
Mr. DeSaulnier..................................          Nay
Mr. McGovern, Chairman..........................          Nay
----------------------------------------------------------------------------------------------------------------

Rules Committee record vote No. 83

    Motion by Ms. Scanlon to report the rule. Adopted: 9-4

----------------------------------------------------------------------------------------------------------------
                Majority Members                      Vote               Minority Members               Vote
----------------------------------------------------------------------------------------------------------------
Mr. Hastings....................................          Yea   Mr. Cole..........................          Nay
Mrs. Torres.....................................          Yea   Mr. Woodall.......................          Nay
Mr. Perlmutter..................................          Yea   Mr. Burgess.......................          Nay
Mr. Raskin......................................          Yea   Mrs. Lesko........................          Nay
Ms. Scanlon.....................................          Yea
Mr. Morelle.....................................          Yea
Ms. Shalala.....................................          Yea
Mr. DeSaulnier..................................          Yea
Mr. McGovern, Chairman..........................          Yea
----------------------------------------------------------------------------------------------------------------

          SUMMARY OF THE AMENDMENTS TO H.R. 987 MADE IN ORDER

    1. Pallone (NJ), Walden (OR): Clarifies communication 
requirements for eligible product developers and license 
holders regarding requests, offers, and delivery of product 
samples. (10 minutes)
    2. Bucshon (IN), McKinley (WV), Upton (MI), Carter, Buddy 
(GA), Collins, Doug (GA), Sensenbrenner (WI): Strikes title 
II--Health Insurance Market Stabilization. (10 minutes)
    3. Welch (VT), Schrader (OR): Prohibits the Secretary of 
HHS from ending autoenrollment. (10 minutes)
    4. Blunt Rochester (DE): Requires the Secretary of the 
Department of Health and Human Services to release all 
aggregated studies and data sets created on or after January 1, 
2014 related to marketing and outreach for the Affordable Care 
Act's individual marketplace. (10 minutes)
    5. DeSaulnier (CA): Commissions a study by the National 
Academy of Medicine into the amount of federal funding and 
research used in the development of drugs by pharmaceutical 
companies, and to put measures in place to curb excessive drug 
costs. (10 minutes)
    6. Harder (CA): Provides opioid specific education and 
training to the Navigators and the Certified Application 
Counselors (CACs) that ensures they can best educate 
individuals on the marketplace plans specifically for opioid 
health care treatment. (10 minutes)
    7. Shalala (FL): States the sense of Congress that the 
Secretary of HHS should not take any action to prohibit or 
restrict ``silver loading.'' (10 minutes)
    8. Hayes (CT), Waters (CA): Amends the Federally-
Facilitated Marketplace (FFM) navigator program to authorize 
$25,000,000 out of amounts collected by user fees for State-
Based Exchanges. Ensures that no state shall receive a grant 
that is less than $1,000,000. (10 minutes)
    9. McBath (GA): Provides pharmacy school outreach by 
directing the Labor HHS and Education Secretaries to do 
outreach to institutions of higher education as it relates to 
the use and availability of generic drugs. (10 minutes)
    10. Scanlon (PA): Requires the HHS Secretary to issue 
biweekly public reports during the annual open enrollment 
period on the performance of the federal exchange and the Small 
Business Health Options Program exchange. Each report will 
include a summary of information on the open enrollment season 
including the number of website visits, accounts created, calls 
to the call center, number of people who enroll in a plan and 
what enrollment path they took, e.g., website, broker, or call 
center. (10 minutes)
    11. Morelle (NY), Wexton (VA): Requires GAO to study the 
effect of President Trump's cuts to ACA outreach and the 
Navigator Program on health insurance enrollment and the cost 
of coverage. (10 minutes)
    12. Waters (CA): Requires HHS to submit to Congress a 
report on the extent to which increases in the prices of 
commonly prescribed drugs have caused individuals with health 
insurance to forego needed treatment. (10 minutes)
    13. Johnson, Eddie Bernice (TX): Requires Navigators to 
receive training on how to assist consumers with Medicaid and 
CHIP enrollment. (10 minutes)
    14. Lynch (MA): Extends the deadline by which States may 
apply for federal assistance to establish state-based 
marketplaces by one year to December 31, 2023. Extends the date 
by which the State Exchanges must be self-sustaining by one 
year to January 1, 2025. (10 minutes)
    15. Lynch (MA): Asks the GAO to conduct a cost benefit 
analysis of the establishment of State-administered health 
insurance plans for states that may want to offer a public 
option in their health insurance exchanges. The report is due 
to Congress no later than one year after enactment. (10 
minutes)
    16. Lipinski (IL): Requires a GAO report to determine 
whether the Department of Health and Human Services has taken 
appropriate steps to ensure that routine maintenance to the 
Healthcare.gov website is minimally disruptive to consumers. 
(10 minutes)
    17. Deutch (FL): Adds a duty requiring navigators to 
provide information in plain language regarding essential 
health benefits and consumer protections under the mental 
health and substance use disorder benefits parity law. (10 
minutes)
    18. Brown (MD), Krishnamoorthi (IL), Barragan (CA): Adds 
that the Secretary shall implement outreach and educational 
activities in areas with high health disparities. (10 minutes)
    19. Gomez (CA): Clarifies the ability of Navigators to 
provide referrals to community-based organizations that address 
social needs related to health outcomes. (10 minutes)
    20. Escobar (TX), Porter (CA), Torres, Norma (CA): Requires 
Navigators to assist vulnerable populations including 
individuals with limited English proficiency and chronic 
illnesses. (10 minutes)
    21. Wexton (VA): Includes findings that the final rule on 
short-term, limited duration insurance weakens protections for 
the millions of Americans living with preexisting health 
conditions, including children with complex medical needs and 
disabilities and their families. (10 minutes)
    22. Pappas (NH): Requires the Secretary of Health and Human 
Services to set annual enrollment targets for the Exchanges for 
the plan year 2020 and each subsequent plan year. (10 minutes)
    23. Cox (CA): Adds a new subsection (b): Promote 
Transparency and Accountability in the Administration's 
Expenditures of Exchange User Fees, which requires HHS to 
submit an annual report to Congress that includes a detailed 
breakdown of the Department's spending on outreach and 
enrollment, navigators, maintenance of Healthcare.gov, and 
operation of the Healthcare.gov call centers. (10 minutes)
    24. Cox (CA): Adds areas with high concentrations of 
unemployment to the list where such outreach and educational 
activities shall be provided. (10 minutes)
    25. Phillips (MN): Directs Exchanges to establish an online 
website portal to facilitate the sharing of information between 
the Exchange and Navigator organizations about their clients' 
applications for health insurance. (10 minutes)
    26. Horn (OK): Ensures rural areas are included in 
navigator outreach. (10 minutes)
    27. Cunningham (SC): Ensures that state healthcare 
Exchanges' outreach activities are also targeted towards 
veteran populations. (10 minutes)

