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tv   Ways and Means Committee Marks Up Health Care Bill as Congress Awaits Cost...  CSPAN  March 8, 2017 2:32pm-4:33pm EST

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all-americans we are committed to making the mer can health care act fiscally responsible. we are currently waiting for cost estimate from the congressional budget office as efrp on this committee understands, this is nothing out of the ordinary for a markup and we will wait for a deliberate comprehensive score from cvo as process moves forward. the most important thing for all-americans to know is that we will ensure our fiscally responsible legislation meets all of the reconciliation instructions before it reaches the house floor. we are dedicated to getting these crucial details right for the american people so we can provide them with the relief they need without any more delays. in closing, i want to thank all of the members who help craft solutions in legislation before us today. this bill represent years of hard work. and a number of bipartisan ways and means bills. thank you all for your
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leadership. today's markup is a critical step in providing all-americans with affordable patient-centered health care tailored to their needs. this is a top priority for all members of our committee and i hope we can all work together to deliver the solutions that our constituents want and deserve. with that, i will now yield to ranking member neal for his opening remarks. >> thank one mr. chairman. i am disappointed we are here today to consider legislation that reflects not only bad policy but bad process. in a number of important groups agree, aarp, american medical association and american hospital association all oppose this bill. this bill suffers from an identity crisis is this health care or is this a tax cut bill? does it lower costs? no. does it bend the cost curve? no. does it cover more americans? no. does it cut the deficit? no. even president trump wants more
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information. earlier this year, and this week he called it an unbelievably complex subject. nobody knew health care could be so complicated. this republican bill, which they dle cleverly broke into separate parts to distract the american public failed to protect 152 million americans with preexisting conditions and would allow insurers to charge older people five times as much as younger people. essentially implementing an age tax. it forces millions to pay more to get less health care. i guarantee you having come from local government in early stages of my career that by turning this over to governors they will use health care money for the purpose of paving streets, patching budget deficits, fixing highways, and not using it for the prescribed purpose of providing health care.
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transparency is clearly lacking in this process. as recently as last week, i called upon house republicans to provide an open and transparent process when they consider any health care legislation aimed at repealing or replacing the affordable care act. the goal, to ensure all-americans have the opportunity to fully understand and consider how many and how much this republican health care plan will cost and how it'll impact them. instead, republicans hid a draft bill somewhere in the basement of the capitol with armed police officers. that is a far cry from the notion of transparency. the american people deserve better. also, to consider a beale of this magnitude without a cbo score is not only puzzling and concerning, it is also irresponsibility. when we created the affordable care act it was a transparent and open process.
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let me give you the numbers, fact, not opinion. 79 bipartisan health insurance reform hearings and markups over two years. 100 hours of hearings. 181 witnesses from both sides of the aisle. 239 republican and democrat amendments of which 121 were accepted. it was a 30-day on-line review of the house bill before the markup. 3,000 health care town hall meetings and public event were held. in the senate, 53 health insurance reform hearings occur id in the senate finance committee. eight days of markups with 135 amendments considered in the senate finance committee. 47 bipartisan hearings and other open dialogues with 300 amendments during 13-day markup in the senate committee. 25 consecutive days this he were
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in session to discuss health care reform in the senate. 160 hours in total, the senate spent considering reform legislation. and there were 147 republican amendments in the final senate bill. this bill sabotages the marketplaces where close to 10 million americans today get coverage and starts death spiral from which it will be very difficult to recover. healthy people won't bother with coverage or instead buy bare bones policy. sick people who need coverage, would buy policies if they're available but that will undoubtedly become more expensive, more unaffordable and harder to get. the most egregious part of the republican plan slashes medicaid funding to pay for tax cuts that benefit the rich. medicaid helps pay the cost for more than 60% of all nursing home care residents nationwide and helps families afford quality nursing home care for
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elderly parent and family members with disabilities. the republican medicaid proposal makes it harder and more costly for long-term care for elderly parent or children with severe disabilities. in addition it would end the medicaid expansion. a move with devastating consequences in my state of massachusetts. where it's been a critical tool for thousands of individuals and families with loved ones in long-term care facilities who have dementia. it also provides rehabilitation options for individuals and families in the grips of the opiate addiction. that will be curtail id. reality is that medicaid is now a middle class benefit. measure would also cut the span of medicare by two years at a time when millions of baby boomers are joining and will rely upon this critical initiative. it is a $170 billion tax give away to the wealthy while
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starving the medicare trust fund. hospitals would face crippling debt. based on increases in uncompensated care and lower reimbursement rates. in turn this leads to job losses in many hospitals and have a negative ripple effect in community where hospitals are the largest employers. in western massachusetts, bay state health center provides 12,000 jobs and has a $4 billion statewide economic impact. let's call this bill what it is, a plan to create chaos in insurance marks that the directly impacts patient and providers. it will hurt hospitals and the community they serve and their regional economies. before concluding, i would like to note that today's markup is the republicans first step at tax reform. this legislation is a tax bill. almost every provision amend the internal revenue code. so we need to view this bill through the lens of tax reform as well and though this and
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through this lens we can see clearly that bill fails the test set out by secretary of the treasury ma movin for tax reform when he said quote there is no absolute tax cut for the upper class. >> thank you, mr. neal. the gentleman's time has expired. the amendment in the nature of substitute is considered as read open for amendment at any point in considered base tax of purpose of amendment. i will now turn to tom bartow, to provide the technical description in the amendment of the nature of the substitute. i ask that members hold questions until after his presentation. mr. bartold? >> thank you, mr. chairman. mr. neal, members of the committee. have you before you two joint committee documents, they describe the underlying proposal and the chairman's amendment and nature of the substitute. in brief, under present law any employer can deduct reasonable compensation for personal services from their employees as
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ordinary conduct of their business. mr. present law, the deduction allowable for compensation attributable to labor services performed by the individual, individuals, of certain health insurance companies is limited to no more of a deduction than $500,000. the proposal before you as amended by the chairman's amendment and nature of the substitute would repeal this provision effective for taxable years beginning after december 31st 2017 and in other words effective in 2018. we have estimated that this proposal will lose approximately $400 million over the budget period through fiscal year 2026. that concludes my brief description. happy to answer any questions that the members might have. >> thank you. are there any questions for mr. barthold? >> thank you. i find t odd that our republican
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friend decided to start on health reform with excessive executive compensation. current law limits the law for compensation paid by health insurance providers to employees and service providers during tax year to $500,000. publicly traded have a similar rule with executive compensation. the republican plan is a broken promise. president trump promised lower cost and wetter covera better cr everyone. increased cost to consumers, reductions in needed care, and reducing help for middle class to you are chas insurance while giving handouts to those again at the very top. instead of focussing that the middle class will have quality health care our republican friend would like it start today's debate providing a tax break it health insurers that provide executive compensation. mr. barthoeld for the record
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would you repeat the cost of this provision? >> the joint committee staff has estimated that over the budget be period fiscal years 2017 through 20206, this will lose approximately $400 million.6, t approximately $400 million. >> thank one mr. barthold. >> million. million, mr. crowley. >> question, mr. barthold? yes, mr. levin. >> thank you, mr. chairman. as mr. neal said, we are starting off with a tax revision that will benefit certain people. could you tell me since this is part of an overall set of tax provisions, how much of the tax provisions will go to people with income over $200,000 a year, total tax provisions?
