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tv   Democrats Defend ACA as GOP Searches for Votes to Replace it  CSPAN  March 23, 2017 3:07pm-6:27pm EDT

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but we are not there yet. we are waiting to hear more from house speaker paul ryan at 3:30. until the speaker arrives, we're going to show you that debate from the house floor this morning. mr. sessions: rules committee will come to order. good morning. welcome to the rules committee. today the committee will consider h.r. 1628. the american health care act of 2017. on march 20, 2010, the rules committee met in this very same room of which i was a part of that meeting. and passed the senate-crafted language and the house bill that would a ultimately destruct and
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devastate our nation's health care system. the american people were promised by the president of the united states, who was so supportive of the bill that even . entually took his own name his party and the bill would lower premiums by $2,500 per family, per year. he promised the american people 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 be more choice, more competition, and lower costs for millions of americans. now seven years later, almost to the day, it is abundantly clear
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that this affordable care act, has failed acare, the american people and the health care system and the people it was designed to help the most. as to the promises, premiums have increased by an average of 25% this year alone on the obamacare exchanges. ruining the pocketbooks of american families and a far cry from the $2,500 reduction that they were promised for each family. at least 4.7 million americans 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 taxeses, mostly falling
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on families and job creators. additionally 18 to 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 now on a track that hurts american workers. and their hours. an equivalent of at least two 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 businesses across this country
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desperate for answers. nearly 1/3 of the united states counties currently have only one insurer offering exchange plans, and quite frankly, it is getting worse. that's not competition and that's 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. h.r. 1628, the american health re act of 2017, eliminates washington's one-size-fits-all health care plan. it dismantles the obamacare taxes, it eliminates the individual employer mandates, it prohibits health insurers from denying coverage and helps young adults across the country have access to health care while stabilizing and restoring a free
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market for all americans. most importantly, this legislation empowers individuals, families to make their own health care decisions. it helps low and middle income families across the country to have affordable quality care by providing monthly tax benefits an ensures parity to unequal today marketplace. americans deserve a competitive insurance marketplace that provides quality care at an affordable cost. for that reason, i'd like to the gentlemen and gentleladies who have been a part of the development of this plan, the architects of this legislation, from oregon, the gentleman, greg walden, the chairman of the energy and commerce committee, the gentleman from texas, montgomery county, texas, kevin brady, who i came to congress with. and the gentlewoman, congresswoman black from tennessee. the chairwoman, we're delighted
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you're able to join us this morning on this first panel. as well as their ranking members. thank you for being here today. to complete our promise to the american people. i'd also like to welcome their panel of ranking members who are no strangers to the rules committee. for their time before us. obviously the gentleman, mr. yarmuth, the gentleman, mr. pallone, the gentleman, mr. neal. without objection, anything you have in writing will be entered into the record. before i yield to the gentleman from hood river, oregon, i would like to defer to the ranking member of this committee, the gentleman from massachusetts, and let me say this. our colleague and gentlewoman, ms. slaughter, who is the long-term member of this committee and actually the ranking member, is still in the hospital. not feeling as well. chest colds are tough.
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when you live in syracuse, new york. and i want us to know that we could still and should keep her in our prayers. but i called her yesterday. she can't wait to get back. she can't wait to get her hands on me. i mean, on the bill. [laughter] but the spirit that ms. slaughter has brought to this committee, the spirit of which she represents her party and ideas, not just from syracuse, new york, but really across this country, is amazing and i'm going to miss her today and i want us to know that she'll be back shortly. and she promises to be full of vinegar and a lot of words. so, before we go too far, i'd like to go back to the ranking member. the gentleman from massachusetts is recognized. mr. mcgovern: thank you, mr. chairman. i talked to ms. slaughter this morning and i assure you, she's watching all of us today.
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[laughter] and taking notes. but, mr. chairman, before i begin my opening statement, i would like to ask a question. it's the same question i asked last night. and that is whether or not we've received an updated c.b.o. score that takes into account the several manager's amendments that we received last night and monday night. mr. sessions: that's a good question. i'm going to give the same answer that i gave probably at least once or twice on the rules committee and once on the floor. the congressional budget office is made up of professionals who are trying to get as close to the answer as possible. that it does me no good to try and tell them their answer, nor their time frame. they have an order that they're attempting to get placed right now. and in fact, the gentleman, mr. brady, who is the chairman of he ways and means committee,
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has indicated publicly that we will not go to the floor without that c.b.o. score. with the answer that i have given is that we fully anticipate it sometime in the early evening or the evening tonight. so as we go through this, i would say that there will be a chance for the gentleman, mr. brady, or the gentleman, mr. walden, or the gentlewoman, chairman black, to forthrightly ddress that, to make any addressing to my assertions that i make today. mr. mcgovern: does that mean we won't report a rule out for consideration of the bill? mr. sessions: i'm going let us get the real answer. because what i gave was an answer about a day and a half ago. i don't know what the current mark is. i know the staff director for mr. walden has a direct line to c.b.o. in as much as being able to get the next guess. we will get that back to you. mr. mcgovern: the reason why i ask is because the last c.b.o. estimate showed that this bill would kick 24 million people off
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of their health insurance. and the brookings institution says that the managers' amendments are unlikely to reduce the number of people c.b.o. estimates will be pushed off their health plans. and in fact, and i quote, they say it is possible that it's revised -- its revised estimate could be somewhat higher. so, mr. chairman, i appreciate your answer. but it strikes me as odd that we are proceeding without all the information. i see a woman sitting in the audience here with a t-shirt that says, what's the rush? i don't know why we just don't wait to consider this bill until we have all the information. given that fact, i feel very strongly about that. i don't think we should be meeting on a bill when we don't even know how many people will will hurt. mr. chairman, i move that the committee adjourn until we receive a revised c.b.o. estimate. mr. hastings: i second that motion. mr. sessions: thank you very much. there's a motion on the floor. the motion is to adjourn. do we have any discussion?
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does anyone wish to discuss this? mr. hastings: yes, i do, mr. chairman. mr. sessions: the gentleman is recognized. mr. hastings: mr. chairman, mr. mcgovern makes the point. and i find it disconcerting that we're going to proceed here today. harkening back, at least you and my dear friend from oklahoma were here when the democrats passed their measure. and there was a lot of discussion. i remember dr. burgess, who is not here, but i remember him railing actively about the fact that we didn't have the c.b.o. score. now, logic dictates that if the congressional budget office has said 24 million people, and footnote right there, i keep hearing arguments, some people say it's 24 million. other people say it's 14 million. some say it's 12 million. someone too many.
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-- one is too many. that needs to be clearly understood. it is it is -- this is a country where everybody has the right, i believe, to have insurance. so, i guess ultimately i don't think we can blame c.b.o. when you keep changing the rules. and the question that i have for you is, is the manager's amendment already scored? i'll ask congresswoman black this question. when you're doing your work, is that manager's amendment scored? and since you're having difficulty getting to 216, are there other things that are going to to cause the c.b.o. core to change when you add or detract things in order to sweeten it for members to be able to vote for the measure? this is very disconcerting. we did not proceed this way.
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we did do things, i think, substantially more hearings. a considerable amount of morin put. and at the very same -- more input, and at the very same time when we did get to this stage, we had the congressional budget score. and i think it's critical. mr. sessions: thank you very much. we'll now move to the motion. the motion is to adjourn. those in favor say aye. those opposed, no. the noes have it. noes have it. mr. mcgovern: ask for roll call. mr. sessions: the clerk will poll the committee. the clerk: mr. cole. mr. cole, no. mr. woodall. mr. woodall, no. mr. burgess. mr. collins. mr. collins, no. mr. byrne. mr. byrne, no. mr. newhouse. mr. newhouse, no. mr. buck. ms. cheney. ms. cheney, no. ms. slaughter. mr. mcgovern. mr. mcgovern, aye. mr. hastings. mr. hastings, aye. mr. polis. mr. chairman.
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mr. sessions: no. the clerk: mr. chairman, no. mr. sessions: the clerk will report the total. the clerk: two yeas. eight anyways. mr. sessions: i'm sorry. could the clerk please report the totals. the clerk: two yeas, seven anyways. mr. sessions: the motion is not agreed to. not agreed to. i would like to, if i could, state, so we're able to get a clear understanding, as many members of congress were not here. charlie rangel, the chairman of the ways and means committee, that day when i asked him about the c.b.o. score, said, one was not necessary. it wasn't like they didn't have it prepared. it was unnecessary because mr. sessions, it will add millions and millions of jobs. it will be the great aest single job creation bill ever -- greatest single job creation bill ever passed by the congress. that's a little bit different and a far cry from the story that's being told today. now seven years later. secondly, i hope they were able to ascertain the difference
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between the c.b.o. said there may be some number of people who are not covered, versus being kicked off their health care plan. i believe the testimony today from our three witnesses will reveal that we don't really anticipate anybody being kicked off their plan. unlike the 4.7 million people who were kicked off their plan by obamacare. so, there's 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 c.b.o. we're delighted that each you are here. mr. mcgovern: do i get to do my opening statement? mr. sessions: the gentleman would be allowed to complete that, yes, sir. mr. mcgovern: good morning. i hope everybody fueled up on coffee and doughnuts. i want to thank the rules staff for getting dunkin' donuts
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coffee from massachusetts. best coffee in the world. because we've got a lot to say about this bill. and none of it is good. first, let me just lay out what the bill actually is. it is a massive tax cut for millionaires and billionaires. paid for by taking health insurance away from 24 million people, period. anyone who takes five minutes to look at any unbiased analysis of the bill knows that this is true. massive tax cuts for the well off at the expense of 24 million people. sometimes i think my republican friends have lost their human ability to feel what 24 million people really means. so let me paint a picture of how big that number is. 24 million people is basically the entire population of the country of australia. it is more people than live in the states of kansas, new mexico, nebraska, west virginia, idaho, hawaii, new hampshire, maine, rhode island, montana,
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delaware, south dakota, north dakota, alaska, vermont, wyoming and the district of columbia combined. you know, you know how i know this bill is a tax giveaway for the wealthy and not a health care bill? because according to the nonpartisan congresslal budget office analysis, and this is truly incredible, it would actuality tulely result in more people being uninsured than if the affordable care act were simply repealed. let that sink in for a minute. second this bill will cause people to pay more out-of-pocket dollars for lower quality health insurance. you're asking people to pay more for less coverage. in particular, lower income and older americans will see their costs skyrocket. those people who can least afford to pay more. third, and this is a big one, this bill guts medicaid and medicare. don't take it from me. the aarp said, and i quote, this bill would weaken medicare's fiscal sustainability, dramatically increase health
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care costs for americans age 50 to 64, and put at risk the health care of millions of children and adults with disabilities and poor seniors who depend on the medicaid program for long-term services, and supports other benefits, end quote. in fact, americans age 50 to 64 will pay premiums five times higher than what others pay for health coverage. no matter how healthy they are. this bill is an age tax. plain and simple. and you're cutting $880 billion from medicaid. that's a 25% cut in funding. all this to give tax cuts to the rich and to corporations. the bill must look like a cruel joke to the most vulnerable among us. representative brooks, a member of the republican conference, said just last night, and i quote, quite frankly, i'm persuaded that this republican health care bill long-term is a detriment to the future of the united states of america. end quote. finally, this process is horrendous.
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the republican majority rushed their bill through the committee process without any hearings. just holding marathon markups where no democratic amendments were accepted. they didn't even wait for c.b.o. score. then when the score finally came, it showed the bill would kick 24 million people off their insurance. did they stop then? no, of course not. we're still full steam ahead, only now we have a cobbled-together manager's amendment. i'm sorry, we have four cobbled-together managers' amendments, since the originals had errors. again, no c.b.o. score. didn't you learn your lesson last week? even worse, this manager's amendment, which we received just 36 hours ago, is full of backroom deals like the buffalo bribe, a cynical agreement with wavering new york republicans who know the republican health care plan would devastate new york. and now they're saying, don't worry, if you don't like this bill, it it's just one -- it's just step one of three. you'll get another chance to vote on health care during step three. never mind that they can't give
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us the full slate of bills that are part of this mysterious step three. or maybe i should just take senator cotton's word for it. and he said, and i quote, there is no three-step plan. this is just political talk. it's just politicians engaging in spend, end quote. ted cruz from your state, mr. chairman, called the third prong of this three-bucket strategy, quote, the suckers bucket, end quote. the suckers bucket. so please slow down. think about what you're doing. don't jam this disastrous bill through the house with patched-up fixes. wait for a revised c.b.o. score. listen to what members of your own conference are saying. or better yet, don't do this at all. it's clear that you never really had a plan to replace the affordable care act. don't represent -- pretend you did and then make our most vulnerable pay the consequences. this is a lousy bill. this is a lousy process. and quite frankly, we should not be considering in this kevment i thank the chairman and i yield back the balance of my time -- committee. i thank the chairman and i yield back the balance of my time.
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mr. sessions: thank you very much. we appreciate the gentleman's opening statement and comments related to that. witnessesn to the six that we have. ladies and gentlemen, what we're going to do is go through a very disciplined, straightforward process here. an that is, i'm going to first acknowledge the gentleman from oregon, the gentleman from the energy and commerce committee, then i'm going to go to the gentleman from texas and let him explain his part. then, mrs. black, i'm going to let you do your part. then we'll go to mr. pallone, mr. neal, and we will go to mr. yarmuth. i want you to know that this committee has attempted to do our homework. but we're here to listen also and listening is an art that our members have gotten very good at. and so we want to make sure that as you speak, please remember that microphone needs to be as close as it can to you. this is a difficult room. and that the green light is turned on.
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and the gentleman from hood river, oregon, is now thanked for being here and the gentleman is recognized. mr. walden: i thank the chairman. i first want to concur on your thoughts about ms. slaughter. she lives just up the street from my old place here in washington, d.c. she's a fierce fighter for the liberal side of the democrat party and we wish her full health and quick recovery. additionally, mr. chairman, i want to wish you happy birthday. can't think of a better place to spend it than right here with you. [laughter] mr. sessions: 50 again. mr. walden: not every day you turn 50. today's not that day either. [laughter] mr. sessions: the gentleman to your right is getting ready to have a birthday around here too. don't forget the gentleman, chairman brady. mr. brady: you're throwing me under the bus. mr. walden: we appreciate the opportunity, mr. chairman. i know your committee members have questions. they have a lot of interest in this bill. many have ppt -- participated in its crafting. so if you'll indulge me. i'll walk through it.
