>> employees can be dumped and condemned to high price plans or quarentined. this will reduce the what are we trying to do with this bill? what did my bill do for susan? before the aca, she could not afford the insurance.

thanks to the subsidies she received she became insured. how does this plan help susan? it just checks a box for republicans and after years of sabotaging the aca, they are now offering a half-baked plan that will leave americans far worse. and they are going to hope they can trump at the fact they quote unquote repealed obamacare. in fact, someone said the other day of prominence within the republican party, let's just

appeal and worry about the rest later and hope no one notices the wreckage left behind. the whole structure will collapse and that gets us back to the question of why the mandates which was not a democratic idea to begin with. regardless, the mandates are critical and help us pay for the service. this is not a totally government plan. the government is involved with this. there is no question about it. but it is not a total government plan. it is not socialized medicine. this is how it has been defined by some opponents. but the fact of the matter is, that this is a complex issue.

i will go back to the example if you remember when we voted in the floor of this house 12 years ago to help resolve and respond to the high prices of drug costs. remember that, democrats. i campaigned against it. told my seniors i would vote against it. there were reasons i did it. but after that thing was over, and you won the election and won the vote that night, the fact of the matter is we didn't stop to try to obstruct you. we did not do that. in fact, what we did was cooperate and we knew let's cooperate and make the plan bet skwr made it better under the aca when we filled in the gab of

2200-5000 dollars. that is cooperation. >> the time is expired. mr. ranacy. >> thank you. it is 8:43 and i want to get back on track. we are talking about the effect on employment and i want to fall back on what my friend kelly talked about. i heard you say medicare and shoring up medicare. we are talking about 81,000 jobs that were lost. this is based on natural news august 2015, 81,000 jobs lost because of this tax. >> will the gentlemen yield? >> no, not at this moment. 81,000 jobs calculated at $10 is $1.6 trillion in wages that would benefit social and

medicare and help the situation we are talking about. this is about jobs. this is about going into discussion about all the other things at 8:00 at night. this is a job killing tax that is shown to be a job killing tax and closed 10:10 because of the salons which eliminated 26,000 worth of wages that could help shore up medicare and social security. that the what we have to stay focused on and that is the reason why we need to repeal the tax. i will yield to my gentlemen friend. >> thank you for yielding. >> we are forgetting why that was one of the taxes we implemented in the bill. we don't want to see anybody lose jobs but the fact of the matter is if something is prove n to be not healthy, and something is proven -- >> there is nothing --

>> excuse me. >> there is nothing that shows it is not healthy. it says it actually could be healthy if you look at some of the studies. you not a doctor. i am not a doctor. there are studies that say it is healthy and studies that say it is not healthy. let's talk about the jobs and wages we lost. >> thank you. some of your figures are lacking in terms of -- >> i am taking back my time. >> i reclaim my time. my figures came from a reference we gave you. >> they are whacky. >> i am telling you where i got it from. we are still talking about jobs. at his point, i yield back my time. >> mr. levin? >> mr. chairman, i have a

statement or a summary of the story of lindsey healthman, who was my guest at the gathering monday and i ask it be entered into the record. >> without objection, so ordered. >> let's spend a few minutes all together talking about the tanning tax. sure, there are jobs involved. but the basic issue is health. the evidence is clear that tanning can be a source of cancer. i just want to read a statement from the president of the american academy of dermatology. the u.s. department of health

and human services recognizes that even a single indoor tanning session can increase a patient's risk of developing squmas cell cancer by 35%. and increase a patient's risk of developing melanoma, the deadliest form of skin cancer by 59%. so, to simply raise the issue of jobs without reference to the health results, i think sells all of us short if i might say so. you know, we had the same battle over cigarette smoke. and some of the arguments that

you have raised were raised t n then. a number of jobs have been lost because of the cigarette smoking is probably in the hundreds of thousands. many of them were small business owners. there is a health issue and there was a reference here to the golden egg. there is no golden egg that came out of these tanning institutions. we take it seriously. take it seriously. and for us here to essentially provide, to lose 600 million because you act on the tanning

tax, i think really raises questions about how you proceeded and kind of the recklessness that is a kind of blind ideaologideology. yed geographic gelt get -- get rid of taxes regardless. i think we have seen a reduction in the tanning entities because of the tax and i think that is a positive and that is what the dermatology association is saying. this is another indication and i close with this. why it is really unfortunate and really sad we are taking up this bill in this way without a single hearing on this bill so

people can raise issues. you are increasing taxes and it isn't going to the very healthy but it is going to a pursuit that has a serious impact in terms of cancer and the lives of human beings. i asked mr. bartow about this and my guess is if you asked experts they would say it a serious mistake to take into account this provision without looking at the health consequences because they are not incidental and we are dealing with results that could be tragic. >> mr. smith of missouri. >> thank you, mr. chairman. why are in xhis committee room

and discussing taxes, a lot of time, most of the time, we talk about who was burdened with that tax. that hasn't been the conversation here. and so, i wanted to see who is the predominant tax this tax is from. is it men? is it women? i went to the google search and what i found was roughly 80% of who is taxed are women. so out of the $600 million that has been created by this tax, which is an interesting excise tax, $480 million has come from the backs and the pockets of women.

today's international women day. it is interesting that no one is bringing that up. i just would like for people to look at the jobs from the tax but also whoever decided to impose this tax sever -- seven years ago before i was here, i would be curious why they just randomly picked this tax to have it paid for on the backs of so many females. >> would the gentlemen yield? >> i am not done yet, sir. so, i wasn't here. one of the newer members. but when you just look at the facts roughly 80% of the individuals who are burdens with this tax are females.

it looks like an interesting target which i think is inappropriate. you know, there is a lot of taxes out there but you could tax a lot of items if you want to stop behavior. i love ice cream. ice cream is probably not the most healthy thing to eat. why is there not a tax on that? you know what? if you look at the number one cause of skin cancer it is not tanning beds. do a google search. it is the sun. i notice the people over here haven't found too many taxes that they dislike so why have they not proposed a tax on the sun instead of tanning beds? with that, mr. speaker, i leave those thoughts and yield the balance of my time.

