tv House Democrats Hold Policy Meeting on Affordable Care Act Changes CSPAN July 25, 2017 1:01pm-2:16pm EDT
right. anyone else that has remarks on whomever come the need to fight and then gag them to stop this. we need to take care of the people. >> host: let's hear from lindsay. you are on the air. go ahead. >> caller: hi my name is lindsay. i just want to make a comment. i think we are forgetting about how many people are sick in our country with preexisting ones and what are we to do, just kicked our moms and let them roll in the ditch? what about are people with disabilities our seniors? i just buried my grandfather. >> host: lindsay, hate to let you go here thanks for calling in. we are going live to
nancy pelosi who is leading a meeting of democrats on health care. >> we acknowledge their great service to our country. doug elmendorf, dean of the john
f. kennedy school of government. teresa miller, insurance commissioner an honor to have you here. gary cohn very similar to the capital. former deputy administrator center for medicare and medicaid services. to our distinguished witnesses coming your testimony today is very important to s. because the marketplace is essential to the success in good health of the american people. it is my privilege not to call to order our hearing action now updating and improving the affordable care act to lower costs and ensure options for families. democrat take great pride in the success of the aca lowering costs them are protecting health and financial situated families. cover more than 20 million. but that is just the beginning of it. we talk about the additional names. that is important.
what is also important are the over 100 million people in the 350 million people who have expanded and if it in one access under the affordable care act. this quality for every american no matter where they get their coverage. the aca health care cost growth has been slowed by the lowest on record. the republicans have been working from day one to drive up cost and sabotage the marketplace in the pretext for passing trump cared. so i want to just focus on the word cost cost, cost, cost. every version of trump cared would hit american with crushing health bill. skyhigh deductibles scoring out of pocket costs. under trump cared that middle-aged men -- middle income
person would change from $5000 to $13000 per paying hundreds or thousands more in premiums. the lower premium costs are still going up with higher deductibles and higher co-pay. a 64-year-old with income is $56,800. a 64-year-old making $56,800 would be forced to pay $11,000 more for the same level of coverage he or she has today. $1700 under the affordable care act. over $14,000 under their bill. according to estimates premiums for those under 40 would be up to 70% more expensive if they want maternity coverage. and without coverage giving birth cost an average of $30,000
or $50,000 for delivery. as a mother of five, that is totally unacceptable. senator mcconnell said if my site isn't able to agree an adequate replacement some action with regard to the private health insurance market massacre. trump care also includes two provisions democrats have long been calling for. car sharing reduction payments and reinsurance to stabilize and buy them cause. republican sabotage and join us in passing and stabilizing measures before the august recess. again we are honored to be joined by our distinguished board of experts on health care and coverage in america who will share their thoughts with us. first i'm going to yield to the distinguished cochair of the policy committee a leader in protecting a good health and american people a champion on this cause, congresswoman rosa delauro.
and replace the aca would unravel protection for patients with preexisting conditions eliminate coverage for essential health benefit. what are essential health benefits? prescription drug coverage, hospitalization pregnancy, maternity and newborn care, screening and testing that would make health care unaffordable by raising premiums ended up. a repeal without a replacement would mean 32 million people without insurance. instead of pursuing a repeal, we ought to work together in a bipartisan manner to reform the current system and to fix the problems that exist. we cannot leave the american people behind in this process. we need to stabilize the market base and ensure there are affordable high quality coverage options for people living in their counties. we also need to keep premiums
down and stabilize the marketplace, which can be done with the reinsurance program similar to the medicare part d of reinsurance program. it is also interesting to note that we have a document is prepared of reinsurance of house republicans house democrats, senate republican senate democrats and republican governors also proposed reinsurance programs. we are deeply disturbed by the trump administration attempt to sabotage the affordable care act a law they are trusted to uphold. despite the narrative of implosion, more than 10 million americans signed up or coverage in the aca marketplace is in 2017 and the environment uncertainty created by the trump administration's refusal to