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in dedaily. so to answer as many questions as possible in advance. first, i want to you know that the energy and commerce committee has convened 31 oversights on the affordable care act. oversight hearings on the affordable care act. the subcommittee on oversight and investigations convened 18 hearings. the subcommittee on health convened nine. the oversight and investigations and health subcommittee convened one joint hearing. the full committee convened three hearings over the last several years. to look at what was working, look at what wasn't working, and as you know, the congress in a bipartisan way on multiple occasions sent president obama legislation to repeal parts of obamacare that were not working. and he signed 20 of those into law. 4,775 votes of those folks voting to make changes in obamacare came from the democrats. so, even democrats have recognized there are problems with obamacare that needed to be fixed. we've had 107 witnesses testify before the committee during that multiyear process. 38 of those were administration
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witnesses. the committee released five investigative reports in the 114th congress, including 59 findings and nine recommendations. all of that work over the last 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 based on pre-existing conditions. this is something we've heard from both sides. i hear it at home, i believe it fully. that just because you've been strict within a health disease should not preclude from you being able to get insurance you can afford. so we kept in place provisions making sure that people could not be denied insurance because they have a pre-existing health care condition. second, our plan helps young adults gain access to health insurance and stabilizes the marketplace, by allowing dependents to continue staying on their parents' plans until they're 26 years of age. this was a republican idea that existed before there was an obamacare. and it's something we feel strongly about.
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our plan proposes a new patient protection for patients who maintain continuous coverage. similar continuous coverage protections have already existed for the vast majority of americans who get their insurance through their employers. it's similar to what is also done in medicare part b. and medicare part d. so we build on those successful provisions to make sure that continuous coverage protections remain. when patients wait until they're sick to seek coverage, it disrupts the entire marketplace. so it's unfair to everyone else. continuous coverage protects -- protections incentivize patients to get and keep health care coverage. in our plan, this protection would apply plie to patients in the individual and small group market as well. so these are new protections. continuous coverage protections will protect those with pre-existing conditions, geanchting, mr. chairman, -- guarantees, mr. chairman, access to coverage. prohibits benefit exclusions and banning premium rating based off of health status.
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so they can't jack up your health care prices for your insurance because you have a pre-existing condition. extending these protections, the individual and small group market is a simple but important reform that will encourage patients to enroll in coverage and stay enrolled. now, some may suggest continuous coverage would lead to higher premiums based off of health status and pre-existing conditions. i think we've heard those fault false charges. they are false -- false charges. they are false. our plan would guarantee access to coverage, prohibit pre-existing condition ex clues, an premium rating. this applies to everyone who remains enrolled in a health insurance plan. whether that individual is switching from employer-based health care to the individual market, or within the individual market. the employer market already has a definition of continuous coverage that allows for gaps of up to 63 days. so you have time in between. right now plans share information to certify and disclose if any applicant has maintained continuous coverage.
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we would bring this same standard to the individual market. it's long overdue. again, medicare parts b and d have similar basic continuous coverage frameworks. to prevent individuals from gaming the system and lower premiums for everyone as a result, our plan allows for a flat surcharge on top of patients' base premium until they reach continuous coverage status. so we take those out of the system that would game it, and say, you have to be responsible and maintain continuous coverage. our plan would protect patients living paycheck to paycheck, giving them a hardship exemption if they're unable to pay one month's premium. as long as patients catch up on their payments, they boo fat -- would not lose this important continuous coverage protection. we envision one open door, one enrollment. so patients without continuous coverage stat russ not treated unfairly for something that's previously not been in the law. to attract younger enrollees, individuals coming off dependent coverage, we're talking about those potentially 26-year-olds getting into 27, are allowed a
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one-year grace period, since it would be their first year as an active purchaser. if an individual experiences a qualifying life event, he or she would not be charged more than the standard rates, even if they're dealing with a serious medical issue. so we protect people with pre-existing conditions, we take those few people who are gaming the system and make them act more responsibly, we provide for continuous coverage. these are very important principles contained in this law. medicaid. our plan refocuses medicaid's limited resources to the patients most in need, mr. chairman. we're talking about the low-income adults, children, pregnant women, elderly adults, people with disables -- disabilities. we do that by responsibly unwinding the medicaid expansion y freezing new enrollment in obamacare's expansion and grandfather existing rollees. we put medicaid on a sustainable budget and we empower states with new freedoms and flexibility to run their medicaid programs. medicaid is a critically
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important program. it 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. this is a state and federal a partnership. medicaid currently covers more than 70 million of our fellow citizens. for more than a decade, the government accountability office, however, has told congress that medicaid is a high-risk program. high-risk program. in 2018, total medicaid spending will be larger than our nation's defense budget. by the end of the decade, total medicaid spending will cost taxpayers $1 trillion. last year alone the g.a.o. reported there were $36.3 billion in improper payments in medicaid. i've met with g.a.o. they've testified before our committee. this is a problem that must be addressed. because that $36.3 billion
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should be going to help those most in need, not going out to improper payments. this is just not a fiscal issue. it's an issue that jeopardizes the ability of federal and state governments to take care of the most vulnerable among us. who rely on this program. can he wwe need to put medicaid on -- we need to put medicaid on a budget and give states greater flexibility to manage the program to best benefit their citizens. obamacare forced states to expand medicaid to cover able-bodied adults or lose their federal medicaid funding. after the supreme court's 2012 ruling in the nifb vs. sebelius case, the requirement was unconstitutional, mr. chairman. some states still chose to expand medicaid eligibility to people under the age of 65 with income up to $13 -- 138% of the federal poverty level. obamacare also provided enhanced federal funding for expansion. and the federal government covering 100% of the costs through 2016. in 2017, the federal government pays 95 cents on the dollar for
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each expanded enrollee. that amount gradually diminishes to 90% under president obama's plan. by 2020. this policy creates a gross inequity in the law because the federal government, think about this, mr. chairman, covers a higher percentage of the cost of care for able-body idea adults than it does -- able-bodied adults than it does for people in poverty, who are disabled, elderly or children below the poverty level. our plan will not pull the rug out from anyone. for 2017, 2018, and 2019, stateds with medicaid expansion enrollees can continue to receive the enhanced federal match available under current law for these enrollees. individuals who are medicaid expansion enrollees can remain enrolled as long as the state kept the program and they otherwise remain eligible and they would continue to receive that enhanced match. that 90% match. so if you're on it today, you're on it tomorrow, you can stay on it. until you no longer qualify for medicaid. because maybe you got a job that
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pays you a lot more and you're no longer eligible and you get your insurance through your employer. this grandfather population expansion of enrollees, we believe and c.b.o. believes, will leave the medicaid rolls at some point, as they naturally move up. on or after january 1 of 2020, if a state with medicaid expansion keeps the ex padges, -- expansion, individuals otherwise eligible for the expansion program could still enroll in the program. however, for any new medicaid expansion enrollee, the state's expenditures for such person would be matched by the state's regular medicaid match rate. so that range is somewhere between 50% and 83%, i believe is the range. oregon's about 63%. so those people who are now at a higher rate, they can still be added but they would be matched at a lower rate. we're asking our partners to step up to help keep these people on. the plan also provides $100 billion to design programs that
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meet the unique needs of patient populations and low-income americans. this is, i think, a really important facet of this. is the $100 billion patient and state stability fund, which i'll get into in just a minute. because i know you want me to get into detail on these issues. so we propose a per capita allotment to determine a fair level of funding for states based on the number of enrollees in each unique medicaid population. this type of allotment has been supported by members of both parties, mr. chairman. not just by 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 allotments a number of years ago as an appropriate means to manage medicaid going forward. a per capita allotment reform protects the individual entitlement and does not change medicaid rules regarding access to care. pecifically our per capita
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reforms proposed in this legislation do not alter, do not alter general eligibility standards and pathways, so you can still get on under the same ways, we do not alter protections, we believe in them for the disabled, the elderly and children. the requirement that states pay their fair share under the federal medical assistance percentage, that's their matching rate we do not alter, coordinatinging with exchanges in individual market coverage. we don't change the children's health insurance program, which we believe is very important and our committee will take up and re-authorize later this year. coordination efforts for individuals who are dual enrolled in medicaid and medicare, and current efforts to improve quality of care and delivery systems. talking about flexibility, mr. chairman. because this is important. we can do some things in this legislation, as you know. there are many other things that secretary price should be able to do through authorities granted to the health and human services secretary under federal law.
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under our plan, states would receive federal funding allotments for each of the major beneficiary categories. aged, blind, disabled, children, and adults. and it would be based on the number of enrollees in each of these categories in their state. a state's total allowable allotment would be calculated as the sum of the total number of people, the enrollees, across these eligibility groups. so you take what they're getting, what they're paying, and that against the population. this formula would represent the total amount of federal funding for which a state would be eligible to receive federal matching funds. this total, computeable approach provides flexibility to governors and state leaders in implementing the policy. importantly, a per capita allotment is not a limit on funding for an individual medicaid beneficiary. it doesn't 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. if an individual's care is more
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expensive than average, federal funding could continue to be used to pay for it, as long as the state as a whole did not exceed the sum. our plan would make additional commonsense reforms to medicaid, including something our oversight and investigation subcommittee and health subcommittee lookedality under dr. burgess. lottery winners who win -- there aren't a lot of these, by the way. but there are some. it's been brought to our attention by states and colleagues, cases where you win the lottery and you get to stay on medicaid. because they don't count the winnings today. we don't think that's fair. so we take care of that in this legislation. while it's not possible to get all the flexibility states may desire through the expedited process, the budget reconciliation, working with the trump administration, states will have the ability to seek additional flexibility through their programs. mr. chairman, we're 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
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and stability fund. in order to stabilize health markets damaged by the current law, and to ensure all americans have access to affordable health care, states need well-functioning and stable marketplaces that encourage and incentivize patients to get covered and stay covered. both the patient and state stability fund and introducing age rating reform will give states the flexibility to bring down health care costs and strengthen the market. so let me start with the patient stability fund, mr. chairman. because i know this is important. our plan provides a solution to help prepare the insurance market by providing more affordable coverage options to consumers. the patient and state stability fund. this fund will help states lower the cost of care for some of their most vulnerable patients. his bill provides $100 billion to design programs to meet the unique needs of patient populations and help low-income americans afford their health care. before obamacare, state-specific high-risk pools were
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program-specific. limiting the flexibility of innovation, the local officials could use to meet the unique needs of diverse communities. we want states to be the great innovators that we know they want to be, and they can be. so the patient state stability fund would give states flexibility and program design. they could use the money in this fund to cut out a pocket costs like premiums and deductibles. we care what those costs are to the people we represent. we have a fund here that will allow states to access money. by the way, that starts in 2018. that doesn't wait until 2020 or 2021. so some of the same subsidies today will continue, but also be augmented initially by this fund. right away. so they can do a lot in the meantime to fix this marketplace. they can arrange partnerships with health care providers to support their efforts to provide care. they can help with higher--- high-risk individuals. without access to employer-sponsored coverage or
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access coverage in the individual market. they can provide incentives to appropriate entities to help a state stabilize premiums in the nongroup market. they can reduce the cost of providing health insurance coverage in the individual and small group markets for high-cost individuals. they can promote participation in the nongroup and small group markets. and increase options that are available. we're about giving people new options, better options, and helping on the affordability piece. we can promote access to preventive services. dental or vision care services. or the prevention treatment and recovery for individuals with mental or substance abuse disorders. this is important to all of us. 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 at the end of last year, to address issues of mental health and substance abuse. we put $1 billion in to deal with opioid abuse. these are in addition to that and pay health care providers. so, mr. chairman, we've got a
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lot more to talk about. i know you have other witnesses. i appreciate the time to get this far into the presentation. we believe we're going to give people new choices and better choices. we think we will far outperform what c.b.o. says. and that we can restore this market before it collapses. if we act now. if we act now. so, mr. chairman, i yield back the balance of my time. i look forward to hearing from your members and further discussing this very important piece of legislation. mr. sessions: thank you very much, chairman walden. chairman brady, welcome to the rules committee. we're delighted that you're here and the gentleman is recognized. mr. brady: thank you, mr. chairman. ranking members, members of the rules committee. thank you for allowing me to stify before the american -- welcome. thank you for having me. thanks for allowing me to testify in support of the american health care act. thank you for your consideration of this important legislation, repeal and replace the affordable care act. the affordable care act, also known as obamacare, has been one failed promise after another.
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the fact is this law has hurt far more americans than it's helped. millions of americans have lost access to the health plans and doctors of their choice. out of pocket d costs are just skyrocketing. and free market competition in health care has all but disappeared. the american health care act, we have the best opportunity in seven years to repeal this sinking ship of obamacare. clear the deck and give our step by step process -- begin our step by step process of delivering a health care system that truly works for the american people. president trump called on congress to take decisive action now on health care reform. this legislation answers the president's call to action in a thoughtful, cl deliberate way that americans truly deserve. the ways and means portion of the american health care act is focused on achieving two important priorities. first, delivering swift relief to the american people by repealing obamacare's most harmful provisions. we end the individual mandate
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tax penalty that's forced millions of americans into plans they do not want and cannot afford. we end the employer mandate tax penalty, which has burden our local businesses and made it harder for them to grow their companies, to hire new workers, and raise wages. and we repeal obamacare tax hikes that have driven up costs for the american people. and reduced access to high quality care. our second priority with this legislation is deliver on our promises to replace obamacare with patient-focused solutions that truly expand choice, that lower costs and enhance competition. here we are taking action to reclaim control of health care from washington and put it back where it belongs. with patients, with families, and with states. we expand health savings accounts and make them more flexible and user friendly. this will give patients and families much greater freedom to save their health care dollars for the future and spend them as
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they see fit. we protect health coverage for the more than 150 million americans who receive it at work. and for low and middle income americans who don't receive coverage through work or federal programs, we offer an advanceable, refundable tax credit. that people can use immediately to help purchase coverage that works best for them. not washington. these tax credits provide a much better free market alternative to the inefficient obamacare subsidies that exist today. they will deliver support to low and middle income americans while also encouraging greater competition and greater innovation in the health insurance market. and with greater competition there will be more choices for the american people. lower costs and better coverage that's tailored to the needs of patients and families, not washington. finally, to further ensure the american health care act accomplishes these important priorities for the american people, i would ask the rules committee to make in order the
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managers' amendments to the bill. these amendments, which were made public on monday evening, followed by a second agreed technical amendment yesterday to correct drafting errors, take important actions to strengthen the american health care act. they will better ensure that all americans have the help they need to access the care again that's right for them. specifically, they will find an additional $85 billion in tax relief by further reducing the medical expense deduction threshold for americans with high health care expenses. many of them in the 50 to 64-year-old range. just last year, aarp supported a similar bill lowering the threshold to pre-obamacare levels. according to aarp, quote, for the approximately eight to 10 million americans who annually take this deduction, it provides important tax relief which helps offset the cost of chronic medical conditions as well as long-term care. unquote.
