79–006 

115TH CONGRESS REPORT " ! HOUSE OF REPRESENTATIVES 2d Session 115–906 

EMPLOYER RELIEF ACT OF 2018 

AUGUST 28, 2018.—Committed to the Committee of the Whole House on the State 

of the Union and ordered to be printed 

Mr. BRADY of Texas, from the Committee on Ways and Means, 

submitted the following 

R E P O R T 

together with 

DISSENTING VIEWS 

[To accompany H.R. 4616] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Ways and Means, to whom was referred the 

bill (H.R. 4616) to amend the Patient Protection and Affordable 

Care Act to provide for a temporary moratorium on the employer 

mandate and to provide for a delay in the implementation of the 

excise tax on high cost employer-sponsored health coverage, having 

considered the same, report favorably thereon with an amendment 

and recommend that the bill as amended do pass. 

CONTENTS 

Page 

I. SUMMARY AND BACKGROUND ............................................................... 2 

II. EXPLANATION OF THE BILL ................................................................... 4 

A. Moratorium on Employer Mandate ................................................ 4 

B. Delay in Implementation of Excise Tax on High Cost EmployerSponsored Health Coverage ........................................................... 5 

III. VOTES OF THE COMMITTEE .................................................................... 8 

IV. BUDGET EFFECTS OF THE BILL ............................................................ 9 

A. Committee Estimate of Budgetary Effects ..................................... 9 

B. Statement Regarding New Budget Authority and Tax Expenditures Budget Authority .................................................................. 11 

C. Cost Estimate Prepared by the Congressional Budget Office ...... 11 

V. OTHER MATTERS TO BE DISCUSSED UNDER THE RULES OF 

THE HOUSE .............................................................................................. 16 

A. Committee Oversight Findings and Recommendations ................ 16 

B. Statement of General Performance Goals and Objectives ............ 16 

C. Information Relating to Unfunded Mandates ................................ 16 


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D. Applicability of House Rule XXI 5(b) ............................................. 16 

E. Tax Complexity Analysis ................................................................. 16 

F. Congressional Earmarks, Limited Tax Benefits, and Limited 

Tariff Benefits ................................................................................. 17 

G. Duplication of Federal Programs .................................................... 17 

H. Disclosure of Directed Rule Makings ............................................. 17 

VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED 17 

A. Text of Existing Law Amended or Repealed by the Bill, as 

Reported .......................................................................................... 17 

VII. DISSENTING VIEWS ................................................................................... 23 

The amendment is as follows: 

Strike all after the enacting clause and insert the following: 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Employer Relief Act of 2018’’. 

SEC. 2. MORATORIUM ON EMPLOYER MANDATE. 

Section 4980H of the Internal Revenue Code of 1986 is amended by adding at the 

end the following new subsection: 

‘‘(e) SUSPENSION.—This section shall not apply to any month beginning after December 31, 2014, and before January 1, 2019.’’. 

SEC. 3. DELAY IN IMPLEMENTATION OF EXCISE TAX ON HIGH COST EMPLOYER-SPONSORED 

HEALTH COVERAGE. 

Section 9001(c) of the Patient Protection and Affordable Care Act is amended by 

striking ‘‘December 31, 2021’’ and inserting ‘‘December 31, 2022’’. 

I. SUMMARY AND BACKGROUND 

A. PURPOSE AND SUMMARY

The bill H.R. 4616, as reported by the Committee on Ways and 

Means, provides retroactive relief from Obamacare’s employer mandate and one additional year of delay in the implementation of the 

law’s ‘‘Cadillac tax’’ on high-cost employer health plans. 

B. BACKGROUND AND NEED FOR LEGISLATION

The Affordable Care Act (ACA), also known as ‘‘Obamacare,’’ imposes a mandate on employers with more than 50 full-time equivalent workers (FTEs) to offer health coverage to their workers or 

pay one of two penalties. Full-time workers for the purposes of the 

employer mandate are defined as those who work at least 30 hours 

per week. After a one-year delay by the Obama Administration, the 

employer mandate was partially implemented in 2015 and then 

fully implemented in 2016. In November 2017, the Internal Revenue Service (IRS) began issuing notices to employers of employer 

mandate penalty collection for 2015. 

The ACA also imposes a 40 percent excise tax on high-cost employer health plans, commonly referred to as the ‘‘Cadillac tax.’’ 

The tax was originally supposed to be implemented in 2018 but has 

since been delayed by Congress until 2022. 

The ACA’s government intrusion into the employer/employee relationship through the employer mandate and flawed Cadillac tax 

increases costs on employers and harms job growth. The Obama 

Administration appears to have failed to take required action to 

protect employees, employers, and the taxpayers with respect to 

timely notification of potential liability under the law’s employer 

mandate. Now, employers are being asked to prove they were in 

compliance with the employer mandate for coverage in 2015, three 

years after the fact. This retroactive enforcement for compliance 


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with a then partially implemented mandate that lacked clear guidance places a needless burden on employers. 

C. LEGISLATIVE HISTORY

Background 

H.R. 4616 was introduced on December 12, 2017 and was referred to the Committee on Ways and Means. 

Committee action 

The Committee on Ways and Means marked up H.R. 4616, the 

‘‘Employer Relief Act of 2018,’’ on July 11, 2018, and ordered the 

bill, as amended, favorably reported (with a quorum being present). 

Committee hearings 

The policy issues associated with the employer mandate and the 

issue of tax pertaining to health care and the ACA were discussed 

at the following Ways and Means hearings during the 112th 

through 115th Congresses: 

• Full Committee Hearing on the Health Care Law’s Impact 

on Jobs, Employers, and the Economy (January 26, 2011) 

• Subcommittee on Health Hearing on the Individual and 

Employer Mandates in the Democrats’ Health Care Law 

(March 29, 2012) 

• Subcommittee on Oversight Hearing on the Tax-Related 

Provisions in the President’s Health Care Law (March 5, 2013) 

• Subcommittee on Health Hearing on the Delay of the Employer Mandate (July 10, 2013) 

• Subcommittee on Health Hearing on the Delay of the Employer Mandate Penalties and Reporting Requirements (July 

17, 2013) 

• Subcommittee on Health Hearing on the Treasury Department’s Final Employer Mandate and Employer Reporting Requirements Regulations (April 8, 2014) 