continue cost sharing payment has caused insurance to propose 2018 premium increases. the biggest economic challenge of our time is that too many people are in jobs that just do not pay them enough to live on. we cannot put american families in jeopardy by raising the cost of health care. we need a country and the health care system that works with the middle class and the vulnerable not just the wealthy and those with the most lobbyists. with back, i want to say thank you to other speakers today. thank you for your work and all you do to inform our debate and we look forward to your discussion. i will now introduce our panelists and then we will proceed with the testimony. and we will start the testimony with that elmendorf former
director at the congressional budget office printing of the john f. kennedy school of government at harvard university previously served as director of the hamilton project at the brookings institution. he is a leading economist lifelong public servant who has devoted his career to examining the relationship between academic research and public policy that affects the lives of people and the lies they are actually living. during the fight to pass the affordable care act god knows better than anyone how the organization works, how it evaluates the cost to the american people. we look forward to hearing from you on the evidence driven adjustments we can make to ensure that middle-class does not get left behind as we move forward on health care. teresa miller as state insurance commissioner or pennsylvania. pennsylvania is the fifth-largest insurance market in the united states in terms of premium volume and the 14
largest insurance market in the world. where she talks about is the urgent action needed aca marketplace stabilization. during her tenure as insurance commission increase consumer protection our reach and education efforts come increasing transparency and advocating for working families. she is an expert with the insurance market every day. she works to ensure pennsylvania has no county and is the national leader on insurance issues that impact american workers. prior to fighting for consumers she served as acting director of the state exchanges group the oversight group in the insurance program group in the federal centers for medicare and medicaid services. let me also introduce gary cohen. gary is the vice president of public affairs at blue shield of
california where he leaves for government affairs community in advancing the public policy initiatives such as reducing the uninsured rate, stabilizing individual health insurance market topics we look forward to hearing more about from him today. i think it was you gary, who said in your testimony that stabilizing the insurance market is a pocketbook issue. they have business and regulatory insurance in california. he served as vice president of enterprise regulatory strategies at kaiser permanente. director also the center for consumer information and insurance oversight at the center for medicare and medicaid services which was instrumental in implementing the affordable care act and the private insurance market.
we will start with you mr. elmendorf. [inaudible] >> i'm very pleased to be here today. you're taking of the critical subject of how to stabilize the market places in which millions of americans buy private health insurance for themselves and their families had some members of congress and some senior members of the trump administration have asserted that the market places are intrinsically and cable because of flaws in their design in the affordable care act. but the evidence does not support that assertion. the evidence shows that the marketplace has helped millions of americans by private health insurance that in turn has enabled them to obtain the health care they need. numerous independent analyses have concluded under the policies in place before the
trump administration took office the market would be stable throughout most of the countries in the years to come. unfortunately, the evidence is the shows are marketplace can be destabilized by the trump administration. if the marketplace is collapsed that will be because the trump administration takes her does not take certain port in action. the responsibility will lie with the trump administration, but the consequences will be felt by millions of americans. in my judgment cometh reactions are paramount to stabilize the private individual health insurance market. first payments to insurers for the cautionary reduction they are required to provide to lower income enrollees must continue. about both cautionary reduction, enrollees would face much larger copayments that would be effectively unable to obtain the health care they need and without the payments to insurers
to cover the required production come insurers would be in an unsustainable condition. the threat of stopping those payments has led some insurers to raise premiums and other insurers to plan to leave the market which hurts individuals and cost the federal government more money in the end. the administration should immediately and unambiguously state that it will continue to payment for cautionary reduction specified in the aca and congress should pass legislation to ensure that happens. second the penalty for not buying health insurance will continue. if one could wait to buy insurance until one of health care someone naturally choose to wait but it would no longer truly be insurance which occurs when protection is bought by a large group of people did some of them end up needing help in some of them do not. imagine what would happen to an insurance premium if one could wait to buy auto insurance until after one has had the accident and needed repairs.