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this new tax relief creates new resources available to the senate, provide assistance, including enhancing the tax credit to older americans who purchase insurance in the individual market. in combination with the age-based tax credit and patient and state 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 access to patient-centered health insurance. furthermore, these manager amendments will provide more immediate relief from obamacare's burdensome taxes on families and our local businesses, moving up the date of their repeal from 2018 to this year, 2017. they will strengthen protections for the right to life, by ensuring that only the amount of tax credit that is needed to cover the premiums is used, rather than allowing the excess to roll over into a health savings account. this further ensures federal dollars cannot be used for abortion services.
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finally, they'll help guarantee that this legislation meets our reconciliation requirements so that it can maintain privileged status in the senate and move quickly to the president's desk. closing i want to thank chairman walden and chairman black for your leadership on the american health care act. again, i want to thank the rules committee for your consideration of this important legislation. mr. chairman, i look forward to taking your questions and i yield back. mr. sessions: chairman brady, thank you very much. chairwoman black. welcome to the rules committee. we're delighted that you're here. i know you're showing up with your ranking member who is ably up to the task as well. we're going to welcome you at this time. mrs. black: thank you, mr. chairman. good morning to all of you and all the members of the committee. especially to my ranking member of the committee. i want to thank you for this opportunity to speak here today. and i come before you to discuss the 1628 american health care act of 2017. the american health care act is
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the first step in our efforts toward patient-centered health care reform. the bill seeks to give american people freedom and choice in 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. and it brings the free market principle of competition to an industry that has long been dominated by government intervention. we're united in our goal to repeal obamacare and replace it with a patient-centered health care. right now obamacare is imploding. we were promised that premiums would indecember -- would decrease by $2,500 and instead average family premiums in the employer market soared by $4,300. we were promised that health care costs would go down. instead we see deductibles have skyrocketed. we were promised that we could keep our doctor and our health care plans. instead millions of americans have lost their insurance and
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the doctors that they liked. in short, the affordable care act was neither affordable, nor did it provide the quality of care that the american people deserve. last week the 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 lively debate and i applaud our members for working to make this bill better. there was concern from members of my committee that this bill did not reflect a strong enough conservative vision for the health care reform and join them in that concern. the budget committee approved four motions to be recommended to this committee and the full house as it laid out in our report. these motions describe potential changes that would address our concerns, including, number one, greater state flexibility in the design of their medicaid programs. number two, minimizing the new medicaid enrollment by able-bodied adults. number three, promoting work
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requirements in the state medicaid program. and number four, ensuring that tax credits are targeted to those individuals who need them most. the managers' amendments submitted this week includes changes advocated by our committee. this is a way the legislative process is supposed to work and i applaud my colleagues for staying in the fight and making sure that we pass a bill that truly reflects our values. it goes a long way toward resolving some of the conflict and disagreement within our conference and addressing the concerns of my committee. it is our -- it is a step in the right direction and i urge the members of this committee to support it. we have a once in a generation opportunity to reform health care with a free market principle in the driver's seat, not government. it's our opportunity that we cannot let pass by. as this bill continues to better reflect our patient-centered vision of health care, we will soon be faced with a stark
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choice. the choice is between repealing and replacing obamacare and voting to keep obamacare status quo. while no legislation is perfect, this bill does accomplish some of those important reforms. it zeros out the mandates, it replaces -- it repeals taxes. and it repeals subsidies. it allows people to choose the health care insurance plans to meet their unique needs of their families, instead of purchasing a one-size-fits-all plan that has been mandated by washington bureaucrats. and 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 deficits and our growing national debt. put simply, this is a good first step. but it's only a first step. my good friend and our former colleague, dr. tom price, will use his position as the secretary of health and human services to address some of the
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regulatory burden of obamacare through hised a -- through the administrative action. and we will vote soon on individual pieces of legislation to implement even more patient-centered free market reforms that we cannot address through reconciliation. this is a three-pronged process. and we are -- that we are taking to rescue the american people from a damaged obamacare that has done to our economy and our health care system. but as we talk about our work to repeal obamacare, and replace it with patient-centered reforms, we also have to remember that the problems with obamacare are not merely numbers on a pages. i've 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 that we had in the state of tennessee called tenn-care. it was a pilot project. i saw costs rise and quality of care fall. it's what inspired me to get involved in the public sector, public service sector to begin
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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 here to congress, having experienced this previously. i get calls every day in my office, and i'm sure that many of you do as well, saying please help us, rescue us. my state, premiums in my state have skyrocketed. there are actually parts of tennessee that don't have a single insurance provider in the marketplace. not one. while in other parts of my state, people may have an insurance card, but they 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 for repealing and replacing obamacare. it's a promise that we made to our voters for years and it's a promise we finally have an opportunity to keep. and i intend to keep that promise. i urge all members to work toward a common goal and with that i look forward to answering
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your questions. mr. sessions: thank you very much. as i previously indicated, i'm going to attempt to go now in order with our colleagues that are here as ranking members, and the gentleman from new jersey, mr. pallone, would be acknowledged and -- it's all ok? ok. the gentleman is recognize -- is ecognized. r. pallone: mr. pallone: i would like to respond to what some of my colleagues have said. when we put together the affordable care act seven years ago, 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 the health insurance was
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lousy, it was skeletal, didn't provide much in the way of benefits and premiums and costs out of pocket were continuing to go up. double digit for the most part every year. so i think that we put in place something that we believe addressed that. you know, the number of people that are uninsured has gone down considerably, something like 95% of americans now have insurance. maybe some areas where there's significant cost increase. for the most part costs have slowed, they're in the single digits, even lower single digits for the most part. when you come along as republicans and say you want to repeal this, the burden is on you to say why it's going to be better. buzz we think we have created a uch better system.
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in response to my own chairman, first of all, he mentioned hearings. there were no hearings on this bill this bill was given to us i think maybe two days, a monday, then we started the markup on wednesday. and speaker ryan said there would be regular order. there was not regular order by any imagination, frankly. also, i think that it's significant that my colleague, chairman walden, talked about the fact that many parts of they have a.c.a. are not repealed, pre-existing conditions, all the discriminatory practices that existed before. so i do want to thank, i know there's not much mention of it, but thank us on the democratic side for actually putting together something that for the most part you're not repealing, ok. but unfortunately, the things you are repealing are the things that i think are the most
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important and that is people's ability to afford coverage. and people's ability to pay for the coverage. the biggest problem right now because chairman walden keeps talking about guaranteed access, guaranteed access to me is nothing if you can't afford your premium. it's nothing if you have insurance but can't get health care because deductibles are co-pays are too high and you have to pay more out of pocket. this is not an issue of access. this is an issue of whether you're going to be able to afford insurance and whether you'll be able to afford to have the health care even if you do have insurance because you have to pay more out of pocketful he also mentioned continuous coverage and that's fine. but lots of people don't have continuous coverage. they lose their insurance, can't pay their insurance from time to time. in this bill there's a 30% penalty if you don't have continuous coverage. and that effects a people with pre-existing conditions and some
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of the other people that have been mentioned. by my chairman. and then he also mentioned, he referenced medicaid limited resources. i have to be honest with you, i'm tired of hearing about the fact that medicaid is unsustainable from a financial point of view. you are cutting out something like $800 billion out of the medicaid program. of course if you cut out $00 billion out of the medicaid program, which is almost the whole cost of the affordable care act, estimated at about $1 trillion, then you're not going to be able to provide medicaid coverage for the working poor. we are talking about with enhanced medicaid, for the most part we're talking about the working poor. they're work bug don't get health insurance on their job job, can't afford to buy it in the individual marketplace. so what's happened? no disrespect but chairman walden said the states will be great innovator, they'll have all kinds of options and flexibility. you don't have any options if
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you don't have any money. i'm telling you in my state of new jersey, most of the state, you met with the governors, they are very, very much afraid that they're not going to have the money to make up the difference. you take the money away and what's going to happen, you don't have essential benefits package anymore or essential benefit guarantees under expanded medicaid under this bill. so they're going to have to cut back. they're not going to be innovators, they're going to cut back. they're going to cut back on mental health care, on treatment for opioids, they're going to cut back on money for nursing homes. nursing homes are pretty good facilities right now. i remember in the 1980's when they were so bad they were burning down in my district. that's what you're going to get. you're going to get the medicaid program where states will have to kick people off medicaid or provide so much less in benefits. i just want to, i know that chairman sessions and chairman black, a lot of what i call ideological arguments. i hear things like freedom,
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choice, competition, i don't really want this to be an ideological debate. this is not a single payer. is you mentioned tenncare. i used to hear from marsha black a lot about tenncare, but the fact of the matter is, this is not a single payer system. this was a private sector, if you will, response, private response, if you will, to a real problem. and we're talking about real people here. so i mean you can talk about all this ideology but the fact of the matter is real people are going to lose their insurance. i wanted to just mention the c.b.o. i haven't -- i know there's a lot of talk about c.b.o. the fact of the matter is the c.b.o. basically says that more people are going to -- fewer people are going to have insurance under your bill than had insurance before the a.c.a. went into effect. something like 24 million people are going to lose their insurance. premiums are going to go up. you have taken away the
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limitations that we had on the a.c.a. in terms of deductibles and co-pays. so deductibles are going to go up. co-pays are going to go up. this is what the c.b.o. is talking about. i haven't heard any, you know, third party, nonpartisan groups to dispute the c.b.o. no. that's why the c.b.o. score is important, not only for the original bill but also with the manager's amendment. no one is disputing, really, essentially, nobody other than republican or conservative think tanks maybe, nobody is disputing what the c.b.o. said in a nonpartisan way. the fact of the matter is, people are going to be harmed. so again, i don't want to talk about the ideology. i want to talk about what this actually means. and so, you know, i'm just going to conclude by saying this. i really, i really think it's your obligation to show how this is going to be better than what we have now under the affordable care act.
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ic that that burden on your part, you've totally failed. and if anything the manager's amendment makes it even worse because it's even more cuts and fewer -- less money that's going to go to state and i think ultimately we -- if we do get a c.b.o. score we might find out that even more people are going to lose their insurance. so just think about this in terms of what it means for real people. i think there's no question that what it means for real people is that this is a really bad bill. and i'll just end by saying, look, we're willing to work with you if you think you have some improvements that can be made, fine. but what you put forth is not an improvement. what you put forth is actually going to harm people, real people, real americans. i thank you and yield back. >> mr. pallone, thank you very much. appreciate your insight. the gentleman from massachusetts, my dear friend, mr. neal. mr. neal: thank you, mr. chairman. thank you, mr. mcgovern, as well. mr. chairman, point of
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clarification, are you suggesting that if you don't have the c.b.o. scores in the next hours you won't bring this measure to the floor. mr. sessions: let me ask you to suspend for just a minute, the gentleman either chairman brady or chairman walden or chairman black do you choose to address this? i was preparing for meeting, not getting a c.b.o. update. and recognize mr. mcgovern mr. polis have been asking for that. do any of you have any update? mr. brady: we expect c.b.o. to give us a new score before the bill moves to the floor with ample time for members to be able to review it. mr. sessions: ok, i have a question. did the gentleman said the score will be available before it goes to the floor? mr. brady: before we vote on this bill we anticipate having this score from c.b.o. i can't give the exact timetable
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for it. but i know they've been working on the manager's amendment. we do anticipate that today. >> mr. chairman. ay i just -- mr. sessions: i think it's fair for us to attempt to answer the question. if the gentleman will suspend just for one minute. i am now going to yield back to the gentleman and if the gentleman would like to engage he gentleman he may. >> i will. in reference to the point mr. brady and mr. walden just suggested, in the absence of a c.b.o. score, do you intend to proceed tomorrow? then i will yield to mr. mcgovern. mr. sessions: let me see if i can allow you to ask questions and if chairman brady wants to come into this. i am proceeding on this and was offering my viewpoint that we felt like it would be available this evening.
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that -- this evening viewpoint would mean we would have it before we would move to the floor on the rule. mr. neal: i'd like to yield time to mr. mcgovern. mr. sessions: he doesn't need time, just to answer the question. mr. mcgovern: this is screwed up. the idea that we might debate this entire bill tomorrow and get the c.b.o. score, you know, prior to our 15-minute vote on final passage is crazy. the reason why i wanted c.b.o., i want facts in front of us without a c.b.o. score. so it sounds like the answer that. the answer seems to be as long as you have it before you cast your vote, that's good enough. but i think people ought to have it well enough in advance to know what we're talking about.