• Subcommittee on Health Hearing on the Individual and 

Employer Mandates in the President’s Healthcare Law (April 

14, 2015) 

• Full Committee Hearing on the Tax Treatment of Health 

Care (April 14, 2016) 

• Subcommittee on Tax Policy Member Day Hearing on Tax 

Legislation (May 12, 2016) 

• Subcommittee on Health Member Day Hearing on Tax-Related Proposals to Improve Health Care (May 17, 2016) 

• Subcommittee on Health Hearing on Rising Health Insurance Premiums Under the Affordable Care Act (July 12, 2016) 

• Subcommittee on Health Hearing on Lowering Costs and 

Expanding Access to Health Care through Consumer-Directed 

Health Plans (June 6, 2018) 


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1Sec. 4980H. As discussed in Part A, premium assistance credits under section 36B apply 

with respect to health insurance purchased through an Exchange. An employer may also be subject to an assessable payment if an employee received reduced cost-sharing with respect to coverage purchased through an Exchange as discussed in Part A. 2The rules for determining controlled group, group under common control, and affiliated service group under section 414(b), (c), (m), and (o) apply for this purpose. 

II. EXPLANATION OF THE BILL 

A. MORATORIUM ON EMPLOYER MANDATE

PRESENT LAW

In general 

An applicable large employer, as defined below, may be subject 

to a tax, called an ‘‘assessable payment,’’ for a month if one or more 

of its full-time employees is certified to the employer as receiving 

for the month a premium assistance credit with respect to health 

insurance purchased through an Exchange (commonly referred to 

as the ‘‘employer mandate’’).1 As discussed below, the amount of 

the assessable payment depends on whether the employer offers its 

full-time employees and their dependents the opportunity to enroll 

in minimum essential coverage under a group health plan sponsored by the employer and, if it does, whether the coverage offered 

is affordable and provides minimum value. 

Definitions of full-time employee and applicable large employer 

Applicable large employer generally means, with respect to a calendar year, an employer who employed an average of at least 50 

full-time employees on business days during the preceding calendar 

year. For purposes of these rules, full-time employee means, with 

respect to any month, an employee who is employed on average at 

least 30 hours of service per week. Solely for purposes of determining whether an employer is an applicable large employer (that 

is, whether the employer has at least 50 full-time employees), besides the number of full-time employees, the employer must include 

the number of its full-time equivalent employees for a month, determined by dividing the aggregate number of hours of service of 

employees who are not full-time employees for the month by 120. 

In addition, in determining whether an employer is an applicable 

large employer, members of the same controlled group, group under 

common control, and affiliated service group are treated as a single 

employer.2 If the group is an applicable large employer under this 

test, each member of the group is an applicable large employer 

even if any member by itself would not be an applicable large employer. 

Assessable payments 

If an applicable large employer does not offer its full-time employees and their dependents minimum essential coverage under 

an employer-sponsored plan and at least one full-time employee is 

so certified to the employer, the employer may be subject to an assessable payment (for 2018) of $2,320 (divided by 12 and applied 

on a monthly basis) multiplied by the number of its full-time employees in excess of 30, regardless of the number of full-time employees so certified. 


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3 Coverage under an employer-sponsored plan is unaffordable if the employee’s share of the 

premium for self-only coverage exceeds 9.5 percent of household income, and the coverage fails 

to provide minimum value if the plan’s share of total allowed cost of provided benefits is less 

than 60 percent of such costs. 4Sec. 4980I, was added to the Code by section 9001 of the Patient Protection and Affordable 

Care Act (PPACA) and amended by section 10901 of PPACA and section 1401 of the Health 

Care and Education and Reconciliation Act (HCERA). The effective date was subsequently 

changed by section 1401(b)(2) of Pub. L. No. 111–152, section 101(a) of Pub. L. No. 114–113, 

and section 4002 of Pub. L. No. 115–120. 

Generally an employee who is offered minimum essential coverage under an employer-sponsored plan is not eligible for a premium assistance credit or reduced cost-sharing unless the coverage 

is unaffordable or fails to provide minimum value.3 However, if an 

employer offers its full-time employees and their dependents minimum essential coverage under an employer-sponsored plan and at 

least one full-time employee is certified as receiving a premium assistance credit or reduced cost-sharing (because the coverage is 

unaffordable or fails to provide minimum value), the employer may 

be subject to an assessable payment (for 2018) of $3,480 (divided 

by 12 and applied on a monthly basis) multiplied by the number 

of such full-time employees. However, the assessable payment in 

this case is capped at the amount that would apply if the employer 

failed to offer its full-time employees and their dependents minimum essential coverage. 

REASONS FOR CHANGE

The Committee believes that the employer mandate imposes an 

undue and unnecessary burden on employers by requiring them to 

offer minimum essential coverage to their full-time employees. The 

Committee believes a retroactive moratorium on the employer mandate will help provide relief for employers that struggled to comply 

with the ACA’s complicated new requirements during the first few 

years of implementation. 

EXPLANATION OF PROVISION

Under the proposal, the employer mandate does not apply to any 

month beginning after December 31, 2014, and before January 1, 

2019. 

EFFECTIVE DATE

The proposal is effective for taxable years beginning after December 31, 2018. 

B. DELAY IN IMPLEMENTATION OF EXCISE TAX ON HIGH COST

EMPLOYER-SPONSORED HEALTH COVERAGE

PRESENT LAW

In general 

Effective for taxable years beginning after December 31, 2021, an 

excise tax is imposed on the provider of applicable employer-sponsored health coverage (the ‘‘coverage provider’’) if the aggregate 

cost of the coverage for an employee (including a former employee, 

surviving spouse, or any other primary insured individual) exceeds 

a threshold amount (referred to as ‘‘high cost health coverage’’).4


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5The health cost adjustment percentage is 100 percent plus the excess, if any, of (1) the percentage by which the cost of standard FEHBP coverage for 2018 (determined according to specified criteria) exceeds the cost of standard FEHBP coverage for 2010, over (2) 55 percent. 6Section 106 provides an exclusion for employer-provided coverage. 