>> mr. lewis. >> thank you, mr. chairman. mr. chairman, we have had a long and ongoing discussion. i want to take a moment to speak about a family in my home state of georgia. a woman, she is married, and she is really the head of the household. she is grateful for the affordable care act. her husband had a pre-existing condition. as a result, they cannot get insurance coverage without buying a company's plan. both are self-employed. before obamacare, they played over $2600 a month for coverage. the high cost plan didn't cover doctor visits, medicine and

their hospital coverage was a nightmare. after the aca, ms. cox and her husband were able to purchase insurance at a significantly cost saving. they signed up for obamacare and are happy to get reasonable affordable coverage. but every single day they live in fear of loosing the affordable care act. we cannot, and we must not turn back the clock on ms. cox and her family. >> i just want to say to the gentlemen from nebraska. it wasn't the tanning provision wasn't picked randomly. it wasn't. there is scientific evidence. ice cream is not the same.

and for you to refer to ice cream compared to the impact that the scientists have maintained -- >> will the gentlemen yield? i referred to ice cream because it isn't the best thing to eat when you are watching your health which leads to congestven heart failure. and i am and from -- >> to relate ice cream to tanning is a serious mistake. there is a major difference in the impact. >> does the gentlemen yield?

>> it wasn't picked randomly. >> what is the difference? you picked -- i wasn't here. i have only been here a much shorter time than you have. why did you not look at a sun tax because that is the number one killer of cancer. >> it is a little hard to tax the sun. >> spain taxes the sun. >> i am not sure how to tax the sun. >> i would send you an article. >> mr. lewis? >> i would ask how they do this on mars. i had an aunt who died from melanoma. she suffered. died in her late 40s. she didn't go to a tanning salon.

we tax the sun? this is a serious subject matter. to suggest that here we are on a day celebrating the value of women and to somehow say that because the woman are the ones causing the tax. maybe we are trying to send a message to men and with women who use tanning salons that maybe it isn't the best thing for your skin or health and you actually place a burden on the rest of society when you get that cancer and go to a hospital and something that is preventable and avoidable if you don't use a tanning salon or bed. ....

they say that the print and online advertising tanning salons target teenage girls with student discounts, prom, homecoming and back-to-school specials. specials with unlimited tanning packages allowing frequent and

even daily tanning despite research showing frequent indoor tanning significantly increases the likelihood that a woman will develop melanoma the deadliest form of skin cancer before she reaches 30 years of age. the salons are well known for disclosing to those who come in the health consequences and the dangers of indoor tanning. this was supposed to be a hearing about how to change the affordable healthcare act and even though there are parts of the bill that continued to emphasize the spirit of obamacare, they said they want to do more about healthcare and yet this bill has become nothing but a tax windfall, nothing but tax breaks using obamacare as an excuse and in this case we

reached it in the health insurance industry and instead of improving health, we are doing the opposite of what the medical professionals say is the purpose of the tax and at the same time reducing the resources that will be available for the hospitals or customers all over the country. you talk about jobs. i'm reminded of a small-business owner in austin texas who told me that he would end behavioral to start his engineering company that hired six people but for the affordable care act. they couldn't get insurance due to the individual market with the affordable care act, they were able to go to the exchange and ensure their employees and create jobs in a business that is contributing to our central texas economy. this ought to be about strengthening the economy, not

encouraging a debilitating tanning industry with a grade three ward off $600 million of your tax dollars. i yield back. >> mr. thompson. >> thank you mr. chairman. i found it interesting that our colleague from ohio credited this tax on tanning services. i would be willing to wager that it wasn't the tax that caused folks to close the doors but it was something else. if you look at it, just a quick search on the internet, i would find that one of these places cost about $40, so that means the tax that would be opposed to that would go from 40 to $44. i don't think that is going to cause people to shy away from

that. the one i looked at had an annual package of $300. it was $330 so it strikes me as a reach to suggest that is going to cause things to slow down and cause the job loss but some on the other side were talking about. but if in fact you are concerned about job loss, look at what you are doing in the bill. all of these titles combined suggest you are going to lose 3 million jobs across the country. it's 350 in my state alone as i mentioned early. my phones in my district offices ran off the hook. we were inundated with mail. people stopped me at the grocery store to talk about how concerned they were about the

aca. i had townhall meetings i've never had to turn out like this before. the last one i had the weekend before last we filled up a gymnasium with standing room only. over 2,000 people came to talk just about the affordable care act and they are concerned about

we have no idea what the broad impact will be to the healthcare system. but we do know a few things. millionaires and corporations will get massive tax cuts and we know we are going to give away $600 million to the tanning industry. we know the state medicaid programs will suffer billions of dollars in cuts and women will face barrierwhen it willface bae reproductive health care and even with all of the unknowns it is easier to see we are getting

less than we are paying for. this is going to be devastating for people in every one of our districts, yours included. it's going to devastate the job market costing 3 million jobs. those are the jobs you should be worried about. this is a reckless measure, it is irresponsible and hurts the people we represent. >> mr. blumenauer. >> just reflecting in terms of trying to put the context in terms of the real life experiences that we are facing like my colleagues, i am hearing in meetings that we are having dealing with this, we had people in portland, oregon not just fill a large gymnasium, they stood outside and 25-degree weather in the ice and snow for an hour, hundreds of them,

listening because they couldn't get into the gymnasium. they were hearing story after story for people whom affordable care act made a difference. there was one it just brought tears to people's eyes peering from a mother and her son for whom the affordable care act made the difference in terms of being able to have liver transplants and people who could stand on that stage and look in the eyes of hundreds and hundreds of their fellows from portland saying that for the affordable care act, we would not be here, and they were begging us to not allow people to play fast and loose with a program that has made the difference for them or hearing from a doctor in portland who cares for patient patients bothn

intensive care and in a clinic. the affordable care act has made the difference. specifically i think of my asthma patients when i hear about a possible repeal. there are no generic inhalers and they are expensive without insurance. if an asthma patients can't use their maintenance inhalers regularly they miss work, school and end up in the emergency room potentially even the icy view on life support. to keep the disease under control, i know patients that have used steroid pills because they cannot afford to inhalers and this causes high blood pressure, diabetes, obesity and worsened their health care in the long run. with the aca, those with a pre-existing condition of asthma frequently since childhood through no fault of their own are not able to sustained the same health-care plan as everyone else and now they can obtain access to life-saving medication that allow them to keep working and keep studying.

