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tv   Democrats Defend ACA as GOP Searches for Votes to Replace it  CSPAN  March 23, 2017 12:24am-3:37am EDT

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the senate judiciary committee holds day four of the confirmation hearing for supreme court nominee neil gorsuch tomorrow at 9:30 a.m. eastern. public witnesses will testify. watch live coverage on c-span3. announcer: the house rules committee debated the gop health care replacement bill. we will hear from the chairs and ranking members from the budget, ways and means, and energy and commerce committees. congressman pete sessions chairs the rules committee. >> come to order and good morning. welcome to the rules committee.
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today, the committee will consider hr 1628, the american health care act of 2017. the american people were promised by the president of the united states, who was so supportive of the bill that he even eventually given his own name. his party and the bill with lower premiums by $2500 per family per year. he promised the american people that if they like their doctor, they could keep their doctor. he promised that if they liked their health care plan, they could keep it also. he promised the american people
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that no family making less than $250,000 a year would see any form of tax increase when he became president. he promised the american people that obamacare would mean more choice, more competition, and lower costs for millions of americans. now seven years later almost to the day, it is abundantly clear that this affordable care act known as obamacare has failed the american people and the health care system and the people it was designed to help the most. , premiums promises have increases by an average of 29% this year alone on the obamacare exchanges. ruining the pocketbooks of american families and a far cry from the $2500 reduction that they were promised for each family. at least 4.7 million americans
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have been kicked off their preferred health care plans and had their coverage canceled due to obamacare law. despite the promise that if you like your plan you can keep your plan and if you like your doctor you can keep your doctor. obamacare contained $1 trillion in new taxes, mostly falling on families and job creators. additionally, 18 of the 23 obamacare co-ops have failed, costing taxpayers nearly $1.9 billion, and forcing patients to have to scurry to find new alternatives for their health care. obamacare has forced employees and employers to not only cut and lose their jobs but to lay off employees. that hurts american workers and their hours, the equivalent of
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at least 2 million jobs being lost. simply put, obamacare is collapsing right before the american people's eyes. options and choices are disappearing for consumers and an anti-competitive government run market has been created that is leaving american patients, families, and business across this country desperate for answers. nearly one third of the united states' current counties have only one insurer offering exchange plans and quite frankly, it is getting worse. that is not competition and that is a government-run monopoly. doctors also need a change. patients need a change. families need a change. and the american people are demanding a change, especially when they went to the ballot box in november. 1628, the american health care act of 2017, a lemonade's
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washington's one size -- eliminates washington's one-size-fits-all health care plan. it dismantles obamacare taxes, eliminates the individual mandate, prevents health insurers from denying coverage, and helps young adults across the country have access to health care while stabilizing and restoring a free market for all americans. most importantly, this legislation empowers individuals and families to make their own health care decisions. and middle income families across the country to have affordable quality care by providing monthly tax benefits that ensures parity to an unequal-today marketplace. americans deserve a competitive insurance marketplace that provides quality care at an affordable cost. for that reason, i would like to welcome the gentleman and gentle ladies who have been part of the
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development of this plan, the architects of this legislation. from oregon, greg walden, chairman of the energy and commerce committee. the gentleman from texas >> thank you for being here today. objection, anything you have in writing will be entered
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into the record. i would like to defer to the ranking member of this committee , the gentleman from massachusetts. chairwomanue and is still in the hospital, chest colds are tough when you live in syracuse new york. shouldus to know that we keep her in our prayers. she can't wait to get back. to get her hands on me, i mean the bill. [laughter] >> the spirit she has brought to this committee, the spirit of which she represents her ideas
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across this country. i will miss her today. i want us to know that she will be back shortly and she promises and a lot of vinegar of words. before we go too far. i would like to go back to the ranking member. we miss you. we hope you are listening today. thank you. i sure you that she is watching all of us today and taking notes. [laughter] chairman, want to ask a question, the same question i asked last night. whether or not we received an updated cbo score that takes into account the amendments? question. a good i will give the same answer i overat least once or twice
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the rules committee and the floor, the congressional budget office is made up of professionals who are trying to get as close to the answer as possible. it does me no good to try to tell them their answer nor their time frame. they have an order they are trying to get placed right now, hasin fact mr. brady indicated publicly that we will not go to the floor without that cbo score. the answer i have given is that we fully anticipated it some time the early evening or evening tonight, so as we go through this. i would say there will be a chance for mr. brady or mr. chairman black to forthrightly address that to make any corrections to my assertions that i make today with the knowledge that i'm
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corrected on a regular basis. >> does that mean there won't be a rollout for consideration? was an answer a day and a half ago. the staff director for mr. walden has a direct line to cbo and is much as we are able to get the next gas. we will get that back to you. -- thelast cbo estimate brookings institution said the manager amendments are unlikely o roos the number of people cbo estimates will be pushed off their health plans. mr. chairman, i appreciate your odder but it strikes me as that we are proceeding without all the information.
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t-shirtwoman with a there. i don't think we should be meeting on a bill when we don't know how many people will be heard. i moved the committee adjourned. >> i second that. >> there is a motion on the .loor to adjourn do we have any discussion? yes, i do. mr. mcgovern makes the point and i find it disconcerting that we are going to proceed here today you andg back at least my dear friend from oklahoma were here when the democrats
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pass their measure, and there was a lot of discussion. i remember dr. burgess railing actively about the fact we did not have the cbo score. logic dictates that if the congressional budget office has , i keepmillion people hearing arguments. some people say 24,000,002 its some people say 14. one is too many and that needs to be clearly understood. this is a country where everybody has the right i believe to have insurance, so i guess ultimately i don't rank we can blame cbo when you keep changing the rules. the question i have for you is is the manager's amendment already scored?
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that managers amendment scored? and since you are having 216, arey getting to there other things that are going to cause the cbo score to change when you add or detract tongs in order to sweeten it .e able to vote for the measure this is very disconcerting. we did not perceive this way. we did substantially more hearings, more input and at the very same time, when we did get , we have the congressional budget score and i think it is critical. >> the motion is to adjourn. aye.
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mo's have it. no's have it. report the total. the motion is not agreed to. to state so that were able to get a clear understanding because many members of congress were not
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here. iarlie wrangle, that day when asked about the cbo score said one was not necessary. wasn't like we didn't have a prepared. it was unnecessary because it will add lanes of jobs and be the greatest single job creation bill passed by the congress. that is different than a far cry from the story that is being told today now seven years later. hope we are able to ascertain the difference between the cbo said there may be some number of people who are not offred versus being kicked .heir health care plan i believe the testimony today will reveal that we don't anticipate anybody being kicked people plan, unlike the who were kicked off their plan by obamacare.
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so there are still 30 million people who are uninsured in this country today. i believe that number of uninsured will go down, and i believe that is what should have been said by the cbo. we are delighted that each of you are here. allowed.eman would be yes, sir. >> good morning. i hope everybody fueled up on coffee and donuts and i want to thank the rules staff are getting dunkin' donuts coffee from massachusetts. it is the best coffee in the world. we have a lot to say about this bill and none of it is good. lay out what the bill it is a massive tax cut from the universe and billionaires paid for by taking health insurance away from 24 million people. toone who takes five minutes look at any unbiased analysis knows this is true. cuts at the expense
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of 24 million people. let me paint a picture of how big that number is. people is basically the entire population of australia. it is more people who live in the state of kansas new mexico, west virginia idaho hawaii new hampshire maine rhode island montana delaware south dakota north dakota alaska. for mott and the district of columbia combined. do you know how i know this is a tax giveaway? according to the cbo analysis, and this is truly incredible. it would result in more people being uninsured than if the affordable care act were simply repealed. let that sink in for a minute.
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second this bill will cause people to pay more out of pocket dollars. you're asking people to pay more for less coverage. those people who can least afford to pay more. third, this bill guts medicaid and medicare. don't take it for me. weakenp said this would fiscal sustainability, increase risk the health care of millions of children's and adults with disabilities and seniors who depend on the medicaid program for long-term services and supports other benefits. age 50-64mericans will pay premiums five times higher than what others pay for health coverage, no matter how healthy they are. ax, all thisan
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to give tax cuts to the rich and corporations. the bill must look like a cruel joke to the most bondable among us. i am persuaded this republican health care bill long-term is a dutchman to the future of the united states of america. finally, this process is for rent us. the republican majority rushed their bill through the committee process without any hearings, just holding marathon markups. they did not even wait for a cbo score. came, itscore finally showed the bill would hit 24 million people. did they stop then? no, of course not. we are still full steam ahead. only now we have cobbled together a managers amendment.
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again, no cbo score. didn't you learn your lesson last week. even worse, this amendment which we received 36 hours ago is full of back deals like the buffalo bride, an agreement with new york republicans who know the health care plan would devastate new york. and now they are saying don't worry if you don't like this step one ofjust three. you will get another chance to vote on health care during step three, nevermind they can't give us the full slate of bills that are part of this. or maybe i should take senator cotton's word for it. he said there is no three-step plan. this is just political talk. it is just politicians engaging in spend. pronguz called the third of this three bucket strategy quote the suckers bucket". .
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slow down. think about what you are doing. don't jam this bill do the house with patched up fixes. wait for a revised cbo score. this and what members of your own conference are saying. it is clear you never had a plan to replace the affordable care act. don't pretend you did and make our most vulnerable pay the consequences. this is a lousy bill, lousy process, and we should not be considering it in this committee. i yield back my time. >> we appreciate the germans opening statements and comments related to that. the six witnesses that we have. ladies and gentlemen, we will go through a disciplined straightforward process here. acknowledgeo first the gentleman from oregon. then i'm going to go to the gentleman from texas and let him explain his part.
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then we will go through and do the same. i want you to know this committee has attempted to do our homework, but we are here to listen also. listening is an art our members have gotten good at. we want to make sure that as you speak please remember the microphone needs to be as close to as you can. the green light is turned on. the gentleman from hood river, for beingnow thank here and the gentleman is recognized. >> i want to concur on your thoughts about miss slaughter. she lives up my place from here in washington dc. she is a fierce fighter and we wish her full health and a quick recovery. i want to wish you happy birthday. i can't think of a better place
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to spend it then right here with you. it's not everyday you turn 50, and today is not that day. the general men, mr. chairman brady. we appreciate the opportunity mr. chairman. many have participated in this bills crafting. if you will indulge me, i will walk through it in detail to answer as many questions as possible in advance. the energy and commerce committee has 31 oversights on the aca, hearings on the aca. the oversight investigations and health subcommittee convened one joint hearing.
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the look at what was working, what wasn't working, and congress and a bipartisan way sent president obama legislation to repeal parts of obamacare that were not working, and he signed 20 of those into law. even democrats have recognize there are problems with obamacare that need to be fixed. we have had 107 witnesses testify. 38 where administration with witnesses. lastf that work over the several years has brought us to this point. first let me describe the bill. this bill prohibits health insurers from denying coverage or charging more money to patients aced on pre-existing conditions. this is something we have heard from both sides.
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have beense you stricken with the help disease should not preclude you from being able to get insurance you can afford. so we kept in place provisions making sure people cannot be denied insurance because they have a pre-existing health care condition. young, our plan helps adults gain access to insurance and stabilizes the marketplace by allowing independenc independents staying on their parents health care plan. our plan proposes a new patient protection for patients to maintain continuous coverage, . similar protections have existed for americans who get their insurance through their employers. we build on those successful provisions to make sure continuous coverage protections remain.