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>> mr. levin, we're working -- the joint committee staff is working jointly with the congressional budget office on this. and so in terms of all of the provisions you have scheduled before you today, some of it involves the new cred its for health insurance. that depend on coverage and take-up rate that analysis is not complete at this time. so i can't answer your question with respect to all the proposals under consideration today. >> how about the specific tax provisions that are before us, though? >> we have not undertaken a distribution analysis of this specific piece. remember in terms of its debating, for its compensation,
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it effects tax liability at the business level. it may also effect the net compensation received by the effected individuals but as i say, we have not undertaken an analysis of how this would affect tax liability of the owners of the insurance business. >> okay. but i was asking for example, the provisions regarding the investment income tax. what's the loss there and who does it go to? >> oh, i didn't realize you were asking about one of the bills that's -- one of the provisions before the committee later. if you will give me a moment i will pull out that piece of paper. >> mr. barthold, if i understand, will focus on that section, on that investment tax
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in a moment. so i would like to focus on the provision before us. >> i want to know the overall tax impact as we take this first one, it's pretty clear whom it's going to benefit. i wanted to ask you, how this fits in to the overall picture in terms of the tax cuts. so could you please answer that. >> well, mr. levin, as i explained, i don't have a distributional analysis for the overall package. i also don't have a distributional analysis for each of the individual component. i have prepared some distributional analysis on some individual provisions in particular on the net investment income tax that you inquired by mr. brady said that could be the subject of discussion later in terms of overall -- >> could you tell us what it is now?
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estimated budget effect of the repeal income tax joint staff estimated at $157.6 billion over the budget period fiscal years 2017 through 2026. >> what's the distribution of that? >> mr. levin, if i recall, you're asking for the overall view of the tax provisions in here. this section deals with renumation to insurers. we welcome those questions. but the specifics on this i think would best be delayed until we tackle this section in-depth in a few moments. >> let me just ask if he has the answer. because as we look at one we
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should look at all of them to see the overall picture. because there's going to be $600 billion in lost revenue. as we start on this, i think dangerous path, i think we need to know the overall picture. >> thank you, but we will be examining this in-depth in just a moment. the focus at this point for mr. barthold at the moment is the provision in front of us. >> mr. barthold, do have you that information? >> mr. levin, my colleagues have prepared a distributional analysis on that investment income. it's a five-page analysis. i will ask my colleagues to prepare copies for all the members of the committee and i will make it available a little bit later. >> thank you, mr. barthold. >> time is expired. anyone else wish to require about the amendment in the nature after substitute?
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>> thank you, mr. barthold. do i understand you are the only human being to come before us today to discuss any of the five provisions? >> i've been asked to describe the provisions before you. >> you're the sole person who will be here to explain these provisions and respond to technical questions? >> i'm going to draw on the assistance of my colleagues. >> but there is no one else here, no staff member or anyone else who will explain this provision? you're the only person we can ask questions to? okay. >> yes. >> i think you'll do mr. barthold. >> it is good to know we have one human being here to respond. in that regard, mr. barthold, if i understand, this one-page bill that is the only thing before us at the this moment of your testimony is part of a 53-page bill, is it not? >> i think the 53 pages, if
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you're describing, is in entirely separate, this is not part of that bill. you have to talk to the chairman about the plans for the entire reconciliation plan. how that would be put together. it will result, i'm sure, in a -- >> from a technical standpoint, is there any reason these five separate bills before us today could not have been joined as up with? one? >> in terms of legislative drafting i cannot think of -- >> but it does have advantages in preventing amendments and narrowing discussion rather than looking at the larger pictures. >> i'm not sure of the -- >> i'm sure that is outside the area of your expertise. as far as the 53-page bill, have you had a chance to review it? >> yes, sir. >> focussing on this provision and other five provisions, i just wanted to ask you if there are provisions in the bill, that
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despite all the rhetoric, criticizing obamacare, that really salute the spirit of obamacare such as the provision on page 37 that says to the greatest extent practical, the methods and procedures used to administer the affordable care act are to be retained with reference to the tax credits. does this provision or any of the other provisions that you're about to talk about, do they salute the spirit of obamacare? >> mr. dog et, while i appreciate the question, this question relates to compensation in the insurance area. i ask you to confine your questions -- >> and so it is. my question to the witness is whether this provision or the other titles to which -- i'll ask him the same question on those titles, whether it includes any of the same to the spirit and preserving of
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elements of obamacare like that on page 37, but says to the greatest extent practical, use the affordable care act as your lead star. >> thank you, mr. dog et, again, this is beyond the technical -- >> it is relating to this section. it is asking him if this title includes anything similar to the spirit of obamacare, someone who has been alleged to be a law breaker but is the, within the past weekend, but is former barack obama, is there anything in this title similar it 37 tries to -- page 37, tries to follow the spirit of obamacare? >> so again, mr. dog et, thank you for repeating the question. mr. barthold here is to answer technical questions about the section in -- >> i'm only asking him about this section. i'm asking him if this section -- >> no, you are asking him about saluting the spirit of
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obamacare. mr. barthold here is to answer questions about the technical revision fles this section. >> let's comply with the narrow scope you are confining me to, is there anything in this title, that contains a reference to the affordable care act or the desire to follow that act to the greatest extent practicable similar to what we find on page 37 of the chairman's bill? >> mr. dog et, this provision amends section 162 of the internal revenue code relating to allowable deductible cost as business expenses. >> so it does not contain the reference to the greatest extent practicable to the affordable care act? >> it is about the measurement of the tax -- >> will all of the benefits of this bill flow to the insurance industry? >> i'm sorry, i didn't hear you. >> will all of the benefit of this $400 million tax cut flow
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to the insurance industry. >> as i was explaining to mr. levin, the distributional affect depend on what happens one to the compensation of individuals who may be subject to the bill and provisions of present law and two since it goes to the determination of net income of the business, it will affect the net returns of the owners of that -- owners of that business. . >> thank you, mr. barthold. time has expired. >> thank you, mr. chairman. thank you, mr. barthold for being here. a lot of people have mentioned the lack of cbo report on this legislation. as you know, and i think everybody here knows, that that document is incredibly important and provides not only members of this committee but the public that rerepresent with some sense of whether the provisions of this bill were expected to cause
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americans to lose their health insurance, how much their premiums would increase or how much out of pocket expenses they would experience. do you have a copy of the estimate from cbo that you can share with us? >> mr. thompson, if the congressional budget office prepared an estimate, they would have given it to the members of the committee probably before tle would have given it to -- >> so you don't have one either? >> the cbo said they put out a statement last night that cbo is in the process of preparing an estimate for the house health care bill. i will add to that that several of my colleagues are actively working right now with counter parts of the congressional budget office on the interrelationship between the tax provisions that you're looking at today and how that effects coverage in terms of the player market, individual
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market, who would qualify, who will choose to purchase insurance and who may choose not to purchase insurance. the cbo added that we will release the estimate as soon as it is ready and we expect that to be early next week. the estimate will include the impact of the legislation on the federal budget as well as effects on health insurance -- as well as effects on health insurance coverage and premiums but i have no specific information on any of those points right now. >> do you know if there was is a cbo report on any previous drafts that the republicans have prepared and refused to share with us? >> well, mr. thompson, when we, when the congressional budget office, when we work with members in developing legislation when we work with your office, we never tell anyone else about any preliminary -- >> have you seen any drafts -- >> i should not comment on
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anything i have seen or not seen to show the same respect that we offered your office, sir. >> so going back, i think this question was asked, but in regard to insurers, is it true that the repeal of this prohibition and this particular bill on windfalls for insurance company executives will cost taxpayers $400 million in lost revenue over the next ten years? >> that is the estimate of the provision prepared by my colleagues, yes, sir. >> is it fair to say that if this bill were passed that it would drive up the cost for middle class to pay for massive tax cuts for the wealthy? >> i shouldn't make any judgmental statement -- >> is a 400 million tax cut considered a massive tax cut? >> could you repeat the
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question, i'm sorry. >> is a $400 million tax cut that the insurance companies would receive if this bill passed, would that be considered a massive tax cut? >> well, in my experience before the committee -- $400 million is one of the smaller numbers that the committee often deals with. >> so $4 h 00 million here and 400 million there and pretty soon you're talking about $593.7 billion over ten years -- that's pretty massive.million there an you're talking about $593.7 billion over ten years -- that's pretty massive. and unpaid for, is that correct? >> you have the estimates that you have before you. again, it's not complete. because the overall analysis will include changes to the existing premium assistance. >> so we don't have a cbo report that would tell us exactly how much it costs. >> we don know the full -- >> we don't have a cbo report that tells us how many people
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will lose coverage. we don't have a cbo report that tells us that your numbers of $600 billion is what the american people would be charged for this bill that we only got last night. thank you, mr. barthold. >> mr. higgins, you're recognized. >> what about -- >> thank you, mr. chairman. as i understand it, this bill would allow insurance companies to claim exorbitant executive compensation as a business expense for deduction from taxes. and i think this is fundamental to the whole health care debate that we're encaged in. sir, are you familiar with the united health care? >> am i familiar with -- >> united health care? >> somewhat, sir. >> ceo earned in 2014 $66
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million. in 2010, that same ceo earned $210 -- sorry, $102 million with stock options. >> cigna ceo earned $2203 million. aet aetna earned and anthem earned $16.3 million.3 million. aetna earned and anthem earned $16.3 million. i would say we should repeal this provision and replace it with admonish insurance companies to bring your salaries in line with reality. united health care ceo, 66 million in 2014. also disclosed last month that united health care, nation's largest provider of medicare advantage services is being sued by the department of justice for fraud.