similarly allowing people to wait to buy health insurance until they need health care would increase premiums for everyone else. administration should immediately and unambiguously state will continue to enforce the mandate to buy health insurance specified by the epa and congress should make sure that happens. third, the marketplace continuing to be administered in ways that encourage people to buy insurance rather than discourage them. that includes advertising outraged that people learn about options they have an includes customer service so people can call with questions and get answers. it includes an open enrollment. sufficient for people to collect information and make decisions. the administration should immediately and i'm ambiguously state the marketplace in ways that encourage rather than discourage enrollment in the congress should make sure that happens. these three steps do not represent a complete list of
important action. for example restoring reassurance between 2014 and 2016 would help the market tremendously. as it tweets the subsidy formula, other panelists will discuss. i want to conclude by emphasizing the subsidies and market rules enacted in the affordable care act has significantly increased enough americans who have health insurance through both medicaid and marketplaces for private health insurance. repealing the subsidies and rules with or without the totally inadequate replacement provision in some of the bills would make health care unaffordable for tens of millions of americans of modest means who can afford health care today. that would be a terrible step for our country. without repealing the affordable care act destabilizing the private health insurance market of the trump administration is currently trying to do what hurts millions of americans. i urge the congress to prevent
this damage. thank you. >> thank you very much mr. elmendorf. >> that afternoon leader pelosi members of the committee for the opportunity to be here today. i applaud the committee for holding this hearing to highlight the urgent need to need for certainty and stability as we strive to make our health care system and health insurance market for all those who need it. what is faith of the current congressional proposals to repeal or replace the aca is unclear that does not mean there are not things they need to be done to move our market stability, inc. that can be done in a thoughtful and bipartisan way and things that need to be done now. i'm not going to sit here today and tell you the aca is perfect. it is not. the narrative the republicans in washington are pushing that the aca is failing and unless congress takes action of will implode is simply false. few americans have benefited from the aca and the employer market for the majority of
people get their insurance have actually seen a moderation of cost since passage of the aca. there are legitimate issues in the individual market, but this is a small market, generally covering 5% of the population and also the market heavily subsidized by the aca. i generally hear from the 1% to 2% of pennsylvanians in this market who don't have access to financial assistance. it's a very small population that the market may not be working as well as it could. the market in pennsylvania is not collapsing but it's on a solid path to stabilization and it will not implode unless the government takes action like refusing for cautionary reduction that would cause it to implode. i believe we need to make targeted commonsense changes that will improve the aca and make it work better for the people but it's not working for today. with that context i want to offer a few comments on issues we currently face, how proposals
impact problems and what a reasonable bipartisan solution that would improve the aca for all would look like. the individual market is stabilizing. that's what i've been hearing from insurers this year and a proposed rate increases which averaged a 20% are further evidence are marketed on a path to stabilizing. while i am pleased about this, the stability is on fragile ground because of the uncertainty here in washington. we quantify uncertainty is part of our great review process. insurers told us to cf cards are not paid the average increase would be 20% instead of the 8.8%. if the individual mandate is not enforced, the average increase would be 23% in if both of these things happen we would like it increases the 36% on average statewide. that means our carriers decided to stay in the market. i cannot stress enough how difficult this uncertainty is on our insurers. if you ask me what single most
that the government can take to stabilize the market is, the answer is easy. commit to paying the csr pants on an ongoing basis and commit to it now. rather than repealing individual mandate the congressional proposals would do for failing to enforce that, we need to strengthen it. the mandate is not popular, but it is critical to radically incentivize everyone in the market, especially the young and healthy. that's how we get stable in lower premiums for everyone. a balanced risk pool for those who need coverage as well as the young and healthy. another way we work to stabilize markets and premium to find a way to bring back the successful reinsurance program. the program mitigated the impact and is estimated to reduce premiums in the first year of the program by 10% to 14%. this is an area ripe for bipartisan action. republicans recognize the value to the program. both congressional proposals allocated funding.
such a program in the context of a careful bipartisan plan could be an effective way to scale back the premiums are currently face. it would be remiss if i didn't say something about the cost of health care. we need to have a serious national conversation on how we can moderate the unsustainable growth in health care costs especially areas experiencing astronomical growth in costs at the pharmaceutical costs today. many of us look for solutions that the state level but these are national problems that merit a national solution. the health reform debate has been without question partisan, but the goals we are trying to achieve are not. recognizing the problems that exist in our health care system shouldn't be either. my hope is we can begin talking about health care differently as a nation. we all want americans to have access to health care and we want them to be a will to afford it. we want them to have choices and that means a competitive insurance market place that can provide this race is.