7Some types of coverage are not included in applicable employer-sponsored coverage, such as 

long-term care coverage, separate insurance coverage substantially all the benefits of which are 

for treatment of the mouth (including any organ or structure within the mouth) or of the eye, 

and certain excepted benefits. Excepted benefits for this purpose include (whether through insurance or otherwise) coverage only for accident, or disability income insurance, or any combination thereof; coverage issued as a supplement to liability insurance; liability insurance, including 

general liability insurance and automobile liability insurance; workers’ compensation or similar 

insurance; automobile medical payment insurance; credit-only insurance; and other similar insurance coverage (as specified in regulations), under which benefits for medical care are secondary or incidental to other insurance benefits. Applicable employer-sponsored coverage does 

not include coverage only for a specified disease or illness or hospital indemnity or other fixed 

indemnity insurance if the cost of the coverage is not excludible from an employee’s income or 

deductible by a self-employed individual. 

The tax is 40 percent of the amount by which aggregate cost exceeds the threshold amount (the ‘‘excess benefit’’). 

The annual threshold amount for 2018 is $10,200 for self-only 

coverage and $27,500 for other coverage (such as family coverage), 

multiplied by a one-time health cost adjustment percentage.5 This 

threshold is then adjusted annually by an age- and gender-adjusted 

excess premium amount. The age- and gender-adjusted excess premium amount is the excess, if any, of (1) the premium cost of 

standard FEHBP coverage for the type of coverage provided to an 

individual if priced for the age and gender characteristics of all employees of the employer, over (2) the premium cost of standard 

FEHBP coverage if priced for the age and gender characteristics of 

the national workforce. For this purpose, standard FEHBP coverage means the per employee cost of Blue Cross/Blue Shield 

standard benefit coverage under the Federal Employees Health 

Benefit Program. 

The excise tax is determined on a monthly basis, by reference to 

the monthly aggregate cost of applicable employer-sponsored coverage for the month and 1/12 of the annual threshold amount. 

Applicable employer-sponsored coverage and determination of cost 

Subject to certain exceptions, applicable employer-sponsored coverage is coverage under any group health plan offered to an employee by an employer that is excludible from the employee’s gross 

income or that would be excludible if it were employer-sponsored 

coverage.6 Thus, applicable employer-sponsored coverage includes 

coverage for which an employee pays on an after-tax basis. Applicable employer-sponsored coverage includes coverage under any 

group health plan established and maintained primarily for its civilian employees by the Federal government or any Federal agency 

or instrumentality, or the government of any State or political subdivision thereof or any agency or instrumentality of a State or political subdivision. 

Applicable employer-sponsored coverage includes both insured 

and self-insured health coverage, including coverage in the form of 

reimbursements under a health flexible spending account (‘‘health 

FSA’’) or a health reimbursement arrangement and contributions 

to a health savings account (‘‘HSA’’) or Archer medical savings account (‘‘Archer MSA’’).7 In the case of a self-employed individual, 

coverage is treated as applicable employer-sponsored coverage if 


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8Section 162(l) allows a deduction to a self-employed individual for the cost of health insurance. 9Sec. 4980B(f)(4). 

10 As defined in section 414(f), a multiemployer plan is generally a plan to which more than 

one employer is required to contribute and that is maintained pursuant to one or more collective 

bargaining agreements between one or more employee organizations and more than one employer. 11The excise tax is allocated pro rata among the coverage providers, with each responsible 

for the excise tax on an amount equal to the total excess benefit multiplied by a fraction, the 

numerator of which is the cost of the applicable employer-sponsored coverage of that coverage 

provider and the denominator of which is the aggregate cost of all applicable employer-sponsored coverage of the employee. 12The employer or multiemployer plan sponsor may be liable for a penalty if the total excise 

tax due exceeds the tax on the excess benefit calculated and allocated among coverage providers 

by the employer or plan sponsor. 

the self-employed individual is allowed a deduction for all or any 

portion of the cost of coverage.8

For purposes of the excise tax, the cost of applicable employersponsored coverage is generally determined under rules similar to 

the rules for determining the applicable premium for purposes of 

COBRA continuation coverage,9 except that any portion of the cost 

of coverage attributable to the excise tax is not taken into account. 

Cost is determined separately for self-only coverage and other coverage. Special valuation rules apply to retiree coverage, certain 

health FSAs, and contributions to HSAs and Archer MSAs. 

Calculation of excess benefit and imposition of excise tax 

In determining the excess benefit with respect to an employee 

(i.e., the amount by which the cost of applicable employer-sponsored coverage for the employee exceeds the threshold amount), the 

aggregate cost of all applicable employer-sponsored coverage of the 

employee is taken into account. The threshold amount for self-only 

coverage generally applies to an employee. The threshold amount 

for other coverage applies to an employee only if the employee and 

at least one other beneficiary are enrolled in coverage other than 

self-only coverage under a group health plan that provides minimum essential coverage and under which the benefits provided do 

not vary based on whether the covered individual is the employee 

or other beneficiary. For purposes of the threshold amount, any 

coverage provided under a multiemployer plan is treated as coverage other than self-only coverage.10

The excise tax is imposed on the coverage provider.11 In the case 

of insured coverage (i.e., coverage under a policy, certificate, or contract issued by an insurance company), the health insurance issuer 

is liable for the excise tax. In the case of self-insured coverage, the 

person that administers the plan benefits (‘‘plan administrator’’) is 

generally liable for the excise tax. However, in the case of employer 

contributions to an HSA or an Archer MSA, the employer is liable 

for the excise tax. 

The employer is generally responsible for calculating the amount 

of excess benefit allocable to each coverage provider and notifying 

each coverage provider (and the IRS) of the coverage provider’s allocable share. In the case of applicable employer-sponsored coverage under a multiemployer plan, the plan sponsor is responsible 

for the calculation and notification.12


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REASONS FOR CHANGE

The Committee believes the excise tax on high-cost employersponsored health coverage was created to provide a tax incentive 

for employers to curb health care costs, including future increases 

in costs. In theory, because health benefits are important to employees, the excise tax on high-cost employer-sponsored health coverage should motivate employers and insurance issuers to find savings and reduce health care costs. While this is a worthy goal, the 

excise tax is poorly designed and disrupts the level of benefits provided to employees. To comply with the limits, employers will have 

to modify their health plans by either cutting benefits or shifting 

costs to employees. The Committee believes that postponing the punitive excise tax on employer-provided coverage until structural 

health care reform can be adopted will provide relief to employers 

and employees who are facing increased costs or decreased benefits 

and give employers more time to identify and implement their own 

measures to contain health care costs. 