this is in this dr.'s words life and death. we must improve the aca including overall healthcare costs by lowering drug prices but a simple repeal would be a step backwards as they would suffer with their other fellow citizens. lots of people have things to say, but as we go through this, we lose the context of what difference it has made for real people and the energy we are finding is that their fellow citizens understand that whether it affects them, their families were for people in the future because that is ultimately what is going to happen is we will lose the capacity going forward with a stripped down version that isn't going to provide that comprehensive framework. thank you mr. chairman, i yield back. >> thank you mr. chairman, strike the last word.

once again, i'm appalled but i'm surprised the majority decided that the top priority today was to increase -- to be clear about this, we don't know the actual increase of the pay of executives at insurance companies. we believe there will be an incentive to pay executives at insurance companies a higher pay directly because of the revision of the bill. but after that, the second priority although the majority seems to be putting millions of more at risk of skin cancer. americans like mandy in new york who have spoken out publicly about her battle with skin cancer in her excellent treatment of the medical center in ithaca new york. she talks about how so many people she knew in high school and college went to tanning beds and were even told tanning is

better for them in order to avoid sunburn. but now after experiencing skin cancer, she said, and i quote him a using a tanning bed and being out in the sun without sunscreen is like playing russian roulette except the gun doesn't go off for another 30 years. we have responsibility to help protect people like mandy. but we shouldn't all be surprised that they would go against the scientific conclusion that excessive tanning leads to skin cancer. the u.s. department of health and human service recognizes that some lamps as a human carcinogen. yes, a cancer-causing agent. so, it makes sense to take steps to prevent skin cancer like discouraging the excessive use of tanning beds which is one of the reasons this tax is in place.

this is not a small problem. at least one in five americans will absolutely develop skin cancer in his or her lifetime and more than four to 19,000 cases in the united states each year are linked to indoor tanning, not the sun but indoor tanning. it's not just a number. it is real with a serious cost not just to the healthcare system that espouses losing spod ones and kids growing up without parents or parents losing their children like donna from collin county texas. her daughter was only 29-years-old when she passed away from melanoma in march of 2007, just three weeks shy of her 30th birthday. her mother writes and i quote jamie went from being a tanning bed addict to a melanoma patient anin just a couple of weeks.

as a teenager, she wanted to look tan and the popular and do what everyone else was doing. during high school she went to a nearby tanning salon just about every day. i don't know how dangerous tanning beds were, i didn't know how dangerous they were. now we know that uv rays are intense and contribute to melanoma. this story should inspire us to do more to prevent skin cancer, not less. we know how to do that. the evidence is there so why would the majority have such an objection to the scientific conclusion? after all, it isn't climate change or vaccines. wait a minute, our current president is raising questions about both scientific conclusions as well.

so let me help to clear of any misconceptioup anymisconceptione dangerous effects. i would like to enter into the record this study from the new england journal of medicine. a scientific publication of the connection between indoor tanning and skin cancer. also concerned about the impact of repealing the affordable care act on young people. when the industry targets teenagers often with misleading claims and minimizing the real danger of some lamps i would also like to enter into the record a very thorough investigative report done by our colleagues in 2012 on the misleading practice of the tanning industry and teens. both the evidence and the signs are clear that we shouldn't be going back article policies that help fight cancer so i strongly oppose the underlining bill and urge my colleagues to do the

same. >> ms. sanchez >> thank you mr. chairman. i want to echo what my colleagues have been saying in terms of the number of people who have had a very positive experience with the aca, and i realized it probably wasn't perfect for everyone an every oe were problems with the legislation that i think could have easily been remedied if we would have put as much time and effort into trying to sit down to figure out solutions to hurl accusations at each other. but the fact of the matter is the bill we are marking up this evening gives no guarantees to the people that actually did have very positive results, and i want to just share one story about a constituent of mine who recently wrote to me about her experience and her name is

sylvia, and before the aca was enacted, she went to six years without health insurance and because she didn't have coverage, she often found herself in the emergency room which i will add is the most expensive point of entry into the healthcare system, but she would find herself in the emergency room for something as simple as strep throat because she didn't have a primary care doctor that would see her because she didn't have insurance. she was also a lifelong asthmatic and she found herself without the life-saving medication that others can rely on who do have healthcare coverage. inhalers cost several hundred dollars out of pocket which as a full-time student and part-time worker she simply could not afford so she used expired rescue inhalers or simply wound up in the emergency room again.