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i'm just saying, i think this is a screwed up process, i think the record is career clear that we ought to think we get a c.b.o. score before, especially since we know from the c.b.o. score that 24 million people are going to lose their health insurance. i yield back. mr. neal: mr. chairman, i would like to begin by submitting a letter from governor baker of massachusetts into the record. mr. sessions: without objection. mr. neal: i want to also acknowledge and begin by thanking former governor romney in massachusetts for having worked with the democratic legislature and having worked with the chamber of commerce and the afl-cio and the american nurses association and the american medical association as we devised a plan that in many ways became a model for the a.c.a. i might point out it falls well
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into the 70's today in terms of customer satisfaction. -- it polls well into the 70's today in terms of customer satisfaction. mr. chairman, the bill before us this morning is a danger to the american people. none of the proposed amendments would improve it to any appreciable degree. in fact most amendments filed would make it more tra conian. in particular the manager's amendment accelerates what really is a tax gave-- giveaway to people at the very top. the combined tax cuts total nearly $900 billion while more than a trillion dollars is take fn the medicaid and medicare trust fund. like millions of americans across the nation, 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 reap the actual tax benefit. governor baker wrote the follow, quote, overall our analysis indicates that the ahca would
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increase -- increasingly strain the fiscal resources necessary to support the commonwealth's continued commitment to universal health care coverage. the bill would not lower costs -- enof quote. the bill would not lower costs for consumers. c.b.o. confirmed americans will face higher costs and less value. let me be clear. the changes being contemplated by republicans make it even more difficult for americans to get the needed care at an affordable price. i have heard republicans tell the c.b.o. -- tout the c.b.o. number that premiums would be 10% lower in later years you should that plan. we have never had an argument in the 28 years i've been in congress about lowering health care costs. how to restrain -- it's how to restrain the growth of health care costs that's been aed. i think that that needs acknowledgment as well. but what they don't say is that these alleged lower premiums would apply only if you can afford coverage with a paltry tax break and there's in guarantee that coverage would
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provide the benefits that are needed. in fact if you really look at what c.b.o. 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 a policy to begin with and c.b.o. is clear that total out of pocket costs would indeed go up. republican plan reminds me today of a used car salesman giving a 10% discount on the cost of a car but only if you want tires nd en-- tires, an engine and a windshield, you have to pay more. that's hardly a recipe that's acceptable to my constituent. the bill doesn't cover everyone as president trump promised. c.b.o. estimates that 24 million americans would have less coverage under this republican scheme. the republican bill is really a tax cut for special interests masquerading as a health care bill this bill would cut $880 billion from medicaid, a program
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that helps pay the costs for more than 60% of all nursing home residents nationwide. i would suggest to members of the committee here that we all have the following understanding that medicaid in many ways has become america's long-term care initiative. it also is a massive tax cut for people at the very top. president trump's cabinet, with a combine worth of well -- in excess of $13 billion, would be amongst 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, and my goodness, i hope we can all agree upon that, that long-term care in children with special needs would also be cut back. by cutting the tax credit that helps families in the mass connector and letting insurance companies reduce the value of the coverage they offer, we acknowledge the challenge that would present. we know that more uninsured means more burden on our local
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hospitals. we will see job losses and hospital closures, something our communities can't afford. a new study this week finds that nearly three million jobs could disappear under this approach but for those who dismiss any analytic study that disagrees with your policy as fake news, look at what the experts say about these jobs. according to the american hospital association, there are 14,800 hospital jobs in my district, and my community would be hard hit if one of our local hospitals closed. both because care would suffer and because constituents would lose good-paying jobs. yet the direction that the republicans take on this bill would be severe in the consequence of the people of western massachusetts. so we've got a bill that breaks promises, we've got a bill that raises costs, we've got a bill that reduces coverage and we've got a massive tax cut for the people at the very top. put simply this republican bill forces million os pay more for lescare. and while raising and knoll
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lowering the number of uninsured americans. that's not enough damage to inflict on america, the measure also would cut the life of $175are by three years and billion when millions of baby boomers who rely heavily on this critical program. when i hear republicans today -- republicans as they've frequently done address the issue of medicare and talk about the medicare trust fund and the shortness of the medicare trust fund's life expectancy and then they turn around and cut three years from what the trust fund accountants say is realistic, that's the equi lent of say, let me set this fire and then call the fire department. as i noted earlier this provision coupled with the medicaid cuts robs more than $1 trillion from health care programs that more than 120 million americans depend upon. let me take a brief moment to contrast this bill with what they're proposing with the a.c.a. and what it did. the a.c.a. added 11 years of
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life to the medicare trust mund. it did so by improving the efficiency and equality of payments to medicare providers. looking at evidence where the program could indeed work better. that's an important suggestion. there were experiments that came along with the a.c.a. the a.c.a. did not drain the trust fund, it strengthened it. the legislation before us robs the trust fund to give a tax cut to those at the very top. who does it hurt? it hurts all our constituents. let me conclude disaying this legislation is the republicans' first attempt at tax reform. as such, it failses the test set out by secretary mnuchin for tax reform , he said there would be no absolute tax cut for the upper class. this bill provides a tax cut for the wealthy in the health care industry of almost $600 billion while hurting middle class citizens through cuts to health care. americans will be paying more and getting less. i urge my colleagues in the
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rulls committee not to move forward with this bill in terms of bringing it to the house floor. i submit this to you, mr. chairman work great regard for the members of the committee and those testifying today. when president trump said who knew how complex health care could be, that owlingt to be the starting point in the conversation. because for those of us who have been on the ways and means committee for a long period of time, we knew just how complex health care could be in america. i guarantee you that the one experience we've all had with the development of health care proposals is like squeezing toothpaste with the cap on. sometimes you don't know what the consequences will be. you go down this path in this manner is a huge mistake. there was a chance here for all of us and i'd be happy to debate how the a.c.a. came to formation, how the a.c.a. was finally passed and the opportunities for all to play based upon some statistical data i brought along as to the number of committee hearings, town hall
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meetings, amendments an the number of republican amendments that were accepted in the a.c.a. oftentimes left out of the argument. a lot of the problems emanated from the senate. as they prolonged the discussion going forward trying to secure more bipartisan help for it. when that didn't work, one party decided to go forward. we have an example here today where both sides could in fact mend this legislation and go forward. always remember that there were a lot of republicans that voted for social security and there were a lot of republicans that voted for medicare and medicaid. nd i yield back my time. mr. sessions: i thank the gentleman for his time today and his insistence that ewith listen not only to wise opportunities but that you've come to the committee to give us your very best and i appreciate that very uch.
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i know you wore your tie in reference to the gentlewoman from tennessee. she noticed that, i did too, the gentleman is recognized. >> thank you, mr. chairman. it's an honor to be here with my colleagues. i certainly join the chairman and others in wishing the speedy return of my fellow kentucky native, ms. slaughter. when the nonpartisan congressional budget office released its report showing that 24 million hardworking americans will lose their health coverage by 2026 if we pass the bill that premium -- the bill. that premiums would rise 15% to 20% with higher deductibles and out of pocket costs. and that middle-aged americans would be priced out of the insurance market by an age tax, i thought for sure this bill was dead on arrival, 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
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corporations and the wealthy paid for by threatening the health and well being of millions of tissue of millions and millions of american families. when i was here in january you invited me to meet with you about your health care replacement bill, the world's greatest health care act as you named it, and while i wouldn't necessarily agree with the characterization in the title, and don't agree with many of the ways in which you proposed to change the affordable care act, it was and is a serious and thoughtful proposal. and i do think it's worth pointing out, a major difference between your bill and the legislation this committee is about to send to the floor. your bill does not provide billions of dollars in tax cuts to corporations and the wealthy. you keep that funding in our health care system and reorganize it. you recognized, as we democrats do and as c.b.o. did that it's impossible to cover as many people and provide better quality of care while making drastic cuts to our nation's
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health care program. it's unfortunate the same logic is not reflected in the bill we are debating right now. but let's be honest. this so-called replacement legislation is not a health care bill. it is an ideology bill. a fantasy about freedom and choice existing in a market that doesn't exist. as i said during our markup in the budget committee, speaker ryan loves to talk about giving people the freedom and choice to decide whether to have health insurance or not. and giving insurance companies the freedom and choice to cheerry pick young, healthy enrollees and sell them cheap, stripped down health plans that would work if young people also had the freedom to choose whether to get cancer or not to get in a serious accident. or not. which they obviously don't. but that doesn't stop speaker ryan from pretending that this bill would create some magical health care free market that exists nowhere else in the world. a fantasyland where young people don't get sick and apparently
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they don't grow old either so they don't have to worry about being priced out of the market. that's just sheer nonsense. but what this bill actually does is striking, particularly given what was promised and considering that the c.b.o. scored coverage losses from the pending manager's amendment has not been factors 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. that number increases to 24 million people by 19 -- by 2026. 1 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. the c.b.o. also estimates premiums in the individual market will jump 15% to 20% in 2018 and 2019. yes, by the end of the decade, c.b.o. says premiums will be 10% less than current law, but the
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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 costs will be higher and for lower income individuals out of pocket costs will be much higher. insurance companies will again be able to sell plans that offer much less financial protection and we will return to the days where millions of people in this country live in fear that they are always one serious illness or car accident away from bankruptcy. mr. chairman, 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 and much better. none of that is in this bill. in fact, the exact opposite of every one of those promises is what's in this bill. those were promises made to every family in our congressional districts and this bill fails them at every turn. as my colleagues have said, we
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can improve the affordable care act and we should but this is not the answer. i urge my colleagues to oppose this legislation and i yield ack my time. mr. sessions: thank you very much. we've now been through our opening panel. it's an opening panel that offered a vision and an alternate vision. a panel that offered a fight that is going on all across america this last -- across america. this last weekend i had an opportunity to engage people in dallas and richardson, texas, not only in the health care bill but also other things that are facing our country and i an insistence by people to stay where they are or want to move has been a collision point this morning, an
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ophthalmologist from dallas, texas, engaged me. last night, dr.t. gill an orthopedic surgeon from dallas, i know both of these gentlemen very well they engaged me and said, many people are delaying and not going to get health care that they need because premiums are not only high but deduckables are the really -- real reason why people are delaying themselves the opportunity to go get things done. mr. chairman, i look at all three of the chairmen that are here, that's a problem. what is this bill going to do that will help deductibles. we keep talking about premiums. we talk about costs. but part of that cost is deductible. and you evidently identified, i know dr. mazow talked directly with you about the doctors are concerned.
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>> i've heard from patients and people who don't get subsidies to just go to the silver plan, they're saying the same thing. they're out of options. their deductibles have gone up. they're working folk who just, you know, they're in the middle class. mr. walden: they're getting priced out of this market. they're coming to me and say, what are you going to do for us? we pay our taxes, we're work, we're forced into this market and it's collapsing around us. our deductible is no longer $500 or $1,000 or whatever it is. and so they're saying, help. so what we try to do here is a couple of things. one is restore to the states more power on the decision making when it comes to health insurance plans. because 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
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may work best. my district in eastern oregon is much different than the metropolitan area. and i would have faith in my state coming up with a plan that would work for a more rural, lower income group that i represent than maybe an upper income group. they have some flexibility so we do that. second, the patient and state stability fund it's $100 billion to the states to come in and help on these issue, help buy down premium, help buy down deductibles if necessary. they don't need to do that because they fix the mark and it works on their own, they can put that toward additional mental health services or opioid mental -- treatment services. we give them flexibility and funding to design a health care system that works for them. so i mean, there are multiple things we're doing here. but if we don't fix these markets, they are collapsing. my colleague from tennessee, your whole state has one option
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in the exchange? we've got a couple in oregon. mr. sessions: so competition would be one answer. mr. walden: that's what we're trying to get to. at this point in the process, c.b.o. said there'd be 1 million people on the individual market -- 21 million people on the individual market in the obamacare exchange. that's what they forecast for 2016. 21 million people. do you know what that number is? mr. sessions: 12.2. mr. walden: it's 10.4. >> mr. chairman. mr. walden: the point is, they're off. there's a reason they're off. people say i'll pay the penalty of the i.r.s. or get a waiver rather than sign up. that's about 2/3 of them. 45% of those who decided to pay the i.r.s. penalty, because remember the coercive element here is the i.r.s. the government says buy this government mandated product or pay a penalty. 45% of those under the age of 35
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said i'll pay the penalty or get a hardship exemption and opt out. we're trying to create a program that work. in terms of creating a plan that work, i'm 60 years old my cost is 4.8 times higher on average than my son who is 26. they kept the 5.1 ratio. we get a lot of critism and go back to the -- to what the market is, 5-1. states can go longer. they can go to a 3-1 a 2-1 if they wanted. 5-1 or 6-1 or 7-1. we say you design it. some states have younger populations, some older. we're giving them flexibility. if the plans are going to be too expensive, we give them the ability to make some fine tuning that works in their states so it becomes less washington telling massachusetts what works and
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telling oregon what work, by the way, it has to be the same thing. mr. session: i have a followup question from the gentleman from new jersey. >> i couldn't disagree more with what my committee chairman says on this issue. bottom line, when we put the a.c.a. in place it was because what was happening in the states and the marketplaces was failing. and that's why we got rid of all those discriminatory practicesen pre-existing conditions and lifetime caps and all that kind of thing. mr. pallone: so for me to assume if you throw this back to the states, somehow they're going to do things better, you don't even agree with that because you kept 60% of the affordable care act and kept a lot of the discriminatory practices, anti-discriminatory laws that put restrictions on the states because obviously you don't believe that if you repealed 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?
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and the second thing is, with regard to the c.b.o., one of the things the c.b.o. said is not only are people going to lose their insurance, 24 million, but a lot of people's deduckables are going to go up because what we did with the a.c.a. is put limits on those various plans on how high those deductibles could be. i know people are complaining about the deductibles, sure, because maybe they think they're too high but the bottom line is that in your bill you let the deductibles go through the roof and the same with the co-pays. again, if you're going to let stay states say, ok, you can raise deductibles or you can increase the rating system so for older people instead of paying 3-1, they go to 5-1 or 6-1. the whole idea that somehow by letting loose the states on the age rate, on the deductibles, on all these other things that we limited, i think it's a huge mistake. and that's why the c.b.o. says that, you know, even if you have insurance, what kind of
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insurance are you going to have under this republican plan? in the good. not good option. mr. sessions: thank you. mr. chairman, you're going to allow the states the flexibility on all these matters, 26 years old? > no, they're protected. >> it's iron, my friend from new jersey said these were democrat ideas. mr. sessions: is there other flexibility as it relates to the pertinent parts that were in the a.c.a. that he spoke about? >> yeah, because we get rid of those mandates, that mandated certain things at certain rates. mr. walden: when you have a government that says here's what you have to buy and an i.r.s. that says if you done, i'll penalize you, that doesn't create a market. one other thing he doesn't mention, last year, 225 counties in america where there was one option on the exchange this year
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that's 1,022. by the way, mr. chairman, that's one out of every three counties where people who have no option but to go on the exchange have no option but one choice. that was before humana pulled out oaf the market. we've heard from some insurers, some big one, who say this year isn't looking good either and they may consider pulling out or they may have to have some pretty substantial rate increases. so the notion that everything is perfect and fine i think is not right. i think what mr. brady said about expanding the health savings account. mr. sessions: i didn't want to prejudge. mr. walden: the democrats wanted to crack down on what you could do with he h.s.a., the over the counter piece, the taxation pieces. i talked to one insurer in my
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state who said the health insurance tax itself, they tax health insurance, does that drive down cost or drive up costs? what do you think happened? was a huge part of why they had a debt last year. so they try and pass that stuff on but who do you think they pass it on to? do you think that lowers rates? we generally tax things we want less of. right? tobacco. we tax tobacco, you want less of to mr. cole.espect but the democrats wanted to tax health insurance. they wanted to -- if you have too good of a health insurance they want the government to say what that health insurance should be and if it was too nice, too good of a plan like a lot of people in the building trades have, they wanted a 40% tax on that. they negotiated for those rights. mr. sessions: mr. brady, the h.s.a. issue, as i recall is a great option for a family to be able to control not only their spending but the way in which they receive their health care.
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what have you done in this bill that's directly related to the questions about the cost? mr. brady: my local doctors are concerned too. they know, they tell me or be macare is a sinking ship. it's taking a lot of good americans down wit. they had patients kicked off their plans who can't see them anymore. the plans in obamacare that they have are too expensive and they can never seem to get through all their out of pocket costs to get to the surgeries and procedures and treatments they really want to get as well in the houston region, we have no p.p.o.'s left. one very skinny one, it's gone. so their patients can't even see them anymore or go to the major hospitals. mr. sessions: what are you going to do to create a better vision for people. mr. brady: this approach is to reject the direction in washington, one-size-fits-all.
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expensive health care, expensive subsidies you can't use. for affordable health care tailored to your needs. part of that, giving patients choice is the ability to double the size of the health savings account, make sure they can use it for what they need, like over the counter med cases, 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 criminal with the -- more control with the tax credit to buy plans that are right for them, tailored to their community. for example, there's a big difference between manhattan, kansas, and manhattan, new york. our plans should reflect that. unlike obamacare, our approach is to allow states to provide a wide variety of products that work for people in their community and their region. that's why many of my local doctors are telling me, please, repeal this monstrosity, restore the doctor-patient relationship, let me patients come see me men.