EXPLANATION OF PROVISION

Under the proposal, implementation of the excise tax on highcost employer-sponsored health coverage is delayed until after December 31, 2022. 

EFFECTIVE DATE

The proposal is effective for taxable years beginning after December 31, 2018. 

III. VOTES OF THE COMMITTEE 

In compliance with clause 3(b) of rule XIII of the House of Representatives, the following statement is made concerning the vote 

of the Committee on Ways and Means during the markup consideration of H.R. 4616, the ‘‘Employer Relief Act of 2018,’’ on July 11, 

2018. 

H.R. 4616 was ordered favorably reported to the House of Representatives as amended by an amendment in the nature of a substitute offered by Mr. Roskam by a roll call vote of 22 yeas to 15 

nays. The vote was as follows: 

Representative Yea Nay Present Representative Yea Nay Present 

Mr. Brady .................................. X ......... ............. Mr. Neal ................................... ......... X .............

Mr. Johnson ............................... X ......... ............. Mr. Levin .................................. ......... X .............

Mr. Nunes ................................. X ......... ............. Mr. Lewis .................................. ......... X .............

Mr. Reichert .............................. X ......... ............. Mr. Doggett .............................. ......... X .............

Mr. Roskam ............................... X ......... ............. Mr. Thompson .......................... ......... X .............

Mr. Buchanan ........................... X ......... ............. Mr. Larson ................................ ......... X .............

Mr. Smith (NE) .......................... X ......... ............. Mr. Blumenauer ....................... ......... X .............

Ms. Jenkins ............................... X ......... ............. Mr. Kind ................................... ......... X .............

Mr. Paulsen ............................... X ......... ............. Mr. Pascrell .............................. ......... X .............

Mr. Marchant ............................ X ......... ............. Mr. Crowley .............................. ......... X .............

Ms. Black .................................. ......... ......... ............. Mr. Davis .................................. ......... X .............

Mr. Reed ................................... X ......... ............. Ms. Sa ́ nchez ............................. ......... ......... .............

Mr. Kelly .................................... X ......... ............. Mr. Higgins .............................. ......... X .............

Mr. Renacci ............................... X ......... ............. Ms. Sewell ................................ ......... X .............

Ms. Noem .................................. ......... ......... ............. Ms. DelBene ............................. ......... X .............

Mr. Holding ............................... X ......... ............. Ms. Chu .................................... ......... X .............

Mr. Smith (MO) ......................... X ......... .............

Mr. Rice .................................... X ......... .............


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Representative Yea Nay Present Representative Yea Nay Present 

Mr. Schweikert .......................... X ......... .............

Ms. Walorski ............................. X ......... .............

Mr. Curbelo ............................... X ......... .............

Mr. Bishop ................................ X ......... .............

Mr. LaHood ................................ X ......... .............

Mr. Wenstrup ............................ X ......... .............

IV. BUDGET EFFECTS OF THE BILL 

A. COMMITTEE ESTIMATE OF BUDGETARY EFFECTS

In compliance with clause 3(d) of rule XIII of the Rules of the 

House of Representatives, the following statement is made concerning the effects on the budget of the bill, H.R. 4616, as reported. 

The bill, as reported, is estimated to have the following effect on 

Federal fiscal year budget receipts for the period 2019–2028: 


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Fiscal Years—Millions of Dollars 

Item 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2019–23 2019–28 

Moratorium on Employer Mandate 1 ............................................ ¥12,111 ¥10,169 ¥3,630 ................ ................ ................ ................ ................ ................ ................ ¥25,910 ¥25,910 

Delay in Implementation of Excise tax on High-Cost Employer 

Sponsored Health Coverage 1,2,3 ............................................ .................... .................... ................ ¥7,822 ¥5,766 ................ ................ ................ ................ ................ ¥13,588 ¥13,588 

Total ..................................................................................... ¥12,111 ¥10,169 ¥3,630 ¥7,822 ¥5,766 ................ ................ ................ ................ ................ ¥39,498 ¥39,498 

NOTE: Details may not add to totals due to rounding. 1 Estimate provided by the staff of the Joint Committee on Taxation and the Congressional Budget Office. 

2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2019–23 2019–28 

2 Estimate includes the following off-budget effects .............. .................... .................... ................ ¥291 ¥113 ................ ................ ................ ................ ................ ¥404 ¥404 3 Estimate includes the following outlay effects ..................... .................... .................... ................ ¥1,359 ¥582 ................ ................ ................ ................ ................ ¥1,941 ¥1,941 


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Pursuant to clause 8 of rule XIII of the Rules of the House of 

Representatives, the following statement is made by the Joint Committee on Taxation with respect to the provisions of the bill amending the Internal Revenue Code of 1986: The gross budgetary effect 

(before incorporating macroeconomic effects) in any fiscal year is 

less than 0.25 percent of the current projected gross domestic product of the United States for that fiscal year; therefore, the bill is 

not ‘‘major legislation’’ for purposes of requiring that the estimate 

include the budgetary effects of changes in economic output, employment, capital stock and other macroeconomic variables. 

B. STATEMENT REGARDING NEW BUDGET AUTHORITY AND TAX

EXPENDITURES BUDGET AUTHORITY

In compliance with clause 3(c)(2) of rule XIII of the Rules of the 

House of Representatives, the Committee states that the bill involves no new or increased budget authority. The Committee further states that the revenue-reducing tax provision involves a new 

tax expenditure. See Part IV.A., above. 

C. COST ESTIMATE PREPARED BY THE CONGRESSIONAL BUDGET

OFFICE

In compliance with clause 3(c)(3) of rule XIII of the Rules of the 

House of Representatives, requiring a cost estimate prepared by 

the CBO, the following statement by CBO is provided. 

H.R. 4616—Employer Relief Act of 2018 

Summary: H.R. 4616 would suspend collection of penalties imposed on large employers who decline to offer their employees 

health insurance coverage that meets specified standards (known 

as the employer mandate) for plan years 2015–2018. It also would 

delay implementation of the excise tax on high-premium insurance 

plans by one year. CBO and the staff of the Joint Committee on 

Taxation (JCT) estimate that enacting the legislation would increase federal deficits by $39.5 billion over the 2019–2028 period. 