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when patients wait until the air sick to see coverage, it disrupts the marketplace, so it is fair to everyone else. in our plan, this protection would apply to patients in the individual and small group market as well. these are new protections. continuous coverage protections will protect those with pre-existing conditions, guaranteeing access to coverage, prohibiting benefit exclusions, and banning premium rating based off of health status. they can't jack up your prices because you have a pre-existing condition. extending these protections, the individual and small group market is a reform that one courage patients to enroll and stay enrolled. some may suggest continuous coverage would be to higher premiums. thosek we have heard false charges. they are false. our plan would guarantee access to coverage, prohibit exclusions, and prima rating
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taste of health status and other important haitian infections. remains safeguard available to everyone, whether switching from employer-based health care to the individual market, or within the individual market. already has market a definition of continuous coverage that allows for caps on of up to 63 days. we take those out of the system that would name it and say you have to be responsible and maintain continuous coverage.
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our plan would protect patients living paycheck to paycheck. as long as patients catch up on their payments, they would not lose this important continuous coverage protection. we envision one open door, one enrollment. to attract younger enrollees, individuals coming off dependent , they are allowed a one-year grace. because it would be their first year as an active purchaser. so we protect people with pre-existing conditions. we take those few people gaming the system and make them act more responsibly and provide for continuous coverage. these are important principles contained in this law. plan focuses
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medicaid's resources to the patient's most in need mr. chairman, the low income adults, children, pregnant women, elderly adults, people with disabilities. we do that by responsibly unwinding by freezing new enrollment and grandfather those existing enrollees per we put medicaid on a sustainable budgets and empower states with freedoms and flexibilities to run their medicaid programs. medicaid is a critically important program that represents a partnership between the federal and state governments to traditionally provide benefits to eligible low income adults, children, pregnant women, elderly adults, people with disabilities. state and federal partnership. medicaid covers more than 70 million of our fellow citizens. the cobe has told congress that
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,edicaid is a high risk program high risk program. 2018, total medicaid spending will be larger than our nation's defense budget. by the end of the decade, it will cost taxpayers $1 trillion. were 36r alone, there point $3 billion in improper payments and medicaid. gao and they testified before our committee. this is a problem that must be addressed because that $36.3 billion should help those most in need, not to improper payments. this is not a physical issue. it is an issue that jeopardizes the ability of state and federal governments to take care of the most vulnerable among us who rely on this program. we need to put medicaid on a budget and give states greater flexibility to manage the program to best benefit their citizens. obamacare force states to expand medicaid to cover able-bodied
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adults or lose their federal medicaid funding. after the supreme court's 2012 , the district requirement was unconstitutional, mr. chairman. to expands chose medicaid eligibility to people under the age of 65 with income up to 100 38% of the poverty level. obamacare and hence federal funding for expansion and the federal government covering 100% of the cost for 2016. in 2017, the federal government pays 90 five cents on the dollar for each expanded in rowley. that amount gradually diminishes to 90% under president obama's plan by 2020. this policy creates a gross and equity and the federal government covers a higher percentage of the cost of care for able-bodied adults than it does for people in poverty who are disabled, elderly or children below the poverty line. our plan will not pull the rug
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out from anyone. for 2017, 2019 states with medicaid expansion can continue to receive the en the match available. enrollees can remain enrolled as long as the state kept the program and otherwise remain eligible and continue to receive that enhanced match, that 90% match. if you are on it today and tomorrow, you can stay on it until you no longer qualify for medicaid because you have a job that pays you more and you are no longer eligible and get your insurance through your employer. grandfather expansion we believe will leave the medicaid rolls at some point as a as they naturally move up. individuals otherwise eligible for the expansion program could still an role in the program.
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for any new medicaid expansion in rowley, the state expenditures for such person would be matched by the state's regular medicaid match rate. so that ranges somewhere between 50% and 83% i believe is the range. now gain ae who are higher rate, the able-bodied adults, they could still be added, but matched at a lower rate. asking our partners and states to step up to keep these people on. provides $100 billion to programs that meet the unique needs of patient populations and low income americans. important facet of this, the $100 billion patient and state stability fund, which i will get into in a minute because i know you want me to get into detail on these issues. we propose a per capita allotment to determine funding for states based on the number of enrollees in each unique medicaid population. this type of allotment has been
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supported by members of both parties, not just republicans, but also by key democrats, including former president bill clinton, former vice president joe biden, former secretary of state john kerry, former senate majority leader harry reid. they all supported per capita allotment's a number of years ago as an appropriate means to an edge medicaid going forward. reformapita allotment protects the individual entitlement and does not change medicaid rules regarding access to care. specifically our per capita reforms proposed in this theslation do not alter general eligibility standards and pathways, so you can still get on in the same ways. we do not alter protections. we believe in them for the disabled, elderly, and children. the requirement that state pay their fair share, we do not alter coordinating with exchanges and individual market coverage. we don't change the children's
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health insurance program which we believe is very important and our committee will take up and reauthorize later this year. coordination efforts for individuals who are duly enrolled, requirements for transferring integrity, and improvements of delivery systems. let's talk about flexibility because this is important. we can do some things in this legislation. there are many other things that secretary price should be able to do. under our plan, states would receive federal funding a lot for each of the major beneficiary categories. it would be based on the number of enrollees in each of these categories in their states. a state's total allowable allotment would be calculated as the sum of the total number of people the enrollees across these eligibility groups. and it with their paying
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that against the population. this form it would represent the total amount of federal funding for which a state would be eligible to receive matching funds. this total approach provides flexibility to governors and state leaders in limiting the policy. importantly a per capita allotment is not a limit on funding. it does not say you as an individual has this amount. it is a total summation and then some people will cost more, some will cost less. the states are able to manage their programs accordingly. provided to be more expensive than average, federal funding can pay for it as long as the state did not exceed the sum. make additional commonsense reforms to medicaid, including something our oversight and health subcommittee looked at, lottery winners who wind -- there are a lot of these, but some. it has brought to our attention by states and colleagues were you when the lottery and get to stay
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on medicaid because they don't winnings.when thing we don't think that's it fair. we work with the trump administration, states will have the ability to seek additional flexibility through their programs. we are making a lot of changes in the law, and i know this is important to you, so let me conclude with the description of the state patient and stability fund. in order to stabilize health markets damaged by the current law and to ensure all americans have access to affordable health states need stable marketplaces that encourage and incentivize patients to get covered and stay covered. both the state stability fund and introducing angel rating reform will give states the flexibility to bring down costs and strengthen the market. that me start with the patient
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stability fund because i know this is important. by plan provides a solution providing more affordable coverage options to consumers. lowerund will help states the cost of care for some of their most volatile patients. this bill provides $100 billion to meet needs and help low income americans. before obamacare, high risk pools were program specific, limiting innovation that officials could use to meet the needs of diverse communities. we want states to be the great integrators. innovators. the fund give states flexibility. they can use the money in this fund to cut out-of-pocket costs, like premiums and deductibles we all care about what those costs are to the people we represent, so we have a fund that will
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allow states to access money. by the way, that starts in 2018. so some of the same subsidies available today will continue, but be augmented and initially by this fund right away, so they can do a lot in the meantime to fix this marketplace. ,hey can arrange marketplaces help with high risk individuals without access to employer-sponsored coverage in the individual market. they can provide incentives to toropriate entities stabilize premiums and the nongroup market. they can reduce the cost of providing health insurance coverage in the individual and small group markets for high-cost individuals. iny can have participation the markets and increase options that are available. giving people better options and helping on the affordability piece. promote access to
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preventive services, dental, vision, or the prevention, treatment, recovery of individuals with mental or substance abuse disorders. we made sure these funds would be available for that purpose, and by the way, on the latter part of this, this is in addition to what congress did last year to address issues of mental health and substance abuse. we put $1 billion in to deal with opioid abuse, so these are in addition to that. morehairman, we have a lot to talk about. i know you have other witnesses. i appreciate this time to get this far into the presentation. we believe we will give people new choices and better choices. we think we will outperform what cbo says and that we can restore this market before it collapses if we act now. mr. chairman, i yield back the balance of my time in the ordinary from your members and further discussing this important piece of legislation. >> chairman brady, welcome.
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we are delighted you are here. {indiscernible] thank you for having me on allowing me to testify. thank you for your consideration of this important legislation to repeal and replace the affordable care act. the affordable care act has been one failed promise after the other. this law has hurt more americans than it has helped. millions of americans have lost access to health plans and doctors of their choice. out-of-pocket costs are skyrocketing. free market competition has all but disappeared. we have the best opportunity and seven years to repeal this sinking ship of obamacare. clear the deck and begin our
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step-by-step process to deliver health care that truly works for the american people. president trump has called on congress to take decisive action now on health care reform. this legislation answers the president's call in a deliberate way that americans truly deserve. ways and means focus is delivering swift relief to the american people by repealing obamacare's most harmful provisions. e and the individual tax penalty. we and the employer mandate tax, which has burdened our local businesses and make it harder for them to grow their companies, to hire new workers, and race wages. we repeal of obamacare tax hikes that trayvon up cost for the american people and reduced access to high-quality care.
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our second priority with this legislation is to deliver on our promises to replace obamacare with patient focused solutions that expand choice, lower cost, and enhance competition. taking action to reclaim control of health care from washington and put it back with patients, families, and with states. savingsd health accounts, make them more flexible and user-friendly. and will give patients families greater freedom to save their health care dollars for the future and spin them as they see fit. forrotect health coverage the more than 150 million americans who receive it at work. and for low and middle income americans who don't receive offer an advanced double tax credit that people can use immediately to help purchase coverage that works best for them, not washington. these tax credits provide a free market alternative to the
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inefficient obamacare subsidies that exist today. support to lower and middle income americans while encouraging greater competition and greater in innovation. there will be more choices for the american people, lower costs, and better coverage tailored to the needs of patients and families, not washington. finally to further ensure the american health care act in congress is these priorities, i would ask the rules to committee to make amendments to the bill. these amendments which remain public on monday evening followed by a technical amendment take important actions to strengthen the american health care act. they will better ensure all americans have the help they need to access the care that is right for them. specifically they will have an additional $85 billion in tax relief i reducing the medical
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expense deduction threshold for americans with high health-care expenses. aarp supported a similar bill lowering the threshold to pre-obamacare levels. million approximate 8 to 10 main americans who annually take this to duction, it provides important tax relief that offsets the costs of chronic medical conditions as well as long-term care." this tax relief creates new , enhances the tax credit for older americans who purchase insurance in the individual market. in combination with the age-based tax credit and the stability fund which provides $100 billion to states to help targeted populations, this change reinforces the commitment of house republicans to ensure americans of all ages have
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access to patient centered health insurance. furthermore, these amendments will provide more immediate relief. moves up their data repeal from 2018 to this year, 2017. protectiontrengthen perfectio for the right to life. this ensures federal dollars cannot be used for abortion services. guaranteet will help darren it meets our requirements to senate and movedit to the president's desk. i want to thank you for your leadership on the american health care act and want to thank rules committee. your consideration of this important legislation. mr. chairman, i look for to taking your questions and i yield back.
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chairman black, welcome to the rules committee. we are delighted you are here. you have shown up with your ranking member and welcome you at this time. >> good morning to you and the members of the committee and especially to my ranking member of the committee. i want to thank you for this opportunity to speak your today kicke. the american health care act is the first step in our efforts towards a patient centered health care reform. the bill seeks to give american people freedom and choice and their health care decisions. it gets government out of the relationship between patients and their doctors and puts people back in charge of their own health care. it brings the free market principle of competition to an industry that has long and dominated by government intervention. gold tonited in our
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repeal obamacare. right now, obamacare is imploding. we were promise premiums would decrease by $2500. instead, average family premiums soared by $4300. we were promise that health care costs would go down, and instead we see deductibles have skyrocketed. we were promise that we could keep her doctor and a health care plans. instead, millions of americans have lost their insurance and the doctors that they like. in short, the affordable care act was neither affordable nor did it provide the quality of care the american people deserve. last week, house budget committee favorably reported that the american health care act to the full house of representatives for their consideration. our markup was filled with life the debate and i applaud our members for working to make this bill better. dide was concern the bill
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not reflect a strong enough conservative vision for the health care reform, and i joined them in that concern. the budget committee approved emotions as laid out in a report. these motions described changes that would address our concerns, including greater state flexibility in the design of their medicaid programs. minimizing the, new medicaid enrollment by able-bodied adults. number three, promoting more requirements in the state medicaid programs. taxnumber four, ensuring credits are targeted to those individuals who need them most.