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-- see me again. mr. sessions: all right. >> i understand there are individual physicians who don't support the affordable care act but also i want to point out the american medical association and the american nursing association, the american hospital association, aarp and virtually every disease-related organization have come out opposed the american health care act. they don't see this as a viable option to the affordable care act. mr. yarmuth: health savings accounts are wonderful ideas for people with money. if you don't have several thousand dollars to set aside, h.s.a.'s mean nothing to you and the vast majority of the people we're 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're talking about here almost entirely relates to
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the individual insurance market. that market is basically -- basically affects about 5% of the american people. for the vast majority of the american public, the health care system is working pretty well. whether it's medicare, medicaid, or employer-based insurance. we're talking about a very small sliver of the american public. they are important people. but we should not try to up end an entire health care system that is working well, relatively well, for 95% of the people, to solve a problem that relates to so few. mr. sessions: thank you very much. mr. neal. mr. neal: i think there's one thing we can all agree on, no one of us have met a medicaid recipient who had an h.s.a. mr. sessions: but i have met some that want it. >> if i could, mr. chairman. in a study, there are 20 million americans who use health savings accounts today. in a study nearly half lived in neighborhoods with median incomes between $25,000 and
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$50,000. these are middle class americans who use them for high out of ocket costs. mr. neal: in indiana -- >> in indiana they use it as patient of their healthy indiana plan with their medicaid patients. we should be doing more for the middle class too who needs help n this area. mr. walden: there are multiple folks who need medicaid. we are trying to provide flexibility and new options. this isn't just one size fits all which i know some of my colleagues think that's all that comes out of washington. we're trying to help multiple people and multiple -- in multiple life situations be able to afford and get access to health care. mr. sessions: i think what you did without saying it, because i've studied this issue, by the to anybody go back
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about writing bills, it took and partway s, through my staff and i looked at each other and say said we know why people don't write health care bills. the moral issue involved here was overwhelming to me as you know, mr. chairman, i have a down syndrome son who participates in a program that is necessary for him as a result of my age to make sure he's on that program for the rest of his life as a down syndrome young man. but there are many able-bodied adults that are on there who have the need still for health care and when they're 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 a chance to jump free to a tax credit system and evade that other, what i consider to be a system that
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would not give them flexibility that they need. we're going to keep going, this is all day, we're about to get to mr. mcgovern but first we go to the vice chair of the committee, chairman cole. mr. cole: thank you, mr. chairman, i appreciate that. i will have fewer questions because i had the good fortune of being in chairman lott's committee my good friend from kentucky, last week. we had a pretty thorough education about the bill. there are a number of things i'd like to ask for the record. as my good friend from oregon knows, i spend a lot of time on native american issues. and a number of years ago we had a very good piece of legislation, mr. pallone was a big part of that, the indian health care improvement act which was bipartisan and it was moving along through congress but then was added to the affordable care act. and so as a result of that, i get a lot of questions. i just want to make this clear for the record. there's nothing in this
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legislation that repeals or undoes any part of the indian health care improvement act. s that the case? >> thank you for the question, mr. cole. the clear answer is no, there's nothing in here that affects the authorization of the indian health services act. mr. cole: i appreciate that i'd just add that for some of my friends who only want to do a repeal option without a replacement option, if we were to do that, that's exactly what would happen. we would repeal a number of things that all of us agree on. last lot of contention here obviously a lot of different points of view, but there are things in the affordable care act you mentioned republican ideas about raising the age to -- or allowing people to stay on until they're 26 on their parents' insurance. this is a significant piece of this act. i thank my friend from new jersey for the role he played in that.
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if we just did a simple repeal those idems -- items would go. i want to commend you guys for i think doing the hard work of actually looking through and making tough value decisions. i know there's still a considerable amount of disagreement here, and that's fair enough, but there is a lot of consensus here. in those areas where there is consensus, i want to commend both of you and obviously chairman black as well, who i think offered some really terrific suggestions for improvement of the original bill through her committee. but for keeping those things in. very important. i yield to my friend. >> i appreciate you mentioning that. you're absolutely correct. mr. chairman -- chairman walden's response is absolutely correct. appreciate that you guys have kept some significant things that we had in the affordable care act, including indian health care improvement act. i would point out as you know, when i meet with the tribes or go to the various conferences that were held in the last few
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months, they are very concerned about the impact of this republican repeal both on those american indians in the individual marketplace who will lose their subsidy and don't believe that 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 that have who are concerned that by eliminating or significantly cutting back on the expansion and the per cap or block grant on medicaid they're going to lose their insurance or have significantly less benefits. so the fact of the matter is that as important as the indian health care improvement is, it's also important for tribes that they not see cutbacks in medicaid and that they not see significantly less subsidies or tax credits for those on the individual marketplace. so that, you know, it's not a pan see that that we've kept the
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indian health care imprume act in place. although i do appreciate that. mr. walden: i was going to say, i want to make sure that our committee on energy an commerce, i -- mr. cole: -- >> i asked mr.mark wayne mullin to look at this, we've heard reports of low quality, we want to get after that, because all americans deserve high quality health care. the reports from some reservations indicate they're not getting that. mr. cole: my friend is correct about that we had three hospitals in indian country that were -- that lost emergency room privileges and surgical last , worked with the previous administration and trying to get those up and running again. already had a few conversations
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about dr. price about these issues. a lot go well beyond the insurance issue we're dealing here. everything from remote locations to the difficulty of recruiting trained personnel. but it's an area that's going to need a lot of work. the tax credit, though, is actually a potential vehicle to help a lot of people that aren't getting help. in terms of medicaid expansion, my friend makes a good point but for indians in 19 states which include my own that doesn't matter very much because we're not a medicaid expansion state. those decisions were made largely out of fear that conditions would change and the states would have to be paying a lot more than they do. we can debate that a variety of ways but at least on the area where we agree, your committees did keep that in and i want to thank publicly both of you for doing that. >> i would also mention, mr.
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vice chair, we turn off the disproportionate share of hospital hospitals in nonexpangs states. under obamacare, hospitals got whacked. we stop that and get help for them as well. >> as usual my friend an tess pates my questions. mr. cole: and i appreciate that. because i can make a pretty good argument in my state where frankly we are down to a sing patrol vider, like my friend from tennessee is, and where our rate rts going up 69% for people on the exchange. we are actually much better off in oklahoma with the additions that you've added. and the tax credit provisions, than we are under the current system. i'll leave everybody here to determine that for themselves in their own respective states and jurisdictions. it's a pretty powerful argument when i talk about where we are and what this provides in
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addition to what's available out there now. so again from my state, my area, this is an improvement and let me ask you a theoretical question. obviously we're going to be considering amendments here but this process is a long, winding road, as my friends on the other side would agree, having walked down it thems before. do you anticipate there'll be changes made in this legislation as we go forward? i'm not asking you to predict what they are but you've been around the block a few times. >> this is a legislative process. when you're covering a key issue, so important to americans and each of us, you're always looking for improvements at every step of the way. we worked very carefully to incorporate improvements provided by the broad range of all republicans, from rural to cities, indian communities to metropolitan areas, in ways that we can help cover more people with affordable health care and
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give them choices. mr. brady: i assume the senate will continue that improvement process as we hand this ball to them as well. they have creative ideas. certainly suggested many to us. so you know, i'm hopeful that we continue that process until the bill gets to the president's desk. r. cole: i would concur. we gave -- mr. walden: i would concur. we gave everyone a chance to offer amendments. we spent the first almost 12 hours, maybe 10, on the first amendment from my friends across the aisle threw out an amendment simply to rename the bill. wasn't real y a substantive amendment to address any issue that's a problem, it simply would rename the bill and we debated that for 10 hours or something before we voted. which didn't seem to be very
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thoughtful approach to the importance of this matter. but that was where they chose to go. but we kept the doors open until they were done with amendments and my side was done with amendments. but i think going forward i would want -- i wouldn't want to prejudge what you do here involving amendment nor what our colleagues in the senate may offer as well. i think we should admit there are problems out there in accessing affordable care , in options for insurance, for our consumers and we ought to go shoulder to shoulder and figure out how to solve them. mr. cole: unk my friend, chairman black, will have some excellent suggestions for this committee. i anticipate they're going to be favorable. i'll venture a prediction there. i think that's an important point to realize this isn't a once and forever bill or vote or anything of the kind. we're in a legislative process and what we do here today isn't going to be the final word. what we do tomorrow, assuming this bill comes up and we have the c.b.o. score, etc., etc.,
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won't be the final thing. it will continue to change. i must say, and i say this with great respect to my friend from tennessee, i think coming out of her committee was terrific improvements in this bill. and i'm very proud of, you know, i know even people that will vote against the bill, my good friend from kentucky made that very clear, but did support one of the amendments because he thought he made it better. which i thought was a generous and thoughtful way to proceed. so the gentlelady has any comments i'd love to hear them. >> mr. vice chair, i appreciate that. the ranking member and six of his colleagues supported that suggestion that we have passed on. mrs. black: i keep telling my colleagues they need to have their voice heard, not just in the media but also to let leadership know what their thoughts are. we all need to stay in the fight. as i said before, legislation,
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we all know that analogy, it's like sausage, not pretty watching it being made but tastes pretty good at the enwhen you get it right. so i think that is something we have to encourage all members to continue to bring their suggestions forward. thank you. mr. cole: i hope you don't have all those suggestions today. let me ask, there's been a great deal of discussion amongst the six of you about people losing overage. does anybody actually lose coverage? first in 2017, 2018, 2019. and frankly anybody that's on coverage now ever kicked off of coverage if they want to stay there? i think there's a lot of confusion when people here 24 million people are going to lose coverage, as if they're going to e summarily denied coverage.
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>> thank you for busting that myth of 24 million people being kicked off. that's not what c.b.o. showed. it said the bulk of americans when not forced to buy health care they don't want and can't afford, they choose the option of not having that health care. mr. brady: that they can't use and can't afford. for example, next year work no changes in medicaid and no changes in the exchanges, at all, other than americans are no longer forced to -- nearly 11 million americans say thanks, but no thanks, that's not what i wanted anyway. that continues through the bulk of the 10 years of this. americans voluntarily saying, thank goodness, i'm no longer forced into a plan i don't want, can't use and can't afford. for other americans, the reason we're taking such a deliberate approach over 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
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prorkvide different choices for them in that immediately usable credit, every american will have plenty of time to choose a plan that's right for them. i will finish with this. in america today, this doesn't get much media coverage, but for every one person on the obamacare exchange, two american have said no thanks. most of them have actually paid to say no thanks. think about it. there's a product fare force -- they're forced to take, given generous subsidies to take they want it so bad, they don't want it so badly they'll pay not to be on there. i can't help but think in texas there are many small business people, entrepreneurs, young people that are no longer on their parents' plans but still going to college, you know, working their way up the economic ladder, who frankly now don't get really any coverage, who will have an opportunity with a credit to buy a plan that's right for them, for their
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business, for their family as well. so i see coverage increasing for those today who have seen no hope in obamacare's man cate. -- mandate. >> i think this is a very important point that you make, i want to emphasize it and anybody is free to comment who wants to. mr. cole: if you're on -- if you've paid a fine not to be on the affordable health care exchange or system or whatever, we don't do anything to help you get insurance, you're just sort of out there on your own. in this situation you are going to get something, a tax credit, to help you do something, if you don't like what's available there, you don't -- ok. you've got a better idea for yourself and you want to do it, we're going to help you get there. now we relate it to age and income to some degree which i think is wise. some people don't need it a lot
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of people that frankly are fortunate we wish there were more but they -- they want to go get something of their own, they can write a check. but here you're actually helping people who said, i don't like that. and you're say, here's something to go build something you do like. >> i was with a small businessperson this weekend who can't afford the $1,200 per month for obamacare, had to pay the fine. when i described with you and your daughter the amount of money you'd get, the ability to buy plans more tailored to your needs, he said, i'd give anything to have that option. because i don't have that today. i get no help at all. there are a lot of small business people, a lot of students working their way up, years etirees, five more
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until medicare, who are anxious to have better choices than they have today. mr. pallone: i disagree strenuously. if you look at the c.b.o. report, the reason why they say, i think it's 14 million in the next year will lose coverage, 24 million over in the year beyond that, is basically for three reasons. one is as those in the individual markets, because the tax credit you're giving is paltry compared to the subsidy and the tax credit we give in obamacare, a lot of people now are going to have to pay another $4,000 or $5,000 a year for insurance on the individual market and won't be able to afford it so that's why many in the individual market lose coverage and that contributes to that number of 14 and 24. with regard to regard to medicaid and the expansion is limited and the cap
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and the block grant go into play . the point i'm trying to make. i'm making two points, the reason for c.b.o. scoring is the redugs of people on medicaid, because of the lack of subsidy for people on the individual market and also people who because there is no longer a mandate that a lot of employers will not offer health insurance. but beyond that, what i also disagree with, the chairman is basically buying into this freedom argument that these people that pay the penalty really don't want health insurance or maybe don't want the insurance that's offered. but that again is an affordability issue. it was envisioned when we put this together that at some point we would look at the subsidies again and see if the subsidies needed to be more generous.
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mr. cole: the employers are three million people. mr. pallone: i think it's seven. these are not people that are choosing to pay the penalty and not have insurance. mr. cole: that's not the group i'm talking about. i'm just saying, the majority of americans get their insurance through their employer right now. and talking 7 million people than 150 million people and most eople know they have to have insurance. mr. pallone: insurance is a pool. as more and more people go off insurance and the people more likely to do it are the ones for the various reasons i said can't afford it anymore, then that insurance pool shrinks and more sickly people, older people and then the premiums go up. this is like a vicious cycle.
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mr. cole: that is what is happening to obamacare. mr. pallone: i disagree. you are giving them less of a subsidy. mr. walden: it's important to look at the c.b.o. numbers because what they project there will be four million uninsured million in 2019. all that obamacare subsidies are in place through 2019, all of them and additional support going to the states, they could buy down premiums and co-pays through the patient stability fund. they get that money starting in 2018. two years where states will get $15 billion per year, two years before any of the subsidies go away. c.b.o. said you are still going to have this problem. that tells me you have a failing market out there and doing
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nothing to bring down costs and i can assure that the energy and commerce committee is going to look at what is driving the costs up because as my friend from kentucky said, we are only arguing about 5% of the market here. everybody in the market is being hit by higher health cost and from one end to the other and i guarantee you, we are going to go after the cost drivers wherever they are. i have a degree in journalism. we are going to find the facts and shine bright lights on every piece of this and find out what is driving the costs up whether you are high income or low income. we all get too many examples of people who spend very little bit of time in a hospital and come outgoing with a $70,000 bill and why is a box of kleenex for. you say how is this the case.