                    TEXT OF AMENDMENTS MADE IN ORDER

  1. An Amendment To Be Offered by Representative Pallone Jr. of New 
            Jersey or His Designee, Debatable for 10 Minutes

  Page 28, strike lines 8 through 11 and insert the following:
                          (iii) that the eligible product 
                        developer has submitted a written 
                        request to purchase sufficient 
                        quantities of the covered product to 
                        the license holder and such request--
                                  (I) was sent to a named 
                                corporate officer of the 
                                license holder;
                                  (II) was made by certified or 
                                registered mail with return 
                                receipt requested;
                                  (III) specified an individual 
                                as the point of contact for the 
                                license holder to direct 
                                communications related to the 
                                sale of the covered product to 
                                the eligible product developer 
                                and a means for electronic and 
                                written communications with 
                                that individual; and
                                  (IV) specified an address to 
                                which the covered product was 
                                to be shipped upon reaching an 
                                agreement to transfer the 
                                covered product; and
  Page 32, strike lines 15 through 18 and insert the following:
                  (C) that the license holder made an offer to 
                the individual specified pursuant to paragraph 
                (2)(A)(iii)(III), by a means of communication 
                (electronic, written, or both) specified 
                pursuant to such paragraph, to sell sufficient 
                quantities of the covered product to the 
                eligible product developer at commercially 
                reasonable market-based terms--
  Page 33, strike lines 13 through 22.
  Page 33, line 23, strike ``(5)'' and insert ``(4)''.
                              ----------                              