let's start by recognizing where consumers may not have access for portability and look for solutions to address problems. in the short-term, let's continue paying csr is robustly enforced if not strengthen the mandate them to put in place to reinsurance program is stabilizing moderate premiums. in the long-term look for ways to moderate the growth of health care costs to ensure we have a health care system that will meet the needs of those who need it now as well as the needs of those who need it in the future. i sincerely hope we can move away from drastic proposals that would jeopardize the security of millions of americans and immediately on solving real problems with commonsense solutions like these. thank you. >> thank you very, very much. mr. cohen if you would bear with us we are going to go upstairs to though. we will be right back.
there's a series of votes on house floor. the house later today we'll be taking up a bill dealing with sanctions on russia, iran and north korea. follow the house over on c-span. on c-span2, the senate in recess. they will be back at 2:15 eastern and then will be voting on the health care law sometime midafternoon today. we are outside of the u.s. senate chamber in the ohio clock area. we expect to hear from leaders public and democratic leaders after their meeting today. they're meeting getting underway about an hour ago 40 minutes or so ago. the senate coming back in a 2:15 eastern. we'll show you that they are available and we'll take you back live once the house meaning on health care gobbles back in. a couple of a non-the house floor happening now. that is why they have recess.
[inaudible conversations] [inaudible conversations] [inaudible conversations] >> a live look at the ohio clock area outside the u.s. senate. we should be hearing from senators in just a bit after their weekly party meeting to ensure that this afternoon once they come in at 2:15, the vote on moving ahead with debate on the health care law. all of that life here this afternoon on c-span2. lots of speeches yesterday as well ahead of the action today in the u.s. senate. publisher the comment that georgia senator coming david
perdue. >> mr. president nice to see you here at 11:00 p.m. on monday night. it's one of the privileges we have been in the minority or majority do we get to preside over the united states senate. we get to listen to all the colleagues talk here to this body. i've been in the chair for the last couple of hours mr. president and i can't go to bed tonight without putting his record straight in this body. i don't think there is a member of this united states senate that doesn't want america to have the best health care in the world. the problem is, we have a campaign of disinformation right now and it is outrageous and i cannot let it stand. a mission tonight, very briefly and will be to put them facts on the table, on the record.
they have a lot of innuendo, a lot of misinformation. people are going to die. but remind everyone we are sitting with a health care system that is collapsing. no other way to describe it. why are we here tonight 11:00 p.m.? i want to remind the american public of why the united states senate is here tonight. something historic is underway right now in this united youth of america and that is this. for the first time in our history, the minority party would not cost the rule that would put in the rules of the senate would confirm a nominee by the president of the united states. because of that we today have something around 29% of this president's nominees. mr. president. the prior president at this point in time had over 70%. almost 300 people. i think the number today is 50
for this president. it wasn't until a month or so ago he could have a staff meeting. who's running america today? holdovers from the last administration because we haven't been able to confirm the nominees. over 200 people right now standing in line waiting to be confirmed by this body. it's outrageous. the american people ought to be upset. but he was doing that? not the majority party the minority party because it slows down everything. guess what doesn't get done this year mr. president if we continue with this schedule, unless we are in here every night like we are tonight we will get to taxes this year. we will get to it the american people are assuming we will get to. consumer confidence is at a 13 year high. they're anticipating will clear up this mess. let me move on the health care and put a few facts on the
record before we close. there are five health care systems in america and we forget this. we only talk about obamacare right now but there are five health care systems in america. first we have group policy. the vast majority are in this. anybody who wants in a company or organization has a group policy mr. president. .. m. only 13%. then there's the v.a. then there's medicare and medicaid. five different systems of health care in the united states. what we're dealing with is the individual market and medicaid, mostly the individual market, mr. president. but let me try to describe the situation as we see it today. in 2008 before the a.c.a. there were 48 million people in america who did not have insurance. that's a catastrophe by anybody's measure. the richest one in the history of the world we had -- the