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we are going after the cost drivers. there are a lot of programs that spend a lot of money and flood the swamp with high-paid folks and going to figure out what is driving those costs, too. mr. cole: that will be a much more bipartisan pursuit. >> republicans talk about personal responsibility. what is more personally responsible than buying health care insurance. why should the rest of us be assessed $1,000 in our own plans to take care of those who refuse at 28 years old not to buy health insurance? our proposal is richard nixon's proposal. our proposal here is bob dole's proposal. our position here is mitt romney's proposal. it's shared response built with discipline in the marketplace would come best from the idea of
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trying to manage risk where people in the risk pool where who are younger who are particularly healthier, points to the notion of shared risk. when do we buy homeowners' insurance after the house burns down or car insurance, after the car hits the tree. i don't understand republicans rejecting proposals all the way back to the nixon years about the notion of personal responsibility and buying health insurance. mr. walden: may i respond to that? while we reject the issue of the individual mandate. we have a disagreement on that. we do support the issue of personal responsibility and that is continuous coverage and if you step out and say i'm not going to play and say maybe i do, you pay a penalty of 30% just on the premiums of that year and hardship exclusion and all that. to your point, there is more an individual decision. you get to make that decision, but if you have a pre-existing
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condition, there is hardship and all those things. but to your point, you are going to pay a little penalty. you don't get to buy homeowners' insurance when your house is on fire. ou will pay a penalty. they can't afford to pay it. they get a different job. there are numerous reasons why people don't pay their bill. and i don't think it has to do with personal responsibility at all. it depends on your circumstances and what happens with your ncome and your health.
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mr. cole: i'm going to finish my time here. d we are talking about a relatively small portion. most people continue to get health care through their employer on medicare or through classic medicaid. that's the huge preponderance of this market. and the quicker we get through this and get to what my friend from oregon wants to focus on, the better off the entire country will be, because i think
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that's a bigger problem. this is certainly a problem and certainly a problem with pre-existing conditions. may disagree what we are doing but you deserve the credit for establishing the threshold that people with pre-existing conditions are going to be able to buy insurance. that came out of the obamacare debate. and we are keeping large elements of that plan that some were added to it. there are a lot of change here, but i don't think there is as much change as everybody suggests, 80% of the country is going to continue getting insurance the same way it does and trying to make sure that everybody has something to build off of, which they don't now and going to protect people with pre-existing conditions in a proven way. i think there is probably a
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little bit more desperation in this debate than needs to be. i suggest again, once we get through it and it will change as everybody here knows and we get on to these other questions that my friend from oregon wants this committee to focus on, we'll actually do something in addition to this that will be meaningful and really good for everybody and will be bipartisan. but in this case, we have to work through it, because i gee with my friends on the side of the aisle, the system isn't working. when the rates are going up to 69% and down to one provider and not a medicaid expansion provider provider and this is a whole lot better than what we've got and will continue to improve through the process. with that, mr. chairman, you have been very indug gent. mr. sessions: we'll make sure
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that every single person has that chance. if i could, i would like to say that both the gentleman and gentlewoman has addressed this issue. the gentleman from oklahoma has a strong content and that is the tribal nations around the united states and wants to make sure that they are properly dealt with. aware lso, mr. brady are m faithful to the disability community. you know where i am on disability issues and concerned about that and will continue to believe that we will if continue inome back the their roles of oversight to continue looking at tribal issues and the implementation and disability issues.
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and if the gentlemen do gee with that, now is their chance to say because i hope you will agree that part of your follow-up of oversight of this would include our opportunity to make us aware of that. without objection, i would like enter into the record the national physicians council on health care policy has issued a statement in support of the bill that we have here today. without objection, i would like to enter that into the record. i will have our clerk give to chairman walden an amendment that i would like him to look at before he exits and if he could address this and try to remember to do that. yes, sir. mr. hastings: do you have a copy of that? mr. sessions: thank you for the request. the gentleman from massachusetts
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is now recognized. mr. mcgovern: thank you, mr. chairman. and let me insert the aarp's strong opposition to the republican bill. i should also say that the republican governors are very concerned about the republican bill. i would like to ask unanimous consent to insert the letter from massachusetts governor charlie baker and the republican governor of michigan letter into the record. they have deep concerns about this. and you know, i want -- i guess my first question is about process. and while i appreciate the chairman of the rules committee saying we want to have a robust discussion here in the rules committee, to be honest, the robust discussion occurred in your respective committees on the form of hearings on this legislation and i'm trying to understand why there was a decision made to do know
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hearings on the actual text of this bill, because the details are important on this. we can have hearings on general issues what's working and what's not with the affordable care act, but quite frankly language matters, legislative language matters. you know, i heard mr. walden when he opened up said that this bill would be good for the people with disabilities and and and yet i have a letter here from -- if an organization signed on opposing this bill, the consortium for citizens with disabilities. i would be here reading all day. i ask unanimous consent to put those in the record.
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i have a letter from the rural association urging a strong no on this bill. , i respect the members of this panel, but i also have to say with all due respect, you all don't know everything and neither do i and that's why you do hearings. so i'm trying to understand the mad rush to get this thing done tomorrow without c.b.o. scores, without hearing from members of the disability community, without hearing from the american hospital association, without hearing from health care providers all around the country. can someone explain to me why this is a good process to bring this bill to the floor? mr. brady: if i may, i can speak for the ways and means' approach
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which is far more open and transparent than our democratic predecessors. i was there the night before the markup where we were delivered an 800-page bill that no one had read and nearly at midnight and given the manager's amendment, no score, no explanation. we began voting -- mr. mcgovern: if i could reclaim my time. we don't have a lot of time -- i have the time and i will be happy to yield to you. the house held 79 bipartisan hearings and markups in the affordable care act. house members spent 100 hours in hearings, hearings are different than markups and 1 1 witnesses and 239 amendments both democratic and republican and accepted 1121 amendments. in markup, the energy and commerce committee adopted 24
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republican amendments. in markup, education and work force adopted six republican amendments. the original bill was posted online for 30 days and more than 100 days before the committees produced a merged bill. the house democrats posted their first bill online for the promised 72-hour bill. and senate-voted bill was online for three months and reckon silings was online for 72 hours. house democrats heard and answered constituents at 300 public town halls and tens of thousands of emails and letters were registered. i will not say this was a perfect process, but compared to what you're doing, it is a much better process. i just want to know why no hearings. mr. brady: with all of that
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said, speaker pelosi resorted to pleading, you have to pass the bill to find out what's in it. mr. mcgovern: that's your answer to why there are no hearings? mr. brady: we held 200 hearings. mr. mcgovern: on this bill? i didn't see this bill until march 6. mr. brady: if i may finish. this bill includes 37 pieces of legislation that have been considered by the full house of representatives and approved in the past and includes the elements that were created and unveiled last summer in the better way health care replacement and as opposed to democrats handing us 1,100 pages 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
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which -- mr. mcgovern: no hearings. no hearings. mr. brady: so if you don't know what's in this bill, you have no one to look at but yourself in the mirror. mr. hastings: that's not how ongress works. mr. hastings: the chairman introduced into the record all
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of those things have changed considerably in that period of time. and that's why you should have started over. mr. mcgovern: some of your own members, mo brooks says it was not indicative of an open process. justin amash says this place may have been more open under speaker boehner sadly. we should have an open process. mr. walden, how many hearings have you had on this bill since you became chair? mr. walden: i appreciate the question. we went into markup. but let's go back -- you are comparing apples and oranges. mr. mcgovern: how many hearings have you had since you have been chair? mr. walden: we had hearings on some things on this bill. there are things from burgess. you are comparing what you all did with the a.c.a. versus
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reconciliation. we are dealing with a reconciliation. mr. mcgovern: how many hearings have you had on this bill since you are chair? mr. walden: on reconciliation, last time the energy and commerce committee waived and all the things got shoved in there, there wasn't a hearing let alone a markup. r. mcgovern: is that zero? mr. walden: we had hearings on issues involved. mr. mcgovern: you answered my question, none. >> the hearings culminated in a 14-month process. everybody was on the ways and means committee was tired, if not exhausted from the amount of witness testimony that we took. and i also hope that mr. cole was going to have a chance if he addresses the republican conference today to point out that about 80% of what you are doing is obamacare. i think that would help our
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argument as you bring the matter to the floor and i hope that the evidence that we presented here the number of hearings is 3,000 and the number of hours that were spent in the united states senate, they were in 25 days of consecutive meetings on the affordable care act. mr. pallone: mr. chairman, mr. were no hearings. we got the bill monday night late and the markup started wednesday morning. and you know, speaker ryan said this was going to be regular order. i don't know how many times on tv or in the media, this is going to be regular order. regular order would that the health subcommittee would have a hearing and then have a markup and then the bill would go to the full committee for a markup. and i would point out that the health subcommittee has had at least one hearing per week on other topics since january when we were sworn in.
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there was a.m. will time they could have had a hearing as opposed to the other things. mr. mcgovern: how many hearings has the budget committee had since you have been chair of the committee? mrs. black: our role is in the reconciliation process so we follow the reconciliation process. mr. mcgovern: no hearings mrs. black: reconciliation is a process and not hearings. mr. mcgovern: how many witnesses from the current administration ever testified before your committees on this bill? mr. brady: in the reconciliation process, we don't talk, we do. the house bill before you today is a result of much hard work including dr. price, secretary of health and human services who along with other committee chairmen developed a better way
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agenda. mr. mcgovern: that's the most incredible thing i have ever heard -- i mean, the idea that you are rewriting health care law that is going to impact millions and millions of people and just going to do it without taking testimony. not on this bill. on not on this bill. . is bill i will yield >> wasn't the affordable care act actually passed under a reconciliation bill? and did we have a hearing on that? mr. walden: energy and commerce committee was excluded from the process and came up for final passage. mr. brady: the final bill was -- [talking over one another]
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mr. mcgovern: to the point while we are on this. let me ask a different question to mr. pallone, mr. neal and mr. yarmuth, how many democratic amendments that were offered in markup were approved? >> every -- [inaudible] mr. mcgovern: mr. neal? mr. neal: every one was objected. mr. yarmuth: we offer motions to instruct the rules committee which chairman black is going to present, but we offered seven motions and none of them were approved. mr. mcgovern: ok, here we have a
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bill that again had no hearings and we are rushing -- what is the magic date dr i'm trying to understand, what is the reluctance to push this off a week to do some hearings or wait for c.b.o. scores? what's the difference between today or next week? mr. brady: i can answer. for seven years, americans have been hurt by obamacare. i hear this from our small business people, i hear from our patients and doctors and nurses. and give them health care they can afford. these efforts trying to delay and try to continue this failed bamacare -- it's over. mr. mcgovern: even people who
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may be critical of obamacare would like this body to be thoughtful in about how they proceed. i was watching this hearing right now and we are acting because you know, for political reasons or because we have to rush this to the floor because we just want to for the sake of passing a bill, i think people who may not like the affordable are act won't approve of that.
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prenatal care and prescription drugs.
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mr. mcgovern: the population had berne optional guaranteeing parity. this guaranteed that programs provided a level of sameness in the level of benefits offered but ensured that the quality and variety of different behavioral treatment options was available to these individuals along with important consumer protections like appeal rights included. the underlying g.o.p. bill would repeal this for the medicaid expansion. people in the medicaid expansion would no longer be guaranteed mental health or substance abuse treatment and then representative kennedy asked
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council in the meeting about millions think that of viewers saw it because it went viral. it struck the language that repealed it which seemed like a positive move in terms of providing care for sick beneficiaries. however, what i'm being told, mr. walden's second degree manager's amendment re-repealed the manager's amendment and knowingly and purposefully guaranteed coverage of behavioral services. i'm trying to figure out why, mr. pallone. am i correct? mr. pallone: everything you said is accurate. what happens when you don't have this essential benefit package and why mr. kennedy is making that point, states, because they
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are getting less money from medicaid, have to decide what to cover and don't have to cover everything because there is no essential benefits package. and the thing that didn't exist was mental health coverage, drug treatment, prescription drugs, because these things are very expensive. this bill, gentlemen, and ladies is not a reconciliation bill. there were many provisions put into this bill that because of the bivered amendment and authorizing things will have to drop out. when my colleagues on the republican side say this is a reconciliation bill, the fact of the matter is it is not. there are many things that could pass here with 51 votes but will
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have to drop out in the senate because they are changing the authorizing language and don't meet the byrd rule. you talked about parity and some of these other things that were put in. mr. mcgovern: representative kennedy will be up here talking about this. and this was a great process and such a good vetting process, we ave four manager amendments. misunderstanding of what your second degree manager's amendment would do? mr. walden: no. i should point out, if i may, we believer mental health services re important and removes and and by the way, that is not
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dissimilar from what congress voted on unanimously. representative guthrie asked unanimously. mr. polis was a co-sponsor of that bill. remember on the alternative benefit plans for states, the option to enroll beneficiaries is still bench marked to blue cross/blue shield provider plan, the plan offered to state employees to the largest commercial health maintenance organization. this coverage, this change does not remove the essential health benefits requirements for the private health insurance system. it is important to know that the provision does not change the ederal health mental parity or chip. removing these requirements for the alternate benefit plans does
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give states flexibility. and so i think you would find the federal employee health plan covers benefits. and a report from h.h.s. noted more than 94% of small group products in employee plans appear to cover mental health benefits. stability fund created by the proposal before us provides states $100 billion over 10 years and some of that money can be used by the states to help with mental health and addiction reatment services. mr. pallone: that was for a small group market and it's sad and admitting that ok, we will have these guaranteed benefits for these other people but not
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have it for those in the medicaid expansion population, which is mostly childless adults and those are the ones that often have the biggest problem with need drug treatment and behavioral health services. to say that group of childless adults are the ones that are not oing to have these guarantees. >> one of the things that have our d.n.a. in local government, this idea that governors are going to win here, the mission statement of health care as allotted by the federal government to put those dollars in health care. they are going to use it to patch rod ways and brimmings and claim they have on surplus in the budget and nextier to say they don't have enough money.
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that's the challenge we have. local government, we all know how that happens. mr. mcgovern: i want to ask unanimous consent a group expresses strong concern over the republican bill. mr. pallone, let me ask you a question, this bill will permit age rating for individual health insurance. that means that health insurance will become far less affordable for people aged 50 and over. a.c.a. is three-to-one. mr. pallone: this goes to five- to-one. mr. mcgovern: this would allow five-to-one beyond and charge -- mr. pallone: chairman walden said they go to six-to-one but the likelihood is higher because that's what it was before we had
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before the a.c.s. and the c.b.o. said -- the reason they say they are doing this is they want to get younger and healthier people but the c.b.o. said that's not going to happen. more of the people between 50 and 65 won't get insurance and very few people will sign up. and won't accomplish anything. mr. mcgovern: how many individuals will lose coverage as a result of the bill's changes to age rating? mr. pallone: i don't have it in front of me. that was a big part of why they said so many people will be uninsured. mr. mcgovern: it would be helpful to have an estimate of age rating and the smaller tax credits will be there for older americans. you know, this bill as far as i can tell, even though we are being told it is about repealing and replacing obamacare,
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contains provisions some of the provisions would do that, but the bill seems to go far beyond repealing and replacing the affordable care act. it will reduce federal payments and shift costs to states and providers and beneficiaries and their families. in fact, the bill seems to be less about repeal and replace but capping and cutting medicaid. this is a full blown entitlement reform. since we don't have an estimate of the provisions from c.b.o., i would like someone to explain to me what the following provisions has to do with repealing. 103 prohibits chp to providers that are not paid for by medicaid or chip. what provision does this section repeal?