 2. An Amendment To Be Offered by Representative Bucshon of Indiana or 
                 His Designee, Debatable for 10 Minutes

  Strike title II (and redesignate the subsequent title and 
update the table of contents accordingly).
                              ----------                                

3. An Amendment To Be Offered by Representative Welch of Vermont or His 
                   Designee, Debatable for 10 Minutes

  Add at the end of title II the following new section:

SEC. 205. PROTECTION OF HEALTH INSURANCE COVERAGE IN CERTAIN EXCHANGES.

  In the case of an Exchange that the Secretary of Health and 
Human Services operates pursuant to section 1321(c)(1) of the 
Patient Protection and Affordable Care Act (42 U.S.C. 
18041(c)(1)), the Secretary may not implement any process that 
would terminate the health insurance coverage of an enrollee 
solely because such enrollee did not actively enroll during the 
most recent open enrollment period.
                              ----------                                

  4. An Amendment To Be Offered by Representative Blunt Rochester of 
           Delaware or Her Designee, Debatable for 10 Minutes

  Page 47, line 24, strike ``Section 1321(c)'' and insert:
  (a) In General.--Section 1321(c)
  Page 49, after line 18, insert the following:
  (b) Study and Report.--Not later than 30 days after the date 
of the enactment of this Act, the Secretary of Health and Human 
Services shall release to Congress all aggregated documents 
relating to studies and data sets that were created on or after 
January 1, 2014, and related to marketing and outreach with 
respect to qualified health plans offered through Exchanges 
under title I of the Patient Protection and Affordable Care 
Act.
                              ----------                              

     5. An Amendment To Be Offered by Representative DeSaulnier of 
          California or His Designee, Debatable for 10 Minutes

  At the end of title I, add the following:

  Subtitle D--Study on Role of Federal Assistance in Drug Development

SEC. 131. STUDY ON ROLE OF FEDERAL ASSISTANCE IN DRUG DEVELOPMENT.

  (a) In General.--Not later than two years after the date of 
the enactment of this Act, the Secretary of the Health and 
Human Services shall enter into a contract with the National 
Academy of Medicine to conduct a study on, and submit to 
Congress a report on, the following:
          (1) The percentage of drugs developed in the United 
        States using at least some amount of Federal funding 
        from any Federal source.
          (2) The average cost incurred by a drug developer to 
        develop a drug.
          (3) The average amount of revenue and profits made by 
        drug developers from the sales of drugs.
          (4) The percentage of such revenue and profits that 
        are reinvested into research and development of new 
        drugs.
          (5) The appropriate percentage, if any, of such 
        revenue and profits the Secretary, in consultation with 
        the National Academy of Medicine, recommends should be 
        returned to Federal entities for Federal funding used 
        in the development of the drugs involved.
  (b) Enforcement.--A drug developer shall, as a condition of 
receipt of any Federal funding for the development of drugs, 
comply with any request for the data necessary to perform the 
study under subsection (a).
  (c) Confidentiality.--This section does not authorize the 
disclosure of any trade secret, confidential commercial or 
financial information, or other matter listed in section 552(b) 
of title 5, United States Code.
  (d) Definitions.--In this section:
          (1) The term ``drug'' has the meaning given such term 
        in section 201 of the Federal Food, Drug, and Cosmetic 
        Act (21 U.S.C. 321).
          (2) The term ``drug developer'' means an entity that 
        submitted, and received approval of, an application 
        under section 505 of the Federal Food, Drug, and 
        Cosmetic Act (21 U.S.C. 355) or section 351 of the 
        Public Health Service Act (42 U.S.C. 262).
                              ----------                              

6. An Amendment To Be Offered by Representative Harder of California or 
                 His Designee, Debatable for 10 Minutes