Enacting H.R. 4616 would affect direct spending and revenues; 

therefore, pay-as-you-go procedures apply. 

CBO and JCT estimate that enacting H.R. 4616 would not increase net direct spending or on-budget deficits in any of the four 

consecutive 10-year periods beginning in 2029. 

JCT has determined that the bill contains no intergovernmental 

or private-sector mandates as defined in the Unfunded Mandates 

Reform Act (UMRA). 

Estimated cost to the Federal Government: The estimated budgetary effect of H.R. 4616 is shown in the following table. The costs 

of this legislation fall within budget function 550 (health). 


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By fiscal year, in billions of dollars— 

2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2019– 2023 2019– 2028 

DECREASES (¥) IN REVENUES 

Moratorium on Employer Mandate 

Estimated Revenues ................................................................................... 0 ¥12.1 ¥10.2 ¥3.6 0 0 0 0 0 0 0 ¥25.9 ¥25.9 

Delay in Implementation of Excise Tax on High-Premium Insurance Plans 

Estimated Revenues ................................................................................... 0 0 0 0 ¥9.2 ¥6.3 0 0 0 0 0 ¥15.5 ¥15.5 

Total Changes in Revenues ................................................................................ 0 ¥12.1 ¥10.2 ¥3.6 ¥9.2 ¥6.3 0 0 0 0 0 ¥41.4 ¥41.4 

On-Budget .................................................................................................. 0 ¥12.1 ¥10.2 ¥3.6 ¥8.9 ¥6.2 0 0 0 0 0 ¥41.0 ¥41.0 

Off-Budget a ................................................................................................ 0 0 0 0 ¥0.3 ¥0.1 0 0 0 0 0 ¥0.4 ¥0.4 

DECREASES (¥) IN DIRECT SPENDING 

Delay in Implementation of Excise Tax on High-Premium Insurance Plans 

Estimated Budget Authority ....................................................................... 0 0 0 0 ¥1.4 ¥0.6 0 0 0 0 0 ¥1.9 ¥1.9 

Estimated Outlays ...................................................................................... 0 0 0 0 ¥1.4 ¥0.6 0 0 0 0 0 ¥1.9 ¥1.9 

NET INCREASE IN THE DEFICIT FROM DECREASES (¥) IN DIRECT SPENDING AND REVENUES 

Impact on Deficit ................................................................................................ 0 12.1 10.2 3.6 7.8 5.8 0 0 0 0 0 39.5 39.5 

On-Budget .................................................................................................. 0 12.1 10.2 3.6 7.5 5.7 0 0 0 0 0 39.1 39.1 Off-Budget a ................................................................................................ 0 0 0 0 0.3 0.1 0 0 0 0 0 0.4 0.4 

Annual amounts may not sum to totals because of rounding. a All off-budget effects would come from changes in Social Security revenues. b For revenues, a negative number indicates a decrease (adding to the deficit). 


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1To meet the standards, the cost to employees for self-only coverage must not exceed a specified share of their income (which is 9.56 percent in 2018 and is scheduled to grow over time), 

and the plan must pay at least 60 percent of the cost of covered benefits. 2The excise tax will apply to plans that have total premiums above a certain threshold. The 

tax will be equal to 40 percent of the difference between the total value of the contributions 

and the applicable threshold. 

Basis of estimate: For this estimate, CBO assumes the legislation 

will be enacted near the end of fiscal year 2018. CBO and JCT estimate that enacting the legislation would increase federal deficits by 

$39.5 billion over the 2019–2028 period; that change would result 

from a $1.9 billion decrease in outlays and a $41.4 billion decrease 

in revenues. 

Moratorium on Employer Mandate Penalties. Section 2 of H.R. 

4616 would suspend collection of employer mandate penalties related to plan years 2015 through 2018. CBO and JCT estimate that 

the moratorium on the penalties would decrease revenues by $25.9 

billion over the 2019–2028 period. 

Under current law, large employers that do not offer health insurance coverage that meets certain standards under the Affordable Care Act will owe a penalty if they have any full-time employees who receive a subsidy through a health insurance marketplace.1 The requirement generally applies to employers with at 

least 50 full-time equivalent employees. The Internal Revenue 

Service (IRS) is in the process of collecting penalties for plan year 

2015. CBO and JCT estimate that, under the bill, any penalties 

that have been collected would be refunded and that the IRS would 

cease collecting penalties for plan years 2015 through 2018. Because the penalties would not be collected for prior plan years and 

would remain in place for years after 2018, CBO and JCT estimate 

that the provision would not significantly affect employer decisions 

about offering insurance coverage. 

Delaying Implementation of Excise Tax on High-Premium Insurance Plans. Section 3 of H.R. 4616 would delay the implementation 

of the excise tax on high-premium employment-based insurance 

plans until 2023. (The tax is currently scheduled to take effect beginning in 2022.) CBO and JCT estimate that the delay would decrease outlays by $1.9 billion and decrease revenues by $15.5 billion over the 2019–2028 period, resulting in an estimated $13.6 billion increase in the deficit. 

Current law requires providers of employment-based insurance 

to pay a federal excise tax on certain high-cost employment-based 

coverage beginning in 2022.2 CBO and JCT expect that the excise 

tax will cause employers and employees to shift to lower cost plans 

to avoid paying the tax or to reduce their taxable liability. H.R. 

4616 would delay the tax from applying until 2023. The estimated decrease in revenues of $15.5 billion over the 

2019–2028 period stems from foregone excise tax receipts and from 

fewer employers and workers shifting to lower-cost health insurance plans to avoid paying the tax. That is, relative to current law, 

more people would remain in higher cost health insurance plans, 

and a larger share of total compensation would take the form of 

non-taxable health benefits, decreasing the share that takes the 

form of taxable wages and salaries. The reduction in revenues also 

reflects CBO and JCT’s expectation that some employers who are 

projected to stop offering health insurance under current law would 

instead continue to offer insurance whose total value exceeds the 


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14 

specified thresholds for the excise tax. That response would further 

reduce the share of compensation taking the form of taxable wages 

and salaries. 

The estimated $1.9 billion decrease in outlays over the 2019– 

2028 period is attributable to individuals who would have received 

marketplace subsidies under current law and would instead enroll 

in employment-based coverage. 