another condition she had is that she suffered from chronic migraines and she couldn't afford the out-of-pocket cost for medications to help reduce the pain and be debilitating nature of the migraine headaches. the only medicine she could keep filled during the six years when she had no coverage was her birth-control pills and thabirts only thanks to the local planned parenthood who provided it for free. when it was passed, sylvia was finally able to get health insurance and with the insurance, she didn't have to rely on the expired and inhalers or miss time for work because of her migraines and she now has regular preventive care and found a wonderful primary doctor that she likes to visit. what troubles me greatly is the legislation we are marking up today would affect sylvia and the 80,000 other constituents in

my district. the letters from the folk talking about how much they've made a difference in their liv lives. contract that with a bill we are talking about now. as the bill becomes law and unlike some of my colleagues i cannot in good faith hold the rug out from under millions of people whose lives have improved because of the aca. earlier this evening, folks misquoted me, and i want to correct the record on that. i wasn't given the opportunity but said on healthcare republicans would have to go it alone. i didn't say that. it was taken out of context. what i said as i was looking for a bill that would introduce

coverage for the millions of americans who had gained coverage because of the aca and if there was a bill that reduced the coverage, then republicans were going to have to be on their own. so i wanted to clarify and wasn't given a time when i requested that for my colleagues. but the bill that we are marking up today reduces coverage and increases costs for the people that most need help, and i can't fathom how this is seen as an improvement or a better path forward for a majority of american. there are things with the aca that need fine-tuning or fixing or overhauling. but we never got to the discussion. and with this bill, we were never invited into the room. and until about 40 hours ago, maybe 48 now because we have been there for quite some time,

it is hardly an invitation to sit down and work on important issues and try to find the common ground. and i just want to reiterate that for the constituents that rely on healthcare, with that i would yield back. >> thank you, mr. chairman. let me first go on the record adding my voice to oppose today's markup as a gop repeals built without the cost estimates and giving us only 48 hours to consider the bill. surely we are not doing our duty for the american people. if we do not know the full impact of the repeal bill on our families and state and federal budget before we mark this legislation up. the american people have a right to know the full impact of the bill before any votes are taken on this bill.

after seven years of calling for the affordable care act repealed, it is unconscionable, unacceptable that the best republican leadership has to offer is a repeal bill that cuts medicaid, destabilizes medicare and takes insurance away from millions of hard-working americans. in fact, 20 million americans including 357 from alabama are at risk of losing their coverage if we repeal the current law. studies show the gop health plan would increase costs for the average enrollee by $1,540 if the repeal bill were in effect today. at the same time it eliminates requirements for insurance companies to cover preventive care and makes it harder, almost impossible for seniors to be able to afford their prescription drugs. by cutting medicaid and reducing health assistance to low income families, to help the bill would reduce revenue for the hospitals

nationwide. 700 of which are labeled as financial aid risk. this bill only helps the wealthy and the healthy. all we have here are broken promises. trump promised the american people every one would get health care coverage and everyone would like it. actually, he said everyone would love it. how will people afford health insurance if they get less financial assistance to purchase health insurance under this bill? people across my district will lose financial assistance under this bill. in jefferson county, residents of coverage will be lowered by 33% in financial assistance that they currently get under the plan. mr. chairman, how do you love a plan that gives you less benefits for less cost? for my constituents, having affordable healthcare insurance is a life and death issue. healthcare is a fundamental

right, not a privilege. protecting care for seniors, disabled americans and working in low-income families goes to the very heart of who we are as a country. since januar january, i posted e town hall meetings on healthcare and i've met with many constituents. i met with patient groups and healthcare providers that have asked me to evaluate the republicans bill by three criteria. coverage, quality and cost. my litmus test is what impact will this bill have on the coverage, quality and cost of my constituents. clearly, we cannot assess the last criteria cost since we do not have a cbo cost estimate. the joint committee on taxation issued a set of revenue estimates for losses under the gop bill caused by the repeal and totaled it at 256 billion over ten years. this is not fiscal responsibility.

instead of repealing the revenue-generating taxes instead, we are guaranteeing certain benefits without having a pay for. i don't think that is fiscal sponsor ability. it's another tax cut for the wealthy and the people that get screwed are obviously low income seniors and the disabled. i want to end by sharing a story of one of my constituents. she writes me this morning good morning, congresswoman. the aca has had a profound effect on my life because my father was able to have insurance because of the aca. he retired and was able to carry the insurance from his employment because of his fixed income. initially he couldn't get coverage because he had a pre-existing condition, but through the aca has been able to obtain insurance which allows them to receive a treatment and

physician attention he needs. my father has cancer and we are very thankful that it is available and we pray that it stays in place. i ask that my colleagues both know on the underlining bill because it is not, it has more of a pay raise and a pay cut and no benefits. thanks. >> thank you. you are recognized to strike the last word. >> thank you mr. chairman. as a former businesswoman and entrepreneur, i am saddened to see the leaders put forth a half made a plan like this one, one that has massive disruption and chaos released in the middle of the night without any data or metrics to show ho how it makes anything better and in particular how it makes healthcare for americans better. in the private sector that is the sort of behavior that can get you fired. for a moment, let's put aside that less than 48 hours that my

constituents have to read this s bill or that i had to read this misguided bill before it was jammed through the committee. let's even put aside the fact it's being jammed through without any data from the congressional budget office to tell our constituents how many of them can expect to lose coverage or see their taxes go up. >> the gentle lady would suspend i would like to have order in the committee room so we can have here the members speak. please go forward. >> let's talk about the one thing we do know. this bill is an enormous tax cut for wealthy americans. republicans are trying to get an average tax cut of around $7 million to each of the top 400 highest income households in the country. a tax cut they don't need and didn't ask for and while they are doing that, they are ripping

health insurance away from millions of hard-working americans, forcing seniors to pay a staggering $3,200 more on premiums every year for less coverage, increasing the cost of prescription drugs for middle-class families, d. funding planned parenthood on international women's day, undermining coverage for women's health care like birth control, breast cancer screenings and maternity care on international women's day and decimating the medicaid program for 62 million children and families, seniors, pregnant women and people with disabilities. this is hardly what i would call a great deal or a better way for the middle class which is what the american people were repeatedly promised by president trump and speaker paul ryan. no, their idea of a healthcare plan is a tax cut for the