  Page 46, beginning on line 17, amend clause (ii) to read as 
follows:
                          (ii) by striking the period and 
                        inserting a semicolon; and
  Page 46, line 20, strike ``clause'' and insert ``clauses''.
  Page 46, line 23, strike the period and the end quotes.
  Page 46, after line 23, insert the following:
                          ``(iv) receive opioid specific 
                        education and training that ensures the 
                        navigator can best educate individuals 
                        on qualified health plans offered 
                        through an Exchange, specifically 
                        coverage under such plans for opioid 
                        health care treatment.''; and
                              ----------                              

 7. An Amendment To Be Offered by Representative Shalala of Florida or 
                 Her Designee, Debatable for 10 Minutes

  Add at the end of title II the following new section:

SEC. 205. SENSE OF CONGRESS RELATING TO THE PRACTICE OF SILVER LOADING.

  It is the sense of Congress that the Secretary of Health and 
Human Services should not take any action to prohibit or 
otherwise restrict the practice commonly known as ``silver 
loading'' (as described in the rule entitled ``Patient 
Protection and Affordable Care Act; HHS Notice of Benefit and 
Payment Parameters for 2020'' published on April 25, 2019 (84 
Fed. Reg. 17533)).
                              ----------                              

8. An Amendment To Be Offered by Representative Hayes of Connecticut or 
                 Her Designee, Debatable for 10 Minutes

  Page 47, line 3, strike ``Grants under'' and insert ``Subject 
to subparagraph (C), grants under''.
  Page 47, line 6, strike ``subparagraph'' and insert 
``subparagraphs''.
  Page 47, line 18, strike the end quotations and the second 
period.
  Page 47, after line 18, insert the following:
                  ``(C) State exchanges.--For the purposes of 
                carrying out this subsection, with respect to 
                an Exchange operated by a State pursuant to 
                this section, there is authorized to be 
                appropriated $25,000,000 for fiscal year 2020 
                and each subsequent fiscal year. Each State 
                receiving a grant pursuant to this subparagraph 
                shall receive a grant in an amount that is not 
                less than $1,000,000.''.
                              ----------                              

 9. An Amendment To Be Offered by Representative McBath of Georgia or 
                 Her Designee, Debatable for 10 Minutes

  At the end of title I of the Rules Committee Print, add the 
following:

                  Subtitle D--Pharmacy School Outreach

SEC. 131. PHARMACY SCHOOL OUTREACH.

  The Secretary of Health and Human Services and the Secretary 
of Education shall make every effort necessary to ensure 
appropriate outreach to institutions of higher education to 
ensure that students and faculty at schools of pharmacy are 
provided with materials regarding generic drugs and biosimilar 
biological products, including materials on--
          (1) how generic drugs and biosimilar biological 
        products are equivalent or similar to brand-name drugs;
          (2) the approval process at the Food and Drug 
        Administration for generic drugs and biosimilar 
        biological products;
          (3) how to make consumers aware of the availability 
        of generic drugs and biosimilar biological products;
          (4) requirements for substituting generic drugs and 
        biosimliar biological products in place of 
        corresponding drugs products; and
          (5) the impacts of generic drugs and biosimilar 
        biological products on consumer costs.
                              ----------                              

      10. An Amendment To Be Offered by Representative Scanlon of 
         Pennsylvania or Her Designee, Debatable for 10 Minutes

  Page 50, insert after line 2, the following:

SEC. 205. CONSUMER OUTREACH, EDUCATION, AND ASSISTANCE.