richest country in the history of the world we had 48 million people who did not have insurance. you could be precluded from having insurance because of a preexisting condition. you could lose your insurance. you couldn't transfer it across state lines if you changed policies -- even if group so we have real problems, mister president. both sides have responsibility for that existence. but today , after the aca, 28 million people as we stand here tonight still do not have insurance in america, 28 million. over 20 million that, 16 million got it only because of the extension to medicaid, not because obamacare is working in the future market. the million become got it because of the expansion to medicaid and all that was was from the federal government to decide to take the money and run. they didn't do their citizens for justice. the remaining 4 million of
the 20 million that got insurance during obamacare, over 16 got it because of the expansion of medicare. 2 million was my wife and myself. mister president, remember the day when president obama said if you like your insurance, you can keep your insurance? if you like your doctor, you can keep your doctor? like most democrats in the house who voted on obamacare who didn't read it, he obviously didn't know what was in the bill because neither of those things were true. i was canceled. in an individual policy before i ran for the senate, my individual policy as a retiree was canceled . and the only policy we could get under the exchange in obamacare included things like vision, hearing, drug rehabilitation, never had a e problem with that and my wife either. i met my wife in first grade, we're not having babies at this age . what is that? my rate is doalmost double because we are having to pay,
we had to pay things and policies that we did not need. okay? so the remaining 2 million, 1 million or the most destitute, low income people who really do need our help but we disrupted the entire health care system because we ou thought , democrats thought that bigger government approach would work. how that worked out with places like the va? i hear talk now about single-payer i'll get to that in a second but if you like the va, you will love the single-payer system because that's what it is. let me go on mister president. i paid a lot of italk in this chamber about all my god, the republicans are going to hurt people in america. we talk about who's hurting people in america. in 2014, this is a travesty, we cannot get the information from the irs. we just now gotten information and in 2014
mister president the irs over the rules of obamacare wind 8 million people 1.8 billion dollars, mister president. i know about you but i'm outraged and i know you are too. the irony of that is that 85 percent of the people that were filed in 2014 , $1.8 million, 85 percent less than $50,000 and have them mister president made less than $25,000 so what are democratic friends did was they cram down the throat of americans this thing called obamacare and put fines on people who can afford insurance and they're the poorest people in our country. who's standing for those guys today? the democrats? don't you bet. they want a big government solution that gives them more power and they could care less about the poor people they claim to champion mister president, i had enough of it. this is outrageous.
22 million people are going to lose insurance, that's what they tell us. let's clean this up right now. the cbo's estimate says once you remove the mandate, what else is available, if you remove the mandate because things are so expensive, the policies are so expensive, 15 million are going to get it out . happening today. you know the ceo is using a march 2016 baseline to compare these numbers two? is outrageous. in business you would never accept this yet today, there determined to be the holy grail appeared. i haven't seen the unnumbered come out of the ceo i would depend on you. in 2010 overestimated the number of people who would sign up for obamacare by 12 million people, mister president. they missed the estimate by more than 50 percent. this is a rounding error, they don't know what they're doing. right now today we have the same problem, 50 million they say would get their insurance voluntarily because it's too expensive. i have nothing to do with the new plan, that's because
obamacare is too expensive. 84 million people would get medicaid. medicaid is free, why would somebody get medicaid to mark they say if obamacare is so good and so horrible there 5 million people, there is no reason to believe that. there's no evidence that would back that claim up. that is not a quantified model outcome. it is a person's estimate sits over there and makes this up, mister president and the other side is acting like oh my goodness, this is the holy grail. let's talk about this. of premiums under obamacare prior to this year , over last year of over 105 percent in america. and they say well, the reason premiums are going up is because of the eamaternity coming out of the white house. these rates were determined last year before we knew this president was going to be a nominee. another disinformation , one i'm fed up with mister president is it sounds like a good story until you see the facts . the premiums in my state alone going into next year
are going up 42 percent and here's the untold truth. in my state 9659 counties have one carrier. that's a monopoly. they can do whatever they want. that's under obamacare, not anything else. that's the reality today. and by the way, here's the real comeuppance. today in pmy state, and you got the same problem in your state, 300,000 people who make less than the poverty rate in my state and not get insurance today under obamacare. forget about what we are talking about to fix this mess . today under obamacare they can't get insurance. 300,000 people in my state and that's true of every state in our country. that the untold ugliness of obamacare. obamacare is hurting people right now. i'm tired of hearing the other side , then they find the poorest people in america, $1.8 billion mister president and 300,000 people in my state denied them access to