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united health care reported $46 billion in revenues in the third quarter. the fraud alleges that the united health care is improperly charging the medicare program by hundreds of millions of dollars and likely billions of dollars. we're sitting here talking about getting big insurance companies a tax break? on the exorbitant compensation that they pay their executives? you can be on one side of this debate. you're either with people in america that work hard every single day, that follow the rules, that pay health insurance premiums that are too high and expect one thing, and that is at the end of the day, when they or their family needs health insurance it will be there for them and they won't get screwed by private insurance companies
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or you're width private insurance companies who want to embrace provisions in this bill that protect consumers and particularly the elderly. so when we talk about executive compensation and tax deductibility for in the bill, exorbitant executive compensation, it says it all. so i don't think this provision is justifiable. and i think it's morally reprehensible. i yield back. >> so in order of hands being raised, i'll recognize under kind, then mr. larson, then dr. davis. >> just so we are clear, it is
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my understanding that undercurrent law, health insurance companies are allowed to deduct as business expense up to $500,000 or half a million dollars of executive compensation, is that correct? >> it's actually more than executives that covered by the provision, mr. kind. but yes, it's correct. the individuals covered are officers, employees, directors and service providers such as consultants -- >> basically anyone working for that insurance company. >> pretty much, sir. >> right down to the janitor. >> yes, sir. >> being compensated -- >> compensation up to $500,000 is permitted. >>. >> what this sub title will do is lift that current cap on $500,000 and make it the sky's the limit that they can deduct all employee -- >> it would conform, conform the treatment of health insurance providers to that of all other businesses.
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remember that there is still for all businesses the million-dollar limitation of code section 162-m. >> so there would currently still be even with the sub title passing a $1 million cap on employee compensation. >> health insurance is subject to general rules that apply economy wide, sir. >> so removing the cap back up to $1 million. >> $1 million and 162-m, remember, is a narrower group. only the top five officers. >> the ceo and the next three highest paid. >> so that 1 million cap only will apply to ceo on next three highest paid employees. >> that's what the general rule that applies across all business he in the united states is, sir. >> now this sub title, do you
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know how many insurance companies would be affected by this? what the number is? >> i do not off the top of my head. i'll ask my colleagues to check and see if i can get that information. >> do you know how many individuals that this lifting of the 500 cap would effect in the insurance companies -- >> not knowing the number of companies, i'm not sure if i know off the top of my head the number of individuals either, sir. i'll check. >> but we know we bring a ten-year cost of -- >> that so far sir. >> do you know the policy why it is putting $500,000 cap on compensation? >> i would have to research some of the debate at the time of the affordable care act. >> yeah. would it seem plausible that it was so if insurance companies were to benefit in any way, as far as increased profit under health care reform that they would not pass that on in the form of higher compensation that they could then deduct for tax
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purposes? >> perhaps, but member, code section 162-m, general rule, million dollar limit, which we were reviewing a couple moments ago, has been part of the law since 1993. so well predated. >> just with the general knowledge of insurance companies, and employee compensation, are there a number of people that work for insurance companies that exceed a $1 million annual compensation package? >> mr. higgins noted some -- >> he just cited ceos, i'm talking overall. >> large corporations in the united states, it's not uncommon to see among high-ranking officers, compensation in excess of $1 million. >> and when you see the analogy between the fixed operating cost
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of medicare, of roughly 3.5 to 4% versus what you get with private insurers in the private marketplace being closer to 17 or 18% fixed operating cost, part of that fixed operating cost is employee compensation that the insure uncompanies dish out to their employees. is that correct? >> yes, sir. >> so one of the reasons why almost 1 out of every $5 to insurance companies goes to fixed operation costs is because of fixed employee packages which under this legislation before us, they would be able to deduct more for tax purposes, is that correct? >> the legislation would remove the current law cap, leaving in place the other current law cap on the ney narrower cost of covered employees.arrower cost employees. >> thank you. mr. crowley, you're recognized. >> thank you.
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mr. barthold, thank you for coming before the committee again. if this bill becomes law, and that's a big if, would modifications be updated? jact iceland -- >> if congress passes any change to existing health care legislation, the joint committee and congressional budget office would update baselines for receipts and outlays. >> so it would have an impact? >> yes. >> so does that mean the tax reform will begin that debate with $600 billion in tax cuts for corporations, form suit cal companies and pharmaceutical companies and wealthy individuals? >> just remember the net budget, we don't have the full estimate. in term of what i'm reporting to
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you -- if those were the only change -- only changes enacted, yes. >> we are debatinging this with a l a lot of information absent, frankly. this is a $600 billion hit overall, correct? >> correct, sir. approximately. >> i certainly hope you will be able to analyze the impact of the republican 2017 tax cuts spree. the american people want to know what they have done to the overall deficit when that time comes about. the five committee prints before us provide tax give away of nearly $600 billion. i do appreciate that you clarified that, it was muffled before. 600 billion with a b. can you tell me how much of this tax benefit are to individuals with less than $100,000 in income? >> mr. crowley, as i explained to mr. levin, i do not have a complete distributional analysis
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in part because we don't have a complete analysis of the effects of the entire legislation. i do have some distribution analysis on some individual parts, one of which i'm going to provide to the committee later -- the answer to your question is no, i cannot provide that information. >> do you know when you may have that information? >> it'll be part of the work we do jointly with the congressional budget office. >> so i'm assuming monday of next week we might have that before it goes to the budget committee? >> i don't think they said monday. i think they said next week. >> so if the committee meets up next week they too may not have the information is that correct? >> i don't want to speak for where my colleagues are right now. >> it is quite possible the information won't be possible before the budget
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themselves and majority will slow down and allow you to report that information before we take up legislation like we are here today. what about incomes over $1 million. can you tell me what the impact will be for them? >> again, mr. crowley, since we don't have an analysis of the entire bill i cannot give a complete answer. i do have some pieces. one of which are made available later as i promised mr. levin. >> and at the same four people making over $5 million or $10 million -- >> as routine matter, we do distributional analysis relative to individual tax simulation model, mr. crowley. and we don't think that we can make good statistical inferences for the relatively smaller sample of individuals above $5 million. so we report to the committee at levels above $1 million but not at 5 or 10 above that.
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i would not be reporting anything. >> i appreciate your candor. and your honesty with the committee. but it's clear that you don't have the information to give us to and yet we're taking action on a bill without incredibly pertinent information that constituent want to hear about, that american people deserve to know, who benefits and how well they benefit from these tax cuts. this is not impugn to you but i would suggest to the overall committee in the process that before we take this markup, i think we should head the words and slow down. get that information before we actually move forward and do incredible damage to the system at hand. as much as you may not like it, what you're attempting to do could have incredibly serious health and life risks, mr. chairman. >> thank you, time is expired. mr. larson, you're recognized.