  (a) Open Enrollment Reports.--For plan year 2020 and each 
subsequent year, the Secretary of Health and Human Services 
(referred to in this section as the ``Secretary''), in 
coordination with the Secretary of the Treasury and the 
Secretary of Labor, shall issue biweekly public reports during 
the annual open enrollment period on the performance of the 
Federal Exchange. Each such report shall include a summary, 
including information on a State-by-State basis where 
available, of--
          (1) the number of unique website visits;
          (2) the number of individuals who create an account;
          (3) the number of calls to the call center;
          (4) the average wait time for callers contacting the 
        call center;
          (5) the number of individuals who enroll in a 
        qualified health plan; and
          (6) the percentage of individuals who enroll in a 
        qualified health plan through each of--
                  (A) the website;
                  (B) the call center;
                  (C) navigators;
                  (D) agents and brokers;
                  (E) the enrollment assistant program;
                  (F) directly from issuers or web brokers; and
                  (G) other means.
  (b) Open Enrollment After Action Report.--For plan year 2020 
and each subsequent year, the Secretary, in coordination with 
the Secretary of the Treasury and the Secretary of Labor, shall 
publish an after action report not later than 3 months after 
the completion of the annual open enrollment period regarding 
the performance of the Federal Exchange for the applicable plan 
year. Each such report shall include a summary, including 
information on a State-by-State basis where available, of--
          (1) the open enrollment data reported under 
        subsection (a) for the entirety of the enrollment 
        period; and
          (2) activities related to patient navigators 
        described in section 1311(i) of the Patient Protection 
        and Affordable Care Act (42 U.S.C. 18031(i)), 
        including--
                  (A) the performance objectives established by 
                the Secretary for such patient navigators;
                  (B) the number of consumers enrolled by such 
                a patient navigator;
                  (C) an assessment of how such patient 
                navigators have met established performance 
                metrics, including a detailed list of all 
                patient navigators, funding received by patient 
                navigators, and whether established performance 
                objectives of patient navigators were met; and
                  (D) with respect to the performance 
                objectives described in subparagraph (A)--
                          (i) whether such objectives assess 
                        the full scope of patient navigator 
                        responsibilities, including general 
                        education, plan selection, and 
                        determination of eligibility for tax 
                        credits, cost-sharing reductions, or 
                        other coverage;
                          (ii) how the Secretary worked with 
                        patient navigators to establish such 
                        objectives; and
                          (iii) how the Secretary adjusted such 
                        objectives for case complexity and 
                        other contextual factors.
  (c) Report on Advertising and Consumer Outreach.--Not later 
than 3 months after the completion of the annual open 
enrollment period for the 2020 plan year, the Secretary shall 
issue a report on advertising and outreach to consumers for the 
open enrollment period for the 2020 plan year. Such report 
shall include a description of--
          (1) the division of spending on individual 
        advertising platforms, including television and radio 
        advertisements and digital media, to raise consumer 
        awareness of open enrollment;
          (2) the division of spending on individual outreach 
        platforms, including email and text messages, to raise 
        consumer awareness of open enrollment; and
          (3) whether the Secretary conducted targeted outreach 
        to specific demographic groups and geographic areas.
                              ----------                              

11. An Amendment To Be Offered by Representative Morelle of New York or 
                 His Designee, Debatable for 10 Minutes

  Page 47, after line 18, insert the following:
  (b) Study on Effects of Funding Cuts.--Not later than 1 year 
after the date of the enactment of this Act, the Comptroller 
General of the United States shall study the effects of funding 
cuts made for plan year 2019 with respect to the navigator 
program (as described in section 1311(i) of the Patient 
Protection and Affordable Care Act (42 U.S.C. 18031(i))) and 
other education and outreach activities carried out with 
respect to Exchanges established by the Secretary of Health and 
Human Services pursuant to section 1321(c) of such Act. Such 
study shall describe the following:
          (1) How such funding cuts negatively impacted the 
        ability of entities under such program to conduct 
        outreach activities and fulfill duties required under 
        such section 1311(i).
          (2) The overall effect on--
                  (A) the number of individuals enrolled in 
                health insurance coverage offered in the 
                individual market for plan year 2019; and
                  (B) the costs of health insurance coverage 
                offered in the individual market.
  Page 47, line 19, strike ``(b)'' and insert ``(c)''.
                              ----------                              

 12. An Amendment To Be Offered by Representative Waters of California 
               or Her Designee, Debatable for 10 Minutes

  At the end of title I of the Rules Committee Print, add the 
following new subtitle:

                          Subtitle D--Reports

SEC. 131. EFFECTS OF INCREASES IN PRESCRIPTION DRUG PRICE.