wealthy at the expense of everyone else and when our healthcare system .-full-stop art, we will all pay the price. my inbox has been flooded with phone calls, e-mails and letters from constituents who are terrified by what republicans are trying to do. like diana from mount vernon whose husband had a partial seizure in his right arm on what lies otherwise a normal night in 2015. within an hour at the emergency room, they discovered that he had a brain tumor. his surgery and rehabilitation ended up costing half a million dollars. her husband has since developed epilepsy requiring three different medications, his yearly mri and regular follow-ups with his doctors. she wrote to me and said this is his life now. it proves one minute you are all right and the next you are having brain surgery. she is thankful for coverage for pre-existing conditions and

ending lifetime caps on insurance. the republicans bill spells disaster for families like diana. and as her representative in congress, i will not stand for it. i will fight every day to protect the reforms that made health insurance accessible and affordable for everyone. we cannot go back to the time when getting sick and going bankrupt, and that is exactly what this legislation would do. thank you and i will deal back. >> before he recognize you to strike the last word, under peactheremarks we'll move to the amendments. you are recognized to strike the last word. >> i want to share this story for my constituents rachel forrester. last month i held a town hall because i wanted to hear from my constituents. i wanted to hear about their experiences of obtaining health care, what was working and what

could be improved. as my town hall, a young woman is here with her family got up to speak, and i want to share her story with you today. rachel has worked as a hairdresser for 16 years and worked for large companies that offer some health insurance, small businesses that offer no coverage and has an independent contractor where she was in charge of finding her own coverage. in 2009 she became pregnant and throughout her pregnancy, she was terrified that her baby would be born with a pre-existing condition because she didn't know how she would pay for her child's care. with two more children and her family, she's the primary breadwinner for her family. her husband stays home to care for their daughters because child care is so expensive. that means her family relies on their income that depends entirely on how many hours she

works in a day and how many clients she can see. through the expansion of medicaid, her children qualify for coverage and she and her husband were able to purchase silver plans with the help of subsidies. without the expansion she had a clip for the families like hers and this is what happens when you are on the line making just enough money no services are available to you or your family any more. you have fallen off the cliff. if she and her husband have to drop their own health care coverage for their children, they would be penalized by the continuous coverage position. rachel put it best the continuous coverage requirement feels like a penalty for people who have bad things happen to them. tax credits like the ones proposed in the bill we are debating today what didn't help families like rachel.

even the maximum tax credit which she isn't eligible for because she and her husband are too young being in their 30s wouldn't be close to covering the total healthcare costs of a family in california. she doesn't make enough money to save more than a few hundred dollars a year and a health savings account or an hsa. as rachel put it, that is enough for pair of glasses, not enough for a broken leg. she was also lucky enough to have healthy complication free pregnancies. but the complication free birth of her third child would have cost without insurance $15,000. without insurance, that is a bill that could sink her family. no health savings account would be enough to cover the birth of another child. she grew up without health insurance until her parents both

got jobs at unions that provided good coverage. she has personally seen how employer-sponsored coverage can increase preventative care and solve a difference but it made for her parents. in contrast, rachel's husband grew up in a family that rely on emergency rooms and a mix for care often waiting for hours for an appointment. now rachel isn't unique the rac, she's a hard-working taxpaying american who would be left behind by the republican plan that is before us. the plan b plan before us cuts s for the wealthy and increases taxes for people like rachel. it gives insurance companies a break while cutting coverage for poor americans. the republican plan would force rachel and her family to pay more money for less coverage. for rachel and the nearly 1,000 people in my district at risk of losing their health insurance,

this is tragic. without the analysis we are making critical decisions that will negatively affect the lives of millions and make decisions in the dark. this is not right. >> the gentle lady yields back. are there any amendments to the amendment in the nature of a substitute? >> i have an amendment at the desk. >> if the gentle lady would suspend. >> i reserve the point of order. >> point of order has been reserved and will distribute the amendment and ask the gentle lady to suspend while the clerk distributes.

>> mr. chairman, i'm going to withdraw my point of order. >> the gentle man's point of order has been withdrawn. >> [inaudible conversations] >> the gentle lady is recognized to explain her amendment. >> thank you mr. chairman.

the amendment i have at the desk would state the defensive congress shouldn't be repealed, and i know we covered some of this already this evening, but i am having a hard time believing that the bill before us repeals the tanning tax when the science behind skin cancer is abundantly clear. it is a simple fact skin cancer is the most common cancer and that at least one in five americans will develop skin cancer in their lifetime. each year, more than 400,000 cases of skin cancer are linked to the use of indoor tanning. that is 400,000 cases that could have been prevented if we implemented policies such as this tax to mitigate the risk of those associated with tanning. to piggyback on the comments that were made earlier, what is

particularly shocking about the use of tanning beds is the impact that it has particularly on children and youth. the centers for disease control convention warned the people that became tanning during adolescence or early adulthood have a higher risk of melanoma, the deadliest type of skin cancer. and according to the 2015 youth risk behavior survey system, indoor tanning is used by 7% of all high school students, 11% of high school girls and a 16% in the 12th grade. using tanning beds before the age of 30 has been found to increase the risk of developing melanoma by 75% and those are shocking numbers and i did not know that often times tanning salons target specifically youth and kids by offering promotions for prawn or back-to-school. as we have seen with taxes on cigarettes for economic

incentives discouraging the use of cancer-causing products have proven to be effective. the tanning tax is a similar incentive meant to save people from cancer and encourage positive healthy behavior. not only that, but it saves the government money and they estimate that repealing the tax will cost about $600 million. with this analysis under the state how much this will actually cost society as a whole because it doesn't include the students from extensive tanning nor does it talk about the cost of treating skin cancer when people actually get it. repealing this tax would lose the deficit while adding new members to cancer and i'm proud to offer this amendment that will strike the repeal of this vital public health policy that protects millions of americans. and to comment on some of the comments made by my colleagues