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-- it is a step in the right direction and i urge the members of the committee to support it. generationnce and a opportunity to reform health care with free market principles and the driver seat, not government. it is our opportunity we cannot let pass by as this ilk continues to better reflect our patient-centered vision of health care, we will be faced with a stark choice. the choice is between repealing and replacing obamacare and voting to keep obamacare status quo. is perfect,slation this bill accomplishes important south mandates, repeals taxes, and repeals subsidies. it allows people to choose the health care insurance plans to meet their unique needs of families instead of purchasing a
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one-size-fits-all plan mandated by washington bureaucrats. it modernizes medicaid, a once in a lifetime entitlement reform. ending medicaid's open ended funding structure will play an important role in addressing the future budget deficit and are growing national debt. good first this is a step, but only a first that. dr. tom price will use his position to address some of the regulatory burden of obamacare through his administrative action, and we will vote soon on individual pieces of legislation . process, three-pronged we are taking it to rescue the american people from a damaged to ourre that has done economy and health care system.
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as we talk about our work to repeal obama care and replace it with patient centered reforms, we also have to remember the problems with obamacare are not merely numbers on a page. i have been a nurse for more than 45 years and i saw the impact in the 1990's of a government run single-payer health care system in the state of tennessee. it was a pilot project. i saw costs rise and quality of care fall. it is what inspired me to get involved in the public sector to begin with. when i saw some of the broken principles applied to health care on the national level with obamacare i felt compelled to bring my voice and my experience to congress. day in mys every office, and i'm sure many of you do as well, saying please help us, rescue us. my state, the premiums in my state have skyrocketed. there are parts of tennessee
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that don't have a single insurance provider in the marketplace, not one, while other parts of my state, people may have an insurance card, but can't get care. they actually are going to health departments, even though they have an insurance card. we must work together on a conservative vision. it is a promise we made to our voters for years, and a promise we finally have an opportunity to keep, and i intend to keep that promise. worke all members to towards a common goal, and with that come look for to answering your questions. >> thank you very much. i will attempt to go now in order with our colleagues that are here as ranking members. the gentleman from new jersey would be acknowledged. we did not spill anything there, did we? it is all ok? the gentleman is recognized. >> thank you.
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i would like to respond, start by responding to some of the things my colleagues on the republican side have said. i am not doing that because of any personal reason. it is just that i feel that when we put together the affordable care act, the democrats did seven years ago, and i was part of that. we were responding to what we thought was a crisis in the health care system, in the sense that more and more people did not have health insurance. often times it was lousy, skeletal, did not provide much in the way of benefits, and premiums and costs are going up double-digit for the most part every year, and so i think we put in place something we believe addressed to that. the number of people who are uninsured has gone down considerably, something like 95% of americans now have insurance. we believe the quality of care has improved.
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we don't have the double digit inflation for the most part. there may be some areas where there is significant cost increase, but for the most part, costs have slowed. they are in the single digits for the most part, so i feel that when you come along as republicans and say you want to repeal this. the burden is on you to say why it is going to be better, because we think we have created . much better system ca so in response to chairman walden, first of all, he mentioned hearings, but there were no hearings on this. this bill was given to us i think maybe two days, then we started the markup on wednesday. they're still has never been a hearing on this bill, and speaker ryan said there would be regular order. there was not regular order --
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unfortunately, the things you are repealing are the things that i think of the most important, and that is people's ability to afford coverage and people's ability to pay for their coverage. the biggest problem right now guaranteed access to me is nothing if you can't afford your premium. it is nothing if you have insurance but you can't get health care because deductibles or co-pays are too high and you have to pay more out of pocket,
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so i want to stress this is not an issue of access. this is an issue of whether you can afford to have insurance and have health care even if you do have insurance because you have to pay more and more out-of-pocket. you also mention continuous coverage. oft is fine, that a lot people don't have continuous coverage. they lose their insurance, go off, can't pay from time to time, and there is a 30% penalty if you don't have continuous coverage, and that affects people with pre-existing conditions and others mentioned by my chairman. , he he also mentioned referenced medicaid's limited resources. honest with you, i am tired of hearing about the fact that medicaid is unsustainable from a financial point of view. you are cutting out something like 800 alien dollars out of the medicaid program. -- 800 alien dollars out of the medicaid program. if you cut out 800 alien dollars
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out of the medicaid program, then you're not come to be able to provide medicaid coverage for the working poor, and we are talking about with enhanced medicaid for the most part, the working poor, people who are working but don't get health insurance on their job and can afford to buy it in the individual marketplace so what happens? no disrespect, but chairman walden said the states will be great innovators and have all kinds of options and flexibility. you don't have any options if you don't have any money. state ofng you in my new jersey and most the state because i've met with governors, they are very much afraid that they will not have the money to make up the difference. you take the money away and what is going to happen? you don't have essential guarantees under expanded medicaid under this bill, so they will have to cut back. they won't be innovators. they will cut back on mental health care, cut act on a treatment for opiates.
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they will cut back on the money for nursing homes. i remember the 1970's when they were so bad that they were burning down. that is what you will get. you will get a medicaid program where the states kick people off medicaid or provide less in benefits. sessionsat chairman and chairman black come a lot of what i call ideological arguments. i cured things like freedom, choice, competition. i don't really want this to be an ideological debate. this is not a single-payer system. the fact of the matter is this is not a single-payer system. this was a private sector response, private response if you will to a real problem, and we are talking about real people here.
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you can talk about all this ideology, but the fact of the matter is that real people will lose their insurance. mention the cbo. the cbo basically said that the more people, fewer people will have insurance under your bill that had insurance before the aca even went into effect, something like 24 million people will lose their insurance. premiums are going to go up. you have taken away the limitations that we had on the aca in terms of deductibles and co-pays, so deductibles are going to go up. at co-pays are going to go up. cbo is talkinge about and i have not heard any third party nonpartisan group dispute and the cbo. no, that is why the cbo score is important. no one is disputing really essentially other than
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republicans or conservative think tanks maybe. nobody is disputing what the cbo said in a nonpartisan way. the fact of the matter is people are going to be harmed. i don't want to talk about the ideology. i want to talk about what this actually means, so i will conclude by saying this, i really think it is your obligation to show how this is going to be better than what we have now under the affordable care act. i think that burden on your part, you have totally failed. the amendment makes it worse because it is more cuts and less money that's going to go to states, and i think ultimately find out thatight even more people are going to lose insurance. so just think about this in terms of what it means for real people. i think there is no question that what it means is that this is a bad bill. i would just in by saying we are
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willing to work with you if you think you have some improvements a can made, fine, but what you push for is not improvement. willyou have put forth harm people, real people, real americans. >> thank you very much. appreciate your insight. the gentleman from massachusetts, mr. neil. >> thank you, mr. chairman. mr. chairman, point of clarification, are you suggesting that if you do not have a cbo score in the next hours that you were not bring this to the floor tomorrow? see if i can -- you to suspend for just one minute. orher chairman brady chairman walden or chairman black, do you choose to address that issue as you are closer. i do recognize the german, mr. mcgovern and the judge have been
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after me for that. do either could you have a new update german from chairman brady? we anticipate cbo to give us a new score before the bill moves to the floor with ample times for members to review it. did the gentleman say the score will be available before goes to the floor? >> before we vote on this bill, we anticipate on having the score from the cbo. been working on the admin meant and we anticipate that today. >> mr. chairman? is fair for us attempt to answer the gentleman's question. if the gentleman will suspend for just one minute. i am now going to yield back to the gentleman, and if the gentleman would like to engage the german, he may.
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-- engage the gentleman, he may. >> in the absence of the cbo score, do you intend to proceed tomorrow? can allow youif i and of chairman brady wants to come into this. and wasceeding on this offering my viewpoint that we felt like it would be available this evening. that viewpoint would mean that we would have it before we would move to the floor. he does not need time. he just these to answer the question. >> this whole process is screwed up. the whole idea that we might conceivably debate this entire bill tomorrow and get the cbo score prior to our 15 minute vote and final passage is crazy.
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the reason why we want a cbo score is because we want the facts in front of us. inshould not be proceeding this committee without a cbo score, so it sounds like the answer from the chairman of the ways and means committee is that as long as you have it before you cast your vote, that is good enough. i don't think it is good enough. i think people ought to have it well in advance of people know what we are talking about. maybe it will come tonight, but if it doesn't, it sounds like you will consider the bill and debate a bill without a cbo score. >> as we did seven years ago -- mr.'m just saying, chairman, that this is a screwed up process and i think the record is clear that we think we ought to wait until we get a cbo score, especially given the fact o show 24initial cb
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million people would lose insurance. like to submit a letter from governor baker from massachusetts to the record. he races questions about what you intend to do today. i would like to thank former governor romney of massachusetts for having worked with the democratic legislature and working with the chamber of commerce and the afl-cio and the american nurses association and the american medical association has we devised a plan that in many ways became a model for the aca. mr. chairman, the bill it self in front of us this morning is a danger to the american people. none of the proposed amendments will improve the legislation to any appreciable degree. most of the minutes make the bill more ciccone and. -- more draconian. the combined tax cuts now total
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nearly $900 billion. while more than a trillion dollars is taken from the medicaid and medicare trust fund. like millions of americans, my constituents recognize the danger posed by this legislation. millions of middle-class americans will be worse off while many millionaires will be better off and read the tax benefit. governor baker wrote the following, "over all our ahcasis indicates that the which strain necessary resources for universal health care coverage." .he bill would not lower costs in fact, cbo confirmed that americans will face higher costs and less value. that me be clear. the changes being contemplated by republicans making it more difficult for americans to get the needed care at an affordable
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price. toute heard republicans the cbo number that premiums would be 10% lower under later years in that plan. we have never had an argument in the 28 years i have been in congress about lowering health care costs. thes about restraining growth of health-care costs, and that needs acknowledgment as well. what they don't say is these alleged lower premiums would apply only if you could afford coverage with a paltry tax credit. there is no guarantee coverage will provide the benefits that are needed. really look at what cbo says, they make it clear that americans would get fewer benefits at a higher cost overall. premiums that are 10% less are irrelevant if you can't afford the price of the policy to begin with, and cbo is clear that the total out-of-pocket cost would go up. the republican plan reminds me today of a used car salesman
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giving a 10% discount on the cost of a car, but only if you want tires, and engine, and a windshield. you will have to pay more. that is hardly a recipe acceptable to my constituents. the bill does not cover everyone as president trump promise. cbo estimates that 24 million americans would have less coverage under this republican scheme. the republican bill is a tax cut for special interests masquerading as a health care bill. cut 880 billion dollars from medicaid, program that helps pay the cost for more than 60% of all nursing home residents nationwide. i would suggest to members of the committee that we all have the following understanding, that medicaid in many ways has become america's long-term care initiative. it is also a massive tax cut to the people at the very top. president trump's cabinet in excess ofh of $13 billion would be a month
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those who would benefit handsomely. the republican plan really harms my state of massachusetts by cutting medicaid funding that is used to pay for opiate addiction treatment. i hope we can all agree on that, that long-term care for children with special needs also be cut back, and by cutting the tax by leading health insurance companies reduce the value of coverage they offer, we all acknowledge the challenge that would present. we know that more uninsured means more burden on our local hospitals. we will see job losses in hospital closures, something our communities can't afford. a new study finds 3 million jobs could disappear under this approach, but for those who dismiss any analytic study that disagrees with the policy, look at what the experts say about these jobs. to the american hospital association, 14,000 800 hospital jobs in my district, and my community would be hard hit.