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>> thank you, mr. chairman. thank you, mr. barthold. i think it is already has been explained, this dealing with health care in america is a very complex and can be a complicated issue for people to grasp and fuel fuelly understand. so i appreciate the time you and your staff do put into this. i was wondering, if you might be able to, and i you've talked about this when you were addressing mr. levin, you said that you would provide a distributional analysis. to a lot of our listeners out there and people viewing this right now, people in my hometown or seniors looking in fearful of what will happen to them, they hear all these numbers thrown around and they say well you're going to be talking about js-6
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and js-7. they have no idea what that means. but you said a distributional analysis. can you explain to the public what that is? >> certainly, mr. larson. the distributional analysis that we provide to the members tries to look at the effected tax benefits or effected tax increase across the tax-paying population dividing tax paying population by income. >> so in other words, so a person listening at home who is making $20,000 a year or let's say $35,000 a year, they would know from your analysis what they're going to receive and what individuals say let's say earning over $1 million would receive. is that correct? >> not specifically. we report to you averages. within any, you know, swath
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of -- >> what would the ban be of those averages typically. >> i'm sorry? >> what would those bans be distributionly? >> our standard report to the members reports income categories of less than $10,000, 10,000 to 20,000. 20,000 to 30,000, 0,000 to -- >> these individuals would have clearer understanding30,000 to >> these individuals would have clearer understanding but you can't give that us to today because you doidon't have information -- >> i do have some of the information. >> but you in fact don't have what we don't have and what our constituent don't have which is the information which begs the question, why are we rushing to this? we've had seven years to come up with what should be, after you gather from the acrimony on the
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other side, which should be pretty simple and straight forward. and yet people at home that are scared to death can't even get from the congress and the government that they rely on and staffs, competent staffs like yours that would very much like to provide them with the information that they need, they can't get one sin tilla of information in order to know what's going to happen to their health care.tilla of information in order to know what's going to happen to their health care. even in a very narrow area of discussion we are having here, i wonder if the insurance executives know, is this something they asked for? is this something they were looking for in the bill? is this something they suggested? would be part of driving cost down and making health care more affordable and making sure that all-americans have health care?
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geez, i know a lot of them. and in my district. i don't think that that's, that the case. and yet we see this incredible windfall before us and that's why i think a distributional analysis is so important. people because are actually going to see what they're going to get versus what people at the top end are going to receive. i thank your committee. unfortunately you're not able to give us maybe a small portion or maybe even a complete portion. that is not your fault. that is, as mr. neal pointed out, this rush to two to public vote on today, and markup today, when we definitely need to know more facts especially distributional analysis that
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would be ex trextraordinarily helpful and insightful to the public p. thank you. >> thanks pup mr. davis, you're recognized. >> thank you, mr. chairman. thank you, mr. barthold. >> community centers have become one of the most effective wayes it becoming health care to low and moderate income people. would passage of this repeal in any kind of way impact those centers of excellence? and if so, how? >> mr. davis, the information before us, as a general matter
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community centers are not affected by the present law provision that limit compensation. there might be some circumstances, i'm not aware of it, where an insurance company may sponsor a certain community health center so there could be, you know, could be some cases where there might be some related effect. but the provision before us right now is about the deductibility of compensation paid to employees of health insurance companies. health insurance providers. >> let me ask about hospitals. i think all of us are concerned about hospitals and what impact passage might have on those dispdi dispr portionate shares of hospitals. those hospitals that care for large numbers of low/moderate
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income patient as part of their base. would there be impact on provisions for continued services of those institutions? >> from this provision, no, sir. again, this is about effects health insurance providers. so it's not people that manage care facilities, hospitals, clinics, or the like. it's about people that offer insurance in the individual market or group market. those businesses that offer insurance. >> and let me ask, some states have decided during the period of the affordable care act, to expand medicaid. what impact would this have on
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the medicaid in those states? >> mr. johnson, i'm afraid i'm not knowledgeable enough about medicaid and what other proposed legislation they do in terms of funding or choices made under medicaid. so i can't answer your question. >> so we really don't see any great disruption of health care delivery? >> i can't speak to your question about medicaid saying this particular provision is much ney narrower relative to your questions. you were asking questions about clinics and hospitals so service providers, this provision is aboutquestions. you were asking questions about clinics and hospitals so service providers, this provision is about taxable income, allowable deductible skpen ands of those businesses, in the business of offering individuals or group health insurance coverage. >> are we in any way executing a
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robin hood in reverse plan? where we diminish services while the middle and lower income and provide breaks for wealthy? >> mr. davis, mr. barthold is here to answer technical questions about this section of the bill. that is beyond the questions, beyond the scope of this section. >> thank you, mr. chairman. i yield back. >> thank you. representative, you're recognized. >> thank you. i have a question based on a heart-breaking letter i received from one of my constituent. her name is diane from sumass, washington. before democratic reformser with not acted, diane's 25-year-old daughter, sarah, the doctor recommended care because she didn't have health insurance.
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we all ne that one of the greatest challenges in health reform is bringing young americans into the system but drastically for diane her daughter's lack of health care ended up being fatal. she died at the tender age of 25. diane wrote to me and she said, quote, we didn't know her headaches were a symptom of a life-threatening condition. she was recommended an mri but at the time she didn't have health care and was afraid of the cost, thinking her headaches might just be migraines. we struggle daily with our loss of 7 1/2 years ago. deal with guilt and anger where we live in this wealthy country where young people are afraid to get what could be a life-saving test because of the cost. end quote. i don't think there is any parent in this room who wouldn't be moved by that story. it's awful. but also highlights the important between access and
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coverage. it doesn't matter if working families like diane's have access, it matters if they have coverage for doctor-recommended care this they need. it can be the difference between life and death. we are looking at this sub title that you have said would estimate as revenue loss of $400 million over ten years. is that correct? >> correct. >> so given the loss of revenue there, what impact would that have, given that we're -- it's taking away a revenue that could be used for health care. what impact does that lots of revenue have on coverage for families leak diane's? >> the coverage questions go to the broader scope of the u.s. health care system. this provision is really just about deductible expenses of
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health insurance providers. what happens in terms of the federal budget and how the members choose to spend those funds is up to this committee. >> but given this is less revenue and we are supposed to only be looking a tht particular sub title by itself because we're not talking about the entire bill, is there anything this subtitle would do to improve coverage for a family like eye an's. diane's? >> i shouldn't comment on the overall coverage effects of how this weaves into the entire package. again, that's part of the analysis that is still forthcoming. >> so we have a piece of -- that we're talking about -- that causes tax break for companies, reduces revenues by $400 million, your number, and does nothing to help families across
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our country? does nothing to help provide coverage of anything probably undermines that by reducing revenues that are available to support those families? that's disappointing we are only talking about a tax break and not families and coverage at all. and we don't have the information that you discussed, cbo score, or the distribution. so until we have that, there's no other information that's going to help us understand at all, once again, how legislation like this really helps families and providing quality coverage to americans across the country. >> well, as i did report earlier, the -- pli colleagues are working with the cbo and cbo has said that they will release their estimate as soon as it's ready. they hope early next week.
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it will cover effects on health coverage and premium. >> but we are supposed to be voting on this today. so i guess we will vote with the absence of any of that information. thank you for your time. i yield back. >> mr. chu, you're recognized. >> i want to make sure that i understand the underlying legislative text and its treatment of maternity care and abortion services. i'm concerned because unbelievably this bill takes away the requirement that health plans offer maternity care. and the objective result is that it would incentivize women to have abortions. now there are many women -- >> ms. chu, if i may, we will have in a later section of the bill a great almost unlimited opportunity to explore those issues. the section in front of us, mr.
