Health Care

As a physician with more than 30 years of experience—and co-chairman of the GOP Doctors Caucus—taking care of patients has been my life’s work. That’s why my top priority in Congress is repealing ObamaCare and replacing it with patient-centered health reforms that will improve access to care, lower costs, and improve quality.

Obamacare

I voted against the Patient Protection and Affordable Care Act (Obamacare) in the 111th Congress, and have since been leading the charge to repeal the law and replace it with commonsense reforms.

This flawed law has proven to be a disaster, resulting in less choice and skyrocketing costs for patients. Though supporters of the law claimed it would lower health care costs, give more choice to Americans regarding their care and offer a higher quality of services, year after year Obamacare has proven to do just the opposite. Since its inception, average premiums on the Exchange in Tennessee under Obamacare have gone up 176 percent over 10 years. This is anything but affordable care.

When Tennessee adopted TennCare – a proposal similar to Obamacare – in the 1990s, it failed both to keep costs under control and to extend universal coverage. The cost of the program tripled within 10 years, putting an unbearable strain on the state budget. Additionally, access to health care for TennCare beneficiaries was poor.

House Republicans continue to work with our Senate counterparts and the Trump administration on plans to bring substantive relief to Americans so they can once again afford health care coverage for their families.

The American Health Care Act

I supported H.R. 1628, the American Health Care Act (AHCA), which passed the House on May 4, 2017 by a vote of 217 to 213. AHCA repeals Obamacare and replaces it with patient-centered, free-market reforms designed to spur competition, lower costs, and improve the quality of care – all while maintaining consumer protections such as for pre-existing conditions. While the Senate failed to act on this legislation, I will continue working with the Trump administration and my colleagues in the Senate to find a path forward to repeal and replace Obamacare.

The American Health Care Reform Act 

Obamacare is a disaster for the American people. But we must also remember that there were serious challenges in American health care even before the president’s law came into effect.

To address these challenges, in the 115^th Congress I introduced H.R. 277, the American Health Care Reform Act. This bill, supported by a majority of House Republicans, puts free-market competition to work for patients and their families. Specifically, H.R. 277 would:

• Fully repeal President Obama's health care law, eliminating billions in taxes and thousands of pages of unworkable regulations and mandates that are driving up health care costs. 
• Spur competition to lower health care costs by allowing Americans to purchase health insurance across state lines and enable small businesses to pool together and get the same buying power as large corporations.
• Reform medical malpractice laws in a commonsense way that limits trial lawyer fees and non-economic damages while maintaining strong protections for patients.
• Provide tax reform that allows families and individuals to deduct health care costs, just like companies, leveling the playing field and providing all Americans with a standard deduction for health insurance.
• Expand access to Health Savings Accounts, increasing the amount of pre-tax dollars individuals can deposit into portable savings accounts to be used for health care expenses.
• Safeguard individuals with pre-existing conditions from being discriminated against purchasing health insurance by bolstering state-based high risk pools and extending HIPAA guaranteed availability protections.
• Protect the unborn by ensuring no federal funding of abortions.

I was pleased many of these reforms were included in the American Health Care Act.

Independent Payment Advisory Board (IPAB)

Among the worst parts of Obamacare was the Independent Payment Advisory Board (IPAB), an unelected, unaccountable bureaucracy that had been granted sweeping powers to “reduce the per capita rate of growth in Medicare spending.” I introduced legislation to repeal the board the day the law was passed by Congress, and have introduced the legislation in each Congress since then. I was thrilled the IPAB was fully repealed as part of H.R. 1892, the Bipartisan Budget Act of 2018, when it passed the House by a vote of 240 to 186 and was signed into law later that same day on February 9, 2018.

Under IPAB, the board would propose Medicare cuts and Congress would have had to consider that proposal using “fast track” procedures and – absent a three-fifths vote of the Senate –Congress can only modify the type of cuts, not the amount. Should Congress have failed to act on the board’s recommendations, they automatically would have gone into effect. To make matters worse, the IPAB was exempt from administrative or judicial review.

I reintroduced bipartisan legislation in the 115^th Congress to repeal the authority of the IPAB to be empaneled. H.R. 849, the Protecting Seniors’ Access to Medicare Act of 2017, would repeal the IPAB’s authority and make it so there is no opportunity for an unelected body to make cuts to Medicare without Congressional oversight and approval. This is a bipartisan, bicameral issue. The House passed my bill with a strong, bipartisan vote of 307 to 111 on November 2, 2017.

Opioids

The opioid epidemic has ravaged all communities across the United States, and has hit East Tennessee especially hard. In 2016, there were 1,631 Tennesseans who died from a drug overdose, a 12 percent increase over 2015. A staggering 294 of these deaths were due to fentanyl or synthetic opioids. I have been working with my colleagues in the House on addressing the opioid crisis and while we are making progress, there is still a great amount of work to be done.

On March 22, 2018, I was proud to vote for H.R. 1625, the Fiscal Year 2018 Consolidated Appropriations Act, which passed the House by a vote of 256 to 167 and was signed into law by President Trump. Among its provisions, this legislation included a substantial investment of $4 billion in programs designed to prevent opioid abuse and help those struggling with addiction.

I was also proud to support H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, which passed the House on June 22, 2018, by a vote of 396 to 14. The legislation enhances Medicare and Medicaid coverage to allow for medication-assisted treatment for substance abuse, expanded use of telehealth services, and incentives for the use of non-opioid prescription alternatives. Additionally, the legislation includes provisions to better fight against the influx of synthetic opioids, such as fentanyl, which are having devastating impacts on many communities; to enhance physician awareness of patients who should not be prescribed opioids because of a prior addiction; and to provide for better disposal of unused prescription opioids, which often become a source that fuels addiction, among others.

Additionally, $3.7 billion was appropriated in the Fiscal Year 2019 Defense and Labor-Health and Human Services Appropriations Bill that was signed into law on September 28, 2018. This funding will go to agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Institutes of Health (NIH) to help people addicted to drugs receive treatment as well as help fund prevention tools to keep people from becoming addicted in the first place.

In October 2017, I introduced H.R. 3964, the Opioid Addiction Prevention Act of 2017. This legislation would create additional safeguards for initial opioid prescriptions, most notably creating a 10-day maximum fill for any opioid prescription. While chronic pain, cancer, hospice of end-of-life and palliative care patients are exempted from this restriction, addiction to opioids increases in patients receiving these drugs for acute incidents after three and seven days. We must do everything we can to end this epidemic and that starts with the first prescription.

In an effort to curb the in-flow of illegal opioids from abroad, I also introduced H.R. 5298, the Modernizing Drug Enforcement Act of 2018. This legislation would automatically place any substance that triggers the opioid receptors in your brain into Schedule I. This is an important piece of legislation because it is the easiest way to immediately combat compounds such as synthetic fentanyl from hitting our streets and remaining legal until the compound can be classified under Schedule I. This legislation also has an exception for legitimate medical and research use.

In September 2018, I introduced H.Con.Res.136, which expresses the sense of Congress on the need to improve and expand training for future physicians on properly treating pain and prescribing opioids. It is imperative that the next generation of doctors learns how best to treat and manage pain, as well as learning the best prescribing practices for opioid prescriptions. Additionally, current prescribers should receive additional training on best prescribing practices to ensure they do not accidentally create new addicts through legitimate prescriptions.