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both because care would suffer and because constituents would lose good paying jobs. yet, the direction the republicans take on this bill for the people western massachusetts. we have a bill that breaks promises, raises costs, a bill that reduces coverage, and a max massive tax cut for those at the very top. it raises, not lowers, the number of uninsured americans. enough damage to inflict on america. the measure would also cut $175are by three years and billion for millions of baby boomers who rely on this program. republicans continually talk about the medicare trust fund and the shortness of the
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medicare trust funds life expectancy. they turn around and cut three years from what the trust fund account and say is realistic. that is the equivalent of saying let me set the fire then call the fire department. as i noted earlier, this cuts more than $1 trillion from health-care programs that 120 million members of the american family depend on. take a brief moment to contrast this bill and what they're proposing with the aca and what aca added 11 years of life to the medicare trust fund. it did so by improving efficiency and quality of payments to medicare providers. that is an important suggestion. there were experiments that came along with the aca. it did not drain the trust fund. it strengthened it. who does it hurt?
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it hurts all of our constituents. let me conclude by saying this legislation is the republicans first attempt at tax reform. putuch, it fails the test out by secretary minogue should and protection form that "no absolute tax cut for the upper class." this provides a tax cut for the wealthy and the health care industry. americans would be paying more and getting less. on themy colleagues rules committee not to move forward with this bill in terms of bringing it to the house floor. i submit this to mr. chairman with great regard to members of this committee and those testifying today. when president trump said who knew how complex health care could be, that ought to be the starting point for the conversation. for those of us on the ways and means committee, we knew how complex health care could be in america. one expenseyou that
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we have all had with the development of health care for puzzles is that it's like squeezing toothpaste with the cap on. sometimes you don't know what the consequence will be. and it isn this path a mistake. onould be happy to debate how the aca came to formation and was passed and the as to theies for all number of committee hearings, town hall meetings, and republican amendments accepted in the aca, often times left out of the argument. of the problems emanated from the senate because they prolong the discussion trying to secure bipartisan reform. when that didn't work, one party decided to go for it. we have an example here today where both sides could amend this legislation go forward. always remember there were a lot
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of republicans who voted for so security and medicare and medicaid and i get back my time. i appreciate the gentleman very much for his insistence that we listen to not only wise opportunities, but you come to the committee to give us your very best. i appreciate that very much. a couple of weeks ago, it seemed like -- we are delighted you are back. you wore your tie in difference to the gentlewoman from tennessee during she noticed that. i did too. >> it is an honor to be here today with my colleagues. chairmanly join the and others in wishing a speedy return of my fairly kentucky native, miss slaughter. the nonpartisan
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congressional budget office released its report showing that 24 million hard-working americans would lose their health coverage by 2026 if we premiumsbill, that would rise 15% to 20% with hard deductibles and out-of-pocket costs, and that middle-age americans would be priced out of the insurance market by an age tax, i thought for sure that this bill was dead on arrival, that there was no way republicans would walk this plank. i would not want to, nor would i know how to justify giving $900 billion in tax cuts to corporations and the wealthy paid for by threatening the health and well-being of millions of american families. when i was here in january, you invited me to meet with you about your health care , and while iill would not necessarily agree with the characterization and the title, and don't agree with many of the ways in which you propose to change the aca, it was and is a serious and doubtful proposal.
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-- thoughtful proposal. a major difference between your bill and legislation this committee is about to send to the floor. your bill does not provide onions of dollars in tax cuts to corporations and the wealthy. you keep that funding in our health care system and the organize it. as cbo did that it is impossible to cover as many people and provide better quality care while making drastic cuts to our nation's health care programs. logicunfortunate the same is not reflected in the bill we are debating right now, but let's be honest. so-called replacement legislation is not a health care bill. bill, a ideology fantasy about freedom and choice existing in a market that does not exist. as i said during our markup in the budget committee, speaker ryan loves about talking about
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giving people freedom and choice. giving insurance companies of freedom and choice to cherry pick young, healthy enrollees and sell them cheap, stripped-down health-care plans. that would work if young people also have the freedom to choose whether to get cancer or not to get in a serious accident or not, which they obviously don't. ryandoes not stop speaker from pretending that this bill would create some magical health care free market that exists nowhere else in the world. a fantasy land where young people don't get sick and apparently they don't grow old either, so they don't have to worry about being priced out of the market. it is just sheer nonsense. is striking,l does particular given what was promised and considering the cbo score of coverage losses from the amendment has not been factored in. under this legislation, the number of people without insurance in the united states will nearly double. 14 million americans will lose coverage next year.
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that number increases to 24 million people by 2026. 21 million americans will lose coverage in the next three years alone. that means all of the coverage gains from the affordable care act will be wiped out in just three years. cbo also estimates premiums on the individual market will and by 15% to 20% in 2018 2019. yes, cbo says premiums will be 10% less than current law, but a main reason for that drop is largely because older people will be priced out of the market. for pretty much everyone else in the individual market, deductibles and other cost will be higher, and for lower income individuals, out-of-pocket costs will be much higher. insurance companies will be able to sell plans that offer less financial protection. we will return to the days when millions of people in this country live in fear that they are always one serious illness
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or car accident away from bankruptcy. president trump and members of congressional leadership repeatedly said this replacement bill would preserve existing coverage. that everybody would have insurance and it would be less expensive than much better. is in this bill. in fact, the exact outset of every one of those promises is what is in this hill. promises made to every family in our congressional districts and this bill fails them at every turn. said, weleagues have can improve the affordable care act and should, but this is not the answer. i urge my colleagues to oppose this and yield back my time.
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anthis last week i had opportunity to engage people in dallas in richardson, texas, and i recognize that an insistence by people to stay where they are or want to move where they go is a collision point. this morning, an ophthalmologist from dallas, texas engaged me. last night, dr. gill, an orthopedic surgeon from dallas -- i know both gentleman very well. they engaged me and said people are delaying and not going to get health care they need because premiums are not only high, but deductibles are the real reason why people are delaying themselves the
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opportunity to go get things done. i look at all three of the chairman that are here. that is a problem. what is this bill going to do that will help deductibles? we keep talking about premiums, costs, but part of that cost are deductibles. doctors are concerned. have heard from patients and people who don't get the subsidies provided under the obamacare plan. they are saying the same thing. they are out of options. there deductibles have gone up. working folk, the middle class, and they're getting priced out of the market. they are saying, what are you
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going to do for us? we are forced into this market and it is collapsing around us. our deductible is $10,000 or whatever the number is. help.y are saying what we tried to do here is a couple of things. we tried to restore to the states more power on the decision making when it comes to health insurance plans. we actually put faith in local and state leaders who are there on the ground. they know better than somebody sitting here in washington what may work best. my district in eastern oregon is different than the metropolitan area. i would have faith in my state coming up with a plan that would work for a rural, low income group that i represent that maybe an upper income group -- they will have flexibility. fundd, the state stability is $100 billion to the states to come in and help on these issues to help buy down premiums and
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deductibles. if they don't need that because they fixed the market and it works on their own, they can put that towards mental health services or opioid treatment services. flexibility and funding to design health-care system that works for them. we arere multiple things doing here, but if we don't fix these markets, they are collapsing. comelleague from tennessee your state has one option on the exchange. >> competition would be one answer. >> that is what we are trying to get to. cbo, cbodue respect to said there would be 21 million people on the individual market and obamacare exchange. for is what they forecast 2016, 20 one million people would have insurance. it is 10.4. 10.4. >> thank you.
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>> excuse me. i will allow the general and -- and there is a, reason they are off. i will pay aid penalty or get a waiver rather than sign up. irswho decided to pay the penalty. the tax man says by this government mandated product or pay a penalty. 45% of those under the age of 35 said i will pay the penalty or get a hardship exemption. we are trying to create a plan that works. i am 60 years old. my cost is 4.8 times higher on average than my son who is 26. and what obamacare did was artificially compressed that band to a three to one ratio. so what we do in this bill and
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we get criticism fort and i think it is unfair, we go back to the market, 521. states, states, can go lower. and can go to three to one 221, 521 or six to one or seven to one. we say you design it because some states have younger populations, some older, we are just giving them the flexibility , so if the plans will be too expensive, they can adjust that. we give them the ability to make fine tuning in their state so it becomes less washington telling massachusetts what works and organ what works. >> thank you. i have a follow-up question from the gentleman from new jersey. disagree more. the bottom line is when we put the aca in place, it was because what was happening in the states in the marketplaces was failing, and that's why we got rid of all those discriminatory practices on pre-existing conditions and lifetime caps, so for me to
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assume that you throw this back to the states and they would do things better, first of all, you don't agree with that because you kept 60% of the affordable care act those discriminatory anti-discriminatory laws that put restrictions on the states because obviously you don't believe that if you repeal those things like a pre-existing condition prohibition that the states would do the right thing. so why should we believe the states will do the right thing? with regard to the cbo, one of the things the cbo says is not only will people lose insurance, 24 million, but a lot of people's the duck bubbles will go up because what we did with the aca was put limits in those plans on how high does the duct was could be. i know people are complaining about the deductibles, sure. they think they are too high, but the bottom line is in your bill, you let deductibles go
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through the roof, and the same with the co-pays come a so again if you're going to let states say ok you can raise to dr. bowles or you can increase the rating systems for older people canaise deductibles or increase the rating systems for older people, this whole idea of letting loose the states on the age ratings, the dr. bowles, all these things we limited, i think it is a huge mistake and that is why the cbo says that even though you have insurance, what insurance will you have under this republican plan? not good. not good options. >> thank you. you are going to allow the states flexibility's on all these matters? >> no, they are protected. >> it is ironic. my dear from new jersey said these were only democratic ideas -- ratingflexibility in the
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, was there other flexibility as it relates to the pertinent parts in the aca that he spoke about? that get rid of the tiers mandated certain expenditures for certain things in certain rates. when you have a government that says this is what you have to buy, and an irs that says if you don't come i woke and allies, that does not create a market. last year, 225 counties in america had one option on the exchange. this year, 1022. that is one out of every three counties where people have no option but one choice. that was before humana pulled out of the market. we have heard from some insurers who have told us that issue isn't looking very good either. they may consider pulling out or have some substantial rate increases, so the notion that everything is perfect and fine i
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think is not accurate. do a lot better. what mr. brady did in the ways and means committee did was expand health savings accounts. >> the hsa -- >> this is an important part of this. the democrats want to clamp down what you could do with your hsa. you remember hearing from the community, the taxation pieces, all of that is in there. i talked to one insurer who said the health insurance tax itself -- remember, they tax health insurance. is that drive costs up or down? would you think happens? try to pass that stuff on, but who do you think they pass it on to? you think that lowers rates? we tax tobacco. that is what happens, right?