Pay-As-You-Go considerations: The Statutory Pay-As-You-Go Act 

of 2010 establishes budget-reporting and enforcement procedures 

for legislation affecting direct spending or revenues. The net 

changes in outlays and on budget revenues that are subject to 

those pay-as-you-go procedures are shown in the following table. 


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CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 4616, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON WAYS AND MEANS ON JULY 11, 2018 

By fiscal year, in millions of dollars— 

2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2018–2023 2018–2028 

NET INCREASE OR DECREASE (¥) IN THE ON-BUDGET DEFICIT 

Statutory Pay-As-You-Go Effect ............................................................ 0 12,111 10,169 3,630 7,531 5,653 0 0 0 0 0 39,094 39,094 Memorandum: 

Changes in Outlays ...................................................................... 0 0 0 0 ¥1,359 ¥582 0 0 0 0 0 ¥1,941 ¥1,941 

Changes in Revenues (on-budget) .............................................. 0 ¥12,111 ¥10,169 ¥3,630 ¥8,890 ¥6,235 0 0 0 0 0 ¥41,035 ¥41,035 


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Increase in long-term direct spending and deficits: CBO and JCT 

estimate that enacting the legislation would not increase net direct 

spending or on-budget deficits in any of the four consecutive 10- 

year periods beginning in 2029. 

Mandates: JCT has determined that the bill contains no intergovernmental or private-sector mandates as defined in UMRA. 

Estimate prepared by: Federal Costs: Kate Fritzsche, Emily 

Vreeland, and the staff of the Joint Committee on Taxation; Mandates: The staff of the Joint Committee on Taxation. 

Estimate approved by: Chad M. Chirico, Chief, Low-Income 

Health Programs and Prescription Drugs Cost Estimates Unit; 

Sarah Masi, Special Assistant for Health; Leo Lex, Deputy Assistant Director for Budget Analysis. 

V. OTHER MATTERS TO BE DISCUSSED UNDER THE 

RULES OF THE HOUSE 

A. COMMITTEE OVERSIGHT FINDINGS AND RECOMMENDATIONS

Pursuant to clause 3(c)(1) of rule XIII of the Rules of the House 

of Representatives, the Committee advises that the findings and 

recommendations of the Committee, based on oversight activities 

under clause 2(b)(1) of rule X of the Rules of the House of Representatives, are incorporated into the description portions of this 

report. 

B. STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

With respect to clause 3(c)(4) of rule XIII of the Rules of the 

House of Representatives, the Committee advises that the bill contains no measure that authorizes funding, so no statement of general performance goals and objectives for which any measure authorizes funding is required. 

C. INFORMATION RELATING TO UNFUNDED MANDATES

This information is provided in accordance with section 423 of 

the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104–4). 

The Committee has determined that the bill does not contain 

Federal mandates on the private sector. The Committee has determined that the bill does not impose a Federal intergovernmental 

mandate on State, local, or tribal governments. 

D. APPLICABILITY OF HOUSE RULE XXI 5(b) 

Rule XXI 5(b) of the Rules of the House of Representatives provides, in part, that ‘‘A bill or joint resolution, amendment, or conference report carrying a Federal income tax rate increase may not 

be considered as passed or agreed to unless so determined by a 

vote of not less than three-fifths of the Members voting, a quorum 

being present.’’ The Committee has carefully reviewed the bill and 

states that the bill does not involve any Federal income tax rate 

increases within the meaning of the rule. 

E. TAX COMPLEXITY ANALYSIS

Section 4022(b) of the Internal Revenue Service Restructuring 

and Reform Act of 1998 (‘‘IRS Reform Act’’) requires the staff of the 


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17 

Joint Committee on Taxation (in consultation with the Internal 

Revenue Service and the Treasury Department) to provide a tax 

complexity analysis. The complexity analysis is required for all legislation reported by the Senate Committee on Finance, the House 

Committee on Ways and Means, or any committee of conference if 

the legislation includes a provision that directly or indirectly 

amends the Internal Revenue Code of 1986 and has widespread applicability to individuals or small businesses. 

Pursuant to clause 3(h)(1) of rule XIII of the Rules of the House 

of Representatives, the staff of the Joint Committee on Taxation 

has determined that a complexity analysis is not required under 

section 4022(b) of the IRS Reform Act because the bill contains no 

provisions that amend the Internal Revenue Code of 1986 and that 

have ‘‘widespread applicability’’ to individuals or small businesses, 

within the meaning of the rule. 

F. CONGRESSIONAL EARMARKS, LIMITED TAX BENEFITS, AND

LIMITED TARIFF BENEFITS

With respect to clause 9 of rule XXI of the Rules of the House 

of Representatives, the Committee has carefully reviewed the provisions of the bill and states that the provisions of the bill do not 

contain any congressional earmarks, limited tax benefits, or limited 

tariff benefits within the meaning of the rule. 

G. DUPLICATION OF FEDERAL PROGRAMS

In compliance with Sec. 3(c)(5) of rule XIII of the Rules of the 

House of Representatives, the Committee states that no provision 

of the bill establishes or reauthorizes: (1) a program of the Federal 

Government known to be duplicative of another Federal program, 

(2) a program included in any report from the Government Accountability Office to Congress pursuant to section 21 of Public 

Law 111–139, or (3) a program related to a program identified in 

the most recent Catalog of Federal Domestic Assistance, published 

pursuant to section 6104 of title 31, United States Code. 

H. DISCLOSURE OF DIRECTED RULE MAKINGS

In compliance with Sec. 3(i) of H. Res. 5 (115th Congress), the 

following statement is made concerning directed rule makings: The 

Committee advises that the bill requires no directed rule makings 

within the meaning of such section. 

VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS 

REPORTED 

A. TEXT OF EXISTING LAW AMENDED OR REPEALED BY THE BILL, AS

REPORTED

In compliance with clause 3(e)(1)(A) of rule XIII of the Rules of 

the House of Representatives, the text of each section proposed to 

be amended or repealed by the bill, as reported, is shown below: 

CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In compliance with clause 3(e) of rule XIII of the Rules of the 

House of Representatives, changes in existing law made by the bill, 


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18 

as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, 

and existing law in which no change is proposed is shown in 

roman): 

INTERNAL REVENUE CODE OF 1986 

* * * * * * * 

Subtitle D—Miscellaneous Excise Taxes 

* * * * * * * 

CHAPTER 43—QUALIFIED PENSION, ETC., 

PLANS 

* * * * * * * 

SEC. 4980H. SHARED RESPONSIBILITY FOR EMPLOYERS REGARDING 

HEALTH COVERAGE. 