healthcare. enough already. what are we doing about it? six months ago this president said there were four ur objectives that any healthcare system in america m and the individual market had to do. one, the first was access. we've already talked about how obamacare is feeling people who need access. the lowest income people in america denied insurance under obamacare. we fixed that.hi people who want insurance are going to get insurance and by the way, premiums was the second thing we have to do to get cost down because it becoming too prohibitive. i got ends in the middle of their career they can't afford insurance they are being offered today. i see it firsthand in my own life. but if we put in to place these suggestions that we have on the table right now , hhs department has estimated last week with a very credible model that rates
could come down as much as 78 percent, mister president in the next four years. has anybody heard the other side remind us of all of us of that point. why do those rates come down? the free market gets to act de again instead of being shackled and choices being removed, all of a sudden we move in. they talk about these made-up fantasy policies, wait a minute. i had one of those made-up fantasy policies . catastrophic coverage. for some people with a high deductible that's what works. there denied that today mister president because the government knows more about what you need in your personal life. the third thing we had to do, and this was important, the second part of this problem is that medicaid is not on a sustainable path, mister president. they overpromised and they cannot deliver. there is no way over the next years we can sustain medicaid just like medicare and social
security are going bankrupt, we cannot afford to do what they are promising people we are going to do and they know that. they already know that. just like the great society mister president, these big government programs they promise all the time or going rt to work have never worked . the great society, war on poverty was going to remove poverty from america, i remember that. i said it to death where that bill was signed by the then democratic leader of the senate, richard russell before it went to the white house. i'm reminded every day of how big government has failed the american people. that war on poverty has been trillions of dollars trying to reduce poverty in america and yet today the poverty rate is fundamentally the same as it was in 1965 when it was signed into law. big government does not work in situations like this. i lived under a single-payer .
what single-payer does and this is the alternative thereafter, i heard it mentioned three times on the floor of the senate tonight. we cannot go there. it bifurcated and would add $3.2 trillion, that's more than we spend on all our mandatory expenses today, mister president. 3.2 trillion every single year, that's impossible. if you think that would work, imagine this. look at your tax bill. whatever you paid the d federal government last year, double it. that's what that would mean. that's what that would mean. double it. it's not workable. the fourth thing we had to do is make sure pre-existing conditions were protected. i worried about that through my career, when i changed jobs if my family had been sick i might have been denied insurance. we cannot allow that. this doesn't allow that. we protected pre-existing conditions, but medicaid on a ss sustainable path for the long term. we also bring premiums budown, that was a major priority and we get everybody otin america access to health care, and of the conversation. that's not good enough. the other sides not going to be happy until the federal government over 18 percent of
our economy called healthcare. if they tried to do it in 92 and 94 under hillary care, they tried to do it here. the speaker of the house that if you want to know what's in this bill, you've got to vote for the bill. we're not doing that today. this cloud of innuendo the other side is perpetrating on 2 the people is just not true. in 2010 not one republican voted for obamacare. not one and then got to the floor of the senate. and yet they want to talk about oh, this great open policy. they had seven years to fix this mess. seven years. and people in my state have been hurt by it. it's unforgivable. we can do something about it this week. senator john mccain is very sick . a fighter. take care of this. i hope you will be back this week to help us and if he can, i think he will but we're going to vote on this
this week, mister president. we got to do this for the american people. i want to remind everybody what's at stake here. if we don't pass this tomorrow, then we end up moving toward a single-payer system and let me remind ie everybody of the other big nk government failures we talk about, the va, the postal service. we talk about the obamacare failures and then the great society, a war on poverty. let me close with this. i heard tonight this is a reckless action. the new policy. i've heard new examples about how to take care of your brother, mister president. it's shocking to me that somebody on the other side would say that when they know these statistics is what they got. 8 million poorest people in america have been fined $1.8 billion. half of them make under 25 thousand dollars a year, that's taking care of your brother all right. i'm embarrassed. we can fix that.