  Not later than 1 year after the date of enactment of this 
Act, the Secretary of Health and Human Services shall submit a 
report to the Congress on the extent to which increases in 
prescription drug prices may have caused Medicare beneficiaries 
to forego recommended treatment, including failing to fill 
prescriptions.
                              ----------                              

 13. An Amendment To Be Offered by Representative Johnson of Texas or 
                 Her Designee, Debatable for 10 Minutes

  Page 46, beginning on line 17, amend clause (ii) to read as 
follows:
                          (ii) by striking the period and 
                        inserting a semicolon; and
  Page 46, line 20, strike ``clause'' and insert ``clauses''.
  Page 46, line 23, strike the period and the end quotes.
  Page 46, after line 23, insert the following:
                          ``(iv) receive training on how to 
                        assist individuals with enrolling for 
                        medical assistance under State plans 
                        under the Medicaid program under title 
                        XIX of the Social Security Act or for 
                        child health assistance under State 
                        child health plans under title XXI of 
                        such Act.''; and
                              ----------                              

14. An Amendment To Be Offered by Representative Lynch of Massachusetts 
               or His Designee, Debatable for 10 Minutes

  Page 42, beginning on line 6, strike ``December 31, 2022'' 
and insert ``December 31, 2023''.
  Page 43, line 6, strike ``January 1, 2024'' and insert 
``January 1, 2025''.
                              ----------                              

15. An Amendment To Be Offered by Representative Lynch of Massachusetts 
               or His Designee, Debatable for 10 Minutes

  Page 50, after line 2, insert the following section:

SEC. 205. GAO REPORT.

  Not later than one year after the date of the enactment of 
this Act, the Comptroller General of the United States shall 
submit to Congress a study that analyzes the costs and benefits 
of the establishment of State-administered health insurance 
plans to be offered in the insurance market of such States that 
choose to administer and offer such a plan.
                              ----------                                

 16. An Amendment To Be Offered by Representative Lipinski of Illinois 
               or His Designee, Debatable for 10 Minutes

  Add at the end of title II the following new section:

SEC. 205. REPORT ON THE EFFECTS OF WEBSITE MAINTENANCE DURING OPEN 
                    ENROLLMENT.

  Not later than 1 year after the date of the enactment of this 
Act, the Comptroller General of the United States shall submit 
to Congress a report examining whether the Department of Health 
and Human Services has been conducting maintenance on the 
website commonly referred to as ``Healthcare.gov'' during 
annual open enrollment periods (as described in section 
1311(c)(6)(B) of the Patient Protection and Affordable Care Act 
(42 U.S.C. 18031(c)(6)(B)) in such a manner so as to minimize 
any disruption to the use of such website resulting from such 
maintenance.
                              ----------                                

 17. An Amendment To Be Offered by Representative Deutch of Florida or 
                 His Designee, Debatable for 10 Minutes

  Page 45, line 24, strike ``and''.
  In section 202(a)(2)--
          (1) redesignate subparagraph (B) as subparagraph (D); 
        and
          (2) insert after subparagraph (A) the following new 
        subparagraphs:
                  (B) in subparagraph (D), by striking ``and'' 
                at the end;
                  (C) in subparagraph (E), by striking the 
                period at the end and inserting ``; and''; and
  Page 46, line 1, strike ``following'' and insert 
``following:''
  Page 46, line 2, strike ``flush left sentence:'' and insert 
the following:
                  ``(F) conduct public education activities in 
                plain language to raise awareness of the 
                requirements of and the protections provided 
                under--
                          ``(i) the essential health benefits 
                        package (as defined in section 
                        1302(a)); and
                          ``(ii) section 2726 of the Public 
                        Health Service Act (relating to parity 
                        in mental health and substance use 
                        disorder benefits).''
                              ----------                              

 18. An Amendment To Be Offered by Representative Brown of Maryland or 
                 His Designee, Debatable for 10 Minutes