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the democrats want to tax health insurance. if you have too good of a health insurance, the government says with that insurance should be, and if it was too good of a plan, they wanted a 40% tax on that. they negotiated for those rights. >> mr. brady, this hsa issue as i recall is a great option for a family to be a little control not only their spending, but the way in which they receive their health care. what have you done in this bill that is directly related to questions about costs? >> my local doctors are concerned too. they tell me obamacare is a sinking ship and it is taking good americans stand with it. they had patients who were kicked off their plans, can't see them anymore. the plans they have are too expensive, and they can never all theirt through
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out-of-pocket costs to get to the surgeries, procedures, and treatments they want to get as well. in the houston region, we have no ppos. it is gone. even see them can anymore or go to the major hospitals. >> what are you going to do to create a better vision for ppos? the approach rejects direction from washington that one-size-fits-all. for affordable health care tailored to your needs, and part of that giving patients choices the ability to double the size of their health savings accounts, make sure they can use , like what they need over-the-counter medications for example. to be able to cover those out-of-pocket costs that are so expensive so they can see that local doctor and we give them more control with the tax credit
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to buy plans that are right for them, tailored for their community. for example, there is a big difference between manhattan, kansas and manhattan, new york, and plan should reflect that. it allows states to provide a wide variety of choices for people who work in their communities and regions. that is why many of my local doctors are telling me repeal this monstrosity, restore the doctor-patient relationship. let my patients come see me again. i want to make several points. first of all, i understand there are individual physicians who don't support the affordable care act, but also i want to point out the ama and the american nursing association, the american hospital association, aarp and virtually every disease related organization has come out
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opposed to the american health care act. they don't see this as a viable option to the affordable care act. health savings accounts are wonderful for people with money. if you don't have several thousand dollars to set aside, then hsa's me nothing to you and the vast majority of the people we are trying to help either through the american health care act or through the affordable care act don't have several thousand dollars to set aside. finally, i want to point out that what we are talking about here almost entirely relates to the individual insurance market. market is basically affecting 5% of the american people. thethe vast majority of american public, the health care system is working pretty well, medicare, indicate, employer-based insurance. we are talking about a small sliver of the public. but are important people, we should not try to of the end and entire health care system that is working well for 95% of
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the people to solve a problem that relates to so few. think there is one thing we can agree on, none of us have met a medicare recipient who have an hsa. >> but i have met some who wanted. >> there are 20 million americans who use health savings accounts. in the study, half lived in neighborhoods with median incomes between $25,000 and $50,000. these are middle-class americans who use them for these high out-of-pocket costs. in indiana, they use health savings accounts and a plan with their medicaid patients, so they have them. they make them work. we should be doing more for the middle class who needs help in this area, who has been left out. >> that is what that tax credit is therefore.
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we are trying to provide flexibility and new options for people who are lower income. we are trying to help those in between. this is not one-size-fits-all. we are trying to help multiple lifee and multiple situations be able to afford and get access to health care. >> i think what you did without saying it -- it took me a year and a half to do this. we said we know why not many people right health care bills. there is a reason why it took us a long time. the moral issue that is involved .as overwhelming to me as you know, mr. chairman, i have a down syndrome son who participates into a program that is necessary per him as a result
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of my age to make sure he is on that program. there are many able-bodied thets on their who have need still for health care, and when they are on medicaid, they are limited in the amount of work they can do, and so i view this as a moral issue to allow them the chance to jump free to a tax credit system and eve ate that other what i consider to be a system that would not give them flexibility. >> we will keep going. this is all day fun. the viceirst go to chairman of the committee. >> thank you, mr. chairman, i appreciate that. i have fewer questions because i had the good fortune of being on chairman blacks committee, so we had a thorough education about the bill. there are a number of things i
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would like to ask for the record. as my good friend from organ knows, i spent a lot of time on native american issues. a number of years ago, we had a good piece of legislation that was a big part of that, the indian health care improvement act, which was bipartisan and moving along through congress, but was then added to the aca. as a result of that, i get a lot of questions and i wanted to make this clear for the record. there is nothing in this legislation that repeals or does any part of the indian health care improvement act, that the case? >> that issue has been raised in other venues. the clear answer is no, there is nothing in here that affects the authorization of the indian health care services act. >> for some of my friends who
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only want to do a repeal option without a replacement, if we were to do that, that is exactly what would happen. we would repeal a number of things that all of us agree on. there is a lot of contention and different points of view, but there are things in the aca, republican ideas about raising the age -- allowing people to stay on until they are 26 on their parents insurance. this is a significant piece of the act and i think my friend from new jersey for the role he played in that. repeal, thosemple items would go, so i want to commend you for doing the hard thereooking through and is still a considerable amount of disagreement, but there is a lot of consensus here. in those areas where there is consensus, both you and obviously chairman black as well, who offered some really terrific suggestions for improvement in the bill through
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her committee, but for keeping those things in -- >> yes, sir. you appreciate mentioning that. chairman walden's response is absolutely correct. i appreciate the fact you have kept some significant things that we had in the aca, including the indian health care improvement act. when i meet with the tribes or go to the various conferences held in the last few months, they are concerned about the impact of this republican on american indians in the individual marketplace who would lose their subsidy and don't believe the tax credit will make up for it, and at the same time, many american indians who have been able to take advantage of medicaid expansion in those states are concerned by eliminating or significantly
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cutting back on the expansion and the block grant on medicaid that they will either lose their insurance or have significantly less benefits, so the fact that the matter is that as important as the indian health care improvement act is, it is also important for tribes that they not see cutbacks in medicaid and did not see significantly less subsidies or tax credits for those on the individual market place. it is not a panacea that we cap the indian health care improvement act in place, although i appreciate that. >> we did. >> i was going to say mr. vice chairman, i want to make sure people understand that our committee on energy and commerce -- i've asked to head up a task force to look at the delivery of health care in indian country, because we have heard reports tout low-quality and we want
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get after that. all americans deserve high quality health care, and the reports that have come in from some reservations would indicate they are not getting that. >> they are not. my friend is correct about that. we had three hospitals in indian country that austin emergency room privileges and surgical since last year. lost emergency room privileges and surgical since last year. a couple ofad conversations about these issues. a lot of them go well beyond the insurance issue we are dealing with here, everything from remote locations to recruiting and training personnel. it is an area that one need a lot of work. the tax credit oh is a potential vehicle to help a lot of people who aren't getting help. in terms of medicaid expansion, my friend makes a good point.
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a medicaid expansion state. those decisions were made out of fear that conditions would change and the states would pay more than they do, so we hav can debate that come of it at least on the area -- that, but at least on the airy where we can disagree come i want to thank both of you for doing that. we turnr legislation, off the disproportionate share and and hospitals -- cuts hospitals. under obamacare, hospitals got whacked, and we turned off those customer hospitals in non-expansion states. we have safety net funding and patient and state stability fund for those states. >> my friend anticipates my questions, and i appreciate that because i can make a pretty good argument in my state where
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single we are down to a provider like my friend in tennessee, and our rates are going up 69%. we are actually much better off with the additions you have added and the tax credit provisions then we are under the current system. i will leave it up to everybody here to determine that for themselves and their respective states and jurisdictions, but it is a pretty powerful argument when i talk to people about where we are and what this provides in addition to what is myilable now, so again from state, my area, this is an improvement. let me ask you a theoretical question. obviously we will be considering amendments here, but this process is a long winding road as my friends would agree having walked down it themselves before. do you anticipate changes in this legislation as we go forward?
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i'm not asking you to predict what they are, but you have been around the block a few times. a legislative process. when you are covering a key issue, you are always looking for improvements every step of the way. we have worked carefully to incorporate improvements provided by the broad range of in ways that we can cover more people. i assume the senate will continue that improvement process as we handed this ball to them as well. they have creative ideas, and so we continue until the bill gets to the president's desk. i would concur. we give members of both parties to offer up amendments in committee.
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i am told that we set a record for the length of our markup, 27 hours and 27 minutes. we spent the first 12 hours, maybe 10, on the first amendment to rename the bill. it was not a substantive anydment that addressed issue are consumers and voters are talking about. something like 10 hours before we voted, which did not seem to be a thoughtful approach to the importance of this matter, but that is where they chose to go. doors open until they were done with the amendments. i would not want to prejudge what you do here in the rules committee or what our colleagues in the senate may offer as well. thatnk we should admit there are problems accessing affordable care and options for insurance for our consumers and we ought to go shoulder to
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shoulder to figure out how we solve them. , chairman my friend black, who has had excellent suggestions for this committee. favorablyhey will be considered, so i will venture a prediction there. that is an important point to realize. this is not a once and forever bill or vote or anything of the kind. we are in a legislative process and what we do here today isn't going to be the final word. what we do tomorrow when this bill comes up and we have the cbo score, it won't be the final thing. it will continue to change and improve. i must say and say this with great respect to my friends from tennessee, i think coming out of her committee were terrific improvements in this bill. votew even people that friend the bill, my good from kentucky who made that very clear, but did support one of the amendments because he taught
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it made it that are, which i thought was a generous, thoughtful way to proceed. if the gentlelady has any comments, i would love to hear them. >> i appreciate that. the ranking member and six of his colleagues supported that suggestion that we have passed on, and i keep telling my colleagues that they need to have their voice heard not just in the media, but also to let leadership know what their thoughts are. we all know the analogy that it is made like sausage, not pretty watching it made, but it tastes good at the end when you get it right, and that's something we have to encourage all members to continue to bring their suggestions forward. have all of don't those suggestions today, but i think we will get quite a few of them. [laughter] a great dealbeen
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of discussion of months the six of you about people losing coverage. this anybody actually lose coverage? 17, 18, and 19, and frankly does anybody who is on coverage now kicked off if they want to stay there? there is a lot of confusion that 24 million people are going to lose coverage as though they were going to be summarily denied coverage. >> thank you for busting that myth. that is not what the cbo showed. it shall the bulk of americans when not forced to buy health care they don't want and cannot afford, they choose the option of not having that health care that they can't using can afford. for example, next year, with no changes in medicaid and the exchanges at all other than americans are no longer forced to do it, nearly 11 million
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american safe thanks, but no thanks. that is not what i wanted anyway. the bulk ofes to the 10 years of this, american saying thank goodness i am no longer forced into a plan i don't want, can't use, and can afford. for other americans, the reasons we are taking such a deliberate approach of the next three years to make sure that states can approve a wide range of products and insurance companies can now with the free market provide different choices for them and that immediately usable credit, every american will have time to choose a plan that is right for them. i will finish with this, in america today, this is not get much media coverage, but for the obamaperson on care exchange, two americans have said no thanks. most of them actually paid to say no thanks. think about it.
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there is a product they are forced to take given generous subsidies to take, they want it so -- don't want it so badly that they will pay not to be on there. i can't but help think in texas that there are entrepreneurs, young people no longer on their plans but still going to college, working their way up the economic ladder that now don't get any coverage will have an opportunity with the credit to buy a plan that is for theirthem, business, for their families as well. and so i see coverage increasing for those today who have seen no hope in obamacare's methods. an importantis is point and i want to stop and emphasize it. you have paid a fine not be on the affordable health care
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exchange or system or whatever, we don't do anything to help you get insurance. you are sort of out there on your own. situation, you are going to get something, a tax credit, to help you do something to it you don't like what is available, ok. you have got a better idea for yourself and you want to do it, we will help you get there. age and income to some degree, which i think is wise. a lot of people are fortunate. we wish there were more, but they can write the check. here you are helping people. butsaid i don't like that, here is something to help you go build something you do like. mr. chairman, i was with a small business person this weekend who cannot afford the
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$1200 a month for obamacare and had to pay the fine. when i described with you and your daughter the amount of money you would get to buy plans tailored to your needs come he said i would give anything to have that option because i don't have that today. we get no help at all. so there are a lot of those small business people, students in their first job, those early retirees those anxious, five long years, anxious to have better choices. >> we will go around. strenuouslydisagree with what chairman brady said. if you look at the cbo report, the reason why they say 14 million in the next year will lose coverage. 24 million in the years beyond that, it is basically for three reasons. is those in the individual market because the tax credit
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you are given his paltry compared to the subsidy and tax credit we give in obamacare, a lot of people now are going to have to pay another $4000 to $5,000 a year for insurance on the individual market. they won't be able to afford it, and that's why many lose coverage with regard to medicaid as time goes on, fewer states and the expansion is limited and and the block grant go into place -- >> will you have to leave coverage? points.making two the reason for cbo scoring of the loss of coverage is because reduction of people on medicaid, lack of subsidy for people on the individual market, and also people who because there is no longer a mandate that a lot of employees will not offer health insurance.