about small businesses create jobs and tanning salons are going out of business, it seems almost like we want them to turn a profit even while turning a blind eye to the fact that they are peddling is something that increases risk for injury and death, but so long as people are making a profit and putting money into the economy that seems to be okay. i think we have an obligation to look at the policy behind it, and i think keeping that tax that disincentive rises the behavior in a way that hopefully will discourage people from tanning i think overall it's a good thing especially for the health of the citizens of this country and with that i would ask for unanimous support to enter into the record a letter from the academy of dermatology expressing their opposition to

this provision of the tax and as well a new england journal of medicine study on the connection between indoor tanning and skin cancer. and with that i will yield back. >> does anyone else wish to speak on the amendment? >> i would like to support this amendment and actually, i have a question. we heard testimony that by a repealing the tanning bed surcharge it would result in the loss of revenue of 600 billion over the next ten years, is that correct? >> that is correct. >> since we don't have any type of congressional budget office score in front of us today, is there anyone your self or on your side of the aisle that can explain what type of offset you are going to use in this legislation in the loss of $600 billion so that we are not

running budget deficits over the next ten years because of the loss of this revenue? anyone have any idea? >> he made a very clear declaration that may not have been hurt when he said this provision is not in this section in the entire bill combined with the energy and commerce will repeals not just the taxes $600 billion or so in subsidies that creates savings by giving states more control over medicaid and as does a number f those provisions as you know under the budget reconciliation process. this bill in total has to balance over the first ten years and over the second decade for it to pass the senate reconciliation process and go to the president's desk so as i said repeatedly before, this goes to the rules committee and to the house floor. this will let outlines both in

the short-term and long-term. thank you. >> thank you for that candid response. so, basically it confirms many of our deepest fears that you are here now repealing the revenue for the large insurance companies, the wealthiest individuals in the nation, tanning bed salons and expect to pay for that through a reduction in premium tax credits for working families or significant cuts in medicaid funding to the states which will inevitably lead to a spike in the uninsured rate again in this country. that could be problematic and i would suspect there's going to be considerable blow back from the states and governors in particular if that does come to fruition. so i would still agree with this amendment and thank the gentle lady for offering and encourage the committee to adopt it and go back. >> does anyone else wish to speak on the amendment?

>> just briefly, there is an irony in that there are two different arguments coming out for my friends on the other side of the aisle and my recommendation would be to pick one. one argument is in the examples of the price it is fairly dismissive of the notion that jobs were impacted. $40 plus $4, that isn't a big deal, $300 for the tanning package plus $30 but isn't a big deal and he was dismissive of the notion. ms. sanchez is now making a health argument. these are wildly inconsistent and have no firm foundation so my suggestion is you can use the rest of my time and pick one. >> i won't yield back. >> the gentleman yield back. you are recognized to speak on the amendment. >> i will speak in opposition.

you will recall that originally, the revenue stream that was represented now by the tax when the bill was originally proposed was a tax on cosmetic surgery and the reconciliation process was switched out for a tanning tax instead, perhaps one day the people who are in the room at the time of the switch can explain it, but without debating the health issue and health benefits for veterans of tanning, i know for sure that this tax has destroyed a lot of small businesses and has caused the result of losing a lot of jobs. looking at the statistics in alabama, we've lost 169 tanning

salons and 1500 jobs. in california and you've lost 500 with a loss of 4,000 jobs. in new york, 328 have closed with a loss of 2500 jobs and in wisconsin, 250 with a loss of 2,000 jobs. so that it's clear data. it isn't controversial. and i think that an excise tax like this but for this amount of detrimental damage, the sooner we can lift this tax and allow the small businesses to get on with the business of living the american dream and growing their business, being profitable and paying taxes and employing people, the better off we will be and i will urge my colleagues

to go against the amendment. >> the gentleman yield back. does anyone else wish to speak on the amendment. you are recognized >> thank you mr. chairman. i'm just a little uncomfortable with my good friend from north carolina in his analysis about the economic impact. there are other analogies and i have one he can relate to being from north carolina in terms of some of the efforts that we have undertaken through regulation dealing with tobacco. there was a time when we subsidized tobacco heavily. >> will the chairman yield? there was never a tobacco subsidy there was a program but not a subsidy. >> i suggest a difference. the government was encouraging the production of the tobacco in fact we've been involved with getting our g.i. --

>> will the gentleman yield? >> we distributed tobacco in the devastating consequences. >> my father died as a result of being hooked on tobacco as a veteran in world war ii. there were jobs involved in terms of education and taxation and engineering the product and ensure they've had some consequences. we supported the effort in the program to help tobacco farmers but the notion that we shouldn't have done something with taxation or regulation because of job loss i think is something that most people would now agree with the misguided.

the loss, the cost in terms of the health care my father took dying of lung cancer probably created a lot of jobs in the healthcare arena. but at a terrible cost economically. the notion that we have hundreds of thousands of young people who are exposed to unnecessary exposure through tanning beds and will suffer from skin cancer have serious economic consequences far beyond a few jobs in tanning salons. people in tanning salons can find other things to do. it's not a unique skill. but it doesn't add much value to the community.

the longer we got into this the longer the consequences of skin cancer. it costs a. we were dealing in the area of 2006 to 2010 or something like that we've seen skin cancer increased five times as fast as other cancers and cost more than doubled to the billions of dollars in that time frame and i can't imagine what it is now.

to trivialize the impact that this could have on young people who are not sensitive to the risks. it is a modest disincentive to put themselves at risk having cancer, what happens to their family, the costs economically are i think just a relatively small part of this being able to avoid the tragedy of preventable cancer. i really appreciate my colleague from southern california bringing this forward. i appreciate people zeroing in on this in terms of what a difference it made. this was part of the affordable care act but yes provided some extra resources to expand healthcare. but it was one of those areas to harness some economic disincentive to avoid doing

unnecessary damage, particularly to young women. and i yield back. >> does anyone else wish to speak on the amendment? >> questions on the amendment offered by the gentle lady in california all of those signify? opposed, no. chairman i would ask for a recorded vote. >> rollcall is requested. the clerk will call the roll. [roll call] /[roll call]

[roll call] [roll call]

[roll call] [roll call] [roll call]

[roll call] the clerk will report the vote. >> 16 yeas, 24 nays. >> the amendment is not agreed to. are there any others? if there are no further amendments the question is on the nature of the substantive. all of those in favor signify? opposed. we will now recognize mr. johnson for the purpose of offering a motion. >> i moved the committee transmit the committee print related to repealing the tanning tax as amended to the house committee on the budget in

response to the reconciliation instructions. >> questions on the house committee on the budget all of those in favor signify by saying aye, those opposed, no. the ayes have it. the order transmitted to the house budget. rollcall is requested. the clerk will call the roll. [roll call] [roll call] ..