  Page 48, line 21, strike the period and insert ``and shall be 
provided to populations residing in high health disparity areas 
(as defined in subparagraph (E)) served by the Exchange, in 
addition to other populations served by the Exchange.''.
  Page 49, line 18, strike the end quotes and the second period 
and insert the following:
                  ``(E) High health disparity area defined.--
                For purposes of subparagraph (A), the term 
                `high health disparity area' means a contiguous 
                geographic area that--
                          ``(i) is located in one census tract 
                        or ZIP code;
                          ``(ii) has measurable and documented 
                        racial, ethnic, or geographic health 
                        disparities;
                          ``(iii) has a low-income population, 
                        as demonstrated by--
                                  ``(I) average income below 
                                138 percent of the Federal 
                                poverty line; or
                                  ``(II) a rate of 
                                participation in the special 
                                supplemental nutrition program 
                                under section 17 of the Child 
                                Nutrition Act of 1966 (42 
                                U.S.C. 1786) that is higher 
                                than the national average rate 
                                of participation in such 
                                program;
                          ``(iv) has poor health outcomes, as 
                        demonstrated by--
                                  ``(I) lower life expectancy 
                                than the national average; or
                                  ``(II) a higher percentage of 
                                instances of low birth weight 
                                than the national average; and
                          ``(v) is part of a Metropolitan 
                        Statistical Area identified by the 
                        Office of Management and Budget.''.
                              ----------                              

19. An Amendment To Be Offered by Representative Gomez of California or 
                 His Designee, Debatable for 10 Minutes

  Page 45, line 24, strike ``and''.
  Page 45, after line 24, insert the following new 
subparagraphs:
                  (B) in subparagraph (D), by striking ``and'' 
                at the end;
                  (C) in subparagraph (E), by striking the 
                period at the end and inserting ``; and'';
                  (D) by inserting after subparagraph (E) the 
                following new subparagraph:
                  ``(F) provide referrals to community-based 
                organizations that address social needs related 
                to health outcomes.''; and
  Page 46, line 1, strike ``(b)'' and insert ``(e)''.
                              ----------                              

 20. An Amendment To Be Offered by Representative Escobar of Texas or 
                 Her Designee, Debatable for 10 Minutes

  Page 45, strike lines 20 through 24 and insert the following:
                  (A) by amending subparagraph (C) to read as 
                follows:
                  ``(C) facilitate enrollment, including with 
                respect to individuals with English proficiency 
                individuals and individuals with chronic 
                illnesses, in qualified health plans, State 
                medicaid plans under title XIX of the Social 
                Security Act, and State child health plans 
                under title XXI of such Act; and''.
                              ----------                              

21. An Amendment To Be Offered by Representative Wexton of Virginia or 
                 Her Designee, Debatable for 10 Minutes

  In section 204, strike ``The Secretary'' and insert the 
following:
  (b) Prohibition.--The Secretary
  In section 204, insert after the header the following new 
subsection:
  (a) Findings.--Congress finds the following:
          (1) On August 3, 2018, the Administration issued a 
        final rule entitled ``short-term, limited-duration 
        insurance'' (83 Fed. Reg. 38212).
          (2) The final rule dramatically expands the sale and 
        marketing of insurance that--
                  (A) may discriminate against individuals 
                living with preexisting health conditions, 
                including children with complex medical needs 
                and disabilities and their families;
                  (B) lacks important financial protections 
                provided by the Patient Protection and 
                Affordable Care Act (Public Law 111-148), 
                including the prohibition of annual and 
                lifetime coverage limits and annual out-of-
                pocket limits, that may increase the cost of 
                treatment and cause financial hardship to those 
                requiring medical care, including children with 
                complex medical needs and disabilities and 
                their families; and
                  (C) excludes coverage of essential health 
                benefits including hospitalization, 
                prescription drugs, and other lifesaving care.
          (3) The implementation and enforcement of the final 
        rule weakens critical protections for up to 130 million 
        Americans living with preexisting health conditions and 
        may place a large financial burden on those who enroll 
        in short-term limited-duration insurance, which 
        jeopardizes Americans' access to quality, affordable 
        health insurance.
                              ----------                              

    22. An Amendment To Be Offered by Representative Pappas of New 
          Hampshire or His Designee, Debatable for 10 Minutes