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barthold technical expertise is enumerated to the insurance area. >> i'm getting to that. >> i'm asking that you focus your questions on this scope of the bill. >> so getting to tax credits issue, mr. barthold, on page 5 of committee print i read this as saying there are no tax credit for plans that cover abortions, is that correct? >> if i may again, ms. chu, we will have plenty of opportunity to explore those questions. in this section of the markup, mr. barthold is available it answer technical questions about this section dealing with enumeration in the insurance area. >> how about tax credit to provide maternity care. >> again, ms. chu, the repeated question, mr. barthold is here to answer technical questions about this sec of the bill related enumeration and insurance companies. >> well i would just comment that republicans are taking away women's access to maternity
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services and care. >> thank you. there will be plenty of opportunity to explore these issues for you a and all members of the committee when that section of the bill comes before us. >> i would like to yield to mr. dog et. >> i think the gentleman woman and it is regrettable that you can't get answers to questions with such a forwarding effect. i understand this bill's effect, currently an insurance company can deduct the first $500,000 of compensation toity chief executive. >> chief executive and any other employees. >> right. if this bill is passed and that compensation is in the form of performance pay, it will be able to deduct like in aetna and k
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cigna's case, their chief executives earned $17.3 million. they can deduct $17.3 million if it is performance pay instead of mere $a '0500,000. >> mr. dog et, i think you're referring to the allowance of00. >> mr. dog et, i think you're referring to the allowance of,0. >> mr. dog et, i think you're referring to the allowance of00. >> mr. dog et, i think you're referring to the allowance of00. >> mr. dog et, i think you're referring to the allowance of00. >> mr. dog et, i think you're referring to the allowance of50. >> mr. dog et, i think you're referring to the allowance of performance pay which has such allowance approved by shareholders -- >> i understand the requirement of the provision -- >> the answer is yes -- >> yes. so basically, what this bill will do, what this title will do, from a tax standpoint, is that taxpayers are now just subsidizing first $500,000 of insurance executive compensation but once this bill passes, american taxpayers will be asked to subsidize, if it's in performance pay and meet other provisions of the statute, $17.3 million for aetna, 14.5 million
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for united health, 13.6 million for anthem, and so on. millions of dollars that american taxpayers have to subsidize instead of limiting it it a half million dollars. it's not that those insurance companies can't pay out those enormous sums for chief executives and i guess if you're a mere vice president, maybe just 10 or $12 million, but it's not that they can't pay it out, currently they're shareholders have to be responsible for cover willing all those cost. now we will inject the american taxpayer and let us subsidize those salary amounts by permitting their 100% deduction. isn't that way it works mr. barthold? >>, mr. barthold? >> it would permit deduction as ordinary business expense. >> it could be $100 million and
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still be possible, right? no limit at all? >> it would be possible. although there are prohibitions against unreasonable -- >> how are those enforced? $17 million for a year's good work, extorting payment from the insurance rate payer, is not unreasonable. but what is the limit or how do you determine what's unreasonable? >> reasonable -- >> time has expired. ms. sanchez, you're recognized. >> mr. chairman, i'll yield back. save questions for another section of the bill. oh, pardon me? i yield to mr. kind my time. >> thank you. i appreciate yielding me time. my question indicated to you there is current law that imlimit ceo and top three earners of an insurance company to a million dollars of expensing. if it structured in performance
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pay, the sky's the limit. >> i did not intend to mislead you. since 1993, the congress enacted limit of $1 million in compensation -- compensation -- >> when we recess, the chairman's amendment the nature of substitute was pending. are there further amendments? >> sir? >> for what purpose is the gentleman from new york wish to be recognized? >> to offer an amendment. mr. chairman? >> gentleman from ohio. >> i would like to reserve point of order. >> point of order is reserved. clerk will reserve the amendment. i ask the gentleman to suspend while the clerk distributes.
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the gentleman from new york, mr. higgins, is recognized for
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five minutes. >> thank you, mr. chairman. it is ironic that the first item we dealt with is this morning was executive compensation for insurance companies. and i think we all got a sense as to how excessive they are, and that we would give them a tax break. seems somewhat counter intuitive to what we aught to be doing. i don't think we need to necessarily have an id logical fistfight over this stuff. health care should be -- it should be accessible, affordable, and simple. and i think sometimes it's overcomplicated and overbureaucratic. so toward the goal of kpen senssens common sense, there's an age group in this bill that seems to be particularly hurt, and it's the group between ages of 55 and 65.this bill that seems to be particularly hurt, and it's the group between ages of 55 and 65. under the affordable care act,
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insurance companies can't charge someone because of their age. they can't charge more than three times their youngest enrollees. this would increase to five times. again, less health care for americans and more compensation for insurance company executives. under the republican plan, americans ages 55 through 64 face higher costs. they would pay more if the bill were enacted by about $50200 a year. and almost $7,000 more per year in the year 2020.200 a year. and almost $7,000 more per year in the year 2020. before medicare was enacted in 1965, 56% of american seniors had no health insurance because private insurance companies would not write a policy for someone older than statistically sicker and likely to be more expensive.
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56%, no health insurance. medicare enacted. today, 93% of american can seniors have health care. and the vast majority of that population is satisfied with the care that they have. we should allow the opportunity of choice and competition here for individuals to buy into medicare at the age of 55. for they would pay the full cost of their health care which would be about half of what they would be paying in private insurance. it would also provide the added incentive of stabilizing the private insurance market because the private insurance companies could then compete amongst the most statistically healthier segment of the population. and thus leaving this group of
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55 to 64 with an opportunity to buy in and substantially cut their cost. today a policy for family of four on average is about $17,000 a year. with the medicare buy-in paying full cost. americans between ages of 55-65 could buy in for about $7200 a year. a substantial savings which wouldn't cost anybody anything and would provide quality health care to a segment of the population that's going to be hurt badly by this health care proposal. with that, i would yield time to my colleague, ms. dell bene. >> thank you. i strongly support this from mr. higgins that would keep this from taking effect if it results in higher costs from our seniors. grace from redmond, lance and doer fris kirkland, and we
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talked about the financial challenges they are facing. for the last two years millions of seniors did not receive an adequate cost of living adjustment and with the cost of prescription drugs, transportation and housing at a time when millions of seniors have to make difficult decisions about filling prescriptions or putting food on the table, we shouldn't be making their lives any more difficult. so this legislation actually would do that though. allow insurance companies to dramatically increase older american's health insurance premiums slash financial assistance, co-pays and other out of pocket costs. nursing home funding every year. so absolutely we should be supporting this amendment for grace, doris and lance. and for millions of americans in each of my colleagues' district there is no reason it shift more cost it seniors. i urge everyone to vote yes and
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i yield back. >> gentleman from ohio insist on point of order. >> mr. chairman, i do. amake a point of order to the amendment because it is not germane to the substitute. house rule 16 clause 7 because it makes the enactment contingent on things outside the subject matter of the chairman's amendment and the nature of substitute i require the cbo to look into out of pocket cost availablebility of coverage. >> thank you, mr. tiberi. does the gentleman offering the amendment wish to speak on the order? >> yeah. i would -- >> gentleman is recognized. >> again, mr. chairman, i would make the argument, if the standard here, if the stated objective of the president and of proponent of this bill, is to make insurance available to everybody, and make it more affordable and increasing quality, there is no better way
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to do it than allowing them to buy into a program that is proven to contain costs, to be run efficiently at about 6% of administrative costs and to be met with the satisfaction of the vast majority of people that are covered by this program. medicare was established in 1965 because private insurance companies didn't want to write policies for this segment of the population. and when they did write policies for this segment of the population, the premiums were high. deductibles were high. and quality was sub standard. why would we do that? why would we do that? why would we allow that to happen, to folks in this country between ages of 55 and 65 is beyond me and any measure, we don't even need congressional budget office report on this. i know what it's going to say. look what it does, detrimentally to this segment of the population. if you can live with that, then
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you can live with that. i would yield now to my colleague, ms. sewell? >> thank you. you know, it really is a travesty that broken promises have already plagued this administration. the president said that he would not touch medicare. and in fact, this bill, the repeal bill, would repeal the .9% medicare tax which will steal three years from the medicare trust fund still costing $170 million. so what this bill does is it basically takes away three years of solvency from the medicare trust fund. it is another broken promise, i would submit to you, mr. chairman and really unacceptable. i know for me, in my district, i have lot of seniors over 55 who
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are struggling everyday to not only make ends meet but also to be able to pay for prescription drugs. and frankly, currently under the aca, they've been able to do that because we have closed the doughnut hole and they have been able to save sub stan willy. but this bill, you know, we were promised by this administration they would not touch medicare and that's simply not true. for that reason alone i agree with mr. higgins' amendment and yield back to him. >> mr. larson? >> mr. larson, mr. higgins yield to you for his time. >> the microphone. >> i thank the gentleman for yielding. and fully support his amendment and let me say, that especially when you take a look at the cost
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of medicare and i was here seven years ago, when we heard very poignantly from the other side about what we were doing, in fact to hurt medicare, but the fact of the matter was that we increased an and enhanced medicare. and to sit here and realize that $170 billion in three years, three years of medicare solvency, go down the tubes, is staggering. all of you back in your districts. that's why the aarp has come out so strongly. against this bill is because what this does to medicare. medicare is the lifeline for so many of our seniors and then to cut the solvency by three years
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and then $170 billion so that people at the top end can get a tax break? are you kidding me? that is just flat out immoral, ill logical, and wrong! and i stand strongly beside my colleague in support of his amendment. i yield to mr. thompson. >> thank the gentleman for yielding. i would like to ask unanimous consent to have this letter made part of the record. a letter from the department of health and human services. actuaries from medicare and medicaid that state the official position that if you pass your bill it will shorten the life of medicare by three years. >> without objection. >> so all time is expired. i'm prepared to rule. before i do, i would like to point this out. obamacare,some promises were broken. one of tlem was so seniors. in this age group, mr. higgins talks about 55 to 65. the promise was if we hammer
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young people and make them pay more than they should, this will help you. but of course, that backfired. by forcing young people to pay more than they should, young people simply didn't sign up. didn't become part of the pool. guess what happened? premiums went up on seniors. so the promise not only failed, it backfired and hurt seniors. the republican alternative treats everyone fairly and by doing so will attract more of those who are getting health care in the younger ages and help more seniors moving forward. so this amendment is not germane. to the amendment in the nature of substitute because it violate house 16 cause 7 by treating unrelated contingency. out of pocket costs, availability of coverage, outside of the subject matter of amendment in the nature of the substitute. point of order is sustained and amendment is not in order.