(a) LARGE EMPLOYERS NOT OFFERING HEALTH COVERAGE.—If— 

(1) any applicable large employer fails to offer to its full-time 

employees (and their dependents) the opportunity to enroll in 

minimum essential coverage under an eligible employer-sponsored plan (as defined in section 5000A(f)(2)) for any month, 

and 

(2) at least one full-time employee of the applicable large employer has been certified to the employer under section 1411 of 

the Patient Protection and Affordable Care Act as having enrolled for such month in a qualified health plan with respect 

to which an applicable premium tax credit or cost-sharing reduction is allowed or paid with respect to the employee, 

then there is hereby imposed on the employer an assessable payment equal to the product of the applicable payment amount and 

the number of individuals employed by the employer as full-time 

employees during such month. 

(b) LARGE EMPLOYERS OFFERING COVERAGE WITH EMPLOYEES

WHO QUALIFY FOR PREMIUM TAX CREDITS OR COST-SHARING REDUCTIONS.— 

(1) IN GENERAL.—If— 

(A) an applicable large employer offers to its full-time 

employees (and their dependents) the opportunity to enroll 

in minimum essential coverage under an eligible employersponsored plan (as defined in section 5000A(f)(2)) for any 

month, and 

(B) 1 or more full-time employees of the applicable large 

employer has been certified to the employer under section 

1411 of the Patient Protection and Affordable Care Act as 

having enrolled for such month in a qualified health plan 

with respect to which an applicable premium tax credit or 

cost-sharing reduction is allowed or paid with respect to 

the employee, 

then there is hereby imposed on the employer an assessable 

payment equal to the product of the number of full-time employees of the applicable large employer described in subparaVerDate Sep 11 2014 03:24 Aug 30, 2018 Jkt 079006 PO 00000 Frm 00018 Fmt 6659 Sfmt 6602 E:\HR\OC\HR906.XXX HR906

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graph (B) for such month and an amount equal to 1⁄12 of 

$3,000. 

(2) OVERALL LIMITATION.—The aggregate amount of tax determined under paragraph (1) with respect to all employees of 

an applicable large employer for any month shall not exceed 

the product of the applicable payment amount and the number 

of individuals employed by the employer as full-time employees 

during such month. 

(c) DEFINITIONS AND SPECIAL RULES.—For purposes of this section— 

(1) APPLICABLE PAYMENT AMOUNT.—The term ‘‘applicable 

payment amount’’ means, with respect to any month, 1⁄12 of 

$2,000. 

(2) APPLICABLE LARGE EMPLOYER.— (A) IN GENERAL.—The term ‘‘applicable large employer’’ 

means, with respect to a calendar year, an employer who 

employed an average of at least 50 full-time employees on 

business days during the preceding calendar year. 

(B) EXEMPTION FOR CERTAIN EMPLOYERS.— (i) IN GENERAL.—An employer shall not be considered to employ more than 50 full-time employees if— 

(I) the employer’s workforce exceeds 50 full-time 

employees for 120 days or fewer during the calendar year, and 

(II) the employees in excess of 50 employed during such 120-day period were seasonal workers. 

(ii) DEFINITION OF SEASONAL WORKERS.—The term 

‘‘seasonal worker’’ means a worker who performs labor 

or services on a seasonal basis as defined by the Secretary of Labor, including workers covered by section 

500.20(s)(1) of title 29, Code of Federal Regulations 

and retail workers employed exclusively during holiday seasons. 

(C) RULES FOR DETERMINING EMPLOYER SIZE.—For purposes of this paragraph— 

(i) APPLICATION OF AGGREGATION RULE FOR EMPLOY- ERS.—All persons treated as a single employer under 

subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as 1 employer. 

(ii) EMPLOYERS NOT IN EXISTENCE IN PRECEDING

YEAR.—In the case of an employer which was not in 

existence throughout the preceding calendar year, the 

determination of whether such employer is an applicable large employer shall be based on the average number of employees that it is reasonably expected such 

employer will employ on business days in the current 

calendar year. 

(iii) PREDECESSORS.—Any reference in this subsection to an employer shall include a reference to any 

predecessor of such employer. 

(D) APPLICATION OF EMPLOYER SIZE TO ASSESSABLE PEN- ALTIES.— 

(i) IN GENERAL.—The number of individuals employed by an applicable large employer as full-time 


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20 

employees during any month shall be reduced by 30 

solely for purposes of calculating— 

(I) the assessable payment under subsection (a), 

or 

(II) the overall limitation under subsection 

(b)(2). 

(ii) AGGREGATION.—In the case of persons treated as 

1 employer under subparagraph (C)(i), only 1 reduction under subclause (I) or (II) shall be allowed with 

respect to such persons and such reduction shall be allocated among such persons ratably on the basis of the 

number of full-time employees employed by each such 

person. 

(E) FULL-TIME EQUIVALENTS TREATED AS FULL-TIME EM- PLOYEES.—Solely for purposes of determining whether an 

employer is an applicable large employer under this paragraph, an employer shall, in addition to the number of fulltime employees for any month otherwise determined, include for such month a number of full-time employees determined by dividing the aggregate number of hours of 

service of employees who are not full-time employees for 

the month by 120. 

(F) EXEMPTION FOR HEALTH COVERAGE UNDER TRICARE 

OR THE DEPARTMENT OF VETERANS AFFAIRS.—Solely for 

purposes of determining whether an employer is an applicable large employer under this paragraph for any month, 

an individual shall not be taken into account as an employee for such month if such individual has medical coverage for such month under— 

(i) chapter 55 of title 10, United States Code, including coverage under the TRICARE program, or 

(ii) under a health care program under chapter 17 or 

18 of title 38, United States Code, as determined by 

the Secretary of Veterans Affairs, in coordination with 

the Secretary of Health and Human Services and the 

Secretary. 

(3) APPLICABLE PREMIUM TAX CREDIT AND COST-SHARING RE- DUCTION.—The term ‘‘applicable premium tax credit and costsharing reduction’’ means— 

(A) any premium tax credit allowed under section 36B, 

(B) any cost-sharing reduction under section 1402 of the 

Patient Protection and Affordable Care Act, and 

(C) any advance payment of such credit or reduction 

under section 1412 of such Act. 