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beyond that, what i also disagree with is the chairman is basically buying his freedom argument that these people who pay the penalty really don't want health insurance or maybe don't want the insurance that is offered. that again is an affordability issue. it has been seven years. it was the vision when we put this together seven years ago that at some point we would look at those subsidies again and see if those subsidies needed to be more generous. >> the employers, 3 million people. i think it is seven. >> i think it is three. >> my point is these are not people choosing to pay the penalty of not having insurance because they want that. >> that's not what i'm talking about. the majority of americans get their insurance from the employer right now. we are talking 7 million people versus 150 million people, and thatemployers realize
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there are certain benefits you need to provide them or you won't have them. , as morence is a pool people go off insurance and people more likely to do it are who for the various reasons i said cannot afford it anymore, then that insurance bel shrinks and it gets to more sickly people, older people, and then the premiums go up, so this is like a vicious cycle. >> that is what is happening to obamacare right now. >> i disagree. the idea is to help people more with subsidies, not give them less subsidies, which is what you are doing. >> i think it is important to look at the cbo numbers because what they project is that there will be 4 million uninsured in 2017, 14 million in 2018, and 16 million in 2019.
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all of the obamacare subsidies are in place through 2019. plus there is additional support going to the states. they can buy down premiums and co-pays to the patient stability fund. they get that money starting in 2018, so there are two years in which states will get $15 billion per year those two years before any of the other subsidies away. cbo said you will still have this problem. that tells me you have a failing market out there, and we are doing nothing to bring down costs. that is where i can assure the gentleman that the energy and commerce committee will look at what is driving the costs up. said,friend from kentucky we are only arguing about 5% of the market. is being in america hit by higher cost health care, and it is from one into the other. i guarantee you mr. vice chairman and members of the committee, we will go after the
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cost of drivers no matter where they are. facts going to find the and shine bright lights on every piece of this, and we will find out what is driving the cost of to the point of whether you are low income or high income, you are paying more. many examples of people who spend very little bit of time in a hospital and come out with a $70,000 bill and wonder what the heck is that for. why is a box of kleenex what it is. we have all seen that on bills and wondered how is that the case? we will go after cost structures. there are a lot of programs that throw money around and flood the swamp with high paid folks. we are going to figure out what is driving those costs. >> certainly. i am sorry, mr. neil. >> thank you. republicans talk about personal responsibility.
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how much more person responsible than buying health care insurance? bssshould the rest of us $1000 on our own plans to take care of those who simply refuse at 29 years old not to buy health insurance. our proposal is richard nixon's proposal. op doles proposal. our position here is mitt romney's proposal. the shared responsibility offering discipline in the marketplace would come best from the idea of trying to manage risks. more people in the risk pool, particular those who are younger and tended to be healthier than those who are older, points to the whole notion of shared risks good so when do we buy homeowners insurance? after the house burns down. i don't understand republicans all of a sudden rejecting proposals all the way back to the nixon years about the notion of personal responsibility in
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buying health insurance. >> may i respond to that? >> certainly. >> why we do reject the issue of the individual mandate, we do support the issue of personal responsibility. that is called continuous coverage. if you step out and step income you pay a penalty of 30% for premiums for that year. your point, we approach that in a different way that is more individual decision allowed. you get to make that decision. pre-existing condition, we take care of you. to your point, they will pay a little penalty if they are not going to sign up for insurance. you don't get to buy homeowners insurance when the roof is on fire. you will pay a penalty until you are sick to buy insurance. >> people don't trot out and does the continuous coverage most of the time it is because
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they can't afford to pay it. they get a different job. there are numerous reasons why people don't pay their bill and lose their coverage, and i don't think it has to do with personal responsibility at all. it depends on your circumstances, your income, and your health. >> my time if i may? i have had much more time. [laughter] >> we don't want to re-create all the debates right here for all of us to go through it again. but let me just into with this is an observation. , with all due respect there arend, the fact more people who get exceptions to obamacare or pay a fine than are actually in the exchanges tells me it is not working very well. no, i will finish
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my time here. i tried to be generous with everybody. and we are talking about a ofatively small portion total population. most people continue to get health care through their employer on medicare or through classic medicaid. that is a huge preponderance of this market. the quicker we get to this and to what my friends want to focus on, the better off the entire country would be. a biggerhat is where problem -- i'm not saying this is a problem. it is certainly a problem. i want to complement my friends on the democratic side. you may disagree with what we are doing now but you deserve the credit for establishing the threshold for people with pre-existing conditions allowed to buy insurance. that is something that came out of the obamacare debate, and we
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are keeping large elements of that plan, some related, some is a lotit, so there of change share, but i don't think they're as much changes people suggest. if 80% of the country will continue to get insurance the same way it does and trying to make sure everybody has something to held off of, which they don't now. to protect people with pre-existing conditions and the different way, but a proven way that has worked before. once we get through it, and it will changes of when here knows and we get on to these other , we will actually do something in addition to this and i think it will be meaningful and really good for , butbody and be bipartisan
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this case we have to work their it. i agree with my friends on my side of the aisle, this is not working, this is not working in my state. wen rates go up to 69% and have one provider and are not a medicaid expansion state, it is not working for us. this alternative is better than what we have got. with that, mr. chairman, you have been very generous and i yield back. intend tomittee does take the time to debate the bill and make sure every single person has that chance. if i could, i would like to say that both the gentleman and gentlewoman who press this issue, the gentleman from oklahoma has a strong comment which i agree with, which is about tribal nations around the united states and his insistence to make sure that they are properly dealt with them i also and the gentleman mr. b.
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thed equally fateful to disability community. i think every member of the congress is aware of where i am on disability issues and very concerned about that and will continue to believe that we will if necessary come back. the gentleman were ask about that, would continue in their to continued looking at tribal issues and implementation .nd disability issues if the general and do agree with that, now is their chance to say they do agree with that. the hoping, mr. brady, that follow-up of oversight of this will include our opportunity to make us aware of that. without objection, i would like to enter into the record a policy from the national careions council on health policy has issued a statement in support of the bill we have here today.
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secondly, mr. chairman, our clerk, i'm going to have yes her, we will get there to you. thank you for the requests. the gentleman from massachusetts is now recognized. >> thank you, mr. chairman. aarp's strong opposition to the republican bill. that there arey republican governors that are concerned about the republican bill. i would like to add unanimous consent to enter the letter, as -- the the public and republican governor from michigan. they have concerns. is aboutquestion process. while i appreciate the midi
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saying, we want to have a robust discussion, to be honest, the robust discussion occurred in your respective committees in the form of hearings on this legislation. i'm trying to understand why there was a decision made to do no hearings on the text of this bill, because the details are important. we can have hearings on general with thehat is working affordable care act, but like which matters -- but language matters. mr. walden, when he opened up, he said this bill would be good for people with disabilities. and yet, i got a letter here from the national disability rights network strongly opposing the republican bill. we have letters here from the
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chronic illness partnership, different organizations signed on opposing this bill. the consortium for citizens with disabilities -- i would be here all day if our to read this -- if i were to read all the letters. he also mentioned the republican bill is good for rural communities. i have letter here urging a no on this bill. the members of this that, but i have to say you all don't know everything, and neither do i. that is why you do hearings. i am trying to understand the mad rush to get this thing done tomorrow without scores, without hearing from members of the
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disability community, without hearing from the health care providers all around the country . can someone explain why this is a good process to bring this bill to the floor? >> if i may. i can speak to the ways and means approach which is far more open and transparent than our democrat predecessors. i was there the night before the markup in the ways and means where we were delivered last-minute an 800 page bill that no one in that committee had read. nearly midnight, we were given a 300 page manager's amendment, no score, no explanation. >> if i could reclaim my time. we don't have a lot of time for revisionist history. the house held 79 bipartisan hearings for the affordable care
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act. house number spent $100 million in hearings. hearings are different than markups. amendments, both democratic and republican and accepted 100 amendments. they adopted party for republican amendments. in markup, education adopted six republican amendments. more than 100 days before the try committees formally introduced their merged bill in the house. house democrats hosted the this posted the first highest bill online. months andfor three a reconciliation bill was online .or 72 hours house democrats heard and answered questions from constituents in more than 3000 health care town halls and tens
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of thousands emails, calls and letters. -- i am not going to say this was a perfect process. it is a much better process. i want to know, why no hearings? >> after all of that said, speaker pelosi resorted to pleading, you have to pass the bill to find out what is in it. let me just say on the republican side, we have held 200 hearings. >> on this bill? i didn't see this bill until march 6. >> this bill also includes 37 pieces of legislation that have been considered by the full house of representatives and approved. it includes the elements that were created and unveiled last summer in a better way health care replacement.
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as opposed to democrats handing of proposed law in the ways and means hearing, we gave with full two days notice our 50 pages, easily understandable, transparent, and we held an 18 hour markup in which every -- >> no hearings. x if you don't know -- >> if you don't know what is in this bill and you have no one to look at than someone in the mirror. >> i yield to the german from florida. >> i thank the gentleman for yielding. this is not how congress works. this stuff is hard. when something fails, we start over. when you start over, you have hearings. you hear from different people. seven years ago, in the run-up to a formal care act, we didn't have all of this cockamamie technology.
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we didn't have the ability for people to flood us with emails and also to things that are changes that have occurred. not to mention, the various organizations, including those that mr. mcgovern has introduced . the one that has 500 physicians that the chairman introduced into the record. all of those things have changed considerably in that period of time. in that time, you should've started over. >> i point out some of your own members, the health care bills were not indicative of an open process. says this place may have been more open under speaker boehner. let me ask you, ms. -- how many hearings have you had on this bill? >> first of all, i appreciate the question. we went into markup, but let's go back and look at you are
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comparing apples and oranges. if i could please respond. we had some hearings on some things that were on this bill. there were some provisions. other things came to us, but remember you are comparing would you all did with the aca versus reconciliation. we are doing with a reconciliation bill. >> how many hearings have you had on this bill? reconciliation, last time the energy and commerce committee got all shoved in their. there wasn't even a hearing. we do not have a hearing. but we did have hearings on issues involved. >> you answered my question. use the mic. >> the health care markup culminated in a 14 month process. everybody was on the ways and
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means committee. exhausted from the amount of witness's testimony that we took. mr. cole was going to have a chance to adjust the republican conference today to point out about 80% of what you're doing is obamacare. i think that would help our argument. that wehat the evidence presented here on a number of and the number of hours spent in the united states senate, there were 25 days in consecutive meetings on the affordable care act. >> mr. chairman, briefly, there were no hearings. we got the bill monday night late and then markups started wednesday morning. the speaker ryan kept saying this is going to a regular order. i don't know how many times on tv, he would say this to be regular order.
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that would mean the health subcommittee would have a hearing. the health subcommittee would have a markup and then the bill would go to the full committee for a markup. i would point out that the house subcommittee has had at least one hearing per week on other topics since january when we were sworn in, so there was ample time as opposed to all the other things they did. >> how many hearings has the budget committee had? >> mr. mcgovern, our role and responsible to a is the reconciliation process. we follow the reconciliation process, sir. >> no hearings, right? looks the reconciliation process is a process and not a hearing. havew many witnesses testified before your committee on this bill?
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as chairman black pointed out in the reconciliation process, we don't talk, we do. the house bill before you today is a result of much hard work, , who alongr. price with other committee chairman developed a better way agenda and this bill. >> that is the most incredible thing i have heard. that you are rewriting health care law that is going to impact millions of people and we are just going to do it without listening to anybody, without taking testimony >> nearly 200 hearings. >> not on this bill. >> wasn't the affordable care act actually passed in a new reconciliation bill? >> elements. >> did we ever have a hearing?
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>> the energy and commerce committee was excluded from the process. >> the final bill was 10 minutes of debate. >> we have four people talking over each other. [indiscernible] >> as i recall, it was a reconciliation. >> so let me ask a different question. manyallone, mr. neil, how democratic amendments were offered in markup were approved? >> every democratic amendment [indiscernible] >> all right. mr. neil? >> rejected.
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>> we don't in our process introduce amendments to change the underlying bill. we offer motions to obstruct the committee which chairman black is going to present. we offered seven motions and none were approved. looks ok, so here we have a bill -- >> ok, so here we have a bill . had no hearings and we are rushing this. i am trying to understand, what is the reluctance to push this off a week to do some hearings? or wait for cbo scores? what is the difference between today or next week? >> i can answer. americansen years, have been hurt by obamacare. i hear this from our small business people, from our doctors and nurses.