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are there north amendments? >> i request a recorded vote. >> mr. tiberi. >> before i move to table the appeal, i would like to tell mr. higgins about a constituent named kimberly. speaking of broken promises. kimberly add broken promise made to her. kimberly said to me since obamacare went into effect the insurance choices and coverage has gotten lower and costs are higher. kimberly has a brain tumor. she was seeing a neuro oncologist but can't any more. she has been forced to change because of the market choice she is left with. on her behalf of the 30 years of not seeing the doctor she had, her broken promise that she can't see any more, i move to table the appeal. >> questions on the motion to table the appeal of the rules chairs ruling all those in favor signify by saying aye. >> aye. those opposed, no. >> no. >> the ayes have it and motion
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to table is agreed to. >> we would like a recorded vote. >> recorded vote is requested. the clerk will call the roll. >> mr. johnson? mr. johnson, aye. mr. nunes? mr. nunes, aye. mr. tiberi? mr. tiberi, aye. mr. reich ert? mr. reich ert, aye. mr. ras cam? mr. ras cam, aye. mr. buchanan? mr. buchanan, aye. mr. smith of nebraska? mr. smith, aye. ms. jenkins? mr. paulsen? mr. paulsen, aye. mr. merchant? mr. marchant, aye. ms. black? mr. reed? mr. reed, aye. mr. kelly? mr. kelly, aye. mr. reneecy?
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mr. reneecy, aye. mr. reeian in mr.myian, aye. ms. noem? aye. mr. holding? mr. holding, aye. mr. smith of missouri. mr. smith, aye. mr. rice? mr. rice, aye. mr. swag ert? mr. swag ert, aye. mr. with a lor ski? ms. ms. with a lor ski sooi. mr. corps bellow in aye. mr. bishop? mr. bishop, aye. mr. neal? mr. neal, no. mr. levin? mr. levin, no. mr. lewis? mr. lewis, no. mr. dog et? mr. dog et, no. mr. thompson? mr. thompson, no. mr. larson? mr. larson, no. mr. blumenauer? mr. blumenauer, no. mr. kind? mr. kind, no. mr. pascrell? mr. basrell, no. mr. crowley? mr. davis?
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mr. davis, no. ms. san clez? ms. sanchez, no. mr. higgins? mr. higgins, no. ms. sewell? ms. sewell, no. ms. dell sewell, no. >> ms. chew. >> no. >> ms. black, aye. >> chairman brady. >> aye. >> chairman brady, aye.
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>> the clerk will report the vote. the motion to table is agreed to. are there additional amendments in the nature of a substitute. mr. thompson for which purpose do you request to be served. >> i ask for the gentleman to suspend while the clerk distributes.
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>> gentleman from california is recognized for purposes of recognized for five minutes. >> thank you, mr. chairman. the republicans say their plan insures more choices and moves health care decisions away from washington. they say that, quote, we all want a market that works. we all patients to have access to high-quality affordable priced health care coverage. if they truly want to achieve this shared goal, states need stable market places.
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my amendment would hold them accountable for those choices. in california my home state we'd like to keep the system we now have in place because it works and we know that the bill before us would disrupt that. two providers in my district says we have serious concerns that the bill will result in significant numbers of americans losing their coverage by scaling back the medicaid expansion in 2020 and eliminating cost share and subsidies and restructuring based on age rather than income. the california hospital association that represents all hospitals in california said we're waiting for the cbo score to be able to more specifically project the impact the changes to medicaid and coverage will have in california, but are deeply concerned that the number
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of the insured in california will grow significantly hurting the patients and hospitals that care for them. since 1975 california has worked to empower health insurers through state and insurance regulation and consumer protection. since 2010 california has used all the tools available to it under federal law to further strengthen our marketplace. the state's republican governor at the time established the first state exchange in the nation. today 25,400 of my constituents and nearly 1.5 million californians are covered under cover california. every health insurance company in the exchange goes through a review to make sure they meet accountability standards. the state has saved consumers more than $300 million in premiums by negotiating better prices. the exchange has some of the
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youngest healthiest enrollees and some of the lowest costs in the nation. premium increases averaged 7%. if this bill passes and california losses the projected $10 billion and the 350,000 jobs our system will be devastated. i suggest that it's not just california. every one of us, you look at michigan, $989 million loss, 101,000 jobs. ohio, $1.3 billion loss, 126,000 jobs. washington state, $1.4 billion loss, 41,000 jobs. illinois, $1.4 billion loss, 114,000 jobs. pennsylvania, $870 million loss. new york $5.7 billion, 131,000
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jobs. currently each region in the state of california has between three and six plans serving consumers. even in rural california, our consumers have choices. let my state continue to do what they are doing so well. let my constituents keep the health care coverage that they enjoy today and is keeping them healthy and saving everybody money in this debate. if we do what this republican bill wants to do, we're going to roll back the clock on consumers in california, on health care providers in california and that's why we've heard loud and clear from the organizations throughout the country, from the hospital association, from the american medical association and from aarp. this is a bad bill that you guys are trying to run through here without the benefit of any
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public review, without the benefit of a cbo report. this is a bad bill that's going to hurt consumers in all of our districts. let us opt out of this if we have a health care delivery system that's working, let us keep it. let our constituents have access to a good quality health care system that's working in our state. i yield back the balance of my time. >> thank you. >> mr. chairman. >> i do insist on my point of order to the amendment base it's not germane to the amendment in the nature of a substantiaject . it's outside of the subject matter of the amendment in the nature of substitute which granting states authority to construe federal law as not taking effect. >> if i may, does the gentleman offering the amendment wish to speak on the point of order? >> i do. >> if so, you need to yield to other members as well.