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mr. walden: i don't think snib said we are dealing with obamacare repeal and replace. mr. mcgovern: when i hear the president that's what i'm saying. mr. walden: we are trying to fix a broken insurance market and people have access. and making sure that places in my district have federally qualified health centers. and so we are trying to money out into those. i have districts more than multiple size of your states. mr. mcgovern: deals with authorization. mr. mcgovern: section 114, three-month retroactive eligibility requirement. what does this have to do with a.c. oomplet? mr. pallone: nothing. these are authorization changes. mr. mcgovern: section 114 --
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over another] mr. mcgovern: what does that have to do with. section 117 caps matching payments not just those covered under the medicaid expansion and it does so locking low spending states into the 2016 base. . the bill makes a series of changes to the medicaid expansion. 32 states have expanded medicaid under the a.c.a. and more states before this bill were considering expanding medicaid but for states to make these decisions, need to understand what the financial provisions. it allows states that have already expanded medicaid to enhance the matching rate for
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those enrollees provided those individuals contain medicaid coverage from december 31, 2019. what about new enrollees. so for expansion, states freeze enrollment and only cover for those the expansion is available. and would it put a freeze on coverage? mr. pallone: i think it's important you point these things out. the medicaid population more than any other population, these are the working poor under medicaid expansion and what happens, there are people ooking for jobs or change in jobs. mr. walden: we don't put that reeze in place until 2021.
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and we can begin reforming these markets and maybe this year you get reduced premiums. the insurers are trying to figure out what this market is going to look like. that's when you wrap the tax cuts, reduce the tax costs on the insurers and make these other changes, they think we can lower premiums this year. -- f i could finish mr. pallone: we are talking about real people. medicaid expansion population, these are working people, making $25,000 a year and looking for a job sometimes they have two or three jobs and fall out of this medicaid eligibility if they get a second or third job, what are we talking about? they aren't going to take advantage of these tax credits but suffer from the lack of continued -- they are not having a continuous job experience or
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continuous salary. we aren't talking real life people here in my opinion. mr. brady: we are talking about real-people. there are huge coverage gaps in obamacare and i know of no governor democrat or republican who doesn't want to help people work their way off of medicaid and into better paying jobs. there needs to be a tax credit to buy a plan that is right for that young person or that individual, usually a small business person. that's why we worked hard with our republican governors to make sure this is a seamless approach. and tax credit and the work that chairman walden did on the stability fund is exactly for governors like mark walker or scott walker of wisconsin who lowered the medicaid levels, helped those people work their
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way off of medicaid with the private sector plan and the subsidy for that care and he achieved lower uninsured rates than many states who have had the expansion. it's not only usable but proven. mr. mcgovern: most people would say tax credits are not helpful. mrs. black: would the gentleman yield. mr. mcgovern: i think everybody gree we are facing a new and serious problem with opoids. and i have some specific questions about how the bill will affect states' ability to respond. the bill provides per capita amounts among categories of people. what expense category in the bill will contain people who are addicted to opyoids? mr. pallone: i don't think it
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has any reference to that. you get less money. mr. walden: there is no reference in medicaid today that specifically pulls out opoids. it's not right to say there is no reference, but there is no reference in the existing law. states would have flexibility within their allotted funds. they can move money under this bill and attack that problem. mr. mcgovern: with your caps on medicaid reimbursements, do you ve the average cost of treating opioids addiction? mr. pallone: that is the most speps i have thing and why it is important to have an essential benefits package and the states get less money and eliminate the most expensive things which is drug treatment. mr. mcgovern: you have to cut
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something. mr. pallone: drug treatment. those are the expensive items. mr. mcgovern: i want to understand what the bill does to medicaid eligibility for school-aged kids. section 111 of the substitute appears to repeal the requirement that state programs kids from six through to 18. for a family of three and 133% of poverty. for medicaid eligibility once called these kids the fair step kids because of the way medicaid eligibility evolved over time. based on research, we know there are over a half a million stair step kids and more now. i don't understand what this has to do with repealing the medicaid expansion which is for adults, but why are we picking
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on kids? in three short lines of legal language, this bill erases mandatory medicaid coverage for these kids as of december 31, 2019 and three short lines don't say what will happen to the coverage of these kids or state budgets beginning in 2020. if a state wants to continue covering these kids under medicaid, can it do so and can you show me in the bill where it is described and if it's not in the bill, where is the authority? mr. walden: they forced kids off of s-chip into medicaid. we are saying no, states get a higher reimbursement rate and put the kids back under chip and they will do better and the kids will do better. and we are going to re-authorize the chip program this year because we believe it.
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and we think it makes sense to put them under that where they belong. it's a better way to take care of our children. you forced them into medicaid where they get delayed access to care because the reimbursement rates are so low. the studies show that. i think it is better to have children under chip. mr. neal: 1% of the children in massachusetts are covered. mr. pallone: let me say this that i appreciate the chairman wants to re-authorize chip and hopefully it will be as strong and as good. but understand, there's no funding for this in this bill. we have no guarantees that the
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way it operates and wraps around and fills in gaps that that is going to continue. it's very nice to say, and they say the senate will correct this and do amendments and we got plan two and plan three. that's very nice, but none of these guarantees are going to be here on thursday. i appreciate the fact that my chairman is saying we are going to authorize and be bipartisan. but forgive me for not believing that and focusing on what this bill does and not providing the funding for it. mr. mcgovern: i appreciate the answers to my questions. i will close by saying, i continue to believe that this is a terrible way to proceed, a terribly flawed process. i mean the people who know best about our health care system weren't even asked to come and testify at a hearing because you had to rush this thing so
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quickly and appreciate to use washington speak and did hearings on this or that over a period of a few years. we got the text of this bill on march 7. and i think that's why -- you are seeing the polls that people are losing confidence in this institution because we are not adhering to regular order and this is a big deal. idea of 24 million americans losing health insurance, that is a big deal and it seems like it's no big deal in this majority. and i regret very much we are going down this path and i hope this bill loses. and i yield back. mr. cole: the gentleman from georgia is recognized. mr. woodall: i thank you, mr. chairman. i wanted to start talking about things we agree on, mr. yarmuth, i enjoyed seeking you on the
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budget committee but i thought you to say you do see problems that need to be corrected but don't need to change the system for everybody in order to correct these problems, did i understand you correctly? mr. yarmuth: you absolutely did. mr. woodall: you have your very own -- i thought i understood you to say that one of the things that your state has most proshted the way a republican governor and mitt romney worked together col and bratively and is working well in massachusetts. mr. neal: with the chamber of commerce. and with help from the heritage foundation from a mandate. mr. woodall: i value both of those agencies. i was not here in 2009 and 2010, but my frustration and the one i hear from folks so often is,
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rob, folks have a real problem with the uninsured and instead of working together to solve a problem that we agree needs to be solved, we instead change the system for everybody and jammed it true on a purely partisan manner. the opposition was bipartisan and it was the support that was partisan. i am the first to confess it looks similar to what is happening here in 2017 and i hope the cure is going to be better than the disease. we have a real challenge here holding each other accountable. i think about all we agree on and in the budget committee and all that i see in budget and ways and means and seems like we are going out of our way to make this more divisive. i wish that the death spiral of obamacare was not happening so
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fast that so many my folks weren't losing coverage and the uncertainty was not so paralyzing to folks back home that we could have moved more slowly. we do have new members in this institution and have held hundreds of hearings in the six years i have been here on how to repeal and replace but i wish e death spiral was going slowly. mr. mcgovern knows that it came over here from the senate with brand new language that the senate worked out by itself with no input from a single member in the house and not one single hearing held on that bill or markup held on that bill. this committee was the only committee on capitol hill to see that bill and went to the floor of the house after having been examined by no one else. i don't think my friends on the other side of the aisle would say that is the right way to
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move legislation either. folks could have done better there. i want to ask about what happens next. i support this legislation and i support moving forward but i don't think i can bring down health insurance costs without bringing down health care he costs. i have a family friend who is a doctor and said i'm the only medicaid doctor in the county and hand out as many medicaid cards in your office, i don't have any more room. a new study came out yesterday, 52 days on average, 109 days to see a family physician. what good is massachusetts' health care to my family that i have to wait three months. mr. neal: recently, it was rated as the healthiest state in the country and governor baker took full credit and the argument you
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made, you are depending on the senate to fix this bill and send it back to us. mr. woodall: i would be happy if they passed the bill and pass it onto the president's desk. mr. neal: if they change the bill, could we get a hearing? mr. woodall: my friends have both said, rob, i don't know what you are upset it. the obamacare. we wanted a single payer plan. i would say to my friends, the american health care act is a compromise. i want more freedom and competition and involvement. this is the compromise. so my focus is we are going to build on that. tell me from the chairman's perspective, i was talking to a couple last week and both in their 50's and children are
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grown, their understanding is that they can't go out and buy a health care plan that doesn't cover pediatric plan and maternity coverage that they won't have. is that providing more choice in the marketplace. this group that we know is priced higher because they are more expensive to insure is going to have to buy benefits they don't need. mr. walden: i appreciate your passion and your intell elect on these things. if i could go to one thing. when i met with governor baker and a group of democrat and republican governors, he said to the group that what they have in romney care is different than what a.c.a. is and he said what happened when obamacare came in, they saw an increase of 7% in the medicaid population and 7% decrease in the individual insurance population.
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they went from here to here. the result from massachusetts, i believe and maybe dr. burgess would remember this as well, $1 billion in added costs in medicaid which they are a 50/50 match state. i'm sure there are natural transitions here but that was one of the points he made and the irony is a state that was doing on its own. laboratories, innovation and given opportunities and 97% coverage and now 97% covered now. he saw a cost shift occur and went on the back of the taxpayers. going forward, what are we looking at. i want to know why epi-pen ki became so expensive. how do we get competition in the pharmaceutical world. the president has spoken out on this issue as well. we are hooking at a bill that
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will be on the house floor as well on association house plans. we paid 100% of the premium we worked for us but we had 15 or 20 people workic for us. i had no market power and pressure back on the insured so i could negotiate. the association health plans i think is really important. i think being able to buy across state lines and working on legislation to do that. and i want to look at the costs. there are a lot of embedded programs where a lot of money flows into the health care system. the g.a.o. has figured out there are money in medicaid from improper payments. it's on the high risk list and has been for 14 years. they can't figure out where this money is going but not going to the right places. think what you can do with community health centers. this is year after year after
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year after year. nd we are figure out what is driving these costs. 5% of the market here roughly. what about the other 95%. they are paying these unfortunate unnecessary high costs. and i have asked for oversight investigations team to drill down, figure out where are these costs. we bring down costs and get more choice. the flexibility that my colleague is giving for h.s.a.'s for a different group of people. when we did medicare part d in the energy and commerce committee, we went through these arguments and said no to all the things you are hearing. we said we are going to let the market work. you talk about a market with consumers like. the cost to the taxpayers is 52% less today than what the congressional budget office said
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it would cost. so if you have faith and create a market in the right way and empower consumers, they are the most potent faction to drive down costs. choice is fleing. down to one choice or no choice. how is that productive? and their ideas are going in that i'd ask them, what do you do they think is wrong with obamacare today if anything? i think what we're doing here really matters. what we're going to do going forward i hope will be bipartisan like it was on 21st century cures, like it was on opioid. like it was on mental health reform. these are all things that really matter to the people that we live among, that are next to us, that are our constituentses. getting health cures. getting mental health -- dealing with this opioid issue. getting fent nal and it's il-- fentanyl and its illegal importation into this country. hese are all critical to us.
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>> i regret sometimes it sounds like when folks tell me they've watched a hearing on tv, it sounds like we're talking about who cares and who doesn't. mr. woodall: i reject that. i absolutely do. we all care. you display that. could you answer my essential benefits question? we no that older americans are in the highest cost insurance of their life. they might rather buy a plan that's more generous on prescription drugs and less generous on pediatric and maternity benefits. is that -- mr. walden: basically that's what the guthrie amendment allowed in the small market. or the small business market. if you will. the flexibility away from the government-mandated benefit. we ratchet that way down. get rid of the metal tear, the bronze, st. the silver, the gold, the platinum.