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they have waited with congress to please that this please get the government out of the examining room -- please get the government out of the examining room. efforts to continue this failed obamacare experiment is over. >> with respect, i think even people who may be critical would like this body to be thoughtful about how they proceed. someone is watching this hearing reasonsw, for political or we want to rush this to the floor, because we want to for the sake of passing a bill, thing most people, even people who may not like the affordable care act won't approve. of 24 millionue americans losing health insurance came up, i want to make sure the record is clear why we say that. i think mr. pallone -- i think it is worth reinforcing.
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to thison why we get view that 24 million americans will lose their coverage, we are talking about americans working full-time in the minimum wage jobs, daycare workers, employers and local businesses who will see their coverage disappear as a result of the republican plan cuts and medicaid. also repeals income-based rim tax credits. they will see their coverage evaporate and republicans continue to sabotage the market, returning to the days when people with pre-existing conditions could be left without affordable coverage, for prenatal care or prescription jugs -- prescription drugs. that is why we are concerned and i thinkthat is the --
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that is why americans are concerned. i want to ask a question of mr. kennedy -- question mr. kennedy raised. to put this in perspective, it is my understanding before the aca, law said that health plans had to offer mental health coverage on par with physical health coverage at the extent they offered mental health coverage in the first place. -- including mental health and behavioral health coverage for the medicaid expansion population which previously had been optional with guaranteed parity. this guaranteed medicaid program which provided level of sameness and benefits offered but ensured the quality and variety of different premium options was available to these individuals along to consumer protection
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like appeal rights. the underlying gop bill would repeal for the medicaid expansion population. people in the medicaid expansion would no longer began to mental health and substance abuse treatment along with the other each peas. -- ehp's. kennedy asked about this and that video got millions of years -- millions of viewers because it went viral. it seems like a positive move in terms of providing care. what i am being told is mr. language-repealed the and in this amendment, the republicans knowingly and purposely rescinding guaranteed coverage of mental health and behavioral health services to
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low income workers and families. i am trying to figure out why. ? i can -- am i correct >> on to say two things. what happens when you don't have the essential benefits package, and the reason mr. kennedy is making that point, is states, because they're getting less money from medicaid have to decide what to cover. they don't have to cover everything. we know from the past that the thing that always goes was mental health coverage, drug treatment and prescription drugs, because these things are very expensive. the other thing i would point out, because you raise this process and there's a lot of talk about reconciliation. really a is not reconciliation bill. there were many provisions put into this bill because of the
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burden because of authorizing things will have to drop out. my colleagues on the republican side say this is a reconciliation bill. the fact of the matter is it is not. that are many things going to have to drop out in the senate because they are changing the authorizing language and don't meet the bird rule. he took about parity and some of these other things that came up. things were put in by the republicans that are not a part of reconciliation. >> and he will be appear later talking about this. this is such a great process. .uch a good vetting process each one correcting the other. what myunderstanding interposition of which are second-degree management amendment would do?
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>> no. out if ishould point may that we all believe mental health services are important. the bill does remove the mandate of states. by the way, does not the similar what this entire congress voted on unanimously from representative guthrie a few years ago. .sked unanimously remember on the alternative benefit plans for states, the option to enroll in medicaid beneficiaries and coverage is still benchmarked. the blue cross blue shield standard, the plan offered available to state employees with the largest health maintenance organization approved by the secretary, this coverage, this change does not remove the health benefits
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required from a private insurance system but is a change traditional medicaid benefits. change theons do not parity requirements established in the public health services benefitsving these requirements for the alternate benefits plans does give states additional flex ability -- i think you find the program standard options covers no health benefits. this has to be benchmarked. noted moreom hhs than 94% of small group products and all state and federal employees appear to cover mental health benefits. the fund created by the proposal $100e us might save billion over 10 years and so that money can be used to help with mental health, addiction treatment services and a number of acceptable uses.
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>> i just want to say that the chairman mentioned the pace. that was for a very small group market. it is pretty sad and he is admitting that we don't have these guaranteed benefits for these other people but we are not going to have it for those in the medicaid expansion population which is mostly childless adults and those are the ones that often have the -- i meanoblem with on thethat that group ones that are not going to have these guarantees. for those of us who have -- in state government, this idea that governors are going to adhere
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the mission statement of health care as allotted by the federal government with those dollars in health care? that is not going to happen. they are going to use it to patch highways and bridges. the next year to say they are deficient because the federal government has not put enough in while they put much -- while they used money for the purpose. that is the challenge. we all know how that happens. >> i want to ask unanimous consent. objection. >> this bill will permit age rating, five to one for individual health insurance. that means health insurance will become far less affordable for people age 50 or over. aca, it is like three to one.
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this bill will allow states to go beyond five to one and allowing the shores -- allowing insurers. >> he said that they could charge more. they can go six to one or two to one. the likelihood is they are going to go higher because that is what it was before the aca. >> it sounds like a prescription to make health care less affordable. but the studio says that's the reason they say they are doing this is because they want to get more younger and healthier people into the insurance pool. the cbo said that is not going to happen. between 50 and 65 will not get insurance. it will not accomplish anything in terms of insurance. that.o had i don't have it in front of me. there was a big part of why they said so many people will be
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uninsured. >> it will be helpful to have an estimate on how the combined effects of age rating will impact amongst the older americans. tell,ill from what i can even though we are being told it is about repealing and replacing just some of the provisions would do that which is why i oppose it. the go -- the bill goes far beyond repealing and replacing. it contains provisions that will .educe beneficiaries the bill seems to be less about repealing and replacing and more about capping exciting medicaid. this is a full-blown entitlement reform. since we have not had the benefit of hearings and we don't have an estimate, i would like someone to explain to me what exactly needs of the following
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provisions has to do with repealing and replacing the affordable care act. section 1.3, prohibits payments to providers that offer legal abortions that are not paid for by medicaid. what provision of the aca does this section repeal? saiddon't think anybody that we are only given with obamacare repeal. >> when i hear you guys on tv, that is what we are saying. >> we are trying to make sure that people have access so part of that is mceachin places in my district that have four more -- we are trying to put money into those. size --ict is multiple we try to expand coverage.
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>> section 114 repeals if they want interactive eligibility requirement. what does this have to do with aca? >> nothing. a lot of these are authorization changes. >> section 114 -- with high-cost real estate markets to adjust a $500,000 on home equity when determining eligibility for home care. notral matching payments just those covered under the medicaid expansion. it does so in perpetuity. provision of the aca does that repeal? >> nothing. >> the bill mixi series of changes to medicaid expansion, 32 states have expanded medicaid under the a.c.l. and more states
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were considering expanding medicaid. for states to make these decisions, they need to understand what the financial implications will be. the amendment appears to allow states that have already expended medicaid to receive the match rate for those enrollees provided that those individuals maintain continuous medicaid coverage from december 31, 2019 on. what about new enrollees? people not able to maintain continuous coverage? could state freeze enrollment for expansion enrollees? could this put a freeze on coverage back of because that is how i read the link which appeared >> -- i read the language. >> i think it is important that you point these things out. what happens is that our people looking for jobs. they are changing jobs.
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they are not going to have continuous coverage. >> there are two answers. we don't put that freeze in 2020.until january 1 of the tax credits are there to help people have flux ability to buy insurance -- to have flexibility to buy insurance. maybe even this year you will get reduced premiums out there in the market. ensures i try to figure out what this market is going to look like. that is why when you wrap the make thesed you other changes, they think we can lower premiums this year perhaps. if i could finish. >> i don't mean to be disrespectful. it's just that we are talking about real people.
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they're looking for a job. sometimes they have two or three jobs. a fall out of medicaid eligibility. if they get a second or third job. they are not going to be able to take advantage of these tax credits. they will suffer from the lack of continue -- they are not having a continuous job experience. a continuous salary. we are not talking real life people in my opinion with this. >> we are. there are huge coverage gaps in obamacare. doesn'that no governor want to help people medicaid and into better paying jobs. it is critical that there be an immediate so useful tax credits to buy a plan that is right for ,hat young person or individual usually a small business person, moving forward. that is why we work so hard with
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republican governors to make sure this is a seamless approach to helping people work off the economic ladder. scott walker, wisconsin lowered the medicaid levels and help those people working their way off medicaid with a target sector playing so sticky -- subsidy for that care. he achieved lower uninsured rates from many states that have the expansion. >> i think most people would say that there will be higher other expenses. i want to talk about the crisis for minutes. i think everybody will agree that we are talking a new problem with opiates. i have specific questions about
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how the bill will affect ability to respond to the opioid outbreaks. the bill provides per capita amounts of amount -- with people. what's per capita expense story in the bill will contain people who are addicted to abuse? -- opiates? >> i don't think it has any reference. >> correct. you get less money? >> there is no reference in medicaid today that specifically pulls out opioids. there is no reference in existing law that states more flexibility within the allotted funds. they can move money under this bill. the flexibility to go attack that -- with lower medicaid reimbursement any idea what the average cost of treating opioid addiction is?
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>> the whole point is that that is the most expensive thing. that is why it is important to have a benefit package. the states get less money. the first thing they will do is eliminate the market expensive things. drug treatments. >> cut something or not provide treatment. and wants to understand what the bill does to medicaid eligibility for school kids. section 111 of the substitute appears to repeal the requirement that state medically programs cover children from age six through 818 and families with income between 100% of policy, 1001 or $71 for a month for family of three and 133% empty which is 2000 -- medicaid eligibility cold these kids is to attend -- called
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these kids stairstep kids. there were over half a million kids in 2014 and there are more now. i don't know what this has to do with repealing medicaid expensive -- expansion. why are we picking on kids? >> in three short lines, this will erase is mandatory medicaid coverage for these kids as of december 31, 2019. these three short lines do not say anything above what will happen to these kids or to state budgets beginning in 2020. if a state wants to continue covering these kids can it do so? can you show me where this is described? iswhat the democrats did forced kids into medicaid. that is what you did when you
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fast -- past the affordable care act. we are saying states get a higher reimbursement state and can put kids back in the chip -- in chip> we will reauthorize the program this year because we believe in it as a big bipartisan piece of legislation. you get more reimbursements by doing so. a better way to take care of children. you force them into medicaid where sometimes they get laid access to care because the reimbursement rates are so low. >> in reference to your question, between medicaid covered., 100% are >> that my chairman is saying
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he wants to reauthorize chip. it expires in september. hopefully it will be as strong and as good. there is no funding in this bill. we have no guarantees that the wage of operates landfills and gaps, that that is going to continue. it is all very nice to say. i have planned to and plan three, that is all very nice. i appreciate the fact that my chairman will be partisan. everything will be beautiful. forgive me if or not necessarily believing that and focusing on what the bill actually does. >> i appreciate the answers to
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my question. i'mll close by saying, continue to believe this is a terrible way to succeed. people who know best about the health care system were asked to testify at a hearing. the bottom line, we just got a text of this bill on march 7. i think that's what you are seeing reflected. people are losing confidence in this institution because we are not adhering to regular order. the idea of 24 million americans losing health insurance is a big deal. like it is no big deal. i regret very much going on this path and i hope this bill loses.
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>> i appreciate you all on the side of the aisle. i wanted to start by talk about things we agree. when i thought i understood you to say was that you do see problems that need to be corrected but we don't need to change the system for everybody in order to correct these problems. >> you absolutely did. >> you have your very own. i thought i understood you to say that one of the things that your state has most appreciated is the way that they republican governor and mitt romney antidemocratic legislature work together collaboratively and came up with a solution working well in massachusetts.