i believe we've heard the rain of devastation, no one felt like this bill, it's a reckless act and here's the one i love. we want to work with you. we want to work with you to help fix this thing. a year ago mister president i didn't hear any speeches and i don't think you did either from that chair where anybody acknowledged there was anything wrong with h obamacare. here they are we want to work with you to help obamacare. it's seven years too late in my opinion. it ilwould have been nice to be included in the conversation in 2009 and 10 when it was crammed down the throat of republicans. i will close with this. i believe this is a historic moment in america ynot just for healthcare, healthcare is important but it's bigger than that. this is about the direction of the country. are we going to trust the government again and again until we can't afford it? we are already well down that
rabbit hole. we cannot afford this chance again. we've already proven it doesn't work. i hope this week that colleagues on our side will get together and vote this thing and i welcome the democratic support as well, i know we're not going rato get it but it's time to stand and i hope we will have that boat. i encourage my colleagues here to support that and let's get on with business. thank you mister president. >> speeches on health care went late last night in the u.s. senate so they dabbled in today at noon eastern, the majority leader mitch mcconnell laying out the plan ahead with a 215 return time that as they come back from their weekly party lunches so about 30 minutes from now we will have live coverage of the u.s. senate and a vote expected this afternoon on advancing to debate on the healthcare law.joining us from capitol hill is bill
that seems to me the house republican bill and senate bill admit there is no way to create a viable individual market without government involvement either through subsidies through csr through reinsurance in the case of the house bill. that is something i think they had never been willing to admit but implicitly admitted it in their legislation. the other question i have and i'm just asking particularly mr. mr. elmendorf because i know he studied these other bills i have been saying under any of the republican offered alternative there's no way they
can guarantee that any single american citizen will have better coverage than they do now would you say that's a fair statement? >> congressman, i think you are right to say that have infective competition and a private health insurance market requires a set of rules that insurers and families have to abide by because health insurance is not a commodity like every other commodity and i think you are also correct to say the bills republicans have advanced with that healthcare for tens of millions of americans would be a step backwards for our country. >> one point convert-- congressman. people who are talking about one and a half competition need to remember before the affordable care act there was no health insurance market in the individual market for the millions and millions of people
who had pre-existing condition no market at all, so when we talk about wanting to have a competitive market we need to keep that in mind. we have created a market with the affordable care act. >> thank you. >> thank you and we turn now to our assistant leader of south carolina. >> thank you. thank you madam leader and chair. i am extremely impressed with the presentation tier today. i'm used to hearing from doctor elmendorf having that a part of that super committee and other things that sort of-- again it's a great deal of respect and i thank you so much for your testimony here today. i'm interested in this whole issue certainty in the marketplace in people's homes and people's lives. it seems to me that it's
the court said appropriation is needed to fund this money do a preparation. we have to provide this benefit. of the insurance industry is worth billions of dollars to the insurance industry nationwide. they won their case made their point and now is their obligation to appropriate the money. >> i would add the consequences of uncertainty show why a strategy of repeal and delay would be such a disaster for the country. there's a lot of uncertainty already created the federal government policy and if on top of that the government said we will take the whole thing away in a few years and do something, we don't know what that would have a damaging effect.
>> so you are saying if the senate tour to come up with the legislation it's discussing that is to pass something to repeal and delay implementation out to 2019 you say this would have even greater adversary impact? >> absolutely. >> thank you. >> to recognize you will state your questions and we will have answers from our panelists. the first go around we want representative or release representative mike thompson, representative scott peters and representative jan should kautsky. >> thank you. thank you for holding this
hearing and it's a special treat to have you three on the panel. i'm personally connected to all of you. ima alumni and graduate of the harvard school of government. i trained at the university of pittsburgh in pennsylvania in emergency medicine and i grew up and live in my heart is always in california, so thank you all for being here. i'm emergency medicine doctor and i take care of complex patients with different multiorgan trauma with different needs and urgencies and we always have a method of approaching these complex situations. simple recipe here would be first do no harm to stabilize the market, three take care of the patient and you have talked about how there is active decision that the trump administration is currently doing that is harming the marketplace harming patients and that's an outrage and a
shame because the people suffering are the american people the people that need healthcare. second, we need to stabilize the market and i had introduced a bill called the marketplace certainty act that will do just about permanently funded csr and increase the eligibility to receive those co-pays and deductibles subsidies for patients up to 400% federal poverty level, which were an individual is about 40000 46000 so the quote of letting obamacare ale is misleading and that's one of the more frustrating things about this discourse and you have hit it on the head it's politically motivated. it's a way to hurt people in order to force people to want to swallow their placebo or actually their poison. i know this question was asked of mr. alan dorff and i want to ask you in your testimony