>> t11 t11 did. [roll call] and

outthrust back. >> to shin this agreed to offer to repeal the tanning tax as amended without objection pass a staff to make the changes in the members of two additional days to file with the pending clerk fifth descent or minority views. the next order business is the budget reconciliation to the repeal of consumer focus tax without objection to will be considered as read and open at any point beat

the sugar did it in france with the green sheet. initially be discovered as read any .4 purpose of amendment i will now turn the chief of staff of the joint committee on taxation to provide the technical description in the nature of the substitute it have members hold their questions until after his transfer - - explanations. >> members of the committee have to joint documents that describe the underlying trend in the chairman's amendment. this document describes to provisions and very briefly under present law there is an annual fee on branded prescription pharmaceutical manufacturers.

it is the allocated feed for 2017 that is $4 billion this is allocated among the manufacturers based upon their share of total market sales. the proposal before you would eliminate eliminate the fee for calendar years after 2017 effective 2018. did even over the budget period. in with that budget reconciliation relates to the annual providers with a one-year moratorium of the 14.$3 billion and like the

pharmaceutical free allocated on total market share and for any period after 2016 in the joint committee staff has estimated to lose 100 and $44 billion for quebec includes my brief description of the two provisions that would be happy to its any questions. >> you recognized deal have any information on the profitability of the pharmaceutical industry?

>> not at my fingertips. in general the pharmaceutical industry has been profitable over the recent past. >> i have a chart here that shows the of profitability going back through 2012. does anybody have material on that quick. >> we have detailed information across industries we could prepare some information on pharmaceuticals if you would like to. i did not know the committee would want federation it is not a table with me currently. >> that estimate is based on what?

began to describe islamic the estimate for the pharmaceutical industry that it is somewhat unusual tax structure. it is the aggregate feed that is collected industrywide. so as far as i stated the fee is 4.$1 billion to be collected county year 2018 it is actually an vat proposal repeal the collection so is the simplest terms to some of 4. 1000000000 + 2.eight that is repealed. with that economic analysis since repealing taxes affect profitability of that industry consumer to pay it - - consumer demand what

they refer to as the equilibrium effect that takes into account in terms of reporting to the committee in terms of government receipts. and for that proposal to the health insurance industry. >> so to half information about profitability. blondie income earned but to distinguish, this is essentially the excise tax

that is assessed in a different way from other excise taxes. >> is the excise tax on the sales of the industry the amount that any one company pays but is totally determined by their sales. >> to look at the grove -- the gross sales quick. >> caicos to the administration collection of the tax. the assessment is fixed by statute. again as described on page number two. the aggregate of be on the branded pharmaceutical importers and manufacturers manufacturers, is $4 billion

would be 4.$1 billion to .8 billion in 2019 and any year thereafter. >> it is set in the statute if the total amount of sales increases, it remains a $4 billion assessment. if the amount decreases' remains for billion dollar assessment 2017. >> mr. chairman i think this is another indication why we should have had a hearing on this bill. so we could hear from the pharmaceutical industry what their role was to put together the affordable care act.

and it would be interesting to hear what their role was and what their position is now formally regarding that position if we had such a hearing we would find out that this is a giveback. >> your time is expired. >> mr. chairman we have bet on small potatoes for the insurance industry and with the tuning and cancer causing entities now we're into real money as dynasty ended the pharmaceutical industry will have a total of $25 billion of tax breaks ? isn't that right?

>> the repeal will reduce reseats. >> guest. >> this industry all you don't have the data at your fingertips it would not surprise you that they are about the most profitable major industry in the country that they report profit margins of more than 25%. >> i cannot comment but i do a quality industry in general has been fairly profitable. >> and they're not exactly needy with tax breaks. they have some of the lowest tax rates among the major industries. >> i cannot comment on the tax rates without looking at the data which i don't have available. >> unfortunately in your

testimony you are aware that this is a $25 billion tax break and it is only directed to big forma? the dozen apply to generics. lee branded pharmaceuticals? so companies like pfizer with only two wondered billions of profits with 181 subsidiaries to avoid taxes. are there any tax breaks this provision in the community pharmacies on the west side of san antonio or any other pharmacies around the country quite. >> i am not clear on your question. this special tax provision that the republicans have

provided, a $25 billion for big forma but there isn't any for any community pharmacy. >> as i was explaining, this is like an excise tax on the manufacturers it does not the apply to retail sales. >> might experience with community pharmacies they don't have one subsidiary to dodge taxes but pfizer has 181. they have booked over $200 billion offshore profits. it just seems to me that they are also able to take advantage of the research and development tax credit where taxpayers are not subsidized a significant portion of their expenses. don't they? been a times rea.