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>> can i follow up a question? and with help from the furnace -- the heritage foundation. >> i valuable to those observations. i was not here in 2009, 2010. my frustration and the one i alsofrom folks so often as identified a real problem with the uninsured in america and instead of working on them collaboratively to solve the problem is we all agree needs to be solved, we instead change the system for everybody and jammed it through on a partisan method. bipartisan.on was i'm the first to confess that it looks very similar to 2017. i hope the cure is going to be better than the disease. we have a real challenge here of holding each other accountable.
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although we talk about the budget committee. although to think about the ways and means. it seems like we going out of our way to make this more divisive than it has to be. i agree with mr. mcgovern. i wish that the death spiral of obamacare was not happening so fast that somebody folks were not losing coverage so fast that the insurgency was not so paralyzing to folks back home that we could have moved more slowly in this process. we do have new members in the institution. i wish the death spiral was moving slower so we could have done better. that said mr. mcgovern knows full well that hr 3590 came over here from the summit with brand-new language that the senate worked out all by itself with no input from a single member of the house.
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not one single markup on that bill. this committee but the only , itittee on capitol hill went directly to the floor of the house having been examined by no one else. i don't think any of my friends the other side of the aisle will argue that is the right way to move legislation either. we know we can do better here. i want to ask about what happens next. i support this legislation. i don't think i can bring down health insurance costs without bringing down health care costs. i have a family friend who is a doctor in south georgia. he says i'm the only medicated doctor in the county. hand out as many new medicaid cards as you wants to. i don't have many more room in my waiting room. massachusetts, the longest in the country. a new study out yesterday 52 days on average. 109 days to see a family
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physician. what good is massachusetts health care to my family if i have to wait three months to get in the door to see a doctor? recently it rated as the healthiest state in the country. governor becker took full credit for it as well. the argument you make a couple of minutes ago, you're depending on the senate to fix this bill and send it back to us. >> i would be happy of the senate would pass the bill and move it on. >> can we get a hearing? >> i sit here with my friends from massachusetts and the boat said regularly i don't know what you are so upset about. the formal care act was the compromise. we want a single -- they want a single player. -- payer. i want more freedom. more competition. more involvement in health care.
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this is the compromise. my hope is that we will be able to build on that. was talking to a couple last week. they're both in their 50's. their children are grown. their understanding is they can't go out and buy health care plans that does not cover pediatric care for children they don't have an paternity for children they want cap. this would that we know, they're more expensive to insure. we'll still have to buy benefits they don't need. >> i appreciate your passion and intellect. if i could go to one thing. when i met with governor baker and a group of democrats and republican governors, he said to the group that what they had
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with romney care is different then the aca. i think you have to agree. what happened when obamacare came in as they saw an increase of 7% in the medicaid population and a 7% decrease in individual insurance population. they went from here to here. ie result for massachusetts believe, maybe dr. burgess would remember as well. i'm sure there is natural transition here and there, but that was one of the points he made. the irony is this is a state doing it on its own. this is what our states are. at the end of the day, 97% coverage. , 97% now.macare
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going forward what we looking at? i want to know why epipen became so expensive. palazzo became so expensive. how do we get composition? president has spoken out on this as well. we are looking at a buildup. we paid 100% of the premiums for people that work with us but we have 15 or 20 people working for us. i want you to get market power and put pressure on the insurers so i could negotiate. i cannot do that as a small business owner. being able to buy across state lines. we are working on legislation to do that. a lot of embedded programs where a lot of money flows into the health care system, we want to know what happens to it.
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there is 36.3 billion dollars in medicaid of improper payments. improper payments. think what you can do with $36 million. this is your after year after year after year. and care is actually higher displaced cost. what is driving these costs? we are dealing with 5% of the markets right here. what of the other 95%? they are paying these unfortunate and unnecessary high cost. oversight investigations team to begin the process and drilling down. figure out where these costs. get more choice, the possibility that might colleague is giving, offered a different group of people. did part b, we went through the same arguments.
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we said no we will let the market work. market with satisfied customers, 85% of seniors save you like medicare. the a lot of choices. the cost to the taxpayer is 52% less than what the congressional budget office said it would cost. if you have faith and create a market in the right way and empower consumers they are the most pointed -- cogent factors to drive down costs. choice is fleeing. one choice or no choice. how is that productive? their ideas keep going that direction. they did not offer reform amendments. what a think is wrong with obamacare? i think what we are doing is bipartisan like it was on opioids. on mental health.
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these are all things that really matter to the people that we live among next to us. getting mental health. dealing with the opioid issue. getting fentanyl into the country. helping people with mental health services. >> you make an important point. i regret sometimes it sounds like when folks tell me they have watched a hearing on tv, it's on the queer talking about who cares and does not. i reject that. we all care. to answer my question, we know that older americans are in the highest cost insurance up there. they might rather buy a plan generous on drugs --
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>> that is what the guthrie amendment allowed in the small markets. the flexibility away from the government mandated benefits. down, get rid way of the bronze, silver, gold, and on thee do that expanded medicaid we do away with essential benefits. remainicaid itself they but we reduce the not the government says you have to put in each of those to give flexibility so they can design plans that people might actually have to fit their needs. their lifestyle in their budgets. first of all, -- >> i had this discussion was virginia foxx many times before this committee. >> she regrets not being here. [laughter]
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>> this idea that we should go whereo a skeletal plan people choose whether they want hospitalization, maternal care is a huge mistake. is not like freedom of assembly. market where fair people are paying a fair rate cannot let people pick and choose because it will have the same effect if you don't cover a lot of people. it will increase costs for everyone else. a person will say i don't need that. for some reason they do needed and is not covered, everybody else has to pay because they did not provide coverage. i would also point out with regard to medicare part two, the aca plugs of the a lot of the problems. we get rid of the doughnut hole.
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creditpoint out to his that this bill does not get rid of those things. talk forever about how great part d was but we plug those holes up. we made it possible to seniors have the prescription drugs. >> you would not have had a donut hole there. >> give us credit for fixing it immediately and saying it worked. >> i would like to give us all credit for passing hit but in 1996 a bipartisan way. we don't have hearings about how to repeal the exclusions. about how to limit the fact that
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folks who don't play like the rules of a two-year timeframe to get back and it get themselves -- we did that together. i hear about so much that we can do together and i still come to these hearings and it sounds very different. i think we would all stipulate both sides of the aisle that we have six top health care experts sitting at this table and i am grateful. expert bygroceries final 43.49 per gallon. gallon.per i don't know whether i paid the right price for my mother's surgery diagnosed with skin cancer.
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took off half of my face. i don't know if i got the right price. do any of you know what i should be paying today? i had to go in for a ct scan. i shopped around, do you know what i should be paying? >> when the diagnosis to place you did not care. >> no. the diagnosis took place. got a plan and flew back home. i did not go to emergency room. i deducted from the urgent care center to the emergency room. they told me they could not take care of it, get on the computer and deal with my savings. i found of a ct scan was a saturday dollars in a facility beside me. if i were to drive 25 minutes of the row i could get it for $200.
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i was lucky that i have that sensibility. i suspect those of you can tell me what lasik might have costs. >> the newsworthy part is that you are a snowboarder. >> we cannot let this continue. the only reason i subscribed to the sunday paper is to get the coupons when they come out. we cannot lower the cost of health care without having , something we have worked on collaboratively. -- we can do these things together.
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i hope we can get to the transparency in cost. i can feel my excedrin into one pill, two dollars per pill. pill with the off name brand. i go to costco and they will give me $10. child hadother whose a seizure. which drive to the emergency room and walked to the emergency room the first thing she does not say is how much is this going to cost? >> that is not the issue. child of mother has a a 104 degree temperature, did opportunity to go to
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a primary care first? she has no choice to go to the emergency room. urgent care clinics. community health centers. where they said medicaid population is missing appointments, they cannot afford the bus fare. they built the click in the housing projects so folks would go there. they have personal-care people to walk folks to their appointment to make sure they got there. tore is so much that we can together. i regret instead of somebody some of that we are still wrapped around the angle. >> will a gentleman yield? >> my 45 years of living the i've beenring, -- sitting here thinking where do i insert this comment, but you are right.
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we are missing talking about one piece that is actually funded by the federal government. the department of health and the state and local levels. is good, simple, decent health care. we are missing that in this conversation. as we start talking more about where people receive their care, we have got to insert that in there. this is simple health care where you can actually find out what something really costs. i know that we are talking about continue, but as we dr. burgess can speak to this. we continue this conversation about the cost of health care and what is available to people. there are other available resources from local funding, state funding, and federal funding that have got to be made part of this. there are people as you have already referenced that have something right in the love their community.
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>> i want to applaud mr. woodall. he and i was the a few weeks ago walking down the hall and i think we solve the market problem. we had a similar solution. i want to raise this point, we talk about how we go forward. let's talk about where we have been to a certain extent. that havehe problems been created over the last few years were the result of things that happened after the passage of the informal care act. this report ruled that states did not have to expand medicaid so 19 states chose not to. upther thing is we set mechanisms to create competition by funding co-ops.
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that funding disappeared. in kentucky our co-op $60 million the first year. lost 60 million dollars the second tier. on the path to profitability and the safety net evaporated. that point you took one of the biggest competitors out of the market. tominating the risk or horse indemnify insurance companies when they had so many sick of and they would have anticipated. we had mechanisms that would have helped getting sustained competition and create better individual markets.
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> the debate changed america's mind> about the state market. chased america's mind about keeping children on their policies until they were 26. that can things there still be finding common ground. i wish as we go through this process in this time that folks would begin the conversation with there were folks that like their plan and were not able to keep it. there really were folks that were so unserved by the informal care act that they saw a penalty. there are families in tennessee down to zero insurers. left with no choice whatsoever. we can come together and fix that.
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>> i know you member to the federally qualified health can. -- plan. in the aca the biggest expansion we have ever had a federally qualified health centers in terms of numbers and services provided. the biggest problem that they are telling me right now is in this republican bill because of the cutbacks to medicaid that we have described today, they get a lot of third-party reimbursement from medicaid. they will not have the money to continue to do the things they do. i hope that we will have support. they will have less money because of the cutbacks in
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medicaid. >> you absolutely point out an area of broad agreement. much thinking i hear from everyone is to give away. everyone of our patients as skin in the game and that is so critically important you have to do more to serve communities but a no skin make this in the game operation. you have to have halt involved in their own health care. i look forward to being your partner this fall. i yield back. >> you mentioned the small business association. that the well be on the part of the house.
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>> we have been here three hours and i have had to a facility.go eyewitnesses have not. unwise if webe take five or 10 minutes for them to be able to research. >> i interject something. we expect to break for votes in five or 10 minutes. i hope everybody would be ok for that length of time. [laughter] aboutt trying to be nice what i know are continuous problems. >> maybe it is that i am 80 in the kidneys are -- aging
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all of us know the baby boomers are amongst us in significant numbers like 10,000 every week. pulling them are going to be the other generation who are aging as well as. somewhere along the line that will be as much our responsibility and those that succeed us as anything. on, my colleagues from massachusetts, i would like to yield to him. >> i wanted to respond to say about massachusetts, we are the healthiest state in the nation. you should all try to be like us. number two, you mentioned a study. there was a study. doctorsle size for nine and 20 and --
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officers. i don't know whether if you think nine is a good sample size -- >> i would say i don't contest his numbers. add that this is a study that has been going on every year for the past decade and the leader of the massachusetts medical society agrees with that conclusion. said massachusetts doctors affect medicare at 100% acceptance rate. something a lot of your states don't do. gentlemen would rather talk about an issue that has nothing to do with the underlying bill when it comes to transparency in pricing. i think could be a bipartisan issue. you guys have had seven years. if you wanted to put that in there you could have. it had nothing to do with what
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we're talking about today. this actually tears things down and take things away from people. we have to focus on what this does. we're dealing with a bill that has --\ itcontinuing to debate as continues. we are going to show you another portion of the hearing. we will hear from nancy pelosi and cindy lawyer. >> are delighted to have a new panel.


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