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>> to raise the germane issue in this record is a contradiction of why we're on this diaz. we're here to make sure our constituents have access to quality affordable health care. your bill deprives californians from access to quality affordable health care. your bill hurts the very providers that deliver quality affordable health care. all my amendment does is says let us opt out. if california doesn't want to be part of your health care program, let us opt out. let us keep the coverage that we have now. let us keep the system that's working quite well in
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california. now, how that can be -- how that can be a germane problem, it seems to me that it speaks to the heart of your bill. it speaks to the heart of quality affordable health care to my constituents and other constituents throughout california. >> thank you. i strongly support mr. thompson's amendment allowing states to opt out. the republican health care system created under this bill forces middle class families to pay for less and working families that have struggling to afford the cost of care, raises the cost of prescription drugs and rips health insurance away for tens of millions of americans. state should not be forced into this dangerous system if their families are better off under the current law and in washington state they are.
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750,000 individuals have gained health coverage. the uninsured rate has dropped by nearly 60% since 2013. 50,000 young people have been able to stay on their parents' plans until the age of 26, over 3 million people have gained coverage for services like check ups and cancer screenings. nearly 3 million individuals with preexisting conditions can no longer be denied health coverage and more than 115,000 people have received an average of $330 each month in premium tax credits to help them afford insurance. washington state is a prime example of how democrat reforms are working for middle class families. i would like to submit for the record a statement from our governor where he states this proposal would kick 600,000 washingtonians off medicaid unless the state can come up with $1.3 billion, a burden that
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would be borne by the state's taxpayers. >> without objection. >> thank you. in our state we have robust competition among insurance companies. we've seen a stabilization of premiums and we've slowed long term growth of health care costs. all that progress is on the line. if my colleagues are truly concerned about state's rights and state flexibility, they support this amendment to protect states like washington that have thrived under reforms that are helping millions of working families, seniors and their children. i urge my colleagues to vote yes and i yield back to mr. thompson. >> reclaiming my time, mr. chairman, members, if you remember last summer cover california's executive director testified before this committee and he said, giving consumers the ability to understand their plans and options, which they could not have prior to the affordable care act, is bringing
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market forces to bear and promoting choice and competition. this is a competitive market that works and consumers are holding our health insurance carriers kbl for their rates by carefully examining their costs and their choices. mr. chairman, i appeal to you aga again, let my state continue to do what they're doing so well. let my constituents keep their health care coverage that's working so well. allow any state that has a promise that's working to opt out of this wrong headed measure that you're pushing down our throats. i yield back the balance of my time. >> thank you, mr. thompson. i am prepared to rule. it's not germane to the amendment because violates house rule 16 by exceeding subject matter of the amendment and the nature of the substitute by granting states new that's righrigh
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right -- authority. the ruling is appealed. >> i move to table the appeal. >> questions on the motion to table the appeal of the chair's ruling, all those in favor say aye. >> aye. >> those opposed no. >> no. >> the table is agreed to. a recorded vote is requested. the clerk will call the roll. >> mr. johnson, aye. >> mr. none ez. >> aye. >> >> mr. roscum aye. >> mr. buchanan. >> aye. >> ms. jenkins. >> mr. paulson, aye. >> ms. black aey. >> mr. reid, aye.
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>> mr. kelly, aye. >> mr. meen, aye. >> mr. holding. >> aye. >> mr. smith of missouri, aye. >> mr. rice, aye. mr. schwigart, aye. mr. cobelo, aye. mr. bishop, aye. mr. neil, no. mr. levin, no. mr. lewis, no. mr. doggat, no. mr. thompson, no. mr. larson, no.
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mr. kind, no. mr. pascrel, no. >> mr. crowley, no. mr. davis, no. ms. sanchez, no. mr. higgins, no. ms. sewell, no. ms. delbena, no. ms. choo, no. chairman brady, aye. >> the clerk will report the vote. >> 23 ayes, 16 no. >> the motion to table is agreed to. are there additional amendments to the amendment in the nature of a substitute? >> mr. chairman.
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>> what purpose does the gentleman seek the recognition. >> i have an amendment at desk. >> the gentleman is recognized for the purpose of offering an amendment. a point of order has been reserved. the clerk will reserve the amendment and i ask the gentleman to suspend while the clerk zrubdistributes.
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>> mr. chairman i offer this amendment on behalf of myself and my colleague. this amendment is simple. it says that the republican health bill will not go into effect unless we can certify that no person will lose his or her health insurance coverage. mr. chairman, any effort to reform our health care system must consider this basic question.
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we need to know how many people are going to be pushed out. how many people are going to be left behind. this committee most know these answers before we can act responsibly. we must note in our hearts we are truly acting on behalf of the american people. with the information we have today we cannot honestly say this bill will not do harm to women, the sick, the elderly and the working class. i am deeply concerned that working people cannot shoulder the republican plan. there's not a family in this country that has not known sickness or injury that cannot afford to lose their insurance coverage and we must be sure that we are not taking it from them. over the past few years, we have seen millions of americans gain
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coverage that was meaningful. it saved lives and gave people hope. gone are the days when insurance companies could put caps on care. gone were the days of discrimination because of preexisting condition. gone were the days when you could be charged more just for being a women. mr. chairman, we have come too far to sweep away all the good. we cannot and we must not turn back the clock on progress. i urge our colleagues to join us and support this basic common sense amendment. now, mr. chairman, i would like to yield time to my friend and colleague, mr. larson. >> i thank my distinguished colleague and i thank him for the ernest in which he has
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approached his life long service to his country and the urgency of which he brings this message forward. today as people view what's taking place in this committee, what you're observing is not an actual debate and dialogue, but one side of the aisle checking off a campaign promise and the other side of the aisle amendme attempting to be heard, attempting to make sure that the voices of those people who are protected by the affordable care act are heard as well. roosevelt observed pretty much what the discipline that has been exertd on the other side of the aisle has been today. you sit in icy silence. as the other side pours out the
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humanitarian concerns that have been impacted and will be impacted if this bill were to become law roosevelt observed that you appear frozen in the ice of your indifference towards the people that the affordable care act protects. i know that not to be the case of the members who serve on this committee, but that is what it appears to the general public when appeal after appeal and lack of information you would sit in silence as we perpetrate a catastrophe among the american people. as dorothy thompson said i am
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concerned about what will happen to me and my brother and the prospect of losing this coverage. that sounds very much to me like a death panel. and i believe that what mr. lewis has put forward in his amendment is what we need to do as a committee, stop checking the campaign box and come together as a committee and work constructively to truly fix and repair the affordable care act in a way that services all of o citiz citizens. thank you mr. lewis. >> thank you. >> before i make a point of order, i'd like to tell mr. larson about alice from ohio. alice from ohio calls the affordable care act not affordable. her medical insurance doubled. she's told me that president obama promised people would not
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have to choose between the quality of care and the basic essentials of life. she said i think this system and president obama have greatly failed me and many americans in what was promised. today is not about a campaign promise. it's about alice who says i go to bed at night wondering how i'm going to pay the increase in the medical insurance premiums and the increases in the out of pocket medical expenses we face as a family. mr. chairman, the amendment is not germane to the amendment. the amendment violates house bill 16 because it creates an unrelated contingency by requiring cbo to examine the issues on certain individuals. >> does the gentleman from georgia offering the amendment wish to speak on the point of order? >> my friend, i wish you would reconsider making a point of order on this amendment. it is very very simple. it is only saying, sir, let's
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certify, let's certify. let's make it plain. let's make it clear that no one but no one will lose their insurance. lose their health care. >> mr. lewis, if i may borrow m some of your time, i have a tremendous amount of respect for you. >> i have respect for you. >> and for mr. larson, as well. but i think over the last seven years there's been a reluktance to understand the negative impact the affordable care act had on many of our constituents, some who lost the insurance they liked and the doctors they liked. people in my district who can't go to the hospital in the county they live. they have to travel 60 miles away to get care. i wish we would have had this discussion seven years ago. >> i'm asking at this time can we certify that no one, but no one, will lose their health
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care, their health insurance? >> will the gentleman yield? i think -- i have enormous regard for. i think he cuts to what these hearings really should be about. they should be about the woman that you just spoke about and your concerns and it should also be about leslie guthrie from west hartford in my district who is a young woman who grew up in west hartford and she is a canc cancer survivor who was helped by the affordable care act. the affordable care act had many problems with it and for the last six years you've spent saying that the only thing that you could come up with is repeal instead of sitting duown workin together -- >> will the gentleman yield?