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we do that, then on the expanded medicaid we do away with the essential benefit. for made cade itself, they remain, but we reduce the amount that the government says you have to put into each of those. to give some flexibility so they can design plans that people might actually have to fit their need and their lifestyle and their budget. mr. woodall: i'll have to continue to look at that. >> first of all, i had this discussion with virginia foxx many times before this committee. she's not here anymore. i kind of regret that. because i enjoyed -- mr. woodall: she regrets not being here too. [laughter] >> this idea that we should go back to skeletal plans, as i call them, where people choose whether they want hospitalization or they want maternal care i think is a huge mistake. mr. pallone: first of all, you talk about freedom of choice. it's not like, you know, it's not like religious freedom or freedom of assembly or something of that nature. if you want to have a fair
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market with an insurance pool where people are paying a fair rate, you can't let people pick and chules. because it's going to have the same effect of, you know, if you don't cover a lot of people. it's going to increase costs for everyone else. the person's going to say, oh, i don't need that. and then if for some reason they do need it and the not covered, then everybody else has to pay because they didn't provide the coverage. the like the people who are uninsured. i would also point out with regard to medicare part d, the a.c.a. plugs up a lot of the problems that you guys didn't address. with medicare part d. we get rid of the doughnut hole, for example. and, i will point out, again to his credit, that this bill does not get rid of those things. so, again, you can talk forever about how great part d was. but, again, we plug those holes up. we made it possible under the a.c.a. so that seniors have the prescription drug benefits and
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thankfully that's not being repealed here. let's not talk about how great part d was. because there were a lot of things that were left out that e corrected. mr. walden: you wouldn't have had a doughnut hole if you hadn't passed it over our objections. >> you're right. but give us credit for fixing it immediately and saying, it's worked. mr. woodall: i'd like to give us all credit for passing hipaa in 1996. in a collaborative, bipartisan way. we don't have hearings about how to repeal the pre-existing conditions exclusion in hipaa. we don't have hearings about how to eliminate the fact that folks who don't play by the rules have a two-year time frame that they can get back in and get themselves right. because we did that together. behind the closed doors, i hear about so much, that we can do together, these hearings, it sounds very different. i'll close with this. i think we would all stipulate,
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both sides of the aisle, that we have six of our top health care expert in the congress sitting here at this table. i'm grateful for you for all the time you're going to give us. i can tell you, i'm not a groceries expert. but i can buy milk for $3.49 a gallon down the road. i'm not a clothes horse but i can tell that you josephbacks will give me a good -- joseph banks will give me a good shirt n clearance for 35ds -- $35. i don't know whether i paid the right price for my mother's surgery here. diagnosed with skin cancer. they took off about half my face. i shopped it but i don't know if i got the right price. do any of you all know what i should be paying for mole surgery today? i had to go in for a c.t. scan. i fell off my snowboard. i'm getting older and a little more frail. i shopped around again with my medical savings account. do you know what i should be
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paying in georgia for a c.t. scan? mr. neal: when the diagnosis took place, you didn't care what it would cost to get it fixed. mr. woodall: truth be told, no. the diagnosis took place, i got on the plane, i flew back home. i didn't go to the emergency room. when the headaches didn't go away. i went to the urgent care center. i didn't go from the urgent care center to the emergency room when they told me they couldn't take care of it. i went back home to get on the computer to deal with my medical savings account. then i found out that the c.t. scan was $800 at the facility right beside me. but if i were to drive 25 minutes up the road, i could get it for $200. i got in my car and i drove up the road. i was lucky that i had that flexibility. i stipulate that emergency care completely different. but i suspect for those of you with gray hairs, you can tell me what lacic surgery ought to cost. you might have priced it a little bit. mr. neal: the newsworthy part is
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that you're a snowboarder. the thing i take away. mr. woodall: claiming to be a snowboarder and getting a concussion all at the same time. we can't let that continue. i read every grocery ad every week when it comes out the door. i click the coupons. the only reason i subscribe to the sunday paper is to get the coupons when they come out. we cannot lower the cost of health care without having knowledge and skin in the game. mccarran-ferguson is something we worked on collaboratively. democrats have passed it when they've been in control. republicans have passed it when they've been in control. we can do these things together. i have the benefit of being on the rules committee. i get the best and brightest. you can sit here and visit with me one-on-one. i hope we can get to the transparency in cost. headache n get my pill for 2ds a pill at sam's
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club. the name brand. or a penny a pill with the off name brand. but if i go to the hospital they're going to charge me $10 a pill. mr. neal: so, let's take the mother whose child has a fever and has a seizure. when she drives to the emergency room or walks to the emergency room, the first thing she does not say is how much is this going to cost? mr. woodall: absolutely. mr. neal: that's the -- mr. woodall: but that's not the issue, mr. neal. the issue is when that mother has a child with 104-degree temperature, did chef an opportunity to go to a primary care doctor first? if your state it would have taken $109 days to get the appointment. she has no choice but to go to the emergency room. urgent care clinics, community health centers, great pilot project up in philadelphia, new jersey there on the border, where they said, our medicaid population is missing their appointments. they can't afford the bus fare.
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they're not getting to the doctor. they've built the clinic in the housing project so that folks would go there. they have signed personal care people -- assigned personal care people to walk folks to their appointment to make sure they got the nonurgent care that they needed so it didn't become an urgent care issue. there's so much we can do together. there's so much success we have had. i regret that instead of celebrating some of that success today, we're sill wrapped around -- mrs. black: will the gentleman yield? mr. woodall: to my 45 years of living the life of caring about patients, the nurse and chairwoman of the budget committee. mrs. black: i've been sitting in this chame just wiggling, thinking, where do i insert this comment. but you are so right. we are missing talking about one piece that is actually funded by the federal government. the funded by state governments. and that is the federally qualified health centers, the department of health and the state and the local levels. this is good, simple, decent health care. and so we're missing that in this conversation.
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as we start talking more about where people receive their care, we've got to insert that in there. because this is simple, decent health care, where you can actually find out what something really costs. and so i know that we're talking about this bill today. but as we continue, and dr. burgess can absolutely speak to this, as we continue this conversation about the cost of health care and what's available to people, there are other available resources that are coming both from local funding, state funding and also federal funding. that's got to be made part of this mix. because there are people, as you have already referenced, that have something right in the middle of their community that's good, simple health care. it's a safety net that we're not talking about here. i know mr. yarmuth also has a comment. mr. yarmuth: i want to applaud mr. woodall. he and i were speaking a few weeks ago, walking down the hall, i think we solved the individual market problem. we had a similar solution. the question was, we wanted to call it different things.
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but anyway. there are solutions. i just want to raise this point. we talk about how we go forward. let's talk about where we've been to a certain extent. a lot of the problems that have been created over the last few years were the result of things that happened after the passage of the affordable care act. one, for instance, the supreme court ruled states zpint have to expand made cade. so 19 states chose not to -- medicaid. so 19 states chose not to. other things happened. we set up mechanisms under the affordable care act to create competition at the state level by funding co-ops, nonprofit co-ops, that funding disappeared. the indemnification that helped those co-ops go from loss situations to profitability. in kentucky, our co-op, which was the most popular choice in the exchanges, more people signed up for insurance under the co-op than any private insurer. lost $60 million the first year. lost $6 million the second year.
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was actually on a path to profitability and the safety net evaporated and they had to give up the ship. obviously at that point, you took one of the biggest competitors out of the market. we also eliminated the risk corridors that helped indemnify insurance companies when they had adverse selection, when they had so many sicker people sign up than they would have anticipated. so, we have mechanisms that would have helped sustain competition and create a better individual market and those mechanisms were changed. mr. woodall: i never talk about the affordable care act without recognizing that that debate changed america. changed america's mind about pre-existing conditions and state markets. changed america's mind about lifetime caps. changed america's mind about keeping children on their policy until they're 26. i begin every conversation in that way because there are some
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things in there that we can still find common ground. i just wish as we go through this very difficult process, in this time, that folks would begin the conversation with, there really were folks who liked their plan and weren't able to keep it. there really were folks who were so unserved by the affordable care act they decided to pay a penalty instead of take the subsidy. there really are families in tennessee who are down to zero insurers. families with serious pre-existing conditions who are going to be left with no choice whatsoever. we can come together collaboratively and fix that. i appreciate the work that my chairman and my ranking members have done. mr. pallone: can i say one thing? i know you mentioned the federally qualified health plans. i wanted to say one thing. first of all, as you i think were alluding to, in the a.c.a., the biggest expansion that we've ever had of federally qualified health centers. not only in terms of numbers, but services provided. but the biggest problem that
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they're telling me right now is that in this republican bill, because of the cutbacks in medicaid that we described today, remember, they get a lot of third party reimbursement for medicaid and to some ex present it those in the individual market -- extent to those in the individual market. they will not have the noun continue to do the things they do -- money to continue to do the things they do. i will point out, again in cement, we're going to have to re-authorize the federally qualified health centers. i hope we will have support the way you're describing, to do more. but right now, with this bill, they'll have less money. because of the cutbacks in medicaid. that will negatively impact them. mr. woodall: you absolutely point out, mr. pallone, an area of broad agreement. i've been to every community health care center in my district. the most interesting thing i hear from each and every one is, rob, don't give away health care for free. we have a sliding scale. every one of our parents has skin in the game -- patients has skin in the game and that's so
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critically important. you have to do more to help underserved communities but you cannot, you cannot make this a no-skin-in-the-game operation. you have to have folks involved n their own health care. they're dedicated their lives to serving the underserved. i look forward to being your partner on that this fall. it's critically important. i believe we'll get it done collaboratively and in a way that makes america proud. with that, mr. chairman, i yield back. >> the gentleman yields back. you mentioned the small business association health plans. that bill will be on the floor of the house this afternoon. so you'll have a chance to vote on it this afternoon. chair recognizes the gentleman from florida. mr. hastings: thank you very much, mr. chairman. mr. chairman, we've been here ow three hours and 10 minutes. i've had an opportunity to go to the facility. but our witnesses have not. i would urge that it might not
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be unwise if we just take five or 10 minutes for them to be able to -- >> can i interject something there? we expect to break for votes in five or 10 minutes. i hope everybody will be ok for that length of time. mr. walden: we appreciate your compassion. >> just trying to be nice about what i snow a continuing problem. mr. hastings: maybe it is that i'm 80 and the kidneys call ore. you know, this nation is aging rapidly. all of us know the baby boomers amongst us in significant umbers like 10,000 every week. following them are going to be the other generations. who are aging as well.
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somewhere along the line, that's going to be as much our responsibility and those that succeed us as anything. before i carry on, my colleague from massachusetts, i'd like to yield to him. mr. mcgovern: i just wanted to respond to something mr. woodall said about my great state of massachusetts. one, i want to re-emphasize what congressman neal said, we're the healthiest state in the nation. so you should all try to be like us. [laughter] go on. number two, you mentioned the study. we did some exploration. there was a study. it found a soomple size for doctor, it called in boston, it between -- is between nine and 20 offices. i don't know whether you think nine is a good sample size. but i point that out to the gentleman. mr. woodall: would the gentleman yield? mr. hastings: i'll yield. mr. woodall: say i would say to my friend, i don't contest to his numbers. i would just ask that he also stipulate that this is a study hat's been going on every year
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for the past decade and the leader of the massachusetts medical society agrees with that conclusion. mr. mcgovern: it also said that the same city found that in massachusetts doctors accept medicare at 100% acceptance rate which is something a lot of your states don't do. i want to also say, i understand why the gentleman, given what we're talking about here today, would rather talk about an issue that has nothing to do with the underlying bill, when it comes to transparency in pricing. which i think could be a bipartisan issue. but you guys have had seven years to come up with your repeal bill. if you wanted to put that in there, could you have put that in there. it has nothing to do with what we're talking about here today. what we're talking about here today actually tears things down. it takes things away from people. takes health care away from people. i think we have to focus on what this bill does. we can speculate about other things we ought to do, but we're dealing with bill that has had no hearings, it's going to the
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floor. mr. brady: if the gentleman will yield -- mr. hastings: i'll yield. mr. brady: clearly it sounds like massachusetts came together to have a health care plan right for the state of massachusetts. why are you denying other states the ability to do the same? that's what this republican bill does. gives states the flexibility to design medicaid and for those small business people who don't have coverage, health care that works for texas and for tennessee and for oregon and ther states. mr. mcgovern: what would you -- what you would do -- mr. hastings: i'm going to take back all my time. [laughter] mr. mcgovern: if you pass this bill, will you hurt people in massachusetts as well as everyone else in the country. mr. hastings: ex cue me. mr. mcgovern: read the letter from my governor. mr. hastings: i'll yield to mr. neal. mr. neal: basically they repeal the mandate. that's why the massachusetts
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plan worked. mr. brady: that worked for massachusetts. wisconsin did not do the expansion at all and lowered their insurance rates more than the expansion states. why deny -- mr. hastings: reclaiming my time, sir. florida didn't expand medicaid and 900,000 people were left walking and i can tell you that it would have made a difference. let's make it very clear here. among the reasons that the so-called obamacare plan failed was because we did not work together and your party continued efforts to undermine it. and many, because of a political decision, states did not expand medicaid and therefore it was unworkable in many of those places. one of the reasons that all of the states -- let me -- mr. chairman, i was told we're going to recess. i can split my time. but i don't want to -- mr. mcgovern: judge -- mr. sessions: judge, how would you like to pursue the matter? mr. hastings: two things to put on the minds of everybody here
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as we proceed. my good friend from georgia and i attended a bipartisan demo -- dinner last week. we had a lot of fun. both of us the other day said, that we had great enthusiasm during the weekend after having had that bipartisan dinner with other colleagues of ours. but we both agreed that when we got back here on monday and came to the rules committee, our enthusiasm vanished. [laughter] and it's going to get worse. listen to the constitution. we the people, the preamble of the, of the united states, in order to form a more perfect union, establish justice, ensure domestic tranquility and provide for the common defense, provide for the common defense, promote the general welfare and secure the blessings of liberty to
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ourselves and our posterity, do ordain and establish this constitution. my friends in the republican party, their mantra has been, since introducing this measure, talk about liberty. and talk about freedom. it's as if those liberties and freedoms for all the people that advanced us here in the united states congress did not have the same kind of underpinnings in their thought. but when you look at that liberty portion of the preamble, it's preceded by the overlooked, often, part of that sentence, to promote the general welfare. that's a part of our responsibility. so when you talk about the freedom, and i love that, i asked one of my staffers to pull it up.
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as many of you are a lover of every kind of music, bach, beethoven, braum, b.b. king, i like them all. but i especially like janice joplin and i'm still wrestling with what she meant and what it must have meant to her. let me give you the first aragraph, the first portion of "her song. she said, busted flat in batten runing, waiting for a train -- baton rouge, waiting for a train. i was feeling nearly faded as my jeans. bobby thumbed a diesel down, referring to a truck, just before it rained. and rode us all the way to new orleans. i pulled my harp out of my dirty red been a dana. i was playing soft while bobby sung the blues. wind shield wipers slapping time, i was holding bobby's hand
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in mine. we sang every song that driver knew. and then, she says, freedom, just another word for nothing left to lose. nothing, i mean nothing, honey, if it isn't free. i'm sure you all wrestle with this particular situation. but let me, at my age, older than everybody in this room, tell you something. we didn't always have health insurance in america. and it wasn't until the turn of the century that we did have health insurance. interestingly enough, germany, russia, several -- hungary, several countries preceded us with health insurance. our health insurance ultimately arose as disability insurance. and what we wound up doing in
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those days was everybody paid out of their pocket for -- whatever they had. and that's how we proceeded. the tragedy is, at the turn of the century, when we did get health insurance, my grandmother and grandfather didn't have insurance. my mother and father didn't have health insurance. because the insurance companies wouldn't sell insurance to black people. it was interesting. they would sell them all sorts of things, street insurance it was called. for life insurance. now we come to where we are and i chastise everybody in this room for us not working collaboratively, to come up with a plan that can assist america. mr. chairman, i'd like to recess here and then i'll tell the rest of what i intend for y'all to know about. mr. sessions: judge hastings, i
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will allow us -- we're going to go to recess here in a minute. we will start back with you, judge hastings. i want to thank you very much for our guests who are also guests and witnesses. i want to thank each of you, not only for your time. we're going to be at subject to my call, but we're going to allow about 10 minutes after the vote to allow you time, if would you like to go get a drink or something like that. but i would like to ask that all six of you please come back and be prepared as we move forward. i will also tell you, i promise not to talk about z.z. top. but the band music is good up here. subject to the call of the chair at the end of the last vote. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org] [captions copyright national cable satellite corp. 2017] >> and the rules meeting here on the repeal and replace bill of

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