highlight different cost-sharing subsidies for your members. can you explain more they have to lose if this instability occurs and i also want to-- i want you to emphasize the time urgency we have. i don't think a lot of people understand that right now insurance companies are deciding whether they will stay in the market or leave the market what the price that they will hold and all of them are pointing to the uncertainty so can you elaborate on that timeframe and on the urgency of need to act right now? >> thank you. on our timeline once we get to the middle of august that's when our rates get locked down and get put in our system. it takes time to get that done. when i was in the obama administration i had the painful experience of knowing what happens when you have it got your data locked down and it working properly so you have to
get that done in time for open aroma in november. we need to inform our current members with their rates will be for the future because they will be renewing and they may have the opportunity to shop around so we have to get those rates locked down and less than a month. we are dealing with the situation where we have to be looking at are we going to be getting cost reduction funding or not and we are not hearing about a preparation from congress and we are hearing about statements from the president and others that funding may not be there, so we have to take into consideration the fact that we may not get the funding. if we don't then we have to increase rates for everyone. it's not just for the people that get the benefit but everyone will pay more to spread the cost of month our members. no one should want that. no one should want people to have to pay more. when the question of what the benefit is worth it's literally
the ability to actually go to a doctor and get to care or not. if you are lower income person and you have a plan with a deductible of $3000, that might as well billy a million and the whole point of that cost-sharing reduction is that it reduces the cost of the deductible in the co-pay you have to pay each time it goes to the doctor on a level that it's a portable for people if you were to pick one thing we could do right now would be cost-sharing reduction? >> for today, guess. >> to stop the bleeding that will save the patient's life; right? >> correct. >> thompson. >> thank you madam chair thank you to the witnesses and thank you for your fantastic testimony. i had questions i planned to asked and i sat down when we first convened and over my device i got two messages to press reports one that said if the affordable care act is repealed we can count on losing
a million jobs right away. then the second one was talking about the skinny bill option that the senate republicans are talking about where they would eliminate the mandate and the device tax and i know you have got great experience with cbo and cbo has already said that if they do some of the things they are talking about it will cost us somewhere between 22 million and a 32 million jobs. if they do the skinny bill, what would cbo estimates look like if you consider that in the million job loss? >> as you know former cbo directors don't carry around in their head the ability to do the analysis. >> i have confidence in you. >> all i can really say is that the mandates by health insurance is critically important because the essence of insurance is that eight set of people sign up
true for auto insurance, homeowners insurance or health insurance, a set of people sign up not knowing who will have the car accident or whose house will be hit by lightning or who will be diagnosed with eight serious disease and by pooling those risks we each paid average cost of what will happen rather than some people that may be totally fine but other people completely hammered by health problems which they cannot afford. the essence of insurance is that people sign up ahead of time. those of us with employer sponsored health insurance are left in a pool automatically so the genius of the zero formal care was to create a similar pooling mechanism for people who could not get that insurance through their employer as the congressman pointed out we need more affordable benefits not less. >> thank you. my colleague and i have legislation that would provide an adjustment for the premium tax credit depending upon the cost of living.
both of us represent a high cost of living area and a lotta folks are squeezed out of the market because of that. with that be a help? >> i think it would be. i think it's important that the premium tax credit reflect what actually caused by health care in a particular location so i think that would be a helpful thing to look at. >> thank you madam chair. >> thank you madam chair. on very discouraged that in the house process energy and commerce committee did not have hearings so it's nice to have a hearing to ask questions. as a consequence of not having a hearing a few of us led by mr. schrader decided to have our own hearing. >> the house democrat event on healthcare continues live on c-span.org. we are live outside the u.s. senate in the ohio clock building waiting for the senate
to gavel back in to take up the motion to proceed voting to begin debate on the healthcare law. the democrats and republicans have been in their weekly conference meeting and during those meetings we heard on twitter and from a number of reporters saying that dean heller plans to vote yes as does senator rob portman of ohio. the majority leader mitch o'connell will come to the senate floor make comments on the floor and step out to speak with reporters as we are able we will have it live for you hear on c-span2. ficer: the majority leader. mr. mcconnell: i ask unanimous consent the democratic leader be recognized for five minutes for debate only and that i then be recognized. the presiding officer: is there objection? without objection.