i did not catch all of your question. >> we have a host of legal ways for big four months to dodge taxes at the same time reprise gouges all over the country. we pay more for pharmaceuticals and just about any other country in the world it does not relate to the tax break and there is not a penny that the medicare recipient -- recipient will get out of this provision only $25 billion right back into the heathens of big farm up. this provision resulted from negotiations and began the legislative process here in congress between the obama administration in the pharmaceutical industry in lieu of been doing something significant life the medicare price negotiation to bring down prices to redress what president trump

literally calls murder by the pharmaceutical companies >> 80 not know the first team and i am aware of the news reports that the time when the negotiations of multiple industry sectors. >> and you are aware of the many comments that president trump has made about the of regis drug prices quick. >> i have read the papers. >> it would be good if he were supporting something to do something instead of another windfall of $25 billion to big farmers. >>. >> got want to make sure i understand this because my and standing as a little different we will do this piece by piece this is a tax

on the printed pharmaceuticals. >> correct spirit operates like an excise tax that is bifurcated a fixed amount of revenue. >> is fixed amount across the sales of products. >> as it would be to be calculated to the amount of sales. if this attacks to the amount of sales than it is in the actual prices of branded pharmaceuticals for this is not a tax as the percentage of the of profitability but at the retail volume. >> this is like and excise

tax that is reflected and the purchase price. >> should we help our brothers and understands the excise tax dubious to that they understand that it is attached to that retail? denied that is the way the excise taxes worked either assessed on the value or a specific dollar amount. >> so with that line of thought if i fell members cared about patent or branded pharmaceutical pricing this particular tax is almost an immediate detachment to that pricing mechanism. >> our economic analysis is the tax is passed through '02 consumers in higher prices. >> so it right or left if it

is the pricing of pharmaceuticals you know, have the opportunity to vote to lower their prices. >> just so i understand this commentary is two parts of pharmaceutical company fee and the health insurance company v $25 billion for the of pharmaceutical and monitored $45 billion for the insurance company section. >> this is the toll of $170 billion tax expenditure that is not paid for that comes out of the treasury to show up on the deficit with

data on their own they cost $170 billion over the 10 year period outside of the context of whatever decisions they make with respect to the budget and this legislation. >> anybody that is worried about the dead or deficit this should be of concern? >> on its own it would increase the deficit. >> this comes about during the of drafting of the affordable care act as pharmaceutical came to congress to say we'll understand what is you were trying to do we will participate and this is how we believe this is a fair contribution on our part and now what we say is we will give that back to create a

hole in the budget. >> as i understand it in responded there are the negotiations with members of congress don't have firsthand knowledge of the representation made spanish this is the big pharmaceuticals not the small drugstores for this small mom-and-pop schedule home delivery for the small mom-and-pop says stay open on saturday and sunday to make sure to mention get the services they need or to carry credit to. this is a big car run -- a big pharma. >> and those industries tend to be larger one-hundred $70 billion that we don't have.

>> the total revenue loss for these provisions is $170 billion. >> the gentle man from arizona was making the case if we were to pass this bill and a big pharma was to receive this $170 billion windfall that consumers would see a benefit from this because their prices would go down. is there anything in this bill that requires a dollar for dollar give back to the consumers but. >> there is no requirement that economic analysis that i have discussed it is based on market economics. >> if this were to pass and big pharma got there $170 billion we don't know if they would reduce prices by a similar amount. >> bill $170 billion.

>> there is no guarantee in lot of the market economics it will tend to pass an increase or decrease of the excise tax through to the final consumer. >> we have no way to know that will happen. vat of dollars the bill now why would we think with this windfall that somehow they would be like the good fairy to deliver that to the consumer quick. >> i have to agree that things are not guaranteed in the market outcome. there is uncertainty. >> is it appropriate to put a provision in the bill that says if passes the $170 billion windfall would materialize that it would be

reflected in price reductions spirit that is beyond the scope of his expertise. >> is this something that could be drafted to put into legislation would. >> give the members chose that policy we would help them draft legislation. >> the time is expired recognized for questions. >> you were here in 2009 quick. >> gas per i have been here a while. >> you have spent your time around this committee. what do they have in common? and% sales tax on indoor tanning services, a 3.8% to certain investment income

enumeration from certain issuers ordinary and necessary business expenses creating 2.3% excise tax on certain medical devices. and increase of tax on health savings accounts a repeal of tax on over the counter medications what do those have uncommon? six. >> excuse me? been a bear all from the affordable care act. >> so what we year doing today is repealing those as they were passed in the affordable care act. >> correct so this is not a mystery everything we pealing in this bill was maybe part of the affordable

care act islamic clearly it was. >> is there anything in this legislation that we are cutting taxes like members salaries that was not part of the affordable care act but. >> actually i think there are some modifications related to health savings accounts so i think we can talk about it later but that expansion of joy ain't spousal contributions to health savings accounts. >> making a better for consumers with a high deductible plan. >> to benefit consumers. >> the point is that then tax section's of what we are

repealing in this code were all taken from the affordable care act. >> that is correct. >> so if we went further on the medical device tax we didn't. we took that language exactly as was passed in the affordable care act. >> there is no modification aside from repeal effective after 2017 in the case of pharmaceuticals. >> but the point is. >> is the identical provision. >> so for every other

question that is asked the answer is the same the chairman brady did not come up with ways to tweak the tax cuts we just went back to repeal all of the taxes put in place by the affordable care act and just so we review we repeal in replace 60 times in the last four campaigns i said it would do this so it shouldn't come as a surprise to anybody on the other side of the ideal that chairman brady and has talked about this is doing exactly what we said we would do in washington is a bit of a shock. >> i agree with my dear

friend and colleague you were doing exactly what you said you would do. no question about that. so in terms of what we expend as a nation with health care cost what percentage of gdp does that amount to

>> >> the issue was raised of the united states expenditures of the highest of the world but has affordable care act cause any meaningful reduction of the expenditures of health care in the united states? >> i am not positive of that percentage relative to total national income bear remains high.

>> 11 accurate answer for regression. >> if you were trying to design if you trying to do -- have a plan to resell in insurance premiums dropping for families of four by $2,500 as the president said they would would you do that by paying for that with these on insurance companies because if you tax the insurance companies in charge the fees that are repealed will they have to pass that through to consumers? >> i think that economic analysis is appropriate but like the excise tax date and that been the pre