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>> sure. >> we had a hearing on premium increases last summer and i want to point out that since 2011, when we took control, there have been 200 hearings on the affordable care act and the challenges and problems of the affordable care act. 200 hearings at the united states congress. i'll yield back. >> yes, there have been 200 hearings, but where has the legislation been to correct what's happening in people's lives? rather than sit down together and come up with a constructive proposal -- this is what americans dismiss about congress, what they dismiss about demi dismiss after you get to check off a campaign promise and we get the opportunity to tell you why it's a bad idea, the american public still wonders with great anxiety what is going to happen to them personally. what's going to happen to their
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lives. we talk about things in terms of hr 5342 and all kinds of inside the beltway language that nobody understands. what they do understand is what's going on very powantly in the lives of your constituents and mine. for god's sake what they want from us is to step forward and come up with a solution to the problem, not an endless campaign battle that will run on into the next cycle. how about we work together to actually solve the problems our constituents sent us here to do. that's mr. lewis's point in wanting to guarantee that nobody loses out in their coverage here. >> i wanted to say to the gentleman from ohio, there's not been a single hearing on this bill, not a single hearing on
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some pieces of it, but not on the bill itself and on many many aspects and essentially what you've done is to tailer this gathering today in ways that you say will limit our ability to raise issues relating to the substance of this bill. that's really what you're doing. you're combining the lack of a hearing on this bill itself with a piecemeal approach which prevents us from raising these issues in this committee. so this amendment, mr. lewis, is very clearcut. essentially you don't want to answer it. you don't have any answer as to how many people are going to lose their insurance. you have zero. you don't even say how many would gain.
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it's stoney, stoney silence and abstention from the merits of this issue. thank you. >> gentleman's time has expired. i am prepared to rule. the amendment is not germane to the nature of the substitute because it violates house rule 16 by creating an unrelated contingency requiring the cbo to examine the issue of uninsured individuals. the amendment is not in order. >> i appeal the ruling of the chair. >> mr. teaberry. >> questions on the motion table to appeal. all those in favor signal by saying aye. >> aye. >> those opposed no. >> the ayes have it. >> call the vote. >> the vote is requested. clerk will call the roll.
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>> mr. johnson aye. mr. nunez, aye. mr. teaberry aye. mr. roscum. mr. buchanan, aye. mr. paulson, aye. mr. marchant, aye. ms. black, aye. mr. reid, aye. mr. kelly, aye. mr. ranacy, aye. mr. meean, no. mr. holding, aye. mr. smith of missouri, aye. mr. rice, aye. mr. schagart, aye.
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mr. carbello, aye. mr. bishop, aye. mr. neil, no. mr. levin. mr. lewis, no. mr. doggat, no. mr. thompson, no. mr. larson, no. mr. bloomenhour, no. mr. kind, no. mr. pascral, no. mr. crowley, no. mr. davis, no. ms. sanchez. mr. higgins, no. ms. sewell, no. ms. delbani, no. ms. choo, no. mr. roscum, yes.
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ms. jenkins. ms. sanchez. chairman brady, aye. >> the clerk will report the vote. 23 ayes and 15 no. >> the motion to table the agreement is agreed to. for what purpose does this gentleman seek recognition? >> i have an amendment, mr. chairman. >> can i stop you for a minute. >> i have respect and trust his judgment, but not always. i'd like to reserve a point of
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order. >> the point of order has been reserved. ask the gentleman to suspend while the clerk distributes. >> thank you.
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>> gentleman from new york is recognized for five minutes. >> new jersey. >> he's a jersey boy. >> that's going to cost him. >> point of order. >> yeah. my bad. >> i was thinking of making my remarks short, but i have a second thought. >> my bad. >> mr. chairman, i want to start by saying to my good friend from ohio that this -- i differ with you. i think this amendment is germane. here's why i think it's germane. >> try me. >> you may change your mind before i get into the nuts and bolts here.
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because the windfall for insurance executives is funded by reducing subsidies for middle and low income americans. that is a tax hike. that's why i think it's germane. i want you to review, if i may, i want you to review your decision before i even offered it so that maybe you'd have a second thought. i yield. >> i've been wanting to ask this question, but not belabor the amendments that you're offering any longer, but you forced me to. when you were in the majority and you were on this committee, which has jurisdiction over the tax code, the majority then chose to, through the tax code, single out the insurance industry to this particular provision, right? >> no. >> no, no, you did.
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>> you asked me the question. can i respond? thank you. we looked at many ways to pay for what we were going to propose and we wanted to do it for the most fair fashion and i thought through the process, my friend, that we did it. no one likes to vote on taxes. no one does that. let me speak for myself. >> here is my concern with respect to that provision. you singled out the insurance industry in the four years you were in the majority. you didn't go after hollywood or the grammy award winning musi l musicals or athletes or hedge fund owners. this provision is singly focused on one group and nobody else in america. >> did the gentleman yield? >> not yet. there was a surcharge on capital
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gains. let's come up with the money to pay for this. that would have been very easy. in fact, that's what you're doing in your proposal. if i may continue, mr. chairman, with your permission or yield -- >> the gentleman controls the time. >> yield 30 seconds to my brother levin. >> it's because health -- the health bill related to the health -- to the insurance industry. >> thank you. >> and that wasn't true of what you mentioned. it's just very clear, very simple, and you're making an appeal to understand the relevance of your amendment. >> thank you. >> it's totally relevant except for the way they've chopped up this bill to make it irrelevant. thanks for yielding. >> thank you. here is something. this is a gem. this is the same amendment, my
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friend from ohio, that the republican conference chairwo n chairwoman, i hate to talk about her, she's not here, kathy mcmars rodgers introduced the energy and commerce committee mark up in 2009. you guys have selective memory or short memories or no memory. my amendment would prevent this bill from going into effect if it increases taxes on any american making less than $250,000. the fact is, that there are several provisions in this bill that will clearly raise taxes for working americans and when i
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have time to discuss that, you'll come back to me, mr. chairman, i would like that very very much. so we offer that amendment right now and we'll go into explanations in a little while. >> thank you. do you insist on a point of order? >> after thoughtful deliberation it's not germane to the amendment in the nature of a substitute. the amendment violates house rule 16 clause 7 because it goes outside the narrow subject of remuneration which deals with corporate taxation by creating a contingency related to a family or income taxation. >> does the gentleman offering the amendment wish to speak on point point of order? >> i do. >> your recognized. >> what i heard in not calling this germane is that you're not denying this is a tax hike.
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let me begin by saying this. for the bottom 60% of income earners or households making less than $67,000 a year, this bill results in a tax increase, increase, because these people see a reduction -- hear me -- a reduction in their premium tax credits. i'm making that announcement -- currently offered under the aca. meanwhile, the top 1% would see their taxes fall by an average of $20,000 a year under this bill and the top 0.1.1% of earners would get a tax cut totaling $195,000.
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this is germane to the entire package. it is germane. so we have people who are disabled and who are elderly, like myself, and then you have other people who are on accepting, who are getting medicaid, of course it may not happen in 2020. that's just a trivial point here. what you're doing is not considering these people after your president and my president committed to never letting anybody fall by the wayside. how can you do the two things? i don't know. in addition to this new tax burden for everyday working americans, republicans also pile on with more costs. unlike the tax credits that we have under aca, the less generous tax credit under your plan is not determined based on
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an individual's income to ensure that those who need extra help will get it, the credit -- the credit is not tied to medical inflation. so when premiums rise, there is no insulation. it rhymes. premiums rise, there's no insulation. consumers are on their own. the bill repeals cost sharing reduction payments, a vital subsidy to help low-income americans with out of pocket costs. the individual mandate which will fail to keep young and healthy people in the market further driving up premiums. you're not doing anything in here, not one thing to make it at

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