(4) FULL-TIME EMPLOYEE.— 

(A) IN GENERAL.—The term ‘‘full-time employee’’ means, 

with respect to any month, an employee who is employed 

on average at least 30 hours of service per week. 

(B) HOURS OF SERVICE.—The Secretary, in consultation 

with the Secretary of Labor, shall prescribe such regulations, rules, and guidance as may be necessary to determine the hours of service of an employee, including rules 

for the application of this paragraph to employees who are 

not compensated on an hourly basis. 

(5) INFLATION ADJUSTMENT.— 


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21 

(A) IN GENERAL.—In the case of any calendar year after 

2014, each of the dollar amounts in subsection (b) and 

paragraph (1) shall be increased by an amount equal to 

the product of— 

(i) such dollar amount, and 

(ii) the premium adjustment percentage (as defined 

in section 1302(c)(4) of the Patient Protection and Affordable Care Act) for the calendar year. 

(B) ROUNDING.—If the amount of any increase under subparagraph (A) is not a multiple of $10, such increase 

shall be rounded to the next lowest multiple of $10. 

(6) OTHER DEFINITIONS.—Any term used in this section 

which is also used in the Patient Protection and Affordable 

Care Act shall have the same meaning as when used in such 

Act. 

(7) TAX NONDEDUCTIBLE.—For denial of deduction for the tax 

imposed by this section, see section 275(a)(6). 

(d) ADMINISTRATION AND PROCEDURE.— (1) IN GENERAL.—Any assessable payment provided by this 

section shall be paid upon notice and demand by the Secretary, 

and shall be assessed and collected in the same manner as an 

assessable penalty under subchapter B of chapter 68. 

(2) TIME FOR PAYMENT.—The Secretary may provide for the 

payment of any assessable payment provided by this section on 

an annual, monthly, or other periodic basis as the Secretary 

may prescribe. 

(3) COORDINATION WITH CREDITS, ETC..—The Secretary shall 

prescribe rules, regulations, or guidance for the repayment of 

any assessable payment (including interest) if such payment is 

based on the allowance or payment of an applicable premium 

tax credit or cost-sharing reduction with respect to an employee, such allowance or payment is subsequently disallowed, 

and the assessable payment would not have been required to 

be made but for such allowance or payment. 

(e) SUSPENSION.—This section shall not apply to any month beginning after December 31, 2014, and before January 1, 2019. 

* * * * * * * 

PATIENT PROTECTION AND AFFORDABLE CARE ACT 

* * * * * * * 

TITLE IX—REVENUE PROVISIONS 

Subtitle A—Revenue Offset Provisions 

SEC. 9001. EXCISE TAX ON HIGH COST EMPLOYER-SPONSORED 

HEALTH COVERAGE. 

(a) IN GENERAL.—Chapter 43 of the Internal Revenue Code of 

1986, as amended by section 1513, is amended by adding at the 

end the following: 

øOmitted amendatory text¿ 

* * * * * * *’’. 


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(b) CLERICAL AMENDMENT.—The table of sections for chapter 43 

of such Code, as amended by section 1513, is amended by adding 

at the end the following new item: 

’’Sec. 4980I. Excise tax on high cost employer-sponsored health coverage.’’. 

(c) EFFECTIVE DATE.—The amendments made by this section 

shall apply to taxable years beginning after øDecember 31, 2021¿ 

December 31, 2022. 

* * * * * * * 


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VII. DISSENTING VIEWS 

H.R. 4616 (Nunes, R–CA and Kelly, R–PA) provides retroactive 

relief of the employer mandate for the tax years 2015 through 2018 

and an additional one-year delay of the high-cost plan excise tax 

(often called the ‘‘Cadillac’’ tax) until 2022. 

H.R. 4616 does not undo sabotage, premium hikes, and benefit 

cuts Republicans have caused over the past 18 months. This bill 

was one in a series of 11 bills the Committee marked up that Republicans claim will help lower health care costs for consumers. 

This legislation does not undo the disruption and sabotage on the 

American health care system. Democrats encourage the Committee 

to redirect its attention to legislation that could actually ensure 

that uninsured, low-income, and vulnerable people have real access 

to care. For example H.R. 5155, sponsored by Reps. Pallone, Neal, 

and Scott would protect people with pre-existing conditions, help 

lower premiums for Americans, and improve affordability of health 

coverage. 

H.R. 4616 is a cynical attempt to address issues the Republicans 

could have easily included in their larger tax reform effort earlier 

this Congress. Yet, Republicans strategically left these taxes out 

and now only look to offer retroactive relief or tax delays. This is 

not a permanent solution. If Republicans truly want to help employers and employees, they would look at ways to address drug 

costs and other health care expenses that continue to grow faster 

than inflation. They would work to stabilize the larger health care 

marketplace and offer certainty that helps employers make the 

best decisions about how to get value for their health care dollar. 

Legislation busts the deficit to benefit the wealthy, again. Altogether the 11 bills the Committee marked up would add another 

$92 billion in unoffset tax cuts to the deficit. This bill comes at significant unoffset cost, nearly $39 billion over ten years. While 

many Democrats are supportive of repealing the Cadillac tax, this 

bill’s meager one year delay is unacceptable. Even the Fight 40 Coalition noted that while recognition of the problem is nice, failing 

to move forward with full repeal is a 306 problem, especially as Republicans continue to advocate for full repeal of the medical device 

tax, benefiting one particular industry, while ignoring millions of 

Americans in employer-sponsored coverage. 

The Joint Committee on Taxation estimates the cost of this bill 

to be $39.5 billion over 10 years. Specifically, the employer mandate relief costs $25.9 billion and high-cost plan excise tax delay 

costs $13.6 billion. With this bill, Republicans are adding more tax 

cuts and increasing the deficit. Republicans are using the deficit, 

which they keep making larger with cuts for the wealthy, to justify 

the deep cuts they plan to make to Medicare and Medicaid. Republicans already are proposing to cut Medicare and Medicaid by nearly a trillion dollars to try to pay for the tax cuts they have already 


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24 

enacted. This bill will only increase Republicans’ call for further 

cuts to these critical programs. 

RICHARD E. NEAL, 

Ranking Member. 

Æ 


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