  Page 47, line 23, insert after ``ACTIVITIES'' the following: 
``AND ANNUAL ENROLLMENT TARGETS'' (and update the table of 
contents accordingly).
  Page 48, line 2, strike ``paragraph'' and insert 
``paragraphs''.
  Page 49, line 18, strike the closing quotation mark and 
second period and insert the following:
          ``(5) Annual enrollment targets.--For plan year 2020 
        and each subsequent plan year, in the case of an 
        Exchange established or operated by the Secretary 
        within a State pursuant to this subsection, the 
        Secretary shall establish annual enrollment targets for 
        such Exchange for such year.''.
                              ----------                              

 23. An Amendment To Be Offered by Representative Cox of California or 
                 His Designee, Debatable for 10 Minutes

  Page 47, after line 18, insert the following:
  (b) Promote Transparency and Accountability in the 
Administration's Expenditures of Exchange User Fees.--For plan 
year 2020 and each subsequent plan year, not later than the 
date that is 3 months after the end of such plan year, the 
Secretary of Health and Human Services shall submit to the 
appropriate committees of Congress and make available to the 
public an annual report on the expenditures by the Department 
of Health and Human Services of user fees collected pursuant to 
section 156.50 of title 45, Code of Federal Regulations (or any 
successor regulations). Each such report for a plan year shall 
include a detailed accounting of the amount of such user fees 
collected during such plan year and of the amount of such 
expenditures used during such plan year for the federally 
facilitated Exchange operated pursuant to section 1321(c) of 
the Patient Protection and Affordable Care Act (42 U.S.C. 
18041(c)) on outreach and enrollment activities, navigators, 
maintenance of Healthcare.gov, and operation of call centers.
  Page 47, line 19, strike ``(b)'' and insert ``(c)''.
                              ----------                              

 24. An Amendment To Be Offered by Representative Cox of California or 
                 His Designee, Debatable for 10 Minutes

  Page 48, line 20, after ``populations,'' insert ``individuals 
residing in areas where the unemployment rates exceeds the 
national average unemployment rate,''.
                              ----------                              

25. An Amendment To Be Offered by Representative Phillips of Minnesota 
               or His Designee, Debatable for 10 Minutes

  Page 46, line 23, strike ``and''.
  Page 47, line 18, strike the second period and insert ``; 
and''.
  page 47, after line 18, insert the following:
          (5) by adding at the end the following new paragraph:
          ``(7) Information sharing.--
                  ``(A) In general.--Each Exchange shall 
                establish an online website portal to 
                facilitate, subject to subparagraph (C), the 
                sharing of information described in 
                subparagraph (B) between the Exchange and 
                entities that serve as a navigator under a 
                grant awarded under a program established by 
                the Exchange under this subsection.
                  ``(B) Information.--For purposes of 
                subparagraph (A), the information described in 
                this subparagraph, with respect to an Exchange 
                and an entity described in subparagraph (A), is 
                information about applications of individuals 
                for enrollment in a qualified health plan 
                through the Exchange, including the status of 
                the application; communications such 
                individuals have received from the Exchange 
                regarding such application; and any steps that 
                may be needed to resolve problems with the 
                application that may prevent a determination 
                from being made by the Exchange in regards to 
                an individual's eligibility for premium or 
                cost-sharing assistance.
                  ``(C) Consent.--In carrying out subparagraph 
                (A), an Exchange shall ensure an entity 
                described in such subparagraph may only access 
                information of an individual if such individual 
                has approved such entity as an authorized 
                representative, in accordance with section 
                155.227 of title 45 of the Code of Federal 
                Regulations.''.
                              ----------                              

 26. An Amendment To Be Offered by Representative Horn of Oklahoma or 
                 Her Designee, Debatable for 10 Minutes

  Page 48, line 20, after ``populations,'' insert ``individuals 
in rural areas,''.
                              ----------                              

 27. An Amendment To Be Offered by Representative Cunningham of South 
           Carolina or His Designee, Debatable for 10 Minutes

  Page 48, line 20, after ``populations,'' insert 
``veterans,''.
```